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Voluntary relaxation of the external anal sphincter.  


In this study five volunteers with special training in anal sphincter exercise (Scandinavian Yoga School) managed voluntarily to reduce anal pressure. The mean reduction of anal pressure was 20 mm Hg. In one of the subjects, this was shown by manometry during low spinal anesthesia and electromyography to be caused by relaxation of the external anal sphincter. PMID:2714127

Brodén, G; Dolk, A; Frostell, C; Nilsson, B; Holmström, B



Endosonography of the Anal Sphincter: Findings in Healthy Volunteers  

Microsoft Academic Search

Knowledge of the normal sonographic features of the anal canal is essential for the detection of anal carcinomas, anal sphincteric defects, or other anal abnormalities with endosonography. The anal sphincters consist of the circular smooth muscle fibers of the internal sphincter and the circular striated muscle fibers of the external sphincter together with the sling-shaped puborectalis muscle. Anal endosonography was

Michael Bachmann Nielsen; Jan Fog Pedersen; Christina Hauge; John Christiansen


Damaging effects of anal stretching on the external anal sphincter  

Microsoft Academic Search

Purpose: This study was undertaken to investigate the effects of anal stretching on anal pressures and damage to the external anal sphincter. METHODS: This study was performed on 37 guinea pigs. Animals were divided into three groups: control group, quick stretching group, and continuous overstretching group. Anal stretching was conducted by an 8-F Foley® catheter balloon. RESULTS: It was found

Long Li; Jin-Zhe Zhang; Guo-Wei Lu; Guo-Rei He; Xiao-Hong Lui



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



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. PMID:24759338

de la Portilla, Fernando



Internal anal sphincter augmentation and substitution.  


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



Anal Sphincter Injury After Forceps Delivery: Myth or Reality?  

Microsoft Academic Search

PURPOSE: This study was designed to estimate the prevalence of anal sphincter injury after forceps delivery in a large population of females managed by trained obstetricians in a French hospital and to identify factors predictive for anal sphincter injury. METHODS: We performed a prospective study of healthy females older than 18 years with no history of anal incontinence, anorectal abnormalities,

V. de Parades; I. Etienney; D. Thabut; S. Beaulieu; M. Tawk; B. Assemekang; M. L. Toubia; V. Marié; A. Wehbe; H. Mosnier; P. Gadonneix; T. Harvey; P. Atienza



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


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



Rectocele and anal sphincter defect - surgical anatomy and combined repair.  


This study reports on the surgical anatomy and technique of perineal repair in a selected group of parous women with faecal incontinence and/or difficulty in evacuation. Anal sphincter muscle damage is usually attributed to childbirth, although most of these women present for the first time years later. Consecutive patients with the above symptoms were examined clinically and then investigated with a perineal ultrasound scan. During the perineal operation for repair, further investigation by transillumination and measurements with calipers were done in 50 patients. All patients received routine postoperative care, and were followed up for at least 6 months. From 1995 to 2009 a total of 117 patients, all female, underwent perineal repair by a single surgeon. The age range was 24 - 82 years. In the last 50 consecutive patients, transillumination was positive prior to repair in all, and negative after. The average thickness of the rectocele wall was 2.4 mm prior to repair and 4.8 mm after. In all patients a rectocele was found in conjunction with the anal sphincter defect. The results of combined repair were satisfactory in 109 of 117 patients (93%). A rectocele consists of rectal mucosa, and represents a pulsion diverticulum of the lower anterior rectum. The mucosa herniates through a defect in the midline in the lower anterior rectal muscle wall. This defect then extends into the internal and external anal sphincters. It is a consistent finding in women with faecal incontinence due to anal sphincter disruption. If the anterior rectal muscle wall is repaired first, anal sphincter repair is facilitated. PMID:22353268

Mills, Robert P



Sphincter Preservation in Anal Cancer: A Brief Review  

PubMed Central

Management of anal cancer is a challenge. The goal of treatment is to eradicate tumor without sacrificing the anal sphincters. The idea of organ preservation emerged following the discovery of a high complete response rate from preoperative combined chemoradiation (CRT) prior to abdominoperineal resection. CRT is widely accepted as the standard therapy for treating anal squamous cell cancer. The combination of external beam radiotherapy with interstitial brachytherapy increases the dose to the tumor volume and decreases dose to normal tissues. The current goal is to avoid colostomy, and surgery has become a salvage or secondary therapy. In this article, we review the non-surgical management of anal cancer with special emphasis on CRT, role of intensity modulated radiation therapy and brachytherapy. PMID:23680706

Khosla, Divya; Kumar, Ritesh; Kapoor, Rakesh; Sharma, Suresh C.



Pruritus ani: is anal sphincter dysfunction important in aetiology?  

PubMed Central

Forty-three patients whose principal symptom was pruritus ani were studied. Twenty-eight had anal disease, while in 15 no such disease could be shown. Maximum resting pressures and transient and sustained pressures of the anal canal in response to rectal distension were measured by manometry. Although the maximum resting pressure in the patients with no disease was about the same as that in the group with disease, the pressures recorded in response to rectal distension were significantly lower. These results show that the anal sphincter relaxes in response to rectal distension more readily in patients with no anal disease. Hence soiling may occur, which may be a factor in the genesis of pruritus ani. PMID:534862

Eyers, A A; Thomson, J P



Incontinence, bladder neck mobility, and sphincter ruptures in primiparous women  

PubMed Central

Objective To compare the function of the pelvic floor in primiparae before and during pregnancy with the status post partum concerning symptoms of incontinence, sphincter ruptures, bladder-neck mobility and the influence of the different modes of deliveries. Methods Questionnaire evaluating symptoms of urinary and anal incontinence in nulliparous women before and after delivery and correlating these symptoms with functional changes of the pelvic floor based on a careful gynaecologic examination as well as perineal and endoanal ultrasound. Results 112 women were included in our study and came for the first visit, 99 women returned for follow-up 6 months after childbirth. Stress and flatus incontinence significantly increased from before pregnancy (3 and 12%) to after childbirth (21 and 28%) in women with spontaneous delivery or vacuum extraction. No new symptoms occurred after c-section. There was no significant difference between the bladder neck position before and after delivery. The mobility of the bladder neck was significantly higher after vaginal delivery using a vacuum extraction compared to spontaneous delivery or c-section. The bladder neck in women with post partum urinary stress incontinence was significantly more mobile than in continent controls. The endoanal ultrasound detected seven occult sphincter defects without any correlation to symptoms of anal incontinence. Conclusion Several statistically significant changes of the pelvic floor after delivery were demonstrated. Spontaneous vaginal delivery or vacuum extraction increases the risk for stress or anal incontinence, delivery with vacuum extraction leads to higher bladder neck mobility and stress incontinent women have more mobile bladder necks than continent women. PMID:20696633



External anal sphincter defects: correlation between pre-operative anal endosonography and intraoperative findings.  


In order to correlate operative findings with external anal sphincter (EAS) defects identified on anal endosonography (AES), 30 faecally incontinent patients undergoing overlapping sphincteroplasty or total pelvic floor repair were investigated by AES before and after surgery. Endosonic findings were correlated with the appearance of EAS at operation. 21 out of 22 defects seen at surgery had been pre-operatively detected by AES (one false negative). Post-operatively the sphincteroplasty was clearly evident on AES. In three cases of failure it showed an extensive hypoechoic area and these patients underwent dynamic graciloplasty. Endosonography is the method of choice for pre-operative imaging of EAS, having an established role in identifying sphincter defects and correlating well with intraoperative findings. Post-operatively, it has the potential to identify breakdown of the previous repair, allowing prompt surgical intervention. Endosonography is helpful in planning the best type of operation following sphincter injury and is useful in auditing the results of surgery. PMID:8785623

Romano, G; Rotondano, G; Esposito, P; Pellecchia, L; Novi, A



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



Do changes in anal sphincter anatomy correlate with anal function in women with a history of vaginal delivery?  


Objectives To evaluate anal sphincter anatomy using three-dimensional ultrasonography (3-DAUS) in incontinent women with vaginal delivery, correlate anatomical findings with symptoms of fecal incontinence and determine the effect of vaginal delivery on anal canal anatomy and function. Methods Female with fecal incontinence and vaginal delivery were assessed with Wexner's score, manometry, and 3DAUS. A control group comprising asymptomatic nulliparous was included. Anal pressure, the angle of the defect and length of the external anal sphincter (EAS), the anterior and posterior internal anal sphincter (IAS), the EAS + puborectal and the gap were measured and correlated with score. Results Of the 62, 49 had fecal incontinence and 13 were asymptomatic. Twenty five had EAS defects, 8 had combined EAS+IAS defects, 16 had intact sphincters and continence scores were similar. Subjects with sphincter defects had a shorter anterior EAS, IAS and longer gap than women without defects. Those with a vaginal delivery and intact sphincters had a shorter anterior EAS and longer gap than nulliparous. We found correlations between resting pressure and anterior EAS and IAS length in patients with defects. Conclusions Avaliar a anatomia do esfíncter anal usando ultra-sonografia tridimensional (3D-US) em mulheres incontinentes com parto vaginal, correlacionar os achados anatômicos com sintomas de incontinência fecal e, determinar o efeito do parto vaginal sobre a anatomia e função do canal anal. PMID:25296079

Murad-Regadas, Sthela Maria; Dealcanfreitas, Iris Daiana; Regadas, Francisco Sergio Pinheiro; Rodrigues, Lusmar Veras; Fernandes, Graziela Olivia da Silva; Pereira, Jacyara de Jesus Rosa



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. PMID:21463628

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



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. PMID:22575218

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



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


The early of pelvic irradiation on the anal sphincter has not been previously investigated. This study prospectively evaluated the acute effect of preoperative radiation on anal function. Twenty patients with rectal carcinoma received 4,500 cGy of preoperative external beam radiation. The field of radiation included the sphincter in 10 patients and was delivered above the anorectal ring in 10 patients. Anal manometry and transrectal ultrasound were performed before and four weeks after radiotherapy. No significant difference in mean maximal squeeze or resting pressure was found after radiation therapy. An increase in mean minimal sensory threshold was significant. Histologic examination revealed minimal radiation changes at the distal margin in 8 of 10 patients who underwent low anterior resection and in 1 of 3 patients who underwent abdominoperineal resection. We conclude that preoperative radiation therapy has minimal immediate effect on the anal sphincter and is not a major contributing factor to postoperative incontinence in patients after sphincter-saving operations for rectal cancer. PMID:1643999

Birnbaum, E H; Dreznik, Z; Myerson, R J; Lacey, D L; Fry, R D; Kodner, I J; Fleshman, J W



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


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



In vitro and in vivo assessment of an intelligent artificial anal sphincter in rabbits.  


Artificial sphincters have been developed for patients with fecal incontinence, but finding a way to make such sphincters more "intelligent" remains a problem. We assessed the function of a novel intelligent artificial anal sphincter (IAAS) in vitro and in vivo in rabbits. After the prosthesis was activated, rabbits were continent of feces during 81.4% of the activation time. The fecal detection unit provided 100% correct signals on stool in vitro and 65.7% in vivo. The results indicated that the IAAS could efficiently maintain continence and detect stool; however, the IAAS is still in the preliminary experimental stage and more work is needed to improve the system. PMID:21507023

Huang, Zong-Hai; Shi, Fu-Jun; Chen, Fei; Liang, Fei-Xue; Li, Qiang; Yu, Jin-Long; Li, Zhou; Han, Xin-Jun



[Reconstruction of anal sphincters following fecal incontinence and assessment of functional results].  


The aim of the study was to assess functional results of surgical sphincter reconstructions for anal incontinence. From August 1999 to January 2007, 52 patients (females 50, males 2), 45 y.o.a. on average (24-69), underwent secondary anal sphincters reconstructions for fecal incontinence, resulting from birth injuries, event. in combination with sphincter weakening in pudendal neurophathy, or for post-anorectal surgery incontinence. Duration of the incontinence symptoms prior to the surgery was 2 months to 19 years. The overlap technique in combination with anterior levatorplasty was used in most subjects (n = 31). In 12 subjects, anterior sphincters and levators plication was performed. Four patients underwent overlap reconstructions only and five patients underwent complete sphincter reconstructions. Protective colostomy was performed in six patients. Six patients underwent additional postoperative biofeedback. Endoanal ultrasound was performed in all patients prior to their procedures. Terminal motor latency examination of the pudendal nerve was indicated in all patients with sphincter dysfunction without localized defects. Anal manometry was recorded prior and post-operatively. Incontinence was assessed using the St. Mark's incontinence score (0-13). The patients assessed the reconstruction results based on the Likert scale. The reconstruction was successfull in 46 patients (88.5 %), full continence was recovered in 20 (38.5 %) patients and improvement of incontinence was recorded in 26 (50 %) subjects. In six subjects (11.5 %), the reconstruction failed. The mean incontinence score reduction following the procedure was from 11.8 to 2.4. The short-term sphincter reconstruction results were successful in the majority of the subjects, the long-term results will be assessed in another study. PMID:18988486

Slauf, P; Bartoska, P; Ryska, O; Antos, F



Recovery of the internal anal sphincter and continence after restorative proctocolectomy.  


The internal anal sphincter (IAS) was assessed prospectively using electromyography and manometry in 66 patients (48 men) undergoing restorative proctocolectomy to determine its role in the gradual return of continence. Twenty-nine patients received a J pouch and 37 a W reservoir. Some 38 pouches (J, ten; W, 28) were hand-sewn (mucosal proctectomy with endoanal anastomosis) and 28 (J, 19; W, nine) stapled (end-to-end pouch-anal anastomosis 1 cm above the dentate line). Twelve patients underwent a one-stage procedure (all J pouches), while the remainder had a covering loop ileostomy. Each patient was reassessed immediately after restorative proctocolectomy and again at 7 days, 1 month, 4 months, 9 months and 18 months after pouch formation. Internal sphincter electromyographic activity was greatly reduced after pouch-anal anastomosis (median preoperative frequency 0.51 Hz versus immediate postoperative frequency 0.21 Hz, P < 0.003) and gradually recovered from 4 months after surgery. At 18 months, measurements of IAS function had not fully recovered to preoperative values (median frequency 0.31 Hz; P < 0.03). Resting anal pressures (median preoperative value 99 cmH2O) decreased by over 50 per cent after surgery (median immediate postoperative resting pressure 44 cmH2O) and recovered gradually but incompletely (median pressure at 18 months 63 cmH2O). Eleven patients reported leakage in the follow-up period. The median (range) resting pressure in these patients (54 (40-71) cmH2O) was not significantly different at 9 months from that of those who were continent either before or after operation (59 (46-68) cmH2O). Prolonged recordings in patients with faecal leakage revealed evidence of high-pressure pouch waves that overwhelmed anal sphincter pressures and coincided with leakage. These episodes were most common during sleep, when anal sphincter activity was reduced. PMID:7922067

Farouk, R; Duthie, G S; Bartolo, D C



Electromagnetic effects on the biological tissue surrounding a transcutaneous transformer for an artificial anal sphincter system.  


This paper reports on the electromagnetic effects on the biological tissue surrounding a transcutaneous transformer for an artificial anal sphincter. The coupling coils and human tissues, including the skin, fat, muscle, liver, and blood, were considered. Specific absorption rate (SAR) and current density were analyzed by a finite-length solenoid model. First, SAR and current density as a function of frequency (10-10(7) Hz) for an emission current of 1.5 A were calculated under different tissue thickness. Then relations between SAR, current density, and five types of tissues under each frequency were deduced. As a result, both the SAR and current density were below the basic restrictions of the International Commission on Non-Ionizing Radiation Protection (ICNIRP). The results show that the analysis of these data is very important for developing the artificial anal sphincter system. PMID:21121071

Zan, Peng; Yang, Bang-hua; Shao, Yong; Yan, Guo-zheng; Liu, Hua



Electromagnetic effects on the biological tissue surrounding a transcutaneous transformer for an artificial anal sphincter system*  

PubMed Central

This paper reports on the electromagnetic effects on the biological tissue surrounding a transcutaneous transformer for an artificial anal sphincter. The coupling coils and human tissues, including the skin, fat, muscle, liver, and blood, were considered. Specific absorption rate (SAR) and current density were analyzed by a finite-length solenoid model. First, SAR and current density as a function of frequency (10–107 Hz) for an emission current of 1.5 A were calculated under different tissue thickness. Then relations between SAR, current density, and five types of tissues under each frequency were deduced. As a result, both the SAR and current density were below the basic restrictions of the International Commission on Non-Ionizing Radiation Protection (ICNIRP). The results show that the analysis of these data is very important for developing the artificial anal sphincter system. PMID:21121071

Zan, Peng; Yang, Bang-hua; Shao, Yong; Yan, Guo-zheng; Liu, Hua



Botulinum toxin for the treatment of chronic constipation in children with internal anal sphincter dysfunction  

Microsoft Academic Search

Internal anal sphincter (IAS) dysfunction is a cause of refractory constipation in children. The goal of this study was to\\u000a determine whether intrasphincteric injection of botulinum toxin is effective in the treatment of constipation in pediatric\\u000a patients with IAS dysfunction. A retrospective review was performed of 24 pediatric patients with intractable constipation.\\u000a All patients had abnormal anorectal manometry, with either

Katy Irani; Leonel Rodriguez; Daniel P. Doody; Allan M. Goldstein



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. PMID:24999464

Farouk, Ridzuan



[Intermittent electromechanical dissociation of the internal anal sphincter in idiopathic fecal incontinence].  


Ten patients with median age of 51 years (range 24-75; 9 female) presenting idiopathic faecal incontinence and twelve normal subjects with median age of 34 years (range 25-71; 5 female) underwent fine wire anal sphincter electromyography and anal manometry. The results were analysed using non-parametric methods of statistical analysis. The median IAS EMG was 0.30 Hz (range 0.18-0.38), in incontinent and 0.48 Hz (range 0.31-0.55) in controls; p. < 0.01. Ambulatory resting pressures were a median of 66 cmH2O (range 49-83 cmH2O), for the incontinent and 82 cmH2O (range 66-120) for controls; p < 0.04. IAS EMG frequency correlated with resting anal pressures in both groups (p < 0.003). IAS EMG silence not attributable to electrode movement or to the recto-anal inhibitory reflex, lasting 0.5-4 minutes, occurred in all but two of the incontinent patients. No recruitment of the external sphincter or puborectalis muscle was noted during these episodes. Such electromechanical dissociation was not seen in the control group. PMID:8481284

Gammarota, F V; Farouk, R; Duthie, G S; Bartolo, D C



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


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



Restoration of continence following rectopexy for rectal prolapse and recovery of the internal anal sphincter electromyogram.  


Twenty-two patients with full-thickness rectal prolapse underwent ambulatory fine wire electromyography of the internal and sphincter (IAS), external and sphincter and puborectalis, together with anorectal manometry, using a computerized system. Examinations were performed both before and 3 to 4 months after rectopexy. The median (interquartile range (i.q.r.)) preoperative IAS electromyogram (EMG) frequency was 0.18 (0.05-0.31) Hz and the median (i.q.r.) preoperative resting anal pressure was 28 (15-64) cmH2O. An improvement in the IAS EMG frequency, median (i.q.r.) 0.29 (0.19-0.38) Hz (P less than 0.03), and resting anal pressure, median (i.q.r.) 41 (20-72) cmH2O (P less than 0.05), was recorded after operation, but these variables remained significantly lower than those found in normal controls: median (i.q.r.) IAS EMG frequency 0.44 (0.36-0.48) Hz and median (i.q.r.) resting anal pressure 92 (74-98) cmH2O. We suggest that repair of the prolapse allows the IAS to recover by removing the cause of persistent rectoanal inhibition. PMID:1596729

Farouk, R; Duthie, G S; Bartolo, D C; MacGregor, A B



Functional abnormalities of the anal sphincters in patients with myotonic dystrophy.  


Motility of the anorectal area was studied in 19 patients with myotonic dystrophy and in 20 control subjects, before and after pudendal block. In patients with myotonic dystrophy, before anesthesia, resting pressure in the upper anal canal ( p less than 0.001) and duration and amplitude of relaxation of the rectoanal inhibitory reflex (p less than 0.01) were decreased. A myotonic contraction of high amplitude followed relaxation in all patients, but in control subjects this was not the case. In the lower anal canal, the duration of the rectoanal contractile reflex was prolonged as compared with control subjects (p less than 0.001). The pudendal block had no effect in the upper anal canal either on resting pressure or on amplitude and duration of the rectoanal inhibitory reflex, neither in patients nor in controls. After blockade, however, the myotonic contraction subsequent to the reflex in patients was significantly reduced in amplitude (p less than 0.01). In lower anal canal, the resting pressure was reduced to similar levels, both in patients and in control subjects, after pudendal block (p less than 0.01), and the rectoanal contractile reflex was abolished in both groups. This study demonstrates a number of functional abnormalities in the anorectal structures of patients with myotonic dystrophy. These abnormalities produce a decrease in resting pressure in the anal canal, and a reflex myotonic contraction subsequent to rectal distention due to both external and internal sphincter dysfunction. PMID:6714574

Hamel-Roy, J; Devroede, G; Arhan, P; Tétreault, J P; Lemieux, B; Scott, H



Randomized, Clinical Trial of Bowel Confinement vs. Laxative Use After Primary Repair of a Third-Degree Obstetric Anal Sphincter Tear  

Microsoft Academic Search

PURPOSE: Third-degree tears are generally managed by primary anal sphincter repair. Postoperatively, some physicians recommend laxative use, whereas others favor bowel confinement after anorectal reconstructive surgery. This randomized trial was designed to compare a laxative regimen with a constipating regimen in early postoperative management after primary obstetric anal sphincter repair. METHODS: A total of 105 females were randomized after primary

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



Membrane properties of external urethral and external anal sphincter motoneurones in the cat.  

PubMed Central

1. Intracellular recordings were made from external urethral sphincter (EUS) and external anal sphincter (EAS) motoneurones in the cat spinal cord under pentobarbitone anaesthesia. EUS and EAS motoneurones were located in segments S1 and S2 in the lateral part of the ventral horn corresponding to column Y of Romanes in the cat or group X of Onuf in man. 2. The axonal conduction velocity of sphincter motoneurones, calculated from the latency of the antidromic action potential and the conduction distance, ranged from 16 to 80 ms-1, much slower than that of hindlimb motoneurones. The duration of the spike after-hyperpolarization (AHP) was in a similar range to that of hindlimb motoneurones. The antidromic latency, the duration of the action potential and the duration of the AHP were positively correlated with one another. 3. The input resistance ranged from 2.6 to 9.0 M omega and was positively correlated with the latency of the antidromic spike. The plots of input resistance versus conduction velocity in sphincter motoneurones were distributed around the extrapolated regression line determined for hindlimb motoneurones, indicating that there is a common correlation amongst conduction velocity, input resistance, and size of motoneurones regardless of the muscle type innervated by a motoneurone. 4. The regression line relating AHP duration and input resistance in sphincter motoneurones was quite different from that in hindlimb motoneurones in its slope, indicating that the AHP duration does not depend solely on the size of the motoneurone. 5. The voltage responses to injection of steps of hyperpolarizing current developed a time-dependent depolarizing 'sag' at higher current levels. The delay in onset and the time constant of decay of this depolarizing sag depended upon the peak amplitude of the hyperpolarizing response. The slope resistance in the I-V curve decreased in the hyperpolarizing direction in all neurones examined, indicating the existence of anomalous rectification analogous to the Q current IQ. In some sphincter motoneurones, an increase of slope resistance in the I-V curve was observed when the membrane was further hyperpolarized. 6. The membrane time constant was positively correlated with input resistance, suggesting that motoneurones with high input resistance have high specific membrane resistivity. The dendritic-to-soma conductance ratio (p) and electrotonic length of dendrite (L) were estimated according to Rall's model. p was smaller than that of hindlimb motoneurones, suggesting less developed dendritic arborization. L was similar to that of hindlimb motoneurones. 7. No differences were observed, in any of the above characteristics of motoneurones, between EUS and EAS. PMID:1804967

Sasaki, M



Motor evoked potentials recorded from external anal sphincter by cortical and lumbo-sacral magnetic stimulation: Normative data  

Microsoft Academic Search

Electrophysiological activation of the motor pathways can be obtained by electrical or magnetic stimulation. The latter has the great advantage of being painful and able to stimulate deeply situated nervous structures. Only a few reports describe responses obtained from pelvic floor muscles and external anal sphincter (EAS) by transcranial and lumbo-sacral magnetic stimulation. Our purpose is to present normative data

G Pelliccioni; O Scarpino; V Piloni



Anal sphincter structure and function relationships in aging and fecal incontinence  

PubMed Central

Objective To determine the effect of aging and continence status on the structure and function of the external (EAS) and internal (IAS) anal sphincters Study Design Young (YC) and older (OC) continent women were compared to older women with fecal incontinence (OI). Patients completed the FIQOL and FISI and underwent anorectal manometry and transanal ultrasound. Results 9 YC, 9 OC, and 8 OI women participated. Aging was associated with a thickening of the IAS, while only women with FI had decreased resting pressures. Older incontinent women had a thinner EAS, decreased maximum squeeze pressures, and were hypersensitive to rectal distention with decreased tolerable rectal volumes and urge to defecate at lower volumes. Conclusion Thickening of the IAS occurs with aging. Thinning of the EAS and a corresponding drop in squeeze pressure correlated with FI, but not with aging. Rectal hypersensitivity was associated with FI rather than aging and may play a role in the mechanism of FI. PMID:19136096

Lewicky-Gaupp, Christina; Hamilton, Quinn; Ashton-Miller, James; Huebner, Markus; DeLancey, John O.L.; Fenner, Dee E.



Outcome of repair of obstetric anal sphincter injuries after three years  

PubMed Central

Objective To prospectively assess change in bowel symptoms and quality of life (QoL) approximately 3 years after primary repair of obstetric anal sphincter injuries (OASIS). Methods Between July 2002 and December 2007 women who attended the perineal clinic at Croydon University Hospital, UK, 9 weeks following primary repair of OASIS were asked to complete the Manchester Health Questionnaire and a questionnaire to obtain a St Mark incontinence score. All women had endoanal scans at this visit. In June 2008 all women were asked to complete the questionnaires again. Results Of 344 patients who responded to the questionnaires and were included in the analysis, long-term symptoms of fecal urgency, flatus incontinence, and fecal incontinence occurred in 62 (18.0%), 52 (15.1%), and 36 (10.5%), respectively. Overall, there was a significant improvement in fecal urgency (P < 0.001) and flatus incontinence (P < 0.001) from 9 weeks to 3 years. Of 31 women with fecal incontinence symptoms at early follow-up, 28 were asymptomatic at 3 years. However, 33 women developed de novo symptoms. The only predictors of fecal incontinence at 3 years were fecal urgency at 9 weeks (OR 4.65; 95% CI, 1.38–15.70) and a higher St Mark score (OR 1.40; 95% CI, 1.09–1.80). Conclusion Following primary repair of OASIS, the majority of symptoms and QoL significantly improve, unless there is a persistent anal sphincter defect. This highlights the importance of adequate repair. PMID:25097141

Reid, Annette J.; Beggs, Andrew D.; Sultan, Abdul H.; Roos, Anne-Marie; Thakar, Ranee



Involvement of pituitary adenylate cyclase-activating peptide in opossum internal anal sphincter relaxation.  


Despite its widespread distribution and significance in the gut, the role of pituitary adenylate cyclase-activating peptide (PACAP) in internal anal sphincter (IAS) relaxation has not been examined. This study examined the role of PACAP in nonadrenergic noncholinergic (NANC) nerve-mediated relaxation of IAS smooth muscle. Circular smooth muscle strips from the opossum IAS were prepared for measurement of isometric tension. The influence of PACAP and vasoactive intestinal peptide (VIP) antagonists and tachyphylaxis on the neurally mediated IAS relaxation was examined either separately or in combination. The release of these neuropeptides in response to NANC nerve stimulation before and after the nitric oxide (NO) synthase inhibitor Nomega-nitro-L-arginine and NO was also investigated. Both PACAP and VIP antagonists caused significant attenuation of IAS relaxation by NANC nerve stimulation. The combination of the antagonists, however, did not have an additive effect on IAS relaxation. VIP tachyphylaxis caused significant suppression of IAS relaxation by NANC nerve stimulation. PACAP and VIP were found to be released by NANC nerve stimulation and exogenous NO. The data suggest the involvement of PACAP in IAS relaxation primarily by the activation of PACAP1/VIP receptor and lack of its independent role in the relaxation. Furthermore, NO may regulate the presynaptic release of PACAP and VIP. PMID:9756508

Chakder, S; Rattan, S



Mechanism of internal anal sphincter smooth muscle relaxation by phorbol 12,13-dibutyrate.  


We investigated the mechanism of the inhibitory action of phorbol 12,13-dibutyrate (PDBu), one of the typical protein kinase C (PKC) activators, in in vitro smooth muscle strips and in isolated smooth muscle cells of the opossum internal anal sphincter (IAS). The inhibitory action of PDBu on IAS smooth muscle (observed in the presence of guanethidine + atropine) was partly attenuated by tetrodotoxin, suggesting that a part of the inhibitory action of PDBu is via the nonadrenergic, noncholinergic neurons. A major part of the action of PDBu in IAS smooth muscle was, however, via its direct action at the smooth muscle cells, accompanied by a decrease in free intracellular Ca(2+) concentration ([Ca(2+)](i)) and inhibition of PKC translocation. PDBu-induced IAS smooth muscle relaxation was unaffected by agents that block Ca(2+) mobilization and Na+-K+-ATPase. The PDBu-induced fall in basal IAS smooth muscle tone and [Ca(2+)](i) resembled that induced by the Ca(2+) channel blocker nifedipine and were reversed specifically by the Ca(2+) channel activator BAY K 8644. We speculate that a major component of the relaxant action of PDBu in IAS smooth muscle is caused by the inhibition of Ca(2+) influx and of PKC translocation to the membrane. The specific role of PKC downregulation and other factors in the phorbol ester-mediated fall in basal IAS smooth muscle tone remain to be determined. PMID:11352829

Chakder, S; Sarma, D N; Rattan, S



Newborn endothelin receptor type B mutant (piebald) mice have a higher resting anal sphincter pressure than newborn C57BL/6 mice.  


Hirschsprung's disease is characterized by aganglionosis of the distal colon and hypertonicity of the anal sphincter. Endothelin receptor type B mutant (piebald) mice phenotypically resemble infants with Hirschsprung's disease in that these mice are susceptible to developing toxic megacolon because of the absence of ganglion cells in their distal colon. Therefore, we hypothesized that newborn piebald mice would have a higher resting anal sphincter pressure than would newborn wild-type mice. To test this hypothesis, we developed a reliable and reproducible technique for measuring the resting anal sphincter pressure in mice. Heterozygote breeding pairs of endothelin receptor type B mutant mice were purchased and bred in our animal facility. Pregnant, time-dated C57BL/6J mice provided control newborn mice. One-day-old newborn mice were evaluated for resting anal sphincter pressure. Under the operating microscope, a 24-gauge open-tip epidural catheter was placed into the anus until a deflection (approximately 3 to 5 mm) was noticed on a polygraph pressure monitor. Three consecutive measurements were obtained for each mouse. Mean values for each group were determined and compared using Student's t test. The resting anal sphincter pressure (mean +/- standard deviation) in newborn C57BL/6J mice was 13.3 +/- 2.6 mmHg, whereas that in piebald mice 22.7 +/- 2.5 mmHg (P < 0.0001). Therefore, because of their increased resting anal sphincter pressure, piebald mice may provide a useful animal model for the study of Hirschsprung's disease. PMID:14615959

Nadler, Evan P; Boyle, Patricia; Murdock, Alan D; Dilorenzo, Carlo; Barksdale, Edward M; Ford, Henri R



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

Microsoft Academic Search

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

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



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

PubMed Central

In 40 women with idiopathic (neurogenic) faecal incontinence, 20 of whom also had stress urinary incontinence, single fibre EMG studies showed an increased fibre density in the external anal sphincter muscle. All these patients showed excessive descent of the pelvic floor on straining. The mean terminal motor latencies in the pudendal and perineal nerves, measured by a digitally-directed intrarectal stimulating technique, were increased when compared with 20 control subjects (p less than 0.01). The perineal nerve terminal motor latency was more markedly increased in the 20 patients with double incontinence than in those with faecal incontinence alone (p less than 0.01). These results provide direct electrophysiological evidence of damage to the innervation of the pelvic floor musculature in idiopathic faecal and double incontinence, and imply that idiopathic stress urinary incontinence may have a similar cause. PMID:6512547

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



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


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



Anal Fissure  


... INVOLVE? Surgical options for treating anal fissure include Botulinum toxin (Botox ® ) injection into the anal sphincter and surgical division ... pain and spasm, allowing the fissure to heal. Botox ® injection results in healing in 50-80% of ...


Arachidonic acid metabolites follow the preferential course of cyclooxygenase pathway for the basal tone in the internal anal sphincter  

PubMed Central

Present studies determined the roles of the cyclooxygenase (COX) versus the lipoxygenase (LO) pathways in the metabolic pathway of arachidonic acid (AA) in the internal anal sphincter (IAS) tone. Studies were performed in the rat IAS versus the nontonic rectal smooth muscle (RSM). Indomethacin, the dual COX inhibitor, but not nordihydroguaiaretic acid (NDGA), the LO inhibitor, produced a precipitous decrease in the IAS tone. However, when added in the background of indomethacin, NDGA caused significant reversal of the IAS tone. These inhibitors had no significant effect on the RSM. To follow the significance of COX versus LO pathways, we examined the effects of AA and its metabolites. In the IAS, AA caused an increase in the IAS tone (Emax = 38.8 ± 3.0% and pEC50 = 3.4 ± 0.1). In the RSM, AA was significantly less efficacious and potent (Emax = 11.3 ± 3.5% and pEC50 = 2.2 ± 0.3). The AA metabolites (via COXs) PGF2? and U-46619 (a stable analog of thromboxane A2) produced increases in the IAS tone and force in the RSM. Conversely, AA metabolites (via 5-LO) lipoxin A4, 5-HETE, and leukotriene C4 decreased the IAS tone. Finally, the contractile effects of AA in the IAS were selectively attenuated by the COX-1 but not the COX-2 inhibitor. Collectively, the specific effects of AA and the COX inhibitor, the Western blot and RT-PCR analyses showing specifically higher levels of COX-1, suggest a preferential role of the COX (specifically COX-1) pathway versus the LO in the regulation of the IAS tone. PMID:19221012

de Godoy, Marcio A. F.; Rattan, Neeru; Rattan, Satish



Arachidonic acid metabolites follow the preferential course of cyclooxygenase pathway for the basal tone in the internal anal sphincter.  


Present studies determined the roles of the cyclooxygenase (COX) versus the lipoxygenase (LO) pathways in the metabolic pathway of arachidonic acid (AA) in the internal anal sphincter (IAS) tone. Studies were performed in the rat IAS versus the nontonic rectal smooth muscle (RSM). Indomethacin, the dual COX inhibitor, but not nordihydroguaiaretic acid (NDGA), the LO inhibitor, produced a precipitous decrease in the IAS tone. However, when added in the background of indomethacin, NDGA caused significant reversal of the IAS tone. These inhibitors had no significant effect on the RSM. To follow the significance of COX versus LO pathways, we examined the effects of AA and its metabolites. In the IAS, AA caused an increase in the IAS tone (Emax=38.8+/-3.0% and pEC50=3.4+/-0.1). In the RSM, AA was significantly less efficacious and potent (Emax=11.3+/-3.5% and pEC50=2.2+/-0.3). The AA metabolites (via COXs) PGF2alpha and U-46619 (a stable analog of thromboxane A2) produced increases in the IAS tone and force in the RSM. Conversely, AA metabolites (via 5-LO) lipoxin A4, 5-HETE, and leukotriene C4 decreased the IAS tone. Finally, the contractile effects of AA in the IAS were selectively attenuated by the COX-1 but not the COX-2 inhibitor. Collectively, the specific effects of AA and the COX inhibitor, the Western blot and RT-PCR analyses showing specifically higher levels of COX-1, suggest a preferential role of the COX (specifically COX-1) pathway versus the LO in the regulation of the IAS tone. PMID:19221012

de Godoy, Márcio A F; Rattan, Neeru; Rattan, Satish



Anal Fissure  

PubMed Central

Anal fissure is one of the most common anorectal problems. Anal fissure is largely associated with high anal sphincter pressures and most treatment options are based on reducing anal pressures. Conservative management, using increased fiber and warm baths, results in healing of approximately half of all anal fissures. In fissures that fail conservative care, various pharmacologic and surgical options offer satisfactory cure rates. Lateral internal sphincterotomy remains the gold standard for definitive management of anal fissure. This review outlines the key points in the presentation, pathophysiology, and management of anal fissure. PMID:22379402

Zaghiyan, Karen N.; Fleshner, Phillip



Anal fissure  


... bath two to three times a day. The water should cover only your hips and buttocks. If the anal fissues do not go away with home care methods, treatment may involve: Botox injections into the muscle in the anus (anal sphincter) ...


Dosimetric Coverage of the External Anal Sphincter by 3-Dimensional Conformal Fields in Rectal Cancer Patients Receiving Neoadjuvant Chemoradiation: Implications for the Concept of Sphincter-Preserving Radiation Therapy  

PubMed Central

Background. We evaluated the anatomic location of the external anal sphincter (EAS) to pelvic bony landmarks related to 3-dimensional conformal radiotherapy (3DRT) and studied the dosimetric coverage of the EAS in patients undergoing neoadjuvant chemoradiation for rectal cancer. Methods. Sixty-four consecutive rectal cancer patients treated with neoadjuvant chemoradiation were included. All patients were treated in a prone position on a bellyboard by 3DRT. The inferior border of the RT fields was at least 3–5?cm inferior to the gross tumorous volume (GTV) or at the inferior border of the obturator foramen (IBOF), whichever was more inferior. The EAS was contoured and dose distributions were determined using dose-volume histograms. Results. In 53 out of 64 cases (82.8%), the EAS was completely inferior to the IBOF. In the remaining 11 cases, the EAS was either overlapping the IBOF (10 cases; 15.6%) or completely superior to the IBOF (1 case; 1.7%). The average mean dose delivered to the EAS was 2795?cGy. Lower mean doses were delivered to the EAS when the center of the EAS was located more distant from the GTV. Conclusions. Meticulous planning to define the inferior border of the RT field is recommended to avoid irradiating the EAS. PMID:25089274

Chen, Michelle B.; Liu, Alan J.; Tsai, Peter



Defensive anality and anal narcissism.  


This paper aims at demonstrating a currently beleaguered assumption: the central importance, the continuing vitality, and the appropriate complexity of Freud's theory of the drives and of his idea of the primacy of the body ego. It is not enough to consider man a thinking machine or a social being; his animal nature must be given a central place in psychology. The paper postulates that 'anal or sphincter defensiveness' is one of the precursors of the repression barrier. Anality has been comparatively neglected in recent psychoanalytic literature, and so has its explorer, Karl Abraham. The paper's thesis is that there is a special defensive importance to anal erogeneity and libido, and to those aspects of ego and superego that are functionally operative (as the 'sadistic-anal organization' (Freud, 1917)) during the so-called 'sadistic-anal' developmental phase. Any of the psychic danger situations can evoke regression to manifestations of 'anal narcissim'--an attempt to master overwhelming feeling by a kind of emotional sphincter action, narrowing down the world to the controllable and the predictable. The basic assumption here is Fliess's idea that the attainment of anal sphincter control functions--with, as-it-were, 'psychic resonance'--as a means to master primal (murderous, cannibalistic) affect. For optimal psychic development, a proper balance must be attained between anal control of, and anal expression of, instinctual derivatives--especially of affect laden with aggression. PMID:4066168

Shengold, L



Surgical Reconstruction of the Urinary Sphincter after Traumatic Longitudinal Disruption  

PubMed Central

The question is whether the urethral sphincter may be reconstructed after longitudinal injury similar to anal sphincter injuries. Analogue to obstetric, anal sphincter repair, an approximation repair of the sphincter may be feasible. An overlap repair is possible in anal sphincter repair, but because of the little tissue available in the urethral sphincter this is not an option. We describe three cases of urethral sphincter injury of different aetiologies. All resulted in a total longitudinal disruption of the muscular components of the urethral sphincter complex. After making the diagnosis of urethral sphincter injury, a primary approximation repair was done. Follow-up of at least two and up to three years is promising with one male patient being completely continent and the two female patients needing one safety pad per day. Longitudinal disruption of the muscular elements of the sphincteric urethra may be primarily reconstructed with good success using an approximation technique with simple interrupted sutures. PMID:25258694

Rehder, Peter; Schillfahrt, Florian; Skradski, Viktor



Role of phospholipase A2 (group I secreted) in the genesis of basal tone in the internal anal sphincter smooth muscle.  


The role of phospholipase A(2) (PLA(2)) in the genesis of basal tone in the internal anal sphincter (IAS) is not known. We determined the effects of PLA(2) and inhibitors on the basal tone and intraluminal pressures (IASP) in the rat IAS vs. rectal smooth muscles (RSM). In addition, we determined the correlations between the IAS tone, PLA(2) levels, and the actual enzymatic activity. Inhibition of PLA(2) by 4-bromophenacyl bromide (universal inhibitor of PLA(2)) and MJ33 [selective inhibitor of secreted isoform of PLA(2) (sPLA(2))] caused concentration-dependent decrease in the IAS tone and in the IASP. Maximal decreases in the IAS tone and IASP by 4-bromophenacyl bromide and MJ33 were 58.8 +/- 6.9 and 51.5 +/- 6.3%, and 66.7 +/- 5.1 and 79.8 +/- 8.2%, respectively. The sPLA(2) inhibitors were approximately 100 times more potent in decreasing the IASP than the mean blood pressure. Conversely, the selective inhibitors of the cytosolic and calcium-independent PLA(2) arachidonyl trifluoromethyl ketone and bromoenol lactone, respectively, produced no significant effect. The IAS had characteristically higher levels of sPLA(2) activity (26.5 +/- 4.9 micromol.min(-1).ml(-1)) vs. the RSM (3.2 +/- 0.4 micromol.min(-1).ml(-1)), and higher levels of sPLA(2) as shown by Western blot and RT-PCR. Interestingly, administration of sPLA(2) transformed RSM into the tonic smooth muscle like that of the IAS: it developed basal tone and relaxed in response to the electrical field stimulation. From the present data, we conclude that sPLA(2) plays a critical role in the genesis of tone in the IAS. PLA(2) inhibitors may provide potential therapeutic target for treating anorectal motility disorders. PMID:17717042

de Godoy, Márcio A F; Rattan, Satish



Excitatory and inhibitory actions of pituitary adenylate cyclase-activating peptide (PACAP) in the internal anal sphincter smooth muscle: sites of actions.  


Unlike its effects on the rest of the GI tract, the effects of pituitary adenylate cyclase-activating peptide (PACAP) on the internal anal sphincter (IAS) are not known. We examined the actions of PACAP-38 (here PACAP) and PACAP-27 on the basal IAS tone of circular smooth muscle strips before and after the administration of different neurohumoral antagonists. PACAP caused a concentration-dependent fall in the basal tone of the IAS. Interestingly, however, at higher concentrations, PACAP caused a biphasic response: an initial contraction followed by a relaxation. Both the contractile and the relaxant responses were insensitive to atropine, guanethidine, apamin or tetrodotoxin. Both the contractile and the relaxant effects were inhibited by PACAP 6-38 (a selective antagonist of PACAP), vasoactive intestinal polypeptide 10-28 (a vasoactive intestinal polypeptide antagonist) and PACAP tachyphylaxis. The nitric oxide synthase inhibitor Nomega-nitro-L-arginine attenuated the inhibitory but not the excitatory effect of PACAP. Conversely, the contractile but not the relaxant effect of PACAP on the IAS was nearly obliterated by the substance P antagonist spantide. The N-type Ca++-channel blocker omega-conotoxin caused significant suppression of both the contractile and the inhibitory actions of PACAP. We conclude that in the IAS, PACAP has a dual effect: a contraction followed by a relaxation. The contraction of IAS by PACAP is speculated to occur via the activation of PACAP receptor at the substance P-containing nerve terminals. PACAP-induced IAS relaxation, on the other hand, appears to be mediated in large part by its direct action at the smooth muscle cells and in part by its action at the nerve terminals of the myenteric inhibitory neurons. PMID:9353391

Rattan, S; Chakder, S



Chronic anal fissure  

Microsoft Academic Search

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

Miguel Minguez; Belen Herreros; Adolfo Benages



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

Microsoft Academic Search

INTRODUCTIONThe internal anal sphincter receives a stimulatory alpha1adrenergic innervation. Use of an adrenergic agonist may therefore have a role in treating patients with faecal incontinence.METHODSTen patients (seven females, median age 66 years) with passive faecal incontinence related to weak internal anal sphincter were studied. All patients had intact anal sphincters as assessed by endoanal ultrasound. Phenylephrine gel was applied in

M J Cheetham; M A Kamm; R K S Phillips



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



[Role of anal endosonography in inflammation and trauma of the anal canal].  


