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1

Successful overlapping anal sphincter repair  

Microsoft Academic Search

BACKGROUND: Fecal incontinence from single anal sphincter defects are surgically remedial and commonly the result of obstetric injuries. Overlapping anal sphincter repair has previously been associated in small series with good results in 69 to 97 percent of patients. OBJECTIVES: The aims of this study were to assess the results of overlapping anal sphincter repair in one institution and to

Christopher J. Young; Manu N. Mathur; Anthony A. Eyers; Michael J. Solomon

1998-01-01

2

Local thermal stimulation relaxes hypertonic anal sphincter  

Microsoft Academic Search

PURPOSE: Although it is generally believed that warm perineal baths reduce pain resulting from anal fissure, complicated hemorrhoids, or anal surgery, the exact mechanisms remain unclear. Because hypertonicity of the internal anal sphincter contributes to increasing pain in these conditions, it has been postulated that warm perineal baths could help to relax the anal sphincter, hence reducing pain. It is

Jeng-Kae Jiang; Jen-Hwey Chiu; Jen-Kou Lin

1999-01-01

3

Obstetric events leading to anal sphincter damage  

Microsoft Academic Search

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

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

1998-01-01

4

Overlap repair of damaged anal sphincter  

Microsoft Academic Search

PURPOSE: This study was undertaken to review consecutive cases of anal sphincter repair performed by a single surgeon with respect to outcome as measured by continence grade using the Parks-Browning scale. Other parameters such as manometry, pudendal nerve function, and morbidity are also reviewed with respect to outcome. METHODS: Thirty-one of 52 patients identified by computer were available for analysis.

P. J. Sitzler; J. P. S. Thomson

1996-01-01

5

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

2014-01-01

6

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

Microsoft Academic Search

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

H. L. Duthie; R. C. Bennett

1963-01-01

7

Overlapping Repair in Patients with Anal Sphincter Injury  

Microsoft Academic Search

Objective: The aim of this study was to demonstrate the improvement of anal canal function after overlap sphincter repair and confirm that this treatment option is superior in patients with nonobstetric sphincter damage. Subjects and Methods: From 1998 to 2003, 44 women who underwent overlapping sphincter repair were enrolled in this study. The women were allocated to one of two

Sezai Demirbas; Vedat Atay; Ilker Sucullu; A. Ilker Filiz

2008-01-01

8

Ultrastructural changes in internal anal sphincter in neurogenic faecal incontinence  

Microsoft Academic Search

The ultrastructural features of the internal anal sphincter (IAS) muscle were studied in biopsies from five patients with neurogenic anorectal incontinence and six control subjects undergoing anorectal excision for cancer, or for inflammatory bowel disease. In the patients with idiopathic neurogenic anorectal incontinence the internal anal sphincter showed loss of smooth muscle cells, disruption of the normal relationships of the

M Swash; A Gray; D Z Lubowski; R J Nicholls

1988-01-01

9

Neuropeptides in the internal anal sphincter in neurogenic faecal incontinence  

Microsoft Academic Search

The internal anal sphincter has both an intrinsic and extrinsic innervation which modulates its activity. While the nature of the extrinsic innervation has been well characterised, the same is not true of the intrinsic innervation. Although a variety of neurotransmitters have been identified in the human internal anal sphincter, their physiological role in health, and possible involvement in disease processes,

C. T. M. Speakman; C. H. V. Hoyle; M. A. Kamm; M. M. Henry; R. J. Nicholls; G. Burnstock

1993-01-01

10

Prospective study of artificial anal sphincter and dynamic graciloplasty for severe anal incontinence  

Microsoft Academic Search

Background and aims. Dynamic graciloplasty and artificial anal sphincter are two options for refractory incontinence, the efficacy of which was compared in a prospective study.Patients and methods. Between November 1966 and June 1998, 16 patients were operated on (artificial anal sphincter 8, dynamic graciloplasty 8). Four consecutive operations with each technique were performed by two colorectal surgeons (one initiated the

