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1

Is There Any Correlation Between Objective Anal Testing, Rupture Grade, and Bowel Symptoms After Primary Repair of Obstetric Anal Sphincter Rupture?  

Microsoft Academic Search

PURPOSE: The purpose of this study was to investigate the relationships between the grade of anal sphincter rupture, anal sphincter defect, manometry variables, and anal incontinence. METHODS: A total of 132 females with first-time obstetric sphincter rupture were evaluated by transanal ultrasound, manometry, and scoring of bowel symptoms five months after delivery. RESULTS: Anal sphincter rupture and transanal ultrasound grade

Mohammad Nazir; Erik Carlsen; Anne Flem Jacobsen; Britt-Ingjerd Nesheim

2002-01-01

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

Standards for anal sphincter replacement  

Microsoft Academic Search

PURPOSE: Anal sphincter replacement offers a new treatment option for patients with severe refractory fecal incontinence or for those who require abdominoperineal resection for localized malignancy. The purpose of this study was to review the current status of anal sphincter replacement, formulate a consensus statement regarding its current use, and outline suggestions for future development. METHODS: Four areas of interests

Robert D. Madoff; Cornelius G. M. I. Baeten; John Christiansen; Harald R. Rosen; Norman S. Williams; John A. Heine; Paul A. Lehur; Ann C. Lowry; David Z. Lubowski; Klaus E. Matzel; R. J. Nicholls; Massimo Seccia; Alan G. Thorson; Steven D. Wexner; W. Douglas Wong

2000-01-01

4

Riddle of the sphincters in anal fissure  

Microsoft Academic Search

To the Editor The pathogenesis of anal fissure is not yet fully clear. Essential to the development of a chronic anal fissure is a vicious circle with the factors of inflammatory infiltrate, pain, and sphincter hypertonicity. One cannot safely say whether the sphincteric tone is primarily increased or whether the contraction of the sphincter is because of the intense pain.

Wolfgang H. Jost; Klaus Schimrigk; Horst Mlitz

1995-01-01

5

Cesarean delivery and anal sphincter injury  

Microsoft Academic Search

Objective: Cesarean delivery has been thought to prevent all obstetric anal sphincter damage. The objective of this study was to determine the relationship between the timing of cesarean during primiparous delivery and injury to the anal sphincter mechanism.Methods: A prospective observational study was conducted, using a continence questionnaire and anorectal physiology assessment before and six weeks after primiparous delivery. A

Michelle Fynes; Valerie S Donnelly; P. Ronan O’Connell; Colm O’Herlihy

1998-01-01

6

Sphincter anal artificiel dans l’incontinence anale sévère  

Microsoft Academic Search

\\u000a Résumé  \\u000a Objectif: Evaluer le résultat de l’implantation d’un sphincter anal artificiel pour incontinence fécale sévère chez 56 patients opérés\\u000a dans le même hôpital. L’implantation d’un sphincter anal artificiel est proposé dans le cadre de l’incontinence anale sévère\\u000a lorsque le traitement local n’est pas adapté ou a échoué.\\u000a \\u000a \\u000a Méthodes: Un sphincter anal artificiel a été implanté chez 56 patients de 1993

F. Michot; Anne-Marie Leroi; Ph. Denis

2004-01-01

7

Obstetric events leading to anal sphincter damage  

Microsoft Academic Search

Objective: To identify the obstetric factors relating to anal sphincter injury at first vaginal delivery by prospective cohort study of primiparous women.Methods: We compared the results of a bowel function questionnaire and anal vector manometry before and 6 weeks after delivery in 184 primiparous women. Postpartum, pudendal nerve conduction latency was measured in all women, and anal endosonography was performed

Valerie Donnelly; Michelle Fynes; Deirdre Campbell; Howard Johnson; P. Ronan O’Connell; Colm O’Herlihy

1998-01-01

8

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

9

Internal anal sphincter augmentation and substitution.  

PubMed

There is an increasing recognition of the importance of internal anal sphincter (IAS) dysfunction presenting as passive faecal incontinence. This problem may manifest after anal sphincterotomy or following the more minimally invasive operations for haemorrhoids, as well as with advancing age. Because of the poor results of IAS plication and the beneficial outcomes with peri-urethral bulking agents in urology, these materials have been developed for use in IAS dysfunction. This review outlines the basic purported mechanisms of action, defining the materials in clinical use, their methods of deployment, complications and reported outcomes. There is still much that is unknown concerning the ideal agent or the volume and the technique of deployment, which will only be answered by powerful, prospective, randomized, controlled trials. The specific role of autologous stem cells designed to regenerate the sphincters in cases of functional impairment or muscle loss is yet to be seen. PMID:24759338

de la Portilla, Fernando

2014-05-01

10

Internal anal sphincter augmentation and substitution  

PubMed Central

There is an increasing recognition of the importance of internal anal sphincter (IAS) dysfunction presenting as passive faecal incontinence. This problem may manifest after anal sphincterotomy or following the more minimally invasive operations for haemorrhoids, as well as with advancing age. Because of the poor results of IAS plication and the beneficial outcomes with peri-urethral bulking agents in urology, these materials have been developed for use in IAS dysfunction. This review outlines the basic purported mechanisms of action, defining the materials in clinical use, their methods of deployment, complications and reported outcomes. There is still much that is unknown concerning the ideal agent or the volume and the technique of deployment, which will only be answered by powerful, prospective, randomized, controlled trials. The specific role of autologous stem cells designed to regenerate the sphincters in cases of functional impairment or muscle loss is yet to be seen.

de la Portilla, Fernando

2014-01-01

11

[Sphincter-preserving radiotherapy of anal carcinoma].  

PubMed

During the last decade radiotherapy, in combination with chemotherapy, has become the treatment of choice in cure of anal carcinoma with preservation of anal function, and has replaced abdominoperineal resection (APR). From 1979-1990 54 patients with anal carcinoma were treated by radiotherapy. 24 patients received radiotherapy after APR (12 adjuvant, 12 after recurrence). 11 received palliative radiotherapy without prior APR. 19 patients were treated curatively, 17 of whom received a combination of external irradiation followed by interstitial iridium implantation in a split course regimen. 11 of the 19 patients received short simultaneous chemotherapy (mitomycin C and 5-fluorouracil). All 19 patients had a complete remission. 18/19 patients had no local recurrence after mean 14 months' follow-up. 2 patients developed regional recurrence. 3 patients died of other causes. Colostomy was necessary in 5/19 patients with anal necrosis which was dose-related. The maximum tolerated dose was 71.4 Gy. Our results support the recommendation in the literature of primary, curative, radiotherapy and chemotherapy of anal carcinoma with preservation of the anal sphincter. PMID:1439687

Thöni, A F; Greiner, R; Peyer, T; Leicht, E; Lampret, T; Feuz, J

1992-10-31

12

The relation of sensation in the anal canal to the functional anal sphincter: a possible factor in anal continence  

Microsoft Academic Search

In normal subjects the length of the functional anal sphincter has been compared with the extent of sensation to light touch in the anal canal. At rest, the sphincteric zone was the longer. On distension of the rectum, a decrease in pressure in the anal canal so shortened the functional sphincter that intrarectal pressure extended down to contact the sensory

H. L. Duthie; R. C. Bennett

1963-01-01

13

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

14

Abnormalities of innervation of internal anal sphincter in fecal incontinence  

Microsoft Academic Search

Physiological and histological studies have shown that the internal anal sphincter is abnormal in idiopathic fecal incontinence. We have recently demonstrated that the invitro contractile response of the internal anal sphincter to the sympathetic neurotransmitter noradrenaline is decreased in incontinence. In this study we have further defined this reduced sensitivity and provided more information about the intrinsic innervation in both

Christopher T. M. Speakman; Charles H. V. Hoyle; Michael M. Kamm; Michael M. Henry; R. John Nicholls; Geoffrey Burnstock

1993-01-01

15

Influence of rectal prolapse on the asymmetry of the anal sphincter in patients with anal incontinence  

Microsoft Academic Search

BACKGROUND: Anal sphincter defects have been shown to increase pressure asymmetry within the anal canal in patients with fecal incontinence. However, this correlation is far from perfect, and other factors may play a role. The goal of this study was to assess the impact of rectal prolapse on anal pressure asymmetry in patients with anal incontinence. METHODS: 44 patients, (42

Henri Damon; Luc Henry; Sabine Roman; Xavier Barth; François Mion

2003-01-01

16

Prospective study of the extent of internal anal sphincter division during lateral sphincterotomy  

Microsoft Academic Search

PURPOSE: The aim of lateral internal anal sphincterotomy when treating anal fissure is to divide the distal one-third to one-half of the internal anal sphincter. This study aimed to evaluate prospectively the extent of disruption to the internal anal sphincter following lateral anal internal sphincterotomy and also to establish the prevalence of symptoms of anal incontinence in these patients. METHODS:

Abdul H. Sultan; Michael A. Kamm; R. John Nicholls; Clive I. Bartram

1994-01-01

17

Ultrasound imaging of the anal sphincter complex: a review  

PubMed Central

Endoanal ultrasound is now regarded as the gold standard for evaluating anal sphincter pathology in the investigation of anal incontinence. The advent of three-dimensional ultrasound has further improved our understanding of the two-dimensional technique. Endoanal ultrasound requires specialised equipment and its relative invasiveness has prompted clinicians to explore alternative imaging techniques. Transvaginal and transperineal ultrasound have been recently evaluated as alternative imaging modalities. However, the need for technique standardisation, validation and reporting is of paramount importance. We conducted a MEDLINE search (1950 to February 2010) and critically reviewed studies using the three imaging techniques in evaluating anal sphincter integrity.

Abdool, Z; Sultan, A H; Thakar, R

2012-01-01

18

Topical diltiazem and bethanechol decrease anal sphincter pressure without side effects  

Microsoft Academic Search

BACKGROUNDTopical 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.AIMSTo investigate the effect

E A Carapeti; M A Kamm; B K Evans; R K S Phillips

1999-01-01

19

Adaptive transcutaneous power delivery for an artificial anal sphincter system.  

PubMed

For controlling anal incontinence, a novel artificial anal sphincter system with sensor feedback based on transcutaneous energy transmission was developed. The device mainly comprises an artificial anal sphincter, a wireless power supply subsystem, and a communication subsystem. A transcutaneous power delivery system employing a class-E power amplifier, based on the adaptive control technique, is discussed in this paper. Amplitude modulation of the class-E power amplifier is integrated in the system and applied for the adaptive transcutaneous power delivery. Optimization of the power transfer efficiency and the misalignment tolerance is obtained. Experiments show that the system is capable of delivering at least 150 mW, with a power transfer efficiency of 41% over a distance of 3 cm, which can meet the electric power requirements of the artificial anal sphincter system. The power transfer frequency is 760 kHz. PMID:19085203

Zan, P; Yan, G; Liu, H; Luo, N; Zhao, Y

2009-01-01

20

Are sphincter defects the cause of anal incontinence after vaginal delivery?  

Microsoft Academic Search

PURPOSE: Anal incontinence affects approximately 10 percent of adult females. Damage to the anal sphincters has been considered as the cause of anal incontinence after childbirth in the sole prospective study so far available. The aims of the present study were to determine prospectively the incidence of anal incontinence and anal sphincter damage after childbirth and their relationship with obstetric

Laurent Abramowitz; Iradj Sobhani; Roland Ganansia; Albert Vuagnat; Jean Louis Benifla; Emile Darai; Patrick Madelenat; Michel Mignon

2000-01-01

21

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

22

[Anal sphincter injury caused by falling off a trampoline].  

PubMed

A girl of preschool age fell off a trampoline in a sitting position onto an iron bar sticking up from the ground. In addition to a laceration of the terminal portion of the rectum, she was found to have a severe sphincter injury. The sphincters were repaired by a surgeon the next morning. After one month from the surgery the anal canal pressure was found to be symmetrical with good contractile force of the sphincters. No abnormalities were found in a contrast study or in rectoscopy. The protective stoma was closed after three months from the injury and fecal continence was normal after one and a half years. PMID:23901741

Pakarinen, Mikko

2013-01-01

23

Topical diltiazem and bethanechol decrease anal sphincter pressure and heal anal fissures without side effects  

Microsoft Academic Search

PURPOSE: Topical glyceryl trinitrate heals anal fissures, but a majority of patients experience headache. Topical gels of the calcium channel blocker diltiazem and the cholinomimetic bethanechol significantly lower and sphincter pressure in volunteers. This study investigated the use of these two new pharmacologic agents in the treatment of patients with chronic anal fissure. METHODS: Two studies were conducted, each involving

Emin A. Carapeti; Michael A. Kamm; Robin K. S. Phillips

2000-01-01

24

A comparison between electromyography and anal endosonography in mapping external anal sphincter defects  

Microsoft Academic Search

Mapping of the external anal sphincter by anal endosonography was compared with the electromyographic findings in 15 patients with fecal incontinence after perineal trauma. Both examinations showed no defect in three patients. In the 12 patients with muscle defects, there was agreement on the quadrant involved in all patients. In seven patients, there was total agreement in the hours of

Penelope J. Law; M. A. Kamm; C. I. Bartram

1990-01-01

25

Lower genital tract and anal sphincter trauma  

Microsoft Academic Search

Anal incontinence occurs more frequently in women but its incidence is grossly underestimated because of under-reporting. Obstetric trauma is a major cause of anal incontinence but it is only recently that attention has been focused on this subject. Episiotomy and choice of instrument at assisted delivery have been subjected to randomized trials but some issues, such as the benefit of

Abdul H. Sultan; Ranee Thakar

2002-01-01

26

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

Microsoft Academic Search

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

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

2005-01-01

27

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

28

Influence of pudendal block on the function of the anal sphincters  

Microsoft Academic Search

The function of the anal sphincters has been studied by obtaining continuous recordings of the pressure in the anal canal and the electromyographic activity in the striated sphincter muscles during expansion of the ampulla recti by means of an air balloon. Ten healthy subjects were examined before and after the striated muscles had been entirely paralysed by bilateral pudendal block,

B Frenckner; C V Euler

1975-01-01

29

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

30

Translabial ultrasound assessment of the anal sphincter complex: normal measurements of the internal and external anal sphincters at the proximal, mid-, and distal levels  

Microsoft Academic Search

The purpose of this study was to measure the internal and external anal sphincters using translabial ultrasound (TLU) at the\\u000a proximal, mid, and distal levels of the anal sphincter complex. The human review committee approval was obtained and all women\\u000a gave written informed consent. Sixty women presenting for gynecologic ultrasound for symptoms other than pelvic organ prolapse\\u000a or urinary or

Rebecca J. Hall; Rebecca G. Rogers; Lori Saiz; C. Qualls

2007-01-01

31

Anal sphincter injuries during hemorrhoidectomy: a multi center study.  

PubMed

Hemorrhoidectomy is the treatment of choice for patients with third or fourth-degree hemorrhoids. Although the majority of surgeons believe that surgical hemorrhoidectomy is the most effective approach with excellent results in the management of hemorrhoid disease, but hemorrhoidectomy is not a simple procedure. One of the complications of this surgery is an injury to anal sphincters that can lead to incontinency in some patients. In this study, we aimed to reveal the percentage of external and internal anal sphincter injuries in surgical hemorrhoidectomy. We prospectively enrolled 128 patients from April 2006 to February 2007. They underwent hemorrhoidectomy in three general hospitals in Tehran. All patients were in grade III or IV and underwent open hemorrhoidectomy (Milligan-Morgan). After surgery, all resected material was histopathologically examined by two expert pathologists and the results confirmed by other one if there is any discrepancy. From all specimens which sent to the pathology department 15.8% (21 Pts.) had muscle fibers that Smooth muscle fibers were seen in 80.5% (17 Pts.) of them and striated muscle fibers were found in 19.5% (4 Pts.). Although hemorrhoidectomy is a safe and effective method for treatment of hemorrhoid, but the inadvertent removal of smooth and striated muscle during open hemorrhoidectomy had raised concerns about its effects on postoperative anorectal function. PMID:23165814

Mirzaei, Rezvan; Mahjoubi, Bahar; Kadivar, Maryam; Azizi, Rasoul; Zahedi-Shoolami, Leila

2012-01-01

32

Vaginal delivery is associated with occult disruption of the anal sphincter mechanism.  

PubMed

Childbirth is thought to be an important cause of pelvic floor dysfunction. Heretofore, this has been thought due to pudendal denervation. Endovaginal sonography allows thorough assessment of the anorectum and in this study was used to assess nulliparous women and women before and after delivery. Two groups were studied. Thirty-two nulliparous subjects without complaints of incontinence were studied once. Thirty-four pregnant women were studied before and after delivery. Endovaginal sonography was used to assess integrity of internal and external anal sphincters, thickness of the levator bundle, internal and external sphincters, anal length, and the angle between the levator bundles. Delivery was associated with disruption of the internal and external sphincters. No nulliparous women (nonpregnant or pregnant) had sphincter disruption demonstrated. Episiotomy in the index delivery was associated with increased thickness in the external sphincter and a smaller angle between the levator bundles. Vaginal delivery is associated with occult disruption of the anal sphincters. PMID:9394161

Sandridge, D A; Thorp, J M; Roddenberry, P; Kuller, J; Wild, J

1997-10-01

33

Effect of propofol on anal sphincter pressure during anorectal manometry.  

PubMed

We evaluated the effect of propofol on resting anal sphincter pressure (RP) during anorectal manometry performed under general anesthesia in 20 children with chronic constipation. After propofol bolus administration, there was a significant decrease in the RP in 95% of children from a mean of 51.5 ± 15.3 to a mean nadir of 21.7 ± 10.5 mmHg (P < 0.001). The new postpropofol RP of 47.0 ± 12.4 mmHg was significantly lower compared with prepropofol RP (P < 0.0001). Propofol should be used with caution as an anesthetic agent for anorectal manometry, given the potential for confounding RP measurements. PMID:24121151

Tran, Khoa; Kuo, Brad; Zibaitis, Audrius; Bhattacharya, Somaletha; Cote, Charles; Belkind-Gerson, Jaime

2014-04-01

34

Successful Implantation of Bioengineered, Intrinsically Innervated, Human Internal Anal Sphincter  

PubMed Central

Background & Aims To restore fecal continence, the weakened pressure of the internal anal sphincter (IAS) must be increased. We bioengineered intrinsically innervated human IAS, to emulate sphincteric physiology, in vitro. Methods We co-cultured human IAS circular smooth muscle with immortomouse fetal enteric neurons. We investigated the ability of bioengineered innervated human IAS, implanted in RAG1?/? mice, to undergo neovascularization and preserve the physiology of the constituent myogenic and neuronal components. Results The implanted IAS was neovascularized in vivo; numerous blood vessels were observed with no signs of inflammation or infection. Real-time force acquisition from implanted and pre-implant IAS showed distinct characteristics of IAS physiology. Features included the development of spontaneous myogenic basal tone; relaxation of 100% of basal tone in response to inhibitory neurotransmitter vasoactive intestinal peptide (VIP) and direct electrical field stimulation of the intrinsic innervation; inhibition of nitrergic and VIPergic EFS-induced relaxation (by antagonizing nitric oxide synthesis or receptor interaction); contraction in response to cholinergic stimulation with acetylcholine; and intact electromechanical coupling (evidenced by direct response to potassium chloride). Implanted, intrinsically innervated bioengineered human IAS tissue preserved the integrity and physiology of myogenic and neuronal components. Conclusion Intrinsically innervated human IAS bioengineered tissue can be successfully implanted in mice. This approach might be used to treat patients with fecal incontinence.

Raghavan, Shreya; Gilmont, Robert R.; Miyasaka, Eiichi A.; Somara, Sita; Srinivasan, Shanthi; Teitelbaum, Daniel H; Bitar, Khalil N.

2011-01-01

35

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

36

Maternal Body Mass Index and Risk of Obstetric Anal Sphincter Injury  

PubMed Central

Objective. To estimate the association between maternal obesity and risk of three different degrees of severity of obstetric anal sphincter injury. Methods. The study population consisted of 436,482 primiparous women with singleton term vaginal cephalic births between 1998 and 2011 identified in the Swedish Medical Birth Registry. Women were grouped into six categories of BMI. BMI 18.5–24.9 was set as reference. Primary outcome was third-degree perineal laceration, partial or total, and fourth-degree perineal laceration. Adjustments were made for year of delivery, maternal age, fetal head position at delivery, infant birth weight and instrumental delivery. Results. The overall prevalence of third- or four-degree anal sphincter injury was 6.6% (partial anal sphincter injury 4.6%, total anal sphincter injury 1.2%, unclassified as either partial and total 0.2%, or fourth degree lacerations 0.6%). The risk for a partial, total, or a fourth-degree anal sphincter injury decreased with increasing maternal BMI most pronounced for total anal sphincter injury where the risk among morbidly obese women was half that of normal weight women, OR 0.47 95% CI 0.28–0.78. Conclusion. Obese women had a favourable outcome compared to normal weight women concerning serious pelvic floor damages at birth.

2014-01-01

37

Role of alpha adrenoceptors in opossum internal anal sphincter.  

PubMed Central

The purpose of the present investigation was to examine the role of alpha adrenoceptors in the internal anal sphincter (IAS). Studies wer performed on alpha-chloralose anesthetized opossums. Resting pressure in the IAS (IASP) was recorded using low compliant continuously perfused catheters. The effects of the alpha-1 adrenoceptor agonist phenylephrine and alpha-2 adrenoceptor agonist clonidine and their corresponding selective antagonists, prazosin and yohimbine, respectively, were examined on the resting IASP, and on rectal balloon distension (RBD)-mediated IAS relaxation. Phenylephrine caused a rise in the IASP that was blocked by prazosin and not by yohimbine. Phenylephrine had no effect on IAS relaxation caused by RBD. Clonidine on the other hand caused significant suppression of IAS relaxation in response to RBD, but caused minimal changes in the resting IASP. The suppression of IAS relaxation by clonidine was selectively antagonized by yohimbine but not by prazosin. From these studies we conclude that alpha-2 adrenoceptors exert important neuromodulatory influences on rectoanal inhibitory reflex, while alpha-1 adrenoceptors may exert modulatory effects on the resting IAS tone.

Yamato, S; Rattan, S

1990-01-01

38

Anal sphincter electromyography: editing of sampled motor unit action potentials.  

PubMed

During multi-motor unit action potential (MUAP) analysis of the tonically contracted external anal sphincter (EAS), a mild interference pattern often obscures the baseline, affecting the algorithm's ability to determine accurate boundaries of detected MUAPs. To assess the equivalence of methods of editing and selecting candidate MUAPs from the EAS, 17 nulliparous women underwent concentric needle electromyography (EMG) of the EAS using multi-MUAP software. The selected MUAPs either were accepted without question ("automated"), or a subset was deleted due to a noisy baseline ("manual-deletion") or manually marked ("manual-mark"). A second examiner repeated the analysis. Each examiner found that the two editing methods were equivalent and yielded results that differed from those obtained by automated analysis of unedited data. However, there was a moderate difference in MUAP amplitude when the manual-deletion method was compared between the two examiners. Editing of selected EAS MUAPs during multi-MUAP analysis is required, and development of common protocols is essential to enable meaningful comparisons between similar studies. PMID:15468053

Gregory, W Thomas; Clark, Amanda L; Johnson, Joshua; Willis, Kimberly; Stuyvesant, Amy; Lou, Jau-Shin

2005-02-01

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

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

41

Functional Morphology of Anal Sphincter Complex Unveiled by High Definition Manometery & 3-Dimensional Ultrasound Imaging  

PubMed Central

Objective Anal sphincter complex consists of anatomically overlapping internal anal sphincter (IAS), external anal sphincter (EAS) & puborectalis muscle (PRM). We determined the functional morphology of anal sphincter muscles using high definition manometery (HDAM), 3D-ultrasound (US) and Magnetic resonance (MR) imaging. Patients We studied 15 nulliparous women. Interventions HDAM probe equipped with 256 pressure transducers was used to measure the anal canal pressures at rest and squeeze. Lengths of IAS, PRM and EAS were determined from the 3D-US images and superimposed on the HDAM plots. Movements of anorectal angle with squeeze were determined from the dynamic MR images. Results HDAM plots reveal that anal canal pressures are highly asymmetric in the axial and circumferential direction. Anal canal length determined by the 3D-US images is slightly smaller than measured by HDAM. The EAS (1.9 ± 0.5 cm long) and PRM (1.7 ± 0.4 cm long) surround distal and proximal parts of the anal canal respectively. With voluntary contraction, anal canal pressures increase in the proximal (PRM) and distal (EAS zone) parts of anal canal. Posterior peak pressure in the anal canal moves cranially in relationship to the anterior peak pressure, with squeeze. Similar to the movement of peak posterior pressure, MR images show cranial movement of anorectal angle with squeeze. Conclusion Our study proves that the PRM is responsible for the closure of the cranial part of anal canal. HDAM, in addition to measuring constrictor function can also record the elevator function of levator ani/pelvic floor muscles.

Raizada, Varuna; Bhargava, Valmik; Karsten, Anna; Mittal, Ravinder K.

2011-01-01

42

[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

43

External sphincter resection for lower rectal and anal canal adenocarcinoma: achieving anal preservation with oncological and functional satisfaction.  

PubMed

Intersphincteric resection (ISR) has recently been performed for very low rectal cancer, whereas abdominoperineal resection (APR) is typically reserved for cancers extremely close to the anal verge and/or when the depth of tumor invasion is suspected to involve the intersphincteric space. This is because impairment of anal function is considered unavoidable if the external sphincter (ES) is excised. We describe our technique of ISR with ES resection and discuss its outcomes. This surgical technique may offer major clinical advantages to selected patients and should be considered as an alternative to APR, although careful consideration of anal function is required. PMID:24817058

Akagi, Yoshito; Kinugasa, Tetsushi; Oka, Yousuke; Mizobe, Tomoaki; Yoshida, Takefumi; Yuge, Kotaro; Shirouzu, Kazuo

2014-07-01

44

Functional outcome after anal sphincter injury and treatment with mesenchymal stem cells.  

PubMed

This research demonstrates the regenerative effects of mesenchymal stem cells (MSCs) on the injured anal sphincter by comparing anal sphincter pressures following intramuscular and serial intravascular MSC infusion in a rat model of anal sphincter injury. Fifty rats were divided into injury (n = 35) and no injury (NI; n = 15) groups. Each group was further divided into i.m., serial i.v., or no-treatment (n = 5) groups and followed for 5 weeks. The injury consisted of an excision of 25% of the anal sphincter complex. Twenty-four hours after injury, 5 × 10(5) green fluorescent protein-labeled MSCs in 0.2 ml of phosphate-buffered saline (PBS) or PBS alone (sham) were injected into the anal sphincter for i.m. treatment; i.v. and sham i.v. treatments were delivered daily for 6 consecutive days via the tail vein. Anal pressures were recorded before injury and 10 days and 5 weeks after treatment. Ten days after i.m. MSC treatment, resting and peak pressures were significantly increased compared with those in sham i.m. treatment (p < .001). When compared with the NI group, the injury groups had anal pressures that were not significantly different 5 weeks after i.m./i.v. treatment. Both resting and peak pressures were also significantly increased after i.m./i.v. MSC treatment compared with treatment with PBS (p < .001), suggesting recovery. Statistical analysis was done using paired t test with Bonferroni correction. Marked decrease in fibrosis and scar tissue was seen in both MSC-treated groups. Both i.m. and i.v. MSC treatment after injury caused an increase in anal pressures sustained at 5 weeks, although fewer cells were injected i.m. The MSC-treated groups showed less scarring than the PBS-treated groups, with the i.v. infusion group showing the least scarring. PMID:24797828

Salcedo, Levilester; Penn, Marc; Damaser, Margot; Balog, Brian; Zutshi, Massarat

2014-06-01

45

The Onuf's nucleus and the external anal sphincter muscles in amyotrophic lateral sclerosis and Shy-Drager syndrome  

Microsoft Academic Search

The anterior sacral horns and external anal sphincter muscle were examined histologically with special reference to Onuf's nucleus in amyotrophic lateral sclerosis (ALS) and Shy-Drager syndrome. Onuf's nucleus and the external anal sphincter muscles were well preserved in ALS, but in Shy-Drager syndrome both structures showed marked degenerative changes. These findings suggest that Onuf's nucleus does not belong to the

T. Mannen; M. Iwata; Y. Toyokura; K. Nagashima

1982-01-01

46

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

47

Modeling of human colonic blood flow for a novel artificial anal sphincter system*  

PubMed Central

A novel artificial anal sphincter system has been developed to simulate the normal physiology of the human anorectum. With the goal of engineering a safe and reliable device, the model of human colonic blood flow has been built and the relationship between the colonic blood flow rate and the operating occlusion pressure of the anorectum is achieved. The tissue ischemia is analyzed based on constitutive relations for human anorectum. The results suggest that at the planned operating occlusion pressure of less than 4 kPa the artificial anal sphincter should not risk the vascularity of the human colon.

Zan, Peng; Yan, Guo-zheng; Liu, Hua

2008-01-01

48

Endoanal MRI of the anal sphincter complex: correlation with cross-sectional anatomy and histology.  

PubMed Central

The purpose of this study was to correlate the in vivo endoanal MRI findings of the anal sphincter with the cross-sectional anatomy and histology. Fourteen patients with rectal tumours were examined with a rigid endoanal MR coil before undergoing abdominoperineal resection. In addition, 12 cadavers were used to obtain cross-sectional anatomical sections. The images were correlated with the histology and anatomy of the resected rectal specimens as well as with the cross-sectional anatomical sections of the 12 cadavers. The findings in 8 patients, 11 rectal preparations, and 10 cadavers, could be compared. In these cases, there was an excellent correlation between endoanal MRI and the cross-sectional cadaver anatomy and histology. With endoanal MRI, all muscle layers of the anal canal wall, comprising the internal anal sphincter, longitudinal muscle, the external anal sphincter and the puborectalis muscle were clearly visible. The levator ani muscle and ligamentous attachments were also well demonstrated. The perianal anatomical spaces, containing multiple septae, were clearly visible. In conclusion, endoanal MRI is excellent for visualising the anal sphincter complex and the findings show a good correlation with the cross-sectional anatomy and histology. Images Fig. 1 Fig. 2

Hussain, S M; Stoker, J; Zwamborn, A W; Den Hollander, J C; Kuiper, J W; Entius, C A; Lameris, J S

1996-01-01

49

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

50

Local transdermal delivery of phenylephrine to the anal sphincter muscle using microneedles  

PubMed Central

We propose pretreatment using microneedles to increase perianal skin permeability for locally targeted delivery of phenylephrine (PE), a drug that increases resting anal sphincter pressure to treat fecal incontinence. Microneedle patches were fabricated by micromolding poly-lactic-acid. Pre-treatment of human cadaver skin with microneedles increased PE delivery across the skin by up to 10-fold in vitro. In vivo delivery was assessed in rats receiving treatment with or without use of microneedles and with or without PE. Resting anal sphincter pressure was then measured over time using water-perfused anorectal manometry. For rats pretreated with microneedles, topical application of 30% PE gel rapidly increased the mean resting anal sphincter pressure from 7 ± 2 cm H2O to a peak value of 43 ± 17 cm H2O after 1 h, which was significantly greater than rats receiving PE gel without microneedle pretreatment. Additional safety studies showed that topically applied green fluorescent protein–expressing E. coli penetrated skin pierced with 23- and 26-gauge hypodermic needles, but E. coli was not detected in skin pretreated with microneedles, which suggests that microneedle-treated skin may not be especially susceptible to infection. In conclusion, this study demonstrates local transdermal delivery of PE to the anal sphincter muscle using microneedles, which may provide a novel treatment for fecal incontinence.

Baek, Changyoon; Han, MeeRee; Min, Junghong; Prausnitz, Mark R.; Park, Jung-Hwan; Park, Jungho

2014-01-01

51

Treatment of recurrent high anal fistula by total excision and primary sphincter reconstruction  

Microsoft Academic Search

Fourteen patients with recurrent high anal fistula were treated by total excision of the fistulous tract with primary sphincter reconstruction. Nine patients with sepsis had seton drainage for one to three months before the operation. The surgical approach was the transsphincteric technique described by Mason. No covering stoma was used routinely, but three patients referred with a colostomy had the

J. Christiansen; C. Rønholt

1995-01-01

52

Characteristics of the internal anal sphincter and the rectum of the vervet monkey.  

PubMed

1. The physiology of the internal anal sphincter of the vervet monkey was investigated. 2. Strips of sphincter in vitro contracted to noradrenaline and adrenaline; adrenoceptors were mainly alpha-excitatory. Strips of rectal circular muscle relaxed to noradrenaline and contained both inhibitory alpha- and beta-adrenoceptors. 3. All strips contracted to acetylcholine. After hyoscine or atropine, high doses of acetylcholine relaxed all strips by stimulating intramural inhibitory neurones as relaxations were blocked by tetrodotoxin and hexamethonium. Nicotine and DMPP gave relaxations with similar characteristics. 4. It was concluded that relaxations to acetylcholine, nicotine and DMPP were not adrenergic as relaxations still occurred in strips from sympathetically denervated or reserpinized animals. The block of these relaxations by propranolol and guanethidine was considered to be unrelated to their actions as adrenergic blocking drugs. 5. All strips relaxed to field electrical stimulation (1--5 Hz) through stimulation of intramural inhibitory neurones as tetrodotoxin blocked these relaxations. Adrenergic blocking drugs, prior reserpinization or prior section of the hypogastric nerves did not block these responses. The relaxations were not therefore adrenergic. 6. 5-Hydroxytryptamine relaxed all strips but was not the transmitter in relaxations to acetylcholine, DMPP or nicotine, nor to field electrical stimulation, as desensitization of strips of 5-HT did not alter these responses. 7. The circular smooth muscle of the internal anal sphincter had a dense terminal adrenergic innervation which rapidly decreased orad. 8. In vivo, hypogastric nerve stimulation relaxed the rectum but contracted the sphincter. Sacral nerve root stimulation caused an after-contraction in both rectum and sphincter. In vivo, a close arterial injection of adrenaline or noradrenaline inhibited the spontaneous contraction waves of the rectum, but contracted the sphincter. Both these responses were blocked by phentolamine. 9. It was concluded that the internal anal sphincter is a discrete high pressure zone which was excitatory cholinergic and adrenergic innervations and an inhibitory non-adrenergic innervation. PMID:108393

Rayner, V

1979-01-01

53

Assessment of experimental animal model for training obstetric anal sphincter injury techniques.  

PubMed

The Multiparous Goat Pelvic Model was used to train obstetricians and residents for perineal and anal sphincter anatomy and techniques of repair of Obstetric Anal Sphincter Injuries (OASIs). The purpose of this study was to assess the similarity of this model with human anatomy and the usefulness of goat model for training obstetricians for perineal tears. Six workshops were conducted between June 2009 and December 2010. A total of 90 participants, including 64(70.3%) residents and 26(28.5%) consultants in Obstetrics and Gynaecology, attended hands-on training workshops using experimental goat pelvic model for the repair of perineal tears. Among the consultants, 23 (88.5%), and 60 (93.7%) residents could easily identify the goat anal sphincter. With reference to the similarity to human vaginal dimensions, 20 (76.9%) consultants and 43(67.1%) residents found it to be similar with human anatomy. Evaluating the anal canal anatomy, 22 (84.6%) consultants and 34(53.1%) residents reported it to be similar to the human anal canal. The perineal body anatomy was reported as very different by both consultants and residents (80% and 67.9% respectively). All the consultants and 49(76.5%) of the residents strongly recommended the use of this model for future hands-on workshops. PMID:23865143

Rizvi, Raheela Mohsin

2013-01-01

54

Endosonographic and manometric evaluation of internal anal sphincter in patients with chronic anal fissure and its correlation with clinical outcome after topical glyceryl trinitrate therapy  

Microsoft Academic Search

Background and aims  Anorectal pressure studies have demonstrated internal anal sphincter (IAS) hypertonia in patients with chronic anal fissure.\\u000a It is unknown however, if these changes in IAS function are associated with any abnormality in sphincter morphology. The first\\u000a aim was to investigate the clinical characteristics and the manometric and endosonographic findings of the IAS in a cohort\\u000a of patients with

Marta Pascual; Miguel Pera; Ricard Courtier; Mariá José Gil; David Parés; Sonia Puig; Montserrat Andreu; Luis Grande

2007-01-01

55

An electromyographic study of the normal function of the external anal sphincter and pelvic diaphragm  

Microsoft Academic Search

Summary  The electrical activity of the external anal sphincter and puborectalis muscle of normal subjects has been investigated using\\u000a concentric needle electrodes.\\u000a \\u000a The activity in these muscles at rest, during voluntary and involuntary contractions and during defecation is described.\\u000a \\u000a \\u000a The findings show a delicate adjustment of activity to changing needs.\\u000a \\u000a \\u000a Variations in sphincter tone result from changes in the firing rate

D. Taverner; F. G. Smiddy

1959-01-01

56

Colorectal and rectocolonic reflexes in canines: involvement of tone, compliance, and anal sphincter relaxation  

PubMed Central

Distention of the proximal colon may have inhibitory or excitatory effects on the rectum and vice versa. The reflexes between the proximal colon and the rectum have not been well studied due to difficulties in accessing the proximal colon. The aim of this study was to investigate the reflex responses and their mechanisms between the proximal colon and the rectum in consideration of distention-related changes in tone and compliance of these regions as well as anal sphincter relaxation in a canine model. Proximal colon/rectal tone, compliance, and anal sphincter relaxation were investigated in six dogs chronically implanted with a proximal colon cannula while in the fasting state and during proximal colon distention or rectal distention. It was found that: 1) both rectal distention and proximal colon distention significantly and substantially decreased the compliance of the opposite regions, and guanethidine abolished proximal colon distention-induced changes in rectal compliance; 2) rectal/proximal colon distension decreased proximal colonic/rectal tone, and guanethidine abolished both of these inhibitory effects; 3) the anal sphincter was more sensitive to rectal distention than proximal colon distention; and 4) the minimal distention pressure required to induce anal inhibitory reflex was lower for rectal distention than proximal colon distention. It was concluded that distention-related changes in tone and compliance suggest the long inhibitory reflexes between the proximal colon and the rectum with the sympathetic involvement in rectal responses. The anal sphincter is more sensitive to the distention of the rectum than that of the proximal colon.

Chen, Ji-Hong; Sallam, Hanaa S.; Lin, Lin

2010-01-01

57

Determining the shape of the turns-amplitude cloud during anal sphincter quantitative EMG.  

PubMed

We aimed to compare our normative data for quantitative interference pattern (IP) analysis of the anal sphincter to previously published data. In 28 nulliparous women, we performed IP analysis during quantitative concentric needle electromyography (QEMG) of the anal sphincter. At each sampling site, a 500-ms epoch was analyzed. The data were log transformed. Linear regression lines (with 95% confidence intervals) were calculated from the log transformed variables "turns-second" and "amplitude-turn." These confidence intervals were then transformed back into the original parameters to yield scatterplots with confidence curves. The mean turns-second were 203 (SD 174). The mean amplitude (mcv)-turn was 266 (SD 87). The regression coefficients for the log-transformed variables are constant = 1.5, slope = 0.3, and resultant cloud of raw data has a convex upper boundary. These appear slightly different than previously published reports, potentially influencing the determination of normal and abnormal studies. PMID:18250946

Gregory, W Thomas; Clark, Amanda L; Simmons, Kimberly; Lou, Jau-Shin

2008-07-01

58

Sphincter preservation with chemoradiation in anal canal carcinoma  

Microsoft Academic Search

PURPOSE: This study contained herein assessed long-term results, toxicity, and prognostic variables following combined modality therapy of patients with International Union Against Cancer Classification T1–4, N0–3, M0 squamous-cell carcinoma of the anal canal. PATIENTS AND METHODS: Between 1985 and 1996, 62 patients completed treatment with combined modality therapy. A median total dose of 50 Gy was given to the primary,

Gerhard G. Grabenbauer; Klaus E. Matzel; Ignaz H. F. Schneider; Martin Meyer; Christian Wittekind; Birgit Matsche; Werner Hohenberger; Rolf Sauer

1998-01-01

59

Prolonged anorectal manometry and external anal sphincter electromyography in ambulant human subjects  

Microsoft Academic Search

We have developed a method for prolonged combined anorectal manometry and electro-myography (EMG) of the external anal sphincter in ambulant subjects. Fourteen healthy volunteers were studied for a total of 284 hr (mean of 20.3 hr\\/subject). Anorectal manometry was performed using a probe with twin pressure sensors. EMG was recorded by one indifferent and two differential silver-silver chloride surface electrodes

D. Kumar; D. Waldron; N. S. Williams; C. Browning; M. R. E. Hutton; D. L. Wingate

1990-01-01

60

Incidence of obstetric anal sphincter injuries after training to protect the perineum: cohort study  

PubMed Central

Objective To compare the incidence of obstetric anal sphincter injuries (OASIS) in two time periods, before and after implementing a training programme for improved perineal support aimed at reducing the incidence of obstetric anal sphincter injuries. The secondary aim was to study incidence of obstetric anal sphincter injuries in subgroups defined by risk factors for OASIS. Design Population-based cohort study. Setting University hospital setting in Oslo, Norway. Participants Two cohorts of all delivering women in the largest hospital in Norway during two time periods (2003–2005 and 2008–2010) were studied. After excluding caesarean sections and preterm deliveries (< week 32), the study population consisted of 31?709 deliveries, among which 907 women were identified with obstetric anal sphincter injury. Primary and secondary outcome measures Incidence of OASIS in two time periods. Maternal, obstetrical and foetal risk factors for OASIS were collected from the hospital obstetric database. Univariate analyses and multivariate logistic regression analyses, presenting adjusted ODs for OASIS, were performed. Results The OASIS incidence was significantly reduced by 50%, from 4% (591/14787) in the first time period to 1.9% (316/16?922) in the second. This reduction could not be explained by changes in population characteristics or OASIS risk factors during the study years. The reduction of incidence of OASIS between the two study periods was consistent across subgroups of women; regardless of parity, delivery method and infant birth weight. Conclusions A marked reduction in the incidence of OASIS was observed in all studied subgroups of women after implementing the training programme for perineal protection. Further, this reduction could not be explained by the differences in patient characteristics across the study period. These findings indicate that the training programme with improved perineal protection markedly reduced the risk of OASIS.