Anal endosonography (US) is a valuable tool to represent the normal anatomy of the anal canal and also to reliably examine patients with anal conditions. Our series consisted of 40 patients with suspected inflammatory and traumatic conditions of the anal canal submitted to anal US, which showed the presence of abscesses in 18 patients with suspected anal canal inflammation. A fistula was associated in 14 of the 18 patients and US after air injection easily showed a cutaneous orificium in 6 of the 14 patients. Anal US showed the presence and site of all abscessual foci and fistulae, also identifying the inner orificium and the involvement of muscular sphincteral structures, which is useful information to plan the most appropriate medical or surgical treatment. As for traumas, anal US is also a useful tool for identifying sphincteral injuries secondary to blunt trauma and for following-up sphincteral reconstruction with graciloplasty. Twenty-two patients with suspected sphincteric trauma were examined and anal US showed a sphincteral injury in 7 of 13 patients with acute postpartum-related symptoms; the clinical picture was ascribed to postpartum stretching of the pudendal nerve in 6 other patients. Finally, this method can be very useful in the follow-up of anal diseases, both to study surgical drainages and in the postoperative study of anal fistulae. PMID:9122465

Brunese, L; Amitrano, M; Gargano, V; Pinto, A; Vallone, G; Grassi, R; Rotondo, A; Smaltino, F



Postdelivery anal function in primiparous females  

Microsoft Academic Search

To the Editor--We read with interest the article by Damon and colleagues ~ concerning postdelivery anal function in primiparous females. We concur that anal sphincter defects are frequent after first vaginal delivery and that such defects are not always symptomatic. However, we take issue with the authors' statement that forceps assistance to delivery is not associated with a higher frequency

P. Ronan O'Connell; Colm O'Herlihy



[Reconstruction of anal function after abdomino-perineal resection].  


After abdomino-perineal resection for rectal cancer, most surgeons believe that colostomy is necessary after anal function is abolished and that patients are satisfied with this. Recently, reconstruction of anal function has been performed using new surgical techniques such as creation of an artificial sphincter, dynamic graciloplasty, gluteoplasty with pudendal nerve anastomosis, and smooth muscle implanted neoanus. However, most surgeons do not have sufficient knowledge of reconstruction of anal function. Since all reconstruction methods are associated with low mortality and morbidity rates, and can be converted to conventional colostomy when required, surgeons must consider first-line reconstruction of anal function after resection of the anal sphincter. PMID:10919156

Shatari, T; Kodaira, S



Anal manometric parameters: Predictors of outcome following anal sphincter repair?  

Microsoft Academic Search

Controversy exists over the utility of manometry in the management of fecal incontinence. In light of newer methods for the\\u000a management of fecal incontinence demonstrating favorable results, this study was designed to evaluate manometric parameters\\u000a relative to functional outcome following overlapping sphincteroplasty. Twenty women, 29 to 84 years of age (mean age 50 years),\\u000a with severe fecal incontinence and large

Susan Gearhart; Tracy Hull; Crina Floruta; Tom Schroeder; Jeff Hammel



Relationship of symptoms in faecal incontinence to specific sphincter abnormalities.  


We aimed to determine if the type of clinical presentation in patients with faecal incontinence correlated with the underlying sphincter pathology. One hundred fifty one consecutive patients (129 female) with faecal incontinence were classified as having either passive (faecal incontinence without the patient's knowledge) or urge incontinence (incontinence occurring with the patient's awareness, against their will because of lack of voluntary control), and were investigated by routine anorectal physiological testing and anal endosonography. Sixty six patients had passive incontinence (PI) only, 42 patients had urge incontinence (UI) only, 38 patients had combined passive and urge incontinence, and 5 patients had soiling after defaecation only. Patients with PI alone (n = 66) were significantly older than those with UI alone (PI vs UI, 60 vs 42 yr, p < 0.001), had a lower maximum resting anal pressure (51 vs 64 cm H2O, means, p = 0.02) and had a significantly (p < 0.001) greater prevalence of internal anal sphincter (IAS) defects. Patients with UI alone (n = 42) had a significantly lower maximum voluntary contraction pressure (PI v UI, 72 v 42 cm H2O, p < 0.001), and a significantly (p < 0.001) greater prevalence of external anal sphincter (EAS) defects. The clinical classification of faecal incontinence into passive and urge incontinence relates to specific patterns of abnormality of the internal and external anal sphincters. PMID:7561433

Engel, A F; Kamm, M A; Bartram, C I; Nicholls, R J



Sphincteroplasty for anal incontinence.  


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. PMID:24759337

Pescatori, Lorenzo Carlo; Pescatori, Mario



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. PMID:24759337

Pescatori, Lorenzo Carlo; Pescatori, Mario



Abnormal transient internal sphincter relaxation in idiopathic pruritus ani: physiological evidence from ambulatory monitoring.  


Patients with idiopathic pruritus ani have an abnormal rectoanal inhibitory reflex and a lower threshold for internal sphincter relaxation during the saline continence test. This led to the hypothesis that these patients may exhibit abnormalities of the transient internal anal sphincter relaxation reflex. To study this, 23 men of median age 41 (range 27-64) years with idiopathic pruritus ani and 16 male controls of median age 39 (range 26-68) years were assessed using computerized ambulatory anorectal electromyography and manometry. Resting anal pressure, maximum anal squeeze pressure, internal sphincter electromyogram frequency, the number of internal sphincter relaxations and pudendal nerve terminal motor latency were similar for the two groups. The rise in rectal pressure during internal sphincter relaxation was higher in patients with pruritus than in controls (median (range) 29 (18-60) versus 18 (11-37) cmH2O, P < 0.01). Furthermore, the fall in anal pressure was greater in patients with pruritus than in controls (median (range) 39 (15-52) versus 29 (21-43) cmH2O, P < 0.01). The duration of internal sphincter relaxation was prolonged in patients compared with controls (median (range) 29 (18-55) versus 8 (5-12) s, P < 0.001). Fourteen patients reported staining of underclothes and 17 complained of perianal itch within 1 h of these episodes of abnormal internal sphincter relaxation. Pruritus ani may result from occult faecal leakage as a result of abnormal transient internal sphincter relaxation. PMID:8205448

Farouk, R; Duthie, G S; Pryde, A; Bartolo, D C



New Techniques for Treating an Anal Fistula  

PubMed Central

Surgery for an anal fistula may result in recurrence or impairment of continence. The ideal treatment for an anal fistula should be associated with low recurrence rates, minimal incontinence and good quality of life. Because of the risk of a change in continence with conventional techniques, sphincter-preserving techniques for the management complex anal fistulae have been evaluated. First, the anal fistula plug is made of lyophilized porcine intestinal submucosa. The anal fistula plug is expected to provide a collagen scaffold to promote tissue in growth and fistula healing. Another addition to the sphincter-preserving options is the ligation of intersphincteric fistula tract procedure. This technique is based on the concept of secure closure of the internal opening and concomitant removal of infected cryptoglandular tissue in the intersphincteric plane. Recently, cell therapy for an anal fistula has been described. Adipose-derived stem cells have two biologic properties, namely, ability to suppress inflammation and differentiation potential. These properties are useful for the regeneration or the repair of damaged tissues. This article discusses the rationales for, the estimated efficacies of, and the limitations of new sphincter-preserving techniques for the treatment of anal fistulae. PMID:22413076



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



Prosthetic Sphincter Controls Urination  

NASA Technical Reports Server (NTRS)

People who lost muscular control of urinary canal through disease or injury aided by prosthetic sphincter. Implanted so it surrounds uretha, sphincter deflated and inflated at will by wearer to start and stop urina tion. Operating pressure adjusted after implantation to accommodate growth or atrophy of urinary canal and prevent tissue damage from excess pressure. Principle adapted to other organs, such as colon, ureter, or ileum.

Tenny, John B., Jr



Anal Cancer  


Anal cancer is a rare type of cancer. The anus is where stool leaves your body when you go to the bathroom. It is made up of your outer layers of ... and the end of your large intestine. Anal cancer is a disease in which cancer cells form ...


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



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. PMID:24982770

Kovács, Gyoergy



HDR brachytherapy for anal cancer.  


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



Prosthetic urinary sphincter  

NASA Technical Reports Server (NTRS)

A pump/valve unit for controlling the inflation and deflation of a urethral collar in a prosthetic urinary sphincter device is described. A compressible bulb pump defining a reservoir was integrated with a valve unit for implantation. The valve unit includes a movable valve member operable by depression of a flexible portion of the valve unit housing for controlling fluid flow between the reservoir and collar; and a pressure sensing means which operates the valve member to relieve an excess pressure in the collar should too much pressure be applied by the patient.

Helms, C. R.; Smyly, H. M. (inventors)



What Is Anal Cancer?  


... of cancer can start in the anal region: Squamous cell carcinomas: Most anal cancers in the United States are ... rest of this document focuses mainly on anal squamous cell carcinomas, which account for the vast majority of anal ...


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

PubMed Central

The aim of this study was to evaluate the feasibility and the effectiveness of preoperative radiochemotherapy followed by total mesorectal excision (TME) and sphincter-preserving procedures for T3 low rectal cancer. Patients with rectal cancer and T3 tumors located within 1–6 cm of the dentate line received preoperative radiochemotherapy. Concurrent 5-fluorouracil-based radiochemotherapy was used. Radical resection with TME and sphincter-preserving procedures were performed during the six to eight weeks following radiotherapy. Survival was analyzed using the Kaplan-Meier method. The anal function was evaluated using the Wexner score. The clinical response rate was 83.5%, overall downstaging of T classification was 75.3% and pathological complete response was 15.3%. The anastomotic fistula rate was 4.7%. A median follow-up of 30 months showed the local recurrence rate to be 4.7% and the distant metastasis rate to be 5.9%. The three-year overall survival rate was 87%. The degree of anal incontinence as measured using the Wexner score decreased over time, and the anal sphincter function in the majority of patients gradually improved. Preoperative radiochemotherapy was found to improve tumor downstaging, reduces local recurrence, increase the sphincter preservation rate, and is therefore of benefit to patients with T3 low rectal cancer. PMID:22783445




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

Microsoft Academic Search

Anal fissure is one of the most common and painful proctologic diseases. Its treatment has long been discussed and several\\u000a different therapeutic options have been proposed. In the last decades, the understanding of its pathophysiology has led to\\u000a a progressive reduction of invasive and potentially invalidating treatments in favor of conservative treatment based on anal\\u000a sphincter muscle relaxation. Despite some

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



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

PubMed Central

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

Poggio, Juan Lucas



Common anal problems.  


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



[Physiology of the upper esophageal sphincter].  


The upper esophageal sphincter (UES) forms a barrier between the pharynx and the esophagus. When opened, the UES allows the food bolus to pass into the esophagus, as well as permitting emesis and eructation. The basal sphincter tone constitutes a barrier function which serves to prevent reflux and passive aerophagia in the case of deep breathing. Basal sphincter tone is dependent on several influencing factors; during swallowing, sphincter opening and closure follow a complex multiphase pattern. This article presents an overview of the current understanding of UES physiology. PMID:24916353

Jungheim, M; Miller, S; Kühn, D; Schwemmle, C; Schneider, J P; Ochs, M; Ptok, M



Functional sphincter ani externus reconstruction for treatment of fecal stress incontinence using free latissimus dorsi muscle transfer with coaptation to the pudendal nerve: preliminary experimental study in dogs.  


The external anal sphincter (EAS) is a skeletal muscle capable of voluntary contraction to prevent accidental defecation. Current reconstructive options for a severely damaged EAS using local muscle flaps are not always adequate for functional repair. The present preliminary experimental model was designed to assess the feasibility of a neuromicrovascular latissimus dorsi muscle transfer for functional external spincter muscle reconstruction. In nine mongrel dogs, the anal sphincter muscles were totally resected, leaving a mucosal canal in place. A segmental latissimus dorsi muscle was shaped around the anal canal in a circular fashion, with coaptation to the pudendal nerve, and vessel anastomosis at the ischiorectal fossa. Functional evaluation was performed using electromyogram, sphincter manometry, video documentation, and histologic examination with standard and immunohistochemical staining. After 8 months, the remaining three eligible dogs were continent. Muscle function was verified by means of electromyogram, sphincter manometry, and a video record. Histologic and immunohistochemical examination confirmed the functional results, showing only minor zones of fatty and fibrous degeneration. Transplantation of a segmental latissimus dorsi muscle with vascular anastomosis and coaptation to the pudendal nerve has proved to be successful in restoring (voluntary) anal continence experimentally in dogs. Its feasibility for perfect orientation as a neosphincter seems to be superior to any pedicled muscle flap. However, these preliminary results deserve further investigation prior to considering application in humans. PMID:17330203

Schwabegger, Anton H; Kronberger, Peter; Obrist, Peter; Brath, Endre; Miko, Iren



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. PMID:21876616

Dudukgian, Haig; Abcarian, Herand



Clinical results and manometric studies after rectal flap advancement for infra-levator trans-sphincteric fistula-in-ano.  


Eleven patients with infra-levator trans-sphincteric fistula-in-ano underwent fistula excision with rectal flap advancement. The clinical results were assessed by interview and the physiological function determined by ano-rectal manometry. Nine patients underwent paired studies before and 5 (range 2 to 6) months after operation. Median maximum resting anal pressure was 84 (48-135) cm water before operation and 76 (29-139) cm water after operation (P = N.S.). Median maximum squeeze pressure was 112 (64-290) cm water before operation and 88 (44-316) cm water after operation (P = N.S.). The median sphincter length was preserved after operation. There was one clinical failure following the development of an abscess under the flap. All patients are continent and there have been no recurrences. We conclude that rectal flap advancement is an acceptable way to cure more complex fistula-in-ano. Good functional results are achieved by maintaining anal sphincter function together with preservation of the integrity of the anal margin. PMID:8568401

Lewis, W G; Finan, P J; Holdsworth, P J; Sagar, P M; Stephenson, B M



Can Anal Cancer Be Prevented?  


... How is anal cancer found? Can anal cancer be prevented? Since some people with anal cancer have ... years without having any symptoms. So it can be nearly impossible to know whether a sex partner ...


General Information about Anal Cancer  


... tumors, not anal cancer . Being infected with the human papillomavirus (HPV) increases the risk of developing anal cancer. Risk factors include the following: Being infected with human papillomavirus (HPV). Having many sexual partners. Having receptive anal ...


The anocavernosal erectile dysfunction syndrome. II Anal fissure and erectile dysfunction.  


A previous study has demonstrated that the bulbocavernosus muscle (BCM) is a part of the external anal sphincter (EAS) [Shafik, Arch Androl, 1999]. It aids erection by compressing the penile bulb and the dorsal penile vein, and acts as a 'suction-ejection' pump in the ejaculatory process. Being a part of the EAS, the BCM is assumed to be involved in the different EAS pathologies. A recent study showed that erectile (ED) and ejaculatory dysfunction in 16 men with fecal incontinence (FI) after an anal fistula operation was cured after sphincteroplasty [Shafik, in press]. This article investigates the erectile and ejaculatory status in patients with anal fissure. The study comprised 32 men with acute anal fissure (mean age 36.7 +/- 8.2 s.d. years), 21 with chronic anal fissure (mean age 38.8 +/- 10.3 s.d. years), and 10 healthy volunteers (mean age 35.2 +/- 7.3 s.d. years). Erectile dysfunction occurred in all men with an acute fissure and in 16 of the chronic fissure patients; erection had been normal before fissure occurrence. The volunteers had normal erection. The anal pain radiated to the penis and was exaggerated on erection and penile thrusting. Erectile dysfunction investigations showed normal results. The electromyographic (EMG) activity of the external and internal (IAS) anal sphincters and the BCM as well as anal, penile bulb and cavernosal pressures were recorded. The acute fissures were treated conservatively and chronic ones by internal anal sphincterotomy. The patients were followed for mean periods of 17.3 +/- 3.6 s.d. months. The bulbocavernosus reflex as well as EMG activity of EAS and BCM were normal, while the resting EMG activity of the IAS was increased. The anal pressure in the acute and chronic anal fissure was increased (P < 0.01, P < 0.05, respectively), while the bulbar and cavernosal pressures showed no significant changes. Fissure treatment effected cure of the fissure and the ED in 30/32 of the acute and in 19/21 of the chronic cases. Erectile dysfunction persisted in the four patients in whom the fissures did not heal. In conclusion, a relationship is suggested to exist between anal fissure and ED. The ED occurred in the presence of anal fissure and was normalized with fissure cure. The BCM and anal pain seem to play a role in the etiology of ED associated with anal fissure. PMID:11424966

Shafik, A; El-Sibai, O



Anal endosonography in the diagnosis and management of perianal endometriosis: report of a case.  


We report a rare case of perianal endometriosis, diagnosed in a 39-year-old woman who presented with a several-day history of a painful mass in the perineum. Perianal examination showed redness and swelling in the right anterior direction. A soft tumor was palpated, but there was no evidence of an episiotomy scar, or of fistula orifices. An anal endosonography in the right anterior direction revealed a sharply defined lesion, 17 x 14 mm in diameter, with high echoic enhancement at its center. The lesion was located along the edge of the external anal sphincter but did not involve it. Based on these endosonographic findings, the tumor was not considered to be an abscess or fistula. We detected its location, and judged it possible to enucleate the tumor under local anesthesia without injuring the anal sphincter. The operation was performed uneventfully and a histological diagnosis of endometriosis was confirmed. Using anal endosonography, we were able to determine the exact anatomic relationship of the lesion in the internal and external sphincter, which substantially influenced the diagnosis and operative procedures. PMID:12884104

Watanabe, Makoto; Kamiyama, Goichi; Yamazaki, Katsuo; Hiratsuka, Kenshi; Takata, Manabu; Tsunoda, Akira; Shibusawa, Miki; Kusano, Mitsuo



Ligation of intersphincteric fistula tract (LIFT) to treat anal fistula: systematic review and meta-analysis.  


Sphincter-preserving approaches to treat anal fistula do not jeopardize continence; however, healing rates are suboptimal. In this context, ligation of the intersphincteric fistula tract (LIFT) can be considered promising offering high success rates and a relatively simple procedure. This review aimed to investigate the outcomes of LIFT to treat anal fistula. We conducted a systematic review of the Pubmed, Web of Science, and Cochrane databases, to retrieve all relevant scientific original articles and scientific abstracts (Web of Science) related to the LIFT procedure for anal fistula between January 2007 and March 2013. The search yielded 24 original articles including 1,110 patients; these included one randomized controlled study, three case control studies, and 20 case series. Most studies included patients with trans-sphincteric or complex fistula, not amenable to fistulotomy. During a pooled mean 10.3 months of follow-up, the mean success, incontinence, intraoperative, and postoperative complication rates were 76.4, 0, 0, and 5.5%, respectively. A sensitivity analysis showed that the impact on success in terms of follow-up duration, study size, and combining other procedures was limited. There was no association between pre-LIFT drainage seton and success of LIFT. Ligation of the intersphincteric fistula tract appears to be an effective and safe treatment for trans-sphincteric or complex anal fistula. Combining other procedures and a pre-LIFT drainage seton does not seem to confer any added benefit in terms of success. However, given the lack of prospective randomized trials, interpretation of these data must be cautious. Further trials are mandatory to identify predictive factors for success, and true effectiveness of the LIFT compared to other sphincter-preserving procedures to treat anal fistula. PMID:24957361

Hong, K D; Kang, S; Kalaskar, S; Wexner, S D



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



[Surgical tactics in acute inter-sphincter paraproctitis].  


The peculiarities of the clinical course, diagnosis and operative treatment of acute inter-sphincter paraproctitis were analysed. The expediency of singling out inter-sphincter paraproctitis into an independent form of the disease is substantiated. PMID:2724797

Timerbulatov, V M



Carcinoma of the anal canal and flow cytometric DNA analysis.  

PubMed Central

Using flow cytometric DNA analysis of paraffin embedded tissue, DNA histograms were successfully obtained from the anal cancers of 117 patients. DNA diploid patterns were given by 82 cancers (70%) and DNA non-diploid patterns by 35 cancers (30%): 15 DNA aneuploid, 20 DNA tetraploid. Well differentiated squamous cell cancers were mainly DNA diploid, while a larger proportion of poorly differentiated and small cell cancers were DNA non-diploid. The large majority of stage A cancers were DNA diploid. A greater proportion of tumours that had invaded through the anal sphincter or had lymph node metastases or distant spread were DNA non-diploid. Prognosis was slightly poorer for patients with DNA non-diploid cancers when compared to patients with DNA diploid tumours (P = 0.08) and significantly poorer for individuals with DNA aneuploid anal cancers (P = 0.037). However, in a multivariate analysis model, the DNA ploidy pattern of an anal cancer was not of independent prognostic significance alongside tumour histology and tumour stage. PMID:2803916

Scott, N. A.; Beart, R. W.; Weiland, L. H.; Cha, S. S.; Lieber, M. M.



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. PMID:23094214

Ahn, Hyo Kwang; Huh, Youngbuhm



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


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



[Acute anal pain].  


Anal pain is a common reason for consultation, whose etiology is varied and should not be limited to the hemorrhoidal disease. The purpose of this article is to conduct a review of the literature on anorectal pathologies most frequently encountered and make recommendations regarding their management. PMID:24701675

Pittet, O; Demartines, N; Hahnloser, D



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


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



Anal cancer in women.  


We studied predisposing factors in 56 women with anal cancer, comparing them with 56 matched controls drawn from the population. A detailed pretested questionnaire was administered to each study subject in a structured interview and blood was drawn for detection of herpes simplex virus antibodies by radioimmunoassay. Pathologic material from cases was obtained and evidence of human papilloma virus infection was sought. By univariate analyses we found associations between anal cancer and positive herpes simplex virus 2 titer (p = 0.0017), cigarette smoking (p = 0.0028), previous positive or questionable cervical Papanicolaou smear (p = 0.0124), and increasing number of sexual partners (p = 0.0224). By the multivariate technique of logistic regression there were independent and significant associations with cigarette smoking (p = 0.0126), previous use of hemorrhoid preparations (p = 0.0149), and history of disturbed bowel habits for greater than 1 mo (p = 0.0273). Anal cancer in women is a rare disease associated with cigarette smoking and sexual experience. Its association with previous anorectal disease is unclear and deserving of further study. PMID:2836255

Holmes, F; Borek, D; Owen-Kummer, M; Hassanein, R; Fishback, J; Behbehani, A; Baker, A; Holmes, G



Screening for anal neoplasia: anal cytology - sampling, processing and reporting.  


Anorectal cytology (ARC) is increasingly accepted as a valid screening tool for the diagnosis of squamous intraepithelial lesions in populations at increased risk for anal cancer. As with cervical cancer screening protocols, proper patient preparation, specimen collection and specimen processing are essential for obtaining an optimal cytological sample. With attention and experience, the clinician can collect the best possible ARC specimen for laboratory evaluation. The incorporation of repeated interval anal cytology into standard surveillance practices for high-risk individuals is a valuable tool for the early detection of human papillomavirus-related anal squamous epithelial lesions and the prevention of anal squamous cell carcinomas. PMID:22950982

Darragh, Teresa M; Winkler, Barbara



Electrophysiology of motor pathways for sphincter control in multiple sclerosis.  

PubMed Central

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



Electrophysiology of motor pathways for sphincter control in multiple sclerosis.  


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



[Disorders of the bladder sphincter. Etiopathogenic approach].  


Disorders of the vesico-sphincteral system are due to multiple causes (urological, gynaecological, neurological, psycho-behavioural, iatrogenic) which may be associated. By providing information on the type and evolution of these disorders and on the circumstances in which they developed, questioning is fundamental for the diagnosis. Completed by physical examination, it must precede all exploratory methods, including urodynamic, electrophysiological and radiological examinations. It allows these examinations to be graded and, compared with the results, it gives a better understanding of the physiopathology and aetiology of micturition disorders and therefore ensures their better treatment. PMID:8265530

Amarenco, G; Kerdraon, J; Denys, P



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. PMID:24759339

Nevler, Avinoam



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



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

PubMed Central

AIM: To study the effect of botulinum toxin in patients with chronic anal fissure after biliopancreatic diversion (BPD) for severe obesity. METHODS: Fifty-nine symptomatic adults with chronic anal fissure developed after BPD were enrolled in an open label study. The outcome was evaluated clinically and by comparing the pressure of the anal sphincters before and after treatment. All data were analyzed in univariate and multivariate analysis. RESULTS: Two months after treatment, 65.4% of the patients had a healing scar. Only one patient had mild incontinence to flatus that lasted 3 wk after treatment, but this disappeared spontaneously. In the multivariate analysis of the data, two registered months after the treatment, sex (P = 0.01), baseline resting anal pressure (P = 0.02) and resting anal pressure 2 mo after treatment (P < 0.0001) were significantly related to healing rate. CONCLUSION: Botulinum toxin, despite worse results than in non-obese individuals, appears the best alternative to surgery for this group of patients with a high risk of incontinence. PMID:22416176

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



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



Anal manometric studies in hemorrhoids and anal fissures  

Microsoft Academic Search

Manometric study with the use of continuous water perfusion system was performed on 50 patients with Grade III or IV hemorrhoids\\u000a and for 29 patients with chronic anal fissure. Another 36 patients who had no anorectal symptoms or pathology were chosen\\u000a as the control group. The maximal basal pressures for the controls, hemorrhoids, and chronic anal fissures 71.2±24.9, 85.3±27.7,\\u000a and

Jen-Kou Lin



Pharmacological Sphincterotomy for Chronic Anal Fissures by Botulinum Toxin A  

PubMed Central

Chronic anal fissure is a common proctologic disease. Botulinum toxin (BTX) can be used for temporary chemical denervation to treat this painful disorder. Its application is by intramuscular injections into either the external or internal anal sphincter muscle. The mode of action, application techniques, and possible complications or adverse effects of BTX therapy are discussed in this report. The healing rate is dependent on the BTX dosage. The short-term healing rate (? 6 months) is 60–90%, whereas about 50% of the patients show a complete response in long-term follow-up studies (> 1 year). Adverse effects are generally mild, but relapses occur more often than with surgery. Conservative therapy is currently considered as a first-line treatment. With increasing evidence for its efficacy, BTX can now be considered among the first-line nonsurgical treatements. Although, surgical management by lateral sphincterotomy is the most effective treatment, it shows a higher incidence of incontinence and greater general morbidity rate than BTX. BTX is a useful alternative to surgery and in many cases, surgery can be avoided with the use of BTX. PMID:20300345

Wollina, Uwe



[Therapy of male urinary incontinence: artificial sphincter versus male slings].  


Different kinds of sling systems for the therapy of male urinary incontinence have been developed during the last decade. All systems work by compressing the male urethra. There are adjustable and non-adjustable systems. Implantation is mostly a minimally invasive procedure. On the other hand the well-established AMS 800 hydraulic artificial sphincter has been available since 1972. Recently, another hydraulic artificial sphincter (FlowSecure) has become available providing a boost of occlusive pressure during stress. The aim of this review is to compare effectiveness and indications of the different techniques compared to the artificial sphincter. PMID:22399110

Leicht, W; Thüroff, J



Anal lesions in hematologic diseases  

Microsoft Academic Search

Of 514 patients hospitalized for miscellaneous hematologic diseases, 31 had severe anal lesions (6 per cent); these complications\\u000a were most commonly observed in agranulocytosis, acute myeloid leukemia, and medullar aplasia. They included infiltration of\\u000a the perianal area, ulceration, and abscesses. In 20 per cent of the 31 patients, the anal lesion was the first manifestation\\u000a of the hematologic disease. In

R. Vanheuverzwyn; A. Delannoy; J. L. Michaux; C. Dive



[Brachytherapy for anal cancers].  


Low dose-rate brachytherapy as a boost after concomitant chemoradiation therapy is a standard of care for locally advanced anal carcinoma, providing a rigorous selection taking into account the initial staging and tumor response to external beam radiotherapy. Local control is likely to be superior when the boost is performed with brachytherapy than with external beam radiotherapy. The several steps of the brachytherapy procedure are described. The standard treatment scheme is a concomitant chemoradiation therapy, including 45 Gy (1,8 Gy × 5) pelvic external beam radiotherapy and two courses of 5-fluorouracil and mitomycin-C, followed by a 15 Gy brachytherapy boost with a gap limited to 2 to 3 weeks. Higher irradiation dose for the most advanced cases has not yet demonstrated a therapeutic gain in terms of colostomy free survival. Exclusive brachytherapy for in-situ carcinoma or invasive carcinoma less than 10mm is not recommended due to a high risk of local recurrence. Pulsed dose rate brachytherapy is an alternative to low dose rate brachytherapy (iridium wires) providing the respect of the recommended dose rate (0.5 to 1 Gy/hour). High dose rate brachytherapy is still under evaluation. PMID:23582604

Pommier, P; Mirabel, X; Hannoun-Lévi, J-M; Malet, C; Gérard, J-P; Peiffert, D



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


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



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. PMID:23197880

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



Painful anal ulceration in homosexual men.  


Forty homosexual men with painful anal ulceration were studied. Two patients had primary syphilis; sixteen men had primary anal herpes and twenty-two men had traumatic ulceration of the anal canal. The clinical features of the men with primary herpes were compared with those of the group with traumatic anal fissures. Fever, paraesthesiae in the buttocks and lower limbs, and difficulty in initiating micturition were found significantly more frequently in the former group of patients. PMID:6697127

McMillan, A; Smith, I W



Hazards associated with anal erotic activity  

Microsoft Academic Search

The recent liberalization of attitudes towards sexuality has brought with it the desire by some individuals to seek alternate methods of sexual stimulation and gratification, among them an exploration of anal eroticism. Various practices associated with anal sexuality carry with them the potential for medical complications. In this paper some of the hazards associated with anal eroticism are outlined and

Jeremy Agnew



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



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. PMID:22701539

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



Effect of histamine and substance P on the rabbit and human iris sphincter muscle  

Microsoft Academic Search

• Background and methods: In an attempt to clarify the functional action of histamine and substance P on atropine-resistant miosis, we isolated rabbit and human iris sphincter muscles and investigated their mechanical properties using the isometric tension recording method. • Results: Substance P dose-dependently contracted the rabbit iris sphincter, but had no effect on the human iris sphincter. In the

Takeshi Yoshitomi; Hitoshi Ishikawa; Isao Haruno; Satoshi Ishikawa



Fibrin glue in the treatment of anal fistula: a systematic review  

PubMed Central

Background New sphincter-saving approaches have been applied in the treatment of perianal fistula in order to avoid the risk of fecal incontinence. Among them, the fibrin glue technique is popular because of its simplicity and repeatability. The aim of this review is to compare the fibrin glue application to surgery alone, considering the healing and complication rates. Methods We performed a systematic review searching for published randomized and controlled clinical trials without any language restriction by using electronic databases. All these studies were assessed as to whether they compared conventional surgical treatment versus fibrin glue treatment in patients with anal fistulas, in order to establish both the efficacy and safety of each treatment. We used Review Manager 5 to conduct the review. Results The healing rate is higher in those patients who underwent the conventional surgical treatment (P = 0,68), although the treatment with fibrin glue gives no evidence of anal incontinence (P = 0,08). Furthermore two subgroup analyses were performed: fibrin glue in combination with intra-adhesive antibiotics versus fibrin glue alone and anal fistula plug versus fibrin glue. In the first subgroup there were not differences in healing (P = 0,65). Whereas in the second subgroup analysis the healing rate is statistically significant for the patients who underwent the anal fistula plug treatment instead of the fibrin glue treatment (P = 0,02). Conclusion In literature there are only two randomized controlled trials comparing the conventional surgical management versus the fibrin glue treatment in patients with anal fistulas. Although from our statistical analysis we cannot find any statistically significant result, the healing rate remains higher in patients who underwent the conventional surgical treatment (P = 0,68), and the anal incontinence rate is very low in the fibrin glue treatment group (P = 0,08). Anyway the limited collected data do not support the use of fibrin glue. Moreover, in our subgroup analysis the use of fibrin glue in combination with intra-adhesive antibiotics does not improve the healing rate (P = 0.65), whereas the anal fistula plug treatment compared to the fibrin glue treatment shows good results (P = 0,02), although the poor number of patients treated does not lead to any statistically evident conclusion. This systematic review underlines the need of new RCTs upon this issue. PMID:19912660



Anal Disorders - Multiple Languages: MedlinePlus  


... JavaScript. Anal Disorders - Multiple Languages Arabic (???????) French (français) Hindi (??????) Japanese (???) Korean (???) Russian ( ... ??? ?????? - ??????? Bilingual Health Information Translations French (français) Barium Enema Lavement baryté - français (French) Bilingual PDF ...


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

PubMed Central

Background Chronic anal fissure (CAF) is a painful condition that is unlikely to resolve with conventional conservative management. Previous studies have reported that topical treatment of CAF with glyceryl trinitrate (GTN) reduces pain and promotes healing, but optimal treatment duration is unknown. Methods To assess the effect of different treatment durations on CAF, we designed a prospective randomized trial comparing 40 versus 80 days with twice daily topical 0.4% GTN treatment (Rectogesic®, Prostrakan Group). Chronicity was defined by the presence of both morphological (fibrosis, skin tag, exposed sphincter, hypertrophied anal papilla) and time criteria (symptoms present for more than 2 months or pain of less duration but similar episodes in the past). A gravity score (1 = no visible sphincter; 2 = visible sphincter; 3 = visible sphincter and fibrosis) was used at baseline. Fissure healing, the primary endpoint of the study, maximum pain at defecation measured with VAS and maximum anal resting pressure were assessed at baseline and at 14, 28, 40 and 80 days. Data was gathered at the end of the assigned treatment. Results Of 188 patients with chronic fissure, 96 were randomized to the 40-day group and 92 to the 80-day group. Patients were well matched for sex, age, VAS and fissure score. There were 34 (19%) patients who did not complete treatment, 18 (10%) because of side effects. Of 154 patients who completed treatment, 90 (58%) had their fissures healed and 105 (68%) were pain free. There was no difference in healing or symptoms between the 40- and the 80-day group. There was no predictor of fissure healing. A low fissure gravity score correlated with increased resolution of pain (P < 0.05) and improvement of VAS score (P < 0.05) on both univariate and multivariate analysis. A lower baseline resting pressure was associated with better pain resolution on univariate analysis (P < 0.01). VAS at defecation and fissure healing significantly improved until 40 days (P < 0.001), while the difference between 40 and 80 days was not significant. Conclusion We found no benefits in treating CAF with topical GTN for 80 days compared to 40 days. Fissure healing and VAS improvement continue until 6 weeks of treatment but are unlikely thereafter. PMID:20632059

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



Spontaneous Kidney Allograft Rupture  

Microsoft Academic Search

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

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



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

PubMed Central

Introduction Lower esophageal sphincter (LES) lift seen on high resolution manometry (HRM) is a possible surrogate marker of the longitudinal muscle contraction of the esophagus. Recent studies suggest that longitudinal muscle contraction of the esophagus induces LES relaxation. Aim Our goal was to determine, 1) the feasibility of prolonged ambulatory HRM and 2) to detect LES lift with LES relaxation using ambulatory HRM color isobaric contour plots. Methods In vitro validation studies were performed to determine the accuracy of HRM technique in detecting axial movement of the LES. Eight healthy normal volunteers were studied using a custom designed HRM catheter and a 16 channel data recorder, in the ambulatory setting of subject’s home environment. Color HRM plots were analyzed to determine the LES lift during swallow-induced LES relaxation as well as during complete and incomplete transient LES relaxations. Results Satisfactory recordings were obtained for 16 hours in all subjects. LES lift was small (2 mm) in association with swallow-induced LES relaxation. LES lift could not be measured during complete transient LES relaxations (TLESR) because the LES is not identified on the HRM color isobaric contour plot once it is fully relaxed. On the other hand, LES lift, mean 7.6 ± 1.4 mm, range 6–12 mm was seen with incomplete TLESRs (n = 80). Conclusions Our study demonstrates the feasibility of prolonged ambulatory HRM recordings. Similar to a complete TLESR, longitudinal muscle contraction of the distal esophagus occurs during incomplete TLESRs, which can be detected by the HRM. Using prolonged ambulatory HRM, future studies may investigate the temporal correlation between abnormal longitudinal muscle contraction and esophageal symptoms. PMID:22074595

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



Does an anatomical sphincter exist in the distal esophagus?  

Microsoft Academic Search

The presence or absence of a lower esophageal sphincter (LES) has been a matter of debate. The aim of the present study was\\u000a to revisit the gastro-esophageal region in an attempt to elucidate further the presence or absence of such a structure. The\\u000a distal part of the esophagus was investigated in 12 fixed and 2 fresh cadavers with the aid

Nihal Apaydin; Aysun Uz; Alaittin Elhan; Marios Loukas; R. Shane Tubbs



Influence of the duration of the second stage of labor on the likelihood of obstetric anal sphincter injury  

E-print Network

extracted from the Protos database, including 114 maternal age (at time of delivery), body mass index (BMI) at first trimester prenatal booking, 115 ethnicity and birthweight. Birthweight was recorded to the nearest gram. Variables related to 116... of episiotomy in our center 126 is in keeping with UK national guidance on intrapartum care (20) and is typical of a UK 127 institution. 128 129 Statistical analyses 130 Group-wise comparisons were carried out using Student’s t-test for continuous...

Aiken, Catherine; Aiken, Abigail R.; Prentice, Andrew



Vagal afferent innervation of the lower esophageal sphincter.  


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



Anal erotic instrumentation. A surgical problem.  


Anal sexual eroticism is a fact of modern life and a part of the male homosexual relationship. A delineation of surgical problems associated with anal erotic instrumentation with enema is presented. The cases of three patients with rectal perforation are described. PMID:6714052

Witz, M; Shpitz, B; Zager, M; Eliashiv, A; Dinbar, A



Nocturnal faecal soiling and anal masturbation  

Microsoft Academic Search

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

A F Clark; P J Tayler; S R Bhate



Sphincter-sparing surgery after preoperative radiotherapy for low rectal cancers: feasibility, oncologic results and quality of life outcomes  

PubMed Central

The present study assesses the choice of surgical procedure, oncologic results and quality of life (QOL) outcomes in a retrospective cohort of 53 patients with low-lying rectal cancers (within 6 cm of the anal verge) treated surgically following preoperative radiotherapy (RT, median dose 45 Gy) with or without concomitant 5-fluorouracil. QOL was assessed in 23 patients by using two questionnaires developed by the QOL Study Group of the European Organization for Research and Treatment of Cancer: EORTC QLQ-C30 and EORTC QLQ-CR38. After a median interval of 29 days from completion of RT, abdominoperineal resection (APR) was performed in 29 patients (55%), low anterior resection in 23 patients (20 with coloanal anastomosis) and transrectal excision in one patient. The 3-year actuarial overall survival and locoregional control rates were 71.4% and 77.5% respectively, with no differences observed between patients operated by APR or restorative procedures. For all scales of EORTC QLQ-C30 and EORTC QLQ-CR38, no significant differences in median scores were observed between the two surgical groups. Although patients having had APR tended to report a lower body image score (P = 0.12) and more sexual dysfunction in male patients, all APR patients tended to report better physical function, future perspective and global QOL. In conclusion, sphincter-sparing surgery after preoperative RT seems to be feasible, in routine practice, in a significant proportion of low rectal cancers without compromising the oncologic results. However, prospective studies are mandatory to confirm this finding and to clarify the putative QOL advantages of sphincter-conserving approaches. © 2000 Cancer Research Campaign PMID:10735495

Allal, A S; Bieri, S; Pelloni, A; Spataro, V; Anchisi, S; Ambrosetti, P; Sprangers, M A G; Kurtz, J M; Gertsch, P



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

SciTech Connect

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

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



Anal melanosis diagnosed by reflectance confocal microscopy.  


Until now, in vivo reflectance-mode confocal microscopy (IVCM) has been applied only to pigmented lesions of the vulvar and oral mucosa, but not to anal mucosa lesions. We present the first case in which IVCM has been used to diagnose anal melanosis. Clinical and dermoscopic features were of concern while IVCM found the draped pattern already described for genital melanosis. IVCM adds information to the clinical and dermatoscopic examination and allows skin biopsies to be avoided. Further studies are needed to define the IVCM features of anal melanosis and to compare the performance of IVCM with the findings of histological examinations. PMID:24004266

Cinotti, Elisa; Chol, Christelle; Perrot, Jean Luc; Labeille, Bruno; Forest, Fabien; Cambazard, Frédéric



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. PMID:22797662

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



Constipation in 44 patients implanted with an artificial bowel sphincter  

Microsoft Academic Search

Purpose  Constipation with or without obstructed defecation (OD) is frequent in patients with artificial bowel sphincter (ABS). The\\u000a aims of this study were (1) to evaluate the functional outcome of ABS based on postoperative constipation and (2) to assess\\u000a pre-implantation data to predict post-implantation constipation.\\u000a \\u000a \\u000a \\u000a Materials and methods  Thirteen men and 31 women were followed up. Both fecal incontinence and constipation with

Syrine Gallas; Anne-Marie Leroi; Valérie Bridoux; Benoît Lefebure; Jean-Jacques Tuech; Françis Michot



Can Anal Cancer Be Found Early?  


... cervical cancer or vulvar cancer , anyone who is HIV-positive, and anyone who has received an organ transplant. Some experts also recommend screening for anyone with a history of anal warts. For these people, some experts ...


Ruptured ulnar artery pseudoaneurysm  

Microsoft Academic Search

Ulnar artery aneurysms and pseudoaneurysms are rare lesions that usually occur distal to the wrist and cause symptoms as a result of embolization and not rupture. An elderly woman presented with acute rupture of an ulnar artery pseudoaneurysm proximal to the wrist, which caused severe neurologic compromise as a result of bleeding into Guyon's canal and the carpal tunnel. The

Luke S. Erdoes; William C. Brown



Possible earthquake rupture speeds  

NASA Astrophysics Data System (ADS)

Though mode II shear fractures (primarily strike slip earthquakes) can not only exceed the shear wave speed of the medium, but can even reach the compressional wave speed, steady-state calculations showed that speeds between the Rayleigh and shear wave speeds were not possible, thus defining a forbidden zone. For more than 30 years it was believed that this result in which the rupture jumps over the forbidden zone, also holds for 3-D ruptures, in which mode II and mode III (mainly dip-slip faulting) are mixed. Using unprecedentedly fine spatial and temporal grids, we show that even in the simple configuration of homogeneous fault properties and linear slip-weakening friction law, a realistic 3-D rupture which start from rest and accelerates to some higher velocity, actually does pass smoothly through this forbidden zone, but very fast. The energy flux from the rupture tip is always positive, even within the so-called forbidden zone, contrary to the 2-D case. Finally, our results show that the width of the cohesive zone initially decreases, then increases as the rupture exceeds the shear wave speed and finally again decreases as the rupture accelerates to a speed of ~90% of the compressional wave speed. Several movies illustrating the development of the ruptures will be shown. A. Bizzari and S. Das (2012). Possible earthquake rupture speeds, EPSL, submitted.

Das, S.; Bizzarri, A.



Effect of Pituitary Adenylate Cyclase-Activating Peptide on Isolated Rabbit Iris Sphincter and Dilator Muscles  

Microsoft Academic Search

PURPOSE. Pituitary adenylate cyclase-activating peptide (PACAP) is a sensory neuropeptide in the eye that is released by noxious stimuli and considered to be a mediator of the neurogenic ocular injury response, including miosis. The pur- pose of this study was to clarify the functional role of PACAP in iris sphincter and dilator muscles. METHODS. Iris sphincter and dilator muscles were

Takeshi Yoshitomi; Kazutsuna Yamaji; Hitoshi Ishikawa; Yoshitaka Ohnishi


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



Monitoring of Erectile and Urethral Sphincter Dysfunctions in a Rat Model Mimicking Radical Prostatectomy Damage  

E-print Network

1 Monitoring of Erectile and Urethral Sphincter Dysfunctions in a Rat Model Mimicking Radical post-RP urethral sphincter and erectile dysfunctions, and non-invasive methods to assess erectile of Sexual Medicine 2012;9(11):2827-37" DOI : 10.1111/j.1743-6109.2012.02905.x #12;2 Keywords: erectile

Paris-Sud XI, Université de


High revision rate following artificial urethral sphincter implantation.  


Abstract Objective. In severe cases of stress urinary incontinence (SUI), with sphincter dysfunction, the artificial urinary sphincter AMS 800™ may be the last solution. The purpose of this study was to evaluate the outcome of surgical intervention for SUI with the AMS 800 in patients who were treated at Sahlgrenska University Hospital, Gothenburg. The primary aim of the study was to determine the complications related to the operation. Material and methods. A retrospective follow-up was done by reviewing medical records. The material comprised 97 men, who underwent their first AMS 800 implantation between May 1997 and June 2010 at Sahlgrenska University Hospital. Results. The revision rate was 28%, including an infection rate of 3% and an erosion rate of 7%. The mean follow-up for revised patients was 3 years. The median time until revision was 1 year. Seventy-five per cent of all patients were satisfied with the operation at 6 months' follow-up. Radical prostatectomy was the reason behind incontinence in 84% of patients in this series. Conclusion. The results clearly demonstrate a need for revision procedures in a considerable proportion of patients implanted with an AMS 800 device. Patient satisfaction was high, but although this operation has extremely low mortality it has its complications and the system will need to be replaced in time. PMID:24930564

Andreasson, Anders; Fall, Magnus; Persson, Erik; Stranne, Johan; Peeker, Ralph



What's New in Anal Cancer Research and Treatment?  


... 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 ...


What Are the Risk Factors for Anal Cancer?  


... or no known risk factors. Human papilloma virus (HPV) infection Most squamous cell anal cancers seem to ... can eventually cause certain cancers, including anal cancer. HPV in men For men, the 2 main factors ...