H. Ortiz; P. Armendariz; M. DeMiguel; A. Solana; R. Alós; J. V. Roig

2003-01-01

11

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

Microsoft Academic Search

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

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

1994-01-01

12

Topical diltiazem and bethanechol decrease anal sphincter pressure without side effects  

Microsoft Academic Search

BACKGROUNDTopical nitrates lower anal sphincter pressure and heal anal fissures, but a majority of patients experience headache. The internal anal sphincter has a calcium dependent mechanism to maintain tone, and also receives an inhibitory extrinsic cholinergic innervation. It may therefore be possible to lower anal sphincter pressure using calcium channel blockers and cholinergic agonists without side effects.AIMSTo investigate the effect

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

1999-01-01

13

Hereditary internal anal sphincter myopathy: the first Caribbean family  

Microsoft Academic Search

Hereditary proctalgia is an extremely rare condition characterized by endosonographic evidence of internal anal sphincter\\u000a (IAS) thickening and specific ultrastructural changes seen at light and electron microscopy (EM). We report the case of a\\u000a 54-year-old Caribbean woman with severe proctalgia and IAS thickening, treated with IAS myectomy. Transmission EM showed PAS-positive\\u000a inclusions and granulofibrillary smooth muscle inclusion bodies. Anal endosonography

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

2007-01-01

14

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

PubMed

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

2011-11-01

15

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

Microsoft Academic Search

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

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

1990-01-01

16

Thermal responses of shape memory alloy artificial anal sphincters  

NASA Astrophysics Data System (ADS)

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

Luo, Yun; Takagi, Toshiyuki; Matsuzawa, Kenichi

2003-08-01

17

Obstetrics anal sphincter injury and repair technique: A review.  

PubMed

The Urogynecology Committee of the Asia and Oceania Federation of Obstetrics and Gynaecology (AOFOG) has held seminars and workshops on various urogynecological problems in each country in the Asia-Oceania area in order to encourage young obstetricians and gynecologists. In 2013, we organized the operative seminar for obstetrical anal sphincter injuries (OASIS) in which we prepared porcine models to educate young physicians in a hands-on workshop at the 23rd Asian and Oceanic Congress of Obstetrics and Gynaecology in Bangkok, Thailand. Laceration of the anal sphincter mostly occurs during vaginal delivery and it can develop into anal sphincter deficiency, which causes fecal incontinence, if an appropriate suture is not performed. OASIS has become an important issue, especially in developing countries. The prevalence of OASIS of more than the third degree is around 5% in primary parous women and the frequency is higher when detected by ultrasonographic evaluation. Several risk factors, such as macrosomia, instrumental labor, perineal episiotomy and high maternal age, have been recognized. In a society where pregnant women are getting older, OASIS is becoming a more serious issue. An intrapartum primary appropriate stitch is important, but the 1-year outcome of a delayed operation after 2 weeks postpartum is similar. A randomized controlled study showed that overlapping suture of the external sphincter is better than that of end-to-end surgical repair. The Urogynecology Committee of the AOFOG would like to continue with educative programs about the appropriate therapy for OASIS. PMID:25545893

Temtanakitpaisan, Teerayut; Bunyacejchevin, Suvit; Koyama, Masayasu

2015-03-01

18

Issues in anatomy: the external anal sphincter revisited.  

PubMed

Textbooks of anatomy often fail to reflect controversies or new developments in anatomy. This impinges on the conduct of examinations in anatomy with respect to whether the correct answer is what appears in the textbook or what is known in the research literature. The example of the external anal sphincter is addressed. Whereas textbooks portray this muscle as having three, essentially circular parts, past and more recent work denies this description. Rather, the sphincter consists of three loops; one formed by puborectalis, one stemming from the coccyx and one stemming from the pre-anal skin. Surgeons in training should recognise that anatomy is not a static science and that idealized descriptions that occur in textbooks do not necessarily reflect actual anatomy or controversies about it. PMID:8859165

Bogduk, N

1996-09-01

19

Purine receptors in the guinea-pig internal anal sphincter.  