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

2012-01-01

61

Long-term anal sphincter performance after surgery for Hirschsprung's disease  

Microsoft Academic Search

Background\\/Purpose: The aim of the study was to assess anal sphincter performance in relation to clinical fecal continence in adult patients who have Hirschsprung's disease.Methods: Fifty-four adult patients (mean age, 29 ± 7.2 years; 46 men; 8 women) who had undergone surgery for Hirschsprung's disease during their childhood underwent anorectal manometry and clinical examination. Fecal continence was evaluated with a

M Heikkinen; R Rintala; P Luukkonen

1997-01-01

62

Sphincter-Preserving Therapy for Treating a Chronic Anal Fissure: Long-term Outcomes  

PubMed Central

Purpose To estimate the risk of recurrent fissure in ano after sphincter preserving treatments. Methods A retrospective case note review, combined with a telephone survey was conducted for all patients treated for a chronic anal fissure between 1998 and 2008. Results Six hundred and twelve patients (303 women: mean age, 39 years; range, 16-86 years) were treated for chronic anal fissure between 1998 and 2008. Topical diltiazem 2% was initially prescribed for 8 weeks. The fissure did not heal in 141 patients. These patients (61 women: mean age, 30 years; range, 15-86 years) were treated with 100 IU botulinum A toxin (Botox) injection combined with a fissurectomy under general anaesthesia. Thirty eight patients suffered a recurrence of their fissure within two years. Thirty-four healed with further medical or sphincter conserving surgical therapy while four required a lateral internal sphincterotomy. Conclusion The vast majority of patients with chronic anal fissure can be treated with sphincter conserving treatments. This may require several interventions before healing can be achieved. Assessment for recurrence after 'conservative' treatments requires a minimum of two-year follow-up.

Farouk, Ridzuan

2014-01-01

63

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

2013-02-01

64

Use of vector volume manometry and endoanal magnetic resonance imaging in the adult female for assessment of anal sphincter dysfunction  

Microsoft Academic Search

PURPOSE: This study compared conventional water-perfused and vector volume anal manometry in female patients with neurogenic fecal incontinence and chronic anal fissure and in healthy female volunteers. We used endoanal magnetic resonance (MR) imaging to measure internal and external sphincter lengths and thicknesses and contrasted these with the manometric findings in the different anorectal conditions. METHODS: One hundred thirty-three female

Andrew P. Zbar; Witold A. Kmiot; Mohammed Aslam; Andreanna Williams; Amy Hider; Riccardo A. Audisio; Antonio Chiappa; Nandita deSouza

1999-01-01

65

Purse-string morphology of external anal sphincter revealed by novel imaging techniques.  

PubMed

The external anal sphincter (EAS) may be injured in 25-35% of women during the first and subsequent vaginal childbirths and is likely the most common cause of anal incontinence. Since its first description almost 300 years ago, the EAS was believed to be a circular or a "donut-shaped" structure. Using three-dimensional transperineal ultrasound imaging, MRI, diffusion tensor imaging, and muscle fiber tracking, we delineated various components of the EAS and their muscle fiber directions. These novel imaging techniques suggest "purse-string" morphology, with "EAS muscles" crossing contralaterally in the perineal body to the contralateral transverse perineal (TP) and bulbospongiosus (BS) muscles, thus attaching the EAS to the pubic rami. Spin-tag MRI demonstrated purse-string action of the EAS muscle. Electromyography of TP/BS and EAS muscles revealed their simultaneous contraction and relaxation. Lidocaine injection into the TP/BS muscle significantly reduced anal canal pressure. These studies support purse-string morphology of the EAS to constrict/close the anal canal opening. Our findings have implications for the effect of episiotomy on anal closure function and the currently used surgical technique (overlapping sphincteroplasty) for EAS reconstructive surgery to treat anal incontinence. PMID:24458022

Mittal, Ravinder K; Bhargava, Valmik; Sheean, Geoff; Ledgerwood, Melissa; Sinha, Shantanu

2014-03-01

66

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

PubMed Central

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 in experience of repairing acute anal sphincter injury. The group with largest experience were consultant obstetricians (46.5% undertaking ? 5 repairs/year), whilst only 10% of responding colorectal surgeons had similar levels of experience (p < 0.001). There was extensive misunderstanding in terms of the definition of obstetric anal sphincter injuries. Overall, trainees had a greater knowledge of the correct classification (p < 0.01). Observational studies suggest that a new 'overlap' repair using PDS sutures with antibiotic cover gives better functional results. However, our literature search found only one randomised controlled trial (RCT) on the technique of repair of OASI, which showed no difference in incidence of anal incontinence at three months. Despite this, there was a wide variation in practice, with 337(50%) consultants, 82 (55%) trainees and 80 (89%) coloproctologists already using the 'overlap' method for repair of a torn EAS (p < 0.001). Although over 50% of colorectal surgeons would undertake long-term follow-up of their patients, this was the practice of less than 10% of obstetricians (p < 0.001). Whilst over 70% of coloproctologists would recommend an elective caesarean section in a subsequent pregnancy, only 22% of obstetric consultants and 14% of trainees (p < 0.001). Conclusion An agreed classification of OASI, development of national guidelines, formalised training, multidisciplinary management and further definitive research is strongly recommended.

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

2002-01-01

67

The internal anal sphincter in the cat: a study of nervous mechanisms affecting tone and reflex activity  

PubMed Central

1. Smooth muscle activities in rectum and internal anal sphincter have been recorded using intraluminal balloons. 2. Reflex activation of the sphincter, caused by distension of the rectum, has been assessed before and after various combinations of blocking drugs. 3. Responses to stimulation of hypogastric or sacral nerves, or to the administration of drugs with autonomic actions have been tested before and after various combinations of blocking drugs. 4. Results indicate that the tone of the internal anal sphincter is influenced by a number of neural mechanisms. These include motor pathways involving both ?-adrenergic and cholinergic mechanisms and inhibitory pathways involving both ?-adrenergic and non-adrenergic non-cholinergic mechanisms. 5. Cholinergic contractions of the sphincter were converted to relaxations after ?-adrenergic blockade. This indicates that the contractions are an indirect effect operating through an adrenergic reflex. Cholinergic relaxations may also be indirect and operate through reflex inhibition secondary to rectal contractions. 6. Sphincteric motor activity is controlled largely through ?-adrenergic mechanisms by adrenergic nerves acting directly on the muscle. ?-Adrenergic inhibitory mechanisms are thought to operate indirectly via ganglia. 7. The over-all control of the sphincter is by complex reflex mechanisms involving numerous pathways and the activity of the sphincter at any one time is determined by the net balance between motor and inhibitory influences. 8. Sacral nerve stimulation indicated that it contains cholinergic nerves to the rectum, non-adrenergic non-cholinergic inhibitory axons to the sphincter and variable numbers of adrenergic axons to the sphincter. 9. Responses of the sphincter to drugs and nerve stimulation were often variable, as has been described many times in the literature. It is considered that this is due to complex combinations of indirect reflex effects, secondary to activation of structures outside the sphincter, operating with or against direct effects on the sphincter itself.

Garrett, J. R.; Howard, E. R.; Jones, W.

1974-01-01

68

Mean Absorbed Dose to the Anal-Sphincter Region and Fecal Leakage among Irradiated Prostate Cancer Survivors  

SciTech Connect

Purpose: To supplement previous findings that the absorbed dose of ionizing radiation to the anal sphincter or lower rectum affects the occurrence of fecal leakage among irradiated prostate-cancer survivors. We also wanted to determine whether anatomically defining the anal-sphincter region as the organ at risk could increase the degree of evidence underlying clinical guidelines for restriction doses to eliminate this excess risk. Methods and Materials: We identified 985 men irradiated for prostate cancer between 1993 and 2006. In 2008, we assessed long-term gastrointestinal symptoms among these men using a study-specific questionnaire. We restrict the analysis to the 414 men who had been treated with external beam radiation therapy only (no brachytherapy) to a total dose of 70 Gy in 2-Gy daily fractions to the prostate or postoperative prostatic region. On reconstructed original radiation therapy dose plans, we delineated the anal-sphincter region as an organ at risk. Results: We found that the prevalence of long-term fecal leakage at least once per month was strongly correlated with the mean dose to the anal-sphincter region. Examining different dose intervals, we found a large increase at 40 Gy; {>=}40 Gy compared with <40 Gy gave a prevalence ratio of 3.8 (95% confidence interval 1.6-8.6). Conclusions: This long-term study shows that mean absorbed dose to the anal-sphincter region is associated with the occurrence of long-term fecal leakage among irradiated prostate-cancer survivors; delineating the anal-sphincter region separately from the rectum and applying a restriction of a mean dose <40 Gy will, according to our data, reduce the risk considerably.

Alsadius, David, E-mail: david.alsadius@oncology.gu.se [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden)] [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden); Hedelin, Maria [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden) [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden); Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm (Sweden); Lundstedt, Dan [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden)] [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden); Pettersson, Niclas [Department of Radiophysics, Sahlgrenska Academy at University of Gothenburg (Sweden)] [Department of Radiophysics, Sahlgrenska Academy at University of Gothenburg (Sweden); Wilderaeng, Ulrica [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden)] [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden); Steineck, Gunnar [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden) [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden); Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm (Sweden)

2012-10-01

69

Obstetric anal sphincter injuries: a survey of clinical practice among canadian obstetricians.  

PubMed

Objective: To describe the current practice, experience, and confidence of Canadian obstetricians in the management of obstetric anal sphincter injuries (OASIS) and to explore the need for national practice guidelines on this topic. Methods: We conducted a cross-sectional, Internet-based survey between December 2010 and March 2011. The survey was initially tested among a sample population and then distributed electronically to 665 Canadian obstetricians. Data were analyzed descriptively. The main outcome measures were the self-reported confidence and experience of Canadian obstetricians in OASIS management and the frequency of performing specific OASIS management steps. Results: The survey response rate was 28.7%. The majority of the respondents (95%) reported confidence in performing OASIS repairs. In the event of a perineal laceration, 47.9% of respondents routinely performed a rectal examination. Most OASIS repairs were performed in the delivery room (89.4%) under local anaesthesia (60.6%) when regional anaesthesia was not already present. If lacerated, the internal anal sphincter was repaired separately by 63.4% of respondents, and intraoperative antibiotics were ordered by 51.1% of respondents. Most (92%) reported the absence of a local protocol to guide OASIS repair. Conclusion: The confidence of Canadian obstetricians who participated in this survey in performing OASIS repairs was high. However, their experience in performing repairs and their use of management steps varied. The need for national guidelines and an increase in awareness is suggested. PMID:22947406

Best, Carolyn; Drutz, Harold P; Alarab, May

2012-08-01

70

Preservation of complete anal sphincteric proprioception in restorative proctocolectomy: the inhibitory reflex and fine control of continence need not be impaired  

Microsoft Academic Search

This study evaluates whether reflux function of the anal sphincter remains unchanged after restorative proctocolectomy, provided that the sphincter remaining is kept intact, without mucosal stripping or endo-anal anastomosis. Paired tests of anorectal function were performed before, and a median of 6 (range 2-12) months after restorative proctocolectomy with stapled, end to end pouch-anal anastomosis. Beforehand, distension of the rectum

W G Lewis; M E Williamson; A S Miller; P M Sagar; P J Holdsworth; D Johnston

1995-01-01

71

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

Microsoft Academic Search

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

S J Snooks; P R Barnes; M Swash

1984-01-01

72

Anorectal incontinence and rectal prolapse: differential assessment of the innervation to puborectalis and external anal sphincter muscles  

Microsoft Academic Search

The innervation of the puborectalis and external anal sphincter muscles was studied in 32 patients with idiopathic (neurogenic) faecal incontinence, 12 of whom also had complete rectal prolapse, using transcutaneous spinal stimulation, transrectal pudendal nerve stimulation, single fibre EMG, anorectal manometry, and measurement of perineal descent. Fourteen normal subjects served as controls. Significant increases in the spinal motor latencies from

S J Snooks; M M Henry; M Swash

1985-01-01

73

[The experience of treatment with medicines of botulinum toxin of type A Lantox of chronic anal fissure with sphincter spasm].  

PubMed

The original material of monitoring of 118 patients with chronic anal fissure is presented in the article. Patients' mean age was 48.9+-10.5 years. It was used injections of medicine of botulinum toxin of type A (Lantox) by its introduction in internal anal sphincter in all patients. There was granulating wound with signs of marginal epithelialization in 59.3% of cases on the 10th day after injection. It was detected complete epithelialization of dermis defect in 93.2% of cases on the 21st day, after six weeks - in 100% of cases. According to anorectal profilometry the index of maximal and average pressure in the anal canal at the level of the internal sphincter in patients at rest decreased to norm. Lantox introduction leads to rapid and persistent reduction of pain intensity. "Lantox" use in ambulatory practice permits to minimize the indications for surgical treatment. PMID:24736539

2014-01-01

74

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

75

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

2009-12-01

76

The effects of atropine or benzilonium on pelvic pouch and anal sphincter functions.  

PubMed

Anticholinergic drugs are used on an empirical basis for treatment of functional disturbances after restorative proctocolectomy, but their mode of action on ileal pouch performance is mainly unknown. We studied the acute effects of atropine or benzilonium on pouch characteristics and anal sphincter function in 20 patients with a pelvic pouch. Pouch volume was increased by 27% by atropine at distension with 20 cm H2O (p less than 0.01). Benzilonium tended to have a similar effect, but the changes did not reach statistical significance (p = 0.06). Pouch contractility, as reflected by volume fluctuations and pressure changes during distension, was almost abolished by both drugs. Sensory thresholds for sense of filling and, particularly, urge were raised. Resting anal pressure was slightly lowered, whereas no significant effect was found on maximal squeeze pressure. In conclusion, anticholinergics appear to have specific properties of action on small-intestinal reservoirs, constituting possible explanations for the empirically observed beneficial effects of anticholinergic treatment of functional disturbances after restorative proctocolectomy. PMID:1871549

Hallgren, T; Fasth, S; Delbro, D; Nordgren, S; Oresland, T; Hultén, L

1991-05-01

77

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

78

Functional role of vasoactive intestinal polypeptide in inhibitory motor innervation in the mouse internal anal sphincter.  

PubMed

There is evidence that vasoactive intestinal polypeptide (VIP) participates in inhibitory neuromuscular transmission (NMT) in the internal anal sphincter (IAS). However, specific details concerning VIP-ergic NMT are limited, largely because of difficulties in selectively blocking other inhibitory neural pathways. The present study used the selective P2Y1 receptor antagonist MRS2500 (1 ?m) and the nitric oxide synthase inhibitor N(G)-nitro-l-arginine (l-NNA; 100 ?m) to block purinergic and nitrergic NMT to characterize non-purinergic, non-nitrergic (NNNP) inhibitory NMT and the role of VIP in this response. Nerves were stimulated with electrical field stimulation (0.1-20 Hz, 4-60 s) and the associated changes in contractile and electrical activity measured in non-adrenergic, non-cholinergic conditions in the IAS of wild-type and VIP(-/-) mice. Electrical field stimulation gave rise to frequency-dependent relaxation and hyperpolarization that was blocked by tetrodotoxin. Responses during brief trains of stimuli (4 s) were mediated by purinergic and nitrergic NMT. During longer stimulus trains, an NNNP relaxation and hyperpolarization developed slowly and persisted for several minutes beyond the end of the stimulus train. The NNNP NMT was abolished by VIP6-28 (30 ?m), absent in the VIP(-/-) mouse and mimicked by exogenous VIP (1-100 nm). Immunoreactivity for VIP was co-localized with neuronal nitric oxide synthase in varicose intramuscular fibres but was not detected in the VIP(-/-) mouse IAS. In conclusion, this study identified an ultraslow component of inhibitory NMT in the IAS mediated by VIP. In vivo, this pathway may be activated with larger rectal distensions, leading to a more prolonged period of anal relaxation. PMID:23339175

Keef, K D; Saxton, S N; McDowall, R A; Kaminski, R E; Duffy, A M; Cobine, C A

2013-03-15

79

Feedback control of TET system with variable coupling coefficients for a novel artificial anal sphincter.  

PubMed

For treating severe faecal incontinence, the authors developed an intelligent artificial anal sphincter system (AASS) equipped with a feedback sensor that utilized a transcutaneous energy transfer system (TETS). To deliver the correct amount of power (i.e. to match the load demand under variable coupling conditions caused by changes in positioning between the coils due to fitting and changes in posture), a regulating method to stabilize output voltage with a closed loop variable-frequency controller was developed in this paper. The method via which the voltage gain characteristics of a voltage-fed series-tuned TETS were derived is also described. The theoretical analysis was verified by the results of the experiment. A numerical analysis method was used as a control rule with respect to the relationship between operating frequency and output voltage. To validate the feedback control rules, a prototype of the TET charging system was constructed, and its performance was validated with the coupling variation between 0.12-0.42. The results show that the output voltage of the secondary side can be maintained at a constant 7?V across the whole coupling coefficient range, with a switching frequency regulation range of 271.4-320.5 kHz, and the proposed controller has reached a maximal end-to-end power efficiency of 67.5% at 1 W. PMID:24400997

Ke, L; Yan, G; Yan, S; Wang, Z; Liu, Z

2014-03-01

80

Anal sphincter function after treatment of fissure-in-ano by lateral subcutaneous sphincterotomy versus anal dilatation  

Microsoft Academic Search

Twenty patients with chronic anal fissure were randomized into two groups. Ten patients were treated with lateral subcutaneous sphincterotomy and 10 with anal dilatation. Anal dilatation was carried out preoperatively, and at 1 and 3 months after the operation in all patients. Preoperatively there was a significantly increased maximal resting pressure in the 20 fissure patients (80 mmHg median) compared

J. Olsen; P. E. Mortensen; I. Krogh Petersen; J. Christiansen

1987-01-01

81

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

82

Effect of Second Vaginal Delivery on Anal Function in Patients at Risk of Occult Anal Sphincter Injury after First Forceps Delivery  

Microsoft Academic Search

Purpose  The study was designed to determine the effect of further vaginal delivery on anal sphincter function in women after apparently\\u000a uncomplicated primiparous forceps delivery.\\u000a \\u000a \\u000a \\u000a Methods  Fifty-two secundigravid women whose first child was forceps-assisted were compared with a control group of 20 women who had\\u000a undergone spontaneous first vaginal delivery. Both groups were studied antenatally and again at 12 weeks after second

Rhona Mahony; Michael Behan; P. Ronan O’Connell; Colm O’Herlihy

2008-01-01

83

Anal fissure - series (image)  

MedlinePLUS

... rectum through which passes stool during defecation. The anal sphincter is a critical mechanism for control of ... Anal fissures are tears in the skin overlying the anal sphincter, usually due to increased tone of ...

84

Postoperative anal canal length predicts outcome in patients having sphincter repair for fecal incontinence  

Microsoft Academic Search

PURPOSE: Controversy exists in regard to the prognostic value of clinical data and physiological tests in patients undergoing sphincter repair for fecal incontinence. The aim of this study was to identify prognostic factors. METHODS: Between 1986 and 1996, 405 consecutive patients had a sphincter repair for fecal incontinence. Preoperative and postoperative manometric data were available on 51 of these patients,

Graham R. Hool; Michael L. Lieber; James M. Church

1999-01-01

85

Anal sphincteric pressure in fissure-in-ano before and after lateral internal sphincterotomy  

Microsoft Academic Search

Resting anal canal pressure was measured in 15 patients with anal fissure before and after lateral internal sphincterotomy.\\u000a This pressure was found to be significantly higher in these subjects (mean 9523.08 mm HG) than in the control group (mean\\u000a 66.1014.28 mm Hg) before surgery (P<0.005). After surgery, a normal anal canal pressure was produced. The authors maintain that anal canal

F. Javier Cerdán; Antonio Ruiz de León; Fernando Azpiroz; Jose Martín; José Luis Balibrea

1982-01-01

86

Effects of Scleroderma Antibodies and Pooled Human Immunoglobulin on Anal Sphincter and Colonic Smooth Muscle Function  

PubMed Central

BACKGROUND & AIMS Patients with systemic sclerosis (SSc) have impairments in gastrointestinal smooth muscle function. The disorder has been associated with circulating antibodies to cholinergic muscarinic type-3 receptor (M3-R). We investigated whether it is possible to neutralize these antibodies with pooled human immunoglobulin (Ig)Gs (pooledhIgG). METHODS We studied the effects of IgGs purified from patients with SSc (SScIgGs) on cholinergic nerve stimulation in rat colon tissues. We also examined the effects of SScIgGs on M3-R activation by bethanechol (BeCh), M3-R occupancy, and receptor binding using mmunofluorescence, immunoblot, and ELISA analyses of human internal anal sphincter (IAS) smooth muscle cells (hSMCs), before and after administration of pooledhIgG. Functional displacement of M3-R occupancy by the SScIgGs was compared with that of other IgGs during the sustained phase of BeCh-induced contraction of intact smooth muscles from rats. RESULTS SScIgG significantly attenuated neutrally mediated contraction and acetylcholine release in rat colon as well as BeCh-induced sustained contraction of the IAS smooth muscle. In immunofluorescence analysis, SScIgG co-localized with M3-R. In immunoblot and ELISA analyses, M3-R loop-2 peptide and human IAS SMC membrane lysates bound significant amounts of SScIgG, compared with IgGs from healthy individuals and pooledhIgG. Binding was significantly attenuated by application of pooledhIgG, which by itself had no significant effect. Incubation of samples with pooledhIgG, or mixing pooledhIgG with SScIgG before administration to tissues, significantly reduced binding of SScIgG, indicating that pooledhIgG prevents SScIgG blockade of M3-R. CONCLUSIONS In studies of rat and human tissues, pooled human IgGs prevent and reverse the cholinergic dysfunctions associated with the progressive gastrointestinal manifestations of SSc, by neutralizing functional M3-R antibodies present in the circulation of patients with SSc.

SINGH, JAGMOHAN; COHEN, SIDNEY; MEHENDIRATTA, VAIBHAV; MENDOZA, FABIAN; JIMENEZ, SERGIO A.; DIMARINO, ANTHONY J.; RATTAN, SATISH

2012-01-01

87

Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection for circumferential mixed hemorrhoids  

PubMed Central

AIM: To identify a more effective treatment protocol for circumferential mixed hemorrhoids. METHODS: A total of 192 patients with circumferential mixed hemorrhoids were randomized into the treatment group, where they underwent Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection, or the control group, where traditional external dissection and internal ligation were performed. Postoperative recovery and complications were monitored. RESULTS: The time to wound healing was 12.96 ± 2.25 d in the treatment group shorter than 19.58 ± 2.71 d in the control group. Slight pain rate was 58.3% in the treatment group higher than 22.9% in the control group; moderate pain rate was 33.3% in the treatment group lower than 56.3% in the control group severe pain rate was 8.4% in the treatment group lower than 20.8% in the control group. No edema rate was 70.8% in the treatment group higher than 43.8% in the control group; mild local edema rate was 26% in the treatment group lower than 39.6% in the control group obvious local edema was 3.03% in the treatment group lower than 16.7% in the control group. No stenosis rate was 85.4% in the treatment group higher than 63.5% in the control group; moderate stenosis rate was 14.6% in the treatment group Lower than 27.1% in the control group severe anal stenosis rate was 0% in the treatment group lower than 9.4% in the control group. CONCLUSION: Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection is the optimal treatment for circumferential mixed hemorrhoids and can be widely applied in clinical settings.

Lu, Ming; Shi, Guang-Ying; Wang, Guo-Qiang; Wu, Yan; Liu, Yang; Wen, Hao

2013-01-01

88

Influence of Age and Sex on Anal Sphincters: Manometric Evaluation of Anorectal Continence  

Microsoft Academic Search

To investigate the exact nature of anorectal continence, a manometric evaluation was performed in 88 healthy test persons with a two-balloon catheter. The pressure in the anal canal (Pac) and the rectal ampulla at rest (Par), the maximum squeeze pressure (Pac max) and pressure rise in the anal canal after dilatation of the rectal ampulla (?PAC) were evaluated separately for

R. J. Poos; J. Frank; R. Bittner; H. G. Beger

1986-01-01

89

Anal Disorders  

MedlinePLUS

... pelvis and anal sphincters. It is the final orifice through which stool passes out of the body. ... small hemorrhoid at the edge of the anal orifice can clot off ("thrombosis"). This may be triggered ...

90

"Internal anal sphincter relaxation associated with bisacodyl-induced colonic high amplitude propagating contractions in children with constipation: a colo-anal reflex?"  

PubMed Central

Objectives Describe the association of internal anal sphincter (IAS) relaxation with colonic high amplitude peristaltic contractions (HAPCs). Methods Retrospective review of colon manometry tracings of children with constipation to determine the IAS relaxation characteristics associated to HAPC’s (HAPC-IASR) events and compare them to the those seen during the performance of the anorectal manometry (ARM-RAIR) events. Results A total of 70 HAPC- IASRs were observed in 15 patients, 65 after bisacodyl, 2 during fasting and 3 after a meal. In 64% of events the IAS relaxation started when the HAPC reached left colon and in 36% as proximal as the hepatic flexure. HAPC propagation seems to be important in HAPC-IASR characteristics; those propagating distal to sigmoid colon demonstrated larger and longer IAS relaxation as well as lower residual pressure but equivalent resting pressure compared to HAPC’s ending proximal to sigmoid colon. While IAS resting pressure was comparable for ARM-RAIRs and HAPC-IASRs, the duration and magnitude of anal relaxation was higher and the anal residual pressure was lower in HAPC-IASRs. Conclusions We demonstrated that IAS relaxation in constipated children is associated with HAPCs migrating in the proximal and distal colon; in most cases starting when peristalsis is migrating through left colon and in an important proportion while migrating proximally. We also demonstrated that HAPC-IASRs are different from ARM-RAIRs suggesting a neurally mediated reflex. Lastly, the IAS relaxation characteristics are highly dependent on the degree of propagation of HAPCs, which could have important implications in the understanding of defecation disorders.

Rodriguez, Leonel; Siddiqui, Anees; Nurko, Samuel

2012-01-01

91

Proteinase-activated receptor-1 (PAR1) and PAR2 mediate relaxation of guinea pig internal anal sphincter.  

PubMed

Activation of proteinase-activated receptor-1 (PAR1) and PAR2 stimulates contraction of the rat but relaxation of the guinea pig colon. The aim of the present study was to investigate PAR effects on internal anal sphincter (IAS) motility. We measured relaxation of isolated muscle strips from the guinea pig IAS caused by PAR agonists using isometric transducers. Reverse transcription polymerase chain reaction (RT-PCR) was performed to determine the existence of PAR. In the IAS, thrombin and PAR1 peptide agonists TFLLR-NH2 and SFLLRN-NH2 evoked moderate to marked relaxation in a concentration-dependent manner. In addition, trypsin and PAR2 peptide agonists 2-furoyl-LIGRLO-NH2, SLIGRL-NH2 and SLIGKV-NH2 produced relaxation. In contrast, both PAR1 and PAR2 inactive control peptides did not elicit relaxation. Furthermore, the selective PAR1 antagonist vorapaxar and PAR2 antagonist GB 83 specifically inhibited thrombin and trypsin-induced relaxations, respectively. RT-PCR revealed the presence of PAR1 and PAR2 in the IAS. This indicates that PAR1 and PAR2 mediate the IAS relaxation. The relaxant responses of TFLLR-NH2 and trypsin were attenuated by N(omega)-Nitro-L-arginine (L-NNA), indicating involvement of NO. These responses were not affected by tetrodotoxin, implying that the PAR effects are not neurally mediated. On the other hand, PAR4 agonists GYPGKF-NH2, GYPGQV-NH2 and AYPGKF-NH2 did not cause relaxation or contraction, suggesting that PAR4 is not involved in the sphincter motility. Taken together, these results demonstrate that both PAR1 and PAR2 mediate relaxation of the guinea pig IAS through the NO pathway. PAR1 and PAR2 may regulate IAS tone and might be potential therapeutic targets for anal motility disorders. PMID:24631471

Huang, Shih-Che

2014-02-10

92

The effects on pelvic visceral function of anal sphincter ablating and anal sphincter preserving operations for cancer of the lower part of the rectum and for benign colo-rectal disease.  

PubMed Central

The effects on pelvic visceral function of radical operations for carcinoma of the lower part of the rectum and of operations for inflammatory bowel disease have been determined by studying bladder, sexual and rectal function. Denervation of the bladder was diagnosed in 15% of patients who had undergone sphincter-saving resection of the rectum for carcinoma and in 19% of patients who had undergone abdominoperineal excision of the rectum. In the remaining patients, temporary, less severe, degrees of impairment of bladder function were noted. Abnormalities of function were found on urodynamic testing of patients with denervation of the bladder which explained, in part, the propensity of such patients to develop incontinence of urine. Partial recovery of function was noted in the long term in patients with denervation of the bladder and evidence consistent with regeneration of autonomic nerves was obtained on histological examination of biopsies from the bladders of such patients. In patients who had undergone conventional proctectomy for inflammatory bowel disease, impairment of bladder and sexual function was observed. In contrast, no evidence of damage to pelvic autonomic nerves was found in patients who underwent selective mucosal proctectomy. Mucosal proctectomy and ileo-anal anastomosis in patients with ulcerative colitis did impair ano-rectal reflex function; nevertheless, most patients were continent. Patients in whom, in addition to mucosal proctectomy and ileo-anal anastomosis, a pelvic ileal reservoir had been constructed had better rectal function than patients who lacked such a reservoir.

Neal, D. E.

1984-01-01

93

Increased motor unit fibre density in the external anal sphincter muscle in ano-rectal incontinence: a single fibre EMG study  

Microsoft Academic Search

The motor unit fibre density in the external anal sphincter muscle has been measured in 13 normal subjects aged 18 to 78 years, and in 14 patients with ano-rectal incontinence, aged 17 to 72 years. The mean fibre density in the normal subjects was 1.5 +\\/- 0.16, and in the incontinent subjects it was 2.17 +\\/- 0.28 (p less than

M E Neill; M Swash

1980-01-01

94

Effect of external anal sphincter contraction on the ischiocavernosus muscle and its suggested role in the sexual act.  

PubMed

Whereas the bulbocavernosus muscle shares its contractile activity with the external anal sphincter (EAS), the response of the ischiocavernosus muscle (ICM) to EAS contraction could not be traced in the literature. We investigated the hypothesis that the ICM contracts reflexly upon EAS contraction. The response of the ICM to EAS squeeze and stimulation was recorded in 21 healthy volunteers (13 men, 8 women, age 36.8 +/- 10.7 [SD] years). An electromyographic (EMG) needle (stimulating) electrode was introduced into the EAS and another (recording) one was inserted into the ICM. The test was repeated after individual anesthetization of the EAS and ICM and after muscle infiltration with normal saline instead of lidocaine. EAS electrostimulation (10 stimuli, 200 micros duration, 0.2 Hz frequency, 0-100 mA intensity) produced an increase of ICM EMG activity to a mean of 267.8 +/- 42.7 microV, whereas anal squeeze effected an increase to a mean of 224.5 +/- 45.3 microV. The ICM did not respond to stimulation of the EAS after individual anesthetization of the ICM and EAS, but it did after saline infiltration. The results were reproducible. ICM contracted upon EAS contraction. This effect seems to be mediated through a reflex that we call "anocavernosal excitatory reflex." The ICM lever action is suggested to share in the erectile mechanism by elevating the penile shaft to above the horizontal level. The reflex may prove of diagnostic significance in sexual function disorders, a point that needs further study. PMID:16400076

Shafik, Ahmed; Shafik, Ismail; El-Sibai, Olfat; Shafik, Ali A

2006-01-01

95

Anal fissure.  

PubMed

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. PMID:22379402

Zaghiyan, Karen N; Fleshner, Phillip

2011-03-01

96

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

PubMed

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 MLC(20) 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-MLC(20), 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. PMID:22241857

Rattan, Satish; Singh, Jagmohan

2012-04-01

97

Smoking during Pregnancy Is Associated with a Decreased Incidence of Obstetric Anal Sphincter Injuries in Nulliparous Women  

PubMed Central

Background Smoking is a modifiable lifestyle factor that has been shown to be associated with adverse perinatal outcomes and to have adverse health and dose-dependent connective tissue effects. The objective of this study was to examine whether smoking during pregnancy was associated with the incidence of obstetric anal sphincter injuries (OASIS) among six birthweight groups in singleton vaginal deliveries, considering nulliparous and multiparous women separately between 1997 and 2007 in Finland. Methodology A retrospective population-based register study. Populations included women with spontaneous singleton vaginal deliveries, consisting of all 213,059 nulliparous and all 288,391 multiparous women. Incidence of OASIS (n?=?2,787) between smoking status groups was adjusted using logistic regression analyses. Principal Findings Of the nulliparous women, 13.1% were smokers, 3.6% had given up smoking during the first trimester of their pregnancy and 81.1% were non-smokers. Among these groups 0.7%, 0.9% and 1.1%, respectively suffered OASIS (p?0.001). Nulliparous women who smoked had a 28% (95% CI 16–38%, p?0.001) lower risk of OASIS compared to non-smokers, when adjusting for background variables. In multiparous women, the overall frequencies of OASIS were much lower (0.0–0.2%). A similar inverse relationship between OASIS rates and smoking was significant in pooled univariate analysis of multiparous women, but multivariate analysis revealed statistically insignificant results between non-smokers and smokers. Conclusions Nulliparous women who were smokers had a 28% lower incidence of OASIS. However, smoking during pregnancy cannot be recommended since it has shown to be associated with other adverse pregnancy outcomes and adverse health effects. The observed association warrants clinical repetition studies and, if confirmed, also in vitro studies focusing on connective tissue properties at a molecular and cellular level.

Raisanen, Sari; Vehvilainen-Julkunen, Katri; Gissler, Mika; Heinonen, Seppo

2012-01-01

98

Autocrine regulation of internal anal sphincter tone by renin-angiotensin system: comparison with phasic smooth muscle.  

PubMed

The myogenic control mechanisms that govern the basal tone in the internal anal sphincter (IAS) are not known. The present studies determined the autocrine regulation of ANG II in the IAS. The studies were performed in the freshly isolated smooth muscle cells (SMC) of the IAS. We determined the presence of ANG II precursor angiotensinogen (Angen), and the enzymes that convert it into ANG II, using functional, molecular biology, and immunocytochemical studies in rats. ANG II levels in the SMC were determined using ELISA. The IAS SMC generate ANG II at a rate severalfold higher than those from the adjoining smooth muscle of rectum (RSM). RT-PCR data show that IAS exclusively expresses significant higher levels of renin, Angen, and angiotensin-converting enzyme (ACE). These data were confirmed using Western blot analyses and immunocytochemistry. In the IAS SMC, H-77 (10 microM; renin inhibitor) and captopril (1 microM; ACE inhibitor) decreased the basal as well as Angen-increased levels of ANG II. The following functional data corroborate the role of renin-angiotensin system (RAS) in the IAS tone. Angen produced concentration-dependent shortening of the IAS SMC that was inhibited by H-77 and captopril. In addition, H-77 or captopril caused a concentration-dependent fall in the IAS tone vs. nontonic tissues. Basal tone in IAS is partially under the autocrine control of cellular RAS evident by the expression of mRNA coding Angen, renin, and ACE and translation to the respective proteins in the SMC. PMID:16020656

De Godoy, Márcio A F; Rattan, Satish

2005-12-01

99

Development of the external anal sphincter with special reference to intergender difference: observations of mid-term fetuses (15-30 weeks of gestation).  

PubMed

To investigate intergender differences in muscle cleavage and joining during development of the external anal sphincter (EAS), we examined semiserial sections of 16 fetuses between 15 and 30 weeks of gestation (6 males and 10 females). The subcutaneous part of the EAS (EASsc) developed along the male perineal raphe and extended posteriorly. Thus, the male EAS was characterized by anterior protrusion of the subcutaneous muscle, in contrast to the almost circular female EAS. In both genders, the bulbospongiosus anlage (or the levator ani anlage) issued muscle fibers to form the superficial (or deep) part of the EAS. The EASsc communicated with the superficial part in males, whereas the female bulbospongiosus tended to communicate with the levator ani rather than the EAS. In both genders, the longitudinal muscle bundle(s) of the anorectum contributed to perineal body formation. However, the male perineal body also had a thick fascia between the rhabdosphincter and the levator. The bulbospongiosus seems to play a critical role in forming the EAS. A strict intergender difference in subcutaneous muscle development is evident along the perineal raphe, as the raphe is not evident in females. These results help to explain variations in the EAS, including anal malformations. PMID:20882767

Arakawa, Takashi; Hayashi, Shogo; Kinugasa, Yusuke; Murakami, Gen; Fujimiya, Mineko

2010-08-01

100

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

101

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

102

Normal values and reproducibility of anal endosonographic measurements  

Microsoft Academic Search

Objective: Endosonographic measurements of anal canal structures are used in the description of various anorectal disorders. This study was designed to determine normal values and reproducibility of anal endosonographic measurements. Methods: Anal endosonography was performed in 40 healthy individuals (18 females, 22 males, mean age 45 (range 25–75) years). The mean internal anal sphincter thickness (IST), external anal sphincter thickness

A. C Poen; R. J. F Felt-Bersma; W Devillé; M. A Cuesta; S. G. M Meuwissen

1997-01-01

103

[Treatment of sphincter insufficiency].  

PubMed

Surgical therapy of anal sphincter insufficiency is only indicated if it leads to symptoms and conservative treatment fails to achieve adequate symptom relief. Various new surgical options have evolved over the last decade but evidence of the efficacy varies substantially. Some have gained broader clinical acceptance based on the efficacy, ease of applicability and low risk profile. The paper aims to outline the currently commonly accepted and frequently applied surgical techniques for the treatment of anal sphincter insufficiency and the results, put these into the context of a treatment algorithm and to present novel techniques which carry potential for the future. PMID:23292153

Matzel, K E; Bittorf, B

2013-01-01

104

Therapy of anal fissure using botulin toxin  

Microsoft Academic Search

PURPOSE: With chronic anal fissure, sphincterotomy to relieve sphincter spasm is the recommended therapy. This breaks the vicious circle of inflammation-pain-spasm. This obvious success is weighed against the possible risk of the operation and the risk of subsequent fecal incontinence. The following report describes a therapy for anal fissure involving injection of the external anal sphincter with botulin toxin. METHODS:

Wolfgang H. Jost; Klaus Schimrigk

1994-01-01

105

Lateral Subcutaneous Internal Sphincterotomy in the Treatment of Chronic Anal Fissure: Our Experience in 246 Patients  

Microsoft Academic Search

Background. Chronic anal fissure is the most common cause of anal pain associated with internal anal sphincter hypertonia. Reduction of hypertonia favours fissure healing. Temporary reduction in sphincter tone can be achieved by conservative treatment. Surgical sphincterotomy achieves permanent reduction of sphincter hypertonia and is very successful at healing anal fissures, but requires an operation with associated small morbidity. Methods.