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

PubMed Central

A central role in anal carcinogenesis of high-risk types of human papillomaviruses (hrHPV) was recently established, but the possible role of benign anal lesions has not been addressed in hrHPV-positive and -negative anal cancers. As part of a population-based case-control study in Denmark and Sweden, we interviewed 417 case patients (93 men and 324 women) diagnosed during the period 1991-94 with invasive or in situ anal cancer, 534 patients with adenocarcinoma of the rectum and 554 population controls. Anal cancer specimens (n = 388) were tested for HPV by the polymerase chain reaction. Excluding the 5 years immediately before diagnosis, men, but not women, with anal cancer reported a history of haemorrhoids [multivariate odds ratio (OR) 1.8; 95% confidence interval (CI) 1.04-3.2] and unspecific anal irritation (OR 4.5; CI 2.3-8.7) significantly more often than controls. Women with anal cancer did not report a history of benign anal lesions other than anal abscess to any greater extent than controls, but they had used anal suppositories more often (OR 1.5; CI 1.1-2.0). Patients with hrHPV in anal cancer tissue (84%) and those without (16%) reported similar histories of most benign anal lesions, but anal fissure or fistula was more common among hrHPV-positive cases. Ulcerative colitis and Crohn's disease, reported by <1% of study participants, were not associated with anal cancer risk. The higher proportion of hrHPV-positive anal cancers among case patients with anal fissure or fistula suggests that such mucosal lesions may provide direct viral access to basal epithelial layers. Since risk associations with benign anal lesions in men may be confounded by unreported sexual behaviour, and since risk associations in women were generally negative, it seems unlikely that benign anal lesions act as promoters in hrHPV-associated anal carcinogenesis. Moreover, benign anal lesions appear not to be linked to an alternative, hrHPV-unassociated causal pathway to anal cancer. Ulcerative colitis and Crohn's disease were not supported as causal factors for anal cancer. PMID:9836490

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



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

PubMed Central

Severe persistent stress incontinence following radical prostatectomy for prostate cancer treatment, although not very common, remains the most annoying complication affecting patient's quality of life, despite good surgical oncological results. When severe incontinence persists after the first postoperative year and conservative treatment has been failed, surgical treatment has to be considered. In these cases it is generally accepted that artificial urinary sphincter is the gold standard treatment. AUS 800 by American Medical Systems has been successfully used for more than 35 years. Recently three more sphincter devices, the Flow-Secure, the Periurethral Constrictor, and the ZSI 375, have been developed and presented in the market. A novel type of artificial urinary sphincter, the Tape Mechanical Occlusive Device, has been inserted in live canines as well as in human cadavers. These new sphincter devices are discussed in this paper focusing on safety and clinical results. PMID:22567002

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



New artificial urinary sphincter devices in the treatment of male iatrogenic incontinence.  


Severe persistent stress incontinence following radical prostatectomy for prostate cancer treatment, although not very common, remains the most annoying complication affecting patient's quality of life, despite good surgical oncological results. When severe incontinence persists after the first postoperative year and conservative treatment has been failed, surgical treatment has to be considered. In these cases it is generally accepted that artificial urinary sphincter is the gold standard treatment. AUS 800 by American Medical Systems has been successfully used for more than 35 years. Recently three more sphincter devices, the Flow-Secure, the Periurethral Constrictor, and the ZSI 375, have been developed and presented in the market. A novel type of artificial urinary sphincter, the Tape Mechanical Occlusive Device, has been inserted in live canines as well as in human cadavers. These new sphincter devices are discussed in this paper focusing on safety and clinical results. PMID:22567002

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



How does preoperative radiotherapy affect the rate of sphincter-sparing surgery in rectal cancer?  


The use of preoperative radiotherapy has resulted in significant downstaging and downsizing of tumor, this in turn facilitated resections permitting sphincter preservation and coloanal anastomosis for patients who would otherwise have not been candidates for this type of surgery as concluded by some small studies. On the other hand, other clinical trials have shown that the effect of radiotherapy on the rate of sphincter preservation is still not clear. Moreover, different modes of radiotherapy have been tested on the rate of sphincter preservation such as pelvic irradiation with or without combination of chemotherapy, short or conventional course radiotherapy, and preoperative or postoperative radiotherapy with different timing intervals of surgery. Unfortunately, these trials didn't clearly answer the question of radiotherapy benefit for the sake of sphincter preserving of rectal cancer patients and the question remained hotly debated. PMID:22534311

Baker, Bilal; Salameh, Habeeb; Al-Salman, Mohammad; Daoud, Faiez



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



Topical glyceryl trinitrate relaxes the sphincter of Oddi.  

PubMed Central

BACKGROUND/AIM: Nitric oxide (NO) may be involved in non-adrenergic non-cholinergic (NANC) inhibitory innervation of the sphincter of Oddi (SO). The effects of topical application of glyceryl trinitrate (GTN), a NO donor, upon SO motility were examined. METHODS: Nineteen patients undergoing routine SO manometry for investigation of abdominal pain were studied. After routine recording of SO motility, they were randomised into three groups to receive 10 ml of normal saline, 5 mg GTN (0.5 mg/ml) or 10 mg (1 mg/ml) GTN. Drug solutions were infused topically onto papilla via the manometry catheter and recordings were continued for a further 5 minutes. RESULTS: There was no significant change in SO motor variables following application of normal saline. GTN reduced SO tonic and phasic contractions. In four patients, there was complete abolition of all phasic contraction. CONCLUSIONS: Local application of GTN inhibits SO motility. This may have application for diagnostic and therapeutic biliary endoscopy. PMID:9176086

Luman, W; Pryde, A; Heading, R C; Palmer, K R



Imaging gate oxide ruptures  

Microsoft Academic Search

As minimum feature sizes are reduced in MOS silicon devices, dielectric breakdown continues to pose a formidable challenge. A more complete understanding of the failure mechanism which induces oxide rupture has become an absolute necessity in order to meet the advancing yield and reliability requirements of today's complex integrated structures. This paper will present an interesting insight into the nature

Horacio Mendez; Steve Morris; Sudhindra Tatti; Nicholas Dickson; Ronald E. Pyle



Bipolar infrapatellar tendon rupture.  


Traumatic patella alta in children occurs either distal to the patellar tendon as a tibial tubercle apophyseal fracture or proximally as an osteochondral sleeve fracture of the inferior patellar pole. Acute surgical exploration in a pediatric case of a knee extensor mechanism rupture revealed both proximal and distal (bipolar) patellar tendon pathology. PMID:7790483

Berg, E E



Fault branching and rupture directivity  

Microsoft Academic Search

Could the directivity of a complex earthquake be inferred from the ruptured fault branches it created? Typically, branches develop in forward orientation, making acute angles relative to the propagation direction. Direct backward branching of the same style as the main rupture (e.g., both right lateral) is disallowed by the stress field at the rupture front. Here we propose another mechanism

Sonia Fliss; Harsha S. Bhat; Renata Dmowska; James R. Rice



Schwannoma with an uncommon anal location  

PubMed Central

Schwannomas are slow-growing mesenchymal neoplasms that arise from Schwann cells with low malignant potential. These uncommon neoplasms are nerve sheath tumors that arise at almost any anatomical site. The majority of schwannomas are benign, and few are malignant. The current study presents the rare case of an anal schwannoma that was successfully treated by surgery; there are few such cases previously reported in the literature. The patient was admitted to hospital following the identification of a mass incidentally. The tumor was so large that it compressed the tissue around it, although no symptoms were caused. The pre-operative clinical diagnosis was inconclusive in this case, and a final diagnosis was established based on radiographic and histopathological examination. The current study aimed to provide a possible differential diagnosis for such anally-located masses.




Anal manometric findings in symptomatic hemorrhoids  

Microsoft Academic Search

Anal manometric findings were studied in 50 patients with symptomatic hemorrhoids and an equal number of age- and sex-matched\\u000a control subjects. Manometry was performed with a continuously perfused catheter by the continuous pull-through technique.\\u000a Both the control subjects and patients had significant negative collerations between age and basal pressure;i.e., basal pressure was lower with advancing age. Patients with symptomatic hemorrhoids

Kari-Matti Hiltunen; Martti Matikainen



Expression of serotonin receptors in human lower esophageal sphincter  

PubMed Central

Serotonin (5-HT) is a neurotransmitter and vasoactive amine that is involved in the regulation of a large number of physiological functions. The wide variety of 5-HT-mediated functions is due to the existence of different classes of serotonergic receptors in the mammalian gastrointestinal tract and nervous system. The aim of this study was to explore the expression of multiple types of 5-HT receptor (5-HT1AR, 5-HT2AR, 5-HT3AR, 5-HT4R, 5-HT5AR, 5-HT6R and 5-HT7R) in sling and clasp fibers from the human lower esophageal sphincter (LES). Muscle strips of sling and clasp fibers from the LES were obtained from patients undergoing esophagogastrectomy, and circular muscle strips from the esophagus and stomach were used as controls. Reverse transcription-polymerase chain reaction (RT-PCR), quantitative PCR and western blotting were used to investigate the expression of the various 5-HT receptor types. Messenger RNA for all seven 5-HT receptor types was identified in the sling and clasp fibers of the LES. At the mRNA level, the expression levels were highest for 5-HT3AR and 5-HT4R, and lowest for 5-HT5AR, 5-HT6R and 5-HT7R. At the protein level, the expression levels were highest for 5-HT3AR and 5-HT4R, followed by 5-HT1AR and 5-HT2AR; 5-HT7R was also detected at a low level. The expression of 5-HT5AR and 5-HT6R proteins was not confirmed. The results indicate that a variety of 5-HT receptor types can be detected in the human LES and probably contribute to LES function.




Iatrogenic tracheobronchial rupture  

PubMed Central

Abstract Iatrogenic tracheobronchial ruptures most frequently occur during tracheal intubation, but they can also be produced during tracheobronchial endoscopy or thoracic surgery. The clinical presentation can be brutal, with respiratory failure, cervical emphysema, pneumothorax and hemoptysis. There are also less symptomatic presentations. The diagnosis is confirmed by bronchoscopy. The therapeutic approach can be differentiated, surgical or conservative, although the criteria are not universally accepted. This article aims to review the indications and therapeutic options. PMID:25408752

Paraschiv, M



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. PMID:24759346

Devesa, Jose Manuel; Vicente, Rosana



Anal anomalies: an uncommon feature of velocardiofacial (Shprintzen) syndrome?  

PubMed Central

We report three cases of velocardiofacial syndrome (VCFS) with anal anomalies who have deletions of the 22q11 region and a further case where the proband has VCFS clinically and her father has an anal anomaly. It is important to consider VCFS in the differential diagnosis of children with anal anomalies and to look for other features of the syndrome, such as asymmetrical crying facies, submucous cleft of the palate, developmental delay, cardiac anomalies, and hypoparathyroidism. Images PMID:9032655

Worthington, S; Colley, A; Fagan, K; Dai, K; Lipson, A H



Ileal pouch-anal anastomosis in patients with colorectal cancer  

Microsoft Academic Search

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

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



Investigation and Management of Malignant Anal-Canal Tumours  

Microsoft Academic Search

Tumours of the anal margin and canal are a rare but histologically diverse group of neoplasms. In the United States, anal-canal carcinoma accounts for 1.5% of digestive system cancers, with an estimated 3400 new cases diagnosed each year [1]. Despite its infrequency, insights into anal-cancer biology over the past 30 years have radically altered its management. In the past, chronic

Najjia N. Mahmoud; Robert D. Madoff


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. PMID:23279040

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



Motor function of the opossum sphincter of Oddi.  

PubMed Central

We studied the opossum sphincter of Oddi (SO) because in this species the SO is approximately 3 cm in length and its extraduodenal location permits recording of motor activity with negligible interference from duodenal motor activity. The SO segment of 120 animals was evaluated by one or more of the following: (a) intraluminal manometry; (b) electromyography; (c) common bile duct (CBD) flow monitored by a drop counter; (d) cineradiography of intraductal contrast medium; and (e) histologic examination. SO pull-throughs using an infused catheter of 0.6-mm o.d. invariably showed a high pressure zone (HPZ) of 18 +/- 3 SE mm Hg in the terminal 4-5 mm of the SO segment. This HPZ had a narrow lumen, 0.5-0.7 mm in diam, and prominent circular muscle. The HPZ in the terminal SO had both active and passive components. HPZ with minimal amplitude and a paucity of underlying smooth muscle were present inconstantly at the junction of the SO segment with the CBD and pancreatic duct, respectively. The dominant feature of the SO segment was rhythmic peristaltic contractions that originated in the proximal SO and propagated toward the duodenum. These contractions occurred spontaneously at a rate of 2-8/min, ranged up to 200 mm Hg in magnitude, had a duration of approximately 5 s and were not abolished by tetrodotoxin. Concurrent myoelectric and manometric recordings showed that each phasic contraction was immediately preceded by an electrical spike burst. Simultaneous recordings of cineradiography, CBD inflow of contrast medium, SO manometry, and SO electromyography indicated that rhythmic peristaltic contractions stripped contrast medium from the SO into the duodenum. During SO systole, CBD emptying was transiently interrupted, whereas SO filling occurred during the diastolic interval between SO peristaltic contractions. SO distention increased the frequency of SO peristalsis. We conclude that (a) the dominant feature of the opossum SO is rhythmic peristaltic contractions that originate in the proximal SO and propagate toward the duodenum; (b) these forceful SO peristaltic contractions are myogenic in origin and serve as a peristaltic pump that actively empties the SO segment; (c) CBD outflow occurs passively during SO diastole, but is interrupted transiently during each SO peristaltic contraction; and (d) a short HPZ with active as well as passive components exists in the distal SO segment and acts as a variable resistor to SO outflow. Images PMID:6822661

Toouli, J; Dodds, W J; Honda, R; Sarna, S; Hogan, W J; Komarowski, R A; Linehan, J H; Arndorfer, R C



Carcinoma of the anal canal: radiation or radiation plus chemotherapy  

SciTech Connect

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

Cummings, B.J.



Anal squamous cell carcinoma: An evolution in disease and management  

PubMed Central

Anal cancer represents less than 1% of all new cancers diagnosed annually in the United States. Yet, despite the relative paucity of cases, the incidence of anal cancer has seen a steady about 2% rise each year over the last decade. As such, all healthcare providers need to be cognizant of the evaluation and treatment of anal squamous cell carcinoma. While chemoradiation remains the mainstay of therapy for most patients with anal cancer, surgery may still be required in recurrent, recalcitrant and palliative disease. In this manuscript, we will explore the diagnosis and management of squamous cell carcinoma of the anus. PMID:25278699

Osborne, Marc C; Maykel, Justin; Johnson, Eric K; Steele, Scott R



Abnormalities of the innervation of the urethral striated sphincter musculature in incontinence.  


Perineal nerve and transcutaneous spinal cord stimulation have been used to study 17 patients with idiopathic neurogenic faecal incontinence, 12 of whom also had urinary incontinence. Significant increases in spinal, perineal and pudendal nerve motor latencies were demonstrated in all 17 patients. These results suggest that there is damage to the nerves innervating both the urethral and perianal sphincter musculature in these patients, including those with isolated faecal incontinence. There was evidence of both a distal (perineal nerve) and a proximal (sacral root) component to the damage to the nerve supply of the urethral striated sphincter muscle in half of the patients. PMID:6335972

Snooks, S J; Swash, M



Traumatic rectal hematoma following anal rape.  


We describe the case of a 28-year-old male prisoner with a traumatic rectal hematoma caused by anal rape. Barium enema showed a large rectal mass confirmed to be a hematoma by proctoscopic examination. Surgery was performed due to a falling hemoglobin level, and an 800-mL hematoma was evacuated. The patient became febrile following surgery, and computed tomography revealed a pelvic mass consistent with recurrent hematoma or abscess. Repeat surgery showed recurrent hematoma. The patient recovered uneventfully. PMID:3487997

Chen, Y M; Davis, M; Ott, D J



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

E-print Network

, digital or fomite transference [9,10]. The proportion of Scottish women reporting the practice of anal intercourse is sig- nificantly lower to similar studies in the U.S., where a prevalence of 22 – 29% has been documented [11,12]. These discrepancies may...

Stanley, Margaret A; Winder, David M; Sterling, Jane C; Goon, Peter K C



Ligation of the Intersphincteric Fistula Tract (LIFT): A Minimally Invasive Procedure for Complex Anal Fistula: Two-Year Results of a Prospective Multicentric Study.  


Introduction. The surgical management of anal fistulas is still a matter of discussion and no clear recommendations exist. The present study analyses the results of the ligation of the intersphincteric fistula tract (LIFT) technique in treating complex anal fistulas, in particular healing, fecal continence, and recurrence. Methods. Between October 2010 and February 2012, a total of 26 consecutive patients underwent LIFT. All patients had a primary complex anal fistula and preoperatively all underwent clinical examination, proctoscopy, transanal ultrasonography/magnetic resonance imaging, and were treated with the LIFT procedure. For the purpose of this study, fistulas were classified as complex if any of the following conditions were present: tract crossing more than 30% of the external sphincter, anterior fistula in a woman, recurrent fistula, or preexisting incontinence. Patient's postoperative complications, healing time, recurrence rate, and postoperative continence were recorded during follow-up. Results. The minimum follow-up was 16 months. Five patients required delayed LIFT after previous seton. There were no surgical complications. Primary healing was achieved in 19 patients (73%). Seven patients (27%) had recurrence presenting between 4 and 8 weeks postoperatively and required further surgical treatment. Two of them (29%) had previous insertion of a seton. No patients reported any incontinence postoperatively and we did not observe postoperative continence worsening. Conclusion. In our experience, LIFT appears easy to perform, is safe with no surgical complication, has no risk of incontinence, and has a low recurrence rate. These results suggest that LIFT as a minimally invasive technique should be routinely considered for patients affected by complex anal fistula. PMID:24201738

Sileri, Pierpaolo; Giarratano, Gabriella; Franceschilli, Luana; Limura, Elsa; Perrone, Federico; Stazi, Alessandro; Toscana, Claudio; Gaspari, Achille Lucio



Slow rupture of frictional interfaces  

NASA Astrophysics Data System (ADS)

The failure of frictional interfaces and the spatiotemporal structures that accompany it are central to a wide range of geophysical, physical and engineering systems. Recent geophysical and laboratory observations indicated that interfacial failure can be mediated by slow slip rupture phenomena which are distinct from ordinary, earthquake-like, fast rupture. These discoveries have influenced the way we think about frictional motion, yet the nature and properties of slow rupture are not completely understood. We show that slow rupture is an intrinsic and robust property of simple non-monotonic rate-and-state friction laws. It is associated with a new velocity scale cmin, determined by the friction law, below which steady state rupture cannot propagate. We further show that rupture can occur in a continuum of states, spanning a wide range of velocities from cmin to elastic wave-speeds, and predict different properties for slow rupture and ordinary fast rupture. Our results are qualitatively consistent with recent high-resolution laboratory experiments and may provide a theoretical framework for understanding slow rupture phenomena along frictional interfaces.

Bar Sinai, Yohai; Brener, Efim A.; Bouchbinder, Eran



[Prevalence of anal incontinence in adults].  


Inquiries were conducted to determine the prevalence of anal incontinence in a) the general population over 45 by a gallup poll studying 1,100 persons (A); b) 3,914 patients seen by their general practitioner or their gastroenterologist during the same week (B); c) 500 patients consulting for urinary stress incontinence (C1); d) 1,136 neurological patients suffering from micturation disorders (C2); and e) 10,157 elderly persons living in retirement homes or in hospital (D). In the general community (A), the prevalence of anal incontinence, including gas and stool incontinence, was 11 percent, the prevalence of fecal incontinence, 6 percent, the prevalence of daily or weekly fecal incontinence, 2 percent; prevalences were respectively 15.5 percent, 7.9 percent, and 3.2 percent in group B, and 27 percent, 9 percent and 3.8 percent in group C1. The prevalence of fecal incontinence was 18 percent in group C2 and 33 percent in group D. Prevalence did not depend on age in group A and C1, but was twofold higher in group C1 than in group A. The prevalence increased with age in groups B and D. PMID:1397855

Denis, P; Bercoff, E; Bizien, M F; Brocker, P; Chassagne, P; Lamouliatte, H; Leroi, A M; Perrigot, M; Weber, J



Anal. Chem. 1007, 59, 2747-2749 2747 ACKNOWLEDGMENT  

E-print Network

)1084, 709, 1217. (18) Yarmchuk, P.; Welnberger, R.; Hlrsch, R. F.; Cline Love,L.J. J . Chro- matogr.;DeEchegarary,M.T.; Landy, J. S. Anal. Chem. 1083, 55, 924. (8) Yarmchuk. P.; Weinberger, R.; Hirsch, G. Anal. Chem. 1986,58, 1356. (16) Kirkman, C. M.; Zu-Ben, C.; Men, P. C.; Stratton, W. J

Zare, Richard N.



Microsoft Academic Search

Interest in the existence and function of the glands of the anal region of man has existed for a long time. Today there are almost no differences of opinion about the glands located in the circumanal area. Less consistent are the investi- gative results on the glands of the anal canal proper, particularly those of the zona columnaris. Some authors



Controversies in the treatment of common anal problems  

PubMed Central

Treating common benign anal diseases has evolved towards more outpatient procedures with better outcome. However, minimizing post-procedure morbidities such as pain and the avoidance incontinence remain the most significant concerns. We introduce some controversies and highlight the developments in current surgical practice for the treatment of common anal problems. PMID:16718832

Sagap, Ismail; Remzi, Feza H



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.



Pneumatic dilatation in patients with symptomatic diffuse esophageal spasm and lower esophageal sphincter dysfunction  

Microsoft Academic Search

Nine patients with severe symptoms of diffuse esophageal spasm and lower esophageal sphincter dysfunction who were unresponsive to medical therapy and bougienage dilatation were treated by forceful pneumatic dilatation. Treatment with pneumatic dilatation in eight of the nine patients produced a marked improvement in dysphagia and regurgitation (average follow-up of 37.4 months). Esophageal motility performed up to three years (average

E. C. Ebert; A. Ouyang; S. H. Wright; S. Cohen; W. H. Lipshutz



Mechanisms of lower oesophageal sphincter incompetence in patients with symptomatic gastrooesophageal reflux  

Microsoft Academic Search

Patterns of lower oesophageal sphincter (LOS) function associated with the onset of 644 reflux episodes were recorded and analysed in 67 patients referred for evaluation of gastro-oesophageal reflux (GOR). Patients were studied recumbent, for one hour before and four hours after a standard meal. Transient LOS relaxation was the most prevalent mechanism and overall accounted for 82% of reflux episodes.

J Dent; R H Holloway; J Toouli; W J Dodds



Three-dimensional MRI of the male urethrae with implanted artificial sphincters: initial results  

Microsoft Academic Search

The aim of this study was to develop a method for simultaneous 3D visualization of a new type of artificial urethral sphincter (AUS) and adjacent urinary structures. Serial MR tomograms were acquired from seven men after AUS implantation. 3D reconstruction was performed by thresholding original (positive) and inverted (negative) image intensity and by subsequently fusing positive and negative images. Results




Abnormal electromyographic activity of the urethral sphincter, voiding dysfunction, and polycystic ovaries: a new syndrome?  

Microsoft Academic Search

A potential association between abnormal electromyographic activity--that is, decelerating bursts and complex repetitive discharges--of the urethral sphincter and difficulty in voiding was examined in 57 women with urinary retention. Abnormal electromyographic activity was found in 33. Ultrasonography of the ovaries in 22 of the 33 women showed that 14 had polycystic ovaries. Of the other eight women, two had had

C. J. Fowler; T. J. Christmas; C. R. Chapple; H. F. Parkhouse; R. S. Kirby; H. S. Jacobs



Implantation of autologous bone-marrow-derived cells reconstructs functional urethral sphincters in rabbits.  


The purpose of this study was to determine if implantation of autologous bone-marrow-derived cells has the potential to treat stress urinary incontinence caused by intrinsic sphincter deficiency. Bone marrow cells harvested from femurs of New Zealand White rabbits were cultured for 10 days. Seven days before implantation, the urethral sphincters located at the internal urethral orifice were cryo-injured by spraying liquid nitrogen for 15?s. The cultured autologous bone-marrow-derived cells were implanted 7 days after cryo-injury. For controls, cell-free solutions were injected. At 7 and 14 days after implantation, leak point pressures were determined and the urethral sphincters were examined by immunohistochemistry. At 7 and 14 days, the cell-implanted regions contained numerous striated and smooth muscle-like cells expressing myoglobin and smooth muscle actin, respectively. The proportions of myoglobin- and smooth muscle actin-expressing areas in both the 7- and 14-day cell-implanted regions were significantly higher than in controls. By 14 days, these differentiated cells formed contacts with similar cells, creating layered muscle structures. At that time, the leak point pressure of the cell-implanted rabbits was significantly higher than that of the controls. In conclusion, autologous bone-marrow-derived cells can reconstruct functional urethral sphincters. PMID:21091339

Imamura, Tetsuya; Ishizuka, Osamu; Kinebuchi, Yoshiaki; Kurizaki, Yoshiki; Nakayama, Tsuyoshi; Ishikawa, Masakuni; Nishizawa, Osamu



Sphincter (ring muscle) gymnastics for spinal cord injured and spinal cord transected patients  

Microsoft Academic Search

Sphincter gymnastics seem to be able to recruit central pattern generators – networks of neurons that generate motor patterns – through peripheral rhythmic stimuli and to activate them without supraspinal signals. This physical therapy method is thus suitable for treating spinal cord injured and spinal cord transected patients, for it can reach below the injured segment and feed signals into

S. Yom-Tov



Sphincter of Oddi dysfunction: Managing the patient with chronic biliary pain  

PubMed Central

Sphincter of Oddi dysfunction (SOD) is a syndrome of chronic biliary pain or recurrent pancreatitis due to functional obstruction of pancreaticobiliary flow at the level of the sphincter of Oddi. The Milwaukee classification stratifies patients according to their clinical picture based on elevated liver enzymes, dilated common bile duct and presence of abdominal pain. Type I patients have pain as well as abnormal liver enzymes and a dilated common bile duct. Type II SOD consists of pain and only one objective finding, and Type III consists of biliary pain only. This classification is useful to guide diagnosis and management of sphincter of Oddi dysfunction. The current gold standard for diagnosis is manometry to detect elevated sphincter pressure, which correlates with outcome to sphincterotomy. However, manometry is not widely available and is an invasive procedure with a risk of pancreatitis. Non-invasive testing methods, including fatty meal ultrasonography and scintigraphy, have shown limited correlation with manometric findings but may be useful in predicting outcome to sphincterotomy. Endoscopic injection of botulinum toxin appears to predict subsequent outcome to sphincterotomy, and could be useful in selection of patients for therapy, especially in the setting where manometry is unavailable. PMID:16804961

Bistritz, Lana; Bain, Vincent G



Update on anal fistulae: Surgical perspectives for the gastroenterologist  

PubMed Central

Anal fistulae are common and debilitating; they are characterized by severe pain and discharge. They arise following infection near the anal canal, or as a primary event from an abscess in the abdomen, fistulating into the vagina or perianal skin. The term ‘cryptoglandular’ is given to abscesses arising from the anal glands. For many years, the treatment of choice was to lay open the fistula; however, this risks causing incontinence with potentially devastating consequences. Alternative surgical treatments include setons, fibrin glue, collagen plugs and flaps to cover the internal fistula opening. These have achieved varying degrees of success, as will be discussed. The present review also discusses anal fistulae in light of much recently published literature. Currently, anal fistulae remain challenging and require specialist expertise; however, new treatment options are on the horizon. PMID:22175058

Tabry, Helena; Farrands, Paul A



Uterine rupture: Preventable obstetric tragedies?  

Microsoft Academic Search

Background: Although ruptured uterus is nowadays a rare obstetric emergency in Western countries, it is still alarmingly common in developing countries, where it remains a major cause of maternal mortality and morbidity. Aims: To review the recent experience of uterine rupture at a tertiary obstetric unit in eastern Nepal and to recommend improvements in the current management of labour, especially

Sangeeta K. MISHRA; Norman MORRIS; Dhruba Kumar UPRETY



Spontaneous rupture of the oesophagus  

Microsoft Academic Search

Background: The aim of this study was to evaluate the diagnosis, management and outcome of patients with spontaneous rupture of the oesophagus in a single centre. Methods: Between October 1993 and May 2007, 51 consecutive patients with spontaneous oesophageal rupture were evaluated with contrast radiology and flexible endoscopy. Patients with limited contamination who fulfilled specific criteria were managed by a

S. M. Griffin; P. J. Lamb; J. Shenfine; D. L. Richardson; D. Karat; N. Hayes



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

PubMed Central

Background: Anal fissure is a common painful condition affecting the anal canal. The majority of acute fissures heal spontaneously. However, some of these acute fissures do not resolve but become chronic. Chronic anal fissures were traditionally treated by anal dilation or by lateral sphincterotomy. However, both of these surgical treatments may cause a degree of incontinence in up to 30% of patients. Several recent trials have shown that nitric oxide donors such as glyceryl trinitrate (GTN) can reduce sphincter pressure and heal up to 70% of chronic fissures. Aim: This study addressed the dose-response to three different concentrations of GTN ointment compared with placebo in a double blind randomised controlled trial. Method: A double blind, multicentre, randomised controlled trial was set up to compare placebo ointment against three active treatment arms (0.1%, 0.2%, and 0.4% GTN ointment applied at a dose of 220 mg twice daily) in chronic anal fissures. The primary end point was complete healing of the fissure. Results: Two hundred patients were recruited over an eight month period from 18 centres. After eight weeks of treatment the healing rate in the placebo group was 37.5% compared with 46.9% for 0.1%, 40.4% for 0.2%, and 54.1% for 0.4% GTN. None was significantly better than the placebo response. A secondary analysis excluded fissures without secondary criteria for chronicity. Healing rates were then found to be 24% in the placebo group compared with 50% in the 0.1% GTN group, 36% in the 0.2% group, and 57% in the 0.4% GTN group. These values were statistically significantly different for the placebo group compared with 0.1% GTN, 0.4% GTN, and for the GTN treated group as a whole. Conclusions: The results of this study have demonstrated the significant benefit of topical GTN when applied to patients suffering from chronic anal fissures but acute fissures showed a tendency to resolve spontaneously. The high proportion of fissures which healed in the placebo group suggests that the definition of “chronicity” needs to be reassessed. Further studies are required to confirm the optimal therapeutic strategy. PMID:12524411

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



Anal tuberculosis complicating anti-TNF? therapy.  


A 42-year-old man receiving anti-tumour necrosis factor ? (anti-TNF?) therapy with adalimumab due to psoriatic arthritis presented with a 2-month-old anal ulcer. An apical right lung infiltrate was found in his chest X-ray, although he had no pulmonary symptoms. Two biopsies of the ulcer were taken and reported as granulomatous, necrotising, with chronic inflammation (first), and as hyperplasic epidermis with linfocitary infiltrate and the presence of plenty of plasmatic cells (second). Histochemical techniques, including Ziehl-Neelsen, Grocott and periodic acid-Schiff stains, and PCR for Mycobacterium tuberculosis on both biopsies were negative. Serology for HIV, syphilis and hepatitis were also negative. In the second biopsy culture, moderate colonies of M. tuberculosis finally grew. The patient started a four-drug antituberculosis regimen. Adalimumab was discontinued and etanercept introduced after 2?months of antituberculosis therapy. The patient remained on therapy for 9?months with complete ulcer resolution. PMID:25422341

Luquín, Nuria; Masiá, Mar; Noguera, Raúl; Gutiérrez, Félix



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. PMID:24807024

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



Anal transition zone in the surgical management of ulcerative colitis  

PubMed Central

Preservation of the anal transition zone has long been a significant source of controversy in the surgical management of ulcerative colitis. The two techniques for restorative proctocolectomy and ileal pouch anal anastomosis (RPC IPAA) in common practice are a stapled anastomosis and a handsewn anastomosis; these techniques differ in the amount of remaining rectal mucosa and therefore the presence of the anal transition zone following surgery. Each technique has advantages and disadvantages in long-term functional outcomes, operative and postoperative complications, and risk of neoplasia. Therefore, we propose a selective approach to performing a stapled RPC IPAA based on the presence of dysplasia in the preoperative endoscopic evaluation. PMID:19230038

Holder-Murray, Jennifer; Fichera, Alessandro



Spontaneous rupture of adrenal haemangioma mimicking abdominal aortic aneurysm rupture  

PubMed Central

Serious bleeding from a ruptured adrenal mass limits preoperative diagnostics and can necessitate urgent laparotomy to control blood loss. A 45-year old man underwent an emergency laparotomy due to severe retroperitoneal haemorrhage causing hypovolaemia. Detailed retroperitoneal dissection after splenectomy and clamping of the abdominal aorta revealed bleeding from a ruptured haemangioma of the left adrenal gland. Following a left adrenalectomy, the patient returned to a stable haemodynamic state. Adrenal haemangiomas are rare, but may cause spontaneous life-threatening haemorrhage. PMID:22371732

Ambroziak, Iwona; Holynska-Dabrowska, Katarzyna; Siezieniewska-Skowronska, Zofia; Paluszkiewicz, Andrzej



Can a meta-analysis answer the question: is mucosectomy and handsewn or double-stapled anastomosis better in ileal pouch-anal anastomosis?  


Although ileal pouch-anal anastomosis (IPAA) is the procedure of choice for polyposis and ulcerative colitis with medically refractory disease or dysplasia, controversy exists concerning whether mucosal preservation with double-stapled (DS) IPAA is superior to mucosectomy and handsewn (HS) IPAA anastomosis for postoperative function. Prospective studies have shown no statistically significant differences. The use of meta-analysis can strengthen statistical power by combining the data from related studies. A meta-analysis was performed to determine whether there was a significant difference in functional and manometric outcome between HS-IPAA and DS-IPAA. Prospective, randomized studies were identified using a literature search. Functional outcome variables included number of normal continence, minor incontinence, nocturnal evacuation, the ability to discriminate flatus from stool, and antidiarrheal medication. Manometric outcomes included postoperative resting and squeeze anal pressures. Four prospective, randomized trials were identified. Of the 184 total patients, the HS-IPAA group included 86 patients (48 men and 38 women) and the DS-IPAA group included 98 patients (49 men and 49 women). There were no significant differences in functional outcome between HS-IPAA and DS-IPAA. In addition, there was no significant difference in sphincter resting and squeeze pressures between the two patient groups. This meta-analysis demonstrates that DS-IPAA offers no advantage in functional or manometric outcome when compared with HS-IPAA. PMID:17058734

Schluender, Stefanie J; Mei, Ling; Yang, Huiying; Fleshner, Phillip R



Imaging gate oxide ruptures  

NASA Astrophysics Data System (ADS)

As minimum feature sizes are reduced in MOS silicon devices, dielectric breakdown continues to pose a formidable challenge. A more complete understanding of the failure mechanism which induces oxide rupture has become an absolute necessity in order to meet the advancing yield and reliability requirements of today's complex integrated structures. This paper will present an interesting insight into the nature of dielectric breakdown in MOS transistors produced from a novel cross-sectioning TEM sample preparation method using a focused ion beam tool. By using deductive failure analysis, it was possible to determine the location of the leakage within a 1000 angstroms portion of the transfer gate of a one megabit DRAM. Once localized, a creative combination of conventional glass lapping and focused ion beam techniques were used to produce the thin TEM slice which contained the oxide breakdown. An image of the breakdown was then obtained on a 200 keV TEM. Interestingly, the image revealed that the origin of the breakdown was associated with imperfections in the form of voids in the surface of the silicon substrate. These results proved to be consistent over multiple samples. In this paper a complete description of these images will be presented along with possible theories describing the fundamental origin of these defects.

Mendez, Horacio; Morris, Steve; Tatti, Sudhindra; Dickson, Nicholas; Pyle, Ronald E.



Steam generator tube rupture study  

E-print Network

This report describes our investigation of steam generator behavior during a postulated tube rupture accident. Our study was performed using the steam generator, thermal-hydraulic analysis code THERMIT-UTSG. The purpose ...

Free, Scott Thomas



Partial ACL rupture: an MR diagnosis?  

Microsoft Academic Search

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

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



A professional internship with Texas Breeders Service  

E-print Network

). This injection blocks the rectal contractions and anal sphincter muscle (8). The vulva lips are spread and a catheter is inserted through the vagina into the os cervix. Once in the cervix the chemise cover is retracted until it is ruptured by the catheter...). This injection blocks the rectal contractions and anal sphincter muscle (8). The vulva lips are spread and a catheter is inserted through the vagina into the os cervix. Once in the cervix the chemise cover is retracted until it is ruptured by the catheter...

McKemie, Jack Furman



Electrocautery Superior to Topical Treatments for Precancerous Anal Lesions

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.


Impact of the new cuff design on reliability of the AS800 artificial urinary sphincter.  


The effect of 2 cuff design changes on the mechanical reliability of the current AS800 artificial urinary sphincter was assessed in 126 patients. The surface-treated cuff was introduced in 1983 and the narrow-back design was introduced in 1987. Mean followup for the surface-treated cuff was 40 months, while that for the narrow back was 27.2 months. The incidence of cuff leaks was 1.3%, while the revision rate for clinically significant pressure atrophy, in the absence of a bladder flap urethroplasty, was 2.3%. The overall revision rate for clinically significant pressure atrophy was 9%. No leaks involving the balloon or tubing occurred. The mechanical reliability of the current AS800 artificial urinary sphincter has improved significantly. PMID:1538439

Light, J K; Reynolds, J C



Alliance ruptures and rupture resolution in cognitive–behavior therapy: A preliminary task analysis  

Microsoft Academic Search

An initial ideal, rational model of alliance rupture and rupture resolution provided by cognitive–behavioral therapy (CBT) experts was assessed and compared with empirical observations of ruptures and their resolution in two cases of successful CBT. The initial rational model emphasized nondefensive acknowledgment and exploration of the rupture. Results indicated differences between what therapists think they should do to resolve ruptures

Helen Aspland; Susan Llewelyn; Gillian E. Hardy; Michael Barkham; William Stiles



Preoperative Chemoradiation for Extraperitoneal T3 Rectal Cancer: Acute Toxicity, Tumor Response, and Sphincter Preservation  

Microsoft Academic Search

Purpose: To evaluate whether or not an intermediate dose of preoperative external radiation therapy intensified by systemic chemotherapy could improve the tumor response, sphincter preservation, and tumor control.Methods and Materials: Between March 1990 and December 1995, 83 consecutive patients with resectable extraperitoneal adenocarcinoma of the rectum were treated with preoperative chemoradiation: bolus i.v. mitomycin C (MMC), 10 mg\\/m2, Day 1

Vincenzo Valentini; Claudio Coco; Numa Cellini; Aurelio Picciocchi; Domenico Genovesi; Giovanna Mantini; Brunella Barbaro; Santa Cogliandolo; Claudio Mattana; Fabrizio Ambesi-Impiombato; Manfredo Tedesco; Maurizio Cosimelli



Group I Secreted PLA2 in the Maintenance of Human Lower Esophageal Sphincter Tone  

Microsoft Academic Search

Background & Aims: In cat spontaneous lower esophageal sphincter (LES), tone is maintained by the activity of group I secreted phospholipase A2 (sPLA2-I) that produces arachidonic acid. Arachidonic acid metabolites activate G proteins linked to phospholipases, producing second messengers and activation of a protein kinase C-dependent pathway to maintain tone. We examined the role of sPLA2-I in the maintenance of

Weibiao Cao; Karen M. Harnett; Jose Behar; Piero Biancani



Surgery for symptomatic hemorrhoids and anal fissures in Crohn's disease  

Microsoft Academic Search

This study was undertaken to determine the outcome of surgery for symptomatic hemorrhoids and anal fissures in patients with known Crohn's disease. Seventeen patients underwent surgery for symptomatic hemorrhoids. Fifteen of these 17 patients' wounds healed without complication. Twenty-five patients underwent 27 operations for anal fissures. Twenty-two of these patients had uncomplicated wound healing by two months. Long-term follow-up, which

Alfred F. Wolkomir; Martin A. Luchtefeld



Survey of Heterosexual Anal Intercourse Practices in South Africa  

Microsoft Academic Search

Significance: The role of HAI in sub-Saharan Africa's HIV epidemic has been almost entirely ignored. The only population-based assessment, from a nationally representative household survey of South African youth aged 15-24, found that at least 5% of heterosexually active youth practiced both anal and vaginal intercourse. Young men were twice as likely to be HIV-infected if they reported anal and



ACR Appropriateness Criteria(R)--Anal Cancer  

PubMed Central

ABSTRACT 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

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



ACR Appropriateness Criteria®-Anal Cancer.  


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



Sphincter preservation for distal rectal cancer - a goal worth achieving at all costs?  

PubMed Central

To assess the merits of currently available treatment options in the management of patients with low rectal cancer, a review of the medical literature pertaining to the operative and non-operative management of low rectal cancer was performed, with particular emphasis on sphincter preservation, oncological outcome, functional outcome, morbidity, quality of life, and patient preference. Low anterior resection (AR) is technically feasible in an increasing proportion of patients with low rectal cancer. The cost of sphincter preservation is the risk of morbidity and poor functional outcome in a significant proportion of patients. Transanal and endoscopic surgery are attractive options in selected patients that can provide satisfactory oncological outcomes while avoiding the morbidity and functional sequelae of open total mesorectal excision. In complete responders to neo-adjuvant chemoradiotherapy, a non-operative approach may prove to be an option. Abdominoperineal excision (APE) imposes a permanent stoma and is associated with significant incidence of perineal morbidity but avoids the risk of poor functional outcome following AR. Quality of life following AR and APE is comparable. Given the choice, most patients will choose AR over APE, however patients following APE positively appraise this option. In striving toward sphincter preservation the challenge is not only to achieve the best possible oncological outcome, but also to ensure that patients with low rectal cancer have realistic and accurate expectations of their treatment choice so that the best possible overall outcome can be obtained by each individual. PMID:21412495

Mulsow, Jurgen; Winter, Des C



The Current Role of the Artificial Urinary Sphincter in Male and Female Urinary Incontinence  

PubMed Central

The evolution of the artificial urinary sphincter has affected the current surgical options for urinary incontinence. With its unique features, the artificial urinary sphincter (AUS) has been an attractive option for the treatment of urinary incontinence regardless of gender. The current paper discusses the indications, contraindications, types of devices, surgical approaches, outcomes, and complications of the AUS in the treatment of both male and female urinary incontinence. A PubMed review of the available literature was performed and articles reporting implantation of artificial urinary sphincters for urinary incontinence in both male and female patients were evaluated. There was a comparable satisfactory continence rate after the implantation of an AUS (59~97% in males vs. 60~92% in females). In comparison, there were some differences in the indications, contraindications, surgical approaches, outcomes, and complications of the AUS implanted for urinary incontinence in male and female patients. AUS implantation is a safe and effective surgical option for the treatment of urinary incontinence of various etiologies. Continuous evolution of the device has made it an attractive option for the treatment of both male and female urinary incontinence. PMID:23658862

Islah, MAR; Cho, Sung Yong



The feasibility and reliability of using circular electrode for sphincter of Oddi electromyography in anaesthetised rabbits.  


Sphincter of Oddi manometry (SOM) is the gold standard for assessing sphincter of Oddi dysfunction (SOD), but is considered a diagnostic sensitivity of 30-80% and associated with significant complications of pancreatitis. Electromyography (EMG) of sphincter of Oddi (SO) using a circular electrode (CE) may be useful in improving diagnostic accuracy and reducing complications. To evaluate the feasibility and reliability of the CE, we record myoelectric activity of SO in rabbits using the CE to compare with the traditional needle electrode (NE). The CE was prepared using a double-channel biogel catheter with two silver rings at the head of the catheter. The CE was then inserted into the lumen of the SO through the duodenal papilla, and myoelectric activity was recorded in the SO in 30 rabbits. An EMG recorded using an NE was performed at the same time, when the SO was in basal state, after injection of cholecystokinin and N-butylscopolamine bromide. Electromyographs recorded by the two methods were then evaluated. Satisfactory SO EMGs were acquired using the CE without any injury. Simultaneous recording revealed a very similar traces and one-to-one correspondence of SO spike bursts (SOSB). Linear regression analysis showed a significant direct correlation between the two methods for SOSB duration and amplitude. The results suggested that CE was comparable with NE in terms of recording efficacy. The CE also has advantages of easy fixation, accurate localisation, broad applicability and ease of achieving satisfactory outcomes without trauma, compared with the NE. PMID:19210627

Chen, F; Chen, J; Dong, J-H; Chen, M; Li, H-C; Li, X-W; Li, Z-H



[Anal epidermoid carcinoma: a rare incidence or a rare diagnosis?].  