PubMed Central

1 In the isolated internal anal sphincter of the guinea-pig, adenosine 5'-triphosphate (ATP) and adenosine induced a concentration-dependent and tetrodotoxin-insensitive relaxation. 2 Pretreatment with theophylline (25-50 microM) had no significant effect on the concentration-response curves obtained with either purine compound. 3 Reactive blue 2 (25-100 microM) shifted the curve to ATP to the right in a dose-dependent fashion leaving that to adenosine unaltered. The antagonism appeared to be non-competitive. 4 Neither reactive blue 2 nor purine receptor occupation by ATP or adenosine altered the electrically-induced non-adrenergic, non-cholinergic inhibitory response. 5 The actions of ATP and adenosine in the guinea-pig internal anal sphincter appear to be mediated by separate receptors. These receptors are not involved in the nerve-mediated relaxation. PMID:6301603

Crema, A.; Frigo, G. M.; Lecchini, S.; Manzo, L.; Onori, L.; Tonini, M.

1983-01-01

20

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

PubMed

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

Kersting, S; Berg, E

2012-08-01

21

Anatomical Disruption & Length-Tension Dysfunction of Anal Sphincter Complex Muscles in Women with Fecal Incontinence  

PubMed Central

BACKGROUND Anal sphincter complex muscles; internal anal sphincter, external anal sphincter and puborectalis muscles, play important role in the anal continence mechanism. Patients with symptoms of fecal incontinence have weak anal sphincter complex muscles; however, their length-tension properties and relationship to anatomical disruption have never been studied. OBJECTIVE To assess the anatomy of anal sphincter complex muscles using 3D-ultrasound imaging system and determine the relationship between anatomical defects and length-tension property of external anal sphincter and puborectalis muscles in women with incontinence symptoms and control subjects. DESIGN Severity of anal sphincter muscle damage was determined by static and dynamic 3Dimensional-ultrasound imaging. Length-tension property was determined by anal and vaginal pressure respectively using custom designed probes. PATIENTS 44 asymptomatic controls and 24 incontinent patients participated in this study. MAIN OUTCOME MEAUSURES Anatomical defects and length-tension dysfunction of anal sphincter complex muscles in FI patients were evaluated. RESULT Prevalence of injury to sphincter muscles are significantly higher in the incontinent patients compared to controls. 85% of patients but only 9% controls reveal damage to ?2 of the 3 muscles of anal sphincter complex. Anal and vaginal squeeze pressure increased with increase in the probe size (length-tension curve) in majority of controls. In patients, the increase in anal and vaginal squeeze pressures was either significantly smaller than controls or it decreased with the increasing probe size (abnormal length-tension). CONCLUSIONS Length-tension property of the external anal sphincter and puborectalis muscles is significantly impaired in incontinent patients. Our findings have therapeutic implication in the treatment of anal incontinence. PMID:24105004

Kim, Young Sun; Weinstein, Milena; Raizada, Varuna; Jiang, Yanfen; Bhargava, Valmik; Rajasekaran, M. Raj; Mittal, Ravinder K.

2013-01-01

22

The action of nicotine and catecholamines on the human internal anal sphincter  

Microsoft Academic Search

Exogenous noradrenalin causes contractions in both proximal and distal parts of the internal anal sphincter, adrenalin sometimes causes contractions and sometimes relaxations, and isoprenaline always causes relaxations.

C. A. Friedmann

1968-01-01

23

Evaluation of the development of the fetal anal sphincter with tomography ultrasonography imaging.  