Nikolaos Liratzopoulos; Eleni I. Efremidou; Michael S. Papageorgiou; George Kouklakis; John Moschos; Konstantinos J. Manolas; George J. Minopoulos

106

Anal tonometry: A quick method of anal manometry  

Microsoft Academic Search

Evaluation of anal sphincter tonic activity is important in the proctologic clinic. However, manometric techniques are expensive, complex, and only available in some centers. Because there is often an in-office need for having objective measurements of anal tonic activity, in our clinic we introduced a simple method for measurement of anal pressures. This method is based on the flow of

M. Mascarenhas Saraiva; A. Mascarenhas Saraiva

1991-01-01

107

Anal endosonographic evaluation after closed lateral subcutaneous sphincterotomy  

Microsoft Academic Search

PURPOSE: The present study was undertaken to evaluate anal endosonographic results of the transverse and longitudinal extent of internal anal sphincter division after closed lateral subcutaneous sphincterotomy and its relationship to outcome with respect to anal fissure recurrence and postoperative anal incontinence. METHODS: Ten patients selected for symptomatic anal fissure recurrence (mean follow-up, 10.9 months) and 41 asymptomatic control patients

E. García-Granero; A. Sanahuja; J. García-Armengol; E. Jiménez; P. Esclapez; M. Mínguez; A. Espí; F. López; S. Lledó

1998-01-01

108

Anal sphincter conservation for patients with adenocarcinoma of the distal rectum: long-term results of radiation therapy oncology group protocol 89-02  

Microsoft Academic Search

Purpose: To assess the outcome of a multi-institutional, national cooperative group study attempting functional preservation of the anorectum for patients with limited, distal rectal cancer.Methods and Materials: Between September 21, 1989 and November 1, 1992, a Phase II trial of sphincter-sparing therapy was conducted for patients with clinically mobile rectal cancers located below the pelvic peritoneal reflection. Protocol treatment was

Anthony H Russell; Jonathan Harris; Paul J Rosenberg; William T Sause; Barbara J Fisher; John P Hoffman; William G Kraybill; Roger W Byhardt

2000-01-01

109

Anal endosonography: Technique and normal anatomy  

Microsoft Academic Search

Anal endosonography using a specially designed hard cone attachment to a radial 7-MHz probe has been performed in 26 normal patients — 3 patients following lateral anal sphincterotomy, 1 patient undergoing electromyophysiological mapping of the external anal sphincter, and in 2 resected specimens. The examinations were rapid, simple, and well tolerated, and they provided high-resolution images of the five layers

Penelope J. Law; Clive I. Bartram

1989-01-01

110

Resting Anal Pressure Following Hemorrhoidectomy and Lateral Sphincterotomy  

Microsoft Academic Search

PURPOSE: The role of high anal pressure in the pathophysiology of hemorrhoids and anal fissures is debated. We compared resting anal pressures following left lateral sphincterotomy and hemorrhoidectomy in a prospective manometric study with emphasis on the recovery of the internal anal sphincter activity. METHODS: Included in the study were 38 patients with third-degree or fourth-degree symptomatic hemorrhoids who underwent

Dan Alper; Edward Ram; Gideon Y. Stein; Zeev Dreznik

2005-01-01

111

Total lateral sphincterotomy for anal fissure  

Microsoft Academic Search

Background and aimsInitial experience with the posterior sphincterotomy for treating anal fissures was unsatisfactory, with a significant rate of recurrences and anal incontinence. This report describes the lateral approach to complete section of the internal sphincter.Patients and methodsBetween 1997 and 2001 we surgically treated 164 patients for anal fissure. Preoperative and postoperative anal manometries were recorded. Postoperative course and early

Adriano Tocchi; Gianluca Mazzoni; Michelangelo Miccini; Diletta Cassini; Elia Bettelli; Stefania Brozzetti

2004-01-01

112

Effects of short term sacral nerve stimulation on anal and rectal function in patients with anal incontinence  

Microsoft Academic Search

BACKGROUNDSome patients with faecal incontinence are not amenable to simple surgical sphincter repair, due to sphincter weakness in the absence of a structural defect.AIMSTo evaluate the efficacy and possible mode of action of short term stimulation of sacral nerves in patients with faecal incontinence and a structurally intact external anal sphincter.PATIENTSTwelve patients with faecal incontinence for solid or liquid stool

C J Vaizey; M A Kamm; I C Turner; R J Nicholls; J Woloszko

1999-01-01

113

Anorectal conditions: anal fissure and anorectal fistula.  

PubMed

Anal fissures are linear splits in the anal mucosa. Acute fissures typically resolve within a few weeks; chronic fissures persist longer than 8 to 12 weeks. Most fissures are posterior and midline and are related to constipation or anal trauma. Painful defecation and rectal bleeding are common symptoms. The diagnosis typically is clinical. High-fiber diet, stool softeners, and medicated ointments relieve symptoms and speed healing of acute fissures but offer limited benefit in chronic fissures. Lateral internal sphincterotomy is the surgical management of choice for chronic and refractory acute fissures. Anorectal fistula is an abnormal tract connecting the anorectal mucosa to the exterior skin. Fistulas typically develop after rupture or drainage of a perianal abscess. Fistulas are classified as simple or complex; low or high; and intersphincteric, transsphincteric, suprasphincteric, or extrasphincteric. Inspection of the perianal area identifies the skin opening, and anoscopy visualizes internal openings. The goal of management is to obliterate the tract and openings with negligible sphincter disruption to minimize incontinence. Fistulotomy is effective for simple fistulas; patients with complex fistulas may require fistulectomy. Other procedures that are used include injection of fibrin glue or insertion of a bioprosthetic plug into the fistula opening. PMID:24742084

Fox, Audralan; Tietze, Pamela H; Ramakrishnan, Kalyanakrishnan

2014-04-01

114

Comparison of Botulinum Toxin Injection and Lateral Internal Sphincterotomy for the Treatment of Chronic Anal Fissure  

Microsoft Academic Search

PURPOSE: Botulinum toxin injection into the internal anal sphincter has been shown to be an effective treatment for chronic anal fissure. A randomized, prospective trial was conducted to compare botulinum toxin with lateral internal anal sphincterotomy as definitive management for chronic anal fissure. METHODS: Patients diagnosed as having chronic anal fissure were randomly assigned to one of the two treatment

B. Bülent Mente?; Oktay ?rkörücü; Murat Ak?n; Sezai Levento?lu; Ertan Tatl?c?o?lu

2003-01-01

115

Anal fistula plug and fibrin glue versus conventional treatment in repair of complex anal fistulas  

Microsoft Academic Search

IntroductionHigh transsphincteric fistulas are difficult to treat because fistulotomy of involved sphincter muscle results in incontinence. We compare our outcomes for anal fistula plug, fibrin glue, advancement flap closure, and seton drain insertion.

Wiley Chung; Pooya Kazemi; David Ko; Clare Sun; Carl J. Brown; Manoj Raval; Terry Phang

2009-01-01

116

Postdelivery anal function in primiparous females  

Microsoft Academic Search

PURPOSE: A study was performed to evaluate the early morphologic and functional consequences of vaginal delivery on the anal sphincter in primiparous females. METHODS: Among a cohort of 197 primiparous females who agreed to participate in a clinical evaluation of fecal incontinence and in a transanal ultrasound examination 12 weeks after delivery, 52 also underwent anal manometry using a radial

Henri Damon; Luc Henry; Stéphane Bretones; Georges Mellier; Yves Minaire; François Mion

2000-01-01

117

Does a second delivery increase the risk of anal incontinence?  

Microsoft Academic Search

Objective To evaluate the prevalence of anal incontinence and anal sphincter defects after a first vaginal delivery and assess the effect of a second delivery.Design Prospective cohort study using postal questionnaires assessing incontinence to flatus and stools at three and thirty months postnatally and anal endosonography at three months following delivery.Setting Recruitment was from the antenatal clinic at the University

Daniel L Faltin; Michel R Sangalli; Bruno Roche; Lucia Floris; Michel Boulvain; Antoine Weil

2001-01-01

118

Neuroanatomy of the striated muscular anal continence mechanism  

Microsoft Academic Search

The striated pelvic floor musculature and the striated muscle of the external anal sphincter contribute to anal continence by effecting, respectively, the rectoanal angulation of the bowel and an anal high pressure zone. The muscular anatomy of the pelvic floor is generally understood, but the neuroanatomy remains controversial. The authors dissected three male cadavers and traced the sacral nerves from

Klaus E. Matzel; Richard A. Schmidt; Emil A. Tanagho

1990-01-01

119

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

120

Non-sphincter splitting fistulectomy vs conventional fistulotomy for high trans-sphincteric fistula-in-ano: a prospective functional and manometric study  

Microsoft Academic Search

Purpose  This study compared the clinical and physiological results of non-sphincter splitting fistulectomy (N-SSF) with those of sphincter\\u000a splitting fistulotomy (SSF) for treatment of high trans-sphincteric fistula-in-ano.\\u000a \\u000a \\u000a \\u000a Materials and methods  A prospective, observational study was undertaken in 70 consecutive patients with high trans-sphincteric fistula treated by\\u000a SSF (n?=?35) or N-SSF (n?=?35). Anal manometry was performed before and 3 months after surgery. Anal continence

Takayuki Toyonaga; Makoto Matsushima; Yoshiaki Tanaka; Kazunori Suzuki; Nobuhito Sogawa; Hiroki Kanyama; Yasuhiro Shimojima; Tomoaki Hatakeyama; Masao Tanaka

2007-01-01

121

Concepts in pathogenesis and treatment of chronic anal fissure—a review of the literature  

Microsoft Academic Search

OBJECTIVE:Chronic anal fissures are associated with a persistent hypertonia and spasm of the internal anal sphincter. Classic treatment is surgical sphincterotomy to reduce the anal tone and eliminate sphincteric spasm. However, concerns have been raised about the incidence of fecal incontinence after surgery. Therefore, pharmacological means to treat chronic anal fissures have been explored.METHODS:We conducted a literature review on MEDLINE

M. J. Utzig; A. J. Kroesen; H. J. Buhr

2003-01-01

122

[Perianal fistula and anal fissure].  

PubMed

CRYPTOGLANDULAR ANAL FISTULA: Perianal abscesses are caused by cryptoglandular infections. Not every abscess will end in a fistula. The formation of a fistula is determined by the anatomy of the anal sphincter and perianal fistulas will not heal on their own. The therapy of a fistula is oriented between a more aggressive approach (operation) and a conservative treatment with fibrin glue or a plug. Definitive healing and the development of incontinence are the most important key points. ANAL FISSURES: Acute anal fissures should be treated conservatively by topical ointments, consisting of nitrates, calcium channel blockers and if all else fails by botulinum toxin. Treatment of chronic fissures will start conservatively but operative options are necessary in many cases. Operation of first choice is fissurectomy, including excision of fibrotic margins, curettage of the base and excision of the sentinel pile and anal polyps. Lateral internal sphincterotomy is associated with a certain degree of incontinence and needs critical long-term observation. PMID:23179514

Heitland, W

2012-12-01

123

Neurophysiologic assessment of the anal sphincters  

Microsoft Academic Search

One hundred twenty consecutive patients with either fecal incontinence (60 patients), chronic constipation (41 patients), or idiopathic intractable pelvic pain (19 patients) were prospectively assessed. Patients underwent concentric needle electromyography (EMG), bilateral pudendal nerve terminal motor latency evaluation, anorectal manometry, and cinedefecography. The most common EMG finding in patients with fecal incontinence was decreased recruitment of motor units with squeezing

Steven D. Wexner; Floriano Marchetti; Virgilio D. Salanga; Christobal Corredor; David G. Jagelman

1991-01-01

124

Anal warts and anal cancer  

Microsoft Academic Search

The incidence of anal cancer is higher in patients with anal canal condyloma, a sexually transmitted disease, than in the general population. The prevalence of anal dysplasia and cancer in patients with anal canal condyloma with respect to HIV status, immunity status, and human papillomavirus types was determined. In 174 consecutive patients (114 HIV positive, 60 HIV negative) with anal

Christina M Surawicz

2001-01-01

125

Sphincter of Oddi Dysfunction  

MedlinePLUS

... Buy IFFGD Merchandise Take Action Contact Us Donate Sphincter of Oddi Dysfunction The sphincter of Oddi is a muscular valve that controls the flow ... the first part of the small intestine (duodenum). Sphincter of Oddi dysfunction (SOD) describes the situation when the sphincter ...

126

Sphincteroplasty for anal incontinence  

PubMed Central

Sphincteroplasty (SP) is the operation most frequently performed in patients suffering from moderate-to-severe anal incontinence (AI) who do not respond to conservative treatment. Other costly surgeries, such as artificial bowel sphincter (ABS) and electro-stimulated graciloplasty, have been more or less abandoned due to their high morbidity rate. Minimally invasive procedures are widely used, such as sacral neuromodulation and injection of bulking agents, but both are costly and the latter may cure only mild incontinence. The early outcome of SP is usually good if the sphincters are not markedly denervated, but its effect diminishes over time. SP is more often performed for post-traumatic than for idiopathic AI. It may also be associated to the Altemeier procedure, aimed at reducing the recurrence rate of rectal prolapse, and may be useful when AI is due either to injury to the sphincter, or to a narrowed rectum following the procedure for prolapse and haemorrhoids (PPH) and stapled transanal rectal resection (STARR). The outcome of SP is likely to be improved with biological meshes and post-operative pelvic floor rehabilitation. SP is more effective in males than in multiparous women, whose sphincters are often denervated, and its post-operative morbidity is low. In conclusion, SP, being both low-cost and safe, remains a good option in the treatment of selected patients with AI.

Pescatori, Lorenzo Carlo; Pescatori, Mario

2014-01-01

127

Calibrated lateral internal sphincterotomy for chronic anal fissure  

Microsoft Academic Search

Lateral internal sphincterotomy is an effective\\u000aprocedure for the treatment of anal fissure, but may affected\\u000aanal continence. We describe a procedure aimed at tailoring\\u000athe division of the sphincter according to the degree\\u000aof the hypertonia and to the sphincter length in order to\\u000aoffer an effective and safe treatment for chronic anal fissure.

G. Rosa; P. Lolli; D. Piccinelli; F. Mazzola; C. Zugni; A. Ballarin; S. Bonomo

2005-01-01

128

[The role of glyceryl trinitrate in the treatment of anal fissure].  

PubMed

Anal fissure is a small linear tear in the lining of the distal anal canal below the dentate line. Treatment is aimed at reducing internal sphincter spasm. This can be achieved with surgery (lateral internal sphincterotomy) or pharmacological sphincterotomy applying topical medication, which relaxes the sphincter muscle. Glyceryl trinitrate is the most widely used topical agent. This is a nitric oxide donor which reduces the increased anal canal pressure caused by the hypertonic internal anal sphincter, improving anodermal blood flow. Although headache is a frequent side-effect, it is usually transient and glyceryl trinitrate does not seem to have any long-term adverse effects. PMID:18799408

Takáts, Károly; Tóth, András; Bursics, Attila

2008-08-01

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

2013-01-01

130

Prevalence and Risk Indicators for Anal Incontinence among Pregnant Women  

PubMed Central

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.

Skjeldestad, Finn Egil; Sandvik, Leiv

2013-01-01

131

Conservative management of anal leiomyosarcoma  

SciTech Connect

Leiomyosarcomas of the large intestine are unusual neoplasms, comprising less than 0.1% of all malignancies of the colon and rectum. Six cases of leiomyosarcoma of the anus have been reported. The optimal treatment for this neoplasm is not known. The standard surgical approach is abdominoperineal resection. The authors report the seventh case of this rare neoplasm and outline its treatment using local excision and iridium 192 brachytherapy in an attempt to preserve the anal sphincter. In selected patients, conservative surgery followed by radiation therapy may be an alternative to radical surgery, with the goals of local control of the disease and anal sphincter preservation. However, more experience is needed before this approach could be recommended routinely.

Minsky, B.D.; Cohen, A.M.; Hajdu, S.I. (Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States))

1991-10-01

132

Fibrin glue for all anal fistulas  

Microsoft Academic Search

The aim of this study was to determine if a new sphincter muscle-sparing technique that uses fibrin glue was effective in\\u000a closing all types of anal fistulas. All patients with anal fistulas who were seen by a single surgeon over a 2-year period\\u000a were treated with fibrin glue. Six to 8 weeks after a seton was placed in the fistula

Stephen M. Sentovich

2001-01-01

133

Novel Options for the Pharmacological Treatment of Chronic Anal Fissure - Role of Botulin Toxin  

Microsoft Academic Search

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

Mariusz Madalinski; Leszek Kalinowski

2009-01-01

134

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

2012-06-01

135

Sphincter of Oddi dysfunction  

Microsoft Academic Search

Summary  Evidence continues to accumulate indicating that sphincter of Oddi dysfunction may give rise to cholestasis, pancreatitis,\\u000a or upper abdominal pain syndromes. Diagnosis of such dysfunction may be inferred from noninvasive tests or more precisely\\u000a defined by manometric studies. Both the biliary and pancreatic sphincters are commonly involved. If medical therapy is ineffective,\\u000a sphincter ablation via endoscopy or laparotomy should be

Glen A. Lehman; Stuart Sherman

1996-01-01

136

Sphincter saving surgery is the standard procedure for treatment of low rectal cancer.  

PubMed

Carcinoma rectum is a challenging problem both for the developed and underdeveloped countries. Colorectal cancer accounts for 9% of all cancer deaths (49,920) in 2009 in USA. Carcinoma involving the lower part of the rectum is now successfully managed by sphincter saving surgery with less morbidity and uneventful recovery. To observe the objective, subjective and functional outcome of the patients suffering from cancer of the lower third of the rectum managed by surgical intervention with preservation of sphincter. A comparative study was carried out on 54 patients with low rectal cancer who underwent ultra-low anterior resection in the department of surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2009 to December 2010. Patients were divided into two groups depending on the tumor distance from anal verge. Thirty one (57%) patients were in Group A (Experimental) where tumor distance was 5cm from anal verge and upper 1cm of anal sphincter was sacrificed during surgical intervention. Twenty three (43%) patients were in Group B (Control) where tumor distance was 6cm from anal verge and whole length (4cm) of anal sphincter was preserved during surgical intervention. Functional integrity of anal sphincter was assessed between these two groups of patients following surgery. The mean age of the patients was 45.96±14.41 years. During surgery, ultra low anterior resection was performed to remove the tumor in all patients and for anastomosis double stapling technique was performed in 52(96%) patients and hand sewn technique was performed in 2(4%) patients irrespective of tumor distance from anal verge. Covering ileostomy was fashioned in all but one patient. During post-operative follow up anal sphincter muscle tone, anal sphincter function (Anal continence, p = 0.54), Quality of life (Social life, p = 0.54; Professional life, p = 0.23; House work and Need a diaper, p = 0.54) were not significantly impaired in both groups. Functional outcome of anal sphincter muscle and quality of life was not impaired in comparison to general population after low rectal cancer surgery. PMID:23715349

Rahman, M S; Khair, M A; Khanam, F; Haque, S; Alam, M K; Haque, M M; Salam, M A; Sikder, A H

2013-04-01

137

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

Microsoft Academic Search

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.

Adnan Giral; Kemal Memi?o?lu; Yücel Gültekin; Ne?e ?meryüz; Cem Kalayc?; Nefise B Ulusoy; Nurdan Tözün

2004-01-01

138

Simple Cutaneous Advancement Flap Anoplasty for Resistant Chronic Anal Fissure: A Prospective Study  

Microsoft Academic Search

Background  A proportion of patients with chronic anal fissure have persistent symptoms and pathology despite optimum conservative therapies.\\u000a Lateral anal sphincterotomy, the standard surgical treatment, is associated with functional compromise in a minority of patients.\\u000a Sphincter-sparing anoplasty has been advocated as an alternative procedure for those with “low pressure” sphincters. The aim\\u000a of this study was to determine the efficacy of

Pasquale Giordano; Gianpiero Gravante; Pietro Grondona; Boris Ruggiero; Theresa Porrett; Peter James Lunniss

2009-01-01

139

Anal fissure  

MedlinePLUS

Danakas G. Anal fissure. In: Ferri FF, ed. Ferri's Clinical Advisor 2008: Instant Diagnosis and Treatment . 1st ed. Philadelphia, Pa: Mosby; 2008. Marcello PW. Diseases of the anorectum. In: Feldman M, Friedman LS, Brandt LJ, ...

140

Influence of perineal prostatectomy on anal continence  

PubMed Central

OBJECTIVE: Perineal prostatectomy has been proposed as a less invasive and safe procedure, but the risk of anal incontinence has been studied. This study aimed to evaluate the effects of perineal access on anal continence mechanisms after perineal prostatectomy. METHODS: From August 2008 to May 2009, twenty three patients underwent perineal prostatectomy. These patients were evaluated before surgery and eight months postoperatively using the Cleveland Clinic Anal Incontinence Score, the Fecal Incontinence Quality of Life Score, and anorectal manometry. RESULTS: The mean age of the subjects was 65 (range, 54-72) years, and the mean prostate weight was 34.5 (range, 24-54) grams. Gleason scores ranged from 6-7, and the mean Cleveland Clinic Anal Incontinence Score (mean±standard deviation) values were 0.9±1.9 and 0.7±1.2 (p>0.05) before and after surgery, respectively. The Fecal Incontinence Quality of Life Score did not change significantly after surgery. The mean values for anal manometric parameters before and after surgery were, respectively: Resting Pressures of 64±23 mmHg and 65±17 mmHg (p?=?0.763), Maximum Squeezing Pressures of 130±41 mmHg and 117±40 mmHg (p?=?0.259), High Pressure Zones of 3.0±0.9 cm and 2.7±0.8 cm (p?=?0.398), Rectal Sensory Thresholds of 76±25 ml and 71±35 ml (p?=?0.539), Maximum Tolerated Rectal Volumes of 157±48 ml and 156±56 ml (p?=?0.836), and Sphincter Asymmetry Indexes 22.4±9% and 14.4±5% (p?=?0.003). CONCLUSION: There was a significant decrease in the sphincter symmetry index after perineal prostatectomy. With the exception of the sphincter asymmetry index, perineal prostatectomy did not affect anal continence parameters.

Guilger, Nadia Ricci; Jorge, Jose Marcio Neves; Costa, Renato Prado; Salla, Fernando Cesar; Teixeira, Magaly Gemio; Nahas, Sergio Carlos; Cecconello, Ivan

2011-01-01

141

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

142

HDR brachytherapy for anal cancer  

PubMed Central

The challenge of treating anal cancer is to preserve the anal sphincter function while giving high doses to the tumor and sparing the organ at risk. For that reason there has been a shift from radical surgical treatment with colostomy to conservative treatment. Radiotherapy combined with chemotherapy has an important role in the treatment of anal cancer patients. New techniques as intensity modulated radiotherapy (IMRT) have shown reduced acute toxicity and high rates of local control in combination with chemotherapy compared to conventional 3-D radiotherapy. Not only external beam radio-chemotherapy treatment (EBRT) is an established method for primary treatment of anal cancer, brachytherapy (BT) is also an approved method. BT is well known for boost irradiation in combination with EBRT (+/– chemotherapy). Because of technical developments like modern image based 3D treatment planning and the possibility of intensity modulation in brachytherapy (IMBT), BT today has even more therapeutic potential than it had in the era of linear sources. The combination of external beam radiotherapy (EBRT) and BT allows the clinician to deliver higher doses to the tumor and to reduce dose to the normal issue. Improvements in local control and reductions in toxicity therefore become possible. Various BT techniques and their results are discussed in this work.

Kovacs, Gyoergy

2014-01-01

143

HDR brachytherapy for anal cancer.  

PubMed

The challenge of treating anal cancer is to preserve the anal sphincter function while giving high doses to the tumor and sparing the organ at risk. For that reason there has been a shift from radical surgical treatment with colostomy to conservative treatment. Radiotherapy combined with chemotherapy has an important role in the treatment of anal cancer patients. New techniques as intensity modulated radiotherapy (IMRT) have shown reduced acute toxicity and high rates of local control in combination with chemotherapy compared to conventional 3-D radiotherapy. Not only external beam radio-chemotherapy treatment (EBRT) is an established method for primary treatment of anal cancer, brachytherapy (BT) is also an approved method. BT is well known for boost irradiation in combination with EBRT (+/- chemotherapy). Because of technical developments like modern image based 3D treatment planning and the possibility of intensity modulation in brachytherapy (IMBT), BT today has even more therapeutic potential than it had in the era of linear sources. The combination of external beam radiotherapy (EBRT) and BT allows the clinician to deliver higher doses to the tumor and to reduce dose to the normal issue. Improvements in local control and reductions in toxicity therefore become possible. Various BT techniques and their results are discussed in this work. PMID:24982770

Niehoff, Peter; Kovács, Gyoergy

2014-06-01

144

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

145

Overlapping sphincteroplasty for acquired anal incontinence  

Microsoft Academic Search

When defects of the anal sphincter are caused by trauma, surgical correction can be successful even in long-standing cases.\\u000a At the University of Minnesota, we used overlapping sphincteroplasty in 79 patients with fecal incontinence from 1952 to 1982.\\u000a There were 62 women and 17 men. Ages ranged from 17 to 68 years. Incontinence had been present from three weeks to

David T. Fang; Santhat Nivatvongs; Fred D. Vermeulen; Fred N. Herman; Stanley M. Goldberg; David A. Rothenberger

1984-01-01

146

Anal stenosis.  

PubMed

Anal stenosis occurs most commonly following a surgical procedure, such as hemorrhoidectomy, excision and fulguration of anorectal warts, endorectal flaps, or following proctectomy, particularly in the setting of mucosectomy. Patients who experience anal stenosis describe constipation, bleeding, pain, and incomplete evacuation. Although often described as a debilitating and difficult problem, several good treatment options are available. In addition to simple dietary and medication changes, surgical procedures, such as lateral internal sphincterotomy or transfers of healthy tissue are other potentially good options. Flap procedures are excellent choices, depending on the location of the stenosis and the amount of viable tissue needed. This article presents the definition, pathophysiology, diagnosis, and treatment of anal stenosis, and methods to prevent it. PMID:20109638

Katdare, Mukta V; Ricciardi, Rocco

2010-02-01

147

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

148

The artificial bowel sphincter for faecal incontinence: a single centre study  

PubMed Central

Background and aims Faecal incontinence (FI) is a socially devastating problem. The treatment algorithm depends on the aetiology of the problem. Large anal sphincter defects can be treated by sphincter replacement procedures: the dynamic graciloplasty and the artificial bowel sphincter (ABS). Materials and methods Patients were included between 1997 and 2006. A full preoperative workup was mandatory for all patients. During the follow-up, the Williams incontinence score was used to classify the symptoms, and anal manometry was performed. Results Thirty-four patients (25 women) were included, of which, 33 patients received an ABS. The mean follow-up was 17.4 (0.8–106.3) months. The Williams score improved significantly after placement of the ABS (p?anal resting pressure with an empty cuff was not altered (p?=?0.89). The postoperative ABS pressure was significantly higher then the baseline squeeze pressure (p?=?0.003). Seven patients had an infection necessitating explantation. One patient was successfully reimplanted. Conclusion The artificial bowel sphincter is an effective treatment for FI in patients with a large anal sphincter defect. Infectious complications are the largest threat necessitating explantation of the device.

Melenhorst, Jarno; Koch, Sacha M.; van Gemert, Wim G.

2007-01-01

149

Anal Cancer  

MedlinePLUS

... the type of cell where the cancer began: Squamous cell carcinoma is the most common type of anal cancer. ... likely starts from cells that are similar to squamous cell cancer, and it is treated ... lining. Basal cell carcinoma is a type of skin cancer that can ...

150

Anal Warts  

MedlinePLUS

... affect the skin of the genital area. They first appear as tiny spots or growths, perhaps as small as the head of a pin, and may grow quite large and cover the entire anal area. Usually, they do not cause pain or ...

151

Diffuse large B cell lymphoma presenting as a peri-anal abscess.  

PubMed

A non-healing peri-anal abscess can be difficult to manage and is often attributed to chronic disease. This case documents a male in his seventh decade who presented with multiple peri-anal collections. The abscess cavity had caused necrosis of the internal sphincter muscles resulting in faecal incontinence. Biopsies were conclusive for diffuse large B-cell lymphoma. A de-functioning colostomy was performed and the patient was initiated on CHOP-R chemotherapy. Anal lymphoma masquerading as a peri-anal abscess is rare. A high degree of suspicion must be maintained for an anal abscess which does not resolve with conservative management. PMID:24898408

Jayasekera, Hasanga; Gorissen, Kym; Francis, Leo; Chow, Carina

2014-01-01

152

Diffuse large B cell lymphoma presenting as a peri-anal abscess  

PubMed Central

A non-healing peri-anal abscess can be difficult to manage and is often attributed to chronic disease. This case documents a male in his seventh decade who presented with multiple peri-anal collections. The abscess cavity had caused necrosis of the internal sphincter muscles resulting in faecal incontinence. Biopsies were conclusive for diffuse large B-cell lymphoma. A de-functioning colostomy was performed and the patient was initiated on CHOP-R chemotherapy. Anal lymphoma masquerading as a peri-anal abscess is rare. A high degree of suspicion must be maintained for an anal abscess which does not resolve with conservative management.

Jayasekera, Hasanga; Gorissen, Kym; Francis, Leo; Chow, Carina

2014-01-01

153

V–Y advancement flap as first-line treatment for all chronic anal fissures  

Microsoft Academic Search

Introduction  It was suggested that anal advancement flap be used to treat patients with chronic anal fissures that have failed medical\\u000a management and have a low-pressure sphincter complex. We wished to assess anal advancement flap as a treatment for all chronic\\u000a anal fissures.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  All patients with chronic anal fissures regardless of their previous management underwent V–Y advancement flap. Patient demographics,\\u000a symptom

William Chambers; Rai Sajal; Anthony Dixon

2010-01-01

154

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

155

Closed Lateral Internal Sphincterotomy Versus Anal Sphincterolysis for Chronic Anal Fissure  

Microsoft Academic Search

\\u000a Abstract\\u000a \\u000a \\u000a Purpose:\\u000a   The aim of this randomized, prospective study was to compare the results of closed lateral internal sphincterotomy with the\\u000a authors' innovative approach of finger fragmentation of internal sphincter fibers, termed sphincterolysis, in the treatment\\u000a of chronic anal fissure.\\u000a \\u000a \\u000a \\u000a \\u000a Patients and Methods:\\u000a   Adult patients with chronic anal fissures were randomly assigned to undergo closed lateral sphincterotomy or sphincterolysis.\\u000a The

Pravin J. Gupta; Surekha Kalaskar; Purushottam Heda

2008-01-01

156

Cost considerations in the treatment of anal fissures.  

PubMed

Anal fissure is a split in the lining of the distal anal canal. Lateral internal sphincterotomy remains the gold standard for treatment of anal fissure. Although technique is simple and effective, a drawback of this surgical procedure is its potential to cause minor but some times permanent alteration in rectal continence. Conservative approaches (such as topical application of ointment or botulinum toxin injections) have been proposed in order to treat this condition without any risk of permanent injury of the internal anal sphincter. These treatments are effective in a large number of patients. Furthermore, with the ready availability of medical therapies to induce healing of anal fissure, the risk of a first-line surgical approach is difficult to justify. The conservative treatments have a lower cost than surgery. Moreover, evaluation of the actual costs of each therapeutic option is important especially in times of economic crisis and downsizing of health spending. PMID:24867398

Brisinda, Giuseppe; Bianco, Giuseppe; Silvestrini, Nicola; Maria, Giorgio

2014-08-01

157

Complex anal fistula surgery: personal experience.  

PubMed

Personal experience with the treatment cryptogenic complex anal fistulas over the 10-year period from 1993 to 2002 is reported. Such fistulas accounted for 54 out of 255 fistulas observed (21.1%). Accurate anatomo-pathological classification, based on the connections between the fistulas and the sphincter and the musculature of the pelvic floor, is mandatory, as is thorough preoperative evaluation of ano-rectal function and of the risk of faecal incontinence. The surgical strategies used, in relation to the different kinds of complex fistulas treated, are schematically reported. A mixed technique consisting in fistulectomy-fistulotomy with setons was particularly preferred, because of the risk related to immediate dissection of the sphincter, especially when concurrent risk factors are present. As regards the results obtained, the surgical outcome consisted in healing in 49/54 cases (90.7%) as against recurrence or persistence of the fistula in 5/54 (9.3%). Minor complications occurred in 6/54 (11.1%); no major complications were observed and no cases of permanent faecal incontinence were reported. In conclusion, the surgical choice in cases of complex fistulas must lead to definitive, radical treatment of the lesion, at the same time avoiding irreversible anal incontinence due to severe lesions to the sphincter. PMID:15452991

Pagano, Giovanni; Biondo, Giovanni; Armaleo, Francesco; Scuderi, Giuseppe; Ruggieri, Antonino Giuseppe; Crescenti, Fabio; Fabiano, Natale; Famulari, Ciro

2004-01-01

158

Excision of Anal Fistula With Closure of the Internal Opening  

Microsoft Academic Search

PURPOSE: The aim of this study was to evaluate the results\\u000aconcerning recurrence and continence after sphincter-saving\\u000asurgery for fistula-in-ano. METHODS: Forty-two patients\\u000awith anal fistula traversing the sphincter were operated on\\u000awith fistula excision and closure of the internal opening.\\u000aPatients answered a questionnaire concerning bowel habits\\u000aand continence before and 3 and 12 months after surgery. A\\u000asubgroup

Ulla-Maria Gustafsson; Wilhelm Graf

2002-01-01

159

Study of operated patients of lateral internal anal sphincterotomy for chronic anal fissure.  

PubMed

Introduction: Anal fissure causes significant morbidity in the population. It is proposed that elevated sphincter pressures may cause ischaemia of the anal lining and this may be responsible for the pain of anal fissures and their failure to heal. When pharmacologic therapy fails or fissures recur frequently, lateral internal sphincterotomy is the surgical treatment of choice. Material and Methods: Retrospective analysis was done of admitted and operated patients of anal fissure by lateral anal internal sphincterotomy either by open or closed technique between April 2010 and November 2011 in Gujarat Medical Education & Research Society Medical College, Sola, Ahmedabad, India. The follow-up data of all patients was evaluated for pain relief, recurrence, wound infection, incontinence to flatus or stool or both for a period of up to 6 months. Results: Wound infection rate was 10.3% in open method and 4.2% in closed method. Incontinence to flatus was 8.3% in closed method and 3.4% in open method. This was temporary and controlled within a 1 week. Incontinence to stool was 3.4% in open method which was temporary and controlled within 2 weeks while none in closed method. None of the patients in either group had come with recurrence within 6 months follow-up. Conclusion: Lateral anal internal sphincterotomy is safe regarding long term incontinence and effective regarding recurrence. PMID:24551659

Patel, Harshad Shankarlal; Chavda, Jagdish; Parikh, Jayesh; Naik, Nehal

2013-12-01

160

Free microneurovascular gracilis muscle transfer in the dog for enterostomal sphincter construction and control: an experimental study.  

PubMed

Hundreds of thousands of individuals struggle today with the morbidity of an abdominal wall enterostoma. This study explored two ways of constructing abdominal wall sphincter mechanisms in dogs using gracilis muscles transferred by free microneurovascular technique. Transferred muscles successfully generated pressures greater than the normal external anal sphincter but could not maintain this level of contraction for tonic sphincter closure. Other transferred muscles were designed to straighten the course of stomas continent at rest. They provided strong linear pull uncoiling the stomas but simultaneously pinched off the orifices during contraction. This opening model shows promise if the muscle attachments around the stoma orifices could be made less constricting. PMID:2978825

Merrell, J C; Russell, R C; Zook, E G

1986-07-01

161

Chronic idiopathic anal pain  

Microsoft Academic Search

PURPOSE: This study was undertaken to analyze whether intra-anal ultrasound examination, anorectal physiologic evaluation, and histopathologic examination in patients with chronic idiopathic anal pain presented any common features and whether the results of different treatment modalities correlated with these findings. METHODS: Eighteen patients who met the criteria for chronic idiopathic anal pain were studied. All had an intra-anal ultrasound examination

J. Christiansen; E. Bruun; B. Skjoldbye; K. Hagen

2001-01-01

162

[Treatment of anal fissures with botulinum toxin].  

PubMed

Chronic anal fissure is a common proctological disease. Botulinum toxin (BTX) can be used for temporary chemical denervation. The administration is by intramuscular injections into either the external or the internal anal sphincter muscles. The mode of action, administration techniques and possible complications or adverse effects of BTX therapy are discussed. The healing rate is dependent on the BTX dosage. The short-term healing rate (< or = 6 months) is between 60 and 90 %. In long-term follow-up studies (> 1 year), about 50 % of patients show a complete response. Adverse effects are generally mild but relapses occur more often compared to surgery. Conservative therapies including BTX are currently considered mostly as the first-line treatment. Among the surgical procedures, lateral sphincterotomy is the most effective treatment but shows higher incontinence and general morbidity rates than BTX. PMID:18415898

Wollina, U

2008-04-01

163

Treatment of Complex Anal Fistulas with the Collagen Fistula Plug  

Microsoft Academic Search

Purpose  Anal fistulas that involve a significant amount of sphincter may be difficult to treat without compromising continence function.\\u000a In this study, we evaluated our experience with the Surgisis® anal fistula plug, which was recently reported to be successful\\u000a in >80 percent of patients with complex fistulas.\\u000a \\u000a \\u000a \\u000a Methods  We retrospectively collected patient and fistula characteristics, procedure details, and follow-up information for all

Dimitrios Christoforidis; David A. Etzioni; Stanley M. Goldberg; Robert D. Madoff; Anders Mellgren

2008-01-01

164

Common anal problems.  

PubMed

Anal problems are pervasive, embarrassing and vexing to patients. Primary care providers should be well versed in addressing these concerns, which uncommonly require referral for specialty care. Additionally, anal symptoms and findings may herald previously undiagnosed underlying illness. PMID:24758964

Klein, Jared Wilson

2014-05-01

165

Chronic anal fissure from suspected adult sexual abuse in a traumatic anal sex practice patient.  

PubMed

The aetiopathogenesis of chronic anal fissure (CAF) is unclear and is probably multifactorial. CAF represents 10-15% of proctological consultations. This case report identifies adulthood sexual abuse as a significant risk and a potential aetiopathogenic factor of CAF This case history was discovered while carrying out administrated interviews during authors' clinical retrospective study on CAF. The clinical presentation of this 49-year-old woman is predominated by chronic anal lesions (anal tears in the anoderm, anal sphincter hypertrophy), associated medical history as a high consumer of healthcare with very poor mental health, chronic traumatic anal sex practice history, and especially persistent recurrences of gastro-intestinal symptoms after surgery. Surgical history is summarized as: 7x spontaneous abortion; 5x fistulectomy and 3x anal abscess; 4x Bartholin's gland; 4x hypertrophy papilla ablation; 2x anal manometry, 2x fissurectomy and 1x sphincterotomy; 2x haemorrhoid; and 1x hysterectomy. These symptoms initially started and the operations in particular took place after she was married. After 26 years of sexual abuse within her marriage, the clinical diagnosis was made and was consented by this patient. A referral to a psychiatrist was evident and a long course of multidisciplinary therapy (medical, surgical, physiological and psychological approaches) seemed to be of benefit, in terms of improving the clinical symptoms. Authors suggest that physicians should suspect sexual abuse in any patient with a medical history as a high consumer of healthcare and especially when there is persistent recurrence after the lateral subcutaneous internal sphincterotomy. We recognise that the link or causality is difficult to prove and further study is probably needed to shed light on the link between sexual abuse and CAF: although in the United Kingdom, over 20.83% of the population are subject to sexual abuse. 83%. PMID:18074923

Nzimbala, M J; Bruyninx, L

2007-01-01

166

MRI of anal cancer: assessing response to definitive chemoradiotherapy.  

PubMed

Anal cancer is an uncommon malignancy of the gastrointestinal tract but has a relatively good prognosis with an 80% 5-year overall survival. In this article, we review the role of MRI for assessing treatment response in anal cancer after completion of definitive chemoradiotherapy. New generation MRI scanners with optimal-phased array body coils, resulting in better signal to noise and improved contrast and spatial resolution, have contributed to high-resolution imaging in clinical practice enabling visualization of relevant anatomy including the sphincter complex, adjacent structures, mesorectal and pelvic lymph nodes with a diameter down to 2 mm. Multiplanar, high-resolution T2-weighted and diffusion-weighted sequences have a role in initial locoregional staging of anal SCC, assisting radiotherapy planning, as well as in assessing response to treatment and treatment-related complications. PMID:24072381

Gourtsoyianni, S; Goh, V

2014-02-01

167

Why do we have so much trouble treating anal fistula?  

PubMed Central

Anal fistula is among the most common illnesses affecting man. Medical literature dating back to 400 BC has discussed this problem. Various causative factors have been proposed throughout the centuries, but it appears that the majority of fistulas unrelated to specific causes (e.g. Tuberculosis, Crohn’s disease) result from infection (abscess) in anal glands extending from the intersphincteric plane to various anorectal spaces. The tubular structure of an anal fistula easily yields itself to division or unroofing (fistulotomy) or excision (fistulectomy) in most cases. The problem with this single, yet effective, treatment plan is that depending on the thickness of sphincter muscle the fistula transgresses, the patient will have varying degrees of fecal incontinence from minor to total. In an attempt to preserve continence, various procedures have been proposed to deal with the fistulas. These include: (1) simple drainage (Seton); (2) closure of fistula tract using fibrin sealant or anal fistula plug; (3) closure of primary opening using endorectal or dermal flaps, and more recently; and (4) ligation of intersphincteric fistula tract (LIFT). In most complex cases (i.e. Crohn’s disease), a proximal fecal diversion offers a measure of symptomatic relief. The fact remains that an “ideal” procedure for anal fistula remains elusive. The failure of each sphincter-preserving procedure (30%-50% recurrence) often results in multiple operations. In essence, the price of preservation of continence at all cost is multiple and often different operations, prolonged disability and disappointment for the patient and the surgeon. Nevertheless, the surgeon treating anal fistulas on an occasional basis should never hesitate in referring the patient to a specialist. Conversely, an expert colorectal surgeon must be familiar with many different operations in order to selectively tailor an operation to the individual patient.

Dudukgian, Haig; Abcarian, Herand

2011-01-01

168

[Surgery for anal incontinence: developments in the past two decades and future directions].  