Epidermoid cancer of the anus is a rare entity which represents 1-2% of all gastrointestinal tract cancers. Possible predisposing causes include smoking and sexual behaviour, particularly homosexual anal intercourse, chronic inflammation (Crohn, anal fistula, fissure, sepsis, hydradenitis suppurativa), and transmissible agents (human papillomavirus type 16 y 18, condylomata acuminata). Another factor is the genetic, which may be related to changes in chromosome 11 and the sort arm of chromosome 3. The aetiology of anal carcinoma is a multifactorial interaction between environmental factors. HPV infection, immune status and suppressor genes. We report on three cases of squamous cell carcinoma of the anus seen in our Unit of Proctology. One patient with widespread perianal hydradenitis suppurativa. Another one in a patient VIH+ with anal human papillomavirus infection, in situ cervix cancer and condylomata acuminata of the vulva and anus. A third case, a man with haemorrhoids. Is addition, constant irritation, chronic inflammatory changes, and repeated epithelial regeneration that accompany noninfectious conditions may be related to risk of anal epidermoid cancer. It is important that this cancer is kept in mind. It is unforgivable that a cancerous lesion that can be suspected in a simple inspection or rectal digital examination be attributed, to a benign anal condition. PMID:9115820

Prieto Reyes, M; Vázquez Márquez, L



Unprotected anal Intercourse among Iranian Intra-Venous Drug Users  

PubMed Central

Purpose: To assess the prevalence and associated factors of unprotected anal intercourse among Iranian male heterosexual Intra-Venous Drug Users (IDUs). Methods: In a cross-sectional study 360 male heterosexual IDUs were sampled from streets of eight different geographical parts of Iran. Variables such as socio-demographics, HIV knowledge (10 items), and HIV attitude (16 items) were entered to a logistic regression to determine the predictors of unprotected anal intercourse during the past month. Results: From all, 20.8% reported unprotected anal intercourse during the past month. HIV knowledge was not significantly different among IDUs with and without unprotected anal intercourse. High age [odds ratio (OR)?=?0.954, 95% confidence intervals (CI)?=?0.916–0.992] was associated with a lower likelihood of unprotected anal intercourse, while being not married (OR?=?2.301, 95% CI?=?1.151–4.601), and high perceived HIV risk (OR?=?1.776, 95% CI?=?1.376–2.290) were associated with a higher likelihood of unprotected anal intercourse. Conclusion: Although the results might not be generalizable to all Iranian IDUs, this study findings may still be helpful for design and implementation of public health programs in Iran to prevent sexual transmission of HIV through IDUs. PMID:24350203

Mirabi, Parvaneh; Yarmohmmadi Vasel, Mosaieb; Moazen, Babak; Sehat, Mahmoud; Rezazadeh, Majid; Ahmadi, Khodabakhsh



Elbow tendinopathy and tendon ruptures: epicondylitis, biceps and triceps ruptures.  


Lateral and medial epicondylitis are common causes of elbow pain in the general population, with the lateral variety being more common than the medial by a ratio reportedly ranging from 4:1 to 7:1. Initially thought to be an inflammatory condition, epicondylitis has ultimately been shown to result from tendinous microtearing followed by an incomplete reparative response. Numerous nonoperative and operative treatment options have been employed in the treatment of epicondylitis, without the emergence of a single, consistent, universally accepted treatment protocol. Tendon ruptures about the elbow are much less frequent, but result in more significant disability and loss of function. Distal biceps tendon ruptures typically occur in middle-aged males as a result of an event that causes a sudden, eccentric contraction of the biceps. Triceps tendon ruptures are exceedingly rare but usually have a similar etiology with a forceful eccentric contraction of the triceps that causes avulsion of the tendon from the olecranon. The diagnosis of these injuries is not always readily made. Complete ruptures of the biceps or triceps tendons have traditionally been treated surgically with good results. With regard to biceps ruptures, there continues to be debate about the best surgical approach, as well as the best method of fixation of tendon to bone. This article is not meant to be an exhaustive review of the broad topics of elbow tendinopathy and tendon ruptures, but rather is a review of recently published information on the topics that will assist the clinician in diagnosis and management of these conditions. PMID:19258160

Rineer, Craig A; Ruch, David S



Cervical ruptures in midtrimester abortions.  


2 groups of patients are at risk of traumatic complication after midtrimester abortion: older multiparous women (uterine ruptures) and young primigravid women (cervical ruptures). While the occurrence of uterine ruptures in the former class can be reduced by selective use of abortifacient agents, and avoidance of amnioinfusions and intravenous oxytocin, the occurrence of cervical ruptures continues to be high. From May 1974 through May 1978, 780 women underwent midtrimester abortion by various techniques. 12 patients (1.5%) sustained cervical injuries, 11 of whom were nulliparous aged 16 to 25 years. Intra-amniotic and extra-ovular methods alike produced cervical injuries. The combined method of induction increases the likelihood of damaging the cervix. Oxytocic augmentation, however, does not appear to increase its incidence. Nor does a shorter induction-abortion interval, according to the evidence. Since laminaria tents did not prevent cervical injuries, none of the presently available methods offers any protection. Nevertheless, it may be that cervical injuries can be prevented if midtrimester abortions are undertaken between 13 and 15 weeks of pregnancy. Cervical ruptures can also go unnoticed and cause future obstetric problems; the authors therefore emphasize the importance of routine cervical inspection in all patients. PMID:12335921

Rajan, R; Usha, K R



Ruptures of the rotator cuff.  

PubMed Central

Through the use of improved diagnostic techniques, including arthrography and arthroscopy, ruptures of the rotator cuff that previously might not have been recognized are now being identified more frequently. In most cases the symptoms are relatively mild and respond satisfactorily to rest and therapy. Occasionally, however, there is severe, persistent disability despite treatment. These ruptures require surgical repair. In such cases the data obtained from special investigations help the surgeon select the appropriate surgical approach and repair technique. An imaginative program of physiotherapy before and after the operation contributes greatly to a satisfactory result. Images FIG. 3 FIG. 4 FIG. 5 FIG. 6 FIG. 7 PMID:7437980

Ha'eri, G B



Self-Rupturing Hermetic Valve  

NASA Technical Reports Server (NTRS)

For commercial, military, and aerospace applications, low-cost, small, reliable, and lightweight gas and liquid hermetically sealed valves with post initiation on/off capability are highly desirable for pressurized systems. Applications include remote fire suppression, single-use system-pressurization systems, spacecraft propellant systems, and in situ instruments. Current pyrotechnic- activated rupture disk hermetic valves were designed for physically larger systems and are heavy and integrate poorly with portable equipment, aircraft, and small spacecraft and instrument systems. Additionally, current pyrotechnically activated systems impart high g-force shock loads to surrounding components and structures, which increase the risk of damage and can require additional mitigation. The disclosed mechanism addresses the need for producing a hermetically sealed micro-isolation valve for low and high pressure for commercial, aerospace, and spacecraft applications. High-precision electrical discharge machining (EDM) parts allow for the machining of mated parts with gaps less than a thousandth of an inch. These high-precision parts are used to support against pressure and extrusion, a thin hermetically welded diaphragm. This diaphragm ruptures from a pressure differential when the support is removed and/or when the plunger is forced against the diaphragm. With the addition of conventional seals to the plunger and a two-way actuator, a derivative of this design would allow nonhermetic use as an on/off or metering valve after the initial rupturing of the hermetic sealing disk. In addition, in a single-use hermetically sealed isolation valve, the valve can be activated without the use of potential leak-inducing valve body penetrations. One implementation of this technology is a high-pressure, high-flow-rate rupture valve that is self-rupturing, which is advantageous for high-pressure applications such as gas isolation valves. Once initiated, this technology is self-energizing and requires low force compared to current pyrotechnic-based burst disk hermetic valves. This is a novel design for producing a single-use, self-rupturing, hermetically sealed valve for isolation of pressurized gas and/or liquids. This design can also be applied for single-use disposable valves for chemical instruments. A welded foil diaphragm is fully supported by two mated surfaces that are machined to micron accuracies using EDM. To open the valve, one of the surfaces is moved relative to the other to (a) remove the support creating an unsupported diaphragm that ruptures due to over pressure, and/or (b) produce tension in the diaphragm and rupture it.

Tucker, Curtis E., Jr.; Sherrit, Stewart



Treatment of peri-anal fistula in Crohn's disease  

PubMed Central

Anal fistulas are a common manifestation of Crohn’s disease (CD). The first manifestation of the disease is often in the peri-anal region, which can occur years before a diagnosis, particularly in CD affecting the colon and rectum. The treatment of peri-anal fistulas is difficult and always multidisciplinary. The European guidelines recommend combined surgical and medical treatment with biologic drugs to achieve best results. Several different surgical techniques are currently employed. However, at the moment, none of these techniques appear superior to the others in terms of healing rate. Surgery is always indicated to treat symptomatic, simple, low intersphincteric fistulas refractory to medical therapy and those causing disabling symptoms. Utmost attention should be paid to correcting the balance between eradication of the fistula and the preservation of fecal continence. PMID:25309057

Sica, Giuseppe S; Di Carlo, Sara; Tema, Giorgia; Montagnese, Fabrizio; Del Vecchio Blanco, Giovanna; Fiaschetti, Valeria; Maggi, Giulia; Biancone, Livia



Physiological and Functional Evaluation of the Transposed Human Pylorus as a Distal Sphincter  

PubMed Central

Background/Aims Studies evaluating the human pylorus as a sphincter are scanty and contradictory. Recently, we have shown technical feasibility of transposing the human pylorus for end-stage fecal incontinence. This unique cohort of patients provided us an opportunity to study the sphincter properties of the pylorus in its ectopic position. Methods Antro-pylorus transposition on end sigmoid colostomies (n = 3) and in the perineum (n = 15) was performed for various indications. Antro-pylorus was assessed functionally (digital examination, high resolution spatiotemporal manometry, barium retention studies and colonoscopy) and by imaging (doppler ultrasound, MRI and CT angiography) in its ectopic position. Results The median resting pressure of pylorus on colostomy was 30 mmHg (range 28-38). In benign group, median resting pressure in perineum was 12.5 mmHg (range 6-44) that increased to 21.5 mmHg (range 12-29) (P = 0.481) and 31 mmHg (range 16-77) (P = 0.034) on first and second follow-up, respectively. In malignant group, median post-operative pressures were 20 mmHg (range 14-36) and 21 mmHg (range 18-44) on first and second follow-up, respectively. A definite tone and gripping sensation were felt in all the patients on digital examination. On distal loopogram, performed through the diverting colostomies, barium was retained proximal to the neo-pyloric valve. Both perineal ultrasound and MRI showed viable transposed graft. CT angiography and color doppler studies confirmed vascular flow in the transposed position. Conclusions The human pyloric valve can function as a tonic sphincter when removed from the gastroduodenal continuity. PMID:22837874

Ghoshal, Uday C; Gupta, Vishal; Jauhari, Ramendra; Srivastava, Rajendra N; Misra, Asha; Kumar, Ashok; Kumar, Manoj



Coordinated gastric and sphincter motility evoked by intravenous CCK-8 as monitored by ultrasonomicrometry in rats.  


Gastric and sphincter motility evoked by intravenous injection of CCK-8 were investigated in urethane-anesthetized rats. Digital ultrasonomicrometry was used to monitor pyloric (PYL), antral (ANT), corpus (COR), and lower esophageal sphincter (LES) movements while simultaneously measuring intragastric pressure (IGP) and, in some experiments, subdiaphragmatic intraesophageal pressure (sIEP). Intracrystal distances (ICD) were measured continuously between pairs of piezoelectric crystals affixed to the serosa of PYL, ANT, COR (circular and longitudinal), and LES. Consecutive intravenous injections of CCK-8 (0.3, 1, and 3 microg/kg) at 30-min intervals caused dose-dependent simultaneous tonic contractions of PYL and ANT, LES opening, and drops in IGP with peak changes at 3 microg/kg of -17.9 +/- 2.1, -7.7 +/- 2.5, 6.5 +/- 1.4, and -29.2 +/- 3.8%, respectively, whereas intravenous saline had no effect. Rhythmic contractile activity was inhibited by CCK-8. COR responses were not significantly different from vehicle controls for most metrics, and the direction of response for circular COR varied between preparations, although not for repeated trials in a single preparation. During the LES response to CCK-8, sIEP rose in parallel with drops in IGP, indicating formation of a common cavity. Recovery of LES ICD after intravenous CCK occurred more rapidly than recovery of PYL ICD, suggesting the importance of preventing simultaneous patency of gastroesophageal and gastroduodenal passages. The CCK(A) receptor antagonist devazepide (500 microg/kg intravenous) inhibited motion responses evoked by intravenous CCK-8. These data revealed CCK-8-induced gastric and sphincter activity consistent with retropulsion of gastric content. PMID:14715522

Adelson, David W; Million, Mulugeta; Kanamoto, Koki; Palanca, Tiffany; Taché, Yvette



Resolving sphincter of Oddi incontinence for primary duodenal Crohn's disease with strictureplasty  

PubMed Central

INTRODUCTION Crohn's involvement of duodenum is a rare event and may be associated to proteiform symptoms and uncommon pathological aspects which make diagnosis and treatment complex. PRESENTATION OF CASE The peculiar aspect of this case was a suspected duodeno-biliary fistula. The patient (female, 22 years old) was affected by duodenal Crohn's disease. Magnetic resonance imaging showed a dilated common bile duct, whose final part linked to a formation containing fluid, and characterized by filling of the contrast medium in the excretory phase. Abdominal ultrasound showed intra-hepatic and intra-gallbladder aerobilia. At surgery, the duodenum was mobilized showing an inflammatory stricture and a slight dilatation of the common bile duct, with no signs of fistulas. The opened duodenum was anastomized side to side to a transmesocolic loop of the jejunum. After surgery, the general condition of the patient improved. DISCUSSION Only two cases of fistula between a narrow duodenal bulb and the common bile duct have been described in literature and the Authors were not be able to verify the occurrence of a duodenal biliary fistula at surgery. The association between duodenal Crohn's disease and Sphincter of Oddi incontinence is a very rare finding with different etiology: chronic intestinal pseudo-obstruction, common bile duct stones, progressive systemic sclerosis. CONCLUSION The treatment to resolve Sphincter of Oddi incontinence for primary duodenal Crohn's disease is not clear. Strictureplasty could be the treatment of choice, because, resolving the stricture, the duodenal pressure is likely to decrease and the reflux through the incontinent sphincter can be avoided. PMID:23276753

Alemanno, G.; Sturiale, A.; Bellucci, F.; Giudici, F.; Tonelli, F.



Single piece artificial urinary sphincter for secondary incontinence following successful repair of post traumatic urethral injury  

PubMed Central

Post traumatic urethral injury is uncommon in children. The management of this condition is dependent on the severity of injury. Initial suprapubic cystostomy with delayed repair is the conventional treatment. Successful reconstruction of urethral injury may be followed by urethral stricture, incontinence, impotence, and retrograde ejaculation. Successful repair of post traumatic urethral injury followed by secondary incontinence in children has not been well addressed in literature. We report the management of one such child, with satisfactory outcome with implantation of a new model of single piece artificial urinary sphincter in the bulbar urethra by perineal approach. PMID:24347870

Kandpal, D. K.; Rawat, S. K.; Kanwar, S.; Baruha, A.; Chowdhary, S. K.



Traumatic pericardial rupture with skeletonized phrenic nerve  

Microsoft Academic Search

BACKGROUND: Traumatic pericardial rupture is a rare presentation. Pericardial rupture itself is asymptomatic unless complicated by either hemorrhage or herniation of the heart through the defect. Following diagnosis surgical repair of the pericardium is indicated because cardiac herniation may result in vascular collapse and sudden death. OBJECTIVES: Here we present a case of traumatic, non-herniated pericardial rupture with complete skeletonization

Zain Khalpey; Taufiek K Rajab; Jan D Schmitto; Philipp C Camp



A Retrospective Analysis of Ruptured Breast Implants  

PubMed Central

Background Rupture is an important complication of breast implants. Before cohesive gel silicone implants, rupture rates of both saline and silicone breast implants were over 10%. Through an analysis of ruptured implants, we can determine the various factors related to ruptured implants. Methods We performed a retrospective review of 72 implants that were removed for implant rupture between 2005 and 2014 at a single institution. The following data were collected: type of implants (saline or silicone), duration of implantation, type of implant shell, degree of capsular contracture, associated symptoms, cause of rupture, diagnostic tools, and management. Results Forty-five Saline implants and 27 silicone implants were used. Rupture was diagnosed at a mean of 5.6 and 12 years after insertion of saline and silicone implants, respectively. There was no association between shell type and risk of rupture. Spontaneous was the most common reason for the rupture. Rupture management was implant change (39 case), microfat graft (2 case), removal only (14 case), and follow-up loss (17 case). Conclusions Saline implants have a shorter average duration of rupture, but diagnosis is easier and safer, leading to fewer complications. Previous-generation silicone implants required frequent follow-up observation, and it is recommended that they be changed to a cohesive gel implant before hidden rupture occurs.

Baek, Woo Yeol; Lew, Dae Hyun



A comparison of common bile duct pressures after botulinum toxin injection into the sphincter of Oddi versus biliary stenting in a canine model  

Microsoft Academic Search

Background: Botulinum toxin A (Botox) functionally paralyzes the sphincter of Oddi in both animals and humans, resulting in reduced pressures. No study, however, has specifically addressed common bile duct (CBD) pressures after Botox injection into the sphincter of Oddi with regard to treating biliary leaks and fistulae. The goals of this present study are to compare, versus biliary stenting, the

Jeffrey M Marks; Andrew L Bower; Marlene Goormastic; Janis L Malycky; Jeffrey L Ponsky



A Catheter-Based Acoustic Interrogation Device for Monitoring Motility Dynamics of the Lower Esophageal Sphincter  

PubMed Central

This paper presents novel minimally-invasive, catheter-based acoustic interrogation device for monitoring motility dynamics of the lower esophageal sphincter (LES). A micro-oscillator actively emitting sound wave at 16 kHz is located at one side of the LES, and a miniature microphone is located at the other side of the sphincter to capture the sound generated from the oscillator. Thus, the dynamics of the opening and closing of the LES can be quantitatively assessed. In this paper, experiments are conducted utilizing an LES motility dynamics simulator. The sound strength is captured by the microphone and is correlated to the level of LES opening and closing controlled by the simulator. Measurements from the simulator model show statistically significant (p < 0.05) Pearson correlation coefficients (0.905 on the average in quiet environment and 0.736 on the average in noisy environment, D.O.F. = 9). Measuring the level of LES opening and closing has the potential to become a valuable diagnostic technique for understanding LES dysfunction and the disorders associated with it. PMID:25120160

Lu, Qian; Yadid-Pecht, Orly; Sadowski, Daniel C.; Mintchev, Martin P.



Effect of nitrovasodilators on the rhythmic contractions of guinea-pig isolated sphincter of Oddi.  


The effects of amyl nitrite (CAS 8017-89-8) isosorbide dinitrate (CAS 87-33-2) and sodium nitroprusside (CAS 14402-89-2), on the acetylcholine-induced tachyrhythmia (greater than 9 waves/min) were investigated in the isolated guinea-pig sphincter of Oddi. Acetylcholine (10(-3) mol/l) produced an initial rapid rise in tension, the peak being followed by a gradual decrease associated with the initiation of the peristaltic waves. Nitrovasodilators significantly decreased the initial response to acetylcholine. Methylene blue (5 x 10(-5) mol/l), a soluble guanylate cyclase inhibitor, increased the tonic response to acetylcholine and reversed the inhibition caused by nitrovasodilators. The frequency and amplitude of peristaltic waves were decreased by nitrovasodilators. Methylene blue significantly increased both the frequency and amplitude of peristaltic waves, however, it did not reverse the inhibition caused by nitrovasodilators tested. Results suggest that nitrates decrease the acetylcholine-induced contraction and peristaltism of isolated guinea-pig sphincter of Oddi and NO released by acetylcholine may partially suppress its own tonic contractile response. PMID:8573227

Göçer, F; Yari?, E; Tuncer, M; Kayaalp, S O



Predictors of Unprotected Anal Intercourse Among HIV-Positive Latino Gay and Bisexual Men  

Microsoft Academic Search

This study examined sexual behaviors in a sample of 155 HIV-positive Latino gay and bisexual men. Nearly half the sample had engaged in unprotected anal intercourse in the past 12 months; unprotected anal intercourse was more likely when the partner was also HIV-positive. Separate regression models predicted the number of receptive and insertive partners for unprotected anal intercourse. Participants reported

Paul J. Poppen; Carol A. Reisen; María Cecilia Zea; Fernanda T. Bianchi; John J. Echeverry



The Danger of Desire: Anal Sex and the Homo\\/Masculine Subject  

Microsoft Academic Search

Anal eroticism between men has been a recurrent focus in psychoanalytic theory for over a century. Many theorists conflate anal eroticism with danger, particularly danger to masculinity and male gender identity. Defensive resistance to aggressive penetration and fear of receptivity are repeatedly invoked to understand anal erotic excitement and actions. The author reviews numerous papers on this topic from a

Jeffrey R. Guss



Primary radiation therapy in the treatment of anal carcinoma  

SciTech Connect

From 1966 to 1981, 47 patients with a diagnosis of anal carcinoma were irradiated. This group was composed of 23 males and 24 females, with age ranging from 38 to 84 years (average 64.4 years). Five patients were treated preoperatively and 34 were treated definitively with cancericidal doses of irradiation. Acute radiation reactions requiring a rest-break were noted in 28% of patients, but all were managed as outpatients without untoward chronic sequelae. Chronic complications were noted in 13 patients, including two patients who required colostomy for severe anal stenosis and two who required A-P resection for large painful ulcers. Twenty-eight of 35 patients (80%) treated with irradiation alone have remained locally controlled without further treatment. An additional four have been salvaged by surgery. Only three patients had interstitial implants as part of their treatment course. Actuarial survival at five years for the N/sub 0/ patients and the group as a whole are 95.6 and 79.3%, respectively. It is concluded that external beam irradiation alone, properly fractionated to cancericidal doses, can control anal carcinoma with acceptable morbidity rates and without the use of either chemotherapy or interstitial implants in most cases. There is also a strong correlation suggesting that anal intercourse and male homosexuality play a significant role in the etiology of this disease.

Cantril, S.T. (Children's Hospital of San Francisco, CA); Green, J.P.; Schall, G.L.; Schaupp, W.C.



Volatile Compounds from Anal Glands of the Wolverine, Gulo gulo  

Microsoft Academic Search

Dichloromethane extracts of wolverine (Gulo gulo, Mustelinae, Mustelidae) anal gland secretion were examined by gas chromatography–mass spectrometry. The secretion composition was complex and variable for the six samples examined: 123 compounds were detected in total, with the number per animal ranging from 45 to 71 compounds. Only six compounds were common to all extracts: 3-methylbutanoic acid, 2-methylbutanoic acid, phenylacetic acid,

William F. Wood; Miranda N. Terwilliger; Jeffrey P. Copeland



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



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



SURFACE AND INTERFACE ANALYSIS Surf. Interface Anal. 2007; 39: 6468  

E-print Network

. Too much exposure to moisture and oxygen can lead to remarkable dark spots in an OLED, and its lifeSURFACE AND INTERFACE ANALYSIS Surf. Interface Anal. 2007; 39: 64­68 Published online 21 September applications, i.e. high brightness, high efficiency, wide viewing angle, and quick response time. In addition

Hwang, Sung Woo


SURFACE AND INTERFACE ANALYSIS Surf. Interface Anal. 2004; 36: 304310  

E-print Network

applications. Analysis of the static SIMS fingerprints led to the identification of key species relatedSURFACE AND INTERFACE ANALYSIS Surf. Interface Anal. 2004; 36: 304­310 Published online in Wiley, the resistance­capacitance delay in interconnects becomes the factor limiting the speed of advanced circuits

Rubloff, Gary W.


Traumatically ruptured globes in children.  


This retrospective study was designed to document the etiology of traumatically ruptured globes in children and to determine the prognostic value of several clinical parameters with respect to visual outcome. Forty-six children 16 years of age and under seen in the emergency room over a 2-year period were found to have full thickness penetration of the globe. Fifty-nine percent of injuries occurred during recreational activities, and 59% occurred outside of the home. Boys outnumbered girls by a 6:1 ratio. For children, initial visual acuity proved to be less valuable as a prognostic indicator with regard to final vision than has been reported in adults. Smaller corneal wounds offered better visual outcomes. Four eyes were enucleated. Ten ruptures (22%) were related to activity involving guns. Four of six BB gun injuries were the result of a ricocheted BB. Visual outcomes in gun-related injuries were particularly poor. PMID:7837018

Rudd, J C; Jaeger, E A; Freitag, S K; Jeffers, J B



Achilles tendon rupture in badminton.  

PubMed Central

The typical badminton player with an Achilles tendon rupture is 36 years old and, despite limbering up, is injured at the rear line in a sudden forward movement. He resumes work within three months and has a slight lack of dorsiflexion in the ankle as the main complication. Most patients resume badminton within one year, but some finish their sports career, mainly due to fear of a new injury. The investigation discusses predisposing factors and prophylactic measures. PMID:2605439

Kaalund, S; Lass, P; Høgsaa, B; Nøhr, M



Identifying the best therapy for chronic anal fissure  

PubMed Central

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 effective type of CS and discussion in this article scrutinizes this method specifically. Although the effectiveness of BTX vs. LIS has been discussed, the essential focus of the article concerns identifying the best therapy application for anal fissure. Elements are presented which may help us to predict CAF healing. They provide rationale for the expansion of the CAF therapy algorithm. Ethical and economic factors are also considered in brief. As long as the patient is willing to accept the potential risk of fecal incontinence, we have grounds for the ‘gold standard’ (LIS) as the first-line treatment for CAF. The author concludes that, when the diagnosis of the anal fissure is established, CS should be considered for both ethical and economic reasons. He is convinced that a greater understanding and recognition of benign anal disorders by the GP and a proactive involvement at the point of initial diagnosis would facilitate the consideration of CS at an earlier, more practical stage with improved outcomes for the patient. PMID:21577312

Madalinski, Mariusz H



Anal Human Papillomavirus Infection in Women and Its Relationship with Cervical Infection  

PubMed Central

Human papillomavirus (HPV), the primary cause of cervical cancer, is also associated with the development of anal cancer. Relatively little is known about the epidemiology of anal HPV infection among healthy females and its relationship to cervical infection. We sought to characterize anal HPV infection in a cohort of adult women in Hawaii. Overall, 27% (372 of 1,378) of women were positive for anal HPV DNA at baseline compared with 29% (692 of 2,372) with cervical HPV DNA. Among women with paired anal and cervical samples, anal infection without accompanying cervical infection was observed in 14% (190 of 1,363). Concurrent anal and cervical HPV infections were observed in 13% (178 of 1,363) of women. Women with cervical HPV infection had >3-fold increased risk of concurrent anal infection. Concurrent anal and cervical HPV infection was most prevalent among the youngest women and steadily decreased through age 50 years. By contrast, the prevalence of anal infection alone remained relatively steady in all age groups. Compared with cervical infections, the overall distribution of HPV genotypes in the anus was more heterogeneous and included a greater proportion of nononcogenic types. A high degree of genotype-specific concordance was observed among concurrent anal and cervical infections, indicating a common source of infection. Nevertheless, the association of anal intercourse with anal HPV infection was limited to those women without accompanying cervical infection. The relationship of anal to cervical infection as described in this study has implications for the development of anal malignancies in women. PMID:16284377

Hernandez, Brenda Y.; McDuffie, Katharine; Zhu, Xuemei; Wilkens, Lynne R.; Killeen, Jeffrey; Kessel, Bruce; Wakabayashi, Mark T.; Bertram, Cathy C.; Easa, David; Ning, Lily; Boyd, Jamie; Sunoo, Christian; Kamemoto, Lori; Goodman, Marc T.



Anal. Chem. 1990, 62, 875-877 075 Harris, Jr., W. C.; Chandra, S.; Morrison, G. H. Anal. Chem. 1983, 55,  

E-print Network

.;Colton, R. J.; Mowery, R. L.; McGrath, K. J.; Wyatt, J. R. Appl. Surf. Sci. 1989, 35,507. Clark. M. B., Jr.; Gardella, J. A.. Jr.; Schultz, T. M.; Salvati, L., Jr.; Patil, D. G. Anal. Chem., in press. Clark, M. B.; Cooks, R. G. Anal. Chem. 1983, 55,1157. (38) Lui, L. K.; Busch, K. L.; Cooks, R. G. Anal. Chem. 1981, 53

Weidner, John W.


Effect of atropine on the frequency of reflux and transient lower esophageal sphincter relaxation in normal subjects  

Microsoft Academic Search

Background & Aims Low basal lower esophageal sphincter (LES) pressure is believed to be an important mechanism of reflux. The effects of atropine on the frequency and mechanisms of gastroesophageal reflux under the experimental conditions of a low basal LES pressure in 13 normal subjects were studied. Methods LES pressure, esophageal pressures, esophageal pH, and crural diaphragm electromyogram were recorded

Ravinder K. Mittal; Richard Holloway; John Dent



Human amniotic fluid stem cell injection therapy for urethral sphincter regeneration in an animal model  

PubMed Central

Background Stem cell injection therapies have been proposed to overcome the limited efficacy and adverse reactions of bulking agents. However, most have significant limitations, including painful procurement, requirement for anesthesia, donor site infection and a frequently low cell yield. Recently, human amniotic fluid stem cells (hAFSCs) have been proposed as an ideal cell therapy source. In this study, we investigated whether periurethral injection of hAFSCs can restore urethral sphincter competency in a mouse model. Methods Amniotic fluids were collected and harvested cells were analyzed for stem cell characteristics and in vitro myogenic differentiation potency. Mice underwent bilateral pudendal nerve transection to generate a stress urinary incontinence (SUI) model and received either periurethral injection of hAFSCs, periurethral injection of Plasma-Lyte (control group), or underwent a sham (normal control group). For in vivo cell tracking, cells were labeled with silica-coated magnetic nanoparticles containing rhodamine B isothiocyanate (MNPs@SiO2 (RITC)) and were injected into the urethral sphincter region (n = 9). Signals were detected by optical imaging. Leak point pressure and closing pressure were recorded serially after injection. Tumorigenicity of hAFSCs was evaluated by implanting hAFSCs into the subcapsular space of the kidney, followed two weeks later by retrieval and histologic analysis. Results Flow activated cell sorting showed that hAFSCs expressed mesenchymal stem cell (MSC) markers, but no hematopoietic stem cell markers. Induction of myogenic differentiation in the hAFSCs resulted in expression of PAX7 and MYOD at Day 3, and DYSTROPHIN at Day 7. The nanoparticle-labeled hAFSCs could be tracked in vivo with optical imaging for up to 10 days after injection. Four weeks after injection, the mean LPP and CP were significantly increased in the hAFSC-injected group compared with the control group. Nerve regeneration and neuromuscular junction formation of injected hAFSCs in vivo was confirmed with expression of neuronal markers and acetylcholine receptor. Injection of hAFSCs caused no in vivo host CD8 lymphocyte aggregation or tumor formation. Conclusions hAFSCs displayed MSC characteristics and could differentiate into cells of myogenic lineage. Periurethral injection of hAFSCs into an SUI animal model restored the urethral sphincter to apparently normal histology and function, in absence of immunogenicity and tumorigenicity. PMID:22906045



[Rupture of the diaphragm of late manifestation].  


Twenty one cases of delayed diagnosis of ruptured diaphragm caused by closed trauma are reported: 14 on the left side and 7 on the right side. The clinical signs and the modes of presentation are non-specific. Although the history of thoraco-abdominal trauma and the chest x-ray are sufficient to establish the diagnosis of rupture of the left hemidiaphragm, they can only suggest the diagnosis in cases of righ-sided rupture. The mechanism of rupture is more often due to sudden reflex contraction of the diaphragm against a closed glottis than to excessive abdominal pressure caused by the trauma. Diaphragmatic rupture due to closed trauma causes large tears exposing the patient to a low risk of strangulation of intestinal structures in contrast with ruptures due to a penetrating injury, which causes small tears. The diaphragmatic domes must be systematically explored during laparotomy or thoracotomy performed for thoraco-abdominal trauma. PMID:2189337

Lenot, B; Bellenot, F; Regnard, J F; Dartevelle, P; Rojas-Miranda, A; Levasseur, P



Early second trimester uterine scar rupture.  


Spontaneous uterine scar rupture can be lethal in pregnant women. A spontaneous uterine scar rupture in the early mid-trimester is rare and difficult to diagnose. This is a case of a 30-year-old woman (G2P1L1) at 19 weeks of gestation and having undergone a previous caesarean section presented with acute abdomen in shock. Laparotomy revealed a uterine scar rupture, which was resutured after evacuation of products of conception. This case merits that the uterine rupture should be considered as a differential diagnosis in pregnant women presenting with acute abdomen. In this case, although there was uterine rupture in the second trimester and a complete placental separation, fetus was alive which is quite unusual in patients presenting with rupture uterus. PMID:24326433

Bharatnur, Sunanda; Hebbar, Shripad; Shyamala, G



Delayed aortic rupture following perforating trauma  

PubMed Central

The immediate death rate for aortic rupture caused by pointed and sharp-edged instruments is very high; however, delayed aortic rupture following the trauma is rarely reported. A patient who had an upper abdominal stab wound was sent to our hospital, and an emergency exploratory laparotomy was performed. No traumatic aortic rupture was found at that time. However, on the fifth day after surgery, aortic rupture occurred, and a large retroperitoneal hematoma was formed. The patient eventually died. Aortic rupture was confirmed by a second emergency exploratory laparotomy and the autopsy. The information from exploratory laparotomies, post-operative observations and treatments, medical imaging reports, and reasons for delayed aortic rupture, as well as the underlying pathophysiological processes, are discussed in this case report.

Yang, Xuefei; Xia, Ligang



Prolonged esophagitis after primary dysfunction of the pyloric sphincter in the rat and therapeutic potential of the gastric pentadecapeptide BPC 157.  


Seven or fourteen days or twelve months after suturing one tube into the pyloric sphincter (removed by peristalsis by the seventh day), rats exhibit prolonged esophagitis with a constantly lowered pressure not only in the pyloric, but also in the lower esophageal sphincter and a failure of both sphincters. Throughout the esophagitis experiment, gastric pentadecapeptide BPC 157 (PL 14736) is given intraperitoneally once a day (10 microg/kg, 10 ng/kg, last application 24 h before assessment), or continuously in drinking water at 0.16 microg/ml, 0.16 ng/ml (12 ml/rat per day), or directly into the stomach 5 min before pressure assessment (a water manometer connected to the drainage port of a Foley catheter implanted into the stomach either through an esophageal or duodenal incision). This treatment alleviates i) the esophagitis (macroscopically and microscopically, at either region or interval), ii) the pressure in the pyloric sphincter, and iii) the pressure in the lower esophageal sphincter (cmH2O). In the normal rats it increases lower esophageal sphincter pressure, but decreases the pyloric sphincter pressure. Ranitidine, given using the same protocol (50 mg/kg, intraperitoneally, once daily; 0.83 mg/ml in drinking water; 50 mg/kg directly into the stomach) does not have an effect in either rats with esophagitis or in normal rats. PMID:17452811

Dobric, Ivan; Drvis, Petar; Petrovic, Igor; Shejbal, Drazen; Brcic, Luka; Blagaic, Alenka Boban; Batelja, Lovorka; Sever, Marko; Kokic, Neven; Tonkic, Ante; Zoricic, Ivan; Mise, Sandro; Staresinic, Mario; Radic, Bozo; Jakir, Ana; Babel, Jaksa; Ilic, Spomenko; Vuksic, Tihomir; Jelic, Ivan; Anic, Tomislav; Seiwerth, Sven; Sikiric, Predrag



Reversal of lower esophageal sphincter hypotension and esophageal aperistalsis after treatment for hypothyroidism  

SciTech Connect

A 65-year-old woman suffered from both chronic gastroesophageal reflux, which was complicated by columnar metaplasia (Barrett's epithelium), and profound hypothyroidism. An esophageal motility tracing showed absence of peristalsis in the lower esophagus and the lower esophageal sphincter (LES) could not be identified. Thyroid replacement therapy, in conjunction with antacid and cimetidine treatment, was associated not only with improvement in the gastroesophageal reflux symptoms, but also with a return of esophageal peristalsis and LES pressure to normal. To support our clinical observations, we rendered four cats hypothyroid with /sup 131/I and documented a fall in LES pressure. We propose that abnormal smooth-muscle function of the esophagus may be another manifestation of the gastrointestinal motility disturbances which are associated with hypothyroidism.

Eastwood, G.L.; Braverman, L.E.; White, E.M.; Vander Salm, T.J.



Investigation of cryogenic rupture disc design  

NASA Technical Reports Server (NTRS)

Rupture disc designs of both the active (command actuated) and passive (pressure ruptured) types were evaluated for performance characteristics at cryogenic temperatures and for capability to operate in a variety of cryogens, including gaseous and liquid fluorine. The test results, coupled with information from literature and industry searches, were used to establish a statement of design criteria and recommended practices for application of rupture discs to cryogenic rocket propellant feed and vent systems.

Keough, J. B.; Oldland, A. H.



Neck curve polynomials in neck rupture model  

SciTech Connect

The Neck Rupture Model is a model that explains the scission process which has smallest radius in liquid drop at certain position. Old fashion of rupture position is determined randomly so that has been called as Random Neck Rupture Model (RNRM). The neck curve polynomials have been employed in the Neck Rupture Model for calculation the fission yield of neutron induced fission reaction of {sup 280}X{sub 90} with changing of order of polynomials as well as temperature. The neck curve polynomials approximation shows the important effects in shaping of fission yield curve.

Kurniadi, Rizal; Perkasa, Yudha S.; Waris, Abdul [Nuclear Physics and Biophysics Research Division, Department of Physics, Faculty of Mathematics and Natural Sciences, Institut Teknologi Bandung, Jalan Ganesa 10 Bandung 40132 (Indonesia)



Spontaneous rupture of uterine leiomyoma during labour.  


Uterine rupture in labour requires an emergency caesarean section. In women with a uterine scar, either from gynaecological surgery or from a previous caesarean section, it is well documented that the risk of rupture is higher than in those without. Spontaneous uterine rupture in a uterus with fibroids during pregnancy or labour is extremely rare. We present a case of a 33-year-old, unbooked pregnant woman from Nigeria who had a uterine rupture secondary to fibroids. She required an emergency caesarean section in labour. The fibroids were not removed. Her baby was born alive and in good condition and she made an uneventful recovery. PMID:25199188

Ramskill, Nikki; Hameed, Aisha; Beebeejaun, Yusuf



Contact sensitization in the anal and genital area.  


We analysed the patch test results in 1,374 patients suffering from dermatoses in the anogenital area (n = 561 genital dermatoses, n = 470 anal dermatoses, n = 343 anogenital dermatoses) patch tested in 44 dermatological departments of the Information Network of Departments of Dermatology from 2004 to 2008. All other patients patch tested during this time period without anogenital dermatoses formed the control group (n = 49, 142). Of the total study group, 662 (48.2%) patients were male. 179 (13%) had a past or present atopic dermatitis. The vast majority of the patients was older than 40 years (n = 989, 72%). Suspected allergen sources were first of all topical medicaments, followed by cosmetics, cleansing agents, clothes, rubber products, systemic medicaments and disinfectants. Allergic contact dermatitis was diagnosed in 409 (29.8%) of the tested patients. Patients with anogenital dermatoses were sensitized mainly to active agents of topical medicaments, in particular bufexamac (5.3%). Sensitization pattern and sensitization rates observed in patients with genital and anal involvement differed significantly. Patients with anal disease had significantly higher sensitization rates for bufexamac (9.4 vs. 1.1%), fragrance mix I (8.7 vs. 4.2%) and II (4.5 vs. 2.6%), propolis (5.4 vs. 1.9%) and methyldibromoglutaronitrile (6.3 vs. 4.1%). Patients with chronic anal dermatoses seem to have a higher risk to develop sensitizations to topically applied products and drugs than patients with genital dermatoses. Recommended patch test series (German Contact Dermatitis Research Group) are standard series, local anaesthetics series, topical antibiotics, antimycotics, steroids, ointment bases and preservative series as well as the patients' own products. PMID:21325848

Bauer, A; Oehme, S; Geier, J



Anal fissures, fistulas, abscesses, and hemorrhoids in a tropical population  

Microsoft Academic Search

Summary  Anal fissures, fistulas, abscesses, and hemorrhoids over a seven-year period in a tropical environment are reviewed. It is\\u000a suggested that these diseases may be commoner in urban and city dwellers than in villagers. Increasing sophistication and\\u000a changing food habits in the cities and towns and the attendant limitations on defecating at will are suggested as responsible\\u000a etiologic factors. If diet,

O. O. Ajayi; O. G. Banigo; K. Nnamdi



Drug Use and Unprotected Anal Intercourse Among Gay Men  

Microsoft Academic Search

Conducted a longitudinal study of 604 New York City gay men to examine the link between unprotected insertive and receptive anal intercourse and drug use with sex. Data spanning four 12-month periods from 1980 to 1987 indicated that the link between drug use and high-risk sex diminished as the acquired immunodeficiency syndrome (AIDS) epidemic progressed. Strong and significant cross-sectional associations

John L. Martin



Combined therapy for cancer of the anal canal  

Microsoft Academic Search

Nineteen patients with squamous-cell cancer of the anal canal have been treated with combined chemotherapy and radiation therapy,\\u000a followed by appropriate surgery. The authors are convinced that the combined therapy is effective enough to avoid abdominoperineal\\u000a resection if disappearance of the lesion is proven by adequate examination and biopsy. Although they believe cancers 5 cm\\u000a or less in maximum diameter

Norman D. Nigro; V. K. Vaitkevicius; T. Buroker; G. T. Bradley; B. Considine



Palliative endoscopic trans-anal resection of advanced rectosigmoid carcinoma  

Microsoft Academic Search

There is no consensus on optimal treatment of patients with rectosigmoid cancer and unresectable metastatic disease. This\\u000a is a retrospective review of all patients who underwent palliative endoscopic trans-anal resection (ETAR) of rectosigmoid\\u000a cancer over a 10-year period. Fourteen patients (11 male) with a mean age 69.7 years (range 51–86) underwent ETAR; 11 for\\u000a rectal tumours and 3 for rectosigmoid tumours.

C. L. Donohoe; A. E. Brannigan; P. R. O’Connell



Ruptured liver abscess in a neonate.  


We report a rare case of 17-day-old neonate, diagnosed to have ruptured liver abscess secondary to Methicillin-resistant Staphylococcal aureus infection. The child presented with septicemia and abdominal distension. On exploration, there was pyoperitoneum with ruptured liver abscess. PMID:22382113

Jain, Prashant; Mishra, Ashwani; Agarawal, Vyom



Dynamic Interface Rupture in Extremely Heterogeneous Media  

Microsoft Academic Search

Fracture experiments of monolithic brittle materials usually show the maximum speed of smooth rupture at some 30 % of the relevant shear wave speed. This experimental maximum rupture speed is by far lower than those predicted by theories and inferred from inversions of seismograms, and some seismic inversions (e.g., the 1979 Imperial Valley, 1992 Landers, 1999 Izmit, 2001 the central

K. Uenishi; K. Tsuji



Longitudinal ruptures of polyester knitted vascular prostheses  

Microsoft Academic Search

Aim: The purpose of the study was the characterization of a type of rupture occurring on warp-knitted polyester vascular prostheses. Materials and Methods: We studied 20 cases of warp-knitted polyester vascular prostheses that were explanted from humans that showed a longitudinal rupture as a part of a collaborative retrieval program. All the prostheses were immediately fixed in a 10% formaldehyde

Nabil Chakfe; Gunnar Riepe; Florence Dieval; Jean-Francois Le Magnen; Lu Wang; Elisabeth Urban; Marc Beaufigeau; Bernard Durand; Herbert Imig; Jean-Georges Kretz



Rupture Velocity of Plane Strain Shear Cracks  

Microsoft Academic Search

Propagation of plane strain shear cracks is calculated numerically by using finite difference equations with second-order accuracy. The rupture model, in which stress drops gradually as slip increases, combines two different rupture criteria: (1) slip begins at a finite stress level; (2) finite energy is absorbed per unit area as the crack advances. Solutions for this model are nonsingular. In

D. J. Andrews



Spontaneous splenic rupture in a hemodialysis patient.  


Spontaneous splenic rupture (SSR) in a patient undergoing hemodialysis has been described as an extremely rare and potentially fatal complication. We report here spontaneous splenic rupture in a 52-year-old woman undergoing regular hemodialysis for end-stage renal disease (ESRD). She complained of colicky abdominal pain in the left upper quadrant area and dizziness when she assumed an upright posture. Her vital signs revealed low blood pressure and tachycardia, which was suggestive of hypovolemic shock. Abdomen CT scan showed splenic hematoma and hemoperitoneum. However, she had no history of any event triggering the splenic rupture. An exploratory laparotomy showed a ruptured spleen and an emergency splenectomy was performed. We suggest that spontaneous spleen rupture may be attributed to uremic coagulopathy and heparin-induced coagulopathy. PMID:15988818

Kim, Hyun Jung; Lee, Gyeong Won; Park, Dong Jun; Lee, Jong Deog; Chang, Se Ho



Outcomes of Sphincter-Saving Operation for Rectal Cancer without Protective Stoma and Pelvic Drain, and Risk Factors for Anastomotic Leakage  

Microsoft Academic Search

Background\\/Aims: To evaluate the outcomes of sphincter-saving operation for rectal cancer without protective stoma and pelvic drain and to determine factors influencing anastomotic leakage. Methods: We investigated 170 patients undergoing elective sphincter-saving operation without protective stoma and pelvic drain during 2003–2006 in a single institution. Early postoperative outcomes were evaluated. 17 independent patient-, tumor-, and treatment-related variables were analyzed by

Varut Lohsiriwat; Darin Lohsiriwat; Wiroon Boonnuch; Vitoon Chinswangwatanakul; Thawatchai Akaraviputh; Woramin Riansuwan; Narong Lert-akyamanee



An experimental model of prolonged esophagitis with sphincter failure in the rat and the therapeutic potential of gastric pentadecapeptide BPC 157.  