PubMed

The aim of the study described here was to examine the potential of tomography ultrasonography imaging (TUI) in evaluation of the fetal anal sphincter. In this prospective cross-sectional study of the fetal anal sphincter with TUI, 326 singleton pregnancies (mean age = 28 y, range: 22-38 y) were scanned at 19-40 wk of gestation. The fetal anal region and ischium were revealed in 320 of 326 patients (98.2%). The normal fetal anal sphincter diameter and ischial space reached maximums of 15 and 39 mm, respectively. The normal fetal anal sphincter diameter and the ischial space were plotted as a function of gestational age (GA) on a linear curve, and the regression equations for normal fetal anal sphincter diameter and ischial space as a function of GA in weeks were obtained. A scatterplot was also created that revealed a significant positive relationship between normal fetal anal sphincter diameter and ischial space. On the basis of these criteria, imperforate anus was diagnosed in one fetus. Ultrasonographic assessment of the fetal anal sphincter and the ischium with TUI is feasible. The reference values reported in this article may be useful in prenatal diagnosis of fetal anal sphincter abnormalities. PMID:25438852

Guang, Yang; Wang, Xi; Cai, Ai-Lu; Xie, Li-Mei; Ding, Hai-Long; Meng, Xin-Yue

2015-01-01

24

Anal sphincter biofeedback relaxation treatment for women with intractable constipation symptoms  

Microsoft Academic Search

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

Geoffrey K. Turnbull; Paul G. Ritvo

1992-01-01

25

[Anal sphincter tears after vaginal delivery: risks factors and means of prevention].  

PubMed

To identify incidence and risks factors of obstetrical anal sphincter lacerations, we reviewed all cases of 3rd and 4th degree sphincter lacerations after vaginal deliveries (VD) occured in a tertiary maternity between 2005 and 2010. 78 anal sphincter lacerations were identified (3.8/1000 deliveries). 66 women (85%) were nulliparous. The mean age of women was of 29 +/- 5 years. The mean duration of the second stage of labour was of 3.4 +/- 1,7 hour. The birth weight of 12 newborns (15%) was greater than 4000 grams. Fourty-six women (2.5%) had sphincter lacerations after instrumental delivery and 32 after spontaneous vaginal delivery (0.2%). 51 patients out of 78 (65%) had a medio-lateral episiotomy, 82% occured after instrumental extraction and 43% after spontaneous delivery. A forceps of Tarnier was used in 18 cases, a Suzor forceps in 12 cases, spatula in 12 cases and vacuum in 4 cases. 76% of foetuses were in anterior presentation and 78% at the medium part of the pelvis. 2 patients experienced anal incontinence in early post-partum. Anal sphincter lacerations are relatively frequent after VD especially after instrumental delivery. Macrosomia, nulliparous women, prolonged second stage of labor were associated with anal sphincter tears. Medio-lateral episiotomy does not protect enough anal sphincters. Anal sphincter lacerations lead to anal incontinence in some cases.A long follow-up is useful for these patients. PMID:22141262

Alouini, S; Rossard, L; Lemaire, B; Mégier, P; Mesnard, L

2011-10-01

26

Influence of pudendal block on the function of the anal sphincters  

Microsoft Academic Search

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

B Frenckner; C V Euler

1975-01-01

27

Endoluminal ultrasound is preferable to electromyography in mapping anal sphincteric defects  

Microsoft Academic Search

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

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

1993-01-01

28

Preliminary investigation of the pharmacology of the human internal anal sphincter  

Microsoft Academic Search

The smooth muscle from the human internal anal sphincter has been investigated pharmacologically in vitro. The upper and lower parts of the sphincter responded to catecholamines in a similar manner. Noradrenaline caused contraction which could be antagonized by phenoxybenzamine. After phenoxybenzamine, noradrenaline caused relaxation which could be blocked by pronethalol. Isoprenaline caused relaxation which could be specifically prevented by pronethalol.