PubMed

Studies showing the frequency of anal incontinence and its social and economic impact have driven progress in surgical treatment, from muscle repair by myorraphy (mainly posterior myorraphy) or sphincteroplasty by direct suture of the external anal sphincter some 20 years ago, to invasive surgery with implantation of an artificial anal sphincter in 1993, mini-invasive surgery based on sacral nerve stimulation in 1998, failure of mini-invasive procedures with injection of a bulking agent or radiofrequency in 2000-2010, and development in 2012 of cellular therapy based on injection of autologous myoblasts. Progress in functional gut exploration (anorectal manometry, electrophysiological tests, endoanal ultrasonography, MRI, colonic transit time) and better knowledge of colonic and ano-rectal physiology will lead to further surgical advances. PMID:24919374

Michot, Francis

2014-02-01

169

A review on functional results of sphincter-saving surgery for rectal cancer: the anterior resection syndrome.  

PubMed

The aim of this review is to characterize the functional results and "anterior resection syndrome" (ARS) after sphincter-saving surgery for rectal cancer. The purpose of sphincter-saving operations is to save the anal sphincters by avoiding the need for rectal abdomino-perineal resection with a permanent stoma. A variety of alternative techniques have been proposed and, today, ultra-low anterior resections of the rectum are commonplace. Inevitably rectal resections modify anorectal physiology. The backdrop of the functional asset for ultralow anterior resections is related to a small neorectal capacity with high endo-neorectal pressures that act together on a weakened sphincteric mechanism. Sometimes a defecation disorder called ARS may be induced and the patient experiences an extremely low quality of life. Impaired bowel function is usually provoked either by colonic dysmotility, neorectal reservoir dysfunction, anal sphincter damage or by a combination of these factors. Surgical technique defects can contribute to these possible causes: anastomotic ischemia, short length of the descending colon and stretching of neorectal mesentery may play a role. Unfortunately, there is no therapeutic algorithm or gold standard treatment that may be used for ARS. Nevertheless, it is rational to use conservative therapy first and then resort to surgery. Drugs, rehabilitative treatment and sacral neuromodulation may be used; after failure of conservative methods, surgical treatment can be considered. PMID:23754496

Pucciani, Filippo

2013-12-01

170

Botulinum Toxin Injection Versus Lateral Internal Sphincterotomy in the Treatment of Chronic Anal Fissure: A Randomized Controlled Trial  

Microsoft Academic Search

Background  Although lateral internal sphincterotomy has been the gold standard of treatment for chronic anal fissure, the main concern\\u000a remains its effects on anal continence. Intrasphincteric injection of botulinum toxin seems to be a reliable option providing\\u000a temporary alleviation of sphincter spasm and allowing the fissure to heal. The aim of the present prospective controlled randomized\\u000a study was to compare the

Maged Nasr; Hussin Ezzat; Magdy Elsebae

2010-01-01

171

How Is Anal Cancer Staged?  

MedlinePLUS

... Survival by stage of anal cancer How is anal cancer staged? Staging is the process of finding ... reached deeper layers of tissue. T categories for anal cancer TX : Primary tumor cannot be assessed T0 : ...

172

Ruptured eardrum  

MedlinePLUS

Tympanic membrane perforation; Eardrum - ruptured or perforated; Perforated eardrum ... Buttaravoli P, Leffler SM. Perforated tympanic membrane (ruptured eardrum). ... Pa: Mosby Elsevier; 2012:chap 37. Kerschner JE. Otitis ...

173

Anal cancer: Multimodal therapy  

Microsoft Academic Search

Anal cancer is a rare clinical entity which represents 1–2% of all gastrointestinal tract cancers. Due to the paucity of this malignancy it has been difficult to establish generally accepted guidelines for treatment, although various therapy modalities have been evaluated. For a long time radical surgery was the primary treatment for anal cancer and still about 30% of the patients

P. M. Schlag; M. Hfinerbein

1995-01-01

174

Anal condyloma acuminatum.  

PubMed

Anal condyloma acuminatum is a human papillomavirus (HPV) that affects the mucosa and skin of the anorectum and genitalia. Anal condyloma acuminatum is the most commonly diagnosed sexually transmitted disease in the United States. To date, there are more than 100 HPV types, with HPV-6, HPV-10, and HPV-11 predominately found in the anogenital region and causing approximately 90% of genital warts. Risk factors for anal condyloma acuminatum include multiple sex partners, early coital age, anal intercourse, and immunosuppression. Transmission occurs by way of skin-to-skin contact through sexual intercourse, oral sex, anal sex, or other contact involving the genital area. The virus may remain latent for months to years until specific mechanisms cause production of viral DNA, leading to the presentation of anal condyloma acuminatum.Patients with anal condyloma acuminatum may be asymptomatic or present with presence of painless bumps, itching, and discharge or bleeding. It is not uncommon to have involvement of more than one area, and multiple lesions may also be present and extend into the anal canal or rectum. To date, there is no serologic testing or culture to detect anal condyloma acuminatum; therefore, diagnosis is made clinically or by detection of HPV DNA. Multiple factors determine the choice of treatment, which may range from patient-applied medications to surgical intervention. Despite treatment choice, recurrence rates are high, indicating the importance of patient education on prevention of HPV infection and reinfection. Unfortunately, at this time, no cure exists for anal condyloma acuminatum; however, recently Gardasil and Cervarix (in Australia only) vaccines have become available and are showing promising results. PMID:19820442

McCutcheon, Tonna

2009-01-01

175

Anal sphincteroplasty for incontinence after ileal pouch-anal anastomosis  

Microsoft Academic Search

PURPOSE: This report reviews two patients who underwent anal sphincteroplasty to improve continence after ileal pouch-anal anastomosis (IPAA). METHODS: A retrospective study of two patients was performed. RESULTS: Two patients underwent anal sphincteroplasty after IPAA for incontinence, one diagnosed preoperatively and one postoperatively. Both had had previous anal surgery. Satisfactory continence was achieved in both cases, despite modest changes in

Jon S. Thompson; Eamonn M. M. Quigley

1995-01-01

176

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

177

CAN BE SPHINCTER ELECTROMYOGRAPHY REFERENCE VALUES SHARED BETWEEN LABORATORIES?1  

PubMed Central

Aims: Sphincter electromyography (EMG) is an important method in diagnosis of neuropathic sacral lesions. Quantitative EMG analysis increases utility of the test, but requires valid reference values. Although commonly employed, validity of sharing reference data between electrodiagnostic laboratories has not been confirmed. In this study, this approach was assessed by comparing the reproducibility of data sets obtained by the same and different laboratories. Methods: Confidence intervals and sensitivity of motor unit potential (MUP) parameters in the external anal sphincter (EAS) muscles were calculated using data obtained from 3 different control groups of women (number of women: 41, 48 and 66), examined by the same (the first two groups) and another investigator (the third group). Sensitivities to diagnose neuropathic changes in a known patient group were compared. Results: When compared to the first reference group, the MUP parameter means of 2/7 (same investigator) vs. 3/7 (different investigator) were significantly different. Similarly, 3/14 vs. 4/14 MUP parameter outliers were different. Finally, 6/14 vs. 7/14 sensitivities (using a combination of MUP parameter means and outliers) were different. Conclusions: This study demonstrated somewhat larger differences between confidence intervals obtained by different investigators, as compared to those obtained by a single investigator. However, most of these differences can be explained by differences in recruited groups of women, and slight inconsistencies in applied techniques. Presented data suggest that confidence intervals from other laboratories can be used, but only if exact protocols from original normative studies are strictly followed.

Podnar, Simon; Gregory, W. Thomas

2010-01-01

178

Anal fissure and stenosis.  

PubMed

Anal fissure is a common anorectal disorder resulting in anal pain and bleeding. Fissures can either heal spontaneously and be classified as acute, or persist for 6 or more weeks and be classified as chronic, ultimately necessitating treatment. Anal stenosis is a challenging problem most commonly resulting from trauma, such as excisional hemorrhoidectomy. This frustrating issue for the patient is equally as challenging to the surgeon. This article reviews these 2 anorectal disorders, covering their etiology, mechanism of disease, diagnosis, and algorithm of management. PMID:24280397

Shawki, Sherief; Costedio, Meagan

2013-12-01

179

Anal Dysplasia Screening  

PubMed Central

Executive Summary Objective This review considered the role of the anal Pap test as a screening test for anal dysplasia in patients at high risk of anal SCC. The screening process is now thought to be improved with the addition of testing for the human papillomavirus (HPV) in high-risk populations. High-resolution anoscopy (a method to view the rectal area, using an anoscope, a lighted instrument inserted into the rectum) rather than routine anoscopy-guided biopsy, is also now considered to be the diagnostic standard. Clinical Need: Target Population and Condition Anal cancer, like cervical cancer, is a member of a broader group of anogenital cancers known to be associated with sexually transmitted viral HPV infection. Human papillomavirus is extremely prevalent, particularly in young, sexually active populations. Sexual practices involving receptive anal intercourse lead to significantly elevated risk for anal dysplasia and cancer, particularly in those with immune dysfunctions. Anal cancer is rare. It occurs at a rate of about 1 to 2 per 100,000 in the general population. It is the least common of the lower gastrointestinal cancers, representing about 4% of them, in contrast to colorectal cancers, which remain the third most commonly diagnosed malignancy. Certain segments of the population, however, such as HIV-positive men and women, other chronic immune-suppressed patients (e.g., after a transplant), injection drug users, and women with genital dysplasia /cancer, have a high susceptibility to anal cancer. Those with the highest identified risk for anal cancer are HIV-positive homosexual and bisexual men, at a rate of 70 per 100,000 men. The risk for anal cancer is reported to be increasing dramatically in HIV-positive males and females, particularly since the introduction of highly active antiretroviral therapy in the mid-1990s. The introduction of effective viral therapy has been said to have transformed the AIDS epidemic in developed countries into a chronic disease state of long-term immunosuppression. In Ontario, there are about 25,000 people living with HIV infection; more than 6,000 of these are women. About 28% of the newly diagnosed HIV infections are in women, a doubling since 1999. It has also been estimated that 1 of 3 people living with HIV do no know it. Health Technology Description Anal Pap test screening involves the blind insertion of a swab into the anal canal and fixing cells either on a slide or in fluid for cytological examination. Anal cytology classified by the standardized Bethesda System is the same classification used for cervical cytology. It has 4 categories: normal, atypical squamous cells of uncertain significance, or squamous intraepithelial lesions which are further classified into low- or high-grade lesions. Abnormal cytological findings are subjected to further evaluations by high-resolution anoscopy, a technique similar to cervical colposcopy, and biopsy. Several HPV deoxyribonucleic acid detection technologies such as the Hybrid 11 Capture and the polymerase chain reaction are available to detect and differentiate HPV viral strains. Unlike cervical cancer, there are no universally accepted guidelines or standards of care for anal dysplasia. Moreover, there are no formal screening programs provincially, nationally, or internationally. The New York State Department of Health AIDS Institute has recently recommended (March 2007) annual anal pap testing in high-risk groups. In Ontario, reimbursement exists only for Pap tests for cervical cancer screening. That is, there is no reimbursement for anal Pap testing in men or women, and HPV screening tests for cervical or anal cancer are also not reimbursed. Methods The scientific evidence base was evaluated through a systematic literature review. Assessments of current practices were obtained through consultations with various agencies and individuals including the Ministry of Health and Long-Term Care AIDS Bureau; Public Health Infectious Diseases Branch, Ministry of Health and Long-Term Care; Cancer Care Ontario; HIV/AIDS researchers; path

2007-01-01

180

Adynamic and dynamic muscle transposition techniques for anal incontinence  

PubMed Central

Gracilis muscle transposition is well established in general surgery and has been the main muscle transposition technique for anal incontinence. Dynamization, through a schedule of continuous electrical stimulation, converts the fatigue-prone muscle fibres to a tonic fatigue-resistant morphology with acceptable results in those cases where there is limited sphincter muscle mass. The differences between gluteoplasty and graciloplasty, as well as the techniques and complications of both procedures, are outlined in this review. Overall, these techniques are rarely carried out in specialized units with experience, as there is a high revision and explantation rate.

Barisic, Goran; Krivokapic, Zoran

2014-01-01

181

Anal Cancer: An Overview  

Microsoft Academic Search

Anal cancer is a rare tumor with an incidence that has been rising over the last 25 years. The disease was once thoughttodevelopasaresultofchronicirritation,butit is now known that this is not the case. Multiple risk fac- tors, including human papillomavirus (HPV) infection, anoreceptiveintercourse,cigarettesmoking,andimmu- nosuppression, have been identified. HIV infection is also associated with anal cancer; there is a higher inci- dence

HOPE E. URONIS; JOHANNA C. BENDELLb

182

Anal abscess and fistula.  

PubMed

Benign anorectal diseases, such as anal abscesses and fistula, are commonly seen by primary care physicians, gastroenterologists, emergency physicians, general surgeons, and colorectal surgeons. It is important to have a thorough understanding of the complexity of these 2 disease processes so as to provide appropriate and timely treatment. We review the pathophysiology, presentation, diagnosis, and treatment options for both anal abscesses and fistulas. PMID:24280399

Sneider, Erica B; Maykel, Justin A

2013-12-01

183

Fibrin Glue as an Adjunct to Flap Repair of Anal Fistulas: A Randomized, Controlled Study  

Microsoft Academic Search

\\u000a Purpose  Both flap repair and fibrin glue are accepted sphincter-preserving techniques for managing anal fistulas. Additionally, the\\u000a two techniques are not mutually exclusive and can be combined. This trial was undertaken to determine whether the combination\\u000a of flap repair and fibrin glue resulted in better outcomes than flap repair alone.\\u000a \\u000a \\u000a \\u000a Methods  Between July 2000 and March 2004, patients with transsphincteric anal fistulas

C. Neal Ellis; Stephen Clark

2006-01-01

184

Application of YAG laser technique in the treatment of anal fistula  

NASA Astrophysics Data System (ADS)

The method of treating anal fistula with YAG laser technique is described in this essay. One-hundred-twenty patients have been treated successfully with this method and no recurrence was found in our series. Anal fistula is a common disorder in the anus and rectum. The tunnel of fistula zigzags around the external or internal sphincters. If the drainage is poor, and the skin around the external opening grows rapidly, false healing may occur and cause recurrent abscess. In this case, a fistula can not be cured except by operation.

Liu, Jian-xun; Zhang, Xinrong

1993-03-01

185

Sphincter saving anorectoplasty (SSARP) for the reconstruction of Anorectal malformations  

PubMed Central

Background This report describes a new technique of sphincter saving anorectoplasty (SSARP) for the repair of anorectal malformations (ARM). Methods Twenty six males with high ARM were treated with SSARP. Preoperative localization of the center of the muscle complex is facilitated using real time sonography and computed tomography. A soft guide wire is inserted under image control which serves as the route for final pull through of bowel. The operative technique consists of a subcoccygeal approach to dissect the blind rectal pouch. The separation of the rectum from the fistulous communication followed by pull through of the bowel is performed through the same incision. The skin or the levators in the midline posteriorly are not divided. Postoperative anorectal function as assessed by clinical Wingspread scoring was judged as excellent, good, fair and poor. Older patients were examined for sensations of touch, pain, heat and cold in the circumanal skin and the perineum. Electromyography (EMG) was done to assess preoperative and postoperative integrity of external anal sphincter (EAS). Results The patients were separated in 2 groups. The first group, Group I (n = 10), were newborns in whom SSARP was performed as a primary procedure. The second group, Group II (n = 16), were children who underwent an initial colostomy followed by delayed SSARP. There were no operative complications. The follow up ranged from 4 months to 18 months. Group I patients have symmetric anal contraction to stimulation and strong squeeze on digital rectal examination with an average number of bowel movements per day was 3–5. In group II the rate of excellent and good scores was 81% (13/16). All patients have an appropriate size anus and regular bowel actions. There has been no rectal prolapse, or anal stricture. EAS activity and perineal proprioception were preserved postoperatively. Follow up computed tomogram showed central placement the pull through bowel in between the muscle complex. Conclusion The technique of SSARP allows safe and anatomical reconstruction in a significant proportion of patients with ARM's without the need to divide the levator plate and muscle complex. It preserves all the components contributing to superior faecal continence, and avoids the potential complications associated with the open posterior sagittal approach.

Pratap, Akshay; Tiwari, Awadhesh; Kumar, Anand; Adhikary, Shailesh; Singh, Satyendra Narayan; Paudel, Bishnu Hari; Bartaula, Rajiv; Mishra, Brijesh

2007-01-01

186

Results with sphincter pharyngoplasty and pharyngeal flap  

Microsoft Academic Search

Objective: To evaluate speech outcomes and complications of sphincter pharyngoplasty and pharyngeal flap performed for management of velopharyngeal insufficiency (VPI). Design: Case series. Setting: Tertiary care children’s hospital. Patients: All patients who underwent pharyngeal flap or sphincter pharyngoplasty from 1990 to 1995. Methods: Perceptual speech analysis was used to assess severity of VPI, presence of nasal air emissions and quality

Lianne M. de Serres; Frederic W.-B. Deleyiannis; Linda E. Eblen; Joseph S. Gruss; Mark A. Richardson; Kathleen C. Y. Sie

1999-01-01

187

Reproducibility of endoscopic sphincter of Oddi manometry  

Microsoft Academic Search

Results from endoscopic sphincter of Oddi manometry are being used to support the diagnosis of sphincter dysfunction in patients with unexplained pain after cholecystectomy. However, there are few data on the reproducibility of manometric records or motility diagnosis during a second test. In this study, the reproducibility of manometric records was assessed in 12 patients with pain after cholecystectomy by

A. Thune; J. Scicchitano; I. Roberts-Thomson; J. Toouli

1991-01-01

188

Can Anal Cancer Be Prevented?  

MedlinePLUS

... can do that might lower your risk of anal cancer. Sex and condom use The best way to reduce ... with many partners and those who have unprotected anal sex. People can have HPV for years without having ...

189

[Prognosis of epidermoid anal carcinoma regression after conservative treatment].  

PubMed

The prospective study was concerned with definition of the clinical and therapeutic factors behind poor response of anal cancer to radio- (RT) or chemoradiotherapy (CRT). Out of 64 female and 8 male patients at the mean age of 57 (33-81), thirty six had split-course of 60-65 Gy (RT), twenty--60-65 Gy, 5-FU and mitomycin C (CRT) and eighteen--up to 55-65 Gy (1.5 Gy--session 1, 1.0 Gy--session 2) (hyper-fractionated RT) plus 5-FU, for squamous cell anal carcinoma. There was no endorectal ultrasound evidence of perirectal lymph node involvement (uN0): T1-2uN-M0 (n=46), T3-4uN0M0 (n=11), uN1 or N2-3 (groin or endorectal ultrasound: T1-2uN-M0 (n=46), T3-4uN0M0 (n=11), uN1 or N2-3 (groin metastases) were detected in 7 patients: T1-2uN1-2M0 (n=7), T3-4N1-3M0 (n=10). Endorectal ultrasound staging (ERUS) used a linear 7.5 MHz transducer. The uTNM system was devised on the basis of tumor invasion parameters. There were no tumors confined to the subendothelial layer of the anal canal (uT1); 24 (32.4%) tumors were confined to the internal anal sphincter (uT2); 19 (25.7%) invaded the external anal sphincter (uT3) and 31 (41.9%)--levator ani (uT4). All carcinomas T4 (n=9) corresponded to the uT4 category. Only T-stage and tumor invasion (uT) proved significant prognostic variables. Complete response of T1-2 was 79.2%, T3-4--33.3% (p=0.0003); uT2--95.8%, uT3--68.4%, and uT4--41.9% (except T4) (p=0.0001). In multivariate logistic analysis, uT alone appeared an independent variable (p=0.015). ERUS uTNM staging is more effective in prognosis for RT and CRT and, therefore, should be recommended for preliminary management of epidermoid anal carcinoma. PMID:15755059

Vorob'ëv, G I; Odariuk, T S; Orlova, L P; Nechushkin, M I; Rybakov, E G

2004-01-01

190

Obstetric Sphincter Injury Interacts with Diarrhea and Urgency to Increase the Risk of Fecal Incontinence in Women with IBS  

PubMed Central

Objectives To confirm that fecal urgency and diarrhea are independent risk factors for fecal incontinence (FI), to identify obstetrical risk factors associated with FI in women with IBS (irritable bowel syndrome), and to determine whether obstetric anal sphincter injuries interact with diarrhea or urgency to explain the occurrence of FI. Methods The study is a supplement to a diary study of bowel symptoms in 164 female patients with IBS. Subjects completed daily bowel symptom diaries for 90 consecutive days and rated each bowel movement (BM) for stool consistency and presence of urgency, pain, and FI. All female participants from the parent study were invited to complete a telephone-administered 33-item bowel symptom and obstetric history questionnaire which included the Fecal Incontinence Severity Index (FISI). Results Out of 164 women in the parent study, 115 (70.1%) completed the interview. Seventy-four (45.1%) reported FI on their diary including 34 (29.6%) who reported at least one episode per month, 112 (97.4%) reported episodes of urgency, and 106 (92.2%) reported episodes of diarrhea. The mean FISI score was 13.9±9.7. Upon multivariable analysis, FI was significantly associated with parity (p=0.007), operative vaginal delivery (p=0.049), obstetrical sphincter lacerations (p=0.007), fecal urgency (p=0.005), diarrhea (p=0.008), and hysterectomy (p=0.004), but was not associated with episiotomy, pelvic organ prolapse, or urinary incontinence. The synergistic interactions of obstetric anal sphincter laceration with urgency (p=0.002) and diarrhea (p=0.004) were significant risk factors for FI. Conclusion Fecal urgency and diarrhea are independent risk factors for FI, and they interact with obstetric anal sphincter laceration to amplify the risk of FI.

Robinson, Barbara L.; Matthews, Catherine A.; Palsson, Olafur S; Geller, Elizabeth; Turner, Marsha; Parnell, Brent; Crane, Andrea; Jannelli, Mary; Wells, Ellen; Connolly, AnnaMarie; Lin, Feng-Chang; Whitehead, William E.

2014-01-01

191

Sphincter of oddi manometry in healthy volunteers  

Microsoft Academic Search

In this study we describe in detail the characteristics of sphincter of Oddi motor function in a large group of healthy subjects. Studies were obtained in 50 healthy volunteers. The findings showed a sphincter of Oddi segment that had a basal pressure of 14.8±6.3 mm Hg (X±sd). Phasic contractions were superimposed on the basal pressure. They had an amplitude of

Moises Guelrud; Sonia Mendoza; Guillermo Rossiter; Maria I. Villegas

1990-01-01

192

Cancer in anal fistulas  

Microsoft Academic Search

Summary  We have presented two examples of difficulties encountered in making a diagnosis, and have shown how improper medical or surgical\\u000a therapy may hinder correct treatment of cancer.\\u000a \\u000a Over a period of 13 years, two patients have been treated for neoplastic anal fistula. The lesson to be learned is that an\\u000a early diagnosis is seldom reached and consequently correct treatment is

Arturo Heidenreich; Hector A. Collarini; Alberto Mario Paladino; José María Fernandez; Teófilo Oscar Calvo

1966-01-01

193

Anal Involvement in Pemphigus Vularis  

PubMed Central

Background. Pemphigus vulgaris (PV) is an autoimmune blistering disease of the skin and mucosa. Anal mucosa may be involved in PV, but the frequency and clinical profile are not fully ascertained. Objective. The aim was to investigate the involvement of the anal area in newly diagnosed PV patients. Patients and Methods. A total of 168 consecutive newly diagnosed PV patients were enrolled. Anal symptoms and signs, involvement of other body sites, and severity of disease were recorded. Results. A total of 47 out of 168 patients (27.9%) had involvement of the anal area. Anal involvement was significantly associated with PV lesions in ophthalmic (P = 0.03), nasal (P = 0.02), and genital mucosa (P < 0.001) but not the oral cavity (P = 0.24). There was a significant association between number of involved mucosal sites and anal involvement (P < 0.001). Anal involvement was associated with oral severity (P = 0.02). Constipation was the most frequent symptom (73.8%) followed by pain on defecation (50%). Seventeen patients (36%) were symptom-free. Erosion was the most frequent sign (91.5%). Conclusion. Anal involvement in PV seems to be more frequent than previously assumed. Routine anal examination is recommended even in asymptomatic patients as anal involvement appears to correlate with the severity of PV.

Khezri, Somayeh; Mahmoudi, Hamid-Reza; Masoom, Seyedeh Nina; Daneshpazhooh, Maryam; Balighi, Kamran; Hosseini, S. Hamed; Chams-Davatchi, Cheyda

2013-01-01

194

Anal involvement in pemphigus vularis.  

PubMed

Background. Pemphigus vulgaris (PV) is an autoimmune blistering disease of the skin and mucosa. Anal mucosa may be involved in PV, but the frequency and clinical profile are not fully ascertained. Objective. The aim was to investigate the involvement of the anal area in newly diagnosed PV patients. Patients and Methods. A total of 168 consecutive newly diagnosed PV patients were enrolled. Anal symptoms and signs, involvement of other body sites, and severity of disease were recorded. Results. A total of 47 out of 168 patients (27.9%) had involvement of the anal area. Anal involvement was significantly associated with PV lesions in ophthalmic (P = 0.03), nasal (P = 0.02), and genital mucosa (P < 0.001) but not the oral cavity (P = 0.24). There was a significant association between number of involved mucosal sites and anal involvement (P < 0.001). Anal involvement was associated with oral severity (P = 0.02). Constipation was the most frequent symptom (73.8%) followed by pain on defecation (50%). Seventeen patients (36%) were symptom-free. Erosion was the most frequent sign (91.5%). Conclusion. Anal involvement in PV seems to be more frequent than previously assumed. Routine anal examination is recommended even in asymptomatic patients as anal involvement appears to correlate with the severity of PV. PMID:24298388

Khezri, Somayeh; Mahmoudi, Hamid-Reza; Masoom, Seyedeh Nina; Daneshpazhooh, Maryam; Balighi, Kamran; Hosseini, S Hamed; Chams-Davatchi, Cheyda

2013-01-01

195

Sphincter-saving surgeries for rectal cancer: A single center study from Kashmir  

PubMed Central

Summary and Background Data: The goals in the treatment of rectal cancer are cure, local control, and preservation of sphincter, bladder and sexual function. Surgical resection using sharp mesorectal dissection is important for achieving these goals. Objectives: The current treatment of choice for carcinoma rectum is sphincter saving procedures, which have practically replaced the previously done abdominoperineal resection. We performed a study in our institute to evaluate the surgical outcome and complications of rectal cancer. Materials and Methods: This prospectivestudy included 117 patients, treated for primary rectal cancer by low anterior resection (LAR) from May 2007 to December 2010. All patients underwent standard total mesorectal excision (TME) followed by restoration of continuity. Results: The peri-operative mortality rate was 2.5% (3/117). Post-operative complications occurred in 32% of the patients. After a median follow up of 42 months, local recurrences developed in 6 (5%) patients and distant metastasis in 5 (4.2%). The survival rate was 93%. Conclusion: The concept of total mesorectal excision (TME), advances in stapling technology and neoadjuvant therapy have made it possible to preserve the anal sphincter in most of the patients. Rectal cancer needs to be managed especially in a specialized unit for better results.

Mir, Shabeer Ahmed; Chowdri, Nisar A.; Parray, Fazl Q.; Mir, Parvez Ahmed; Bashir, Yasir; Nafae, Muntakhab

2013-01-01

196

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

2010-01-01

197

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

198

Management of Anal Canal Cancer  

Microsoft Academic Search

PURPOSE  Chemoradiotherapy has replaced radical surgery as the initial treatment of choice for anal canal cancer. The roles of these therapeutic modalities are discussed and recommendations on management of anal canal cancer are made based on currently available evidence. Areas for further studies also are identified.METHODS  Literature on management of anal canal cancer from January 1970 to July 2003 obtained via MEDLINE

Harunobu Sato; Poh-Koon Koh; David C. C. Bartolo

2005-01-01

199

The trans-sphincteric posterior sagittal repair of recto-urinary and recto-vaginal fistulae using Surgisis™ mesh and fibrin sealant.  

PubMed

Recto-urinary, recto-vaginal and ileo-anal pouch-associated fistulae are rare yet a significant clinical problem due to their profound impact on patients' quality of life and are a challenge to repair. In this report, we describe repair of these complex fistulae using a modified trans-sphincteric posterior sagittal approach with Surgisis™ mesh and fibrin sealant and review our repair outcomes. PMID:23095950

Borowiec, A M; McCall, M; Lees, G M

2014-02-01

200

[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

201

Tailored lateral sphincterotomy for anal fissure  

Microsoft Academic Search

PURPOSE: Most surgical texts describe the length of division of the internal sphincter during closed lateral sphincterotomy as “to just above the dentate line,” resulting in significant rates of incontinence. This study reviews our experience using a “tailored” lateral sphincterotomy by selecting the height of sphincter to be divided with the aim of preserving more sphincter. METHODS: From 1976 to

David R. G. Littlejohn; Graham L. Newstead

1997-01-01

202

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

203

The epidemiology of anal incontinence and symptom severity scoring  

PubMed Central

For many patients, anal incontinence (AI) is a devastating condition that can lead to social isolation and loss of independence, contributing to a substantial economic health burden, not only for the individual but also for the allocation of healthcare resources. Its prevalence is underestimated because of poor patient reporting, with many unrecorded but symptomatic cases residing in nursing homes. Endosonography has improved our understanding of the incidence of post-obstetric sphincter tears that are potentially suitable for repair and those cases resulting from anorectal surgery, most notably after fistula and hemorrhoid operations. The clinical scoring systems assessing the severity of AI are discussed in this review, along with their limitations. Improvements in the standardization of these scales will advance our understanding of treatment response in an era where the therapeutic options have multiplied and will permit a better comparison between specific therapies.

Nevler, Avinoam

2014-01-01

204

The epidemiology of anal incontinence and symptom severity scoring.  

PubMed

For many patients, anal incontinence (AI) is a devastating condition that can lead to social isolation and loss of independence, contributing to a substantial economic health burden, not only for the individual but also for the allocation of healthcare resources. Its prevalence is underestimated because of poor patient reporting, with many unrecorded but symptomatic cases residing in nursing homes. Endosonography has improved our understanding of the incidence of post-obstetric sphincter tears that are potentially suitable for repair and those cases resulting from anorectal surgery, most notably after fistula and hemorrhoid operations. The clinical scoring systems assessing the severity of AI are discussed in this review, along with their limitations. Improvements in the standardization of these scales will advance our understanding of treatment response in an era where the therapeutic options have multiplied and will permit a better comparison between specific therapies. PMID:24759339

Nevler, Avinoam

2014-05-01

205

Epidermoid carcinoma of the anal canal. A series of 276 cases  

SciTech Connect

During the past ten years, substantial progress has been made in the knowledge of the natural history of epidermoid carcinoma of the anal canal and of the response of the disease to radiotherapy alone or combined with chemotherapy. At the present time, the main problem in the management of this tumor concerns identification of the best modalities to achieve local control and preservation of anal function. From a series of 276 cases, followed for more than three years, the necessity for a careful pretreatment evaluation was stressed. This included a systematic search for pelvic metastatic lymph nodes by palpation and CT scan. All patients were treated initially by irradiation except those who underwent groin dissection for inguinal node metastasis or colostomy for complete anal obstruction. Three groups of patients have been identified: unresectable or disseminated tumors (33 cases), resectable tumors but not suitable for sphincter conservation (21 cases) treated by radiochemotherapy and delayed surgery, and resectable tumors suitable for sphincter conservation (222 cases) which were treated by a split-course regimen combining a short course of carefully planned external beam irradiation (19 days) followed by an iridium 192 implant after a two-month rest. In this group, which represents 80 percent of the whole series, 80 percent of patients have had their cancer controlled and 90 percent of controlled patients have retained normal anal function. The use of chemotherapy during the first days of irradiation is advisable in all cases to reinforce the efficacy of treatment and increase the chance of anal preservation. Results of the split-course regimen, combining external beam and interstitial irradiation, demonstrate a clear superiority over external beam irradiation alone, especially for large infiltrating tumors, which represent the majority of cases.

Papillon, J.; Montbarbon, J.F.

1987-05-01

206

Physiologic aspects of continence after colectomy, mucosal proctectomy, and endorectal ileo-anal anastomosis.  

PubMed Central

We examined the physiology of continence in 12 patients at least four months after colectomy, mucosal proctectomy, and endorectal ileo-anal anastomosis for ulcerative colitis and familial polyposis. The mean fecal output (+/-SEM) was 598 +/- 60 gm, passed as 12 +/- 4 movements/24 hr, of which 4 +/- 1 were passed at night. The patients were generally continent during the day and could distinguish gas from stool, but 11 of 12 leaked stools at night. Anal sphincter resting pressures (71 +/- 8 cm H2O) and squeeze pressures (171 +/- 15 cm H2O) of patients were similar to those of ten healthy controls (P greater than 0.05), although the rectal inhibitory reflex was absent in the patients. After operation, the distal bowel had a pressure-volume curve of greater slope (0.15 +/- 0.05 ml/cm H2O) than it had in controls (0.07 +/- 0.01 ml/cm H2O, P less than 0.05) and a lesser maximum capacity (patients, 248 +/- 31 ml; controls, 406 +/- 26 ml; P less than 0.05). The greater the capacity of the neorectum, the fewer was the number of bowel movements/day (r = 0.91, P less than 0.001). We concluded that the operation preserved the anal sphincter, although it decreased the capacity and compliance of the distal bowel and impaired continence. Images Fig. 1.

Heppell, J; Kelly, K A; Phillips, S F; Beart, R W; Telander, R L; Perrault, J

1982-01-01

207

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

2011-06-01

208

Clinical and Functional Anatomy of the Urethral Sphincter  

PubMed Central

Continence and micturition involve urethral closure. Especially, insufficient strength of the pelvic floor muscles including the urethral sphincter muscles causes urinary incontinence (UI). Thus, it is most important to understand the main mechanism causing UI and the relationship of UI with the urethral sphincter. Functionally and anatomically, the urethral sphincter is made up of the internal and the external sphincter. We highlight the basic and clinical anatomy of the internal and the external sphincter and their clinical meaning. Understanding these relationships may provide a novel view in identifying the main mechanism causing UI and surgical techniques for UI.

Ahn, Hyo Kwang; Huh, Youngbuhm

2012-01-01

209

Peptidergic innervation of human sphincter of Oddi  

Microsoft Academic Search

The innervation of the sphincter of Oddi (SO) has been extensively studied experimentally, but human studies have not been published, which is why this study was undertaken. Biopsies, taken by gastroscopy-biopsy forceps from duodenal epithelium of the papilla of Vater and from ampullary epithelium after sphincterotomy, did not demonstrate nerves and could not be used for studying SO innervation. Therefore

Juhani Sand; Hanna Tainio; Isto Nordback

1994-01-01

210

Pancreatitis after sphincter of Oddi manometry  

Microsoft Academic Search

The nature, frequency, severity, and possible causes of complications after 207 sphincter of Oddi manometry measurements were studied in 146 patients. Acute pancreatitis was diagnosed in 6% (12 of 207) of the investigations and in 8% (12 of 146) of the patients examined. The pancreatitis was mild in all patients. After cannulation of the pancreatic duct, acute pancreatitis occurred in

P Rolny; B Anderberg; I Ihse; E Lindström; G Olaison; A Arvill

1990-01-01

211

Functional Gallbladder and Sphincter of Oddi Disorders  

Microsoft Academic Search

The functional disorder of the gallbladder (GB) is a motility disorder caused initially either by metabolic abnormalities or by a primary motility alteration. The functional disorders of the sphincter of Oddi (SO) encompass motor abnormal- ities of either the biliary or the pancreatic SO. Dysfunction of the GB and\\/or biliary SO produce similar patterns of pain. The pain caused by

JOSE BEHAR; ENRICO CORAZZIARI; MOISES GUELRUD; WALTER HOGAN; STUART SHERMAN; JAMES TOOULI

212

Sphincter of Oddi dysfunction following liver transplantation  

Microsoft Academic Search

Although sphincter of Oddi dysfunction (SOD) has been extensively studied in the nontransplant setting, the diagnostic criteria after liver transplantation are not well defined and have been based on clinical features without manometric documentation. The purpose of this study was twofold: (1) to determine the manometric patterns associated with SOD following orthotopic liver transplantation (OLT) and (2) to define the

Viken Douzdjian; Michael M. Abecassis; Frederick C. Johlin

1994-01-01

213

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

2013-09-01

214

Overview of anal fistula and systematic review of ligation of the intersphincteric fistula tract (LIFT).  

PubMed

Anal fistula management has long been a challenge for surgeons. Presently, no technique exists that is ideal for treating all types of anal fistula, whether simple or complex. A higher incidence of poor sphincter function and recurrence after surgery has encouraged the development of a new sphincter-sparing procedure, ligation of the intersphincteric fistula tract (LIFT), first described by Van der Hagen et al. in 2006. We assessed the safety, feasibility, success rate, and continence of LIFT as a sphincter-saving procedure. A literature search of articles in electronic databases published from January 2006 to August 2012 was performed. Analysis followed Preferred Reporting Items for Systematic Reviews recommendations. All LIFT-related articles published in the English language were included. We excluded case reports, abstracts, letters, non-English language articles, and comments. The procedure was described in detail as reported by Rojanasakul. Thirteen original studies, including 435 patients, were reviewed. The most common fistula procedure type was transsphincteric (92.64 %). The overall median operative time was 39 (±20.16) min. Eight authors performed LIFT as a same-day surgery, whereas the others admitted patients to the hospital, with an overall median stay of 1.25 days (range 1-5 days). Postoperative complications occurred in 1.88 % of patients. All patients remained continent postoperatively. The overall mean length of follow-up was 33.92 (±17.0) weeks. The overall mean healing rate was 81.37 (±16.35) % with an overall mean healing period of 8.15 (±5.96) weeks. Fistula recurrence occurred in 7.58 % of patients. LIFT represents a new, easy-to-learn, and inexpensive sphincter-sparing procedure that provides reasonable results. LIFT is safe and feasible, with favorable short- and long-term outcomes. However, additional prospective randomized studies are required to confirm these findings. PMID:23893217

Alasari, S; Kim, N K

2014-01-01

215

BPC 157 therapy to detriment sphincters failure-esophagitis-pancreatitis in rat and acute pancreatitis patients low sphincters pressure.  

PubMed

Possibly, acute esophagitis and pancreatitis cause each other, and we focused on sphincteric failure as the common causative key able to induce either esophagitis and acute pancreatitis or both of them, and thereby investigate the presence of a common therapy nominator. This may be an anti-ulcer pentadecapeptide BPC 157 (tested for inflammatory bowel disease, wound treatment) affecting esophagitis, lower esophageal and pyloric sphincters failure and acute pancreatitis (10 ?g/kg, 10 ng/kg intraperitoneally or in drinking water). The esophagitis-sphincter failure procedure (i.e., insertion of the tubes into the sphincters, lower esophageal and pyloric) and acute pancreatitis procedure (i.e., bile duct ligation) were combined in rats. Esophageal manometry was done in acute pancreatitis patients. In rats acute pancreatitis procedure produced also esophagitis and both sphincter failure, decreased pressure 24 h post-surgery. Furthermore, bile duct ligation alone immediately declines the pressure in both sphincters. Vice versa, the esophagitis-sphincter failure procedure alone produced acute pancreatitis. What's more, these lesions (esophagitis, sphincter failure, acute pancreatitis when combined) aggravate each other (tubes into sphincters and ligated bile duct). Counteraction occurred by BPC 157 therapies. In acute pancreatitis patients lower pressure at rest was in both esophageal sphincters in acute pancreatitis patients. We conclude that BPC 157 could cure esophagitis/sphincter/acute pancreatitis healing failure. PMID:22204800

Petrovic, I; Dobric, I; Drmic, D; Sever, M; Klicek, R; Radic, B; Brcic, L; Kolenc, D; Zlatar, M; Kunjko, K; Jurcic, D; Martinac, M; Rasic, Z; Boban Blagaic, A; Romic, Z; Seiwerth, S; Sikiric, P

2011-10-01

216

Lateral sphincterotomy compared with anal advancement flap for chronic anal fissure  

Microsoft Academic Search

PURPOSE: This study was designed to assess differences between lateral internal anal sphincterotomy and anal advancement flap for chronic anal fissure. METHODS: Forty patients with chronic anal fissure were prospectively studied. Patients randomized to the sphincterotomy group (n=20; median age, 34 (range, 16–61) years) underwent lateral internal anal sphincterotomy. Patients randomized to the flap group (n=20; median age, 32 (range,

A. F. P. K. Leong; F. Seow-Choen

1995-01-01

217

Pharmacological sphincterotomy for chronic anal fissures by botulinum toxin a.  

PubMed

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 ( 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. PMID:20300345

Wollina, Uwe

2008-07-01

218

JAMA Patient Page: Anal Fissure  

MedlinePLUS

... called an anoscope to examine the anal canal. Causes Constipation can cause the skin of the anus to tear. When ... resist having a bowel movement, which worsens the constipation. Other causes include diarrhea and Crohn disease. If you have ...