We report a simple novel rat model that combines prolonged esophagitis and parallel sphincters failure. The anti-ulcer gastric pentadecapeptide BPC 157, which was found to be stable in gastric juice, and is being evaluated in inflammatory bowel disease trials, is an anti-esophagitis therapy that recovers failed sphincters. Twelve or twenty months after the initial challenge (tubes sutured into sphincters for one week and then spontaneously removed by peristalsis), rats exhibit prolonged esophagitis (confluent hemorrhagic and yellowish lesions, thinner epithelium and superficial corneal layer, with stratification derangement); constantly lowered pressure of both sphincters (assessed by using a water manometer connected to the drainage port of a Foley catheter implanted into the stomach either through esophageal or duodenal incision); and both lower esophageal and pyloric sphincter failure. Throughout the esophagitis experiment, BPC 157 was given at either 10 micro g/kg, i.p., once a day (last application 24 h before assessment) or alternatively, it was given continuously in drinking water at 0.16 micro g/ml (12 ml/rat). This treatment recovers i) esophagitis (macroscopically and microscopically, at either region or investigated time period) and ii) pressure in both sphincters (cmH2O). In addition, BPC 157 (10 micro g/kg) or saline (1 ml/rat, 5 ml/kg) was specifically given directly into the stomach; pressure assessment was performed at 5 min thereafter. The effect of BPC 157 is specific because in normal rats, it increases lower esophageal sphincter-pressure, but decreases pyloric sphincter-pressure. Ranitidine, given as the standard drug using the same protocol (50 mg/kg, i.p., once daily; 0.83 mg/ml in drinking water; or 50 mg/kg directly into the stomach) had no effect. PMID:17116974

Petrovic, Igor; Dobric, Ivan; Drvis, Petar; Shejbal, Drazen; Brcic, Luka; Blagaic, Alenka Boban; Batelja, Lovorka; Kokic, Neven; Tonkic, Ante; Mise, Stjepan; Baotic, Tomislav; Staresinic, Mario; Radic, Bozo; Jakir, Ana; Vuksic, Tihomir; Anic, Tomislav; Seiwerth, Sven; Sikiric, Predrag



Anal pressure measurements in the study of hemorrhoid etiology and their relation to treatment  

Microsoft Academic Search

The etiology of hemorrhoids has been explained in the past based on anatomic principles, but this study examines the relationship\\u000a of resting anal pressures to hemorrhoid etiology in 38 patients with hemorrhoids and 29 controls with no perianal symptoms.\\u000a Three months after treatment by elastic band ligation, anal pressures were again measured in the hemorrhoid group. Anal pressures\\u000a were significantly

Alexander Aaron Deutsch; Moshe Moshkovitz; Israel Nudelman; Gabriel Dinari; Raphael Reiss



Correlates of Heterosexual Anal Intercourse Among Substance-Using Club-Goers  

Microsoft Academic Search

Anal sexual intercourse represents the highest transmission risk for infection with the human immunodeficiency virus (HIV),\\u000a yet much of what we know about anal sex is based on men who have sex with men (MSM). Less is known about heterosexual adults\\u000a who practice anal sex, especially those who may be at risk for HIV such as substance users. The present

Gladys E. IbanezSteven; Steven P. Kurtz; Hilary L. Surratt; James A. Inciardi



Heterosexual anal intercourse among community and clinical settings in Cape Town, South Africa  

Microsoft Academic Search

Background:Anal intercourse is an efficient mode of HIV transmission and may play a role in the heterosexual HIV epidemics of southern Africa. However, little information is available on the anal sex practices of heterosexual individuals in South Africa.Purpose:To examine the occurrence of anal intercourse in samples drawn from community and clinic settings.Methods:Anonymous surveys collected from convenience samples of 2593 men

S C Kalichman; L C Simbayi; D Cain; S Jooste



7. Schwartz, H.E., et al.: Int. J. Environ. Anal. Chem. 6, 133 (1979)  

E-print Network

7. Schwartz, H.E., et al.: Int. J. Environ. Anal. Chem. 6, 133 (1979) 8. Corcoran, E.F., Curry, R. Anal. Chem. 5, 187 (1978) 10. Hom, W., et al.: Science 184, 1197 (1974) 11. Mtiller, G., Grimmer, G., B, H.S., Neff, G.S. : Anal. Chem. 47, 225 (1975) 15. Giam, C.S., Wong, M.K.: J. Chromatogr. 72, 283



Upper esophageal sphincter abnormalities are strongly predictive of treatment response in patients with achalasia  

PubMed Central

AIM: To investigate the relationship between upper esophageal sphincter abnormalities achalasia treatment METHODS: We performed a retrospective study of 41 consecutive patients referred for high resolution esophageal manometry with a final manometric diagnosis of achalasia. Patients were sub-divided by presence or absence of Upper esophageal sphincter (UES) abnormality, and clinical and manometric profiles were compared. Correlation between UES abnormality and sub-type (i.e., hypertensive, hypotensive or impaired relaxation) and a number of variables, including qualitative treatment response, achalasia sub-type, co-morbid medical illness, psychiatric illness, surgical history, dominant presenting symptom, treatment type, age and gender were also evaluated. RESULTS: Among all 41 patients, 24 (58.54%) had a UES abnormality present. There were no significant differences between the groups in terms of age, gender or any other clinical or demographic profiles. Among those with UES abnormalities, the majority were either hypertensive (41.67%) or had impaired relaxation (37.5%) as compared to hypotensive (20.83%), although this did not reach statistical significance (P = 0.42). There was no specific association between treatment response and treatment type received; however, there was a significant association between UES abnormalities and treatment response. In patients with achalasia and concomitant UES abnormalities, 87.5% had poor treatment response, while only 12.5% had favorable response. In contrast, in patients with achalasia and no UES abnormalities, the majority (78.57%) had good treatment response, as compared to 21.43% with poor treatment response (P = 0.0001). After controlling for achalasia sub-type, those with UES abnormality had 26 times greater odds of poor treatment response than those with no UES abnormality (P = 0.009). Similarly, after controlling for treatment type, those with UES abnormality had 13.9 times greater odds of poor treatment response compared to those with no UES abnormality (P = 0.017). CONCLUSION: The presence of UES abnormalities in patients with achalasia significantly predicted poorer treatment response as compared to those with normal UES function.

Mathews, Simon C; Ciarleglio, Maria; Chavez, Yamile Haito; Clarke, John O; Stein, Ellen; Chander Roland, Bani



Changing Patterns of Anal Canal Carcinoma in the United States  

PubMed Central

Purpose Persistent human papillomavirus infection is associated with squamous cell carcinoma of the anal canal (SCCA). With changing sexual behaviors, SCCA incidence and patient demographics may also have changed in recent years. Methods The Surveillance, Epidemiology, and End Results public-use data set from 1973 to 2009 was analyzed to determine incidence trends for and demographic factors characterizing SCCA. Joinpoint analyses identified time points when incidence rates changed. For comparison, similar analyses were conducted for anal adenocarcinoma. Results Joinpoint analyses identified 1997 as the single inflection point among 11,231 patients with SCCA, at which the slope of incidence rates statistically increased (1997 to 2009 v 1973 to 1996: risk ratio [RR], 2.2; 95% CI, 2.1 to 2.3). Annual percent change (APC) increased for all SCCA stages and was the greatest for anal carcinoma in situ (CIS; APC, 14.2; 95% CI, 10.2 to 18.4). Demographic changes characterizing later versus earlier time period included younger age at diagnosis and rising incidence rates in all stage, sex, and racial groups. During 1997 to 2009, women were less likely to present with CIS (RR, 0.3; 95% CI, 0.3 to 0.3) but more likely to present with localized (RR, 1.2; 95% CI, 1.1 to 1.3) and regional SCCA (RR, 1.5; 95% CI, 1.4 to 1.7). In contrast, adenocarcinoma APCs among 1,791 patients remained stable during this time period. Conclusion CIS and SCCA incidence increased dramatically after 1997 for men and women, although men were more likely to be diagnosed with CIS. These changes likely resulted from available screening in men and argue for efforts to identify high-risk individuals who may benefit from screening. PMID:23509304

Nelson, Rebecca A.; Levine, Alexandra M.; Bernstein, Leslie; Smith, David D.; Lai, Lily L.



FDG-PET/CT in the evaluation of anal carcinoma  

SciTech Connect

Purpose: Surgical staging and treatment of anal carcinoma has been replaced by noninvasive staging studies and combined modality therapy. In this study, we compare computed tomography (CT) and physical examination to [{sup 18}F]-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) in the staging of carcinoma of the anal canal, with special emphasis on determination of spread to inguinal lymph nodes. Methods and Materials: Between July 2003 and July 2005, 41 consecutive patients with biopsy-proved anal carcinoma underwent a complete staging evaluation including physical examination, CT, and 2-FDG-PET/CT. Patients ranged in age from 30 to 89 years. Nine men were HIV-positive. Treatment was with standard Nigro regimen. Results: [{sup 18}F]-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) detected 91% of nonexcised primary tumors, whereas CT visualized 59%. FDG-PET/CT detected abnormal uptake in pelvic nodes of 5 patients with normal pelvic CT scans. FDG-PET/CT detected abnormal nodes in 20% of groins that were normal by CT, and in 23% without abnormality on physical examination. Furthermore, 17% of groins negative by both CT and physical examination showed abnormal uptake on FDG-PET/CT. HIV-positive patients had an increased frequency of PET-positive lymph nodes. Conclusion: [{sup 18}F]-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography detects the primary tumor more often than CT. FDG-PET/CT detects substantially more abnormal inguinal lymph nodes than are identified by standard clinical staging with CT and physical examination.

Cotter, Shane E. [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States); Medical Scientist Training Program, Washington University School of Medicine, St. Louis, MO (United States); Grigsby, Perry W. [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States) and Division of Nuclear Medicine, Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO (United States)]. E-mail:; Siegel, Barry A. [Division of Nuclear Medicine, Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States)] (and others)



Dynamic Interface Rupture in Extremely Heterogeneous Media  

NASA Astrophysics Data System (ADS)

Fracture experiments of monolithic brittle materials usually show the maximum speed of smooth rupture at some 30 % of the relevant shear wave speed. This experimental maximum rupture speed is by far lower than those predicted by theories and inferred from inversions of seismograms, and some seismic inversions (e.g., the 1979 Imperial Valley, 1992 Landers, 1999 Izmit, 2001 the central Kunlunshan and 2002 Denali earthquakes) even suggest the existence of supershear rupture speeds (i.e., rupture propagating faster than the relevant shear wave). Recently, Uenishi et al. ( SSJ Fall Meeting, 2004, 2005; AGU Fall Meeting, 2006) experimentally investigated dynamic fracture in monolithic hyperelastic materials under static mode-§ loading conditions with relatively high crack-parallel stresses. Using a high-speed digital video camera system, they showed that cracks may propagate supersonically even in homogeneous materials. However, the exact mechanism for rupture nucleation and the transition of a nucleated rupture from sub-Rayleigh to super-shear rupture speed has not been identified yet. In this contribution, we further develop our experimental system and investigate dynamic fracture in extremely heterogeneous media, consisting of thin fluid and solid films: Inside a wire frame (50mm high, 50mm wide), a flat soap film contacts a flat thin solid plastic film (20mm high, 20mm wide), under static tensile loading conditions. The rupture (crack), initiated at a point, propagates subsonically in the linear elastic fluid film (see e.g., Uenishi et al., SSJ Fall Meeting, 2006, for the dynamic rupture in monolithic fluid films). When the circular rupture front reaches the interface, the rupture advances along the interface and then it is "diffracted" at the two corners of the interface. We record the rupture propagation process utilizing our high-speed digital video camera at a frame rate of 20 ?s (20×10-6s). The observed results show that interface rupture propagation may accelerate (or even decelerate) and the dynamic rupture behavior is very sensitive to the geometry of the interface between the two films: (1) When the subsonic rupture front reaches the first rectangular corner, it accelerates around the corner and then advances supersonically along the interface; and (2) when the supersonic interface rupture front approaches the second corner (obtuse with respect to the rupture front in fluid), it bifurcates for a short period (400 ?s): the first branch unexpectedly expands rather straight into the bulk and the second one propagates along the interface at a lower speed; At a later stage, again unexpectedly, the first branched crack decelerates significantly in the bulk and the two cracks eventually merge into a single crack. The overall behavior is - in some sense - similar to that of the oblique shock and Prandtl- Meyer expansion waves in fluid mechanics, and it might give new insights not only into the question of high rupture speeds of natural earthquakes but also into the generation mechanism of tsunamis.

Uenishi, K.; Tsuji, K.



Assessments of Anal Canal Sensitivity in Patients with Soiling 5 Years or More after Colectomy, Mucosal Proctectomy, and Ileal J Pouch-Anal Anastomosis for Ulcerative Colitis  

Microsoft Academic Search

Introduction  To clarify the significance of anal canal sensitivity contribution to soiling in patients after ileal J pouch-anal anastomosis\\u000a (IPAA) for ulcerative colitis (UC), we studied the sensory function of the anal canal.\\u000a \\u000a \\u000a \\u000a Methods  Forty patients with UC who had undergone IPAA with ileostomy closure at least 60 to 132 months (mean 103.6 months) previously,\\u000a and who had no preoperative or postoperative

Ryouichi Tomita; Seigo Igarashi



Age at intracranial aneurysm rupture among generations  

PubMed Central

Background: Previous studies have reported intracranial aneurysm (IA) occurring at young ages in subsequent generations. These studies did not correct for duration of follow-up. Second-generation members who would have their ruptured IA late in life may not be detected due to shorter follow-up time than the first generation. We examined families in which ruptured IA occurred in two consecutive generations for the hypothesis that the second generation (F1) was more likely to have a rupture at a younger age than the older generation (F0). Methods: The Familial Intracranial Aneurysm (FIA) Study is a multicenter, international study recruiting families of ruptured and unruptured IA. All available family members are interviewed. Cox proportional hazards regression models and Kaplan-Meier curves were used to examine differences by generation. Results: Although we found that the F1 generation was more likely to have an aneurysm rupture at a younger age than the F0 generation, we found that this was largely because of a lack of follow-up time in the F1 generation. The F1 generation had 50% the rupture rate of the prior generation. When analyzed by Kaplan-Meier curves, we found a tendency to have a slightly later rupture rate in the F1 generation once time to follow-up was included in the analysis model. Conclusions: Families of ruptured intracranial aneurysm (IA) do not appear to demonstrate “anticipation.” Our finding suggests that genetic epidemiology of ruptured IA should examine all types of variations such as single base-pair changes, deletions, insertions, and other variations that do not demonstrate anticipation. GLOSSARY FIA = familial intracranial aneurysm; IA = intracranial aneurysm; SAH = subarachnoid hemorrhage. PMID:19237697

Woo, D; Hornung, R; Sauerbeck, L; Brown, R; Meissner, I; Huston, J; Foroud, T; Broderick, J



Brachytherapy and Local Excision for Sphincter Preservation in T1 and T2 Rectal Cancer  

SciTech Connect

Purpose: To report long-term results of brachytherapy after local excision (LE) in the treatment of T1 and T2 rectal cancer at risk of recurrence due to residual subclinical disease. Methods and Materials: Between 1989 and 2007, 32 patients undergoing LE and brachytherapy were followed prospectively for a mean of 6.2 years. Estimates of local recurrence (LR), disease-specific survival (DSS), and overall survival (OS) were generated. Treatment-related toxicity and the effect of known prognostic factors were determined. Results: There were 8 LR (3 T1, 5 T2), of which 5 were salvaged surgically. Median time to the 8 LR was 14 months, and the 5-year rate of local control was 76%. Although there have been 9 deaths to date, only 5 were from disease. Five-year DSS and OS rates were 85% and 78%, respectively. There were 4 cases of Grade 2-3 radionecrosis and 1 case of mild stool incontinence. The sphincter was preserved in 27 of 32 patients. Conclusion: Local excision and adjuvant brachytherapy for T1 and T2 rectal cancer is an appealing treatment alternative to immediate radical resection, particularly in the frail and elderly who are unable to undergo major surgery, as well as for patients wanting to avoid a permanent colostomy.

Grimard, Laval [Division of Radiation Oncology, Ottawa Hospital, University of Ottawa, Ottawa, Ontario (Canada)], E-mail:; Stern, Hartley [Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ontario (Canada); Spaans, Johanna N. M.Sc. [Division of Radiation Oncology, Ottawa Hospital, University of Ottawa, Ottawa, Ontario (Canada)



Management of traumatic aortic rupture.  


A traumatic thoracic aortic injury is a severe and life-threatening clinical entity. Although largely fatal; if untreated, these injuries are amenable to surgical repair if appropriately diagnosed. Therefore, early triage of this condition is critically important. Unfortunately, aortic injuries rarely occur in isolation, and there has been no good cutoff value to help select the appropriate surgical strategy. Algorithms for the both diagnosis and treatment of traumatic thoracic aortic injury have undergone changes in recent years. There have been several case reports, retrospective series and registry data describing the treatment of patients with traumatic thoracic aortic rupture using endovascular treatment. Endovascular treatment is a less-invasive management option for polytraumatized patients. Because it is less invasive, without the need for thoracotomy or the use of heparin, endovascular repair can be performed even in acutely injured patients, without the risk of destabilizing pulmonary, head or abdominal traumatic lesions. Long-term follow-up especially in young patients is necessary after endovascular treatment. PMID:23338596

Watanabe, Ken-ichi; Fukuda, Ikuo; Asari, Yasushi



Rupture of lenticulostriate artery aneurysms.  


The authors report on 3 rare cases of ruptured lenticulostriate artery (LSA) aneurysms that were heralded by deep cerebral hematomas. The hematomas were unilateral in 2 cases and bilateral in 1; in the bilateral case, only a single LSA aneurysm could be identified on the right side of the brain. Because of their small size (? 2 mm), fusiform aspect, and deep location within the brain, all of the aneurysms were treated conservatively. There was no hemorrhage recurrence, and follow-up angiography demonstrated spontaneous thrombosis in 2 of the 3 cases. The clinical course was favorable in 2 of the 3 patients. The course in the patient with the bilateral hematoma was marked by an ischemic event after the initial episode, resulting in an aggravation of deficits. The cause of this second event was uncertain. Because our knowledge about the natural history of LSA aneurysms is incomplete, there is no consensus concerning a therapeutic strategy. The authors' experience in 3 reported cases leads them to think that a conservative approach involving close angiographic monitoring may be proposed as first-line treatment. If the monitored aneurysm then persists or grows in size, its occlusion should be considered. Nonetheless, other studies are needed to further strengthen the legitimacy of this strategy. PMID:24053505

Heck, Olivier; Anxionnat, René; Lacour, Jean-Christophe; Derelle, Anne-Laure; Ducrocq, Xavier; Richard, Sébastien; Bracard, Serge



Surgical treatment of distal biceps rupture.  


Rupture of the distal biceps tendon accounts for 10% of all biceps brachii ruptures. Injuries typically occur in the dominant elbow of men aged 40 to 49 years during eccentric contraction of the biceps. Degenerative changes, decreased vascularity, and tendon impingement may precede rupture. Although nonsurgical management is an option, healthy, active persons with distal biceps tendon ruptures benefit from early surgical repair, gaining improved strength in forearm supination and, to a lesser degree, elbow flexion. Biomechanical studies have tested the strength and displacement of various repairs; the suspensory cortical button technique exhibits maximum peak load to failure in vitro, and suture anchor and interosseous screw techniques yield the least displacement. Surgical complications include sensory and motor neurapraxia, infection, and heterotopic ossification. Current trends in postoperative rehabilitation include an early return to motion and to activities of daily living. PMID:20190104

Sutton, Karen M; Dodds, Seth D; Ahmad, Christopher S; Sethi, Paul M



Ruptured uterus: an ongoing tragedy of motherhood.  


This study aimed to determine the frequency of ruptured uterus, possible aetiologic factors, foetomaternal out come and changes in obstetric care proposed to reduce this catastrophy. From September 1994 to September 1999 in Dhaka Medical College Hospital 39,782 deliveries occurred. All delivery records were reviewed and rupture uterus cases were identified. The result was compared with studies carried out in home and abroad. During the five years period among 39,782 deliveries 424 cases were of rupture uterus with a frequency of 1/93 deliveries. Eighty three percent rupture occurred in intact uterus and 17% occurred in uteri scarred by caesarian section. Common contributing factors were -prolonged/obstructed labour, grand multiparity, injudicious use of uterine stimulants, mismanaged labour by traditional birth attendant, delayed referral to well equipped centre, poor communication, poverty and ignorance. PMID:11942487

Khanam, R A; Khatun, M



Supershear Rupture Propagation in Homogeneous, Monolithic Media: Experimental Observations  

Microsoft Academic Search

The rupture speeds obtained by fracture experiments of monolithic brittle materials are usually by far lower than those predicted by theories and inferred from inversions of seismograms: Some seismic inversions even suggest the existence of supershear rupture speeds (i.e., rupture propagating faster than the relevant shear wave). Exceptionally, a few laboratory experiments of dynamic rupture on pre-cut interfaces do indicate

K. Uenishi



Describing Soils: Calibration Tool for Teaching Soil Rupture Resistance  

ERIC Educational Resources Information Center

Rupture resistance is a measure of the strength of a soil to withstand an applied stress or resist deformation. In soil survey, during routine soil descriptions, rupture resistance is described for each horizon or layer in the soil profile. The lower portion of the rupture resistance classes are assigned based on rupture between thumb and…

Seybold, C. A.; Harms, D. S.; Grossman, R. B.



Spontaneous rupture of tubal leiomyoma causing haemoperitoneum.  


Leiomyomas are benign tumours that usually originate from the genital tract organs, particularly from the uterus. Spontaneous rupture of leiomyomas is a relatively rare condition. Herein, we report a 70 years old lady who was admitted through the emergency room with sudden abdominal pain. A ruptured mass originating from the fallopian tube, causing haemoperitoneum was revealed at laparotomy. Pathological examination revealed cellular leiomyoma. PMID:24906284

Ozkan, Zeynep; Gonen, Ayse Nur; Emir, Seyfi; Yazar, Fatih Mehmet; Gul, Evrim; Artas, Zeynep Dogan; Aslan, Ozgen; Artas, Hakan



Successful management of postinfarction ventricular septal rupture  

PubMed Central

Ventricular septal rupture is a rare but devastating complication of acute myocardial infarction. Especially in patients with cardiogenic shock, right ventricular dysfunction or an inferior infarct mortality is very high. We present a case in which an 83-year-old patient survived rupture of the ventricular septum complicating an inferior myocardial infarction. Unlike most patients his haemodynamic status did not deteriorate and delayed elective surgical repair was carried out successfully. ImagesFigure 1Figure 2

Swinkels, B.M.; Peters, R.H.J.; van den Brink, A.



Cost-effectiveness of screening for anal squamous intraepithelial lesions and anal cancer in human immunodeficiency virus–negative homosexual and bisexual men  

Microsoft Academic Search

PURPOSE: Homosexual and bisexual men are at an increased risk for human papillomavirus–induced squamous intraepithelial lesions and cancer of the anus. Our objective was to estimate the cost-effectiveness of screening for anal squamous intraepithelial lesions in these high-risk patients.SUBJECTS AND METHODS: A Markov model was developed to evaluate alternative screening strategies using anal cytology in a hypothetical cohort of homosexual

Sue J Goldie; Karen M Kuntz; Milton C Weinstein; Kenneth A Freedberg; Joel M Palefsky



Resisting the "Condom Every Time for Anal Sex" Health Education Message  

ERIC Educational Resources Information Center

Objective: Ensuring men who have sex with men (MSM) adopt and maintain condom use for anal sex is a challenging health education goal. In order to inform the development of social marketing practices to encourage safe-sex practices, the views of MSM about a key HIV health education message ("using a condom every time for anal sex") were sought.…

Adams, Jeffery; Neville, Stephen



Surgical treatment of locally advanced anal cancer after male-to-female sex reassignment surgery  

Microsoft Academic Search

We present a case of a transsexual patient who under- went a partial pelvectomy and genital reconstruction for anal cancer after chemoradiation. This is the first case in literature reporting on the occurrence of anal cancer after male-to-female sex reassignment surgery. We describe the surgical approach presenting our technique to avoid postoperative complications and preserve the sexual reassignment.

Marco Caricato; Fabio Ausania; Giovanni Francesco Marangi; Ilaria Cipollone; Gerardo Flammia; Paolo Persichetti; Lucio Trodella; Roberto Coppola



Adenocarcinoma arising from an anal gland--Report of a case  

PubMed Central

INTRODUCTION Adenocarcinoma arising from an anal gland is extremely rare. Most anal canal cancers are squamous cell carcinoma, and adenocarcinoma is infrequently diagnosed. Diagnostic criteria and the standard treatment for adenocarcinoma of the anal canal have not been clearly defined, in part because of the rarity of this lesion. PRESENTATION OF CASE An 84-year-old man who presented with a piece of tissue prolapsing from the anus. An incisional biopsy showed adenocarcinoma, and an abdomino-perineal resection was then performed. Cytokeratin 7 (CK7), cytokeratin 19 (CK19) stained positive in the specimen, suggesting that the tumor developed from an anal gland. The patient was discharged after surgery without any complications. DISCUSSION Exact diagnostic criteria for adenocarcinoma of the anal canal have not been previously described. In the present case, CK7 and CK19 were stained, and the tumor showed positivity for both of these markers, which is compatible with the staining patterns of anal gland origin cancer. Radical resection is recommended rather than local resection, because of the tumor's high recurrence rate. Some authors recommend combined modality treatment with preoperative or postoperative chemoradiotherapy because of the high rate of distant recurrence. CONCLUSION The preoperative diagnosis of adenocarcinoma arising from an anal gland is not easily established. However, it may be possible to suspect an anal glandular adenocarcinoma based on a meticulous physical examination, appropriate diagnostic studies and pathological findings on biopsy. PMID:24705191

Sakamoto, Takashi; Konishi, Fumio; Yoshida, Takayoshi; Yoshinaga, Yasuo; Izumo, Toshiyuki; Lefor, Alan



218 C. DAOLIO ET AL. Copyright 2007 John Wiley & Sons, Ltd. Phytochem. Anal. 19: 218228 (2008)  

E-print Network

218 C. DAOLIO ET AL. Copyright © 2007 John Wiley & Sons, Ltd. Phytochem. Anal. 19: 218­228 (2008) DOI: 10.1002.pca Phytochemical Analysis Phytochem. Anal. 19: 218­228 (2008) Published online 21 John Wiley & Sons, Ltd. Keywords: NMR; HPLC; 1 H-HR-MAS; PCA; HCA; Catuaba. Phytochemical Analysis

Ferreira, Márcia M. C.


Fibrin Glue-Antibiotic Mixture in the Treatment of Anal Fistulae: Experience with 69 Cases  

Microsoft Academic Search

Background\\/Aims: To investigate the potential value of the use of the fibrin glue-antibiotic mixture in the treatment of anal fistulae. Materials and Methods: This study included 69 patients with idiopathic nonspecific anal fistulae. Patients with IBD (inflammatory bowel disease), TBC, actinomycosis, and cancer were excluded from the study. The microbiological analysis of the discharge of the fistula was done routinely.

Leonardo Patrlj; Branislav Kocman; Miran Martinac; Tomislav Šoša



Do not have any sex (oral, vaginal, anal or using sex  

E-print Network

Do not have any sex (oral, vaginal, anal or using sex toys) with a partner until their treatment sex (oral, vaginal, anal or using sex toys) with a partner until their treatment has also been antibiotics can stop the contraceptive pill or patch from working. · If you are under 25 and have ever had sex

Talbot, James P.


Sexual coercion and sexual desire: Ambivalent meanings of heterosexual anal sex in Soweto, South Africa  

Microsoft Academic Search

Anal sex within heterosexual relationships is usually underreported or not reported at all, yet is increasingly recognised as a potential mode of HIV transmission. Understanding the circumstances of anal sex is critical for trials that seek to assess the efficacy of microbicides. This article draws on qualitative data collected during a feasibility study for a clinical trial of microbicides in

J. J. Stadler; S. Delany; M. Mntambo



Benign fibrous histiocytoma presenting as anal canal polyp: first case report.  


Nonepithelial and nonmelanocytic anal neoplasms are uncommon. The majority are mesenchymal tumors, most of which are malignant sarcomas, particularly leiomyosarcomas and gastrointestinal stromal tumors. Benign mesenchymal anal neoplasms are even rarer. The most common reported cases were anal leiomyomas, granular cell tumors, fibroadenomas, and xanthogranulomas. Benign fibrous histiocytomas (BFHs) or dermatofibromas are common mesenchymal cutaneous tumors that occur in different sites and at any age. Review of the literature did not show previous reports of BFH arising in the anal canal region. We report the first case of a solitary BFH, an unexpected occurrence of a common tumor type presenting as a polyp in an unusual site such as the anus. This rare occurrence can present diagnostic challenges for the surgeons and pathologists. Clinically, it can be confused with the usual anal tags, fibroepithelial polyps, or hemorrhoids. Benign fibrous histiocytoma is a neoplasm with a potential of local recurrence and, therefore, carries certain clinical implications for the patients' management and follow-up when compared with the common nonneoplastic causes of anal polyps such as the anal tags of anal fissures, hemorrhoids, or fibroepithelial papilla. Histologically, it should be differentiated from other histiocytic lesions. This can be resolved by the application of certain histologic features with the appropriate immunohistochemical markers taken within the correct clinical context. PMID:22999485

AbdullGaffar, Badr; Abdulrahim, Manal; Ghazi, Esaaf



Bacterial contents of the anal and castor glands of beaver ( Castor canadensis )  

Microsoft Academic Search

Bacterial contents of both the anal gland and castor gland of the beaver (Castor canadensis) were determined. Using our culture methods, no bacteria were isolated from the castor glands, but the anal gland contained high numbers of the aerobeEscherichia coli and the anaerobeBacteroides fragilis. The latter may be represented by several variants but facilities were not available for advanced anaerobic

Gerald E. Svendsen; Joseph D. Jollick



Outcome analysis of HIV-positive patients with anal squamous cell carcinoma  

Microsoft Academic Search

PURPOSE: With improved antiretroviral therapy, HIV-positive patients are achieving a longer life expectancy. An increased incidence of anal squamous cell carcinomas has been noted in these patients. The purpose of this study was to determine the outcome of HIV-positive patients with anal squamous cell carcinomas. METHODS: We conducted a review based on our tumor registry from 1980 through 1999. We

Sharon G. Gregorcyk; Philip J. Huber; Clifford L. Simmang



A case of severe anal injury in an adolescent male due to bestial sexual experimentation  

Microsoft Academic Search

This report delineates a case of anal injury in a 12-year-old boy who gave a detailed history of bestial behavior with a male bulldog. The child described how he had seen this behavior modeled on the internet and subsequently initiated contact with his own dog, causing the dog to penetrate him anally. This type of juvenile bestial behavior with injury

Roger O. Blevins



Early results of a rotational flap to treat chronic anal fissures  

Microsoft Academic Search

Background: Treatment of anal fissures has changed dramatically in the past decade. Only a few fail to respond to medical therapy. Sphinc- terotomy and anal dilatation have fallen out of favour due to the risk of incontinence. Island flaps have been proposed to address this, but 60-70% of flap donor sites break down with complications. We proposed that using a

Meheshinder Singh; Abhiram Sharma; Angela Gardiner; Graeme S. Duthie



Quality of life and tumor control after short split-course chemoradiation for anal canal carcinoma  

Microsoft Academic Search

PURPOSE: To evaluate quality of life (QOL) and outcome of patients with anal carcinoma treated with short split-course chemoradiation (CRT). METHODS: From 1991 to 2005, 58 patients with anal cancer were curatively treated with CRT. External beam radiotherapy (52 Gy\\/26 fractions) with elective groin irradiation (24 Gy) was applied in 2 series divided by a median gap of 12 days.

Sawyna Provencher; Christoph Oehler; Sophie Lavertu; Marjory Jolicoeur; Bernard Fortin; David Donath



Impact of the HIV Epidemic on the Incidence Rates of Anal Cancer in the United States  

PubMed Central

Background The risk of anal cancer is substantially increased in HIV-infected individuals. Thus, the HIV epidemic may have influenced the increasing anal cancer trends in the United States. We estimated the impact of the HIV epidemic on trends in anal cancer incidence in the United States during 1980–2005. Methods Data on anal cancer cases with and without AIDS were obtained from the HIV/AIDS Cancer Match Study. The number of HIV-infected anal cancer cases without AIDS was estimated from the number of anal cancers occurring before diagnosis of AIDS. The proportion of anal cancer cases with HIV infection in the general population was calculated. We estimated temporal trends in the incidence rates of anal cancer in the general population overall and after exclusion of HIV-infected cancer cases by calculating annual percent changes and 95% confidence intervals (CIs) using a Joinpoint log-linear model. All incidence rates were standardized to the 2000 US population by age, sex, and race. Results During 1980–2005, of the 20 533 estimated anal cancer cases, 1665 (8.1%) were HIV-infected. During 2001–2005, the proportion of anal cancer cases with HIV infection was the highest—1.2% (95% CI = 0.93 to 1.4%) among females and 28.4% (95% CI = 26.6 to 29.4%) among males. During 1980–2005, HIV infection did not have an impact on the trends in anal cancer among females (incidence rates increased by 3.3% [95% CI = 3.0 to 3.7%] annually overall, and by 3.3% [95% CI = 2.9 to 3.6%] annually without HIV-infected anal cancer cases) but had a strong impact on the trends in anal cancer among males (incidence rates increased by 3.4% [95% CI = 2.9 to 3.9%] annually overall, and by 1.7% [95% CI = 1.2 to 2.3%] annually without HIV infection). Conclusion During 1980–2005, the increasing anal cancer incidence rates in the United States were strongly influenced by the HIV epidemic in males but were independent of HIV infection in females. PMID:23042932



External urethral sphincter motoneuron properties in adult female rats studied in vitro.  


The external urethral sphincter (EUS) muscle plays a crucial role in lower urinary tract function: its activation helps maintain continence, whereas its relaxation contributes to micturition. To determine how the intrinsic properties of its motoneurons contribute to its physiological function, we have obtained intracellular current-clamp recordings from 49 EUS motoneurons in acutely isolated spinal cord slices from adult female rats. In all, 45% of EUS motoneurons fired spontaneously and steadily (average rate = 12-27 pulses/s). EUS motoneurons were highly excitable, having lower rheobase, higher input resistance, and smaller threshold depolarization than those of rat hindlimb motoneurons recorded in vitro. Correlations between these properties and afterhyperpolarization half-decay time are consistent with EUS motoneurons having characteristics of both fast and slow motor unit types. EUS motoneurons with a slow-like spectrum of properties exhibited spontaneous firing more often than those with fast-like characteristics. During triangular current ramp-induced repetitive firing, recruitment typically occurred at lower current levels than those at derecruitment, although the opposite pattern occurred in 10% of EUS motoneurons. This percentage was likely underestimated due to firing rate adaptation. These findings are consistent with the presence of a basal level of persistent inward current (PIC) in at least some EUS motoneurons. The low EUS motoneuron current and voltage thresholds make them readily recruitable, rendering them well suited to their physiological role in continence. The expression of firing behaviors consistent with PIC activation in this highly reduced preparation raises the possibility that in the intact animal, PICs contribute to urinary function not only through neuromodulator-dependent but also through neuromodulator-independent mechanisms. PMID:20573976

Carp, Jonathan S; Tennissen, Ann M; Liebschutz, Jennifer E; Chen, Xiang Yang; Wolpaw, Jonathan R



External Urethral Sphincter Motoneuron Properties in Adult Female Rats Studied In Vitro  

PubMed Central

The external urethral sphincter (EUS) muscle plays a crucial role in lower urinary tract function: its activation helps maintain continence, whereas its relaxation contributes to micturition. To determine how the intrinsic properties of its motoneurons contribute to its physiological function, we have obtained intracellular current-clamp recordings from 49 EUS motoneurons in acutely isolated spinal cord slices from adult female rats. In all, 45% of EUS motoneurons fired spontaneously and steadily (average rate = 12–27 pulses/s). EUS motoneurons were highly excitable, having lower rheobase, higher input resistance, and smaller threshold depolarization than those of rat hindlimb motoneurons recorded in vitro. Correlations between these properties and afterhyperpolarization half-decay time are consistent with EUS motoneurons having characteristics of both fast and slow motor unit types. EUS motoneurons with a slow-like spectrum of properties exhibited spontaneous firing more often than those with fast-like characteristics. During triangular current ramp-induced repetitive firing, recruitment typically occurred at lower current levels than those at derecruitment, although the opposite pattern occurred in 10% of EUS motoneurons. This percentage was likely underestimated due to firing rate adaptation. These findings are consistent with the presence of a basal level of persistent inward current (PIC) in at least some EUS motoneurons. The low EUS motoneuron current and voltage thresholds make them readily recruitable, rendering them well suited to their physiological role in continence. The expression of firing behaviors consistent with PIC activation in this highly reduced preparation raises the possibility that in the intact animal, PICs contribute to urinary function not only through neuromodulator-dependent but also through neuromodulator-independent mechanisms. PMID:20573976

Tennissen, Ann M.; Liebschutz, Jennifer E.; Chen, Xiang Yang; Wolpaw, Jonathan R.



Roles of sphincter of Oddi motility and serum vasoactive intestinal peptide, gastrin and cholecystokinin octapeptide  

PubMed Central

AIM: To investigate roles of sphincter of Oddi (SO) motility played in pigment gallbladder stone formation in model of guinea pigs. METHODS: Thirty-four adult male Hartley guinea pigs were divided randomly into two groups: the control group and pigment stone group. The pigment stone group was divided into 4 subgroups with 6 guinea pigs each according to time of sacrifice, and were fed a pigment lithogenic diet and sacrificed after 3, 6, 9 and 12 wk. SO manometry and recording of myoelectric activity of the guinea pigs were obtained by multifunctional physiograph at each stage. Serum vasoactive intestinal peptide (VIP), gastrin and cholecystokinin octapeptide (CCK-8) were detected at each stage in the process of pigment gallbladder stone formation by enzyme-linked immunosorbent assay. RESULTS: The incidence of pigment gallstone formation was 0%, 0%, 16.7% and 66.7% in the 3-, 6-, 9- and 12-wk group, respectively. The frequency of myoelectric activity decreased in the 3-wk group. The amplitude of myoelectric activity had a tendency to decrease but not significantly. The frequency of the SO decreased significantly in the 9-wk group. The SO basal pressure and common bile duct pressure increased in the 12-wk group (25.19 ± 7.77 mmHg vs 40.56 ± 11.81 mmHg, 22.35 ± 7.60 mmHg vs 38.51 ± 11.57 mmHg, P < 0.05). Serum VIP was significantly elevated in the 6- and 12-wk groups and serum CCK-8 was decreased significantly in the 12-wk group. CONCLUSION: Pigment gallstone-causing diet may induce SO dysfunction. The tension of the SO increased. The disturbance in SO motility may play a role in pigment gallstone formation, and changes in serum VIP and CCK-8 may be important causes of SO dysfunction. PMID:24782626

Zhang, Zhen-Hai; Qin, Cheng-Kun; Wu, Shuo-Dong; Xu, Jian; Cui, Xian-Ping; Wang, Zhi-Yi; Xian, Guo-Zhe



Esophageal wall blood perfusion during contraction and transient lower esophageal sphincter relaxation in humans  

PubMed Central

We recently reported that esophageal contraction reduces esophageal wall perfusion in an animal study. Our aim was to determine esophageal wall blood perfusion (EWBP) during esophageal contraction and transient lower esophageal sphincter relaxations (TLESRs) in humans. We studied 12 healthy volunteers. A custom-designed laser Doppler probe was anchored to the esophageal wall, 4–6 cm above the LES, by use of the Bravo pH system so that the laser light beam stay directed toward the esophageal mucosa. A high-resolution manometry equipped with impedance electrodes recorded esophageal pressures and reflux events. Synchronized pressure, impedance, pH, and EWBP recordings were obtained during dry and wet swallows and following a meal. Stable recordings of laser Doppler EWBP were only recorded when the laser Doppler probe was firmly anchored to the esophageal wall. Esophageal contractions induced by dry and wet swallows resulted in 46 ± 9% and 60 ± 10% reduction in the EWBP, respectively (compared to baseline). Reduction in EWBP was directly related to the amplitude (curvilinear fit) and duration of esophageal contraction. Atropine reduced the esophageal contraction amplitude and decreased the EWBP reduction associated with esophageal contraction. TLESRs were also associated with reduction in the EWBP, albeit of smaller amplitude (29 ± 3%) but longer duration (19 ± 2 s) compared with swallow-induced esophageal contractions. We report 1) an innovative technique to record EWBP for extended time periods in humans and 2) contraction of circular and longitudinal muscle during peristalsis and selective longitudinal muscle contraction during TLESR causes reduction in the EWBP; 3) using our innovative technique, future studies may determine whether esophageal wall ischemia is the cause of esophageal pain/heartburn. PMID:22790599

Jiang, Yanfen; Bhargava, Valmik; Kim, Young Sun



Long-term recording of external urethral sphincter EMG activity in unanesthetized, unrestrained rats.  


The external urethral sphincter muscle (EUS) plays an important role in urinary function and often contributes to urinary dysfunction. EUS study would benefit from methodology for longitudinal recording of electromyographic activity (EMG) in unanesthetized animals, but this muscle is a poor substrate for chronic intramuscular electrodes, and thus the required methodology has not been available. We describe a method for long-term recording of EUS EMG by implantation of fine wires adjacent to the EUS that are secured to the pubic bone. Wires pass subcutaneously to a skull-mounted plug and connect to the recording apparatus by a flexible cable attached to a commutator. A force transducer-mounted cup under a metabolic cage collected urine, allowing recording of EUS EMG and voided urine weight without anesthesia or restraint. Implant durability permitted EUS EMG recording during repeated (up to 3 times weekly) 24-h sessions for more than 8 wk. EMG and voiding properties were stable over weeks 2-8. The degree of EUS phasic activity (bursting) during voiding was highly variable, with an average of 25% of voids not exhibiting bursting. Electrode implantation adjacent to the EUS yielded stable EMG recordings over extended periods and eliminated the confounding effects of anesthesia, physical restraint, and the potential for dislodgment of the chronically implanted intramuscular electrodes. These results show that micturition in unanesthetized, unrestrained rats is usually, but not always, associated with EUS bursting. This methodology is applicable to studying EUS behavior during progression of gradually evolving disease and injury models and in response to therapeutic interventions. PMID:24990895

LaPallo, Brandon K; Wolpaw, Jonathan R; Chen, Xiang Yang; Carp, Jonathan S



Botulinum Toxin Injection for the Treatment of Upper Esophageal Sphincter Dysfunction  

PubMed Central

Objectives We sought to review the dysphagia-related outcomes and quality of life in a series of patients with upper esophageal sphincter (UES) dysfunction treated with cricopharyngeal (CP) botulinum toxin (BTX) injection, and to identify patient characteristics or CP muscle histologic features that predict efficacy of BTX injection. Methods A retrospective chart review was performed on patients with UES dysfunction who underwent CP BTX injection. Dysphagia-related quality-of-life questionnaires based on the Eating Assessment Tool (EAT-10) were mailed to patients. Results Forty-nine patients (30 female, 19 male; average age, 59 ± 16 years) with UES dysfunction have been treated at our institution with CP BTX injection since 2000. Seventeen of these patients also underwent CP myotomy. Injections of BTX were occasionally repeated after the treatment effect subsided, and the BTX dose varied widely (average, 39 ± 19 units). Improvement in symptoms was noted by 65% of patients. The overall complication rate was minimal, although many patients complained of transient worsening of dysphagia after CP BTX injection. Biopsy specimens of the CP muscle were evaluated in the subset of patients with CP BTX injection who proceeded to myotomy, with results of neuropathic, myopathic, and mixed histologic subtypes. The EAT-10 scores demonstrated a general trend toward improved swallowing outcomes after CP BTX injection. Conclusions This study reviewed findings from the largest published series of BTX treatment of UES dysfunction and evaluated the efficacy, patient satisfaction, and complications of this procedure. Dysphagia-related quality-of-life outcomes appear to be improved after CP BTX injection. PMID:23534124

Kelly, Elizabeth A.; Koszewski, Ian J.; Jaradeh, Safwan S.; Merati, Albert L.; Blumin, Joel H.; Bock, Jonathan M.



Castanea sativa Mill. extract contracts gallbladder and relaxes sphincter of Oddi in guinea pig: a natural approach to biliary tract motility disorders.  


Impaired gallbladder motility is a contributing factor to gallstone formation. Since many drugs delaying intestinal motility inhibit gallbladder emptying, the aim of the present study was to evaluate the effect on gallbladder and sphincter of Oddi motility of a Natural Chestnut Wood Extract (NEC) that reduces intestinal motility. In order to evaluate the effect of the extract in normal- and high-risk gallstone conditions, the investigation was performed using tissues from animals fed normal and lithogenic diet. Fifty guinea pigs were administered either control or lithogenic diet. The spontaneous motility of the gallbladder and sphincter of Oddi were recorded on isolated gallbladder tissues; thereafter, the effect of NEC on motility was tested and compared with carbachol (CCh), potassium chloride (KCl), noradrenaline (NA), and A71623. Compared to controls, the lithogenic diet induced an irregular and disordered motor pattern in both the gallbladder and sphincter of Oddi. NEC increased gallbladder and decreased sphincter of Oddi spontaneous motility independently of cholinergic, adrenergic, and CCK-1 receptor-mediated pathways both in controls and in lithogenic diet-fed animals, although the effect was lower in the latter group. The effect was reversible and mediated by calcium channels. The natural extract of chestnut increasing gallbladder contraction and inducing the relaxation of the sphincter of Oddi can be of benefit in pathological conditions associated with increased transit time at risk of gallstones. PMID:24654975

Micucci, Matteo; Ioan, Pierfranco; Aldini, Rita; Cevenini, Monica; Alvisi, Vittorio; Ruffilli, Corrado; Chiarini, Alberto; Budriesi, Roberta



Blood Chemical Abnormalities in Cattle with Ruptured Bladders and Ruptured Urethras  

PubMed Central

A study was undertaken to determine the blood chemical variables and compare changes that occurred with ruptured bladders and ruptured urethras in steers and yearling bulls. The fatality rates were 10.5% in steers with ruptured urethras and 50.8% in steers with ruptured bladders. Both groups had significantly decreased serum sodium and chloride values and significantly increased serum creatinine, blood urea nitrogen, and plasma protein concentrations compared to the normal group. Steers with ruptured bladders were more dehydrated, had significantly lower serum sodium and chloride values and had significantly higher blood urea nitrogen concentrations than steers with ruptured urethras. The combination of a decreased serum sodium, a decreased serum chloride, and a decreased ratio of serum phosphate to blood urea nitrogen occurred consistently within the ruptured bladder group. Of the variables examined, serum phosphate was the best prognostic indicator in the steers with ruptured bladders as all of the steers that died had a serum phosphate in excess of 2.9 mmol/L. The fluid and electrolyte changes are discussed. PMID:17422206

Donecker, J. M.; Bellamy, J. E. C.