A. G. Parks; D. J. Fishlock; J. D. H. Cameron; H. May

1969-01-01

29

Long-Term Clinical Outcome After Botulinum Toxin Injection in Children With Nonrelaxing Internal Anal Sphincter  

Microsoft Academic Search

OBJECTIVES:Children with surgically repaired Hirschsprung's disease (HD) and those with internal anal sphincter (IAS) achalasia may develop obstructive gastrointestinal symptoms and\\/or enterocolitis due to a functional obstruction caused by an inability of the IAS to relax. Anal sphincter Clostridium botulinum toxin (BoTox) injections may provide a reversible therapy. However, there is limited information regarding the long-term outcomes of children receiving

Bruno P Chumpitazi; Steven J Fishman; Samuel Nurko

2009-01-01

30

Anal sphincteric neurogenic injury in asymptomatic nulliparous women and fecal incontinence.  

PubMed

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

Bharucha, Adil E; Daube, Jasper; Litchy, William; Traue, Julia; Edge, Jessica; Enck, Paul; Zinsmeister, Alan R

2012-07-15

31

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

Microsoft Academic Search

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

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

2008-01-01

32

Internal anal sphincter augmentation for fecal incontinence using injectable silicone biomaterial  

Microsoft Academic Search

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

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

2001-01-01

33

Intrarectal ground electrode improves the reliability of motor evoked potentials recorded in the anal sphincter.  

PubMed

Motor evoked potentials (MEPs) can be recorded in the external anal sphincter in response to magnetic stimulation of the cerebral cortex or sacral roots. However, the magnitude of the stimulus artifact may alter the reliability of anal MEP recording. An intrarectal ground electrode substantially reduces stimulus artifact and technical failure, improving MEP latency determination to sacral root stimulation in particular. PMID:15880519

Lefaucheur, Jean-Pascal

2005-07-01

34

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

NASA Astrophysics Data System (ADS)

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

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

2005-02-01

35

Mode of Vaginal Delivery: A Modifiable Intrapartum Risk Factor for Obstetric Anal Sphincter Injury  

PubMed Central

The aim of this study was to analyze the comparative risks of this anal sphincter injury in relation to the type of intervention in vaginal delivery. We performed an observational, retrospective study of all vaginal deliveries attended at a tertiary university hospital between January 2006 and December 2009. We analyzed the incidence of obstetric anal sphincter injury for each mode of vaginal delivery: spontaneous delivery, vacuum, Thierry spatulas, and forceps. We determined the proportional incidence between methods taking spontaneous delivery as the reference. Ninety-seven of 4526 (2.14%) women included in the study presented obstetric anal sphincter injury. Instrumental deliveries showed a significantly higher risk of anal sphincter injury (2.7 to 4.9%) than spontaneous deliveries (1.1%). The highest incidence was for Thierry spatulas (OR 4.804), followed by forceps (OR 4.089) and vacuum extraction (OR 2.509). The type of intervention in a vaginal delivery is a modifiable intrapartum risk factor for obstetric anal sphincter injury. Tearing can occur in any type of delivery but proportions vary significantly. All healthcare professionals attending childbirth should be aware of the risk for each type of intervention and consider these together with the obstetric factors in each case. PMID:25722727

Simó González, Marta; Porta Roda, Oriol; Perelló Capó, Josep; Gich Saladich, Ignasi; Calaf Alsina, Joaquim

2015-01-01

36

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

PubMed

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

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

2014-06-01

37

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

SciTech Connect

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

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

2007-10-01

38

Optimal parameters for effective electrical stimulation of the anal sphincters in a child with fecal incontinence: preliminary report  

Microsoft Academic Search

The purpose of the present study was to examine the optimal parameters for electrical stimulation of the anal sphincters to improve fecal incontinence in a child after abdominoperineal anorectoplasty for imperforate anus. A pair of coiled-wire electrodes was implanted bilaterally into the deep external sphincter, and alternating bidirectional, biphasic pulses of regulated current were applied. Anal pressure increased in response