219

Anal cancer in renal transplant patients  

Microsoft Academic Search

Purpose  A comprehensive literature review was performed to examine the prevalence of anal cancer, anal intraepithelial neoplasia (AIN) and anal human papillomavirus (HPV) infection in renal transplant recipients who are at risk of anal cancer due to iatrogenic immunosuppression.Methods  Pertinent articles were identified from searches performed on the National Center for Biotechnology Information database using the following keywords: anal cancer, AIN, screening,

Heena S. Patel; Andrew R. J. Silver; John M. A. Northover

2007-01-01

220

Bioengineering of physiologically functional intrinsically innervated human internal anal sphincter constructs.  

PubMed

Muscle replacement for patients suffering from extensive tissue loss or dysfunction is a major objective of regenerative medicine. To achieve functional status, bioengineered muscle replacement constructs require innervation. Here we describe a method to bioengineer functionally innervated gut smooth muscle constructs using neuronal progenitor cells and smooth muscle cells isolated and cultured from intestinal tissues of adult human donors. These constructs expressed markers for contractile smooth muscle, glial cells, and mature neuronal populations. The constructs responded appropriately to physiologically relevant neurotransmitters, and neural network integration was demonstrated by responses to electrical field stimulation. The ability of enteric neuroprogenitor cells to differentiate into neuronal populations provides enormous potential for functional innervation of a variety of bioengineered muscle constructs in addition to gut. Functionally innervated muscle constructs offer a regenerative medicine-based therapeutic approach for neuromuscular replacement after trauma or degenerative disorders. PMID:24328537

Gilmont, Robert R; Raghavan, Shreya; Somara, Sita; Bitar, Khalil N

2014-06-01

221

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

222

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

223

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

224

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

2011-08-01

225

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

226

Effect of somatostatin analog octreotide on human sphincter of Oddi  

Microsoft Academic Search

The effect of the long-acting somatostatin analog octreotide on the sphincter of Oddi was investigated in seven subjects referred for endoscopic sphincter of Oddi manometry. Six patients had unexplained right upper quadrant pain and one had bile duct dilatation without evidence of fixed obstruction on endoscopic retrograde cholangiopancreatography. A triple-lumen low-compliance system was used to record the sphincter of Oddi

Kenneth F. Binmoeller; Remy Dumas; Alan G. Harris; J. P. Delmont

1992-01-01

227

Sphincter of oddi (pancreatic) hypertension and recurrent pancreatitis  

Microsoft Academic Search

Major papilla pancreatic sphincter dysfunction, a variant of sphincter of Oddi dysfunction, causes pancreatitis and pancreatic-type\\u000a pain. The gold standard for diagnosis is sphincter of Oddi manometry, most commonly performed at endoscopic retrograde cholangiopancreatography\\u000a (ERCP). Noninvasive testing, such as secretin-stimulated transabdominal or endoscopic ultrasound assessment of pancreatic\\u000a duct diameter, is less reliable and has relatively low sensitivity. Two thirds of

Benedict M. Devereaux; Stuart Sherman; Glen A. Lehman

2002-01-01

228

Effect of cimetidine on the human lower oesophageal sphincter.  

PubMed Central

Lower oesophageal sphincter pressures in healthy volunteers were measured by a rapid pull-through technique during intravenous infusion of the histamine H2-receptor antagonist, cimetidine. No consistent effects on sphincter pressure were observed which are liable to be of clinical importance. Serum gastrin concentrations during cimetidine infusion were measured by radioimmunoassay and showed no significant variation. In a further series of experiments, the response of the lower oesophageal sphincter to intravenous bolus injection of pentagastrin was measured before and during cimetidine infusion. Cimetidine infusion had no significant effect on the sphincter response to pentagastrin.

Osborne, D H; Lennon, J; Henderson, M; Lidgard, G; Creel, R; Carter, D C

1977-01-01

229

Electrophysiology of motor pathways for sphincter control in multiple sclerosis.  

PubMed

The central and peripheral motor pathways serving striated sphincter muscle function were studied using cortical and lumbar transcutaneous electrical stimulation, pudendal nerve stimulation and sphincter electromyography in 23 patients with multiple sclerosis (MS), and sphincter disturbance, including incontinence of urine or faeces, urinary voiding dysfunction, or constipation. The central motor conduction time was significantly increased in the MS group compared to controls (p less than 0.05). Damage to both the upper and lower motor neuron pathways can contribute to sphincter disturbance in MS. The latter may be due to coexisting pathology or to involvement of the conus medullaris by MS. PMID:2178181

Mathers, S E; Ingram, D A; Swash, M

1990-11-01

230

[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

2011-01-01

231

New approach to anal cancer: Individualized therapy based on sentinel lymph node biopsy  

PubMed Central

Oncological treatment is currently directed toward a tailored therapy concept. Squamous cell carcinoma of the anal canal could be considered a suitable platform to test new therapeutic strategies to minimize treatment morbidity. Standard of care for patients with anal canal cancer consists of a combination of radiotherapy and chemotherapy. This treatment has led to a high rate of local control and a 60% cure rate with preservation of the anal sphincter, thus replacing surgical abdominoperineal resection. Lymph node metastases represent a critical independent prognostic factor for local recurrence and survival. Mesorectal and iliac lymph nodes are usually included in the radiation field, whereas the inclusion of inguinal regions still remains controversial because of the subsequent adverse side effects. Sentinel lymph node biopsies could clearly identify inguinal node-positive patients eligible for therapeutic groin irradiation. A sentinel lymph node navigation procedure is reported here to be a feasible and effective method for establishing the true inguinal node status in patients suffering from anal canal cancer. Based on the results of sentinel node biopsies, a selective approach could be proposed where node-positive patients could be selected for inguinal node irradiation while node-negative patients could take advantage of inguinal sparing irradiation, thus avoiding toxic side effects.

De Nardi, Paola; Carvello, Michele; Staudacher, Carlo

2012-01-01

232

Conservative treatment for anal incontinence  

PubMed Central

Anal incontinence (AI) in adults is a troublesome condition that negatively impacts upon quality of life and results in significant embarrassment and social isolation. The conservative management of AI is the first step and targets symptomatic relief. The reported significant improvement with conservative treatments for AI is close to 25% and involves prescribed changes in lifestyle habits, a reduced intake of foods that may cause or aggravate diarrhea or rectal urgency, and the use of specific anti-diarrheal agents. The use of a mechanical barrier in the form of an anal plug and the outcomes and principles of pelvic kinesitherapies and biofeedback options are outlined. This review discusses a gastroenterologist's approach towards conservative therapy in patients referred with anal incontinence.

Carter, Dan

2014-01-01

233

Conservative treatment for anal incontinence.  

PubMed

Anal incontinence (AI) in adults is a troublesome condition that negatively impacts upon quality of life and results in significant embarrassment and social isolation. The conservative management of AI is the first step and targets symptomatic relief. The reported significant improvement with conservative treatments for AI is close to 25% and involves prescribed changes in lifestyle habits, a reduced intake of foods that may cause or aggravate diarrhea or rectal urgency, and the use of specific anti-diarrheal agents. The use of a mechanical barrier in the form of an anal plug and the outcomes and principles of pelvic kinesitherapies and biofeedback options are outlined. This review discusses a gastroenterologist's approach towards conservative therapy in patients referred with anal incontinence. PMID:24759347

Carter, Dan

2014-05-01

234

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

235

Association Between a Close Distal Resection Margin and Recurrence After a Sphincter-Saving Resection for T3 Mid- or Low-Rectal Cancer Without Radiotherapy  

PubMed Central

Purpose To maintain the patient's quality of life, surgeons strive to preserve the sphincter during rectal cancer surgery. This study evaluated the oncologic safety of a sphincter-saving resection with a distal resection margin (DRM) <1 cm without radiotherapy in T3, mid- or low-rectal cancer. Methods This retrospective study enrolled 327 patients who underwent a sphincter-saving resection for proven T3 rectal cancer located <10 cm from the anal verge and without radiotherapy between January 1995 and December 2011. The oncologic outcomes included the 5-year cancer-specific survival, the local recurrence, and the systemic recurrence rates. Results In groups A (DRM ?1 cm) and B (DRM >1 cm), the 5-year cancer-specific survival rates were 81.57% and 80.03% (P = 0.8543), the 5-year local recurrence rates were 6.69% and 9.52% (P = 0.3981), and the 5-year systemic recurrence rates were 19.46% and 23.11% (P = 0.5750), respectively. Conclusion This study showed that the close DRM itself should not be a contraindication for a sphincter-saving resection for T3 mid- or low-rectal cancer without radiotherapy. However, a prospective randomized controlled trial including the effect of adjuvant therapy will be needed.

Han, Jae Woong; Lee, Min Jae; Park, Ha Kyung; Shin, Jae Ho; Ha, Tae Kwun; Kim, Kwang Hee; Bae, Ki Beom; Kim, Tae Hyun; Choi, Chang Soo; Oh, Sang Hoon; Oh, Min Kyung; Kang, Mi Seon; Hong, Kwan Hee

2013-01-01

236

Urethral Sphincter EMG as Event Detector for Neurogenic Detrusor Overactivity  

Microsoft Academic Search

The aim of this study was to investigate the feasibility of using external urethral sphincter electromyogram (EMG) (EUSEMG) to detect the onset of detrusor contractions in patients with both neurogenic detrusor overactivity (NDO) and detrusor sphincter dyssynergia (DSD). Detrusor pressure (Pdet) and EUSEMG was recorded in 23 neurogenic patients during slow artificial bladder filling. The time delay between the onset

John Hansen; Albert Borau; Alfred Rodríguez; Joan Vidal; T. Sinkjaer; N. J. M. Rijkhoff

2007-01-01

237

Anal canal duplication in infants  

Microsoft Academic Search

Background\\/Purpose: Anal canal duplication (ACD) is the most distal and the least frequent digestive duplication. A review of the English-language literature found 15 cases reported in the pediatric age group. Methods: A retrospective chart review was performed for our experience from 1999 to 2001 with 6 patients who presented with a midline postanal opening. Results: All of 6 patients were

Soon-Ok Choi; Woo-Hyun Park

2003-01-01

238

[Anal intraepithelial neoplasia and anal carcinoma: an increasing problem in HIV patients].  

PubMed

Anal dysplasia is common in HIV patients, especially in HIV-positive men having sex with men (MSM). High-grade anal dysplasia can progress to invasive anal cancer. As in cervical carcinoma, there is a cause and effect relationship between anal cancer and human papillomavirus (HPV) infection, especially with high-risk types such as HPV16. Several experts have recommended screening programs for anal cancer, including anal cytology along the lines of the Pap smear in women. Such screenings should only be performed if pathological findings result in further diagnostic steps and, if necessary, appropriate treatment. Clinical inspection, lesion biopsy, and treatment of anal dysplasia are performed under high-resolution anoscopy. Anal cancer is divided into cancer of the anal margin and cancer of the anal canal. This classification is important because of the difference in treatment regimens. Early cancer of the anal margin is excised akin to squamous cell cancer of the exposed skin, whereas cancer of the anal canal is treated by radiochemotherapy. HIV-positive and HIV-negative patients have similar response rates to combined radiochemotherapy. However, side effects, especially acute post-irradiation skin toxicity, early local recurrences, and abdominoperineal rectal excision are more common in HIV-positive patients. Physicians working in the field of HIV/AIDS should regularly screen their patients for the presence of anal dysplasia and anal cancer. Basic diagnostic workup includes clinical inspection of the perianal area, digital rectal examination, and anal cytology. PMID:19967333

Kreuter, A; Brockmeyer, N H; Wieland, U

2010-01-01

239

Comparison of sphincter of Oddi manometry, fatty meal sonography, and hepatobiliary scintigraphy in the diagnosis of sphincter of Oddi dysfunction  

Microsoft Academic Search

Background: Sphincter of Oddi dysfunction (SOD) afflicts approximately 1% to 5% of patients after cholecystectomy. The diagnostic standard for SOD is sphincter of Oddi manometry (SOM), a technically difficult, invasive test that is frequently complicated by pancreatitis. A sensitive and accurate noninvasive imaging modality is thus needed for the diagnosis of SOD. Quantitative hepatobiliary scintigraphy (HBS) and fatty meal sonography

Mark L. Rosenblatt; Marc F. Catalano; Eduardo Alcocer; Joseph E. Geenen

2001-01-01

240

Midline episiotomy and anal incontinence: retrospective cohort study  

PubMed Central

Objective To evaluate the relation between midline episiotomy and postpartum anal incontinence. Design Retrospective cohort study with three study arms and six months of follow up. Setting University teaching hospital. Participants Primiparous women who vaginally delivered a live full term, singleton baby between 1 August 1996 and 8 February 1997: 209 who received an episiotomy; 206 who did not receive an episiotomy but experienced a second, third, or fourth degree spontaneous perineal laceration; and 211 who experienced either no laceration or a first degree perineal laceration. Main outcome measures Self reported faecal and flatus incontinence at three and six months postpartum. Results Women who had episiotomies had a higher risk of faecal incontinence at three (odds ratio 5.5, 95% confidence interval 1.8 to 16.2) and six (3.7, 0.9 to 15.6) months postpartum compared with women with an intact perineum. Compared with women with a spontaneous laceration, episiotomy tripled the risk of faecal incontinence at three months (95% confidence interval 1.3 to 7.9) and six months (0.7 to 11.2) postpartum, and doubled the risk of flatus incontinence at three months (1.3 to 3.4) and six months (1.2 to 3.7) postpartum. A non-extending episiotomy (that is, second degree surgical incision) tripled the risk of faecal incontinence (1.1 to 9.0) and nearly doubled the risk of flatus incontinence (1.0 to 3.0) at three months postpartum compared with women who had a second degree spontaneous tear. The effect of episiotomy was independent of maternal age, infant birth weight, duration of second stage of labour, use of obstetric instrumentation during delivery, and complications of labour. Conclusions Midline episiotomy is not effective in protecting the perineum and sphincters during childbirth and may impair anal continence.

Signorello, Lisa B; Harlow, Bernard L; Chekos, Amy K; Repke, John T

2000-01-01

241

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

242

Effect of cholecystokinin on lower oesophageal sphincter pressure and transient lower oesophageal sphincter relaxations in humans  

Microsoft Academic Search

The effect of cholecystokinin (CCK) on the lower oesophageal sphincter (LOS) pressure, frequency of transient LOS relaxations, and the number of reflux episodes was investigated in six healthy subjects. LOS pressure was recorded on four separate occasions during continuous intravenous infusion of either saline or CCK-33 in doses of 0.25, 0.5, or 1.0 Ivy Dog units per kg body weight

M. Ledeboer; A. A. M. Masclee; M. R. Batstra; J. B. M. J. Jansen; C B Lamers

1995-01-01

243

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

244

Comparative study of lateral internal sphincterotomy versus local 0.2% glyceryl trinitrate ointment for the treatment of chronic anal fissure.  

PubMed

The gold standard surgical treatment of chronic anal fissure is lateral internal sphincterotomy which lowers the resting anal pressure and effectively heals the majority of fissures. Local application of 0.2% glyceryl trinitrate ointment has been used as an agent for chemical sphincterotomy, causing temporary alleviation of sphincter spasm and allowing the fissure to heal without compromising the anal continence. The aim of the present study was to compare the results of surgical sphincterotomy with that of local 0.2% glyceryl trinitrate ointment in the treatment of chronic anal fissure. Seventy adult patients between the age of 18 and 50 years with chronic anal fissure were randomized in a prospective trial to receive either surgical sphincterotomy or 0.2% glyceryl trinitrate ointment locally. Patients were followed up at 2 weeks' interval for 10 weeks. Symptom relief, fissure healing and continence scores were the outcomes assessed. Six patients were excluded for protocol violations. Surgical sphincterotomy was significantly more effective in providing pain relief and was associated with significantly better fissure healing rates at 6 weeks and 10 weeks (both p < 0.001). There were substantial problems with compliance in ointment group related to slow healing and longer time needed for symptomatic relief. Minor incontinence was 6% in sphincterotomy group and none in ointment group (p > 0.05). Considering early symptomatic relief, rapid fissure healing and better patient compliance surgical sphincterotomy is the treatment of choice for chronic anal fissure. PMID:18783071

Siddique, Md Ibrahim; Murshed, Khandker Manzoor; Majid, M A

2008-04-01

245

[Current treatment of cancers of the anal canal].  

PubMed

The major development in the treatment of cancers of the anal canal, over recent years, is the now predominant role of radiotherapy which has replaced amputation surgery as first-line treatment. All stages combined, the average 5-year global survival rate is now 60%, with a local control rate of 70% and good sphincter preservation in the majority of healed patients. However, many questions remain unresolved in these rare cancers: what is the optimal irradiation technique, what is the role of chemotherapy in this very chemosensitive tumour but associated with a low risk of metastases? Amputation surgery still plays an important role, but the exact time at which it should be proposed remains controversial. The rate of inguinal lymph node invasion is approximately 20%. The value of systematic treatment N0 inguinal nodes remains controversial. As for most problems of clinical oncology, only randomized trials rapidly conducted on a large scale will be able to provide an answer to all these questions. PMID:7574346

Gérard, J P; Romestaing, P; Ardiet, J M; Trillet Lenoir, V; Rocher, F P; Baron, M H; Buatois, F

1995-01-01

246

When is Onuf's nucleus involved in multiple system atrophy? A sphincter electromyography study  

PubMed Central

Background: External anal sphincter (EAS) electromyography (EMG) abnormalities can distinguish multiple system atrophy (MSA) from Parkinson's disease in the first five years after disease onset. However, the prevalence of the abnormalities in the early stages of MSA is unknown. Objectives: To present EAS-EMG data in the various stages of MSA. Methods: 84 patients with "probable" MSA were recruited (42 men, 42 women; mean age 62 years (range 47 to 78); mean disease duration 3.2 years (0.5 to 8.0; <1 year in 25%); 50 cerebellar form (MSA-C), 34 parkinsonian form (MSA-P)). EAS motor unit potential (MUP) analysis and EMG cystometry were carried out in all patients. Results: The overall prevalence of neurogenic change of the EAS MUP was 62%—52% in the first year after disease onset, increasing to 83% by the fifth year (p<0.05); it also increased with severity of gait disturbance (p<0.05), storage and voiding disorders, and detrusor sphincter dyssynergy (NS). The neurogenic change was not correlated with sex, age, MSA-P/C, postural hypotension, constipation, erectile dysfunction in men, underactive or acontractile detrusor, or detrusor overactivity. In 17 incontinent patients without detrusor overactivity or low compliance, urinary incontinence was more severe in those with neurogenic change than in those without (p<0.05). Conclusions: Involvement of Onuf's nucleus in MSA is time dependent. Before the fifth year of illness, the prevalence of neurogenic change does not seem to be high, so a negative result cannot exclude the diagnosis of MSA.

Yamamoto, T; Sakakibara, R; Uchiyama, T; Liu, Z; Ito, T; Awa, Y; Yamamoto, K; Kinou, M; Yamanishi, T; Hattori, T

2005-01-01

247

Manometric measurement of human sphincter of Oddi length.  

PubMed Central

Length of biliary (CBD) and/or pancreatic (PD) sphincter of Oddi (SO) was measured during perendoscopic or intraoperative manometry in 21 control subjects and in 46 patients with biliary disease. When the high resting pressure (HPZ) and the phasic wave zone (PAZ) were considered, SO length was, in the control group, 9.5 +/- 0.5 mm (M +/- SE) and 9.4 +/- 0.6 mm at the level of the CBD-SO, and 7.7 +/- 0.6 mm and 6.9 +/- 0.5 mm at the level of the PD-SO. The physiological sphincter length appeared substantially shorter than the anatomical one, as reported in the literature. No significant differences were found between controls and patients with CBD stones. Endoscopic sphincterotomy without manometry reduced mean sphincter length length of the sphincterotomy was tailored to the manometric findings. Surgical partial sphincterotomy reduced sphincter length by only 46.7 +/- 10.3%.

Habib, F I; Corazziari, E; Biliotti, D; Primerano, L; Viscardi, A; Speranza, V; De Masi, E; Fegiz, G; Torsoli, A

1988-01-01

248

Human papillomavirus type distribution in anal cancer and anal intraepithelial lesions.  

PubMed

A systematic review was conducted of HPV type distribution in anal cancer and anal high-grade and low-grade squamous intraepithelial lesions (HSIL and LSIL). A Medline search of studies using PCR or hybrid capture for HPV DNA detection was completed. A total of 1,824 cases were included: 992 invasive anal cancers, 472 HSIL cases and 360 LSIL cases. Crude HPV prevalence in anal cancer, HSIL, and LSIL was 71, 91 and 88%, respectively. HPV16/18 prevalence was 72% in invasive anal cancer, 69% in HSIL and 27% in LSIL. The HPV 16 and/or 18 prevalence in invasive anal cancer cases was similar to that reported in invasive cervical cancer. If ongoing clinical trials show efficacy in preventing anal HPV infection and associated anal lesions, prophylactic HPV vaccines may play an important role for the primary prevention of these cancers in both genders. PMID:19189402

Hoots, Brooke E; Palefsky, Joel M; Pimenta, Jeanne M; Smith, Jennifer S

2009-05-15

249

Glyceryl trinitrate vs. lateral sphincterotomy for chronic anal fissure  

Microsoft Academic Search

INTRODUCTION: Glyceryl trinitrate has been shown to be an effective treatment for chronic anal fissure. It decreases anal tone and ultimately heals anal fissures. The aim of this trial was to compare glyceryl trinitrate with lateral sphincterotomy (current standard treatment) as definitive management for chronic anal fissure. METHODS: All patients with symptoms of chronic anal fissure were randomly assigned to

Justin Evans; Andrew Luck; Peter Hewett

2001-01-01

250

What Are the Key Statistics for Anal Cancer?  

MedlinePLUS

... factors for anal cancer? What are the key statistics about anal cancer? Anal cancer is fairly rare – ... Symptoms of Cancer Treatments & Side Effects Cancer Facts & Statistics News About Cancer Expert Voices Blog Programs & Services ...

251

Sphincter of Oddi stenosis: diagnosis using hepatobiliary scintigraphy and endoscopic manometry  

SciTech Connect

To determine the role of radionuclide imaging in diagnosing sphincter of Oddi stenosis, 21 patients with symptoms suggesting this disorder underwent endoscopic retrograde cholangiopancreatography, cholescintigraphy, and, when possible, endoscopic manometry. Those patients with abnormal hepatobiliary scintigraphy results had a mean basal sphincter pressure of 38.5 mm Hg. Sphincter pressures could not be measured in six patients with sphincters too tight to cannulate. Ten patients who underwent hepatobiliary scanning both before and after sphincter surgery had normal scan results of the repeat study. Hepatobiliary imaging appears useful for diagnosis of sphincter of Oddi stenosis in selected patients in whom manometry cannot be performed and for objective assessment of response to therapy.

Lee, R.G.L.; Gregg, J.A.; Koroshetz, A.M.; Hill, T.C.; Clouse, M.E.

1985-09-01

252

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

253

Prostaglandin E2 and the bovine sphincter pupillae  

PubMed Central

1. The bovine isolated sphincter pupillae incubated in Krebs solution releases a biologically active substance tentatively identified as prostaglandin E2. 2. The prostaglandin did not appear to be of neural origin or to result merely from tissue degeneration. 3. The spontaneous release of prostaglandin E2-like material was related to the tone of the sphincter. Output increased as tone was acquired after setting up the tissue and fell when various procedures were used to reduce the tone. 4. Low concentrations of E and F-type prostaglandins produced slow, well-sustained contractions of the atonic sphincter, prostaglandin E2 being the most potent of those tested. The responses to prostaglandin E2 were antagonized selectively by a prostaglandin antagonist SC-19220 (a dibenzoxazepine derivative) which in higher concentrations caused dose-dependent relaxations of the preparation. 5. Prostaglandins did not appear to modulate transmission from nerve to muscle in the sphincter. 6. The hypothesis that prostaglandin E2 might be produced to act as a local hormone causing tonic contraction of the sphincter pupillae is discussed.

Posner, J.

1973-01-01

254

VAAFT: a new minimally invasive method in the diagnostics and treatment of anal fistulas - initial results.  

PubMed

Abstract The aim of the study was to present our own experience in the treatment of anal fistulas by means of VAAFT (Video-Assisted Anal Fistula Treatment). Material and methods. Twenty patients were qualified for the VAAFT procedure. All were subjected to diagnostics. Two patients after the diagnostic stage underwent classical fistula surgery. The remaining 18 patients were subjected to the full procedure (diagnostic fistuloscopy, supply of the internal ostium, and coagulation of the fistula canal). The mean observation period was 10 months. Results. In most cases the trans-sphincter fistula was observed during the diagnostic phase, including three with additional fluid compartments. There was one intersphincteric fistula. Considering the 18 patients subjected to the full VAAFT procedure the internal ostium was supplied by means of an advancement flap in 3 cases, while in 11 by means of a mattress suture, including one with additional tissue glue. In 4 cases the internal ostium was tightly covered by mucosa. Surgical complications were not observed during the procedure. During further observation a permanent fistula was observed in 4 (22%) patients, and in two (17%), recurrence of anal fistula. In the remaining 12 patients one observed healing without fistula recurrence. Complications were not observed, including stool and gas control deterioration (based on the FISI scoring). Conclusions. The VAAFT method does not affect sphincter efficiency, no intra- and postoperative complications were observed. As compared to other minimally invasive procedures a comparable recovery rate is observed without the risk of incontinence. It is the only method enabling the intraoperative identification of the internal ostium and fistula canal under visual control. Initial optimistic results require further investigations on a larger group of patients. PMID:24578448

Wa??ga, Piotr; Romaniszyn, Micha?; Nowak, Wojciech

2014-01-01

255

Effect of octreotide on sphincter of oddi motility in patients with acute recurrent pancreatitis  

Microsoft Academic Search

Sphincter of Oddi dysfunction has been reported as a cause of acute idiopathic recurrent pancreatitis (IRP). Octreotide, a long-acting somatostatin analogue, is an antisecretory drug used in the treatment and prevention of acute pancreatitis. Its action on sphincter of Oddi motility is controversial and no data are available for IRP patients. The aim of this study was to assess sphincter

Vincenzo Di Francesco; Giampaolo Angelini; Paolo Bovo; Maria Beatrice Casarini; Marco Filippini; Bruna Vaona; Luca Frulloni; Laura Rigo; Maria Paola Brunori; Giorgio Cavallini

1996-01-01

256

Neuroanatomy of the External Urethral Sphincter: Implications for Urinary Continence Preservation During Radical Prostate Surgery  

Microsoft Academic Search

Post-prostatectomy urinary incontinence probably is multifactorial and sphincteric nerve injury could be a contributing cause. Controversy still exists regarding the innervation of the external sphincter, and currently pudendal nerve injury is not believed to be an etiological factor in post-prostatectomy urinary incontinence. To understand better the sphincter and its innervation, we undertook an anatomical and histological study of 18 adult

Perinchery Narayan; Badrinath Konety; Khalid Aslam; Sherif Aboseif; Walter Blumenfeld; Emil. Tanagho

1995-01-01

257

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

258

Distension of the gall bladder inhibits sphincter of Oddi motility in humans  

Microsoft Academic Search

Studies in animals have suggested a neural reflex between the gall bladder and the sphincter of Oddi. The aim of this study was to investigate whether sphincter of Oddi motility is altered by distension of the gall bladder in humans. Sphincter of Oddi motility was recorded intraoperatively in 10 patients undergoing elective cholecystectomy for gall stones. The manometry was performed

A Thune; G T Saccone; J P Scicchitano; J Toouli

1991-01-01

259

Intrasphincteric injection of botulinum toxin for suspected sphincter of Oddi dysfunction  

Microsoft Academic Search

Botulinum toxin is a potent inhibitor of the release of acetylcholine from nerve endings. It has previously been shown that it can effectively reduce lower oesophageal sphincter pressures both in animals and humans with achalasia. This study examined the hypothesis that locally injected botulinum toxin could also reduce sphincter of Oddi pressure in patients with sphincter of Oddi dysfunction. Two

P J Pasricha; E P Miskovsky; A N Kalloo

1994-01-01

260

The iris sphincter in aberrant regeneration of the third nerve.  

PubMed

Fourteen patients with aberrant regeneration of the third cranial nerve were examined using self-developing photographs, motion pictures, and pupillography. These pupillary phenomena were noted: (1) sector contractions of the iris sphincter in response to light, (2) sector contractions of the iris sphincter associated with eye movements, and (3) an abnormal pupillary unrest. The observations strongly support the concept that after injury, fibers regenerate and sprout collateral branches that finally reach muscles of the oculomotor group other than those originally innervated. PMID:687202

Czarnecki, J S; Thompson, H S

1978-09-01

261

Quantification of dynamic velopharyngeal port excursion following sphincter pharyngoplasty.  

PubMed

The sphincter pharyngoplasty is a surgical procedure designed to correct velopharyngeal dysfunction. Its advocates cite the theoretical advantage of its induction of dynamic activity of the neovelopharyngeal port, but this dynamic activity has yet to be quantitatively demonstrated in the literature. The purpose of this study was to quantify postoperative velopharyngeal dynamism and to document the results of intervention outcome on sphincteric excursion measurements from minimal-to-maximal orifice closure. We conducted a 7-year retrospective review of speech videofluoroscopy evaluations in patients who had undergone sphincter pharyngoplasty in our center. Between 1989 and 1994, there were 58 patients so treated for postpalatoplasty velopharyngeal dysfunction by two surgeons using the same operative technique. Patients for whom sphincter pharyngoplasty was recommended fulfilled both of the following criteria: (1) velopharyngeal dysfunction caused by an anatomic, myoneural, or combined deficiency of the velopharyngeal sphincter that would not be expected to be managed by speech therapy alone, and (2) preoperative videonasendoscopy and speech videofluoroscopic studies that demonstrated large-gap coronal, circular, or bow-tie closure patterns or velopharyngeal hypodynamism. Of the original 58 patients, 24 underwent postoperative speech videofluoroscopic evaluations with basal views. Of these, 20 of the evaluations (83 percent) were of adequate quality to be included in a research study. Still images showing maximum and minimum excursion of the sphincter in basal view were obtained. To test for observer reliability, the speech videofluoroscopic studies were randomized and presented for measurement to the same individual on two occasions, each session separated by a 1-month time interval. Topographic imaging software was used to obtain maximum and minimum measurements to within 0.1 mm. Partitioning the variance of the data showed that measurement variability was a very small portion of the total, and that difference between the minimum and maximum values was the largest source of variability. Of the total variability in the data, 64.0 percent originated in the minimum/maximum difference, 34.3 percent came from patient variability, and only 1.7 percent resulted from original or repeat measurements. The patient variability may be exaggerated because of variability in the scale of measurement. Results of this study indicate a quantifiable and statistically significant difference in maximum-to-minimum excursion of sphincteric closure. Sphincter pharyngoplasty appears to be dynamic in the majority of cases. PMID:9529202

Witt, P D; Marsh, J L; Arlis, H; Grames, L M; Ellis, R A; Pilgram, T K

1998-04-01

262

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

263

Ruptured intracranial dermoid cysts  

Microsoft Academic Search

Summary  Rupture of intracranial dermoid cysts (RICDC) is a rare phenomenon. The mechanism of rupture, pathophysiology of fat in the\\u000a ventricles and subarachnoid spaces, possible complications, and proper management of such conditions are proposed on the basis\\u000a of a review of the literature and experience with two cases of ruptured intracranial dermoid cysts (One was in the pineal\\u000a region, while another

K. El-Bahy; A. Kotb; A. Galal; A. EL-Hakim

2006-01-01

264

External Urethral Sphincter Pressure Measurement: An Accurate Method for the Diagnosis of Detrusor External Sphincter Dyssynergia?  

PubMed Central

Background Combined pelvic floor electromyography (EMG) and videocystourethrography (VCUG) during urodynamic investigation are the most acceptable and widely agreed methods for diagnosing detrusor external sphincter dyssynergia (DESD). Theoretically, external urethral sphincter pressure (EUSP) measurement would provide enough information for the diagnosis of DESD and could simplify the urodynamic investigation replacing combined pelvic floor EMG and VCUG. Thus, we evaluated the diagnostic accuracy of EUSP measurement for DESD. Patients & Methods A consecutive series of 72 patients (36 women, 36 men) with neurogenic lower urinary tract dysfunction able to void spontaneously was prospectively evaluated at a single university spinal cord injury center. Diagnosis of DESD using EUSP measurement (index test) versus combined pelvic floor EMG and VCUG (reference standard) was assessed according to the recommendations of the Standards for Reporting of Diagnostic Accuracy Initiative. Results Using EUSP measurement (index test) and combined pelvic floor EMG and VCUR (reference standard), DESD was diagnosed in 10 (14%) and in 41 (57%) patients, respectively. More than half of the patients presented discordant diagnosis between the index test and the reference standard. Among 41 patients with DESD diagnosed by combined pelvic floor EMG and VCUR, EUSP measurement identified only 6 patients. EUSP measurement had a sensitivity of 15% (95% CI 5%–25%), specificity of 87% (95% CI 76%–98%), positive predictive value of 60% (95% CI 30%–90%), and negative predictive value of 56% (95% CI 44%–68%) for the diagnosis of DESD. Conclusions For diagnosis of DESD, EUSP measurement is inaccurate and cannot replace combined pelvic floor EMG and VCUR.

Gregorini, Flavia; Birnbock, Dorothee; Kozomara, Marko; Mehnert, Ulrich; Kessler, Thomas M.

2012-01-01

265

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

266

Anal Cancer: What Happens After Treatment?  

MedlinePLUS

... CT scans (described in the section “ How is anal cancer diagnosed? ”) may also be ordered. Close follow-up is extremely important in the first several months after treatment with chemoradiation, especially if ...

267

Anal Cancer: Treatment Options by Stage  

MedlinePLUS

... sometimes treated differently from anal canal cancers. Stage 0 At this stage, the cancer is still only ... not usually found at this early stage. Stage 0 tumors can often be removed completely by surgery ( ...

268

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

269

Ipsilaterality of Motor Innervation of Canine Urethral Sphincter  

Microsoft Academic Search

The functional activity of the sphincter muscle of the urethra is known to be controlled largely by the hypogastric and pudendal nerves. It remains unknown, however, whether innervation of the muscle by these peripheral nerves is ipsi- or bilateral. In an attempt to answer this question urethral closure pressure was determined simultaneously in the anterior, posterior, right and left portions

Takashi Morita; Norihisa Kizu; Shun Kondo; Shinobu Dohkita; Seigi Tsuchida

1988-01-01

270

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

271

Effect of propofol on human sphincter of Oddi  

Microsoft Academic Search

The effect of propofol was studied in 11 patients who had common bile duct sphincter of Oddi manometry for suspected dysfunction. Patients were initially sedated with midazolam and then further or resedated with propofol for the second set of pressure measurements. Recordings were made about 10 min after giving each drug. No patient had elevated basal pressure initially. Average basal

John S. Goff

1995-01-01

272

Laparoscopic transcystic duct balloon dilatation of the sphincter of Oddi  

Microsoft Academic Search

Balloon dilatation of the sphincter of Oddi has been performed via a laparoscopic transcystic duct technique. Small common duct stones and stone debris have been successfully lavaged into the duodenum in 17 of 20 cases (85%) by this method. Postoperative hyperamylasemia was noted in four patients. Mild clinical pancreatitis was observed in three patients (15%). Further evaluation of this technique

B. J. Carroll; E. H. Phillips; M. Chandra; M. Fallas

1993-01-01

273

Ruptured intracranial dermoid cyst  

PubMed Central

Rupture of an intracranial dermoid cyst is a rare event with considerable associated morbidity and potential mortality. We present a case of intracranial rupture of a dermoid cystic tumor with consequent dissemination of subarachnoid fat droplets resulting in acute aseptic chemical meningitis. Radiographic findings, operative treatment, and pathologic features are described.

Barnett, David W.; Snipes, George J.; Layton, Kennith F.; Opatowsky, Michael J.

2012-01-01

274

Ruptured intracranial dermoid cysts  

Microsoft Academic Search

BACKGROUNDIntracranial dermoid cysts are rare congenital neoplasms that are believed to arise from ectopic cell rests incorporated in the closing neural tube. The rupture of an intracranial dermoid cyst is a relatively rare event that typically occurs spontaneously. In the past it was believed that rupture is always fatal, a hypothesis that is not supported by more recently reported cases.

Ruediger Stendel; Terttu Aulikki Pietilä; Kerstin Lehmann; Ralf Kurth; Olaf Suess; Mario Brock

2002-01-01

275

Nucleolar organiser regions (AgNORS) in anal intraepithelial neoplasia and invasive anal squamous cell carcinoma.  

PubMed Central

AIM: To evaluate the usefulness of counting nucleolar organiser region associated proteins (AgNORs) in the management of anal squamous neoplasia. METHOD: Using a silver staining technique for NOR associated proteins, 32 routinely processed paraffin wax embedded sections of anal epithelium were assessed. These consisted of normal anal epithelium (n = 9), anal intraepithelial neoplasia (AIN) grades I (n = 5), and III (n = 13), and invasive squamous neoplasia of the anus (n = 5). RESULTS: The median AgNOR counts for every 100 cells are as follows: normal anal epithelium 2.15 (95% CI 1.89-3.94); AIN I 3.21 (95% CI 2.89-7.14); AIN III 4.32 (95% CI 4.00-8.10); and invasive squamous cell carcinoma of the anus 5.51 (95% CI 2.48-10.62). There were significant differences between AgNOR counts in anal cancer and normal epithelium (p < 0.05; Mann-Whitney U test)), AIN III and normal anal epithelium (p < 0.005), and AIN III and AIN I (p < 0.05). No significant differences were observed between AIN I and normal anal epithelium, anal cancer and AIN I, and anal cancer and AIN III. There was a considerable degree of overlap among the different groups. CONCLUSIONS: Despite the strong association between AgNOR values and degree of dysplasia, the variability within pathological grade may preclude the adoption of this technique on its own as a prognostic indicator. It may, however, be useful in conjunction with other markers of neoplastic growth such as c-myc oncogene amplification or overexpression as a marker of disease progression in AIN and invasive anal squamous cell cancer. Images

Ogunbiyi, O A; Scholefield, J H; Sharp, F; Ginsberg, R; Rogers, K

1992-01-01

276

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

277

Effects of loperamide on anal sphincter function in patients complaining of chronic diarrhea with fecal incontinence and urgency  

Microsoft Academic Search

We have investigated the effect of loperamide (4 mg tds) on the continence to a standard volume of rectally infused saline and anorectal manometry in 26 patients complaing of chronic diarrhea complicated by fecal incontinence and severe urgency. Each patient was treated for one week with loperamide (4 mg tds) and for one week with an identical placebo in a

Maria Read; N. W. Read; D. C. Barber; H. L. Duthie

1982-01-01

278

Anal endosonography for recurrent anal fistulas: Image enhancement with hydrogen peroxide  

Microsoft Academic Search

Anal endosonography is a new technique that is useful in the preoperative assessment of patients with anal fistulas. Endosonographic images are created by the reflection of sound waves from the interfaces between tissues of varying densities. In order to accentuate tissue interface layers at the level of the fistula tract, we introduced hydrogen peroxide into the fistula tract through the

D. M. O. Cheong; J. J. Nogueras; S. D. Wexner; D. G. Jagelman

1993-01-01

279

[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

280

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

281

Anal dilatation versus left lateral sphincterotomy for chronic anal fissure: a prospective randomized study  

Microsoft Academic Search

Background  Several surgical methods are accepted for the treatment of chronic anal fissure. The most popular are anal dilatation (AD)\\u000a and left lateral sphincterotomy (LLS). The objective of the current study was to prospectively evaluate the results of these\\u000a two procedures in terms of recurrence rate, complications and patient satisfaction.\\u000a \\u000a \\u000a \\u000a Methods  The study enrolled all patients who required operation for chronic anal

E. Ram; T. Vishne; I. Lerner; Z. Dreznik

282

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 ...

283

Effects of morphine on the human sphincter of Oddi  

Microsoft Academic Search

The effects of morphine on intraluminal pressures recorded from the sphincter of Oddi (SO) at endoscopic retrograde cholangiopancreatography in 19 patients who were without evidence of biliary or pancreatic disease were studied. Morphine was given in four successive doses of 2.5, 2.5, 5, and 10 micrograms\\/kg iv at five minute intervals. Morphine in subanalgesic doses increased the frequency of SO

J F Helm; R P Venu; J E Geenen; W J Hogan; W J Dodds; J Toouli; R C Arndorfer

1988-01-01

284

Management of detrusor external sphincter dyssynergia in neurogenic bladder.  