Excisional hemorrhoidal surgery and its effect on anal continence  

PubMed Central

AIM: To investigate the role of anal cushions in hemorrhoidectomy and its effect on anal continence of the patients. METHODS: Seventy-six consecutive patients (33 men and 43 women) with a mean age of 44 years were included. They underwent Milligan-Morgan hemorrhoidectomy because of symptomatic third- and fourth-degree hemorrhoids and failure in conservative treatment for years. Wexner score was recorded and liquid continence test was performed for each patient before and two months after operation using the techniques described in our previous work. The speed-constant rectal lavage apparatus was prepared in our laboratory. The device could output a pulsed and speed-constant saline stream with a high pressure, which is capable of overcoming any rectal resistance change. The patients were divided into three groups, group A (< 900 mL), group B (900-1200 mL) and group C (> 1200 mL) according to the results of the preoperative liquid continence test. RESULTS: All the patients completed the study. The average number of hemorrhoidal masses excised was 2.4. Most patients presented with hemorrhoidal symptoms for more than one year, including a mean duration of incontinence of 5.2 years. The most common symptoms before surgery were anal bleeding (n = 55), prolapsed lesion (n = 34), anal pain (n = 12) and constipation (n = 17). There were grade III hemorrhoids in 39 (51.3%) patients, and grade IV in 37 (48.7%) patients according to Goligher classification. Five patients had experienced hemorrhoid surgery at least once. Compared with postoperative results, the retained volume in the preoperative liquid continence test was higher in 40 patients, lower in 27 patients, and similar in the other 9 patients. The overall preoperative retained volume in the liquid continence test was 1130.61 ± 78.35 mL, and postoperative volume was slightly decreased (991.27 ± 42.77 mL), but there was no significant difference (P = 0.057). Difference was significant in the test value before and after hemorrhoidectomy in group A (858.24 ± 32.01 mL vs 574.18 ± 60.28 mL, P = 0.011), but no obvious difference was noted in group B or group C. There was no significant difference in Wexner score before and after operation (1.68 ± 0.13 vs 2.10 ± 0.17, P = 0.064). By further stratified analysis, there was significant difference before and 2 months after operation in group A (2.71 ± 0.30 vs 3.58 ± 0.40, P = 0.003). In contrast, there were no significant differences in group B or group C (1.89 ± 0.15 vs 2.11 ± 0.19, P = 0.179; 0.98 ± 0.11 vs 1.34 ± 0.19, P = 0.123). CONCLUSION: There is no difference in the continence status of patients before and after Milligan-Morgan hemorrhoidectomy. However, patients with preoperative compromised continence may have further deterioration of their continence, hence Milligan-Morgan hemorrhoidectomy should be avoided in such patients. PMID:22912558

Li, Yan-Dong; Xu, Jia-He; Lin, Jian-Jiang; Zhu, Wei-Fang



D-serine modulates non-adrenergic non-cholinergic contraction of lower esophageal sphincter in rats.  


Endogenous D-serine is known to modulate glutamatergic transmission via interaction with the glycine site of N-methyl-D-aspartate (NMDA) receptors. D-serine is synthesized by racemization of L-serine using an enzymatic reaction catalyzed by serine racemase. Although much attention has been focused on the role of D-serine within the central nervous system, the physiological role of D-serine in enteric nervous system has not been investigated. Lower esophageal sphincter (LES) function is known to be modulated by NMDA-dependent mechanisms. The present study was aimed to study the expression of enzymes involved in D-serine metabolism and the function of D-serine in lower esophageal sphincter in rats. Reverse transcription polymerase chain reaction (RT-PCR) and western blotting showed the expression of serine racemase in isolated rat LES. Electrical field stimulation was used to induce non-adrenergic non-cholinergic (NANC) contraction/relaxation of isolated rat LES in an organ bath using an isometric force transducer. The organ bath studies on isolated rat LES showed that incubation with D-serine (100 ?M) is associated with a significant increase in the NANC contraction of isolated LES. This effect of exogenous D-serine was inhibited by NMDA receptor antagonists (MK-801), suggesting that NMDA receptors are involved in the effects of D-serine on NANC contraction of LES. Incubation with D-serine did not show a significant effect on NANC relaxation within our experimental setting. The results of this study suggest that serine racemase is expressed in LES and D-serine modulates contraction of the lower esophageal sphincter in rats. PMID:23022330

Ghasemi-Kasman, Maryam; Dehpour, Ahmad R; Mani, Ali R



Recurrence Characteristics of 'Full Rupture' Earthquakes  

NASA Astrophysics Data System (ADS)

A prime goal in earthquake geology is to identify the recurrence characteristics of full rupture earthquakes (earthquakes that rupture the full down-dip extend of the seismogenic zone and potentially beyond it) along a given fault. Paleoseismology and tectonic geomorphology enable to extend the seismic record by centuries or millennia --for events that are sufficiently large to disrupt the earth surface. Unfortunately, long records are rare and it is generally difficult to make statistically meaningful statements on recurrence characteristics. Furthermore, the paleoseismic and geomorphic records may also contain partial rupture earthquakes (events that may rupture ground surface but do not activate the full seismogenic width) and by that the masking signal of the full rupture events (as I will show in my presentation, those partial rupture events exhibit different recurrence characteristics than the full rupture events). Physics-based earthquake simulators provide the means to study the long-term behavior of a (simulated) fault with respect to the implemented boundary conditions (e.g., fault geometry, loading conditions, frictional behavior). Here, I present a numerical study on earthquake recurrence characteristics as a function of fault geometric roughness (considered a proxy for fault maturity) and by that as a function of fault interaction and connectivity. Focus was on magnitude-frequency distribution and fault segmentation as a function of roughness. I find that bimodality in magnitude frequency relation --the largest earthquakes occurring more frequently than anticipated from the Gutenberg-Richter relation-- is tightly linked to the structural maturity of a fault. Bimodal seismic behavior and maximum earthquake size increases as fault roughness decreases. Furthermore, the variability of large earthquake rupture characteristics of a given fault decreases with structural maturation and major earthquakes along spatially isolated faults exhibit inherent periodicity. While slip at a point along a fault is variable per se, variability becomes increasingly systematic as the fault matures. Based on my results and supported by paleoseismic data, I propose that previously presented earthquake recurrence models (uniform slip-, and characteristic earthquake model) generalize the seismic behavior of faults with different structural age and fault-system complexity and are characterized by alternating single-segment and multi-segment rupture probability.

Zielke, O.



Caring for people with carotid artery rupture.  


In the second of three articles, the authors discuss the care of people with carotid artery rupture. Carotid artery rupture is a potentially fatal condition that requires swift action on the part of the nurse who is present. The size of the rupture and the prognosis for the individual patient determines whether or not active resuscitation is undertaken. The multi-professional team should decide, in advance of an impending rupture, on the optimum plan of care. Calm, careful explanations should be given to patients and relatives and the decision regarding resuscitation should be recorded in the patient's notes. In the event of unforeseen circumstances where a rupture occurs, an active nursing care plan should be instituted and care taken to keep relatives well informed. The patient's airway should be kept clear through the use of suctioning, inflation of tracheostomy tube cuff and correct positioning. Sedative drugs and palliative care may subsequently be necessary. Support and help should be given to all who witness or are involved in the care of these patients. PMID:16415744

Frawley, Theresa; Begley, Cecily M


[Traumatic rupture of the corpus cavernosum].  


Traumatic rupture of the corpus cavernosum is relatively frequent in the authors' experience. Based on the study of a series of 80 cases and a review of the literature, the authors analyse the diagnostic and therapeutic aspects and outcome of this disease. The patients in this series had a mean age of 30 years. Meticulous and intimate clinical interview demonstrated that the commonest mechanism is forced manipulation of the erect penis (68%). Clinical examination localized the site of the fracture (proximal: 57%, distal 43%). The fracture was unilateral (78 cases), rarely bilateral (2 cases) and associated with complete rupture of the urethra (1 case). Treatment was surgical in 79 patients. A distal semicircumferential incision was used in the case of bilateral rupture, distal rupture and associated urethral lesion (34 cases). A favourable course was observed in 86% of cases. However, 9 postoperative complications (12.5%) were observed (6 cases of fibrous plaques, 3 cases of chordee of the penis), due either to the extent of the haematoma or to the delay in treatment. Traumatic rupture of the corpus cavernosum is a disease of young adults, which requires early surgical treatment with an approach adapted to the type of lesions. PMID:9834519

Bennani, S; Dakir, M; Debbagh, A; Hafiani, M; el Moussaoui, A; el Mrini, M; Benjelloun, S



Anal sex, vaginal sex and HIV risk among female sex workers in Papua New Guinea.  


Female sex workers (FSW) are considered one of the key affected populations in Papua New Guinea at risk of acquiring HIV. An integrated bio-behavioral survey of sex workers in Port Moresby was conducted to determine the nature and extent of this risk. About half (51.1 %) of the 411 FSW who reported having any sexual intercourse with clients had engaged in both anal and vaginal intercourse with clients in the last 6 months. In spite of having poorer HIV knowledge (OR95 % CI = 0.14-0.34), FSW who had anal intercourse with clients were significantly more likely to have used a condom at the last vaginal intercourse with a client (OR95 % CI = 1.04-2.87). Similarly, FSW who had anal intercourse with regular and casual partners were significantly more likely to have used a condom at the last vaginal intercourse. Those who engaged in both anal and vaginal intercourse with clients had similar condom use for both vaginal and anal intercourse, with the majority (78.1 %) using a condom at the last occasion for both vaginal and anal intercourse. These FSW may have different risk and protective factors that affect their use of condom during sexual intercourse. Further research is needed to investigate this difference between those who practice anal intercourse and those who do not in order to provide evidence for better programming. PMID:24264727

Kelly-Hanku, Angela; Rawstorne, Patrick; Kupul, Martha; Worth, Heather; Shih, Patti; Man, Wing Young Nicola



Initial prevalence of anal human papilloma virus infection in liver transplant recipients.  


Although liver transplant recipients are at increased risk of human papilloma virus (HPV)-related anal cancer, limited data are available regarding the initial prevalence of anal HPV infection in this population. Anal swabs collected from 50 liver transplant recipients within the first three postoperative weeks were subjected to real-time polymerase chain reaction for detection of the four HPV genotypes: 6, 11, 16, and 18. Predictors of any, low-risk, and high-risk anal HPV infection were evaluated. Overall, the prevalence of any anal HPV infection was 18.0%, with the corresponding rates for high- and low-risk HPV genotypes being 8.0% and 10.0%, respectively. Infection with any type of anal HPV was higher in patients with hepatitis B virus (HBV) infection (P = 0.027), ?3 sexual partners (P = 0.031), and alcoholic liver disease (P = 0.063). HBV infection was the only factor significantly associated with high-risk HPV infection (P = 0.038). Male sex (P = 0.050), age ?52 years (P = 0.016), ?30 sexual partners (P = 0.003), age at first intercourse ?18 years (P = 0.045), and time since first intercourse ?38 years (P = 0.012) were identified as predictors of low-risk HPV infection. These results indicate that HPV vaccination of liver transplant candidates and screening for anal HPV infection in high-risk groups should be considered. PMID:24750339

Gr?t, Micha?; Gr?t, Karolina; Ho?ówko, Wac?aw; Malejczyk, Magdalena; Walter de Walthoffen, Szymon; Lewandowski, Zbigniew; Kobry?, Konrad; Patkowski, Waldemar; Majewski, S?awomir; M?ynarczyk, Gra?yna; Krawczyk, Marek



Component external leakage and rupture frequency estimates  

SciTech Connect

In order to perform detailed internal flooding risk analyses of nuclear power plants, external leakage and rupture frequencies are needed for various types of components - piping, valves, pumps, flanges, and others. However, there appears to be no up-to-date, comprehensive source for such frequency estimates. This report attempts to fill that void. Based on a comprehensive search of Licensee Event Reports (LERs) contained in Nuclear Power Experience (NPE), and estimates of component populations and exposure times, component external leakage and rupture frequencies were generated. The remainder of this report covers the specifies of the NPE search for external leakage and rupture events, analysis of the data, a comparison with frequency estimates from other sources, and a discussion of the results.

Eide, S.A.; Khericha, S.T.; Calley, M.B.; Johnson, D.A.; Marteeny, M.L.



Anterior Cruciate Ligament Rupture and Osteoarthritis Progression  

PubMed Central

Anterior Cruciate Ligament (ACL) rupture is a common sporting injury that frequently affects young, athletic patients. Apart from the functional problems of instability, patients with ACL deficient knees also develop osteoarthritis. Although this is frequently cited as an indication for ACL reconstruction, the relationship between ACL rupture, reconstruction and the instigation and progression of articular cartilage degenerative change is controversial. The purpose of this paper is to review the published literature with regards ACL rupture and the multifactorial causes for osteoarthritis progression, and whether or not this is slowed or stopped by ACL reconstruction. There is no evidence in the published literature to support the view that ACL reconstruction prevents osteoarthritis, although it may prevent further meniscal damage. It must be recognised that this conclusion is based on the current literature which has substantial methodological limitations. PMID:22896777

Wong, James Min-Leong; Khan, Tanvir; Jayadev, Chethan S; Khan, Wasim; Johnstone, David



Acoustic levels of heavy truck tire ruptures.  


Transportation vehicles, whether they are passenger vehicles or heavy trucks and transport vehicles, rely upon rubber tires to negotiate the roadways and surfaces on which they are driven. These tires have the potential of sudden rupture resulting from various causes including but not limited to over-pressurization, sidewall failures, or punctures from roadway debris. These rupture events can and do occur while the vehicles are stationary (e.g., during servicing) or are being driven, and often occur without notice. While the phenomenon of sudden tire failure has been documented for several decades, the potential bodily injury which can occur when an individual is in close proximity to such a sudden rupture has only more recently been documented. Aside from anecdotal mention in case studies, there has been little quantitative information available on the acoustic levels during these failures. Our study provides measured acoustic levels as a function of distance for such catastrophic tire failures. PMID:23622472

Wood, Matthew; Woodruff, William



Ruptured venous aneurysm of cervicomedullary junction  

PubMed Central

Background: Ruptured venous aneurysm is often seen with arterio-venous malformation (AVM) or developmental venous anomaly (DVA). However, isolated venous aneurysm is unusual. Case Description: We present a case of ruptured venous aneurysm that presented with subarachnoid hemorrhage (SAH) and intraventricular hemorrhage (IVH). Digital substraction angiography (DSA) revealed a saccular contrast filling pouch in the left lateral aspect of cervicomedullary junction (CMJ). Endovascular intervention was not a viable option. During surgery, a saccular pliable structure approx. 1.5 × 1 cm was found in the subarachnoid space that was clipped and excised. There were no arterial feeders, no evidence of surrounding AVM, and no dilated perimedullary vein. Conclusion: This is perhaps the first reported case of ruptured venous aneurysm (without associated AVM) of CMJ, which was successfully managed surgically. The possible etiologies remain an unnoticed head trauma or a congenital vessel wall abnormality. Surgically clipping and excision remains the treatment of choice for such lesion. PMID:24575317

Aggarwal, Ashish; Salunke, Pravin; Futane, Sameer; Mathuriya, S. N.; Kumar, Ajay; Mukherjee, K. K.; Radotra, B. D.



The role of botulinum toxin injection and upper esophageal sphincter myotomy in treating oropharyngeal dysphagia.  


The aims of this study were to assess the efficacy and safety of botulinum toxin (BoTox) injection in the cricopharyngeus muscle (CP) and CP myotomy in patients with oropharyngeal dysphagia (OPD) and to identify factors predicting the outcome of these treatments. The study involved patients with persistent OPD despite 2-6 months of rehabilitation, who all underwent clinical evaluation, esophageal manometry, upper gastrointestinal endoscopy, and videofluoroscopy (VFS). Patients received 5-10 BoTox units injections in the CP, identified by electromyography. Surgical myotomy of the upper esophageal sphincter was performed when dysphagia persisted after two BoTox injections. After treatment, patients were reevaluated with clinical interviews and VFS. The study population included 21 patients (15 mean and 6 women; median age, 68 years), classified into three groups, based on the etiology of their OPD: eight (38%) had central nervous system abnormalities, five (24%) had peripheral nerve disease, and eight (38%) were classified as idiopathic. The median time since the onset of dysphagia was 18 months. Thirteen of 21 patients (62%) needed supplemental/total gastrostomy feeding, and 5 of 21 (24%) had tracheostomy. One patient died, on posttreatment day 7, due to massive aspiration. No other BoTox-related complications were observed. After BoTox injection, dysphagia improved in 9 of 21 (43%) patients. Severely altered VFS findings and CP incoordination or low activity predicted BoTox failure at multivariate analysis. Dysphagia improved in 8 of 11 (72.7%) patients who failed to respond to BoTox and underwent myotomy. A mild impairment of VFS findings and a higher pressure of pharyngeal contractions best predicted response to BoTox with or without myotomy. BoTox injection can be used as the first therapeutic option in patients with OPD: it is safe and simple and relieves dysphagia in 43% of cases. If BoTox fails, CP myotomy can be offered to patients with preserved oral and tongue activity at VFS and an intact bolus propulsion ability on manometry. PMID:15585387

Zaninotto, Giovanni; Marchese Ragona, Rosario; Briani, Chiara; Costantini, Mario; Rizzetto, Christian; Portale, Giuseppe; Zanetti, Lia; Masiero, Stefano; Costantino, Michela; Nicoletti, Loredana; Polidoro, Alessandro; Feltrin, GianPiero; Angelini, Corrado; Ancona, Ermanno; Guidolin, Diego; Parenti, Anna R



Carbon-Coated Microbeads Anal Injection in Outpatient Treatment of Minor Fecal Incontinence  

Microsoft Academic Search

Purpose  Anal bulking agents are injected to pose a stronger obstacle to the involuntary passage of feces and gas. This prospective,\\u000a multicenter study was designed to evaluate the safety and efficacy of Durasphere® anal injection for the treatment of fecal\\u000a incontinence.\\u000a \\u000a \\u000a \\u000a Patients and Methods  Thirty-three unselected patients with incontinence (24 females; mean age, 61.5?±?14 (range, 22–83) years) underwent anal bulking\\u000a agent submucosal

D. F. Altomare; F. La Torre; M. Rinaldi; G. A. Binda; M. Pescatori



Controlled Dose Delivery in Topical Treatment of Anal Fissure: Pilot Study of a New Paradigm  

Microsoft Academic Search

\\u000a Purpose  Topical nitroglycerin has been widely used as a means for avoiding surgery in patients with anal fissure. However, nitroglycerin\\u000a has not been universally accepted for this application because of inconsistency of efficacy and side effects. This study compares\\u000a conventional digital application with precise intra-anal dosing of nitroglycerin using a specialized dose-delivery device\\u000a and anal cannula.\\u000a \\u000a \\u000a \\u000a Methods  Twenty-six consecutive patients (13 males)

Luis Torrabadella; Gervasio Salgado



Myocardial Rupture following Carbon Monoxide Poisoning  

PubMed Central

We present the first case of severe cardiotoxicity of carbon monoxide leading to myocardial rupture and fatal outcome. 83-year-old woman was hospitalized 4 hours after the fire in her house with no respiratory or cardiac symptoms. After two days, she has suffered sudden collapse leading to cardiac arrest. Postmortem examination revealed intramural haemorrhage with myocardial rupture at the apex of the left ventricle. Minimal stenosis was noted in the proximal coronary arteries with no evidence of distal occlusion or any other long-standing heart disease. This case supports recommendations for targeted cardiovascular investigations in cases of CO poisoning. PMID:25110594

Dragelyte, Gabija; Plenta, Juris; Chmieliauskas, Sigitas; Jasulaitis, Algimantas; Raudys, Romas; Jovaisa, Tomas; Badaras, Robertas



Modeling rupture segmentations on the Cascadia megathrust  

NASA Astrophysics Data System (ADS)

The Cascadia subduction zone has produced a series of large to great earthquakes, most recently in 1700 AD. Paleoseismological studies of submarine turbidites suggest a significant difference in recurrence interval between Northern (~500 year) and Southern (~200-300 year) Cascadia. Whether future large ruptures are segmented is very important for estimating hazard in Pacific Northwest, but remains enigmatic from the interpretations of current locking maps. Our approach is to develop rupture scenarios of Cascadia earthquakes by performing numerical simulations using the finite element software, PyLith. Based on the USGS plate interface model of Cascadia, we have constructed a realistic three-dimensional subduction fault model that stretches from Northern California to Central Vancouver Island. We have performed a number of dynamic rupture simulations using a set of artificial friction parameters and uniform stress distributions on the fault governed by a slip-weakening friction law. Preliminary results show that ruptures have initiated from the nucleation zone with higher shear stress than the ambient fault and have propagated on the realistic three-dimensional fault surface. The increase of dip angle with depth has little effect on the rupture propagation because that is governed mostly by the fault strength. The along-strike bend of the fault beneath Washington state and Vancouver Island has not impeded the rupture propagation given the uniform fault strength. To estimate the possible rupture segmentation, we have converted a slip-deficit rate model derived from GPS data into stress change distributions on the fault assuming the entire slip deficit would be released in the next great earthquake. We are also constructing another initial stress map derived from tidal and leveling data, which shows a significant difference in the locking depth beneath Central Oregon. The other important variable, the spatial variation of frictional parameters, however, has to be determined under certain assumptions. We assume the critical distance, Dc, is proportional to the final slip, thus will be obtained from the slip deficit distribution. By combining the estimated stresses and Dc for the slip-weakening relation, we will investigate how the different interseismic locking profiles could influence possible segmentation for future ruptures on the Cascadia megathrust. This work is supported by FM Global.

Yang, H.; Liu, Y.; McGuire, J. J.



[Apophyseal rupture of ischial bone tuberosity].  


The apophyses of the pelvic skeleton are the insertion zones of strong muscles and tendons and are soft points towards the end of growth. Apophyseal ruptures have quite often occurred as a consequence of overstressing in the context of certain athletic disciplines. Reported in this paper are two of the authors' own cases of apophyseal rupture of Tuber ossis ischii. Diagnosis is easy on the basis of case history, clinical manifestations, and X-ray. Treatment is conservative, with the patient hip-straightened confined to bed for three weeks. Surgery might be indicated in cases of continued seating problems or neurological failures. PMID:3577444

Lindner, H O; Winkeltau, G; Kalemba, J



Prevalence and Risk Factors for Human Papillomavirus Infection of the Anal Canal in Human Immunodeficiency Virus (HIV)?Positive and HIV?Negative Homosexual Men  

Microsoft Academic Search

One of the groups at highest risk of anal cancer is homosexual and bisexual men. Like cervical cancer, anal cancer is associated with human papillomavirus (HPV) infection. Anal HPV infection was characterized in a study of 346 human immunodeficiency virus (HIV) - positive and 262 HIV- negative homosexual and bisexual men. Anal HPV DNA was detected in 93% of HIV-positive

Naomi Jay



476 Anal. Chem. 1883, 65, 476-481 Determination of Carbohydrates by Capillary Zone  

E-print Network

476 Anal. Chem. 1883, 65, 476-481 Determination of Carbohydrates by Capillary Zone concernto manyresearchers.'-5 Carbohydrates are significant compounds that are difficult to analyzeby; however, the characteristic response signal is also low in sensitivity. Furthermore, carbohydrates

Zare, Richard N.


Do marmots display a `dear enemy phenomenon' in response to anal gland secretions?  

E-print Network

, Crested Butte, CO, USA Keywords anal gland secretion; dear enemy phenomenon; kinship; Marmota flaviventris. We tested philopatric female yellow-bellied marmots (Marmota flaviventris) for the presence of DEP

Blumstein, Daniel T.


Anal. Chem. 1994,66,168-176 Classification of Countercurrent Chromatography Solvent  

E-print Network

Anal. Chem. 1994,66,168-176 Classification of Countercurrent Chromatography Solvent Systems Cedex 05, France Solvent systems used for countercurrent chromatography (CCC) have been classified predictionof the experimental flow behavior in CCC. Countercurrent chromatography (CCC) is a separation method

Wesfreid, José Eduardo


Toward an understanding of the context of anal sex behavior in ethnic minority adolescent women.  


Understanding the context of anal sex behavior among ethnic minority adolescent women has public health implications for behavioral sexual health promotion and risk reduction interventions. African-American (n = 94) and Mexican-American (n = 465) women (14-18 years of age) enrolled in a clinical trial completed semi-structured interviews to assess psychosocial and situational factors and relationships to sexual risk behavior, substance use, sexually transmitted infection/HIV acquisition, and violence. Bivariate analyses with comparisons by anal sex experiences identified differences by ethnicity and higher self-reported histories of sexual risk behaviors, substance use, violence, and stressful psychosocial and situational factors among adolescent women experiencing anal sex. Predictors of anal sex identified through logistic regression included Mexican-American ethnicity, ecstasy use, methamphetamine use, childhood sexual molestation, oral sex, and sex with friends for benefits. PMID:24963851

Dimmitt Champion, Jane; Roye, Carol F



What Is an Earthquake?: Rupture Models  

NSDL National Science Digital Library

In this activity, the learner will watch three animations based on actual data from fault ruptures from the two largest Southern California earthquakes in the 1990s: Landers (1992) and Northridge (1994). In Section 3, the learner will discover more about how such data is collected and analyzed.


Laparoscopic splenectomy for atraumatic splenic rupture.  


A traumatic splenic rupture (ASR) is a rare clinical entity. Several underlying benign and malignant conditions have been described as a leading cause. We report on a case of ASR in a 41-year-old man treated with laparoscopic splenectomy. Considering ASR as a life-threatening condition, a prompt diagnosis can be life saving. PMID:21675627

Grossi, Ugo; Crucitti, Antonio; D'Amato, Gerardo; Mazzari, Andrea; Tomaiuolo, Pasquina M C; Cavicchioni, Camillo; Bellantone, Rocco



Postintubation Tracheal Ruptures - A case report -  

PubMed Central

Tracheobronchial ruptures (TBR) rarely complicate surgical procedures under general anesthesia. Seemingly uneventful intubations can result in injury to the trachea, which often manifests as hemoptysis and subcutaneous emphysema. We present 2 patients with postintubation TBR who were treated surgically and discuss considerations in the management of this potentially lethal injury. PMID:22263165

Kim, Kyung Hwa; Choi, Jong-Bum; Kuh, Ja-Hong; Jo, Jung-Ku; Park, Hyun Kyu



Star polymers rupture induced by constant forces  

NASA Astrophysics Data System (ADS)

In this work, we study the breakage process of an unknotted three-arm star-shaped polymer when it is pulled from its free ends by a constant force. The star polymer configuration is described through an array of monomers coupled by anharmonic bonds, while the rupture process is tracked in three-dimensional space by means of Langevin Molecular Dynamics simulations. The interaction between monomers is described by a Morse potential, while a Weeks-Chandler-Anderson energetic contribution accounts for the excluded volume interaction. We explore the effect of the molecular architecture on the distributions of rupture times over a broad interval of pulling forces and star configurations. It was found that the rupture time distribution of the individual star arms is strongly affected by the star configuration imposed by the pulling forces and the length of the arms. We also observed that for large pulling forces the rupture time distributions resemble the dominant features observed for linear polymer chains. The model introduced here provides the basic ingredients to describe the effects of tensile forces on stress-induced degradation of branched macromolecules and polymer networks.

García, N. A.; Febbo, M.; Vega, D. A.; Milchev, A.



Bond-rupture immunosensors--a review.  


It has long been the goal of researchers to develop fast and reliable point-of-care alternatives to existing lab-based tests. A viable point-of-care biosensor is fast, reliable, simple, cost-effective, and detects low concentrations of the target analyte. The target of biosensors is biological such as bacteria or virus and as such, the antibody-antigen bond derived from the real immune response is used. Biosensor applications include lab-based tests for the purposes of diagnostics, drug discovery, and research. Additional applications include environmental, food, and agricultural monitoring. The main merits of the bond-rupture method are quick, simple, and capable of discriminating between specific and non-specific interactions. The separation of specific and non-specific bonds is important for working in real-life complex serums such as blood. The bond-rupture technique can provide both qualitative results, the detection of a target, and quantitative results, the concentration of target. Bond-rupture achieves this by a label-free method requiring no pre-processing of the analyte. A piezoelectric transducer such as the quartz crystal microbalance (QCM) shakes the bound particles free from the surface. Other transducers such as Surface Acoustic Wave (SAW) are also considered. The rupture of the bonds is detected as electronic noise. This review article links diverse research areas to build a picture of a field still in development. PMID:18343101

Hirst, Evan R; Yuan, Yong J; Xu, W L; Bronlund, J E



Penile Fracture with Associated Urethral Rupture  

PubMed Central

Penile fracture of the erect penis is an uncommon but emergent urological trauma. Potential outcomes include erectile dysfunction, penile curvature, and urethral injury. Treatment is emergent surgical repair. We present the case of a 42-year-old man with a penile fracture complicated by a urethral rupture and subsequent repair. A discussion of the key aspects of this condition is presented. PMID:21076536

Boncher, Nicholas A.; Vricella, Gino J.; Jankowski, Jason T.; Ponsky, Lee E.; Cherullo, Edward E.



Surface Rupture in Northwest Saudi Arabia  

USGS Multimedia Gallery

Wendy McCausland of the USGS Volcano Disaster Assistance Program and Hani Zahran of the Saudi Geological Survey view the southern end of the surface fault rupture caused by a M5.4 earthquake in the Saudi Arabian desert on May 19, 2009. The ground displacements in the soft sediments of the foreground...



Unusual rupture of a flexor profundus tendon.  


An unusual rupture of a flexor profundus tendon, previously unreported in the literature, is presented. There was avulsion and proximal displacement of a large bone fragment from the palmar base of the distal phalanx and further retraction of the tendon unattached to the bone fragment. PMID:3958452

Langa, V; Posner, M A



Fault branching and rupture directivity Sonia Fliss  

E-print Network

, some understanding of the mechanics underlying dynamic processes of fault branching and jumping has earthquake from the rupture pattern it left? The answer to that question would be very useful for risk assessment of future earthquakes, even if it is cur- rently unknown if large earthquakes do systematically

Dmowska, Renata


Star polymers rupture induced by constant forces.  


In this work, we study the breakage process of an unknotted three-arm star-shaped polymer when it is pulled from its free ends by a constant force. The star polymer configuration is described through an array of monomers coupled by anharmonic bonds, while the rupture process is tracked in three-dimensional space by means of Langevin Molecular Dynamics simulations. The interaction between monomers is described by a Morse potential, while a Weeks-Chandler-Anderson energetic contribution accounts for the excluded volume interaction. We explore the effect of the molecular architecture on the distributions of rupture times over a broad interval of pulling forces and star configurations. It was found that the rupture time distribution of the individual star arms is strongly affected by the star configuration imposed by the pulling forces and the length of the arms. We also observed that for large pulling forces the rupture time distributions resemble the dominant features observed for linear polymer chains. The model introduced here provides the basic ingredients to describe the effects of tensile forces on stress-induced degradation of branched macromolecules and polymer networks. PMID:25362341

García, N A; Febbo, M; Vega, D A; Milchev, A



Deposition of anal-sac secretions by captive wolves (Canis lupus)  

USGS Publications Warehouse

Deposition of anal-sac secretions by captive wolves was investigated by a labelling technique using protein-bound iodine125 and food dye. Wolves deposited secretions on some but not all scats. Adult males, especially the alpha male, deposited anal-sac secretions more frequently while defecating than did females or juveniles. Secretions sometimes also were deposited independently of defecation, suggesting a dual role in communication by these substances.

Asa, C.S.; Peterson, E.K.; Seal, U.S.; Mech, L.D.



Fibrin glue treatment of complex anal fistulas has low success rate  

Microsoft Academic Search

Purpose: Fibrin glue has been used to treat anal fistulas in an attempt to avoid more radical surgical intervention. Reported\\u000a success rates vary widely. The purpose of this study was to review the use of fibrin glue in the management of complex anal\\u000a fistulas at a tertiary referral center. Methods: This study was designed as a retrospective review of all

Rasmy Loungnarath; David W. Dietz; Matthew G. Mutch; Elisa H. Birnbaum; Ira J. Kodner; James W. Fleshman



A Randomized, Controlled Trial of Fibrin Glue vs. Conventional Treatment for Anal Fistula  

Microsoft Academic Search

PURPOSE: Fibrin glue is a novel treatment for anal fistulas\\u000aand possesses many advantages in the treatment of difficult\\u000ahigh fistulas. Fibrin glue treatment is simple and repeatable;\\u000afailure does not compromise further treatment options; and\\u000asphincter function is preserved. We aimed to compare the\\u000aoutcomes of patients with low and high anal fistulas randomly\\u000aassigned to either fibrin glue

Ian Lindsey; M. M. Smilgin-Humphreys; Chris Cunningham; Neil J. M. Mortensen; Bruce D. George



Casual Sexual Encounters Among Gay Men: Familiarity, Trust and Unprotected Anal Intercourse  

Microsoft Academic Search

Familiarity with and a history of prior sex with casual partners is associated with unprotected anal intercourse and may increase\\u000a the risk of HIV transmission among gay men. Using data from the Sydney Gay Community Periodic Survey 2007, we explored the\\u000a relationship between familiarity and unprotected anal intercourse with the last casual partner (UAI-LC). 51% of the men knew\\u000a their

Iryna B. ZablotskaAndrew; Andrew E. Grulich; John De Wit; Garrett Prestage



Attitudes Toward Unprotected Anal Intercourse: Assessing HIV-Negative Gay or Bisexual Men  

Microsoft Academic Search

HIV prevention programs and clinicians have a need to identify clients' attitudes toward unprotected anal intercourse (UAI). This study reports on the development of the Unprotected Anal Intercourse Attitudes Inventory (UAI-AI), a multi-factorial measure designed to assess gay and bisexual men who are HIV-negative or untested. This self-report measure may be useful in helping both counselors and clients discuss the

Ariel Shidlo; Huso Yi; Boaz Dalit



Human papillomavirus DNA prevalence and type distribution in anal carcinomas worldwide.  


Knowledge about human papillomaviruses (HPV) types involved in anal cancers in some world regions is scanty. Here, we describe the HPV DNA prevalence and type distribution in a series of invasive anal cancers and anal intraepithelial neoplasias (AIN) grades 2/3 from 24 countries. We analyzed 43 AIN 2/3 cases and 496 anal cancers diagnosed from 1986 to 2011. After histopathological evaluation of formalin-fixed paraffin-embedded samples, HPV DNA detection and genotyping was performed using SPF-10/DEIA/LiPA25 system (version 1). A subset of 116 cancers was further tested for p16(INK4a) expression, a cellular surrogate marker for HPV-associated transformation. Prevalence ratios were estimated using multivariate Poisson regression with robust variance in the anal cancer data set. HPV DNA was detected in 88.3% of anal cancers (95% confidence interval [CI]: 85.1-91.0%) and in 95.3% of AIN 2/3 (95% CI: 84.2-99.4%). Among cancers, the highest prevalence was observed in warty-basaloid subtype of squamous cell carcinomas, in younger patients and in North American geographical region. There were no statistically significant differences in prevalence by gender. HPV16 was the most frequent HPV type detected in both cancers (80.7%) and AIN 2/3 lesions (75.4%). HPV18 was the second most common type in invasive cancers (3.6%). p16(INK4a) overexpression was found in 95% of HPV DNA-positive anal cancers. In view of the results of HPV DNA and high proportion of p16(INK4a) overexpression, infection by HPV is most likely to be a necessary cause for anal cancers in both men and women. The large contribution of HPV16 reinforces the potential impact of HPV vaccines in the prevention of these lesions. PMID:24817381

Alemany, Laia; Saunier, Maëlle; Alvarado-Cabrero, Isabel; Quirós, Beatriz; Salmeron, Jorge; Shin, Hai-Rim; Pirog, Edyta C; Guimerà, Núria; Hernandez-Suarez, Gustavo; Felix, Ana; Clavero, Omar; Lloveras, Belen; Kasamatsu, Elena; Goodman, Marc T; Hernandez, Brenda Y; Laco, Jan; Tinoco, Leopoldo; Geraets, Daan T; Lynch, Charles F; Mandys, Vaclav; Poljak, Mario; Jach, Robert; Verge, Josep; Clavel, Christine; Ndiaye, Cathy; Klaustermeier, JoEllen; Cubilla, Antonio; Castellsagué, Xavier; Bravo, Ignacio G; Pawlita, Michael; Quint, William G; Muñoz, Nubia; Bosch, Francesc X; de Sanjosé, Silvia



Anal plugs and retrograde colonic irrigation are helpful in fecal incontinence or constipation  

PubMed Central

AIM: To evaluate the feasibility, clinical effect and predicting factors for favorable outcome of treatment with anal plugs in fecal incontinence and retrograde colonic irrigation (RCI) in patients with fecal incontinence or constipation. METHODS: Patients who received treatment with an anal plug or RCI between 1980 and 2005 were investigated with a questionnaire. RESULTS: Of the 201 patients (93 adults, 108 children), 101 (50%) responded. Adults: anal plugs (8), five stopped immediately, one stopped after 20 mo and two used it for 12-15 mo. RCI (40, 28 fecal incontinence, 12 constipation), 63% are still using it (mean 8.5 years), 88% was satisfied. Younger adults (< 40 years) were more satisfied with RCI (94 % vs 65%, P = 0.05). Children: anal plugs (7), 5 used it on demand for an average of 2.5 years with satisfactory results, one stopped immediately and one after 5 years. RCI (26 fecal incontinence, 22 constipation), 90% are still using it (mean time 6.8 years) and felt satisfied. Children tend to be more satisfied (P = 0.001). Besides age, no predictive factors for success were found. There was no difference in the outcome between patients with fecal incontinence or constipation. CONCLUSION: RCI is more often applied than anal plugs and is helpful in patients with fecal incontinence or constipation, especially for younger patients. Anal plugs can be used incidentally for fecal incontinence, especially in children. PMID:17589927

Cazemier, Marcel; Felt-Bersma, Richelle JF; Mulder, Chris JJ




Microsoft Academic Search

PurposeWe determine the long-term durability of the AMS 800? artificial urinary sphincter in the correction of severe urinary incontinence, and evaluate mechanical versus nonmechanical failure and reoperation rates before (1983 to 1987) and after (1988 to present) the introduction of the narrow backing occlusive cuff design.' American Medical Systems, Inc., Minnetonka, Minnesota.




Presynaptic Effects of Botulinum Toxin Type A on the Neuronally Evoked Response of Albino and Pigmented Rabbit Iris Sphincter and Dilator Muscles  

Microsoft Academic Search

Purpose: To investigate the effects of botulinum toxin type A (botulinum A toxin) on the autonomic and other nonadrenergic, noncholinergic nerve terminals.Methods: The effects of botulinum A toxin on twitch contractions evoked by electrical field stimulation (EFS) were studied in isolated albino and pigmented rabbit iris sphincter and dilator muscles using the isometric tension recording method.Results: Botulinum A toxin inhibited

Hitoshi Ishikawa; Yoshihisa Mitsui; Takeshi Yoshitomi; Kimiyo Mashimo; Shigeru Aoki; Kazuo Mukuno; Kimiya Shimizu



Oral and anal sex practices among high school youth in Addis Ababa, Ethiopia  

PubMed Central

Background Understanding the full range of sexual behaviors of young people is crucial in developing appropriate interventions to prevent and control sexually transmitted infections including HIV. However, such information is meager in developing countries. The objective of this study was to describe oral and anal sex practices and identify associated factors among high school youth. Methods A cross-sectional study was conducted among high school youth in Addis Ababa, Ethiopia. A multi-stage sampling procedure was followed to select a representative sample of school youth. The total sample size for this study was 3840. Data were collected using a self-administered questionnaire. Data analysis was guided by the ecological framework. Results The overall proportion of people who reported ever having oral sex was 5.4% (190) and that of anal sex was 4.3% (154). Of these 51.6% (98) had oral sex and 57.1% (87) had anal sex in the past 12 months. Multiple partnerships were reported by 61.2% of the respondents who had oral sex and 51.1% of students practicing anal sex. Consistent condom use was reported by 12.2% of those practicing oral sex and 26.1% of anal sex. Reasons for oral and anal sex included prevention of pregnancy, preserving virginity, and reduction of HIV and STIs transmission. Oral sex practice was strongly and significantly associated with perception of best friends engagement in oral sex (AOR = 5.7; 95% CI 3.6-11.2) and having illiterate mothers (AOR = 11.5; 95%CI 6.4-18.5). Similarly, anal sex practice was strongly and significantly associated with favorable attitude towards anal sex (AOR = 6.2; 95%CI 3.8-12.4), and perceived best friends engagement in anal sex (AOR = 9.7; 95%CI 5.4-17.7). Conclusion Considerable proportion of adolescents had engaged in oral and anal sex practices. Multiple sexual partnerships were common while consistent condom use was low. Sexual health education and behavior change communication strategies need to cover a full range of sexual practices. PMID:22216887



Rupture of the uterus in a primigravida: a case report.  


Uterine rupture during a first pregnancy is rare. We present the case of spontaneous intrapartum uterine rupture in a 40 year old primigravida with no prior uterine surgery, and a structurally normal uterus. The patient had obstructed labor. Operative findings were a male fresh stillbirth weighing 3800 g, massive hemoperitoneum, and an anterior transverse rupture at the lower uterine segment. Repair of the rupture was done without bilateral tubal ligation. Although a rare event, the primigravid uterus is not immune to rupture as exemplified by this report. PMID:20499765

Chigbu, B; Onwere, S; Kamanu, C; Aluka, C; Adibe, E; Onichakwe, C



Genetics of canine anal furunculosis in the German shepherd dog.  


Canine anal furunculosis (AF) is characterised by ulceration and fistulation of perianal tissue and is a disease that particularly affects German shepherd dogs (GSDs). There are some similarities between AF and perianal Crohn's disease (CD) in man. An immune-mediated aetiopathogenesis for AF has been suggested due to tissue pathology, a major histocompatibility complex (MHC) association and clinical response to ciclosporin. Genome-wide association studies (GWAS) can be conducted in dogs with fewer markers and individuals than would be required in a human study. A discovery GWAS was performed on 21 affected and 25 control GSDs from the UK. No SNPs reached genome-wide significance levels at this stage. However, 127 nominally associated SNPs were genotyped in further 76 cases and 191 controls from the UK and Finland. Sequencing of these regions was undertaken to discover novel genetic variation. Association testing of these variants in the UK and Finnish cohorts revealed nine significantly associated SNPs, six of which cause non-synonymous changes in protein sequence. The ADAMTS16 and CTNND2 gene regions were most significantly associated with disease. Members of the butyrophilin protein family, important in intestinal inflammatory regulation, were also associated with disease, but their independence from the MHC region remains to be established. The CTNND2 gene region is also interesting as this locus was implicated in human ulcerative colitis and CD, albeit at a different candidate gene: DAP. We suggest that this represents a common association between inflammatory bowel disease-related conditions in both species and believe that future studies will strengthen this link. PMID:24626934

Massey, Jonathan; Short, Andrea D; Catchpole, Brian; House, Arthur; Day, Michael J; Lohi, Hannes; Ollier, William E R; Kennedy, Lorna J



Detection of supershear rupture in 2013 Craig, Alaska, earthquake  

NASA Astrophysics Data System (ADS)

Seismic ruptures are akin to opening a zipper—a gap in the crust starts in one location and travels along the fault in a particular direction. When a strained fault ruptures in an earthquake, seismic waves also spread out from the epicenter. In some cases, the waves' passage can trigger the initiation of a new rupture ahead of the initial expanding rupture in locked portions of the fault. If the triggered rupture grows successfully, the overall rupture front can then outpace the passage of the shear waves, secondary seismic waves that travel slowly after the earthquake begins and are responsible for the bulk of violent shaking. These earthquakes display what is known as supershear rupture; only seven such earthquakes have previously been recorded.