Yasuo Yamamotol; Kenzo Akazawa

1993-01-01

39

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

PubMed

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

2011-10-01

40

Experience with a new prosthetic anal sphincter in three coloproctological centres  

PubMed Central

Background Fecal incontinence is a common and severely disabling disorder. For patients with severe fecal incontinence, surgery may prove to be the only adequate treatment option. Methods This study reports on 43 patients that were treated with a prosthetic sphincter system between 2005 and 2009 in three coloproctological centres. Main Outcome Measures: complications, anal pressures before and after surgery, fecal continence score. Results The new artificial sphincter system significantly improves continence but leads to some complications in clinical practice. After implantation of the device, continence improved significantly (Keller & Jostarndt continence score 2.6 to 14.3 (P?anal sphincter squeeze pressure (32.2 mmHg versus 85.9 mm Hg, P?anal band of AMI (AAS), a new artificial anal sphincter, improves severe anal incontinence, but it must be regarded as a last treatment option to avoid a stoma. PMID:24502440

2013-01-01

41

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

Microsoft Academic Search

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

D. Taverner; F. G. Smiddy

1959-01-01

42

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

PubMed Central

Distention of the proximal colon may have inhibitory or excitatory effects on the rectum and vice versa. The reflexes between the proximal colon and the rectum have not been well studied due to difficulties in accessing the proximal colon. The aim of this study was to investigate the reflex responses and their mechanisms between the proximal colon and the rectum in consideration of distention-related changes in tone and compliance of these regions as well as anal sphincter relaxation in a canine model. Proximal colon/rectal tone, compliance, and anal sphincter relaxation were investigated in six dogs chronically implanted with a proximal colon cannula while in the fasting state and during proximal colon distention or rectal distention. It was found that: 1) both rectal distention and proximal colon distention significantly and substantially decreased the compliance of the opposite regions, and guanethidine abolished proximal colon distention-induced changes in rectal compliance; 2) rectal/proximal colon distension decreased proximal colonic/rectal tone, and guanethidine abolished both of these inhibitory effects; 3) the anal sphincter was more sensitive to rectal distention than proximal colon distention; and 4) the minimal distention pressure required to induce anal inhibitory reflex was lower for rectal distention than proximal colon distention. It was concluded that distention-related changes in tone and compliance suggest the long inhibitory reflexes between the proximal colon and the rectum with the sympathetic involvement in rectal responses. The anal sphincter is more sensitive to the distention of the rectum than that of the proximal colon. PMID:20554930

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

2010-01-01

43

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

Microsoft Academic Search

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

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

2007-01-01

44

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

PubMed

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

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

2008-07-01

45

A novel artificial anal sphincter system in an in vitro and in vivo experiment.  

PubMed

This paper presents some of the latest progress in the development of a novel artificial anal sphincter system (AASS) to treat severe fecal incontinence. We have redesigned and integrated an intelligent, remote-controlled artificial anal sphincter based on biological signal feedback mechanisms. The device consists of an external telemetry unit, an internal artificial anal sphincter (IAAS), and a transcutaneous energy transfer system (TETS). The mechanical medical micropump of the IAAS can realize bidirectional flow with a maximum flow rate of 8.5 ml/min and can build backpressure up to 170 kPa. The design of the prosthesis reduces occlusion pressure and allows for low inflation volumes (9 mL-10.5 mL); operating pressures between 4.05 kPa and 7.16 kPa indicate that the risk of ischemic injury to the bowel is minimal. Furthermore, the rechargeable battery based on TETS puts the operation time at an estimated 2 days. The performance characteristics of the AASS and its efficiency in achieving continence and sensing the stool inside the anorectum were evaluated in vitro and in vivo in a pig model. Experimental results confirm that the system can maintain continence and build the sense of defecation successfully. Moreover, this innovation can be integrated into not only severe fecal incontinence, erectile dysfunction, and therapy-resistant reflux disease, but also morbid adiposity therapeutic AASS applications. PMID:24744170

Ke, Lei; Yan, Guo-Zheng; Liu, Hua; Jiang, Ping-Ping; Liu, Zhi-Qiang; Wang, Yong-Bing; Ding, Zai-Xian

2014-03-01

46

Use of an anal sphincter pressure monitor during operations on the sacral spinal cord and nerve roots.  