PubMed

Spinal cord injury (SCI) affects 11.5 to 53.4 individuals per million of the population in developed countries each year. SCI is caused by trauma, although it can also result from myelopathy, myelitis, vascular disease or arteriovenous malformations and multiple sclerosis. Patients with complete lesions of the spinal cord between spinal cord level T6 and S2, after they recover from spinal shock, generally exhibit involuntary bladder contractions without sensation, smooth sphincter synergy, but with detrusor striated sphincter dyssynergia (DESD). Those with lesions above spinal cord level T6 may experience, in addition, smooth sphincter dyssynergia and autonomic hyperreflexia. DESD is a debilitating problem in patients with SCI. It carries a high risk of complications, and even life expectancy can be affected. Nearly half of the patients with untreated DESD will develop deleterious urologic complications, due to high intravesical pressures, resulting in urolithiasis, urinary tract infection (UTI), vesicoureteral reflux (VUR), hydronephrosis, obstructive uropathy, and renal failure. The mainstay of treatment is the use of antimuscarinics and catheterization, but in those for whom this is not possible external sphincterotomy has been a last resort option. External sphincterotomy is associated with significant risks, including haemorrhage; erectile dysfunction and the possibility of redo procedures. Over the last decade alternatives have been investigated, such as urethral stents and intrasphincteric botulinum toxin injection. In this review, we will cover neurogenic DESD, with emphasis on definition, classifications, diagnosis and different therapeutic options available. PMID:22081065

Mahfouz, W; Corcos, J

2011-12-01

285

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

2013-10-01

286

Introducing the operation method for curing anal fistula by laser  

NASA Astrophysics Data System (ADS)

The key to the treatment of anal fistula lies in scavenging the infected anal gland thoroughly, which is the source of anal fistula infection. The fistula tract at the internal orifice of the anal fistula is cut 1 cm using laser with the infectious source completely degenerated and the wound gassified and scanned. The residual distal fistula softens and disappears upon the action of organic fibrinolysin.

Ji, Bingzhi

1993-03-01

287

Teaching Men's Anal Pleasure: Challenging Gender Norms with "Prostage" Education  

ERIC Educational Resources Information Center

To help students critique sex/gender norms, sexuality educators should address men's anal pleasure. Men's anal receptivity blurs accepted binaries like male/female, masculine/feminine, and straight/queer. By suppressing men's receptivity, the taboo against men's anal pleasure helps legitimize hegemonic sex/gender beliefs--and the sexism,…

Branfman, Jonathan; Ekberg Stiritz, Susan

2012-01-01

288

Anal fissure: the changing management of a surgical condition  

Microsoft Academic Search

Background Chronic anal fissure is a common benign disorder that causes severe, sharp anal pain during defaecation. Fissures are generally associated with raised resting anal pressures, and treatments are aimed at reduction of these pressures. Surgical sphincterotomy is very successful at healing fissures but is associated with significant morbidity. Much work has gone into the development of new pharmacological agents

A. G. Acheson; J. H. Scholefield

2005-01-01

289

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

290

Challenging the predictive accuracy of goodsall's rule for anal fistulas  

Microsoft Academic Search

To examine the predictive accuracy of Goodsall's rule, the records of 216 patients (155 men and 61 women) who underwent surgery for complete submuscular anal fistulas from 1982 to 1989 were retrospectively reviewed. In accordance with Goodsall's rule, 90 percent of 124 patients with an external opening posterior to the transverse anal line had anal fistulas tracking to the midline

William C. Cirocco; John C. Reilly

1992-01-01

291

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

292

Measurement of anal pressure and motility  

Microsoft Academic Search

A fine open perfused system and a closed balloon system for the measurement of anal pressure and motility have been compared. Measurements were made in 40 normal subjects and 84 patients with haemorrhoids. The rate of perfusion had a marked effect on the recorded pressure and motility details. The motility pattern was seen most clearly with the balloon probe and

B D Hancock

1976-01-01

293

Anal tenesmus caused by seminal vesicle cyst  

Microsoft Academic Search

Congenital cysts of the seminal vesicles with ipsilateral renal aplasia or dysplasia are rare but have been well described in the literature. We report the first case where anal tenesmus was the only presenting symptom. Another unique feature was the combination of this anomaly with a duplication of the inferior vena cava. Copyright 1997 by Elsevier Science Inc. UROLOGY 49:

P. Callewaert; M. De Coster; P. Vuylsteke; R. De Man; S. Brijs; L. Baert

1997-01-01

294

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

295

Anal leiomyoma in a Holstein heifer.  

PubMed Central

A 2-year-old heifer was presented with masses on her anus that were interfering with cervical manipulation during embryo flushing. The masses had broad stalks attached within the anal sphinchter. Recovery was without incident after surgical resection. No recurrence of the masses had occurred 3 months later. Histologic diagnosis was benign leiomyoma. Images Figure 1. Figure 2.

Lopez, M J; Prichard, M; Steinberg, H

1997-01-01

296

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

297

Detection of Human Papillomavirus DNA in Anal Intraepithelial Neoplasia and Anal Cancer1  

Microsoft Academic Search

Forty anal paraffin-embedded tissue specimens from 24 subjects »ere studied for the presence of human papillomavirus (HPV) types 6, 11, 16, 18, 31, and 33, herpes simplex virus (HSV), Epstein-Barr virus, and cytomegalovirus DNA by using the polymerase chain reaction. These tissues ranged from histologically normal to invasive squamous cell carcinoma. HPV DNA was detected in the invasive anal cancer

Joel M. Palefsky; Elizabeth A. Holly; John Gonzales; Jennifer Berline; David K. Ahn; John S. Greenspan

298

Early Experience with the Bioabsorbable Anal Fistula Plug  

Microsoft Academic Search

Purpose  Management of anal fistula represents a balance between curing the condition and maintaining anal continence. Recent reports\\u000a of the results of the porcine anal fistula plug have demonstrated excellent fistula healing rates without reporting significant\\u000a complications.\\u000a \\u000a \\u000a \\u000a Methods  The outcome of patients who underwent treatment for anal fistula with the Surgisis® anal plug was retrospectively reviewed.\\u000a \\u000a \\u000a \\u000a Results  Twenty patients were treated; three underwent

D. A. Lawes; J. E. Efron; M. Abbas; J. Heppell; T. M. Young-Fadok

2008-01-01

299

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

300

[Indirect traumatic diaphragmatic rupture].  

PubMed

Between 1969 and 1988 51 polytraumatized patients were treated for rupture of the diaphragm due to blunt trauma. In 39 cases the lesion was in the left hemidiaphragm, in 11 cases on the right side and in one case on both sides. Clinical investigation and posterior-anterior chest X-ray were the most important diagnostic procedures. A high percentage of ruptures was only detected intraoperatively during acute laparotomy/thoracotomy. Early or delayed surgery had no influence on the survival of patients. The prognosis depends on the severity of associated injuries, which are the main causes of death in these patients. PMID:1858376

Holzberger, P; Königsrainer, A; Tauscher, T; Müller, L; Thöni, H

1991-01-01

301

Splenic abscess rupture postappendicectomy  

PubMed Central

The authors present a case of splenic abscess rupture postappendicectomy. Splenic abscess is rare with a reported incidence of 0.05%–0.7%. It is extremely unusual for a splenic abscess to result in splenic rupture. Contiguous spread, in this case from postappendix perforation, can cause splenic abscess formation. Postemergency splenectomy, the patient required admission to intensive therapy unit for 5 days but made a good postoperative recovery. This case is important to report as this is a rare postoperative complication of generalised peritonitis and this case highlights that astute diagnosis and management of the deteriorating surgical patient and rapid mobilisation of theatre are lifesaving.

Patel, Roshani; Pai, Aakash; Al-Shoek, Ihsan; Evans, Charles; Gordon, Andrew

2012-01-01

302

Investigation of cholecystokinin receptors in the human lower esophageal sphincter  

PubMed Central

AIM: To compare the binding of cholecystokinin (CCK)-8 to CCK receptors in sling and clasp fibers of the human lower esophageal sphincter. METHODS: Esophageal sling and clasp fibers were isolated from eight esophagectomy specimens, resected for squamous cell carcinoma in the upper two thirds of the esophagus, which had been maintained in oxygenated Kreb’s solution. Western blot was used to measure CCK-A and CCK-B receptor subtypes in the two muscles. A radioligand binding assay was used to determine the binding parameters of 3H-CCK-8S to the CCK receptor subtypes. The specificity of binding was determined by the addition of proglumide, which blocks the binding of CCK to both receptor subtypes. RESULTS: There was no significant difference between the sling and clasp fibers of the human lower esophageal sphincter in the amount of CCK-A [integrated optical density (IOD) value: 22.65 ± 0.642 vs 22.328 ± 1.042, P = 0.806] or CCK-B receptor protein (IOD value: 13.20 ± 0.423 vs 12.45 ± 0.294, P = 0.224) as measured by Western blot. The maximum binding of radio-labeled CCK-8S was higher in the sling fibers than in the clasp fibers (595.75 ± 3.231 cpm vs 500.000 ± 10.087 cpm, P < 0.001) and dissociation constant was lower (Kd: 1.437 ± 0.024 nmol/L vs 1.671 ± 0.024 nmol/L, P < 0.001). The IC50 of the receptor specific antagonists were lower for the CCK-A receptors than for the CCK-B (P < 0.01). CONCLUSION: CCK binding modulates the contractile function of the lower esophageal sphincter through differential binding to the CCK-A receptor on the sling and clasp fibers.

Liu, Jun-Feng; Zhang, Jian; Liu, Xin-Bo; Drew, Paul A

2014-01-01

303

Characterization of the Upper Esophageal Sphincter Response During Cough  

PubMed Central

Background: Vagal reflex initiated by esophageal stimulation and microaspiration can cause chronic cough in patients with gastroesophageal reflux disease (GERD). By raising intraabdominal pressure, cough can, in turn, predispose to GERD. The role of the upper esophageal sphincter (UES) in preventing esophagopharyngeal reflux during coughing is not well known. The aim of this study was to evaluate the UES response during coughing. Methods: We studied 20 healthy young (10 women; age, 27 ± 5 years) and 15 healthy elderly (nine women; age, 73 ± 4 years) subjects. Hard and soft cough-induced pressure changes in the UES, distal esophagus, lower esophageal sphincter, and stomach were determined simultaneously using high-resolution manometry and concurrent acoustic cough recordings. Results: Resting UES pressure was significantly higher in the young compared with the elderly subjects (42 ± 14 mm Hg vs 24 ± 9 mm Hg; P < .001). Cough induced a UES contractile response in all subjects. Despite lower UES resting pressures in the elderly subjects, the maximum UES pressure during cough was similar between the young and the elderly subjects (hard cough, 230 ± 107 mm Hg vs 278 ± 125 mm Hg, respectively; soft cough, 156 ± 85 mm Hg vs 164 ± 119 mm Hg, respectively; P not significant for both). The UES pressure increase over baseline during cough was significantly higher than that in the esophagus, lower esophageal sphincter, and stomach for both groups (P < .001). Conclusions: Cough induces a rise in UES pressure, and this response is preserved in elderly people. A cough-induced rise in UES pressure is significantly higher than that in the esophagus and stomach, thereby providing a barrier against retrograde entry of gastric contents into the pharynx.

Amaris, Manuel; S. Dua, Kulwinder; Naini, Sohrab Rahimi; Samuel, Erica

2012-01-01

304

Premature Rupture of Membranes  

PubMed Central

The management of premature rupture of the amniotic membranes before 37 weeks gestation remains controversial. The authors of this article outline the risks involved for the fetus, define the various terms related, and discuss the antepartum and intrapartum management of such an event and offer a protocol that they have developed.

Akierman, Albert; Iwanicki, Stanislaw

1988-01-01

305

Nissen fundoplication has a vagolytic effect on the lower esophageal sphincter  

Microsoft Academic Search

Background: Laparoscopic Nissen fundoplication is an increasingly utilized option for the treatment of gastroesophageal reflux disease (GERD). However, many questions remain as to the mechanism by which this operation prevents GERD in those without hiatal hernias or incompetent lower esophageal sphincters (LES). It is known that these patients experience reflux due to excess transient lower esophageal sphincter relaxations (TLESR), inappropriate

B. Sarani; T. Chan; R. Wise; S. Evans

2003-01-01

306

Urethral sphincter EMG-controlled dorsal penile\\/clitoral nerve stimulation to treat neurogenic detrusor overactivity  

Microsoft Academic Search

The goal of this study was to investigate whether real-time external urethral sphincter (EUS) EMG-controlled dorsal genital nerve (DGN) stimulation can suppress undesired detrusor bladder contractions in patients with both neurogenic detrusor overactivity (NDO) and detrusor sphincter dyssynergia (DSD). Detrusor pressure (Pdet) and EUS EMG were recorded in 12 neurogenic patients who underwent two filling cystometries. The first one was

E. Opisso; A. Borau; N. J. M. Rijkhoff

2011-01-01

307

Effects of Gabexate Mesilate, a Protease Inhibitor, on Human Sphincter of Oddi Motility  

Microsoft Academic Search

Gabexate mesilate is an antiprotease drug, which reduced the severity of pancreatitis and frequency of post-ERCP pancreatitis. In dogs gabexate inhibits sphincter of Oddi motility but no data are available in humans. The aim of this study was to verify by manometry the action of gabexate on human sphincter of Oddi motility. We enrolled 12 patients with idiopathic recurrent pancreatitis

Vincenzo Di Francesco; Alberto Mariani; Giampaolo Angelini; Enzo Masci; Luca Frulloni; Giorgio Talamini; Sandro Passaretti; Pieralberto Testoni; Giorgio Cavallini

2002-01-01

308

Endoscopic approach to the patient with motility disorders of the bile duct and sphincter of Oddi.  

PubMed

Since its original description by Oddi in 1887, the sphincter of Oddi has been the subject of much study. Furthermore, the clinical syndrome of sphincter of Oddi dysfunction (SOD) and its therapy are controversial areas. Nevertheless, SOD is commonly diagnosed and treated by physicians. This article reviews the epidemiology, clinical manifestations, and current diagnostic and therapeutic modalities of SOD. PMID:23540967

Leung, Wesley D; Sherman, Stuart

2013-04-01

309

Paradoxical response to cerulein on sphincter of Oddi in the patient with gastrectomy  

Microsoft Academic Search

Sphincter of Oddi motility was measured in 55 gallstone patients either through the sinus tract of percutaneous transhepatic biliary drainage or through the T tube. The influence of cholecystectomy and gastrectomy on the sphincter of Oddi was analyzed by comparing responses in patients with or without surgery to the administration of cerulein and the ingestion of dry egg yolk. When

Katsuyoshi Odani; Yuji Nimura; Akihiro Yasui; Yukihiko Akita; Shigehiko Shionoya

1992-01-01

310

Can endoscopic papillary balloon dilation really preserve sphincter of Oddi function?  

Microsoft Academic Search

BACKGROUNDEndoscopic papillary balloon dilation (EPBD) is assumed to preserve sphincter of Oddi function because it causes little trauma to the papilla. However, few studies have addressed this issue specifically. In this study, we investigated whether EPBD can preserve sphincter function, and evaluated whether or not such preservation has clinical significance.METHODSSeventy patients with common bile duct (CBD) stones were randomly assigned

I Yasuda; E Tomita; M Enya; T Kato; H Moriwaki

2001-01-01

311

Sphincter of Oddi dysfunction in children with recurrent pancreatitis and anomalous pancreaticobiliary union: an etiologic concept  

Microsoft Academic Search

Background: The exact cause of recurrent pancreatitis among patients with anomalous pancreaticobiliary union is not known. Sphincter of Oddi dysfunction has been implicated as a mechanism. This study evaluated sphincter of Oddi function in children with anomalous pancreaticobiliary union and recurrent pancreatitis and assessed the results of endoscopic sphincterotomy in the management of this condition. Methods: We retrospectively reviewed 128

Moises Guelrud; Claudio Morera; Magaly Rodriguez; Domingo Jaen; Reinaldo Pierre

1999-01-01

312

Manometric study of the sphincter of Oddi in patients with and without common bile duct stones  

Microsoft Academic Search

Motor activity of the sphincter of Oddi has been evaluated in 34 patients who underwent ERCP examination. Manometric recordings from the common bile duct and the sphincter of Oddi were performed with a polyethylene triple lumen catheter. At ERCP 16 patients had undamaged biliary ducts; six had undergone cholecystectomy and six had gall bladder stones; 18 patients had common bile

E De Masi; E Corazziari; F I Habib; B Fontana; V Gatti; G F Fegiz; A Torsoli

1984-01-01

313

Quantitative 99mTc-DISIDA scanning and endoscopic biliary manometry in sphincter of Oddi dysfunction  

Microsoft Academic Search

Sphincter of Oddi (SO) dysfunction is a recognised cause of postcholecystectomy pain, but a difficult condition to diagnose, requiring endoscopic biliary manometry (EBM) to confirm sphincter motor abnormalities. We have assessed quantitative cholescintigraphy in 10 postcholecystectomy (PC) patients with clinical and manometric evidence of SO dysfunction, 10 PC patients with non-biliary type abdominal pain and 10 asymptomatic PC volunteers acting

G M Fullarton; A Allan; T Hilditch; W R Murray

1988-01-01

314

Sphincter of Oddi dysfunction and unexplained abdominal pain: Clinical and manometric study  

Microsoft Academic Search

Unexplained, biliary-type abdominal pain is often attributed to an abnormal pressure profile of the sphincter of Oddi. In spite of this assumption, the true prevalence of this type of motor dysfunction among cholecystectomized patients with unexplained abdominal pain is not known. We studied 64 postcholecystectomy patients who were thought to have sphincter of Oddi dysfunction. Radiologically, other than a dilated

Hooshang Meshkinpour; Michael Mollot

1992-01-01

315

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

316

Action of Cholecystokinin and Caerulein on the Rabbit Sphincter of Oddi  

Microsoft Academic Search

The action of cholecystokinin (CCK) and caerulein upon the rabbit sphincter of Oddi was investigated by eiectromyography, manometry and measuring of the flow. Intravenous injection of CCK resulted in a marked rise of the sphincter activity with a maximum at the 1st min and return to the basal level at the 10th min. Injection of increasing doses of hormone showed

J. C. Sarles; J. M. Bidart; M. A. Devaux; C. Echinard; A. Castagnini

1976-01-01

317

ERCP, biliary crystal analysis, and sphincter of Oddi manometry in idiopathic recurrent pancreatitis  

Microsoft Academic Search

Background: This study investigated the role of ERCP, analysis of bile for microcrystals, and sphincter of Oddi manometry in idiopathic recurrent pancreatitis. Methods: One hundred twenty-six patients met criteria for idiopathic recurrent pancreatitis. Patients with a normal ERCP underwent sphincter of Oddi manometry and analysis of bile. Bile was also collected in patients with papillary stenosis (defined as ductal dilation

Madhukar Kaw; George J. Brodmerkel

2002-01-01

318

Development and Current Status of the AMS 800 Artificial Urinary Sphincter  

Microsoft Academic Search

The American Medical Systems (AMS) 800 artificial urinary sphincter (AUS) has developed into a sophisticated system for the treatment of patients with incontinence secondary to intrinsic sphincter deficiency. In this review article, we describe the development and mechanics of the device before considering the indications for its use. We present a comprehensive review of the recent literature concerning long term

Hari L. Ratan; Duncan J. Summerton; Steven K. Wilson; Timothy R. Terry

2006-01-01

319

Contact neodymium:yttrium-aluminum-garnet laser ablation of the external sphincter in spinal cord injured men with detrusor sphincter dyssynergia  

Microsoft Academic Search

ObjectivesThe purpose of this study was to determine the efficacy and safety of contact neodymium:yttrium-aluminum-garnet (Nd:YAG) laser external sphincterotomy as an alternative treatment of detrusor-external sphincter dyssynergia (DESD).

David A. Rivas; Michael B. Chancellor; William E. Staas; Leonard G. Gomella

1995-01-01

320

Anal fistula: A review of 82 cases  

Microsoft Academic Search

Summary  Eighty-two cases of anal fistula have been retrospectively reviewed, and their clinical presentations, pathology, and management\\u000a presented. Most of the fistulas were primary and, except for the four cases due to tuberculosis, there does not seem to have\\u000a been any underlying systemic or gastrointestinal causative factor. A preoperative fistulogram is essential in the management\\u000a of this condition.

A. N. Ani; T. F. Solanke

1976-01-01

321

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

322

Treatment of fecal incontinence - review of observational studies (OS) and randomized controlled trials (RCT) related to injection of bulking agent into peri-anal tissue.  

PubMed

PURPOSE: Novel treatments are needed to augment medical therapy for fecal incontinence. METHODS: Medline and Google search (fecal incontinence and injection treatment), English publications. RESULTS: Twenty-two observational studies and 4 randomized controlled trials were identified. OS mostly with limited sample sizes reported promising results. Repeated injection was necessary in some patients. Effect on anal sphincter pressures was highly variable. Significant improvements in the length of anal high-pressure zone, asymmetry index and maximum tolerable rectal volume were suggested. Four randomized controlled trials (n=176) revealed: 1. Short-term benefits from injection of Bioplastique under ultrasound guidance compared with digital guidance; 2. Silicone biomaterial (PTQ) provided some advantages and was safer than carbon-coated beads (Durasphere); 3. PTQ did not demonstrate clinical benefit compared to control injection of saline; 4. There was significant improvement at 6 weeks post injection, but no difference between Bulkamid and Permacol. A 2010 Cochrane review, however, noted that these data were inconclusive due to limited number and methodological weaknesses. CONCLUSION: Further studies are warranted to assess patient-centered outcomes (e.g. adequate relief) in addition to the attenuation of severity of incontinence symptoms in ambulatory patients. In nursing home residents, cost-effectiveness studies combining injection treatment and prompted voiding (to mitigate constraints of immobility and dementia) in preventing peri-anal skin complications deserves to be considered. PMID:22586538

Leung, Felix W

2011-10-01

323

Treatment of fecal incontinence - review of observational studies (OS) and randomized controlled trials (RCT) related to injection of bulking agent into peri-anal tissue  

PubMed Central

Purpose Novel treatments are needed to augment medical therapy for fecal incontinence. Methods Medline and Google search (fecal incontinence and injection treatment), English publications. Results Twenty-two observational studies and 4 randomized controlled trials were identified. OS mostly with limited sample sizes reported promising results. Repeated injection was necessary in some patients. Effect on anal sphincter pressures was highly variable. Significant improvements in the length of anal high-pressure zone, asymmetry index and maximum tolerable rectal volume were suggested. Four randomized controlled trials (n=176) revealed: 1. Short-term benefits from injection of Bioplastique under ultrasound guidance compared with digital guidance; 2. Silicone biomaterial (PTQ) provided some advantages and was safer than carbon-coated beads (Durasphere); 3. PTQ did not demonstrate clinical benefit compared to control injection of saline; 4. There was significant improvement at 6 weeks post injection, but no difference between Bulkamid and Permacol. A 2010 Cochrane review, however, noted that these data were inconclusive due to limited number and methodological weaknesses. Conclusion Further studies are warranted to assess patient-centered outcomes (e.g. adequate relief) in addition to the attenuation of severity of incontinence symptoms in ambulatory patients. In nursing home residents, cost-effectiveness studies combining injection treatment and prompted voiding (to mitigate constraints of immobility and dementia) in preventing peri-anal skin complications deserves to be considered.

2011-01-01

324

Simultaneous penile prosthesis and male sling/artificial urinary sphincter  

PubMed Central

Erectile dysfunction (ED) and stress urinary incontinence (SUI) from urethral sphincteric deficiency is not an uncommon problem. The commonest etiology is intervention for localized prostate cancer and/or radical cystoprostatectomy for muscle invasive bladder cancer. Despite advances in surgical technology with robotic assisted laparoscopic prostatectomy and nerve sparing techniques, the rates of ED and SUI remain relatively unchanged. They both impact greatly on quality of life domains and have been associated with poor performance outcomes. Both the artificial urinary sphincter and penile prosthesis are gold standard treatments with proven efficacy, satisfaction and durability for end-stage SUI and ED respectively. Simultaneous prosthesis implantation for concurrent conditions has been well described, mostly in small retrospective series. The uptake of combination surgery has been slow due in part to technical demands of the surgery and to an extent, a heightened anxiety over potential complications. This paper aims to discuss the technical aspect of concurrent surgery for both disease entity and the current published outcomes of the various surgical techniques with this approach.

Lee, Dominic; Romero, Claudio; Alba, Frances; Westney, O Lenaine; Wang, Run

2013-01-01

325

Choledochoscope manometry about different drugs on the Sphincter of Oddi  

PubMed Central

AIM: To assess the effects of H2-receptor blocking pharmacon, protease inhibitor, and gastro kinetic agents on the human Sphincter of Oddi (SO) motility by choledochoscope manometry. METHODS: One hundred and seventy-five patients with T tube installed after cholecystectomy and choledochotomy were assessed by choledochoscope manometry. They were randomly assigned into groups of H2-receptor blocking pharmacon, protease inhibitor, and gastro kinetic agents. The Sphincter of Oddi basal pressure (SOBP), amplitude (SOCA), frequency of contractions (SOF), duodenal pressure (DP), and common bile duct pressure (CBDP) were scored and analyzed. RESULTS: SOBP and SOCA were significantly decreased after Cimetidine administration, and no statistical difference was seen in the Famotidine group. In the Gabexate mesilate group, SOBP had decreased significantly. In the Ulinastatin group, SOCA decreased when Ulinastatin was given at the rate of 2500 U/min; when Ulinastatin administration was raised to 5000 U/min, SOBP, SOF and SOCA all experienced a fall. SOBP and SOCA for Domperidone and SOCA for Mosapride groups all decreased distinctly after administration. CONCLUSION: The regular dosage of Cimetidine showed an inhibitory effect on the motility of SO, while Famotidine had no obvious effects otherwise. Gabnexata mesilate, Ulinastatin and gastro kinetic agents also showed inhibitory effects on the SO motility.

Kong, Jing; Wu, Shuo-Dong; Zhang, Xiao-Bo; Li, Zhen-Sheng; Shi, Gang; Wang, Wei; Chen, Jun-Zhi

2008-01-01

326

The use of a simple anal sling in the management of anal incontinence  

PubMed Central

Background. Many patients presenting with anal incontinence (AI) are frail, with attendant comorbidities precluding the use of complicated, expensive reconstructive techniques. In these cases, revisiting a simple approach—designed to provide some sort of effective barrier to stool—is worthwhile where the options include a customized peri-anal sling or the use of an anal plug. Methods. Analysis of an unselected cohort of 33 patients (mean age 54 years; range 27–86 years) with AI is presented, these patients having undergone insertion of an elastic band peri-anal sling between December 2004 and December 2009. Pre- and post-operative assessment included the Jorge-Wexner score of incontinence, anorectal manometry and the Rockwood Fecal Incontinence Quality of Life (FIQoL) score. Results. The follow-up period ranged from 50 to 108 months with a mean of 65 months. Early post-operative complications included spontaneous disruption of the sling at the fourth and seventh post-operative day in two patients and local infection in a further two cases. Late complications included skin erosion in two patients, (one occurring 3 years post-operatively) and breakage of the sling in a further seven patients. Explantation was performed in 13 cases, and re-implantation in 10 patients. No differences were noted in resting or squeeze manometry, with significant improvement in the Jorge-Wexner scores in 32 cases and in all of the four Rockwood quality of life scales. Conclusions. An anal sling is an effective and simple surgical option for the management of selected cases presenting with anal incontinence. Longer-term data are awaited comparing this technique with other standard surgical alternatives.

Devesa, Jose Manuel; Vicente, Rosana

2014-01-01

327

Three-Dimensional Anal Endosonography May Improve Detection of Recurrent Anal Cancer  

Microsoft Academic Search

\\u000a Purpose  In our center since 2001, follow-up examination has included three-dimensional endosonography in all patients with suspicion\\u000a of local recurrence of anal cancer. This study was designed to investigate whether three-dimensional endosonography surpassed\\u000a two-dimensional endosonography as a diagnostic tool for patients with suspected local recurrence.\\u000a \\u000a \\u000a \\u000a Methods  This prospective study included 38 consecutive patients who have had anal carcinoma and were investigated using

Anders F. Christensen; Michael B. Nielsen; Lars B. Svendsen; Svend A. Engelholm

2006-01-01

328

Distal biceps tendon rupture  

Microsoft Academic Search

The authors report a rupture of the distal tendon of biceps brachii in a 42-year-old athlete. Magnetic resonance imaging confirmed the injury. Early surgical repair was performed by reinsertion of the tendon on the radial tuberosity according to modified Boyd-Anderson technique. Indomethacin was administered prophylactically. No complications were noted. At the latest follow-up, the patient had full elbow range of

Olga D. Savvidou; Panayiotis J. Papagelopoulos; Andreas F. Mavrogenis; Antonios A. Partsinevelos; Evangelos J. Karadimas; Demetrios S. Korres

2004-01-01

329

Heterosexual Anal Intercourse: A Neglected Risk Factor for HIV?  

PubMed Central

Heterosexual anal intercourse confers a much greater risk of HIV transmission than vaginal intercourse, yet its contribution to heterosexual HIV epidemics has been under researched. In this article we review the current state of knowledge of heterosexual anal intercourse practice worldwide and identify the information required to assess its role in HIV transmission within heterosexual populations, including input measures required to inform mathematical models. We then discuss the evidence relating anal intercourse and HIV with sexual violence.

Baggaley, Rebecca F.; Dimitrov, Dobromir; Owen, Branwen N.; Pickles, Michael; Butler, Ailsa R.; Masse, Ben; Boily, Marie-Claude

2014-01-01

330

Carcinomas of the anal canal and anal margin differ in their expression of cadherin, cytokeratins and p53  

Microsoft Academic Search

Carcinomas of the anus are subdivided into those of the anal canal and those of the anal margin. It has been postulated that the various types of tumours of the anal canal represent a spectrum of differentiation rather than tumours of a separate origin. We compared the expression of Pan-cadherin, cytokeratins (CKs) 5\\/6, 7, 13, 18 and 19, p53 and

G. C. Behrendt; M. L. Hansmann

2001-01-01

331

Persistent pain in anal cancer survivors  

Microsoft Academic Search

Introduction  Anorectal cancers are highly curable malignancies. Combined modality treatment with chemotherapy and radiation has dramatically\\u000a improved both disease-free and overall survival. Little is known about symptomatic complications of treatment.\\u000a \\u000a \\u000a \\u000a Methods  Case report based on chart review.\\u000a \\u000a \\u000a \\u000a Results  Two patients presented with painful anal lesions that were diagnosed as squamous cell carcinoma of the anus. Despite successful\\u000a treatment with chemotherapy and radiation, their

Simon Badin; Afsheen Iqbal; Manzurul Sikder; Victor T. Chang

2008-01-01

332

Medium-term results of anal advancement flap compared with lateral sphincterotomy for the treatment of anal fissure  

Microsoft Academic Search

Introduction  Anal fissure is associated with anal pain and bleeding. Lateral internal sphincterotomy (LIS) has been a common form of surgical\\u000a management. This can however cause incontinence and hence an equally effective alternative without this risk would be ideal.\\u000a Anal fissurectomy and an anal advancement flap (AAF) have been used as an alternative to LIS.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We carried out a retrospective analysis

Sanjay D. Patel; Tom Oxenham; Bhandhipalyan V. Praveen

333

Gracilis muscle as neoanal sphincter for faecal incontinence.  

PubMed

Faecal incontinence is a debilitating chronic clinical condition which may affect the patient and care givers. Modality of treatment is based on severity of the symptoms as well as the anatomical defect itself, availability of resources and expertise. We describe a modified technique of dynamic graciloplasty as neoanal sphincter for the treatment severe faecal incontinence who has failed previous over lapping sphincteroplasty. In our modified version, instead of using implanted intramuscular electrodes and subcutaneous neurostimulator to provide continuous stimulation, the patient will undergo an external stimulation on the nerve of transplanted gracilis periodically and concurrent biofeedback therapy. We believe the technique is relatively easy to learn and very cost effective without any electrodes or neurostimulator related complications. PMID:21265253

Zailani, M H M; Azmi, M N; Deen, K I

2010-03-01

334

[Reconstruction of velopharyngeal sphincter in secondary Cleft Palate: surgical alternative].  

PubMed

There are numerous surgical procedures for the repair of Cleft Palate (CP). Since 1998, in children with CP we use a modified Wardill-Kilner technique, with a large section of the nasal mucous layer at the level of the muscular insertion on the hard palate and lateral nasopharingeal wall, obtaining a push-back and reorientation of the muscular fibres without dissection, diminishing this way the risks of haemorrhages and fibrosis, simplifying the intervention. It allows a lower operative time and a short internment. The aim of our study was to evaluate the results of this operative procedure specially in the development of the speech in 73 children operated on from 1998 until 2000 in our hospital. We verify a competence of the velopharingeal sphincter with ideal results in speech in 88,8% of the cases. PMID:16846134

Recamán, M; Bonet, B; Leitão, J; Mesquita, A

2006-04-01

335

Anal dilatation versus left lateral sphincterotomy for chronic anal fissure: a prospective randomized study.  

PubMed

BACKGROUND: Several surgical methods are accepted for the treatment of chronic anal fissure. The most popular are anal dilatation (AD) and left lateral sphincterotomy (LLS). The objective of the current study was to prospectively evaluate the results of these two procedures in terms of recurrence rate, complications and patient satisfaction. METHODS: The study enrolled all patients who required operation for chronic anal fissure in the Division of General Surgery, Campus Golda, Rabin Medical Center, between the years 1997 and 2001. Exclusion criteria were acute anal fissure or inflammatory bowel disease. RESULTS: A total of 108 patients participated in the study, at an average age of 42.4 years (SD=12.5). The patients were randomly assigned to two groups; one for LLS (53 patients, 49.1%) and one for AD (55 patients, 50.9%). The study protocol included a questionnaire and a physical examination performed 1, 2, 3, 6 and 12 months after operation. The questionnaire contained questions about pain, bloody stool, incontinence for gas, fluid or hard feces, during the day or night, and soiling. The patients were also asked about their satisfaction on an analog scale from 1 to 10. The average follow-up was 11.2 months (SD=4.1). Minor incontinence occurred in 8 patients of AD group and in 2 patients of LLS group (p<0.005). Recurrence occurred in 6 cases of the AD group and in one case of the LLS group (p<0.003). Satisfaction score was insignificantly higher in the LLS group (9.1+/-0.8 in the LLS group and 7.4+/-2.0 in the AD group). CONCLUSIONS: These results suggest that LLS is the preferred method for the treatment for chronic anal fissure. PMID:18060530

Ram, E; Vishne, T; Lerner, I; Dreznik, Z

2007-12-01

336

Urethral sphincter EMG as event detector for Neurogenic detrusor overactivity.  

PubMed

The aim of this study was to investigate the feasibility of using external urethral sphincter electromyogram (EMG) (EUSEMG) to detect the onset of detrusor contractions in patients with both neurogenic detrusor overactivity (NDO) and detrusor sphincter dyssynergia (DSD). Detrusor pressure (Pdet) and EUSEMG was recorded in 23 neurogenic patients during slow artificial bladder filling. The time delay between the onset of a detrusor contraction and the onset of EUSEMG activity was calculated together with the detrusor pressure increase related to this delay. Of 23 patients enrolled, 12 patients showed both NDO and DSD. Of these 12 patients, 10 had a strong correlation between detrusor pressure and EUSEMG. One patient in this group was excluded due to a storage pressure above 30 cm H2O. Two detection methods were applied on the remaining 9 patients. Method 1 was a root mean square (RMS)-integrator with simple thresholding. This approach had a good sensitivity but also a poor specificity (many false-positive detections). Detection method 2 included a kurtosis-based scaling function, which was multiplied to a similar RMS-integrator as used in method 1. Onset detection occurred before Pdet exceeded 18 cm H2O with both methods. However, method 1 resulted in 14.1 +/- 12.8 false-positive detections during one bladder filling. Pdet at onset detection was on average 1.0 +/- 1.1 cmH2 0 higher with detection method 2 but the number of false-positives was reduced by 95.8%. This paper demonstrates the feasibility of using EUSEMG to estimate the onset of a detrusor contraction in selected patients. PMID:17605352

Hansen, John; Borau, Albert; Rodríguez, Alfred; Vidal, Joan; Sinkjaer, Thomas; Rijkhoff, Nico J M

2007-07-01

337

[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

338

Blood vessel rupture by cavitation  

PubMed Central

Cavitation is thought to be one mechanism for vessel rupture during shock wave lithotripsy treatment. However, just how cavitation induces vessel rupture remains unknown. In this work, a high-speed photomicrography system was set up to directly observe the dynamics of bubbles inside blood vessels in ex vivo rat mesenteries. Vascular rupture correlating to observed bubble dynamics were examined by imaging bubble extravasation and dye leakage. The high-speed images show that bubble expansion can cause vessel distention, and bubble collapse can lead to vessel invagination. Liquid jets were also observed to form. Our results suggest that all three mechanisms, vessel distention, invagination and liquid jets, can contribute to vessel rupture.

Chen, Hong; Brayman, Andrew A.; Bailey, Michael R.

2011-01-01

339

Nerves in the intersphincteric space of the human anal canal with special reference to their continuation to the enteric nerve plexus of the rectum.  

PubMed

In the intersphincteric space of the anal canal, nerves are thought to "change" from autonomic to somatic at the level of the squamous-columnar epithelial junction of the anal canal. To compare the nerve configuration in the intersphincteric space with the configuration in adjacent areas of the human rectum, we immunohistochemically assessed tissue samples from 12 donated cadavers, using antibodies to S100, neuronal nitric oxide synthase (nNOS), and tyrosine hydroxylase (TH). Antibody to S100 revealed a clear difference in intramuscular nerve distribution patterns between the circular and longitudinal muscle layers of the most inferior part of the rectum, with the former having a plexus-like configuration, while the latter contained short, longitudinally running nerves. Most of the intramural ganglion cells in the anal canal were restricted to above the epithelial junction, but some were located just below that level. Near or at the level of the epithelial junction, the nerves along the rectal adventitia and Auerbach's nerve plexus joined to form intersphincteric nerves, with all these nerves containing both nNOS-positive parasympathetic and TH-positive sympathetic nerve fibers. Thus, it was histologically difficult to distinguish somatic intersphincteric nerves from the autonomic Auerbach's plexus. In the intersphincteric space, the autonomic nerve elements with intrapelvic courses seemed to "borrow" a nerve pathway in the peripheral branches of the pudendal nerve. Injury to the intersphincteric nerve during surgery may result in loss of innervation in the major part of the internal anal sphincter. Clin. Anat., 2013. © 2013 Wiley Periodicals, Inc. PMID:23512701

Hieda, Keisuke; Cho, Kwang Ho; Arakawa, Takashi; Fujimiya, Mineko; Murakami, Gen; Matsubara, Akio

2013-03-20

340

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

341

Frequency of Persistent Anal Symptoms After First Instrumental Delivery  

Microsoft Academic Search

PURPOSE: This study was designed to evaluate persistent anal symptoms after first instrumental delivery beyond the postpartum period. METHODS: This prospective study was performed in a cohort of primiparas who underwent instrumental delivery from January 1, 2001 to September 30, 2002. Questionnaires for anal symptoms were completed in the maternity ward on the day after delivery and by mail or

Chafika Mazouni; Florence Bretelle; Samy Battar; Pascal Bonnier; Marc Gamerre

2005-01-01

342

Anal function in geriatric patients with faecal incontinence  

Microsoft Academic Search

The association of faecal incontinence with constipation and confusion in the elderly is well recognised but the anal function of faecally incontinent geriatric patients is poorly understood. Anal studies were therefore performed on 99 geriatric patients (49 with faecal incontinence, 19 continent patients with faecal impaction and 31 geriatric control patients with normal bowel habit) and 57 younger healthy control

J A Barrett; J C Brocklehurst; E S Kiff; G Ferguson; E B Faragher

1989-01-01

343

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

344

Results of salvage abdominoperineal resection for anal cancer after radiotherapy  

Microsoft Academic Search

PURPOSE: Nonsurgical treatment of anal cancer by radiotherapy alone or combined with chemotherapy is the standard therapy for epidermoid carcinoma of the anal canal. Surgery is only recommended for treatment failures. Very few studies have been devoted to the outcome of this salvage surgery. The aim of this study is to evaluate these results. METHODS: A retrospective review from 1986

Marc Pocard; Emmanuel Tiret; Karen Nugent; Nidal Dehni; Rolland Parc

1998-01-01

345

An approach to managing HPV-associated anal dysplasia.  

PubMed

Although anal cancer is rare, incidence rates are rising in the United States. Recognizing and screening high-risk patients can improve management. Vaccination may also play a role in the prevention of HPV-related anal cancer, but more research is needed. PMID:24049944

Grant, Erich J; Javier, Jimzon T; Kelley, Phillip A; Oliveri, Tia L; Lopez, Lucia A

2013-08-01

346

Predicting rupture arrests, rupture jumps and cascading earthquakes  

NASA Astrophysics Data System (ADS)

The devastation inflicted by recent earthquakes demonstrates the danger of under-predicting the size of earthquakes. Unfortunately, earthquakes may rupture fault-sections larger than previously observed, making it essential to develop predictive rupture models. We present numerical models based on earthquake physics and fault zone data, that determine whether a rupture on a segmented fault could cascade and grow into a devastating, multisegment earthquake. We demonstrate that weakened (damaged) fault zones and bi-material interfaces promote rupture propagation and greatly increase the risk of cascading ruptures and triggered seismicity. This result provides a feasible explanation for the outstanding observation of a very large (10 km) rupture jump documented in theMW7.8 2001 Kunlun, China earthquake. However, enhanced inter-seismic deformation and energy dissipation at fault tips suppress rupture propagation and may turn even small discontinuities into effective earthquake barriers. By assessing fault stability, identifying rupture barriers and foreseeing multisegment earthquakes, we provide a tool to improve earthquake prediction and hazard analysis.