Schultz, Colin



Molecular and pharmacological characterization of a functional tachykinin NK3 receptor cloned from the rabbit iris sphincter muscle  

PubMed Central

A functional tachykinin NK3 receptor was cloned from the rabbit iris sphincter muscle and its distribution investigated in ocular tissues.Standard polymerase chain reaction (PCR) techniques were used to clone a full length rabbit NK3 receptor cDNA consisting of 1404 nucleotides. This cDNA encoded a protein of 467 amino acids with 91 and 87% homology to the human and rat NK3 receptors respectively.In CHO-K1 cells transiently expressing the recombinant rabbit NK3 receptor, the relative order of potency of NKB>>NKA?SP to displace [125I]-[MePhe7]-NKB binding and to increase intracellular calcium, together with the high affinity of NK3 selective agonists (e.g. senktide, [MePhe7]-NKB) and antagonists (e.g. SR?142801, SB?223412) in both assays was consistent with NK3 receptor pharmacology. In binding and functional experiments, agonist concentration response curves were shallow (0.7–0.8), suggesting the possibility of multiple affinity states of the receptor.Quantitative real time PCR analysis revealed highest expression of rabbit NK3 receptor mRNA in iris sphincter muscle, lower expression in retina and iris dilator muscle, and no expression in lens and cornea. In situ hybridization histochemistry revealed discrete specific localization of NK3 receptor mRNA in the iris muscle and associated ciliary processes. Discrete specific labelling of NK3 receptors with the selective NK3 receptor agonist [125I]-[MePhe7]-NKB was also observed in the ciliary processes using autoradiography.Our study reveals a high molecular similarity between rabbit and human NK3 receptor mRNAs, as predicted from previous pharmacological studies, and provide the first evidence that NK3 receptors are precisely located on ciliary processes in the rabbit eye. In addition, there could be two affinity states of the receptor which may correspond to the typical and ‘atypical' NK3 receptor subtypes previously reported. PMID:10516642

Medhurst, Andrew D; Hirst, Warren D; Jerman, Jeffery C; Meakin, Jacqueline; Roberts, Jennifer C; Testa, Tania; Smart, Darren



Effect of chronic and acute cigarette smoking on the pharyngo-upper oesophageal sphincter contractile reflex and reflexive pharyngeal swallow  

PubMed Central

Background—Cigarette smoking is known to affect adversely the defence mechanisms against gastro-oesophageal reflux. The effect of smoking on the supraoesophageal reflexes that prevent aspiration of gastric contents has not been previously studied. ?Aims—To elucidate the effect of cigarette smoking on two of the supraoesophageal reflexes: the pharyngo-upper oesophageal sphincter (UOS) contractile reflex; and the reflexive pharyngeal swallow. ?Methods—Ten chronic smokers and 10 non-smokers were studied, before and 10 minutes after real or simulated smoking, respectively. UOS pressure and threshold volume for the reflexes were determined using a UOS sleeve assembly. Two modes of fluid delivery into the pharynx were tested: rapid injection and slow injection. ?Results—For both rapid and slow injections, the threshold volume for triggering the pharyngo-UOS contractile reflex was significantly higher in smokers than in non-smokers (rapid: smokers 0.42 (SE 0.07) ml, non-smokers 0.16 (0.04) ml; slow: smokers 0.86 (0.06) ml, non-smokers 0.38 (0.1) ml; p<0.05). During rapid injection, the threshold volume for reflexive pharyngeal swallow was higher in smokers (smokers 0.94 (0.09) ml, non-smokers 0.46 (0.05) ml; p<0.05). Acute smoking further increased the threshold volume for the pharyngo-UOS contractile reflex and reflexive pharyngeal swallow during rapid injection. ?Conclusions—Smoking adversely affects stimulation of the pharyngo-UOS contractile reflex and pharyngeal reflexive swallow. These findings may have implications in the development of reflux related respiratory complications among smokers. ?? Keywords: smoking; supraoesophageal reflexes; pharyngo-upper oesophageal sphincter contractile reflex; reflexive pharyngeal swallow; airway protection; gastro-oesophageal reflux PMID:9824582

Dua, K; Bardan, E; Ren, J; Sui, Z; Shaker, R



Tumor Response and Survival Predicted by Post-Therapy FDG-PET/CT in Anal Cancer  

SciTech Connect

Purpose: To evaluate the response to therapy for anal carcinoma using post-therapy imaging with positron emission tomography (PET)/computed tomography and F-18 fluorodeoxyglucose (FDG) and to compare the metabolic response with patient outcome. Patients and Methods: This was a prospective cohort study of 53 consecutive patients with anal cancer. All patients underwent pre- and post-treatment whole-body FDG-PET/computed tomography. Patients had been treated with external beam radiotherapy and concurrent chemotherapy. Whole-body FDG-PET was performed 0.9-5.4 months (mean, 2.1) after therapy completion. Results: The post-therapy PET scan did not show any abnormal FDG uptake (complete metabolic response) in 44 patients. Persistent abnormal FDG uptake (partial metabolic response) was found in the anal tumor in 9 patients. The 2-year cause-specific survival rate was 94% for patients with a complete vs. 39% for patients with a partial metabolic response in the anal tumor (p = 0.0008). The 2-year progression-free survival rate was 95% for patients with a complete vs. 22% for patients with a partial metabolic response in the anal tumor (p < 0.0001). A Cox proportional hazards model of survival outcome indicated that a complete metabolic response was the most significant predictor of progression-free survival in our patient population (p = 0.0003). Conclusions: A partial metabolic response in the anal tumor as determined by post-therapy FDG-PET is predictive of significantly decreased progression-free and cause-specific survival after chemoradiotherapy for anal cancer.

Schwarz, Julie K. [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States); Siegel, Barry A.; Dehdashti, Farrokh [Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States); Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO (United States); Myerson, Robert J. [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States); Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO (United States); Fleshman, James W. [Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO (United States); Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO (United States); Grigsby, Perry W. [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States); Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States); Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO (United States); Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (United States)], E-mail:



Health-related quality of life in patients with anal fissure: effect of type D personality  

PubMed Central

Introduction Health-related quality of life (HRQL) is a significant factor in describing the burden of illness and the impact of treatment in patients with gastrointestinal disease. Type D (distressed) personality is defined as the co-occurrence of negative affect and social inhibition. Aim To assess the prevalence of type D personality in patients with anal fissure and to investigate whether the presence of a type D personality would affect HRQL in patients with anal fissure. Material and methods One hundred outpatients with anal fissure with no psychiatric comorbidity were consecutively enrolled, along with 100 healthy controls. Type D Scale (DS14) and General Health Survey Short Form-36 (SF-36) were used in the collection of data. Results Patients with anal fissure scored lower on physical roles and bodily pain dimensions of SF-36 than healthy subjects (p < 0.05). Thirty-three patients with anal fissure (33%) and 16 controls (16%) had scored above the cut-off score of the DS14 (p < 0.05). Patients with a type D personality were found to score lower on bodily pain and social roles domains of HRQL than patients without a type D personality. Conclusions Type D personality was associated with increased perceived bodily pain and social roles in patients with anal fissure. Type D personality construct may be an important consideration when assessing HRQL outcomes. A multidimensional approach may be valuable in the assessment of patients presenting with anal fissure, because a subgroup with type-D personality might benefit from psychological therapies. PMID:25061489

Yilmaz, Edip Erdal; Canan, Fatih; Yildirim, Osman; Cetin, Mehmet Mustafa



Retinal detachment associated with traumatic chorioretinal rupture.  


Traumatic chorioretinal rupture, also known as sclopetaria, is a full-thickness break of the choroid and retina caused by a high-velocity projectile striking or passing adjacent to, but not penetrating, the globe. Previous reports have emphasized that retinal detachment seldom occurs, and observation alone has been the recommended management strategy. However, the authors present herein a series of consecutive patients with retinal detachment associated with sclopetaria and provide a literature review of the topic. They recommend that patients with traumatic chorioretinal rupture be monitored closely for the development of retinal detachment during the first few weeks after the injury. [Ophthalmic Surg Lasers Imaging Retina. 2014;45:451-455.]. PMID:25153657

Papakostas, Thanos D; Yonekawa, Yoshihiro; Wu, David; Miller, John B; Veldman, Peter B; Chee, Yewlin E; Husain, Deeba; Eliott, Dean



Treatment of Ruptured ICA during Transsphenoidal Surgery  

PubMed Central

Summary Rupture of the internal carotid artery (ICA) during transsphenoidal surgery is a rare but potentially lethal complication. Direct surgical repair of the ICA may be difficult and time-consuming in an acute setting. Urgent endovascular treatments with vascular plug or stent-graft have been the feasible options to date. We desrcibe two cases of iatrogenic rupture of ICA during transsphenoidal surgery. In the first case we occluded the ICA with a vascular plug at the site of tear where cross circulation was adequate. In the second case we had to preserve the ICA with stent-graft since there was no adequate cross circulation. These two strategies are discussed below. PMID:20377977

Ghatge, S.B.; Modi, D.B.



An unusual diagnosis of splenic rupture.  


A 22-year-old woman presented with a 3-day history of worsening epigastric pain, non-productive cough and vomiting. On examination she was pale and had abdominal tenderness predominant in the right upper quadrant. Abdominal ultrasound excluded the presence of gall stones, but was unable to rule out free fluid in the abdomen. CT demonstrated extensive high-density ascites; however, no source of bleeding could be demonstrated. Clinically the patient's condition deteriorated, and an exploratory laparotomy was performed. In theatre the splenic capsule was found to have detached from the splenic body and emergency splenectomy was performed. Virology serology later demonstrated acute cytomegalovirus (CMV) infection, although tissue microscopy and CMV staining were negative. No other cause of rupture was found. The interesting aspects of this case include the poor correlation between initial presenting symptoms and subsequent diagnosis, the difficulty encountered in making a firm diagnosis and the atypical cause of rupture. PMID:25293683

Roche, Matthew; Maloku, Fatmir; Abdel-Aziz, Tarek Ezzat



Creep rupture behavior of Stirling engine materials  

NASA Technical Reports Server (NTRS)

The automotive Stirling engine, being investigated jointly by the Department of Energy and NASA Lewis as an alternate to the internal combustion engine, uses high-pressure hydrogen as the working fluid. The long-term effects of hydrogen on the high temperature strength properties of materials is relatively unknown. This is especially true for the newly developed low-cost iron base alloy NASAUT 4G-A1. This iron-base alloy when tested in air has creep-rupture strengths in the directionally solidified condition comparable to the cobalt base alloy HS-31. The equiaxed (investment cast) NASAUT 4G-A1 has superior creep-rupture to the equiaxed iron-base alloy XF-818 both in air and 15 MPa hydrogen.

Titran, R. H.; Scheuerman, C. M.; Stephens, J. R.



Premature rupture of the membranes: neonatal consequences.  


Premature rupture of the membranes (PROM), membrane rupture before the onset of labor, occurs in 2% to 18% of pregnancies. The time from PROM to delivery (latency) is usually less than 48 hours in term pregnancy. Therefore, the risks of PROM at term are related to fetal distress, prolapsed cord, abruptio placenta, and rarely, infection. Preterm PROM (pPROM), PROM before 37 weeks' gestation, accounts for 20% to 40% of PROM, and the incidence is doubled in multiple gestations. The latency period in pPROM is inversely related to the gestational age thereby increasing the risks of oligohydramnios and infection in very premature infants and their mothers. Because pPROM is associated with 30% to 40% of premature births, pPROM is also responsible for the neonatal problems resulting from prematurity. This review examines the impact of PROM on the neonate including fetal distress, prematurity, infection, pulmonary hypoplasia, and restriction deformations. PMID:8912991

Merenstein, G B; Weisman, L E



Correlates of Anal Intercourse Vary by Partner Type Among Substance-Using Women: Baseline Data from the UNITY Study  

Microsoft Academic Search

Data are limited about anal intercourse among women at risk of HIV infection. HIV-negative non-injection drug using women\\u000a at sexual risk (N = 404) were recruited. At baseline, 41.7% reported anal intercourse in the prior 3 months; of these, 88.2%\\u000a reported unprotected anal intercourse (UAI). Factors associated with UAI varied by partner type: UAI with a steady partner\\u000a was associated with younger age,

Beryl A. Koblin; Donald R. Hoover; Guozhen Xu; Victoria Frye; Mary H. Latka; Debbie Lucy; Sebastian Bonner



Risk of residual rectal mucosa after proctocolectomy and ileal pouch-anal reconstruction with the double-stapling technique  

Microsoft Academic Search

PURPOSE: This study was designed to assess the risk of retained rectal mucosa after proctocolectomy and ileal pouch-anal anastomosis with the double-stapling technique. METHODS: A total of 113 patients underwent proctocolectomy with an ileal pouch-anal reconstruction. In 57 patients the anastomosis between pouch and proximal anal canal was performed using the double-stapling technique. In 26 patients the procedure was carried

J. F. M. Slors; A. E. Ponson; C. W. Taat; A. Bosma



Traumatic dislocation of testes and bladder rupture.  


Traumatic dislocation of the testes with bladder rupture occurred in 2 multiply injured patients with pelvic fracture. One had a history of retractile testes and the other of previous testicular dislocation. Surgical correction was performed after closed reduction failed. These injuries must be recognized and treated promptly to maximize the likelihood of testicular salvage. If early intervention is not possible, duplex ultrasonography and pulsed Doppler analysis are the optional valuative studies. PMID:1466102

Lee, J Y; Cass, A S; Streitz, J M



[Splenic artery rupture in pancreatic pseudocyst].  


Hemorrhage is one of the most threatening complication of pancreatic pseudocyst. It results from erosion of adjacent vessels. Splenic, gastroduodenal, pancreaticoduodenal and middle colic vessels are predominantly involved. Hemorrhage may present different feature: intra and/or extraperitoneal collection, gastrointestinal bleeding. The authors report the rupture of splenic artery into pseudocyst, with the formation of pulsating pseudoaneurysm, increasing progressively until the final rupture. For the diagnosis the authors utilized: ultrasounds (US) which showed the cyst but not its nature and content; the CT scan which disclosed haematic contents; finally the US Color Doppler which proved the dynamic feature of hemorrhage. This technique allows to identify the arterious or venous source of bleeding and the possible presence of arteriovenous fistula. Arteriography was not performed due to circumstances, although it would permit bleeding vessel embolization and the control of hemorrhage. This procedure is not ever achievable, and doesn't exclude the possibility of rebleeding. On surgery, since the intraoperative rupture of the pseudoaneurysm occurred with severe hypovolemic shock, only a timely posterior mesogastric mobilization and the medially displacement of spleen-body-tail pancreatic complex, allowed to clamp the mass and the hemostasis. When such lesion are approached, it is mandatory to be prepared to carry on this maneuver: the severity of bleeding cannot allow intracystic ligature of bleeding vessel. PMID:10920499

Ungania, S; Panocchia, N



[Diagnosis and treatment of diaphragm traumatic ruptures].  


29 patients with traumatic ruptures of left cupola of the diaphragm were studied. Pain, dispnoe, tachycardia more intensive after a meal due to repletion and dislocation of the stomach into pleural cavity and its pressure on the organs of the mediastinum were the main symptoms of the disease. The diagnosis of traumatic rupture of the diaphragm was made on the base of clinical and roentgenological examination. In the acute period of trauma the diagnosis is difficult, especially in combined trauma. In 92.3% of cases the stomach and the bowel move into the pleural cavity, which may simulate pneumothorax or relaxation of the diaphragm. Contrast examination of the gastro-intestinal tract and pleural puncture help in differential diagnosis. All the cases of traumatic ruptures of the diaphragm should be subjected to surgical treatment. Urgent operation is indicated in continuing bleeding, incarceration of organs, acute cardiopulmonary insufficiency due to the collapse of the lung and dislocation of mediastinal organs of into contralateral position. Thoracotomy in VII intercostal space is considered as a valid approach. There were 2 (6.9%) lethal outcomes after 29 operations. Long-term results are quite favourable. PMID:10459187

Gadzhiev, Sh M; Gurbanaliev, I G; Abbasov, F; Mamedov, A S; Ze?nalov, N D; Iusifov, I A



Ruptured Corpus Luteal Cyst: CT Findings  

PubMed Central

Objective To evaluate the CT findings of ruptured corpus luteal cysts. Materials and Methods Six patients with a surgically proven ruptured corpus luteal cyst were included in this series. The prospective CT findings were retrospectively analyzed in terms of the size and shape of the cyst, the thickness and enhancement pattern of its wall, the attenuation of its contents, and peritoneal fluid. Results The mean diameter of the cysts was 2.8 (range, 1.5-4.8) cm; three were round and three were oval. The mean thickness of the cyst wall was 4.7 (range, 1-10) mm; in all six cases it showed strong enhancement, and in three was discontinuous. In five of six cases, the cystic contents showed high attenuation. Peritoneal fluid was present in all cases, and its attenuation was higher, especially around the uterus and adnexa, than that of urine present in the bladder. Conclusion In a woman in whom CT reveals the presence of an ovarian cyst with an enhancing rim and highly attenuated contents, as well as highly attenuated peritoneal fluid, a ruptured corpus luteal cyst should be suspected. Other possible evidence of this is focal interruption of the cyst wall and the presence of peritoneal fluid around the adnexa. PMID:12679633

Choi, Hyuck Jae; Kim, Sun Ho; Kim, Hyo-Cheol; Park, Chang Min; Lee, Hak Jong; Moon, Min Hoan; Jeong, Jun Yong



Single Event Gate Rupture in EMCCD technology  

NASA Astrophysics Data System (ADS)

The high electric fields (typically 3 MV/cm2 interpoly field) utilised in Electron Multiplying Charged Coupled Devices (EMCCDs) reveal a potential vulnerability from Single Event Phenomena (SEP), in particular Single Event Gate Rupture (SEGR). SEGR is where a conduction path between two conductive areas of the CCD is produced, causing device failure. If EMCCDs are to be used for space applications the susceptibility to these events needs to be explored. A positive result from such an investigation can increase the technology readiness level of the device moving it another step closer to being used in space. Testing undertaken at the CYClotron of LOuvain la NEuve (CYCLONE), using the Heavy Ion Facility (HIF), conclusively showed EMCCD technology to have resilience to heavy ions that surpassed initial expectations. The simulations undertaken prior to experiment suggested gate rupture would occur at 20-40 MeV cm2/mg, however Linear Energy Transfers (LETs) greater than 100 MeV cm2/mg proved to not cause a rupture event. Within the radiation belts heavy ions with an LET greater than 60 MeV cm2/mg are not very common when compared to the fluxes used at the HIF. Possible reasons for this result are discussed in this work, leading to a conclusion that EMCCD technology is a secure choice for space flight.

Evagora, A. M.; Murray, N. J.; Holland, A. D.; Burt, D.



Biosensing using rupture event scanning (REVS)™  

NASA Astrophysics Data System (ADS)

We have developed a sensitive and economical method to detect analytes directly. The technique, which we term rupture event scanning (REVS™), is based on rapidly oscillating an acoustic wave device on which the analytes have been captured. As the magnitude of oscillation of the surface of the acoustic wave device is increased, there is increasing acceleration of adherent analytes. This in turn results in a larger force exerted by the surface on the particle, that ultimately causes rupture of the bonds attaching the particle to the surface. Using the same device, we can very sensitively monitor the excitation of vibrations in the acoustic wave device produced by bond rupture, which are then converted into an electrical signal. The signal indicates not only the presence of specifically bound analytes and their affinity for the receptor, but also the number of analytes present. The method works in air, water and complex biological fluids, is quantitative over at least six orders of magnitude of particle titre, and in affinity from sub-mM to pM. For selected analyte-receptor systems the sensitivity can be as low as 80 fg mm-2 (8 × 10-14 g mm-2). In this paper an example application of REVS™ is presented and the physical forces involved in the process are discussed.

Cooper, Matthew A.



Operative intra-aortic balloon rupture.  


Rupture of an intra-aortic balloon (IAB), inserted to assist in weaning from cardiopulmonary bypass, occurred during attempted intra-aortic administration of protamine in a 71-year-old male who later died. Intra-aortic balloon counterpulsation (IABC) is most commonly utilized to assist in weaning from cardiopulmonary bypass (CPB) or to augment low-flow states following CPB. In-hospital survival following IAB insertion in these circumstances in patients with coronary artery disease is approximately 60 per cent. Patients with valvular disease have a lower in-hospital survival rate (50 per cent). Complications of IABC are usually of vascular or infectious origin. Balloon rupture is a rare though potentially lethal complication. The effects of balloon rupture may be compounded by the use of helium as a driving gas to inflate the balloon. Intra-aortic administration of protamine has not been shown to be superior to peripheral administration and should be avoided if an IAB is in place. PMID:3383321

Finegan, B A; Comm, D G



Liver Hydatid Cyst with Transdiaphragmatic Rupture and Lung Hydatid Cyst Ruptured into Bronchi and Pleural Space  

SciTech Connect

The aim of this case study is to present effectiveness of percutaneous drainage as a treatment option of ruptured lung and liver hydatid cysts. A 65-year-old male patient was admitted with complicated liver and lung hydatid cysts. A liver hydatid cyst had ruptured transdiaphragmatically, and a lung hydatid cyst had ruptured both into bronchi and pleural space. The patient could not undergo surgery because of decreased respiratory function. Both cysts were drained percutaneously using oral albendazole. Povidone-iodine was used to treat the liver cyst after closure of the diaphragmatic rupture. The drainage was considered successful, and the patient had no recurrence of signs and symptoms. Clinical, laboratory, and radiologic recovery was observed during 2.5 months of catheterization. The patient was asymptomatic after catheter drainage. No recurrence was detected during 86 months of follow-up. For inoperable patients with ruptured liver and lung hydatid cysts, percutaneous drainage with oral albendazole is an alternative treatment option to surgery. The percutaneous approach can be life-saving in such cases.

Ar Latin-Small-Letter-Dotless-I bas, Bilgin Kadri, E-mail:; Dingil, Guerbuez [A.Y. Ankara Oncology Training and Research Hospital, Department of Radiology (Turkey); Koeroglu, Mert [Sueleyman Demirel University School of Medicine, Department of Radiology (Turkey); Uenguel, Uemit; Zaral Latin-Small-Letter-Dotless-I , Aliye Ceylan [A.Y. Ankara Oncology Training and Research Hospital, Department of Radiology (Turkey)



Comparison of Topical Nifedipine With Oral Nifedipine for Treatment of Anal Fissure: A Randomized Controlled Trial  

PubMed Central

Background: Medical sphincterotomy has gained popularity as a treatment for anal fissure. Calcium channel blockers in topical forms could also be appropriate with low adverse effects. Objectives: This was a prospective randomized controlled trial to compare topical and oral nifedipine in the treatment of chronic anal fissure. Patients and Methods: A prospective randomized controlled trial was conducted at two centers of Shahed University. One hundred and thirty patients with chronic anal fissure aged 18 to 60 years managed in our clinics were included in this study. The patients were randomly divided into two groups. Sixty-five patients received topical nifedipine (TN) and the same number received oral nifedipine (ON). Results: Ulcer healing occurred in 43 (73.33%) of topical nifedipine group compared to 29 (49.5%) patients in oral nifedipine, which was significantly different (P < 0.05). Side effects such as headache and flushing in oral nifedipine group were more prevalent than topical nifedipine, which was statistically different. Recurrence rates were the same after six months of follow-up. Conclusions: Although oral nifedipine can reduce symptom and signs of anal fissure, topical nifedipine has a superior role for anal fissure treatment with higher healing rate and lower side effects. PMID:25389477

Golfam, Farzaneh; Golfam, Parisa; Golfam, Babak; Pahlevani, Puyan



A late-recognized Currarino syndrome in an adult revealed by an anal fistula  

PubMed Central

INTRODUCTION Currarino syndrome (CS) is characterized by the triad of anorectal malformations, sacral bone defects, and presacral mass in which an autosomal dominant inheritance has been described. The surgical community has a little no knowledge of CS in adults, apart from, perhaps, a small number of paediatric surgeons. Therefore, we sought to describe this unusual cause of anal fistula. PRESENTATION OF CASE A 55-year-old man was referred with an anal fistula. The patient was scheduled for drainage of multiple collections and an anal fistulectomy. Cytological results were confirmed that the cyst was dermoid (and non abscess). One month after surgery, the patient informs us of his CS. MRI was performed and it revealed an anterior sacral mass. It was to decide to realize an exeresis of this mass by coelioscopy. The patient experienced severely constipated and urinary retention. After therapy by Peristeen anal irrigation and self Intermittent catheterization (six times daily), there was a good improvement in symptoms. DISCUSSION This is an extremely rare case of CS revealed in an adult. MRI is a sensitive non-invasive diagnostic tool, and could be performed on any patient with long-standing anal fistula. CONCLUSION We recommend an early and multidisciplinary approach of CS is suspected in a patient. The surgeon must always be alert to the possibility of pelvic nerves injury during an exeresis of a retrorectal tumour fistulized. PMID:24704728

Kassir, Radwan; Kaczmarek, David



[Effectiveness of chemoradiotherapy for three cases of squamous cell anal carcinoma].  


We report three patients with squamous cell anal carcinoma who were treated by chemoradiotherapy. Case 1: A 62-year-old female with squamous cell anal carcinoma invading the vagina underwent a posterior pelvic exenteration. She had paraaortic lymph node metastases. She was treated by chemoradiotherapy with 5-FU/CDDP and external irradiation (50 Gy) as an adjuvant therapy, and survived for 5 years. Case 2: A 74-year-old female with anal squamous cell carcinoma Stage II was treated by chemoradiotherapy with tegafur/uracil, external irradiation (30 Gy) and interstitial irradiation (24 Gy). She is currently living without any signs of recurrence for 3 years and 8 months. Case 3: A 53-year-old female with anal squamous cell carcinoma Stage IIIa was treated by chemoradiotherapy using 5'-DFUR and external irradiation (66 Gy). She is currently living without any signs of recurrence for 1 year and 9 months. The prognosis of anal squamous cell carcinoma that received Cur B or C resection was extremely poor with a median survival time (MST) of 7 or 6 months. Chemoradiotherapy seems to be effective as the first line treatment. PMID:15553743

Takeno, Atsushi; Mishima, Hideyuki; Ikenaga, Masakazu; Masuda, Norikazu; Kashiwazaki, Masaki; Takeda, Yutaka; Hirao, Motohiro; Fujitani, Kazumasa; Sawamura, Toshiro; Tsujinaka, Toshimasa



Estrogen protects against intracranial aneurysm rupture in ovariectomized mice.  


Clinical observations suggest that postmenopausal women have a higher incidence of aneurysmal rupture than premenopausal women. We hypothesize that a relative deficiency in estrogen may increase the risks of aneurysmal growth and subarachnoid hemorrhage in postmenopausal women. We assessed the effects of estrogen and selective estrogen receptor subtype agonists on the development of aneurysmal rupture in ovariectomized female mice. We used an intracranial aneurysm mouse model that recapitulates the key features of human intracranial aneurysms, including spontaneous rupture. Ten- to 12-week-old ovariectomized female mice received treatment with estrogen, nonselective estrogen receptor antagonist, estrogen receptor-? agonist, or estrogen receptor-? agonist starting 6 days after aneurysm induction so that the treatments affected the development of aneurysmal rupture without affecting aneurysmal formation. Estrogen significantly reduced the incidence of ruptured aneurysms and rupture rates in ovariectomized mice. Nonselective estrogen receptor antagonist abolished the protective effect of estrogen. Although estrogen receptor-? agonist did not affect the incidence of ruptured aneurysms or rupture rates, estrogen receptor-? agonist prevented aneurysmal rupture without affecting the formation of aneurysms. The protective role of estrogen receptor-? agonist was abolished by the inhibition of nitric oxide synthase. We showed that estrogen prevented aneurysmal rupture in ovariectomized female mice. The protective effect of estrogen seemed to occur through the activation of estrogen receptor-?, a predominant subtype of estrogen receptor in human intracranial aneurysms and cerebral arteries. PMID:24732889

Tada, Yoshiteru; Wada, Kosuke; Shimada, Kenji; Makino, Hiroshi; Liang, Elena I; Murakami, Shoko; Kudo, Mari; Shikata, Fumiaki; Pena Silva, Ricardo A; Kitazato, Keiko T; Hasan, David M; Kanematsu, Yasuhisa; Nagahiro, Shinji; Hashimoto, Tomoki



Anal Sex Role Segregation and Versatility among Men Who Have Sex with Men: EXPLORE Study  

PubMed Central

Anal sex role patterns and correlates during unprotected anal sex were examined longitudinally among HIV-negative men who have sex with men (MSM). 9.6% were exclusively receptive, 16.7% exclusively insertive, and 63.0% versatile. Versatility was more likely with primary and HIV-negative/unknown status partners and among younger men and substance users, but less likely among Blacks and with higher number of partners. Exclusively receptive role was more likely with HIV-negative/unknown status partners and among younger men and substance users, but less likely with higher number of partners. Examining anal sex role patterns helps understand the factors that drive the epidemic among MSM. PMID:23945255

Van Tieu, Hong; Li, Xin; Donnell, Deborah; Vittinghoff, Eric; Buchbinder, Susan; Parente, Zachary George; Koblin, Beryl



Screening and risk factors for anal cancer precursors in men infected with HIV in Taiwan.  


Homosexual men infected with human immunodeficiency virus (HIV) are at a greater risk of developing anal cancer. Men who are infected with HIV and visited the outpatient clinics in Taoyuan General Hospital were enrolled to this study. During March to December 2011, thin preparation anal Pap smear and human papillomavirus (HPV) genotyping were performed in 230 subjects, of which 69 subjects underwent anoscopic biopsy. Their mean age was 32.9?±?8.1 years, and 181 (78.6%) men were homosexual. The proportion and 95% confidence interval (CI) of subjects with anal dysplasia in cytology was 23.0% (17.56-28.44), including 13.4% (9.26-18.14) with atypical squamous cells of undetermined significance, 7.0% (3.70-10.30) with low-grade squamous intraepithelial lesions, and 2.6% (0.54-4.66) with high-grade squamous intraepithelial lesions. For participants having atypical squamous cells of undetermined significance or higher grades, multivariate logistic regression models yielded adjusted odds ratios (95% CI) of 12.61 (1.63-97.56) for homosexuality, 1.62 (1.31-2.00) for number of oncogenic HPV types, and 1.01 (1.00-1.02) for number of lifetime sexual partners. For detection of histological grade II or III anal intraepithelial neoplasm in anoscopic biopsies, the sensitivity of sequential tests for oncogenic HPV and cytology with atypical squamous cells of undetermined significance or higher grades was 100%. The positive likelihood ratio was 3.09 (P?=?0.05). It is important to consider anal cancer precursors among homosexual men who are infected with HIV. Anal cytology and oncogenic HPV genotyping testing are effective screening methods. PMID:24166485

Cheng, Shu-Hsing; Chu, Fang-Yeh; Wang, Chi-Chao; Hsueh, Yu-Mei



Locomotion of free-swimming ghost knifefish: anal fin kinematics during four behaviors.  


The maneuverability demonstrated by the weakly electric ghost knifefish (Apteronotus albifrons) is a result of its highly flexible ribbon-like anal fin, which extends nearly three-quarters the length of its body and is composed of approximately 150 individual fin rays. To understand how movement of the anal fin controls locomotion we examined kinematics of the whole fin, as well as selected individual fin rays, during four locomotor behaviors executed by free-swimming ghost knifefish: forward swimming, backward swimming, heave (vertical) motion, and hovering. We used high-speed video (1000 fps) to examine the motion of the entire anal fin and we measured the three-dimensional curvature of four adjacent fin rays in the middle of the fin during each behavior to determine how individual fin rays bend along their length during swimming. Canonical discriminant analysis separated all four behaviors on anal fin kinematic variables and showed that forward and backward swimming behaviors contrasted the most: forward behaviors exhibited a large anterior wavelength and posterior amplitude while during backward locomotion the anal fin exhibited both a large posterior wavelength and anterior amplitude. Heave and hover behaviors were defined by similar kinematic variables; however, for each variable, the mean values for heave motions were generally greater than for hovering. Individual fin rays in the middle of the anal fin curved substantially along their length during swimming, and the magnitude of this curvature was nearly twice the previously measured maximum curvature for ray-finned fish fin rays during locomotion. Fin rays were often curved into the direction of motion, indicating active control of fin ray curvature, and not just passive bending in response to fluid loading. PMID:25043841

Youngerman, Eric D; Flammang, Brooke E; Lauder, George V



DNA Methylation Profiling across the Spectrum of HPV-Associated Anal Squamous Neoplasia  

PubMed Central

Background Changes in host tumor genome DNA methylation patterns are among the molecular alterations associated with HPV-related carcinogenesis. However, there is little known about the epigenetic changes associated specifically with the development of anal squamous cell cancer (SCC). We sought to characterize broad methylation profiles across the spectrum of anal squamous neoplasia. Methodology/Principal Findings Twenty-nine formalin-fixed paraffin embedded samples from 24 patients were evaluated and included adjacent histologically normal anal mucosa (NM; n?=?3), SCC-in situ (SCC-IS; n?=?11) and invasive SCC (n?=?15). Thirteen women and 11 men with a median age of 44 years (range 26–81) were included in the study. Using the SFP10 LiPA HPV-typing system, HPV was detected in at least one tissue from all patients with 93% (27/29) being positive for high-risk HPV types and 14 (93%) of 15 invasive SCC tissues testing positive for HPV 16. Bisulfite-modified DNA was interrogated for methylation at 1,505 CpG loci representing 807 genes using the Illumina GoldenGate Methylation Array. When comparing the progression from normal anal mucosa and SCC-IS to invasive SCC, 22 CpG loci representing 20 genes demonstrated significant differential methylation (p<0.01). The majority of differentially methylated gene targets occurred at or close to specific chromosomal locations such as previously described HPV methylation “hotspots” and viral integration sites. Conclusions We have identified a panel of differentially methlylated CpG loci across the spectrum of HPV-associated squamous neoplasia of the anus. To our knowledge, this is the first reported application of large-scale high throughput methylation analysis for the study of anal neoplasia. Our findings support further investigations into the role of host-genome methylation in HPV-associated anal carcinogenesis with implications towards enhanced diagnosis and screening strategies. PMID:23226306

Riggs, Bridget; Eschrich, Steven; Elahi, Abul; Qu, Xiaotao; Ajidahun, Abidemi; Berglund, Anders; Coppola, Domenico; Grady, William M.; Giuliano, Anna R.; Shibata, David



Intensity-Modulated Radiation Therapy for Anal Malignancies: A Preliminary Toxicity and Disease Outcomes Analysis  

SciTech Connect

Purpose: Intensity-modulated radiation therapy (IMRT) has the potential to reduce toxicities associated with chemoradiotherapy in the treatment of anal cancer. This study reports the results of using IMRT in the treatment of anal cancer. Methods and Materials: Records of patients with anal malignancies treated with IMRT at Duke University were reviewed. Acute toxicity was graded using the NCI CTCAEv3.0 scale. Overall survival (OS), metastasis-free survival (MFS), local-regional control (LRC) and colostomy-free survival (CFS) were calculated using the Kaplan-Meier method. Results: Forty-seven patients with anal malignancy (89% canal, 11% perianal skin) were treated with IMRT between August 2006 and September 2008. Median follow-up was 14 months (19 months for SCC patients). Median radiation dose was 54 Gy. Eight patients (18%) required treatment breaks lasting a median of 5 days (range, 2-7 days). Toxicity rates were as follows: Grade 4: leukopenia (7%), thrombocytopenia (2%); Grade 3: leukopenia (18%), diarrhea (9%), and anemia (4%); Grade 2: skin (93%), diarrhea (24%), and leukopenia (24%). The 2-year actuarial overall OS, MFS, LRC, and CFS rates were 85%, 78%, 90% and 82%, respectively. For SCC patients, the 2-year OS, MFS, LRC, and CFS rates were 100%, 100%, 95%, and 91%, respectively. Conclusions: IMRT-based chemoradiotherapy for anal cancer results in significant reductions in normal tissue dose and acute toxicities versus historic controls treated without IMRT, leading to reduced rates of toxicity-related treatment interruption. Early disease-related outcomes seem encouraging. IMRT is emerging as a standard therapy for anal cancer.

Pepek, Joseph M.; Willett, Christopher G.; Wu, Q. Jackie; Yoo, Sua; Clough, Robert W. [Department of Radiation Oncology, Duke University School of Medicine, Durham, NC (United States); Czito, Brian G., E-mail: czito001@mc.duke.ed [Department of Radiation Oncology, Duke University School of Medicine, Durham, NC (United States)



Dynamics of three-dimensional thin film rupture  

NASA Astrophysics Data System (ADS)

We consider the problem of thin film rupture driven by van der Waals forces. A fourth-order nonlinear PDE governs the low Reynolds number lubrication model for a viscous liquid on a solid substrate. Finite-time singularities in this equation model rupture leading to formation of dry spots in the film. Our study addresses the problem of rupture in the full three-dimensional geometry. We focus on stability and selection of the dynamics determined by the initial conditions on small finite domains with planar and axisymmetric geometries. We also address the final stages of the dynamics - self-similar dynamics for point, line, and ring rupture. We will demonstrate that line and ring rupture are unstable and will generically destabilize to produce axisymmetric rupture at isolated points.

Witelski, Thomas P.; Bernoff, Andrew J.



HPV and precancerous lesions of anal canal in women: systematic review  

Microsoft Academic Search

Objective  The infection caused by human papillomavirus (HPV) in the anogenital area is considered the most common sexually transmitted\\u000a infection in the world. Although anal cancer is relatively uncommon in the general population, there has been a significant\\u000a increase in incidence in recent years. In this review, we focused on research on anal lesions in women.\\u000a \\u000a \\u000a \\u000a \\u000a Method  Research on HPV and precancerous

Maria das Graças F. C. Castor; Hilton Justino da Silva; Danyelly Bruneska Gondim Martins; Roberto José Vieira de Mello


Uterine rupture following termination of pregnancy in a scarred uterus.  


We present a series of two cases complicated by uterine rupture following termination of pregnancy (TOP) in the 1st and 2nd trimesters using misoprostol in women with caesarean section scar. Current literature and practise have also been reviewed on ruptured uterus in women with caesarean section scar undergoing TOP using misoprostol; the diagnosis of adherent placenta in the 1st and 2nd trimesters in women with previous caesarean uterine scar; and likely implications of a ruptured uterus. PMID:24456452

Bika, O; Huned, D; Jha, S; Selby, K



[Bilateral uterine rupture of an unscarred gravid uterus before labor].  


We report a case of bilateral spontaneous uterine rupture of an unscarred uterus occured in a primigravida at 32 weeks to take care in our department after in utero transfert. Uterine rupture occurs mainly on scarred uterus during labor. This is an unfrequent but serious complication involving fetal-maternal prognosis in the absence of immediate care. We are conducting a review about spontaneous uterine rupture of unscarred uterus, before and during labor. PMID:24394323

Leroux, M; Coatleven, F; Faure, M; Horovitz, J



Successful infarct exclusion for postinfarction left ventricular free wall rupture  

PubMed Central

The mortality of postinfarction left ventricular free wall rupture is still high. Several surgical techniques have been used for repairing such ruptures. Here, we describe using an infarction exclusion technique to successfully treat a case of a blow-out type postinfarction left ventricular free wall rupture. This technique has frequently been used for repairing postinfarction ventricular septal perforation. In this case, infarcted myocardial tearing was prevented, and complete haemostasis was achieved by infarct exclusion. PMID:23424241

Kato, Yasuyuki; Fukui, Toshihiro; Tabata, Minoru; Takanashi, Shuichiro



Migraine before rupture of intracranial aneurysms  

PubMed Central

Background Rupture of a saccular intracranial aneurysm (SIA) causes thunderclap headache but it remains unclear whether headache in general and migraine in particular are more prevalent in patients with unruptured SIA. Methods In a prospective case–control study 199 consecutive patients with SIA (103 females and 96 males, mean age: 43.2 years) received a semistructured face to face interview focusing on past headaches. All were admitted to hospital mostly because of rupture (177) or for unruptured aneurysm (22). In parallel we interviewed 194 blood donors (86 females, 108 males, mean age: 38.4 years). Diagnoses were made according to the International Headache Society criteria. Aneurysms were diagnosed by conventional cerebral angiography. Results During the year before rupture, 124 (62.3%) had one or more types of headache. These headaches included: migraine without aura (MO): 78 (39.2%), migraine with aura (MA): 2 (1%), probable migraine (PM): 4 (2%), tension-type headache (TTH): 39 (19.6%), cluster headache (CH): 2 (1%), posttraumatic headaches (PH): 2 (1%). 1-year prevalence of headaches in controls was 32.5% (63 patients out of 194), they included: TTH: 45 (23.1%), MO: 17(8.8%), PH: 1(0.5%). Only the prevalence of MO was significantly higher in patients with SIA (OR 6.7, 95% CI 3.8-11.9, p?



Forecasting the Rupture Directivity of Large Earthquakes  

NASA Astrophysics Data System (ADS)

Forecasting the rupture directivity of large earthquakes is an important problem in probabilistic seismic hazard analysis (PSHA), because directivity strongly influences ground motions. We cast this forecasting problem in terms of the conditional hypocenter distribution (CHD), defined to be the probability distribution of a hypocenter given the spatial distribution of fault slip (moment release). The simplest CHD is a uniform distribution for which the hypocenter probability density equals the moment-release probability density. We have compiled samples of CHDs from a global distribution of large earthquakes using three estimation methods: (a) location of hypocenters within the slip distribution from finite-fault inversions, (b) location of hypocenters within early aftershock distributions, and (c) direct inversion for the directivity parameter D, defined in terms of the degree-two polynomial moments of the source space-time function. The data from method (a) are statistically inconsistent with the uniform CHD suggested by McGuire et al. (2002) using method (c). Instead, the data indicate a 'centroid-biased' CHD, in which the expected distance between the hypocenter and the hypocentroid is less than that of a uniform CHD; i.e., the directivities inferred from finite-fault models appear to be closer to bilateral than predicted by the uniform CHD. One source of this discrepancy may be centroid bias in the second-order moments owing to poor localization of the slip in finite-fault inversions. We compare these observational results with CHDs computed from a large set of theoretical ruptures in the Southern California fault system produced by the Rate-State Quake simulator (RSQSim) of Dieterich and Richards-Dinger (2010) and discuss the implications for rupture dynamics and fault-zone heterogeneities.

Donovan, J. R.; Jordan, T. H.



Capturing Continental Rupture Processes in Afar  

NASA Astrophysics Data System (ADS)

Both continental and oceanic rifting processes are highly 3D, but the stability of the along-axis segmentation from rifting to breakup, and its relationship to seafloor spreading remains debated. Three-dimensional models of the interactions of faults and magmatism in time and space are in development, but modelling and observations suggest that magmatic segments may propagate and/or migrate during periods of magmatism. Our ability to discriminate between the various models in large part depends on the quality of data in the ocean-transition zone, or, observations from zones of incipient plate rupture. Largely 2D crustal-scale seismic data from magmatic passive margins reveal large magmatic additions to the crust, but the timing of this heat and mass transfer is weakly constrained. Thus, the lack of information on the across rift breadth of the deforming zone at rupture, and the relationship between the early rift segmentation and the seafloor spreading segmentation represent fundamental gaps in knowledge. Our study of Earth's youngest magmatic margin, the superbly exposed, tectonically active southern Red Sea, aims to answer the following questions: What are the geometry and kinematics of active fault systems across the 'passive margin' to zone of incipient plate rupture? What is the relationship between the initial border fault segmentation, and the breakup zone segmentation? What is the distribution of active deformation and magmatism, and how does it compare to time-averaged strain patterns? We integrate results of recent experiments that suggest widespread replacement of crust and mantle lithosphere beneath the 'passive' margin, and explain the ongoing seismic deformation as a consequence of bending stresses across the ocean-continent transition, with or without a dynamic component.

Ebinger, Cynthia; Belachew, Manahloh; Tepp, Gabrielle; Keir, Derek; Ayele, Atalay



Rapid control in ruptured abdominal aneurysms.  


Rapid control of a ruptured abdominal aneurysm can be achieved under local anesthesia by passing a Fogarty catheter, 8/22 F, retrograde from either femoral artery up into the thoracic aorta and inflating the balloon after administering heparin to the patient. This method avoids the often fatal hypotension that may occur with induction of general anesthesia in the hypovolemic patient. In cases in which the Fogarty catheter cannot pass up the iliac artery, direct insertion of the catheter through the aneurysm can be used, but this method requires the induction of general anesthesia prior to aortic control. PMID:7259508

Sensenig, D M



Atherosclerotic plaque rupture and thrombosis. Evolving concepts.  