Finzi, Y.; Langer, S.

2012-12-01

347

[Ruptured abdominal aortic aneurysms].  

PubMed

Eighty two aortic replacements of ruptured abdominal aortic aneurysms have been performed during the last 6 years. There were 72 male and 10 female patients, and the average age was 71.33 years. Hemorrhagic shock on the admission was observed in 45 patients, and 13 have been operated urgently without any diagnostic procedures. The transperitoneal approach have been used for the operation. Two aorto duodenal and one aorto caval fistulas, have been found. Only exploration (three patients died immediately after laparotomy and 6 after cross clamping) has been done in 9 cases, and the aortic replacement in 70 cases (27 with tubular, and 43 with bifurcated graft). In 3 cases and axillobifemoral bypass had to be done. During the operation eleven patients died, and 30 in postoperative period, during the period between one and 40 days. Total intrahospital mortality rate was 50%, compared with 3.5% for 250 electively operated patients with abdominal aortic aneurysms in same period. In postoperative period the most important cause of death was multiple organs failures. Statistically significant greater mortality rate (p > 0.01%) was found in cases of late operative treatment, hemorrhagic shock, intra-operational bleeding, ruptured front wall, suprarenal cross clamping and in patients older than 75 year. In complicated cases such as juxtarenal aneurysm, 3 sutures parachute technique for proximal anastomosis, a temporary transection of the left renal vein, and intraaortal balloon occlusive catheter for proximal bleeding control are recommended. PMID:10951761

Lotina, S I; Davidovi?, L B; Kosti?, D M; Stojanov, P L; Velimirovi?, D B; Djuki?, P L; Cinara, I S; Vojnovi?, B M; Savi?, D V

348

TRANSURETHRAL COLLAGEN INJECTIONS FOR MALE INTRINSIC SPHINCTER DEFICIENCY: THE UNIVERSITY OF TEXAS-HOUSTON EXPERIENCE  

Microsoft Academic Search

PurposeInjectable agents are used to increase urethral coaptation for the treatment of intrinsic sphincter deficiency. We evaluated the long-term results and complications of transurethral collagen injections in males.

O. LENAINE WESTNEY; RICHARD BEVAN-THOMAS; J. LYNN PALMER; R. DUANE CESPEDES; EDWARD J. McGUIRE

2005-01-01

349

[The role of esophageal sphincter tonus and of gastric motility in the extent of reflux esophagitis].  

PubMed

Thirty-two patients with symptomatic gastroesophageal reflux disease were investigated by esophagogastroduodenoscopy, 24 h pH monitoring, esophageal manometry and measurement of gastric emptying of solids, in order to elucidate the relative importance of lower esophageal sphincter tone, amount of acid reflux and gastric emptying on the degree of esophagitis. The mechanical competency of lower esophageal sphincter was significantly deranged in patients with moderate/severe esophagitis than in patients with mild esophagitis. The gastric emptying time was significantly delayed in patients with moderate/severe esophagitis than in patients with mild esophagitis. No relationship was observed between amount of acid reflux, lower esophageal sphincter function and gastric emptying time. Our results suggest that resting pressure of lower esophageal sphincter and the gastric motor function play a major role in severity of reflux esophagitis. PMID:1553047

Cogliandolo, A; Gulino, F M; Pustorino, S; Migliorato, D; Bottari, M; Saitta, F P; Micali, B

1992-01-01

350

Relationship Between Surgeon Caseload and Sphincter Preservation in Patients With Rectal Cancer  

Microsoft Academic Search

PURPOSE  The aim of this study was to determine by means of a national database whether higher surgeon caseload correlates with greater utilization of sphincter-sparing procedures than of abdominoperineal resections in treatment of patients with rectal cancer.METHODS  Patients with a primary International Classification of Diseases-9 diagnosis code of rectal cancer who underwent a sphincter-sparing procedure or abdominoperineal resection were selected from the

Harriett Purves; Ricardo Pietrobon; Sheleika Hervey; Ulrich Guller; William Miller; Kirk Ludwig

2005-01-01

351

Ruptured Abdominal AorticAneurysm  

Microsoft Academic Search

Background and Purpose: A ruptured abdominal aortic aneurysm is one of the most urgent surgical conditions with high mortality. The aim of the present study was to define relevant prognostic predictors for the outcome of surgical treatment. Patients and Methods: This study included 229 subsequent patients (83% males, 17% females, age 67.0 ± 7.5 years) with a ruptured abdominal aortic

Miroslav Markovi?; Lazar Davidovi?; Živan Maksimovi?; Dušan Kosti?; Ilijas ?inara; Slobodan Cvetkovi?; Radomir Sindjelic; Petar M. Seferovi?; Arsen D. Risti?

2004-01-01

352

Plantar Fascia Ruptures in Athletes  

Microsoft Academic Search

Objective: To educate sports medicine practitioners as to length of time for an athlete to return to activity after sustaining a rupture of the plantar fascia.Methods: Athletic patients sustaining plantar fascia ruptures and subsequent treatment were reviewed. Diagnosis was based on clinical findings, although radiographic studies were done. Patients were treated for 2 to 3 weeks with a below-knee or

Amol Saxena; Brian Fullem

2004-01-01

353

Consequential rupture of gas pipeline  

Microsoft Academic Search

In the earlier part of the year 2003, various pipeline ruptures were caused by sabotage activities in the southern part of Pakistan. The event being presented in this paper was fascinating because a pipe, which was blasted with the help of explosives, subsequently caused another pipe (buried 20ft away) to rupture through slow and gradual consequential erosion. On 8 April

F. Hasan; J. Iqbal

2006-01-01

354

Non-linear membrane properties of sacral sphincter motoneurones in the decerebrate cat  

PubMed Central

Responses to pudendal afferent stimulation and depolarizing intracellular current injection were examined in sacral sphincter motoneurones in decerebrate cats. In 16 animals examined, 2–10 s trains of electrical stimulation of pudendal afferents evoked sustained sphincter motoneurone activity lasting from 5 to >50 s after stimulation. The sustained response was observed in: 11 animals in the absence of any drugs; two animals after the intravenous administration of 5-hydroxytryptophan (5-HTP; ? 20 mg kg?1); one animal in which methoxamine was perfused onto the ventral surface of the exposed spinal cord; and two animals following the administration of intravenous noradrenergic agonists. Extracellular and intracellular recordings from sphincter motoneurones revealed that the persistent firing evoked by afferent stimulation could be terminated by motoneurone membrane hyperpolarization during micturition or by intracellular current injection. Intracellular recordings revealed that 22/40 sphincter motoneurones examined displayed a non-linear, steep increase in the membrane potential in response to depolarizing ramp current injection. The mean voltage threshold for this non-linear membrane response was -43 ± 3 mV. Five of the 22 cells displaying the non-linear membrane response were recorded prior to the administration of 5-HTP; 17 after the intravenous administration of 5-HTP (? 20 mg kg?1). It is concluded that sphincter motoneurones have a voltage-sensitive, non-linear membrane response to depolarization that could contribute to sustained sphincter motoneurone firing during continence.

Paroschy, K L; Shefchyk, S J

2000-01-01

355

Quantification of Intramuscular Nerves Within the Female Striated Urogenital Sphincter Muscle  

PubMed Central

Objective To analyze the quantity and distribution of intramuscular nerves within the striated urogenital sphincter and test the hypothesis that decreased nerve density is associated with decreased striated sphincter muscle and cadaver age. Methods Thirteen cadaveric urethras (mean age 47 years, range 15–78 years) were selected for study. A sagittal histologic section was stained with S100 stain to identify intramuscular nerves. The number of times that a nerve was seen within the striated urogenital sphincter (nerve number) was counted. The number of axons within each nerve fascicle was also counted. Regression analysis of nerve density against muscle cell number and age was performed. Results Remarkable variation was found in the quantity of intramuscular nerves in the striated urogenital sphincter of the 13 urethras studied. The number of nerves ranged from 72 to 543, a sevenfold variation (mean 247.1 ± standard deviation 123.2), and the range of number of axons was 431 to 3523 (2201 ± 1152.6). The larger nerve fascicles were seen predominantly in the distal (13.1 ± 5.7 axons per nerve) compared with the proximal part of the striated urogenital sphincter (1.2 ± 2). Reduced nerve density throughout the striated urogenital sphincter correlated with fewer muscle cells (P = .02). Nerve density also decreased with advancing age (P = .004). Conclusion Remarkable variation in the quantity of intramuscular nerves was found. Women with sparse intramuscular nerves had fewer striated muscle cells. Intramuscular nerve density declined with age.

PANDIT, MEGHANA; DELANCEY, JOHN O. L.; ASHTON-MILLER, JAMES A.; IYENGAR, JYOTHSNA; BLAIVAS, MILA; PERUCCHINI, DANIELE

2005-01-01

356

A randomized controlled trial to compare anal dilatation with lateral subcutaneous sphincterotomy for anal fissure  

Microsoft Academic Search

Summary  A prospective randomized trial has compared manual dilatation of the anus (MDA) during general anesthesia with lateral subcutaneous\\u000a sphincterotomy (LSS) during local anesthesia for the management of anal fissure in 156 patients. The two groups were similar\\u000a with respect to age, sex and symptoms. There was no difference in the duration of time off work or early complications of\\u000a treatment

M. Marby; J. Alexander-Williams; P. Buchmann; Y. Arabi; A. Kappas; S. Minervini; D. Gatehouse; M. R. B. Keighley

1979-01-01

357

Ruptured thought: rupture as a critical attitude to nursing research.  

PubMed

In this paper, we introduce the notion of ‘rupture’ from the French philosopher Michel Foucault, whose studies of discourse and governmentality have become prominent within nursing research during the last 25 years. We argue that a rupture perspective can be helpful for identifying and maintaining a critical potential within nursing research. The paper begins by introducing rupture as an inheritance from the French epistemological tradition. It then describes how rupture appears in Foucault's works, as both an overall philosophical approach and as an analytic tool in his historical studies. Two examples of analytical applications of rupture are elaborated. In the first example, rupture has inspired us to make an effort to seek alternatives to mainstream conceptions of the phenomenon under study. In the second example, inspired by Foucault's work on discontinuity, we construct a framework for historical epochs in nursing history. The paper concludes by discussing the potential of the notion of rupture as a response to the methodological concerns regarding the use of Foucault-inspired discourse analysis within nursing research. We agree with the critique of Cheek that the critical potential of discourse analysis is at risk of being undermined by research that tends to convert the approach into a fixed method. PMID:24741691

Beedholm, Kirsten; Lomborg, Kirsten; Frederiksen, Kirsten

2014-04-01

358

Effects of botulinum toxin A on the sphincter of Oddi: an in vivo and in vitro study  

Microsoft Academic Search

Background—Botulinum toxin A is a potent inhibitor of the release of acetylcholine from nerve endings. Local injection of botulinum toxin has recently been suggested to be helpful in sphincter of Oddi dyskinesia by decreasing sphincter of Oddi pressure.Aims—To explore the mechanism of action of botulinum toxin A on sphincter of Oddi (SO) muscle.Methods—Four piglets underwent duodenoscopy and SO manometry was

J Sand; I Nordback; P Arvola; I Pörsti; A Kalloo; P Pasricha

1998-01-01

359

The inhibitory role of nitric oxide in the control of porcine and human sphincter of Oddi activity  

Microsoft Academic Search

Background—The possible role of nitric oxide in the regulation of the sphincter of Oddi is not known in species with a resistor-like sphincter of Oddi such as humans and pigs.Methods—Sphincter of Oddi perfusion manometry and simultaneous electromyography (EMG) were recorded transduodenally in eight anaesthetised pigs. Acetylcholine (4 ?g\\/kg) was given intra-arterially, with or without sodium nitroprusside (10–100 ?g\\/kg), an exogenous

J Sand; P Arvola; V Jäntti; S Oja; C Singaram; G Baer; P J Pasricha; I Nordback

1997-01-01

360

Sphincter patency and hepatic BSP uptake after biliary sphincterotomy.  

PubMed Central

An attempt has been made to assess the patency and function of the choledochoduodenal junction after biliary sphincterotomy by estimating the first arrival time of injected bromsulphalein (BSP) in duodenal aspirate and the effect of morphine on this. Studies on 49 patients 1--12 years after this operation showed the arrival time to be normal in 47, but in 2 cases there was delay, which suggests that stenosis may develop in time in abot 4 per cent of cases. This had not been detected clinically, radiologically, or by liver function testing. Although it did not effect the BSP arrival time in T-tube bile, morphine was found to prolong the duodenal arrival time in control patients and also after sphincterotomy of the type used, indicating that the protective mechanism of the sphincter region may not have been destroyed by this operation. Abnormal BSP retention in plasma has been reported up to 5 years afte supraduodenal exploration of the bile ducts in 30 per cent of cases. Similarly, in the present study after biliary sphincterotomy plasma BSP levels were above normal in 14 of 49 patients, suggesting that this abnormality reflects the original pathological condition rather than the type of operation used to deal with it.

Peel, A. L.; Delvin, H. B.; Ritchie, H. D.

1975-01-01

361

Radial asymmetry characterized the upper esophageal sphincter pressures.  

PubMed

The characteristics of the upper esophageal sphincter (UES) motor functions remain unknown in Chinese. Twenty-three volunteers (M/F: 10/13, age: 19-40) without any pharyngeal/esophageal motor disturbance underwent UES measurement in the left decubitus position using a low compliance pneumohydraulic infusion system. These measurements included the location of UES from nostril, its resting pressure, and the responses to swallow. Mean UES resting pressures measured with three 120 degrees oriented manometric orifices were 22.6 +/- 7.7 mmHg, 16.9 +/- 8.6 mm Hg and 20.7 +/- 9.6 mmHg respectively (p < 0.05). In regard with the swallow-induced UES relax ability, the relax interval, the post-relax contractile amplitude and interval, neither dry swallow nor wet swallow led to a different result. Mean measured UES location from the nostril with the most proximal orifice of probe was 29.3 +/- 2.3 cm. This location did correlate very well with body height (r = 0.60, p < 0.01). In conclusion, this study demonstrates that the UES resting pressures exhibit a radial asymmetry, and that the type of swallow does not influence UES responses. Furthermore, an equation based on the body height may predict the most appropriate UES position. PMID:7796639

Lee, C T; Chang, F Y; Yeh, C L; Lee, S D

1994-01-01

362

Sacral Neuromodulation Effects on Periurethral Sensation and Urethral Sphincter Activity  

PubMed Central

Aims To characterize the effect of sacral neuromodulation (SNM) on urethral neuromuscular function. Methods Following IRB approval, women with refractory overactive bladder (OAB) underwent standardized urethral testing prior to and after stage 1 SNM implantation. Periurethral sensation was measured using current perception thresholds (CPT). Striated urethral sphincter activity was quantified using concentric needle electromyography (CNE) and Multi-Motor Unit Action Potential (MUP) analysis software. Nonparametric analyses were used to characterize pre/post changes with intervention. Baseline CPT and CNE findings were compared between SNM responders and non-responders. Results 27 women were enrolled in this pilot study with a mean age of 61±13 years. Twenty of 26 women (76.9%) responded to SNM and went to stage 2 permanent implantation. Four (14.8%) withdrew after stage 1 implantation; 3 of the 4 withdrawals had not had therapeutic responses to SNM. CPT and CNE parameters did not significantly differ from baseline 2 weeks after SNM. Pre-SNM urethral sensation was not significantly different between responders and non-responders. However, responders had larger amplitude, longer duration and more turns and phases at baseline approaching significance, reflecting more successful urethral reinnervation, than non-responders. Conclusions SNM does not alter urethral neuromuscular function two weeks post Stage 1implantation. Women with more successful urethral reinnervation may be more responsive to SNM.

Gleason, Jonathan L; Kenton, Kimberly; Greer, W. Jerod; Ramm, Olga; Szychowski, Jeff M.; Wilson, Tracey; Richter, Holly E.

2013-01-01

363

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

364

Cell-based therapy for the deficient urinary sphincter.  

PubMed

When sterile culture techniques of mammalian cells first became state of the art, there was tremendous anticipation that such cells could be eventually applied for therapeutic purposes. The discovery of adult human stem or progenitor cells further motivated scientists to pursue research in cell-based therapies. Although evidence from animal studies suggests that application of cells yields measurable benefits, in urology and many other disciplines, progenitor-cell-based therapies are not yet routinely clinically available. Stress urinary incontinence (SUI) is a condition affecting a large number of patients. The etiology of SUI includes, but is not limited to, degeneration of the urinary sphincter muscle tissue and loss of innervation, as well as anatomical and biomechanical causes. Therefore, different regimens were developed to treat SUI. However, at present, a curative functional treatment is not at hand. A progenitor-cell-based therapy that can tackle the etiology of incontinence, rather than the consequences, is a promising strategy. Therefore, several research teams have intensified their efforts to develop such a therapy for incontinence. Here, we introduce candidate stem and progenitor cells suitable for SUI treatment, show how the functional homogeneity and state of maturity of differentiated cells crucial for proper tissue integration can be assessed electrophysiologically prior to their clinical application, and discuss the trophic potential of adult mesenchymal stromal (or stem) cells in regeneration of neuronal function. PMID:23824516

Hart, Melanie L; Neumayer, Katharina M H; Vaegler, Martin; Daum, Lisa; Amend, Bastian; Sievert, Karl D; Di Giovanni, Simone; Kraushaar, Udo; Guenther, Elke; Stenzl, Arnulf; Aicher, Wilhelm K

2013-10-01

365

Vaginal stenosis and hydrometrocolpos: late complication of inadvertent perivaginal placement of an artificial urinary sphincter in prepubertal girls(1).  

PubMed

Urinary incontinence in pediatric and adolescent patients has been successfully managed with the artificial urinary sphincter for several decades. Placement of the sphincter can be difficult in the preadolescent girl due to poorly developed vaginal tissue that can result in difficulty establishing the surgical plane between the bladder and vagina. We report 2 patients in whom the sphincter was placed around the urethra and vagina, a complication that has been reported in only 1 patient previously. All 3 patients presented with hematometrocolpos and bloody vaginal discharge. All were successfully managed with replacement of the sphincter cuff around the urethra and delayed vaginoplasty. PMID:10754150

Cain, M P; Rink, R C

1999-11-01

366

Anal sensitivity test: What does it measure and do we need it?  

Microsoft Academic Search

PURPOSE: This study was undertaken to determine the anal sensitivity in controls and in different patient groups and to establish factors that determine anal sensitivity. METHODS: Anorectal function tests were performed in 387 patients with different anorectal diseases. Anal sensitivity was measured in 36 controls. Anal sensitivity was measured by means of mucosal electrosensitivity (MES) using a catheter with two

Richelle J. F. Felt-Bersma; Alexander C. Poen; Miguel A. Cuesta; Stephan G. M. Meuwissen

1997-01-01

367

The role of the upper oesophageal sphincter in voice rehabilitation after laryngectomy and Staffieri's procedure.  

PubMed

The Staffieri method was used for voice rehabilitation after total laryngectomy in our patients. Leakage of saliva has been a problem in some. It has been suggested that aspiration could be due to specific pressure relations in the pharynx, upper oesophageal sphincter and cervical oesophagus during deglutition (Mann et al., 1980). Regarding voice production, the upper oesophageal sphincter is probably the main sound source, functioning in essentially the same way as in oesophageal speech. Intraluminal pressure recordings at rest and during swallowing were used in 16 Staffieri speakers and 9 oesophageal speakers. Upper oesophageal sphincter dysfunction was seen more often in Staffieri speakers with aspiration problems than in Staffieri speakers without aspiration problems, but the relation is not clearly understood. A definite relation could be established between upper oesophageal sphincter function in terms of relaxation and coordination and aerodynamic pressure measured in the tracheostoma, necessary to sustain phonation. After dilatation of the oesophagus, produced by the inflow of air, a reflex rise in the upper oesophageal sphincter pressure is thought to occur. The pressure necessary to sustain phonation probably depends on the extent to which this reflex mechanism occurs and on the ability of the patient to induce a relaxation of the upper oesophageal sphincter before air expulsion. Selective myotomy will possibly lower the necessary pressure and enhance vocal rehabilitation. Whether this will solve a part of the aspiration problems in Staffieri speakers is completely unpredictable, as the relation of the motor function of the upper oesophageal sphincter and the aspiration problems is not well understood. PMID:3944505

Vuyk, H D; Klinkenberg-Knol, E; Tiwari, R M

1986-01-01

368

Pressing the nerve alters muscle fiber types of the peroneus longus in rats: Preliminary evidence for external anal sphincteroplasty.  

PubMed

Background Studies have demonstrated that anal reconstruction with a gracilis graft pressing the dominant nerve could be used to treat fecal incontinence. However, the detailed mechanism by this remains unknown. Herein, we evaluated the alteration in muscle fiber types and contractility of the peroneus longus muscle in rats after pressing its dominant nerves. Material and Methods The rat soleus and peroneus longus were exposed during surgery. The superficial peroneal nerve was pressed so that the peroneus longus temporarily lost its innervation. The epimysium between the soleus and the peroneus longus was removed. The end point of the soleus was cut off and the epimysium of the contact surfaces of the soleus and the peroneus longus were sutured. Five months later, peroneus longus contractility was recorded by the myograph system, and types of muscle fibers were observed using the myosin ATPase staining method. Results The skeletal muscle fiber type underwent adaptive changes due to double innervations with both fast and slow muscle nerves. Compared with other groups, the percentage of type I fibers in the peroneus longus increased significantly in the group of rats with the pressure on the nerve and removal of the sarcolemma. The maximal contraction and relaxation time at the single twitch and complete tetanus of the peroneus longus were also increased. Conclusions Our results show that pressing dominant nerves alter the skeletal muscle fiber types of the peroneus longus, which lead to increased maximal contraction and relaxation time, and significantly improve the ability in resistance to fatigue in rats. This study provides a basis for future clinical studies for external anal sphincter reconstruction using gracilis grafts that are doubly innervated by pressing on its dominant nerve. PMID:24807024

Shi, Song; Liu, Hao; Bai, Xiaobin; Cao, Yongxiao

2014-01-01

369

Pressing the nerve alters muscle fiber types of the peroneus longus in rats: Preliminary evidence for external anal sphincteroplasty  

PubMed Central

Background Studies have demonstrated that anal reconstruction with a gracilis graft pressing the dominant nerve could be used to treat fecal incontinence. However, the detailed mechanism by this remains unknown. Herein, we evaluated the alteration in muscle fiber types and contractility of the peroneus longus muscle in rats after pressing its dominant nerves. Material/Methods The rat soleus and peroneus longus were exposed during surgery. The superficial peroneal nerve was pressed so that the peroneus longus temporarily lost its innervation. The epimysium between the soleus and the peroneus longus was removed. The end point of the soleus was cut off and the epimysium of the contact surfaces of the soleus and the peroneus longus were sutured. Five months later, peroneus longus contractility was recorded by the myograph system, and types of muscle fibers were observed using the myosin ATPase staining method. Results The skeletal muscle fiber type underwent adaptive changes due to double innervations with both fast and slow muscle nerves. Compared with other groups, the percentage of type I fibers in the peroneus longus increased significantly in the group of rats with the pressure on the nerve and removal of the sarcolemma. The maximal contraction and relaxation time at the single twitch and complete tetanus of the peroneus longus were also increased. Conclusions Our results show that pressing dominant nerves alter the skeletal muscle fiber types of the peroneus longus, which lead to increased maximal contraction and relaxation time, and significantly improve the ability in resistance to fatigue in rats. This study provides a basis for future clinical studies for external anal sphincter reconstruction using gracilis grafts that are doubly innervated by pressing on its dominant nerve.

Shi, Song; Liu, Hao; Bai, Xiaobin; Cao, Yongxiao

2014-01-01

370

Single incision laparoscopic surgery - trans anal endoscopic microsurgery: A technological innovation  

PubMed Central

Trans anal endoscopic microsurgery (TEM) first burst upon the scene several decades ago and then underwent a period of immersion. We have herein reported our experience in two cases who underwent TEM using laparoscopic techniques. The advent of single incision laparoscopic surgery (SILS) has made great inroads into various fields of general and gastrointestinal (GI) surgery. We decided to make use of the same technique in TEM for two patients who had large sessile villous adenomas of the rectum. We used this port and fixed it transanally to the edge of the anus. Carbon dioxide used for insufflation in laparoscopic surgery was used through one of the ports, and a telescope was inserted to the larger port. We made sure that the entire polyp was cut out completely until the circular muscle of the internal sphincter was clearly exposed. Next, the cut edges of the rectum were undermined between the mucosa and the circular muscles in order to bring the cut edges closer together. We were able to perform this SILS TEM in two cases. In both the cases, well differentiated villous adenoma (colonoscopically, biopsy proven before surgery) was confirmed after excision. The question has been raised whether TEM is the new laparoscopy for anorectal surgery. Increasingly, several reports are showing promise for treatment for early stage cancers and large rectal adenomas using TEM. Adoption of our technique using the SILS port that has not been previously described in medical literature, seems to be a promising tool for the future. TEM first burst upon the scene several decades ago and then under went a period of immersion. In recent years, with the onset of laparoscopic surgery, the thoughts and the ideas of using a laparoscopic surgical technique have invaded the area of colorectal cancer as well. We have herein reported our experience in two cases who underwent TEM using laparoscopic techniques.

Shah, Neha; Sasikumar, Pattabi; Rajkumar, Janavikula Sankaran

2014-01-01

371

Single incision laparoscopic surgery - trans anal endoscopic microsurgery: A technological innovation.  

PubMed

Trans anal endoscopic microsurgery (TEM) first burst upon the scene several decades ago and then underwent a period of immersion. We have herein reported our experience in two cases who underwent TEM using laparoscopic techniques. The advent of single incision laparoscopic surgery (SILS) has made great inroads into various fields of general and gastrointestinal (GI) surgery. We decided to make use of the same technique in TEM for two patients who had large sessile villous adenomas of the rectum. We used this port and fixed it transanally to the edge of the anus. Carbon dioxide used for insufflation in laparoscopic surgery was used through one of the ports, and a telescope was inserted to the larger port. We made sure that the entire polyp was cut out completely until the circular muscle of the internal sphincter was clearly exposed. Next, the cut edges of the rectum were undermined between the mucosa and the circular muscles in order to bring the cut edges closer together. We were able to perform this SILS TEM in two cases. In both the cases, well differentiated villous adenoma (colonoscopically, biopsy proven before surgery) was confirmed after excision. The question has been raised whether TEM is the new laparoscopy for anorectal surgery. Increasingly, several reports are showing promise for treatment for early stage cancers and large rectal adenomas using TEM. Adoption of our technique using the SILS port that has not been previously described in medical literature, seems to be a promising tool for the future. TEM first burst upon the scene several decades ago and then under went a period of immersion. In recent years, with the onset of laparoscopic surgery, the thoughts and the ideas of using a laparoscopic surgical technique have invaded the area of colorectal cancer as well. We have herein reported our experience in two cases who underwent TEM using laparoscopic techniques. PMID:24761088

Shah, Neha; Sasikumar, Pattabi; Rajkumar, Janavikula Sankaran

2014-04-01

372

Pathophysiology of anal incontinence, constipation, and defecatory dysfunction.  

PubMed

Anorectal disorders cause significant discomfort and embarrassment in women. The onset typically follows childbirth and symptoms increase with age. This article discusses anal incontinence, defecatory dysfunction, rectal prolapse, and constipation. PMID:19932420

Toglia, Marc R

2009-09-01

373

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.

374

[Diagnosis and treatment for carcinoma associated with anal fistula].  

PubMed

In this article, we focus on the diagnosis and treatment of carcinoma associated with anal fistula. Carcinoma associated with anal fistula is relatively rare, representing 6.9% of all anal carcinoma in Japan. It arises from long-standing anal fistula with more than 10 years duration. Clinical suspicion is crucial in diagnosis, however, early detection is challenging. A biopsy under anesthesia is often needed for histological confirmation of the tumor. Magnetic resonance imaging can facilitate the diagnosis and is essential to determine the range of the surgical resection. Abdominoperineal resection is usually performed as the surgical treatment of choice. Combined chemoradiation therapy may improve the outcome of locally advanced tumor. PMID:24597365

Nagai, Yuzo; Kiyomatsu, Tomomichi; Watanabe, Toshiaki

2014-01-01

375

Adenocarcinoma of the Sigmoid Colon Seeding a Chronic Anal Fistula  

Microsoft Academic Search

Damaged mucosal sites seem to be vulnerable to tumor cell implantation. We describe a case of exfoliated tumor cells from a sigmoid colon cancer seeding a long-standing anal fistula. The implications of this finding are reviewed.

Neil Hyman; Masatoski Kida

2003-01-01

376

Mucosal advancement in the treatment of anal fistula  

Microsoft Academic Search

One hundred eighty-nine patients with anal fistula treated within an eight-month to seven-year period by anal fistulectomy\\u000a and rectal mucosal advancement are presented. An 80 percent follow-up revealed a 90 percent asymptomatic group and a ten percent\\u000a group who had minor symptoms. Eight percent of the symptomatic patients had minor soiling; 7 percent were incontinent for\\u000a gas, and 6 percent

Pedro S. Aguilar; Gustavo Plasencia; Thomas G. Hardy; Rene F. Hartmann; William R. C. Stewart

1985-01-01

377

Does HIV status influence the anatomy of anal fistulas?  

Microsoft Academic Search

PURPOSE: Although anorectal disease is common in human immunodeficiency virus-positive patients, little is known about the type and anatomic distribution of anal fistulas in this patient group. The aim of this study was to compare anatomic characteristics of anal fistulas in human immunodeficiency virus-positive patients with those in human immunodeficiency virus-negative patients by use of a retrospective chart review. METHODS:

Carlo M. Manookian; Thomas P. Sokol; Charles Headrick; Phillip R. Fleshner

1998-01-01

378

Expectant Management of Anal Squamous Dysplasia in Patients With HIV  

Microsoft Academic Search

\\u000a Purpose  Anal squamous dysplasia is commonly found in patients with HIV infection. There is no satisfactory treatment that eradicates\\u000a this premalignant lesion with low morbidity and low recurrence. This study reviews a series of patients with HIV and an abnormal\\u000a anal examination who had squamous dysplasia and who have been followed with physical examination alone and with repeat biopsies\\u000a as necessary

Bikash Devaraj; Bard C. Cosman

2006-01-01

379

Evaluation and treatment of anal incontinence, constipation, and defecatory dysfunction.  

PubMed

Posterior compartment disorders include anal incontinence, constipation, and defecatory dysfunction. These disorders cause considerable morbidity, and are typically underreported by patients and undertreated by providers. The purpose of this article is outline the approach to diagnosis and treatment of anal incontinence, constipation, and defecatory dysfunction with a brief description of the nature of the problem and approaches to evaluation and diagnosis, as well as medical and surgical management. PMID:19932421

Omotosho, Tola B; Rogers, Rebecca G

2009-09-01

380

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

381

Carcinoma and the ileal pouch-anal anastomosis  

Microsoft Academic Search

Of 362 patients undergoing ileal pouch-anal anastomosis, 12 (five with chronic ulcerative colitis and seven with familial adenomatous polyposis) had 16 associated carcinomas. Incidental carcinoma was found in four patients who had undergone ileal pouch-anal anastomosis, six patients had known carcinoma, and carcinoma was suspected in two patients with high-grade dysplasia. No tumor was Stage C or D. After a

Othon Wiltz; Hasan F. Hashmi; David J. Schoetz; Patricia L. Roberts; John J. Murray; John A. Coller; Malcolm C. Veidenheimer

1991-01-01

382

The ruptured PIP breast implant.  

PubMed

Public concern erupted about the safety of Poly Implant Prothèse (PIP) breast implants when it was revealed in 2011 that they contained an inferior, unlicensed industrial-grade silicone associated with a high rate of rupture. There followed national guidance for UK clinicians, which led to a considerable increase in referrals of asymptomatic women for breast implant assessment. In this review we discuss possible approaches to screening the PIP cohort and the salient characteristics of a ruptured implant. PMID:23622796

Helyar, V; Burke, C; McWilliams, S

2013-08-01

383

Effects of ethanol on the sphincter of Oddi: an endoscopic manometric study.  

PubMed Central

The effects of ethanol, given either intragastrically or intravenously, on the sphincter of Oddi was evaluated by endoscopic manometry. In 12 subjects intragastric ethanol (150 ml of 32%) was given over 10 minutes. In five control subjects saline solution (150 ml of 0.9%) was given intragastrically instead of ethanol. In five other subjects ethanol was infused intravenously (6 ml/kg of 10%) for 36 minutes. Ethanol given intragastrically produced a significant inhibitory effect on sphincter of Oddi pressure. Peak pressure fell from a control value of 75.7 +/- 26.35 mmHg to 39 +/- 15.39 mmHg (p less than 0.001) at 35 minutes. Basal pressure fell from a control value of 30.17 +/- 19.47 mmHg to 11.83 +/- 6.35 mmHg (p less than 0.01) at 35 minutes. Wave height fell from a control value of 41.33 +/- 15.4 mmHg to 27.16 +/- 11.25 mmHg (p less than 0.02) at 35 minutes. No effects on sphincter of Oddi wave frequency were observed. No significant modifications of sphincter motor activity were observed after intragastric saline infusion. Ethanol given intravenously also produced an appreciable inhibitory effect on sphincter of Oddi pressure, without affecting its wave frequency.

Viceconte, G

1983-01-01

384

Cholescintigraphic detection of functional obstruction of the sphincter of Oddi. Effect of papillotomy  

SciTech Connect

Unexplained abdominal pain after cholecystectomy has been attributed to sphincter of Oddi dysfunction, but no objective diagnostic criteria exist. Biliary excretion was quantitated by computer-assisted cholescintigraphy in 35 postcholecystectomy controls without symptoms, 9 patients with suspected sphincter of Oddi dysfunction (studied before and after sphincterotomy), and 18 patients with overt cholestasis from other causes (6 with extrahepatic obstruction and 12 with parenchymal liver disease). In patients with sphincter of Oddi dysfunction or with cholestasis, the time to attain maximal activity in the biliary system was significantly (p less than 0.05) longer, the percent of radiotracer excreted at 45, 60, and 90 min was less, and the emptying rate was slower compared with the controls. Cholecystokinin (0.02 U/kg X min) did not abolish biliary output, excluding a paradoxical response of the sphincter. After sphincterotomy, biliary activity peaked earlier and the percent excreted at 45 min increased but did not revert to normal. Relief of symptoms occurred in 8 of 9 patients. The one failure had normal emptying characteristics before sphincterotomy, and did not change after surgery. Another developed recurrent pain and a corresponding deterioration in biliary emptying on serial scans. Thus, functional obstruction at the sphincter of Oddi exists, is not due to any paradoxical response to cholecystokinin, and in the absence of overt cholestasis, can be detected by quantitative cholescintigraphy. Successful sphincterotomy may not completely restore biliary emptying to normal.

Shaffer, E.A.; Hershfield, N.B.; Logan, K.; Kloiber, R.

1986-03-01

385

ACR Appropriateness Criteria®-Anal Cancer.  

PubMed

The management of anal cancer is driven by randomized and nonrandomized clinical trials. However, trials may present conflicting conclusions. Furthermore, different clinical situations may not be addressed in certain trials because of eligibility inclusion criteria. Although prospective studies point to the use of definitive 5-fluorouracil and mitomycin C-based chemoradiation as a standard, some areas remain that are not well defined. In particular, management of very early stage disease, radiation dose, and the use of intensity-modulated radiation therapy remain unaddressed by phase III studies. The American College of Radiology (ACR) Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:24558509

Hong, Theodore S; Pretz, Jennifer L; Herman, Joseph M; Abdel-Wahab, May; Azad, Nilofer; Blackstock, A William; Das, Prajnan; Goodman, Karyn A; Jabbour, Salma K; Jones, William E; Konski, Andre A; Koong, Albert C; Rodriguez-Bigas, Miguel; Small, William; Thomas, Charles R; Zook, Jennifer; Suh, W Warren

2014-01-01

386

[Multivariate analysis of risk factors disappointing functions after anal holding abdominal-anal resection with delayed formation koloanal anastomosis].  

PubMed

Multivariate analysis of clinical factors was conducted on the material histories of 195 patients treated between 2004 and 2006. In Donetsk regional antitumor center, which for rectal cancer (RC) is made abdomino-anal resection of the rectum with the delayed formation koloanal anastomosis after bringing down the colon to the perineum. In 97 patients the operation was performed with the use of electric welding soft tissue (EWST), in 98--a standard way. Studied the quality of life of patients using a questionnaire QLQ C30-CR38 and the function of the anal incontinence (Wexner scale). It is established, that the greatest influence on the function of the anal continence have a view of a combined and complex treatment, radicality intervention, the method of forming koloanal of anastomosis. Application EWST the second stage of surgery to cut off excess relegated intestine helped reduce the risk of poor function of the anal continence. PMID:24923144

2014-01-01

387

Novel treatments of GERD: focus on the lower esophageal sphincter.  

PubMed

Up to 50% of patients with gastroesophageal reflux disease (GERD) still suffer from GERD symptoms despite proton pump inhibitor (PPI) therapy, indicating a need for new treatments. The lower esophageal sphincter (LES) plays a crucial role in maintaining the mechanical barrier necessary for prevention of gastric reflux. Transient LES relaxation (TLESR) is an important factor behind the occurrence of reflux, and preclinical studies have identified a number of targets for pharmacologic modification of TLESR. However, only gamma-aminobutyric acid (GABA) type B receptor (GABA(B)) agonists and metabotropic glutamate receptor 5 (mGluR5) modulators have shown positive proof of concept in the clinical setting. The mGluR5 negative allosteric modulator ADX10059 improved symptoms in GERD patients, but was associated with central side effects such as dizziness. Baclofen, a GABA(B) receptor agonist, reduces the incidence of TLESR and improves GERD symptoms in both adult and pediatric GERD patients. However, the utility of baclofen is similarly limited by poor tolerability and recent research has focused on the development of GABA(B) receptor agonists with improved tolerability. XP19986, a prodrug of R-baclofen, reduced the number of reflux episodes in a dose-ranging study and was similarly tolerated to placebo. AZD3355 and AZD9343 are GABA(B) receptor agonists with limited central nervous system activity that have been shown in preclinical studies to reduce the incidence of TLESR and decrease esophageal acid exposure; data from clinical studies of these agents in GERD patients are awaited with interest. Agents that target TLESR activity may therefore offer a promising new add-on treatment for patients who suffer from GERD symptoms despite PPI therapy. PMID:18924449

Lehmann, A

2008-08-01

388

Characterization of cholecystokinin receptors on the sphincter of Oddi.  

PubMed

To characterize directly the ability of cholecystokinin (CCK) to interact with receptors on the sphincter of Oddi (SO), we measured binding of 125I-labeled Bolton-Hunter-labeled COOH-terminal octapeptide of cholecystokinin (125I-BH-CCK-8) to tissue sections from the guinea pig SO. Autoradiography localized binding of 125I-BH-CCK-8 over the SO smooth muscle layer. Binding was saturable, specific, dependent on time, pH, and temperature, and was reversible. Binding of 125I-BH-CCK-8 was inhibited by various CCK receptor agonists with the following potencies: CCK-8 much greater than des(SO3)CCK-8 much greater than gastrin-17-I and by various CCK receptor antagonists with the following potencies: L-364,718 greater than proglumide analogue 10 much greater than carbobenzoxy-Tyr(SO3H)-Met-Gly-Trp-Met-Asp-NH2 greater than N2,O2' dibutyryl guanosine 3',5'-cyclic monophosphate. The potencies of agonists in stimulating and of antagonists in inhibiting CCK-8-stimulated SO contractions correlated closely with their abilities to inhibit binding of 125I-BH-CCK-8. Analysis of binding of 125I-BH-CCK-8 to SO tissue sections revealed two classes of CCK binding sites: a high-affinity site [dissociation constant (Kd) 0.2 nM] and a low-affinity site (Kd 70 nM). Atropine or tetrodotoxin (TTX) caused a similar rightward shift of the CCK-8 dose-response curve for stimulation of SO contraction. Comparison of receptor occupation to CCK-8-induced contraction suggested that CCK-8 occupation of the high-affinity binding site correlated with contraction in the absence of atropine and the low-affinity CCK binding with contraction in the presence of atropine or TTX.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2240227

Cox, K L; von Schrenck, T; Moran, T H; Gardner, J D; Jensen, R T

1990-11-01

389

Three-Dimensional Anal Endosonography May Improve Staging of Anal Cancer Compared With Two-Dimensional Endosonography  

Microsoft Academic Search

PURPOSE Three-dimensional (3-D) endosonography is a new method of staging anal carcinoma that has not yet been validated in comparison with two-dimensional (2-D) endosonography, the latter using only a single scan plane. The aim of this study was to investigate the differences between the two endosonographic techniques. METHODS Thirty patients with an endosonographically detectable anal tumor were examined with a

Anders F. Christensen; Michael B. Nielsen; Svend A. Engelholm; Henrik Roed; Lars B. Svendsen; Hanne Christensen

2004-01-01

390

Immunohistochemical analysis of p53 expression in anal squamous neoplasia.  