Rupture of an atherosclerotic plaque associated with partial or complete thrombotic vessel occlusion is fundamental to the development of ischemic coronary syndromes. Plaques that produce only mild-to-moderate angiographic luminal stenosis are frequently those that undergo abrupt disruption, leading to unstable angina or acute myocardial infarction. Plaques with increased lipid content appear more prone to rupture, particularly when the lipid pool is localized eccentrically within the intima. Macrophages appear to play an important role in atherogenesis, perhaps by participating in the uptake and metabolism of lipoproteins, secretion of growth factors, and production of enzymes and toxic metabolites that may facilitate plaque rupture. In addition, the particular composition or configuration of a plaque and the hemodynamic forces to which it is exposed may determine its susceptibility to disruption. Exposure of collagen, lipids, and smooth muscle cells after plaque rupture leads to the activation of platelets and the coagulation cascade system. The resulting thrombus may lead to marked reduction in myocardial perfusion and the development of an unstable coronary syndrome, or it may become organized and incorporated into the diseased vessel, thus contributing to the progression of atherosclerosis. In unstable angina, plaque disruption leads to thrombosis, which is usually labile and results in only a transient reduction in myocardial perfusion. Release of vasoactive substances, arterial spasm, or increases in myocardial oxygen demand may contribute to ischemia. In acute myocardial infarction, plaque disruption results in a more persistent thrombotic vessel occlusion; the extent of necrosis depends on the size of the artery, the duration of occlusion, the presence of collateral flow, and the integrity of the fibrinolytic system. Thrombi that undergo lysis expose a highly thrombogenic surface to the circulating blood, which has the capacity of activating platelets and the coagulation cascade system and may lead to thrombotic reocclusion. Measurements aimed at reversing the process of atherosclerosis via cholesterol reduction and enhanced high density lipoprotein activity are encouraging. Active research is being focused on the development of new antithrombotic tools, such as inhibitors of thrombin, thromboxane, and serotonin receptor antagonists, and monoclonal antibodies aimed at blocking platelet membrane receptors or adhesive proteins. These compounds may prove useful when immediate and potent inhibition of the hemostatic system is desired. Intensive research is still needed in the areas of pathogenesis and therapeutic intervention in atherosclerosis. PMID:2203564

Fuster, V; Stein, B; Ambrose, J A; Badimon, L; Badimon, J J; Chesebro, J H



Mild and Severe Anal Incontinence after Lateral Internal Sphincterotomy: Risk Factors, Postoperative Anatomical Findings and Quality of Life  

Microsoft Academic Search

Aim: This study aims to evaluate the risk factors for incontinence after lateral internal sphincterotomy (LIS) and assess quality of life in different levels of incontinence. Methods: All consecutive patients (n = 253) with chronic anal fissure who underwent LIS between 2003 and 2006 were retrospectively reviewed. All patients were questioned for possible anal incontinence according to the Wexner Incontinence

M. Kement; M. Karabulut; F. C. Gezen; S. Demirbas; S. Vural; M. Oncel



766 Anal. Chem. $909, citive current at the ensemble (ic,,) is given by i , , = vC~A,,  

E-print Network

. Registry No. C, 7440-44-0. LITERATURE CITED Martin, C. R. In U/tramicroelectrodes; Fleischmann, M., Pons, S.; Martin, C. R. Anal. Chem. 1987, 59, 2625. Cheng, I. F.; Martin, C. R. Anal. Chem. 1988, 60, 2163. Wang. J,P. T., Heineman, W. R. Eds.; Marcel Dek- ker: New York, 1984; pp 294-301. Schexnayder, George, Mobay

Zare, Richard N.


1494 Anal. Chem. 1988, 60, 1494-1498 related to the relatively small number of total ions utilized  

E-print Network

, K. G.; Reiily, J. P. Anal. Chem. 1987, 57, 1884. (25) Cotter, R. J.; Honovich, J.; Olthoff, J. "Time-of-flight for determining the mass spectra. CONCLUSION It would be a significant advance if the mass resolution of 1500, J. M. Int. J. Mass Spectrom. Ion Phys. 1980. 34. 197. Cotter, R.'J. Anal. Chem. 1984, 56, 485A

Chait, Brian T.


What Is an Earthquake?: Fault-Rupture Analogies  

NSDL National Science Digital Library

This activity has two parts: the first part will demonstrate the weaknesses of simple fault models (like block diagrams) in depicting the process of fault rupture accurately; and the second part is centered around a fairly simple animation of rupture propagation, seen by an oblique map view, that attempts to show more accurately what we should envision when we think about fault rupture. This activity provides different analogies for describing the process of fault rupture, with attention paid to the strengths and weaknesses of each.


Ruptured abdominal aortic aneurysm presenting as buttock pain.  


This is the first case report of a ruptured aortic aneurysm presenting with acute right buttock pain. The patient was an 80 year old man. A literature search revealed one report of ruptured internal iliac artery aneurysm presenting with acute hip pain and another of an unruptured aortic aneurysm presenting with chronic hip pain. Thus the present case is another unusual presentation of ruptured abdominal aortic aneurysm and highlights the importance of careful history taking and clinical examination. A high index of clinical suspicion of aneurysm rupture should be maintained in elderly patients presenting with a history of collapse. PMID:15911962

Mahmood, F; Ahsan, F; Hockey, M



The Modulus of Rupture from a Mathematical Point of View  

NASA Astrophysics Data System (ADS)

The goal of this work is to present a complete mathematical study about the three-point bending experiments and the modulus of rupture of brittle materials. We will present the mathematical model associated to three-point bending experiments and we will use the asymptotic expansion method to obtain a new formula to calculate the modulus of rupture. We will compare the modulus of rupture of porcelain obtained with the previous formula with that obtained by using the classic theoretical formula. Finally, we will also present one and three-dimensional numerical simulations to compute the modulus of rupture.

Quintela, P.; Sánchez, M. T.



Ectopic gastric mucosa and glandular tissue of a salivary type in the anal canal concomitant with a diverticulum in hemorrhoidal tissue: Report of a case  

Microsoft Academic Search

Summary  This is believed to be the first report of aberrant gastric and salivary glands in the anal epithelium. An anal diverticulum\\u000a and scoliosis of the lower spine were concomitant findings.

Katsuhisa Shindo; Earry E. Bacon; Elizabeth J. Holmes



Effects of Age, Gender, Bolus Condition, Viscosity, and Volume on Pharyngeal and Upper Esophageal Sphincter Pressure and Temporal Measurements during Swallowing  

ERIC Educational Resources Information Center

Purpose: The purpose of this study was to determine the effects of trial (i.e., Trial 1 vs. Trial 2); viscosity (i.e., saliva, thin, nectar-thick, honey-thick, and pudding-thick water); volume (i.e., 5 mL vs. 10 mL); age (i.e., young vs. older adults); and gender on pharyngeal (i.e., upper and lower) and upper esophageal sphincter (UES) pressures,…

Butler, Susan G.; Stuart, Andrew; Castell, Donald; Russell, Gregory B.; Koch, Kenneth; Kemp, Shannon



Cytologic detection of Strongyloides stercoralis in a 55-year-old Hispanic man with routine rectal/anal pap smear.  


The anal-rectal cytology is introduced recently to evaluate human-papillomavirus related cellular changes in the cells of anal canal. It is especially useful in high risk patients such as HIV patients. Very few reports were published regarding cytomorphological findings in anal cytology. Strongyloides stercoralis is an enteric helminthic parasite with particular significance in immunocompromised patients. The infection is asymptomatic or manifests as mild gastrointestinal symptoms in normal hosts. The infection can be devastating in immunocompromised persons, and carries a high mortality rate. The presence of S. stercoralis larva in anal-rectal pap smears is rare. We report a case in a routine anal-rectal Pap smear with Strongyloides, and discuss the clinical significance and life cycle of S. stercoralis. PMID:19582805

Zhou, Jianhong; Ferrer, Hector; Cleveland, Ronald; Ganesan, Santhi



Quantifying Contributions of the Cricopharyngeus to Upper Esophageal Sphincter Pressure Changes by Means of Intramuscular Electromyography and High-Resolution Manometry  

PubMed Central

Objectives We sought to determine whether the association between cricopharyngeus muscle activity and upper esophageal sphincter pressure may change in a task-dependent fashion. We hypothesized that more automated tasks related to swallow or airway protection would yield a stronger association than would more volitional tasks related to tidal breathing or voice production. Methods Six healthy adult subjects underwent simultaneous intramuscular electromyography of the cricopharyngeus muscle and high-resolution manometry of the upper esophageal sphincter. Correlation coefficients were calculated to characterize the association between the time-linked series. Results Cricopharyngeus muscle activity was most strongly associated with upper esophageal sphincter pressure during swallow and effortful exhalation tasks (r = 0.77 and 0.79, respectively; P < .01). The association was also less variable during swallow and effortful exhalation. Conclusions These findings suggest a greater coupling for the more automatic tasks, and may suggest less coupling and more flexibility for the more volitional, voice-related tasks. These findings support the important role of central patterning for respiratory- and swallow-related tasks. PMID:24633943

Jones, Corinne A.; Hammer, Michael J.; Hoffman, Matthew R.; McCulloch, Timothy M.



Poxvirus membrane biogenesis: rupture not disruption  

PubMed Central

Summary Enveloped viruses acquire their membrane from the host by budding at, or wrapping by, cellular membranes. Transmission electron microscopy (TEM) images, however, suggested that the prototype member of the poxviridae, vaccinia virus (VACV), may create its membrane ‘de novo’ with free open ends exposed in the cytosol. Within the frame of the German-wide priority programme we re-addressed the biogenesis and origin of the VACV membrane using electron tomography (ET), cryo-EM and lipid analysis of purified VACV using mass spectrometry (MS). This review discussed how our data led to a model of unconventional membrane biogenesis involving membrane rupture and the generation of a single open membrane from open membrane intermediates. Lipid analyses of purified virus by MS suggest an ER origin with a relatively low cholesterol content compared with whole cells, confirming published data. Unlike previous reports using thin-layer chromatography, no depletion of phosphatidylethanolamine was detected. We did detect, however, an enrichment for phosphatidic acid, diacylglycerol and phosphatidylinositol in the virion. Our data are discussed in the light of other pathogens that may require cellular membrane rupture during their intracellular life cycle. PMID:23168015

Locker, Jacomine Krijnse; Chlanda, Petr; Sachsenheimer, Timo; Brugger, Britta



TMI-2 lower head creep rupture analysis  

SciTech Connect

The TMI-2 accident resulted in approximately 40% of the reactor's core melting and collecting on the lower head of the reactor pressure vessel. The severity of the accident has raised questions about the margin of safety against rupture of the lower head in this accident since all evidence seems to indicate no major breach of the vessel occurred. Scoping heat transfer analyses of the relocated core debris and lower head have been made based upon assumed core melting scenarios and core material debris formations while in contact with the lower head. This report describes the structural finite element creep rupture analysis of the lower head using a temperature transient judged most likely to challenge the structural capacity of the vessel. This evaluation of vessel response to this transient has provided insight into the creep mechanisms of the vessel wall, a realistic mode of failure, and a means by which margin to failure can be evaluated once examination provides estimated maximum wall temperatures. Suggestions for more extensive research in this area are also provided. 6 refs., 15 figs.

Thinnes, G.L.



[Surgical consideration of ruptured abdominal aortic aneurysms].  


During the recent 18 and a half years, 30 cases of ruptured abdominal aortic aneurysm (including four cases of A-V fistula) were operated at Saiseikai Utsunomiya Hospital. In 26 cases, a conventional graft replacement was performed. In other four cases, axillo-bifemoral bypass (in the cases ruptured into the colon) or other methods were used. Overall operative mortality rate was 26.7%. However, during the last 9 years, operative results were improved (21.7%, 5 deaths out of 23 cases). Amount of intraoperative blood loss influenced the operative results greatly. Other operative risk factors included preoperative shock, preoperative severe cerebrovascular or cardiovascular complications, and postoperative thromboembolism. Factors of recent improvement in mortality included; establishment of emergency system which resulted in earlier operation after the patient's arrival at the hospital, use of occlusive balloon for bleeding control, heparin administration before the aortic clamp for preventing peripheral thromboembolism and introduction of autotransfusion system for reducing the amount of blood transfusion. PMID:2770687

Kiso, I; Yozu, R; Maehara, T; Umezu, Y; Hirotani, T; Ishikura, Y; Takeuchi, S



Management of extensor mechanism rupture after TKA.  


Disruption of the extensor mechanism in total knee arthroplasty may occur by tubercle avulsion, patellar or quadriceps tendon rupture, or patella fracture, and whether occurring intra-operatively or post-operatively can be difficult to manage and is associated with a significant rate of failure and associated complications. This surgery is frequently performed in compromised tissues, and repairs must frequently be protected with cerclage wiring and/or augmentation with local tendon (semi-tendinosis, gracilis) which may also be used to treat soft-tissue loss in the face of chronic disruption. Quadriceps rupture may be treated with conservative therapy if the patient retains active extension. Component loosening or loss of active extension of 20° or greater are clear indications for surgical treatment of patellar fracture. Acute patellar tendon disruption may be treated by primary repair. Chronic extensor failure is often complicated by tissue loss and retraction can be treated with medial gastrocnemius flaps, achilles tendon allografts, and complete extensor mechanism allografts. Attention to fixing the graft in full extension is mandatory to prevent severe extensor lag as the graft stretches out over time. PMID:23118397

Rosenberg, A G



[Traumatic rupture of the descending aorta].  


During a ten-year period 16 patients were seen with aortic rupture and false aneurysm secondary to blunt trauma. One patient underwent an acute operation, 4 patients had operative therapy elective delayed and 11 patients were operated on for chronic traumatic false aneurysm. Operative delay was done in case of simultaneous multisystem injury (e.g. shock caused by abdominal injuries, cerebral contusion or pulmonary contusion on the right side). The shunt bypass method of repair was used in the case of 3 patients, cardiopulmonary bypass in 6 cases and simple aortic cross-clamping in 6 patients. One operation was performed without aortic cross-clamping. Primary repair was achieved in three patient, in 3 more cases a patch was inserted and in 9 cases interposition Dacron grafting was accomplished. One "wrapping" operation was performed. In 2 cases, reoperation was necessary because of postoperative bleeding. One patient died in the perioperative period. Right sided hemiparesis occurred in one patient postoperatively. Rupture does not affect the whole aortic wall, especially in young people because of the natural elasticity of vessel. The appearing shock and hypotension might protect the mediastinal pleura against bursting. This could provide a chance to survive. Our experience indicate: Elective delay of operation in patients with multiple system injuries can be achieved with antihypertensive therapy. PMID:9380385

Kovács, E; Dzsinich, C; Gyöngy, T; Moravcsik, E; Szabolcs, Z; Bodor, E



[Spontaneous rupture of the spleen disclosing pheochromocytoma].  


The authors report a case of spontaneous rupture of spleen inaugurating the symptomatology of a pheochromocytoma. After presenting the observation, clinical problems are considered with a deceptive abdominal symptomatology and myocardial ischemia that could be part of an "adrenergic myocarditis"; the mechanism of ruptured spleen is analyzed. The diagnosis approach is discussed through a reliability study of various explorations: computed tomography has a sensitivity ranging from 93 to 97% which approaches 100% when associated with magnetic resonance, methyl-iodo-benzyl-guanidine scanning seems to be provided with similar reliability. During checking up for pheochromocytoma spreading, ectopic location was not found, but a cold thyroid nodule was detected which allowed suspecting a SIPPLE syndrome. The three-stage surgical approach was required by symptomatology, hemostasis splenectomy, lateral pheochromocytoma excision after a short preparation by blocking alpha and beta, and then total thyroidectomy after extemporaneous confirmation of the existence of a medullary carcinoma of the thyroid. This pathologic association leading to a SIPPLE syndrome is listed as part of the multiple endocrine neoplasias of type II (MEN II). PMID:2262521

Carles, J; Guegan, H; Crozat, T; Janvier, G; Riant, T; Videau, J



GPU Acceleration of Support Operator Rupture Dynamics  

NASA Astrophysics Data System (ADS)

SORD (Support Operator Rupture Dynamics) is an open-source software based on a fourth-order finite-difference method which can simulate 3D elastic wave propagation and spontaneous rupture on hexahedral mesh. It can be used for many kinds of surface boundary conditions, including free surface. The original software is developed by Geoffrey Ely from USC and modified by us for acceleration on GPU with NVIDIA CUDA. Our motivation on accelerating SORD on GPU is inspired by new generation GPU’s superior ability on general purpose computing and NVIDIA CUDA’s user-friendly developing environment for academic users. After translating the code from Fortran 95 to CUDA and implementing the transformed CUDA SORD code on the NVIDIA Tesla C1060, we obtained a factor of 6 speedup as compared to the original Fortran 95 version code , which was run on Intel Xeon X5570 2.9GHz. Our 3D wave solutions show explicitly visually in 3D format the different propagating wave fronts associated with the P and S waves according to the appropriate elastic parameter ratios. Because of the limitation of the global memory of NVIDIA Tesla C1060, too many more grid points would slow the calculation. However, by using the new NVIDIA Tesla C2070, which has 6 GBytes global memory, we can increase the simulation data size into 350X350X350.

Zhou, Y.; Dong, T.; Yuen, D. A.



Rupture velocity inferred from near-field differential ground motion  

NASA Astrophysics Data System (ADS)

The velocity of the rupture propagation is a fundamental source parameter that strongly affects ground motion. It is commonly assessed from kinematic inversion of strong-motion or teleseismic data, sometimes combined with InSar and/or GPS data. The obtained rupture velocity remains inevitably affected by uncertainties, mainly due to imperfect knowledge of the earth structure and tradeoffs between different source parameters. In this study we show how the analysis of differential ground-motion may help constraining the rupture velocity, without a priori information about the earth velocity structure. Our analysis is based on synthetic ground-motion simulations (0-2 Hz) for vertical strike-slip earthquakes propagating unilaterally at a fixed rupture velocity in a homogeneous elastic medium covered with a 1 km-thick low velocity layer (shear wave velocity equal to 1 km/s). We show that when the rupture reaches the bottom of the shallow layer, the phase velocity of transverse waves measured in the forward rupture direction up to a few rupture lengths is equal to the rupture velocity, for a large range of frequencies. The comparison with the phase velocity obtained for a point source then enables to retrieve the value of the rupture velocity. The phase velocity is simply computed from the ratio between the ground velocity and the shear strain or the rotation about a vertical axis. This study points out the utility of setting up dense arrays at the vicinity of major faults to retrieve rupture features such as the rupture velocity.

Causse, Mathieu; Cornou, Cécile; Bécasse, Julie; Bouchon, Michel



Magnetic Sphincter Augmentation with the LINX Device for Gastroesophageal Reflux Disease after U.S. Food and Drug Administration Approval.  


Magnetic sphincter augmentation (MSA) of the gastroesophageal junction with the LINX Reflux Management System is an alternative to fundoplication for gastroesophageal reflux disease (GERD) that was approved by the U.S. Food and Drug Administration (FDA) in March 2012. This is a prospective observational study of all patients who underwent placement of the LINX at two institutions from April 2012 to December 2013 to evaluate our clinical experience with the LINX device after FDA approval. There were no intraoperative complications and only four mild postoperative morbidities: three urinary retentions and one readmission for dehydration. The mean operative time was 60 minutes (range, 31 to 159 minutes) and mean length of stay was 11 hours (range, 5 to 35 hours). GERD health-related quality-of-life scores were available for 83 per cent of patients with a median follow-up of five months (range, 3 to 14 months) and a median score of four (range, 0 to 26). A total of 76.9 per cent of patients were no longer taking proton pump inhibitors. The most common postoperative complaint was dysphagia, which resolved in 79.1 per cent of patients with a median time to resolution of eight weeks. There were eight patients with persistent dysphagia that required balloon dilation with improvement in symptoms. MSA with LINX is a safe and effective alternative to fundoplication for treatment of GERD. The most common postoperative complaint is mild to moderate dysphagia, which usually resolves within 12 weeks. PMID:25264655

Reynolds, Jessica L; Zehetner, Joerg; Bildzukewicz, Nikolai; Katkhouda, Namir; Dandekar, Giovanni; Lipham, John C



Negotiating Risks in Context: A Perspective on Unprotected Anal Intercourse and Barebacking Among Men Who Have Sex with Men—Where Do We Go from Here?  

Microsoft Academic Search

Recently, an alarming trend toward unprotected anal intercourse has emerged in men who have sex with men. A highly dangerous form of unprotected anal intercourse, barebacking—the deliberate and conscious choice to engage in anal sex without condoms knowing that there are risks involved—has received much attention in the gay press. This trend poses new challenges for HIV prevention. As the

Troy Suarez; Jeffrey Miller



Appl. Comput. Harmon. Anal. 15 (2003) 1832  

E-print Network

Appl. Comput. Harmon. Anal. 15 (2003) 18­32 Analysis of quasi-uniform subdivision Adi Levin a and David Levin b, a Cadent Ltd., 17 HaTa'assiya st., Or Yehuda 60408, Israel b School February 2003; accepted 7 May 2003 Communicated by Charles K. Chui Abstract We study the smoothness

Levin, David


Patterns of Vaginal, Oral, and Anal Sexual Intercourse in an Urban Seventh-Grade Population  

ERIC Educational Resources Information Center

Background: This study examines the prevalence of vaginal, oral, and anal intercourse among a population of urban, public middle school students, the characteristics of early sexual initiators, and the sequence of sexual initiation. Such data are limited for early adolescents. Methods: A total of 1279 seventh-grade students (57.3% female, 43.6%…

Markham, Christine M.; Peskin, Melissa Fleschler; Addy, Robert C.; Baumler, Elizabeth R.; Tortolero, Susan R.



The pathology and molecular biology of anal intraepithelial neoplasia: comparisons with cervical and vulvar intraepithelial carcinoma  

Microsoft Academic Search

Background: Anal intraepithelial neoplasia (AIN) is a well-described pathological precursor of invasive squamous cell carcinoma which has recently been detected with increasing frequency in immunocompromised patients, particularly those with seropositivity for human immunodeficiency virus (HIV). The epidemiology and natural history of this entity is somewhat unclear, since the overall prevalence in the HIV seronegative population is unknown. Discussion: There is

A. P. Zbar; C. Fenger; J. Efron; M. Beer-Gabel; S. D. Wexner



UCSF clinical trial shows first evidence that anal cancer is preventable:

A large, international clinical trial led by doctors at the University of California, San Francisco indicates that a vaccine to prevent anal cancer is safe and effective, according to a study reported in the October 27, 2011 issue of New England Journal of Medicine.


Uptake and Predictors of Anal Cancer Screening in Men Who Have Sex With Men  

PubMed Central

Objectives. We investigated attitudes about and acceptance of anal Papanicolaou (Pap) screening among men who have sex with men (MSM). Methods. Free anal Pap screening (cytology) was offered to 1742 MSM in the Multicenter AIDS Cohort Study, who reported history of, attitudes about, and experience with screening. We explored predictors of declining screening with multivariate logistic regression. Results. A history of anal Pap screening was uncommon among non–HIV-infected MSM, but more common among HIV-infected MSM (10% vs 39%; P?anal Pap screening among both HIV-infected and non–HIV-infected MSM across 4 US sites. PMID:23865658

D'Souza, Gypsyamber; Rajan, Shirani D.; Bhatia, Rohini; Cranston, Ross D.; Plankey, Michael W.; Silvestre, Anthony; Ostrow, David G.; Wiley, Dorothy; Shah, Nisha; Brewer, Noel T.



Posterior sagittal approach: Megasigmoid resection and anal reconstruction for severe constipation and fecal incontinence after anoplasty  

Microsoft Academic Search

Purpose: The aim of this study was to present the technique of megasigmoid resection and anal reconstruction by complete posterior sagittal approach for the children with severe constipation and fecal incontinence after anoplasty. Methods: Six patients (age, 2 to 18 years) born with imperforate anus and originally treated with perineal anoplasty suffered from intractable constipation and fecal incontinence. Contrast enema

Long Li; Wang Yan-Xia; Wu Xia-Na; Zhang Jin-Zhe



Ileal pouch-anal anastomosis (IPAA): functional outcome after postoperative pelvic sepsis  

Microsoft Academic Search

Introduction: The ileal pouch-anal anastomosis (IPAA) has become a standard procedure for patients with ulcerative colitis requiring surgical intervention. The technique has greatly improved and, since 1990, all patients at Huddinge University Hospital have been oper- ated on with the double stapled tech- nique. Pelvic sepsis is one of the most serious complications postoperatively, and, according to previous reports, leads

Helena Hallberg; Dagny Ståhlberg; Jan-Erik Åkerlund



The late onset of an anal abscess caused by a chicken bone that complicated stapled hemorrhoidopexy  

Microsoft Academic Search

Dear editor: Stapled hemorrhoidopexy is a safe and feasible procedure to manage third-degree hemorrhoids, but some rare complication still hinders the desire of the patient and the surgeon from practicing stapled hemorrhoidopexy. Herein, we described a case of recurrent anal pain and anismus associated with intermittent febrile status after stapled hemorrhoidopexy for a period. We postulated that intact stapled line

Wen-Shih Huang; Chih-Chien Chin; Chong-Hung Yeh; Paul Y. Lin; Jeng-Yi Wang



Consideration of Future Consequences and Unprotected Anal Intercourse Among Men Who Have Sex with Men  

Microsoft Academic Search

This study of men who have sex with men (MSM) examined whether tendencies to consider the future consequences of one's actions were associated with sexual behaviors that place oneself at risk for HIV infection. A total of 339 HIV-negative MSM responded to the Consideration of Future Consequences Scale (CFC; Strathman et al, 1994) and to questions about their anal intercourse

Paul Robert Appleby; Gary Marks; Armida Ayala; Lynn Carol Miller; Sheila Murphy; Gordon Mansergh



Redefining gay male anal intercourse behaviors: Implications for HIV prevention and research  

Microsoft Academic Search

Research on gay male HIV risk typically groups subjects by whether they report any unprotected anal intercourse (UAI). Recent research suggests that men who consistently withdraw without ejaculation during UAI may represent a distinct group. Correlates of sexual behavior are examined (n = 1001) for men who report: 1) UAI to ejaculation (30% of subjects), 2) UAI with consistent withdrawal

Donald C. Barrett; Gail Bolan; John M. Douglas Jr



Factors associated with unprotected anal intercourse in gay men's casual partnerships in Sydney, Australia  

Microsoft Academic Search

We assessed the factors associated with unprotected anal intercourse in gay men's casual partnerships, using data from a longitudinal cohort study ongoing since October 1992. Participants were recruited through gay community and a variety of other sources and interviewed for the Sydney Men and Sexual Health study. Of 1,037 interviewees at outset, 834 men had casual partners during the six




Unprotected anal intercourse in HIV?infected and non?HIV?infected gay men  

Microsoft Academic Search

In 1990, gay men (N = 296) in Sydney, Australia, were asked to recall two sexual encounters from the preceding year: one in which they had unprotected anal intercourse (“unsafe” encounter) and one in which they had resisted a strong temptation to have unprotected intercourse (“safe” encounter). The aims were to record self?justifications for unprotected intercourse used in the unsafe

Ron S. Gold; Michael J. Skinner; Michael W. Ross



Body Image, Body Satisfaction, and Unsafe Anal Intercourse Among Men Who Have Sex With Men  

Microsoft Academic Search

Using survey results from the 1998 Twin Cities Lesbian, Gay, Bisexual, and Transgender (LGBT) Pride Festival (N = 535), we explored associations between body image and unsafe anal intercourse (UAI) among men who have sex with men (MSM), and evaluated whether body satisfaction mediated this association. MSM who reported underweight body image had lower odds than those who reported average weight of

Donald Allensworth-Davies; Seth L. Welles; Wendy L. Hellerstedt; Michael W. Ross



Use of anal gland secretion to distinguish the two beaver species Castor canadensis and C. fiber  

Microsoft Academic Search

Rosell, F. & Sun, L. 1999: Use of anal gland secretion to distinguish the two beaver species Castor canadensis and C. fiber. - Wildl. Biol. 5: 119-123. Introduced North American beavers Castor canadensis pose a potential threat to the continuing recovery of Eurasian beaver C. fiber populations in several European countries. For management purposes, it is necessary to be able

Frank Rosell; Lixing Sun


How Lichtenstein hernia repair affects abdominal and anal resting pressures: a controlled clinical study  

PubMed Central

Purpose: Inguinal hernia repair is the most common surgical procedure performed by general surgeons worldwide. The Lichtenstein tension-free hernioplasty was first introduced in 1984 and evolved through 1988. Today it is the gold standard in hernia repair. The objective of this study was to determine if intra-abdominal and anal pressures changed in patients with inguinal hernias after Lichtenstein hernioplasties were performed. Materials and methods: A sample of 103 individuals, 92.2% of whom were male (n = 95) and 7.8% of whom were female (n = 8), aged 38.38 ± 14.03 years was used. The sample was divided into two groups: those with inguinal hernia (n = 53) and those without hernia (n = 50), who served as controls. Anal and abdominal manometric measurements were taken from each control patient at baseline and from each study patient before and after surgical repair. Results: Data analysis revealed differentiation of abdominal and anal pressures between the controls, the study patients before operation, and the study patients after operation. The average [SD] abdominal pressure was -2.58 mmHg [5.35] before hernia repair and 2.33 mmHG [3.62] after repair. The average [SD] abdominal pressure in the control group was 1.16 mmHg [1.96]. Conclusions: The Lichtenstein tension-free hernioplasty causes increases in abdominal and anal pressures, but this increase is not of a pathological level. PMID:24600490

Peker, Kemal; Isik, Arda; Inal, Abdullah; Demiryilmaz, Ismail; Yilmaz, Ismayil; Emiroglu, Mustafa



Med Image Anal . Author manuscript A CANDLE for a deeper in vivo insight  

E-print Network

Med Image Anal . Author manuscript Page /1 18 A CANDLE for a deeper in vivo insight Pierrick Coupé A new ollaborative pproach for e hanced enoising under ow-light xcitation (CANDLE) is introduced for the processing ofC A N D L E 3D laser scanning multiphoton microscopy images. CANDLE is designed to be robust

Boyer, Edmond


Anal. Chem. 1993, 65, 375-379 Analytical Utility of the Iridium-Based Mercury  

E-print Network

Anal. Chem. 1993, 65, 375-379 Analytical Utility of the Iridium-Based Mercury over several days use. The applicationof SWASV theory for mercury film electrodes is shown The mercury electrode in ita many forms has been the overwhelmingsubstrate-of-choicefor electrochemistrysince

Kounaves, Samuel P.


Anal human papillomavirus infection is associated with HIV acquisition in men who have sex with men  

Microsoft Academic Search

Objective: Human papillomavirus (HPV) is a common sexually transmitted agent that causes anogenital cancer and precancer lesions that have an inflammatory infiltrate, may be friable and bleed. Our aim was to determine the association between anal HPV infection and HIV acquisition. Design: A prospective cohort study. Methods: We recruited 1409 HIV-negative men who have sex with men from a community-based

Peter V. Chin-Hong; Marla Husnik; Ross D. Cranston; Grant Colfax; Susan Buchbinder; Maria Da Costa; Teresa Darraghg; Dana Jonesj; Franklyn Judsonh; Beryl Koblini; Kenneth H. Mayerf; Joel M. Palefsky



1880 Anal. Chem. 1987, 59,1880-1882 Californium-252 Plasma Desorption with Fourier Transform Mass  

E-print Network

for scanning instruments. Until re- cently PD has only been used with time-of-flight (TOF) mass spectrometers for obtaining PD/FT mass spectra for a variety of compounds with abundant molecular ion species of masses1880 Anal. Chem. 1987, 59,1880-1882 Californium-252 Plasma Desorption with Fourier Transform Mass

Chait, Brian T.


Combined therapy for cancer of the anal canal: A follow-up report  

Microsoft Academic Search

Summary  We believe this preoperative combined therapy is highly effective in treating squamous-cell carcinoma of the anal canal, and\\u000a that a subsequent larger cooperative study with controls is indicated. This pilot study suggests that some individuals may\\u000a be spared abdominoperineal resection when treated in the manner described.

T. R. Buroker; N. Nigro; G. Bradley; L. Pelok; C. Chomchai; B. Considine; V. K. Vaitkevicius



Anal. Chem. 1987, 59, 909-912 909 Determination of Phenylthiohydantoin-Amino Acids by  

E-print Network

chromatography (HPLC) is by far the most widely used method for PTH-amino acid analysis (34). A sensitivity of 5Anal. Chem. 1987, 59, 909-912 909 Determination of Phenylthiohydantoin-Amino Acids by Two phenyithlohydantoln(PTH)-amino acids can be detected and quantltated by time-of-flight (TOF) mass spectrometryusinga

Zare, Richard N.


Effect of systemic steroids on ileal pouch-anal anastomosis in patients with ulcerative colitis  

Microsoft Academic Search

BACKGROUND: Long-term steroid therapy predisposes to postsurgical complications, especially in patients with inflammatory bowel disease. PURPOSE: This study was undertaken to determine incidence of early septic complications after ileal pouch-anal anastomosis (TPAA) in patients who are undergoing prolonged steroid therapy. METHODS: We reviewed charts of 692 patients undergoing restorative proctocolectomy and IPAA to treat ulcerative colitis. Incidence of early (within

Yehiel Ziv; James M. Church; Victor W. Fazio; Tai-Ming King; Ian C. Lavery



HIV infection connected to rising anal cancer rates in men in the U.S.

Human immunodeficiency virus (HIV) infection contributes substantially to the epidemic of anal cancer in men, but not women in the United States, according to new research from NCI. Their findings were published online October 5, 2012, in the Journal of the National Cancer Institute.


J. Math. Anal. Appl. 325 (2007) 13901399  

E-print Network

J. Math. Anal. Appl. 325 (2007) 1390­1399 Uniform laws of large b,2 a School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA 30332-0205, USA b School of Mathematics, University of Southampton, Highfield Southampton, SO17 1BJ, UK

Shapiro, Alex


Anal cytology and p16 immunostaining for screening anal intraepithelial neoplasia in HIV-positive and HIV-negative men who have sex with men: a cross-sectional study.  


Summary Akin to cervical cancer in sexually-active women, men who have sex with men (MSM) are predisposed to anal cancers, especially those with HIV co-infection. This cross-sectional study endeavored to assess the prevalence of anal dysplasia using Pap smears and p16 immunostaining amongst Indian MSM. A total of 31 consecutive HIV-positive and 34 HIV-negative MSM, from a cohort of sexually transmitted infection clinic attendees, underwent anal cytological evaluation with Pap smear and p16 staining. Chi square test and coefficient of correlation were used for comparison. Eighteen (27.7%) had abnormal anal cytology; increased in HIV-positive as compared to HIV-negative men (35% versus 20%, p?=?0.180). Similarly, both low-grade (25.8% versus 17.6%) and high-grade lesions (8.3% versus 4.8%) were comparable in HIV-positive and HIV-negative group. Thirteen (20%) smears were p16-positive with a sensitivity and specificity for anal dysplasia of 72.3% and 100%, respectively. Anal cytology may be used to screen for anal dysplasia in MSM irrespective of HIV status. Furthermore, the addition of p16, with greater specificity for high-grade lesions, may improve diagnostic accuracy especially for high-grade lesions. A larger study to further corroborate these observations is warranted. PMID:24435064

Arora, Rahul; Pandhi, Deepika; Mishra, Kiran; Bhattacharya, Sambit N; Yhome, Vizodilhou A



Ruptured abdominal aortic aneurysm presenting as buttock pain  

Microsoft Academic Search

This is the first case report of a ruptured aortic aneurysm presenting with acute right buttock pain. The patient was an 80 year old man. A literature search revealed one report of ruptured internal iliac artery aneurysm presenting with acute hip pain and another of an unruptured aortic aneurysm presenting with chronic hip pain. Thus the present case is another

F Mahmood; F Ahsan; M Hockey



The resolution of ruptures in the therapeutic alliance  

Microsoft Academic Search

This article outlines some of the main features of a research program on ruptures in the therapeutic alliance and reports some of the major findings to date. A rupture in the therapeutic alliance is a deterioration in the quality of the relationship between patient and therapist; it is an interpersonal marker that indicates a critical opportunity for exploring and understanding

Jeremy D. Safran; J. Christopher Muran



The Resolution of Ruptures in the Therapeutic Alliance.  

ERIC Educational Resources Information Center

A rupture in the therapeutic alliance is a deterioration in the quality of the relationship between patient and therapist; it is an interpersonal marker that indicates an opportunity for exploring and understanding the processes that maintain a maladaptive interpersonal schema. Outlines features of a research program on ruptures in the therapeutic…

Safran, Jeremy D.; Muran, J. Christopher



Rupture of major bronchi resulting from closed chest injuries  

PubMed Central

Four cases of ruptured bronchus following closed chest trauma are described. All injuries resulted from motor vehicle accidents and were diagnosed and treated within 24 hours of admission to the hospital. A satisfactory result followed early suture repair of the ruptured bronchus in three cases. One patient died during pneumonectomy. The early diagnosis and treatment of the condition are discussed. Images PMID:4724503

Collins, John P.; Ketharanathan, V.; McConchie, Ian



Vaginal birth after cesarean and uterine rupture rates in California  

Microsoft Academic Search

Objective: To describe attempted and successful vaginal birth after cesarean (VBAC) rates and uterine rupture rates for women with and without prior cesareans, and compare delivery outcomes in hospitals with different attempted VBAC rates.Methods: We used California hospital discharge summary data for 1995 to calculate attempted and successful VBAC rates and uterine rupture rates. We used multivariate logistic regression models

Kimberly D Gregory; Lisa M Korst; Patricia Cane; Lawrence D Platt; Katherine Kahn



Non-bleeding Spontaneous Rupture of Hepatocellular Carcinoma.  


Rupture of hepatocellular carcinoma (HCC) is not uncommon and most ruptured HCC present with hemoperitoneum and hemorrhagic shock. Management of ruptured HCC is different than non-ruptured one. Short- and long-term mortality increases following rupture of HCC with increasing chances of tumor dissemination. We describe a case with non-bleeding spontaneous rupture of HCC. A 62-year-old male patient was admitted to our institute hospital with mild to moderate pain in the right upper part of the abdomen. He lost appetite and weight. Ultrasonography of the abdomen was performed and it suggested HCC and ascites. Triple phase computer tomography revealed HCC in segments 6 and 7 of liver with typical radiological characteristics. Portal vein was thrombosed. No extravasation of dye was seen. Ruptured of tumor through liver capsule was seen with necrosis and hemorrhage in the center of the tumor. Non-bleeding ruptured HCC has not been reported in the literature to the best of our knowledge. We herein describe this rare case. PMID:24497757

Islam, Mahibul; Deka, Pranjal; Kapur, Raj; Ansari, Md Abu Masud



Successful Patching of Iatrogenic Rupture of the Fetal Membranes  

Microsoft Academic Search

Rupture of the fetal membranes is a common, but potentially serious complication of invasive fetal procedures. Quintero described a technique to seal the fetal membrane defect by means of a bloodpatch, usually called ‘amniopatch’ in this application. The successful use in two consecutive patients with ruptured membranes after a fetoscopic intervention at respectively 17 and 22 weeks' gestational age is

L Lewi; D Van Schoubroeck; M Van Ranst; G Bries; M-P Emonds; B Arabin; R Welch; J Deprest



Survivors of ruptured abdominal aortic aneurysm: the iceberg's tip  

Microsoft Academic Search

In four and a half years 25 patients in one community suffered a ruptured abdominal aortic aneurysm. Eleven died at home, nine died without operation in hospital, and only five had the aneurysm removed. There were four survivors. A further seven patients might have lived had they had a prompt operation. The average operative mortality for ruptured aneurysms among series

R H Armour



Prevalence of anal HPV infection in solid-organ transplant patients prior to immunosuppression.  


Patients that undergo organ transplantation have a high risk of developing various malignancies, depending on the duration and magnitude of immunosuppressive therapy. Among others, a 10-fold increased relative risk has been reported for the development of anal cancer. There is a strong association between persistent infection with high-risk mucosal types of human papillomavirus (HPV) and anogenital neoplasia. In this study we analysed the prevalence of anal HPV infection in organ transplant patients before starting immunosuppressive therapy. In a university transplant unit, patients ( n=60, 40 male, 20 female) that were undergoing solid-organ transplantation (kidney, liver) for the first time were routinely screened for anal HPV infection. Anal swabs were obtained within 24 h after transplantation and analysed for the presence of mucosal-type HPV DNA by liquid DNA/RNA hybridization [hybrid capture (HC) 2 test]. Overall, some type of HPV DNA was detected in 14/60 (23.3%) patients; 9/60 (15%) were positive for high-risk HPV and 8/60 (13.4%) were positive for low-risk HPV, and 3/60 (5%) were positive for both types. Prevalence of HPV infection tended to be higher in patients that were receiving liver transplants than in those receiving kidney transplants (29.4% vs. 20.9%), but the difference did not reach statistical significance. In our series of organ transplant patients the prevalence of previous HPV infection (23.3%) before immunosuppressive therapy was started was higher than that found in previous epidemiological studies or in a control group. In particular, there was a high rate (15%) of infection with oncogenic HPV types. These findings have important implications on screening and surveillance policies in this patient group at risk of developing neoplasias, including anal cancer. PMID:15349721

Roka, Sebastian; Rasoul-Rockenschaub, Susanne; Roka, Julia; Kirnbauer, Reinhard; Mühlbacher, Ferdinand; Salat, Andreas



Do All Large Strike-slip Earthquakes Have Supershear Ruptures?  

NASA Astrophysics Data System (ADS)

Studying the rupture speeds of earthquakes is of broad interesting for earthquake research because it has a large effect on the strong near-field shaking that causes damage during earthquakes. Also rupture speed is a key observation for understanding the controlling stresses and friction during an earthquake, yet the speed and its variations are usually difficult to determine. Using only far-field seismic waveforms, which is the only data available for many large earthquakes, there are problems for estimating the rupture speed with standard waveform inversions, due to trade-off between the rupture speed and the slip location. Here we applied a back projection method to estimate the rupture speeds of Mw ? 7.5 strike-slip earthquakes since 2001 which could be analyzed using Hi-net in Japan. We found that all events had very fast average rupture speeds of 3.0-6.0 km/s, which are near or greater than the local shear wave velocity (supershear). These values are faster than for thrust and normal faulting earthquakes that generally rupture with speeds of 1.0-3.0 km/s. Considering the depth-dependent shear-wave velocity, the average propagation speeds for all of the strike-slip events are closer to or greater than the shear wave velocity (Figure 1). For large strike-slip events, transition from subshear to supershear usually occurs within distances of 15 to 30 km from the initiation, which is probably the reason for the scarcity of observed supershear earthquakes for smaller magnitudes. Earthquakes with supershear ruptures can cause more damage than events with subshear ruptures because of the concentration of energy in the forward direction of the rupture. Numerical modeling shows strong focusing and other effects of energy at the rupture front which can intensify the ground motions. A recent example is the April 13, 2010 Qinghai, China earthquake (Mw 6.9), where a moderate-size event caused extensive damage in the Yushu region at the southeastern end of the fault. Careful evaluation of long and straight strike-slip faults should be emphasized for predicting strong ground motions due to supershear rupture. a: Average rupture speeds for Mw ? 7.5 strike-slip earthquakes. For comparison, dip-slip earthquakes are also shown. The blue dashed line presents the S wave velocity model of PREM for comparison. b: Rupture velocities are shown as ratio to the local S wave velocity, as a function of depth.

Wang, D.; Mori, J. J.; Koketsu, K.



Rupture of Right Hepatic Duct into Hydatid Cyst  

PubMed Central

Echinococcal disease can develop anywhere in the human body. The liver represents its most frequent location. Hepatic hydatid cysts may rupture into the biliary tract, thorax, peritoneum, viscera, digestive tract or skin. We report a rare case with rupture of the right hepatic duct into a hydatid cyst in a woman with known hydatid disease and choledocholithiasis. The increased intra-luminal pressure in the biliary tree caused the rupture into the adjacent hydatid cyst. The creation of the fistula between the right hepatic duct and the hydatid cyst decompressed the biliary tree, decreased the bilirubin levels and offered a temporary resolution of the obstructive jaundice. Rupture of a hydatid cyst into the biliary tree usually leads to biliary colic, cholangitis and jaundice. However, in case of obstructive jaundice due to choledocholithiasis, it is possible that the cyst may rupture by other way around while offering the patient a temporary relief from his symptoms. PMID:22876065

Laskou, Styliani; Papavramidis, Theodossis S.; Pliakos, Ioannis; Kotidis, Eustathios; Kesisoglou, Isaak; Papavramidis, Spiros T.



Malignant fibrous histiocytoma presenting as hemoperitoneum mimicking hepatocellular carcinoma rupture  

PubMed Central

Malignant fibrous histiocytoma (MFH) is a pleomorphic mesenchynal sarcoma. It is uncommonly arises primarily from the intra-peritoneal cavity. Primary peritoneal MFH with tumor bleeding and rupture is rare. We describe the imaging features of a 70-year-old patient presenting with ruptured hemorrhagic peritoneal MFH at subhepatic area, accompanied by massive hemoperitoneum, mimicking a ruptured pedunculated hepatocellular carcinoma. Computed tomography (CT) revealed a large heterogeneous enhanced subhepatic mass with adjacent liver, gallbladder and colon invasion. Tumor hemorrhage and rupture complicated with peritoneal seeding and massive bloody ascites were also detected. Angiography showed a hypervascular tumor fed by enlarged right hepatic arteries, cystic artery and omental branches of gastroepiploic artery. The patient underwent laparotomy for tumor resection, but the tumor recurred one month after operation. To our knowledge, the CT appearance of ruptured intraperitoneal MFH complicated by hemoperitoneum has not been previously described. PMID:18081238

Chen, Hsin-Chi; Chen, Chi-Jen; Jeng, Chin-Ming; Yang, Chan-Ming



Macroscopic Source Properties from Dynamic Rupture Styles in Plastic Media  

NASA Astrophysics Data System (ADS)

High stress concentrations at earthquake rupture fronts may generate an inelastic off-fault response at the rupture tip, leading to increased energy absorption in the damage zone. Furthermore, the induced asymmetric plastic strain field in in-plane rupture modes may produce bimaterial interfaces that can increase radiation efficiency and reduce frictional dissipation. Off-fault inelasticity thus plays an important role for realistic predictions of near-fault ground motion. Guided by our previous studies in the 2D elastic case, we perform rupture dynamics simulations including rate-and-state friction and off-fault plasticity to investigate the effects on the rupture properties. We quantitatively analyze macroscopic source properties for different rupture styles, ranging from cracks to pulses and subshear to supershear ruptures, and their transitional mechanisms. The energy dissipation due to off-fault inelasticity modifies the conditions to obtain each rupture style and alters macroscopic source properties. We examine apparent fracture energy, rupture