PubMed Central

AIMS--To determine the pattern of expression of the p53 tumour suppressor gene product in anal squamous neoplasia, and to determine if this could be used as a marker of disease progression. The association between p53 expression and human papillomavirus (HPV) 16 DNA status of the anal lesions was also investigated. METHODS--The presence and localisation of the p53 protein in formalin fixed, paraffin wax embedded specimens of anal squamous epithelium (normal and neoplastic) was examined using immunohistochemical staining with a panel of two monoclonal antibodies (DO-1, DO-7) and one polyclonal antibody (CM-1). Thirty nine normal anal epithelia, 14 anal intraepithelial neoplasia (AIN) grade 1, seven AIN 2, and 20 AIN 3 specimens were obtained from patients without demonstrable invasive disease; twelve AIN 3 specimens adjacent to invasive disease and 34 anal squamous cancers were also examined. Genomic DNA from all 126 specimens was extracted and analysed for HPV 16 DNA using the polymerase chain reaction (PCR). RESULTS--Nuclear p53 was strongly expressed in 67% (23/34) of invasive anal squamous tumours, 75% (9/12) of AIN 3 specimens adjacent to invasive disease, and in 60% (12/20) of AIN 3 specimens obtained from patients without demonstrable invasive disease. Two of the patients in the latter group with positively staining specimens subsequently developed invasive tumours which had staining characteristics similar to those of the AIN 3 specimens. p53 protein was expressed in very low concentrations in low grade AIN and not at all in normal anal squamous epithelium. In those specimens which stained positively for p53, HPV 16 DNA sequences were detected in 69.5% (16/23) of invasive disease, 77.7% (7/9) of AIN 3 adjacent to invasive disease, 75% (9/12) of AIN 3 obtained from patients without demonstrable invasive disease, 33.3% (2/6) of AIN 2, and in 40% (2/5) of AIN 1. There was no significant correlation between p53 immunostaining and HPV 16 DNA status (p < 0.05). CONCLUSIONS--Aberrant expression of the p53 gene product is probably involved in the pathogenesis of anal squamous neoplasia. Long term follow up studies of all patients with AIN are required to determine if this could be used as a marker of likely disease progression from high grade AIN to invasive disease. There does not seem to be an association between the presence or absence of HPV 16 DNA sequences and mutant p53 proteins in anal squamous neoplasia. Images

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

1993-01-01

391

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

392

Bladder muscle biopsy and urethral sphincter EMG in patients with bladder dysfunction after pelvic surgery.  

PubMed Central

Eleven patients who suffered persistent bladder dysfunction after pelvic surgery have been investigated by needle urethral sphincter electromyography (EMG) and bladder muscle biopsy, and the results compared with those obtained in a series of controls. Individual motor units recorded from the urethral sphincter in patients who had undergone pelvic surgery were strikingly abnormal, suggesting the presence of reinnervation, and the density of detrusor innervation was significantly reduced. However, since reduction in the density of detrusor innervation may occur in circumstances other than peripheral nerve injury, we conclude that urethral sphincter EMG provides the most effective means of assessing damage to vesico-urethral innervation as a result of previous pelvic surgery. Images Figure 5.

Kirby, R S; Fowler, C J; Gilpin, S A; Gosling, J A; Milroy, E J; Turner-Warwick, R T

1986-01-01

393

Six2 activity is required for the formation of the mammalian pyloric sphincter  

PubMed Central

The functional activity of Six2, a member of the so/Six family of homeodomain-containing transcription factors, is required during mammalian kidney organogenesis. We have now determined that Six2 activity is also necessary for the formation of the pyloric sphincter, the functional gate at the stomach-duodenum junction that inhibits duodenogastric reflux. Our data reveal that several genes known to be important for pyloric sphincter formation in the chick (e.g., Bmp4, Bmpr1b, Nkx2.5, Sox9, and Gremlin) also appear to be required for the formation of this structure in mammals. Thus, we propose that Six2 activity regulates this gene network during the genesis of the pyloric sphincter in the mouse.

Self, Michelle; Geng, Xin; Oliver, Guillermo

2009-01-01

394

Randomized trial of stent placed above and across the sphincter of Oddi in malignant bile duct obstruction  

Microsoft Academic Search

Background: Placement of stents above an intact sphincter of Oddi might prevent migration of bacteria and deposition of organic material into the stent. In patients with malignant obstructive jaundice prolongation of function time of the stent would be expected if it is placed above the sphincter of Oddi. Methods: Thirty-four patients were randomized to stent placement either above (n =

Finn Møller Pedersen; Annmarie Touborg Lassen; Ove B. Schaffalitzky de Muckadell

1998-01-01

395

Comparison of Ultrasound-Secretin Test and Sphincter of Oddi Manometry in Patients with Recurrent Acute Pancreatitis  

Microsoft Academic Search

Manometry is considered the gold standard forevaluating sphincter of Oddi dysfunction. It hasrecently been demonstrated that the ultrasound (US)secretin test proposed a few years ago as a noninvasive test for the study of sphincter of Oddidysfunction yields a substantial percentage ofpathological findings in patients with acute recurrentpancreatitis. The aim of this study was to compare theresults of the US secretin

V. Di Francesco; M. P. Brunori; L. Rigo; J. Toouli; G. Angelini; L. Frulloni; P. Bovo; M. Filippini; B. Vaona; G. Talamini; G. Cavallini

1999-01-01

396

[Innovations in defered emergency surgery for complete rupture of the membranous uretra].  

PubMed

Posterior urethral injuries may be associated with pelvic fractures, which are serious accidents that can be life-threatening, and invariably affect urinary and sexual function. Current strategy for treating complete rupture of the membranous urethra involves minimal cystotomy with emergency surgery within the first 10 days, this is later followed by what is considered to be the ideal solution, end-to-end urethral anastomosis using the transpubic approach. However, this anatomic reconstruction is hindered by the greatdifficulty of locating the distal portion of the uretra below the superior layer of the medial perineal aponeurosis. As we described, this problem is resolved using a maneuver involving elevation of the urogenital diaphragm, which allows for the indentification and exposure of the distal urethra, facilitating tension-free termino-terminal anastomosis, sparing the external sphincter. PMID:22263358

Díaz-Rubio García, Manuel

2010-01-01

397

Current treatment options for management of anal intraepithelial neoplasia.  

PubMed

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. PMID:23788834

Weis, Stephen E

2013-01-01

398

JC Virus T-Antigen Expression in Anal Carcinoma  

PubMed Central

Background & Aims Anal carcinoma is thought driven by HPV infection through interrupting function of cell regulatory proteins such as p53 and pRb. JCV expresses a T-antigen (T-Ag) that causes malignant transformation through development of aneuploidy and interaction with some of the same regulatory proteins as HPV. JCV T-Ag is present in brain, gastric and colon malignancies, but has not been evaluated in anal cancers. We examined a cohort of anal cancers for JCV T-Ag and correlated this with clinicopathologic data. Methods Archived anal carcinomas were analyzed for JCV T-Ag expression. DNA from tumor and normal tissue was sequenced for JCV with viral copies determined by qPCR and Southern blotting. HPV and MSI status was correlated with JCV T-Ag expression. Results Of 21 cases of anal cancer (mean age 49 years, 38% female), 12 (57%) were in HIV-positive individuals. All 21 cancers expressed JCV T-Ag, including 9 HPV-negative specimens. More JCV copies were present in cancer vs. surrounding normal tissue (mean 32.54 copies/?g DNA vs. 2.98 copies/?g DNA, P=0.0267). There was no correlation between disease stage and viral copies, nor between viral copies and HIV-positive or -negative status (28.7 vs. 36.34 copies/?g DNA, respectively, P=0.7804). In subset analysis, we found no association between JCV T-Ag expression and HPV or MSI status. Conclusions Anal carcinomas uniformly express JCV T-Ag and contain more viral copies compared to surrounding normal tissue. JCV and its T-Ag oncogenic protein, presumably through interruption of cell regulatory proteins, may play a role in anal cancer pathogenesis.

Ramamoorthy, Sonia; Deveraj, Bikash; Miyai, Katsumi; Luo, Linda; Liu, Yu-Tsueng; Boland, C. Richard; Goel, Ajay; Carethers, John M.

2010-01-01

399

Location of bladder and urethral sphincter motoneurons in the male guinea pig (Cavia porcellus).  

PubMed

Although the guinea pig is used widely in experimental medical research, including in studies on micturition control, the spinal origin of preganglionic parasympathetic bladder and somatic external urethral sphincter motoneurons is not known. In the male guinea pig using wheat germ agglutinin-conjugated horseradish peroxidase and dextran Alexa Fluor 488/568 tracers, preganglionic parasympathetic bladder motoneurons were observed in the ventrolateral part of the intermediolateral cell group of the first sacral segment. The external urethral sphincter motoneurons were found to be located in the ventral horn of the first sacral segment, in a cell group corresponding with the nucleus of Onuf in cat and human. PMID:15147780

Kuipers, Rutger; Izhar, Zofiet; Gerrits, Peter O; Miner, Wesley; Holstege, Gert

2004-05-13

400

The Anal Pap Smear: Cytomorphology of squamous intraepithelial lesions  

PubMed Central

Background Anal smears are increasingly being used as a screening test for anal squamous intraepithelial lesions (ASILs). This study was undertaken to assess the usefulness and limitations of anal smears in screening for ASILs. Methods The cytomorphological features of 200 consecutive anal smears collected in liquid medium from 198 patients were studied and findings were correlated with results of surgical biopsies and/or repeat smears that became available for 71 patients within six months. Results Adequate cellularity was defined as an average of 6 or more nucleated squamous cells/hpf. A glandular/transitional component was not required for adequacy. Dysplastic cells, atypical parakeratotic cells and bi/multinucleated cells were frequent findings in ASIL while koilocytes were infrequent. Smears from LSIL cases most frequently showed mildly dysplastic and bi/multinucleate squamous cells followed by parakeratotic cells (PK), atypical parakeratotic cells (APK), and koilocytes. HSIL smears contained squamous cells with features of moderate/severe dysplasia and many APKs. Features of LSIL were also found in most HSIL smears. Conclusions In this study liquid based anal smears had a high sensitivity (98%) for detection of ASIL but a low specificity (50%) for predicting the severity of the abnormality in subsequent biopsy. Patients with cytologic diagnoses of ASC-US and LSIL had a significant risk (46–56%) of HSIL at biopsy. We suggest that all patients with a diagnosis of ASC-US and above be recommended for high resolution anoscopy with biopsy.

Arain, Shehla; Walts, Ann E; Thomas, Premi; Bose, Shikha

2005-01-01

401

Spontaneous Rupture of the Esophagus  

PubMed Central

Spontaneous rupture of the esophagus remains a medical and surgical challenge. Its diagnosis is often missed or delayed resulting in increased morbidity and mortality, and controversy exists as to the mode of therapy for the cases seen later than 12 hours after rupture. During the last seven years, nine patients were treated at Grady Memorial Hospital. Four patients, “early group,” were operated upon within 12 hours from the onset of their symptoms and five, “late group,” were operated upon between 20-76 hours (average 41) after rupture. All four patients in the “early group” had primary repair of the rupture and two had, in addition, fundoplication. From the two patients with primary repair alone, one developed postoperative leakage at the esophageal suture line, which closed spontaneously; whereas, in the two patients with fundoplication, no leakage occurred. Three of the four patients recovered and one died from renal failure, gastrointestinal bleeding, and gastric perforation. In the “late group” one patient had T-tube drainage of the esophagus and died. Two had primary repair alone with one death and the other two had primary repair with fundoplication 20 and 76 hours postrupture and both recovered. The two deaths in the “late group” were due to leakage at the site of the rupture. This study suggests that even in patients diagnosed late as having rupture of the esophagus, primary repair can be implemented with reasonable success. Good mediastinal, pleural and gastric drainage, high levels of appropriate antibiotics, and provision of good nourishment are of paramount importance for the successful management of these desperately ill patients. ImagesFig. 2A.FIG. 2B.FIG. 2C.Fig. 2D.

Symbas, Panagiotis N.; Hatcher, Charles R.; Harlaftis, Nickolaos

1978-01-01

402

A Pilot Study of the Effects of Sildenafil on Stool Characteristics, Colon Transit, Anal Sphincter Function, and Rectal Sensation in Healthy Men  

Microsoft Academic Search

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,

Mark Milone; John K. Dibaise

2005-01-01

403

Delayed tracheal rupture following thyroidectomy.  

PubMed

Thyroidectomy is a commonly performed, low-risk procedure. Tracheal perforation during thyroidectomy is rare, and delayed rupture of the trachea rarer still. We present the case of a patient who underwent total thyroidectomy secondary to Grave's disease who, on postoperative day 7, developed massive subcutaneous emphysema and respiratory distress. Surgical exploration revealed a rupture of the anterolateral tracheal wall at the level of the first tracheal ring. The defect was repaired primarily and the patient recovered uneventfully. The risk factors for and the management of this rare complication are discussed. PMID:18487029

Damrose, Edward J; Damrose, John F

2009-02-01

404

Brain metastasis in basaloid undifferentiated anal carcinoma: A case report  

PubMed Central

Anal cancer is a rare tumor that accounts for 2% of all colorectal neoplasms. The brain is a rarely affected organ. The aim of the present study was to the review the only four cases of anal cancer brain metastases previously published in the literature. In addition, the current study presents the case of a 69-year-old male diagnosed with basaloid undifferentiated carcinoma of the anal canal (stage IV with liver, lung and bone metastasis). Despite the patient’s good response to chemotherapy and the achievement of a partial response that was maintained for 14 months, brain metastases developed. Although radiotherapy was administered, the patient succumbed to the condition 12 weeks after the diagnosis of brain metastasis.

HERNANDO-CUBERO, JORGE; ALONSO-ORDUNA, VICENTE; HERNANDEZ-GARCIA, ALBA; DE MIGUEL, ANA CEBOLLERO; ALVAREZ-GARCIA, NATALIA; ANTON-TORRES, ANTONIO

2014-01-01

405

Anal carcinoma and HIV infection: is it time for screening?  

PubMed

A 38-year-old white man had a 10-year history of human immunodeficiency virus (HIV) infection (A3), with no episodes of opportunistic diseases and in good immunologic recovery (CD4 cell count: 450 and indetectable HIV viral load) while on HAART. He presented with a two-month history of mild anal symptoms, including pruritus and episodic bleeding. He referred past episodes of anal warts, self-treated with several topical compounds, all proven unsuccessful. Perianal examination showed erythema and scratching. A 0.5cm sized tumor, with infiltration at the base was detected on digital exam, located at 15mm from the anal margin. Local biopsy driven by high-resolution anuscopy (AAR) yielded a final diagnosis of infiltrative epidermoid carcinoma. Might that neoplasia have been prevented? PMID:24139082

Herranz-Pinto, P; Sendagorta-Cudós, E; Bernardino-de la Serna, J I; Peña-Sánchez de Rivera, J M

2014-03-01

406

Disseminated neonatal herpetic infection simulating abusive anal trauma.  

PubMed

Potential simulators of premortem trauma present problems of misinterpretation and possible false accusations of caregivers. A case of unsuspected neonatal herpes is reported with associated perianal ecchymosis that raises the possibility of sexual abuse. The decedent was an 8-day-old newborn infant who was born by Cesarean section and treated for 5 days postdelivery for sepsis. The newborn infant was discharged home but returned 2 days later with probable sepsis and new onset of perianal hemorrhage. She died 1 day later with autopsy, revealing neonatal disseminated herpetic infection with early anal involvement consisting of microscopic ulcerations with leukocytoclastic-like vasculitis and rare viral cytopathic changes. These histological changes produced grossly appearing anal ecchymosis with an absence of typical herpetic vesiculopapular lesions, which simulated abusive trauma. This case highlights the importance of considering occult neonatal herpes with associated perianal ecchymosis when presented with possible abusive anal trauma in a newborn infant. PMID:21496019

Panella, Michael

2011-07-01

407

Effect of arterial blood loss on myoelectrical activity of the pyloric sphincter and duodenum  

Microsoft Academic Search

Chronic experiments were carried out on six male rabbits weighing 2.6-3.2 kg. Two weeks before the experiment silver loop electrodes were implanted into the smooth muscles under the serous membrane of the pyloric sphincter and duodenum, by a method described previously [10, 11]. Electrical activity of the smooth muscles of the pyloroduodenal zone was recorded on an encephalograph at a

K. A. Shemerovskii

1990-01-01

408

Muscle-Derived Cells for Treatment of Iatrogenic Sphincter Damage and Urinary Incontinence in Men  

PubMed Central

Introduction. Aim of this study was to assess the safety and efficacy of injection of autologous muscle-derived cells into the urinary sphincter for treatment of postprostatectomy urinary incontinence in men and to characterize the injected cells prior to transplantation. Methods. 222 male patients with stress urinary incontinence and sphincter damage after uroloical procedures were treated with transurethral injection of autologous muscle-derived cells. The transplanted cells were investigated after cultivation and prior to application by immunocytochemistry using different markers of myogenic differentiation. Feasibility and functionality assessment was achieved with a follow-up of at least 12 months. Results. Follow-up was at least 12 months. Of the 222 treated patients, 120 responded to therapy of whom 26 patients (12%) were continent, and 94 patients (42%) showed improvement. In 102 (46%) patients, the therapy was ineffective. Clinical improvement was observed on average 4.7 months after transplantation and continued in all improved patients. The cells injected into the sphincter were at least ~50% of myogenic origin and representative for early stages of muscle cell differentiation. Conclusions. Transurethral injection of muscle-derived cells into the damaged urethral sphincter of male patients is a safe procedure. Transplanted cells represent different phases of myogenic differentiation.

Gerullis, H.; Eimer, C.; Georgas, E.; Homburger, M.; El-Baz, A. G.; Wishahi, M.; Boros, M.; Ecke, T. H.; Otto, T.

2012-01-01

409

Alteration of the upper esophageal sphincter belch reflex in patients with achalasia.  

PubMed

Some patients with achalasia have been reported to develop airway obstruction from a massively air-distended esophagus, which may represent an abnormality in the upper esophageal sphincter belch reflex. When questioned carefully, 95% of our achalasia patients reported difficulty with belching. The upper esophageal belch reflex in 23 consecutive achalasia patients and 12 healthy controls was studied using an upper esophageal sphincter sleeve manometry catheter and rapid injection of 20-50 mL of air into the midesophagus. Compared with normal subjects, achalasia patients were significantly less likely to have an esophageal belch for all volumes tested and were more likely to have an increase rather than a decrease in upper esophageal sphincter pressure in response to air injection. This study systematically documents that many achalasia patients have an alteration in the upper esophageal sphincter belch reflex that may be a contributory mechanism for some of the chest and upper airway symptoms reported by some patients during acute esophageal distension. PMID:1426877

Massey, B T; Hogan, W J; Dodds, W J; Dantas, R O

1992-11-01

410

Assessment of Lower Urinary Tract Dysfunction in Children with Non-Neuropathic Bladder Sphincter Dysfunction  

Microsoft Academic Search

Although nonneuropathic bladder sphincter 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. Hoebeke; J. Vande Walle; K. Everaert; E. Van Laecke; J. D. Van Gool

1999-01-01

411

Mini-invasive collagen sling in the treatment of urinary incontinence due to sphincteric incompetence  

Microsoft Academic Search

Objective: To assess the technical feasibility of mini-invasive sling procedure and present preliminary results in the treat- ment of urinary incontinence due to sphincteric insufficiency. Materials and Methods: Thirteen patients (6 males, 7 females, 8 with myelomeningocele, 1 with tethered spinal cord, 3 with bladder exstrophy, 1 with epispadias) underwent sling procedure with porcine dermis acellular collagen matrix (Pelvilace?, Bard

Seppo Taskinen; Riitta Fagerholm; Risto Rintala

2007-01-01

412

The artificial urinary sphincter in the female: Indications for use, surgical approach and results  

Microsoft Academic Search

Female urinary incontinence is a common problem. Among the many treatment options a few patients may be suitable candidates for the artificial urinary sphincter (AUS). The indications for placement of an AUS are much more common in males: however, we review the indications, technique and potential complications of the AUS in the female population. Although few indications exist for the

D. S. Elliott; D. M. Barrett

1998-01-01

413

Effects of transdermal nicotine on lower esophageal sphincter and esophageal motility  

Microsoft Academic Search

Cigarette smoking has been shown to decrease lower esophageal sphincter pressure (LESP) by 19–42%. This decrease in LESP may be due to nicotine in the cigarette smoke or substances other than nicotine. The aim of this study was to evaluate the effects of a nicotine patch on esophageal motility since nicotine patches are devoid of all toxins present in the

Shailesh C. Kadakia; Henry Renom De la Baume; Richard T. Shaffer

1996-01-01

414

Current Evaluation of Upper Oesophageal Sphincter Opening in Dysphagia Practice: An International SLT Survey  

ERIC Educational Resources Information Center

Background: The assessment of adequate upper oesophageal sphincter (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…

Regan, Julie; Walshe, Margaret; McMahon, Barry P.

2012-01-01

415

Management of upper esophageal sphincter disorders: indications and complications of myotomy  

Microsoft Academic Search

Since 1951, when it was first used as a treatment for post-poliomyelitis dysphagia, cricopharyngeal myotomy (CPM) has been used in the treatment of various neurogenic, myogenic, structural, and idiopathic disorders. Yet, the efficacy of CPM in treating patients with upper esophageal sphincter (UES) disorders remains controversial. Despite favorable reports regarding its success, too few studies about indications, complications, and outcomes

James H Kelly

2000-01-01

416

Tripod Modification of Sphincter Corer: Construction, Operation, Core Extrusion and Sampling Efficiency.  

National Technical Information Service (NTIS)

A 21-cm diameter sphincter 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...

J. C. Burke S. A. Casso R. E. Hamblin

1983-01-01

417

Incidence of pancreatitis in patients undergoing sphincter of Oddi manometry (SOM)  

Microsoft Academic Search

Objective:Sphincter of Oddi manometry (SOM) is a useful diagnostic procedure when evaluating patients with unexplained biliary pain or idiopathic recurrent pancreatitis. Acute pancreatitis is a recognized complication of SOM whose pathogenesis appears to be multifactoral. We conducted this study to determine the incidence of pancreatitis in patients after SOM and to identify any variables that may lead to an increased

Martin E. Maldonado; Patrick G. Brady; Jay J. Mamel; Bruce Robinson

1999-01-01

418

RESPONSE OF EXTERNAL URETHRAL SPHINCTER TO HIGH FREQUENCY BIPHASIC ELECTRICAL STIMULATION OF PUDENDAL NERVE  

Microsoft Academic Search

PurposeWe optimized the axonal blocking effect of high frequency, biphasic stimulation on neurally evoked contractions of the external urethral sphincter (EUS) and further investigated the repeatability of the blocking effect during relatively long periods to evaluate any acute nerve damage.

CHANGFENG TAI; JAMES R. ROPPOLO; WILLIAM C. de GROAT

2005-01-01

419

Origins and courses of the nervous branches to the male urethral sphincter  

Microsoft Academic Search

The striated sphincter of the male urethra, the so-called rhabdosphincter, contributes significantly to urethral closure pressure. It is generally agreed that the somatic nerve fibers from the pudendal nerve innervate the rhabdosphincter, and the autonomic nerve fibers innervate the smooth muscle of the urethra. Although it is difficult to clearly identify the rhabdosphincter macroscopically, we minutely investigated the nerve branches

K. Akita; H. Sakamoto; T. Sato

2003-01-01

420

BLOCK OF EXTERNAL URETHRAL SPHINCTER CONTRACTION BY HIGH FREQUENCY ELECTRICAL STIMULATION OF PUDENDAL NERVE  

Microsoft Academic Search

Purpose:High frequency electrical stimulation (1 to 10 kHz) of the pudendal nerve was evaluated as a method to block the external urethral sphincter contractions and increases in intraurethral pressure induced by electrical stimulation of pudendal nerve efferent axons.

CHANGFENG TAI; JAMES R. ROPPOLO; WILLIAM C. de GROAT

2004-01-01

421

Postcholecystectomy Pain Syndrome: Pathophysiology of Abdominal Pain in Sphincter of Oddi Type III  

Microsoft Academic Search

Background & Aims: Persistent abdominal pain occurs in many patients after cholecystectomy, some of whom are described as having sphincter of Oddi dysfunction (SOD). Pain in SOD type III is thought to be of biliary origin with little objective data, and treatment is often unsatisfactory. Chronic abdominal pain without a bio- logical disease marker is similar to irritable bowel syndrome,

STEVEN G. DESAUTELS; ADAM SLIVKA; WILLIAM R. HUTSON; ANDREW CHUN; CARLOS MITRANI; CARLO DILORENZO; ARNOLD WALD

1999-01-01

422

Bile duct crystals do not contribute to sphincter of Oddi dysfunction  

Microsoft Academic Search

Background: Microlithiasis has been proposed as a cause of both occult gallbladder disease and of idiopathic pancreatitis. Theoretically, microlithiasis could also cause postcholecystectomy pain by causing temporary biliary obstruction and may be more common in patients with sphincter of Oddi dysfunction. The frequency of crystals in bile duct aspirates was assessed from patients with symptoms after cholecystectomy with and without

Leonard G. Quallich; Mark A. Stern; Melissa Rich; William D. Chey; Jeffrey L. Barnett; Grace H. Elta

2002-01-01

423

Incidence of pancreatitis in patients undergoing sphincter of Oddi manometry (SOM)  

Microsoft Academic Search

Objective: Sphincter of Oddi manometry (SOM) is a useful diagnostic procedure when evaluating patients with unexplained biliary pain or idiopathic recurrent pancreatitis. Acute pancreatitis is a recognized complication of SOM whose pathogenesis appears to be multifactoral. We conducted this study to determine the incidence of pancreatitis in patients after SOM and to identify any variables that may lead to an

Martin E Maldonado; Patrick G Brady; Jay J Mamel; Bruce Robinson

1999-01-01

424

Visceral Algesia in Irritable Bowel Syndrome, Fibromyalgia, and Sphincter of Oddi Dysfunction, Type III  

Microsoft Academic Search

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 sphincter of Oddi dysfunction, type III, share manydemographic and psychosocial characteristics with patients with irritable bowel syndrome andprovide an opportunity to

Andrew Chun; Steven Desautels; Adam Slivka; Carlos Mitrani; Terence Starz; Carlo Dilorenzo; Arnold Wald

1999-01-01

425

Dilated common duct sign. A potential indicator of a sphincter of Oddi dyskinesia  

SciTech Connect

The cholescintigraphic findings of a Sphincter 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 Sphincter 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 Sphincter 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 Sphincter of Oddi dyskinesia.

DeRidder, P.; Fink-Bennett, D.

1984-05-01

426

Effect of glyceryl trinitrate on the sphincter of Oddi motility and baseline pressure  

Microsoft Academic Search

It is widely accepted that glyceryl trinitrate (GTN) effectively dilates the smooth muscles of blood vessels. A similar effect has been postulated on the smooth muscles in the gastrointestinal tract. In this study the motility of the sphincter of Oddi and the common bile duct pressure as determined by endoscopic manometry was investigated in nine patients before and after sublingual

M Staritz; T Poralla; K Ewe; K H Meyer zum Büschenfelde

1985-01-01

427

Neuropeptides in pig sphincter of Oddi, bile duct, gallbladder, and duodenum  

Microsoft Academic Search

To better understand the complex structure and function of the sphincter of Oddi (SO), the occurrence and localization of nine neuropeptides, including vasoactive intestinal polypeptide (VIP), bombesin, neuropeptide Y, peptide histidine-isoleucine (PHI), calcitonin gene-related peptide (CGRP), galanin, substance P, serotonin, and somatostatin, were studied by immunohistochemical methods in the pig SO. The SO innervation was compared to gallbladder, common bile

Juhani Sand; Hanna Tainio; Isto Nordback

1993-01-01

428

Quadriceps Tendon Rupture due to Postepileptic Convulsion  

PubMed Central

We present a case of quadriceps tendon (QT) rupture. QT ruptures can occur in all ages. The cause is mostly traumatic in origin. Spontaneous ruptures that are thought to result from predisposing conditions are rare. Post-convulsion QT ruptures lacking traumas in their history can be overlooked in clinical examinations. This should be born in mind by the attending physician, as early diagnosis and treatment of the condition can lead to satisfactory outcomes.

Erkut, Adem; Guvercin, Yilmaz; Sahin, Rifat; Keskin, Davut

2014-01-01

429

Unsuspected anal cancer discovered after minor anorectal surgery  

Microsoft Academic Search

Summary  The possibility of an early anal cancer should always be kept in mind when treating common chronic anorectal disease.\\u000a \\u000a Preliminary biopsy of suspect anal areas should always be done before anorectal surgery is performed.\\u000a \\u000a \\u000a All tissues removed during minor anorectal surgery should be examined histologically.\\u000a \\u000a \\u000a Each surgical specimen should be labeled individually to identify the site of origin.\\u000a \\u000a \\u000a A recent

Lewis Grodsky

1967-01-01

430

Collagen Fistula Plug for the Treatment of Anal Fistulas  

Microsoft Academic Search

PURPOSE  This study was designed to evaluate the efficacy of the Surgisis® (Anal Fistula Plug™) in multiple patients at our institution\\u000a and present early clinical results along with notable clinical observations from our experience.\\u000a \\u000a \\u000a \\u000a METHODS  This was a prospective analysis of all patients who received the Anal Fistula Plug™ for treatment of anorectal fistulas between\\u000a April 2006 and February 2007. All tracts

Alex J. Ky; Patricia Sylla; Randolph Steinhagen; Emily Steinhagen; Sergei Khaitov; Erin K. Ly

2008-01-01

431

Spontaneous Splenic Rupture in Melanoma  

PubMed Central

Spontaneous rupture of spleen due to malignant melanoma is a rare situation, with only a few case reports in the literature. This study reports a previously healthy, 30-year-old man who came with chief complaint of acute abdominal pain to emergency room. On physical examination, abdominal tenderness and guarding were detected to be coincident with hypotension. Ultrasonography revealed mild splenomegaly with moderate free fluid in abdominopelvic cavity. Considering acute abdominal pain and hemodynamic instability, he underwent splenectomy with splenic rupture as the source of bleeding. Histologic examination showed diffuse infiltration by tumor. Immunohistochemical study (positive for S100, HMB45, and vimentin and negative for CK, CD10, CK20, CK7, CD30, LCA, EMA, and chromogranin) confirmed metastatic malignant melanoma. On further questioning, there was a past history of a nasal dark skin lesion which was removed two years ago with no pathologic examination. Spontaneous (nontraumatic) rupture of spleen is an uncommon situation and it happens very rarely due to neoplastic metastasis. Metastasis of malignant melanoma is one of the rare causes of the spontaneous rupture of spleen.

Oryan, Ahmad; Davari, Aida; Daneshbod, Khosrow; Daneshbod, Yahya

2014-01-01

432

Spontaneous rupture of a varicocoele.  

PubMed

We present the case of a young male with an acute scrotal haematoma due to spontaneous rupture of a spermatic cord varicocoele confirmed by Doppler ultrasonography. After failure of conservative management, surgical exploration was performed with successful evacuation of the scrotal haematoma. PMID:20441071

Chin, W N; Cadogan, M; Wan, R; Harrison, L

2009-11-01

433

Effects of thienorphine on contraction of the Guinea pig sphincter of Oddi, choledochus and gall bladder.  

PubMed

Opioid analgesics are widely believed to cause spasm of the bile duct sphincter and so impede bile flow. Thienorphine is a partial opioid agonist that is a good candidate for the treatment of opioid dependence; however, to date, no studies have reported the effects of thienorphine on the function of the biliary tract. This study examined the in vivo effects of thienorphine on the guinea pig isolated sphincter of Oddi, choledochus and gall bladder and on bile flow. The area under the curve (AUC) of isolated sphincter of Oddi was not influenced by thienorphine or buprenorphine, whereas morphine increased the AUC of the isolated sphincter of Oddi in a concentration-dependent manner. Thienorphine and buprenorphine concentration-dependently decreased the AUC of isolated choledochus, while morphine increased the AUC of isolated choledochus. Thienorphine had no effect on the contractile amplitude or basal tension of isolated gall bladder muscle strips. In contrast, buprenorphine and morphine increased the contractile basal tension of isolated gall bladder muscle strips in a concentration-dependent manner. Thienorphine (0.01-1.0mg/kg) had no significant inhibitory effect on bile flow. However, morphine (1.0-10mg/kg) and buprenorphine (1.0mg/kg) significantly inhibited bile flow. The maximum inhibition of bile flow by buprenorphine was 63.9±12.9% and by morphine was 74.1±11.3%. In summary, thienorphine has little influence on the guinea pig isolated sphincter of Oddi, choledochus and gall bladder or on bile flow, which may result in a lack of adverse biliary colic effects. PMID:24830319

Zhou, Peilan; Li, Tingting; Su, Ruibin; Gong, Zehui

2014-08-15

434

Centrally-Rupturing Squib-Closure Disks  

NASA Technical Reports Server (NTRS)

Rupture-disk design makes squib action more predictable. In new design, center of rupture disk contains cruciform indentation in which thickness reduced to about 0.5 mil (0.013 mm). Reduces strength of center of rupture disk in same manner as that of pull tabs on beverage cans; therefore, disk will fail predictably in center.

Richter, R.

1986-01-01

435

46 CFR 64.61 - Rupture disc.  

Code of Federal Regulations, 2013 CFR

... 2013-10-01 2013-10-01 false Rupture disc. 64.61 Section 64.61 Shipping COAST...Vacuum Relief Devices for MPTs § 64.61 Rupture disc. If a rupture disc is the only pressure relief device on the tank,...

2013-10-01

436

Conservative treatment for postintubation tracheobronchial rupture  

Microsoft Academic Search

Background. Postintubation tracheobronchial rupture is usually responsible for unstable intraoperative or postoperative conditions, and its management is discussed. We insist on conservative treatment as a viable alternative after late diagnosis of postintubation tracheobronchial rupture.Methods. We conducted a retrospective study including 14 consecutive patients treated between April 1981 and July 1998.Results. Twelve tracheobronchial ruptures occurred after intubation for general surgery and

Jacques Jougon; Michel Ballester; Emmanuel Choukroun; Jean Dubrez; Gilles Reboul; Jean-François Velly

2000-01-01

437

HPV Prevalence in Anal Warts Tested with the MY09\\/MY11 SHARP Signal System  

Microsoft Academic Search

Anal warts are, from an aetiological point of view, a diverse category of lesions including condylomata acuminata, ¢broe- pithelial polyps and seborrhoeic keratosis. Human papilloma- virus induced anal warts, in contrast to other types of warts, are contagious and not infrequently sexually transmitted, they therefore need to be accurately identi¢ed. A total of 24 anal warts were randomly collected and

ANDERS STRAND; SONJA ANDERSSON; INGEBORG ZEHBE; ERIK WILANDER

438

Human papillomavirus type 16 DNA in anal cancers from six different countries  

Microsoft Academic Search

An association between anal squamous cell carcinoma and human papillomavirus (HPV) type 16 DNA has been documented in the UK. If HPV type 16 is an important aetiological factor in the development of this tumour it would be expected to occur in anal cancer tissues from other parts of the world. In this study a series of 173 anal squamous

J H Scholefield; I B Kerr; N A Shepherd; K J Miller; R Bloomfield; J M Northover

1991-01-01

439

Is topical nifedipine effective for chronic anal fissures?  

PubMed

Patients in this study showed remarkable improvement when 1.5% lidocaine and 0.3% nifedipine were applied twice daily for 6 weeks. This extremely safe, well tolerated, and effective treatment should provide family physicians with a reliable nonsurgical method for treating chronic anal fissures. PMID:12620169

Merenstein, Dan; Rosenbaum, Dan

2003-03-01

440

Anovestibular fistula with normal anal opening: Is it always congenital?  

PubMed Central

Aim: To review 12 cases of anovestibular fistula with normal anal opening. Methods: Retrospective analysis of 12 children with anovestibular fistula and normal anal opening were treated between the years 2000 and 2007. Of these, 11 patients were diagnosed as having acquired anovestibular fistula with normal anal opening and were managed by conservative management. Results: Most of them presented with diarrhea and labial redness. One patient was considered to have fistula of congenital origin and was managed surgically. Eleven patients presented between the ages of 1.5–11 months and were considered as cases of acquired anovestibular fistula and only two of them required surgical management in the form of colostomy and fistula excision. Others were successfully managed by conservative treatment; the fistulous output and labial redness decreased gradually within a period of 5–19 (average 11.5) days. Conclusions: Not all presentations of anovestibular fistula with normal anal opening can be considered as congenital. Presence of inflammation, paramedian fistula, and a favourable response to conservative management/colostomy suggest acquired etiology. Trial of conservative management should be given in the acquired variety.

Jain, Prashant; Mishra, Pankaj; Shah, Hemanshi; Parelkar, Sandesh; Borwankar, S. S.

2008-01-01

441

Lateral Subcutaneous Internal Sphincterotomy in Treatment of Anal Fissure  

Microsoft Academic Search

One hundred and three patients with anal fissures have been treated by lateral internal sphincterotomy performed by a subcutaneous myotomy technique, and 99 have been successfully followed up for from 3 to 24 months (mean 11 months). The operation was free from significant complications, apart from slight reactionary bleeding in one case and a perianal abscess in another. The fissure

D. C. Hoffmann; J. C. Goligher

1970-01-01

442

Effect of age, gender, and parity on anal canal pressures  

Microsoft Academic Search

The contribution of the resting anal canal pressure (RAP) and the maximal squeeze pressure (MSP) to the problem of fecal incontinence was assessed by comparing 143 incontinent patients to a control population of 157 healthy subjects. These parameters were determined using a multilumen continuously perfused catheter and a mechanized rapid pull-through technique. In 10 male volunteers both RAP and MSP

Sean M. McHugh; Nicholas E. Diamant

1987-01-01

443

Anal Fissure and Thrombosed External Hemorrhoids Before and After Delivery  

Microsoft Academic Search

PURPOSE: Thrombosed external hemorrhoids and anal fissures are common and are responsible for severe discomfort during childbirth. However, the real incidence of these lesions is unknown. The aim of our study was to evaluate their incidence and the risk factors for these lesions during childbirth. METHODS: A prospective study with proctologic examination during the last 3 months of pregnancy and

Laurent Abramowitz; Iradj Sobhani; JeanLouis Benifla; Albert Vuagnat; Emile Daraï; Michel Mignon; Patrick Madelenat

2002-01-01

444

Thinking the Unthinkable: Anal Sex in Theory and Practice  

Microsoft Academic Search

This essay takes up the issue of anal 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

Steven Botticelli

2010-01-01

445

Treatment of transsphincteric anal fistulas by the seton technique  

Microsoft Academic Search

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 anal deformities\\u000a had continence disorders.

Asbjørn Christensen; Lisbeth Nilas; John Christiansen

1986-01-01

446

Anal versus Rectal Melanoma: Does Site of Origin Predict Outcome?  

PubMed Central

Background Anatomic site is a predictive factor in subtypes of cutaneous and mucosal melanoma. Objective The aim of this study was to examine the clinical relevance of location of origin of anorectal melanoma as a prognostic factor. Design Using a prospectively maintained database, clinical characteristics, management, and outcomes were compared according to site of origin. Settings, Patients, Interventions A retrospective review was conducted of patients diagnosed with anorectal melanoma from 1994–2010. Tumors were defined as anal, anorectal or rectal melanoma according to their anatomic relationship to the dentate line. Main Outcome Measures Clinicopathologic factors were compared by Chi-square test. Time-to-event analysis was performed by Kaplan Meier analysis. Results Of the 96 patients included (41 anal, 32 anorectal, 23 rectal), patients with rectal and anorectal mucosal melanoma had advanced primary tumors (median Breslow thickness 12mm and 8mm respectively, p =0.002), while anal lesions could be found at earlier depths (median thickness 6.5mm). Patients with anal tumors more commonly underwent transanal excision (p <0.02) and sentinel lymph node biopsy (p=0.004) versus anorectal and rectal tumors. Patterns of recurrence were also distinct; nearly two-thirds of anorectal and rectal tumors recurred systemically, while anal melanoma more often recurred within the lymph nodes first (63%; p <0.02). Recurrence occurred in 24 (59%) patients with anal tumors, 23 (72%) anorectal tumors, and 16 (70%) rectal tumors. Median OS was 22 months for anal melanoma, 28 months for anorectal melanoma and 27 months for rectal melanoma. Recurrence and survival were not statistically different between the groups. Limitations This study is limited by small sample size and its retrospective nature. Conclusions This study represents the only series describing the outcomes of anorectal melanoma by anatomic location. Lesions at or proximal to the dentate line present with more advanced disease, possibly related to a delay in diagnosis. Lesions distal to the dentate line more commonly recur within lymph nodes, which may represent differences in nodal drainage. Irrespective of location, long-term prognosis remains poor for all cases of anorectal melanoma.

Bello, Danielle M.; Smyth, Elizabeth; Perez, Daniel; Khan, Shaheer; Temple, Larissa K.; Ariyan, Charlotte E.; Weiser, Martin R.; Carvajal, Richard D.

2012-01-01

447

Identifying the best therapy for chronic anal fissure.  

PubMed

Chronic anal 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 anal 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 ef