PubMed

The distinction of sacral roots and conus medullaris from lipoma, fibrous adhesions, and an abnormally thickened filum terminale can be difficult during operations on certain complicated dysraphic lesions. We describe a simple, noninvasive method of monitoring external anal sphincter "squeeze pressure" by means of an elongated, fluid-filled, polyethylene anal balloon connected to a pressure transducer. Cutaneous electrocardiographic (ECG) leads on both hips register the stimulus artifact from a monopolar nerve stimulator. The simultaneous display on the oscilloscope screen of the stimulus artifact and the resultant pressure response form an electromechanical coupling that allows the operator to identify a faulty stimulator probe and to distinguish true stimulus-induced external anal sphincter activity from spontaneous rhythmic contractions of the internal anal sphincter. Unilateral stimulation of the S-2, S-3, and S-4 roots generates tall pressure spikes between 40 and 75 torr in peak amplitudes, whereas S-1 and L-5 stimulation produces a stimulus artifact on the ECG but either no pressure response or a mere "ripple wave" of less than 7 torr. During operations on 11 patients with various dysraphic lesions, the S-2, S-3, and S-4 roots were identified easily and preserved, and the caudal extent of functioning neurons was localized within coni grossly distorted by intramedullary lipoma or chronic tethering. We prefer the anal sphincter pressure monitor to anal sphincter electromyography because of its simplicity, the inexpensive equipment, and its noise-free display that is virtually unaffected by other electronic systems in the operating room. PMID:6358936

Pang, D; Casey, K

1983-11-01

47

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

PubMed Central

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

Bhargava, Valmik; Sheean, Geoff; Ledgerwood, Melissa; Sinha, Shantanu

2014-01-01

48

Relation between electromyography and anal manometry of the external anal sphincter  

Microsoft Academic Search

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

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

1991-01-01

49

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

2004-01-01

50

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

SciTech Connect

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

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

2012-10-01

51

Latency of compound muscle action potentials of the anal sphincter after magnetic sacral stimulation.  

PubMed

The aim of this study was to present the failure rate and normal values for motor latency of the anal sphincter after magnetic sacral stimulation (LMSS) using a modified recording technique. A bipolar sponge electrode was placed in the anal canal for recording. A ground electrode was placed in the rectum to reduce stimulus artifact. Magnetic stimulation was induced through a twin coil energized by a Maglite-r25 generator. Two groups were examined: 14 healthy volunteers and 14 patients with a spinal cord injury (SCI) above the conus. Nine of 56 studies (16%) failed. There were no significant differences in latency between right- and left-sided stimulation or between the healthy group and the SCI patients. As described, LMSS measurements are minimally invasive and have a low failure rate. They may be used to test the integrity of the distal motor pathway in patients with bladder or bowel dysfunction who may benefit from continuous electrical sacral root stimulation. PMID:11494279

Morren, G L; Walter, S; Lindehammar, H; Hallböök, O; Sjödahl, R

2001-09-01

52

Automatic detection of motor unit innervation zones of the external anal sphincter by multichannel surface EMG.  

PubMed

A method to detect automatically the location of innervation zones (IZs) from 16-channel surface EMG (sEMG) recordings from the external anal sphincter (EAS) muscle is presented in order to guide episiotomy during child delivery. The new algorithm (2DCorr) is applied to individual motor unit action potential (MUAP) templates and is based on bidimensional cross correlation between the interpolated image of each MUAP template and two images obtained by flipping upside-down (around a horizontal axis) and left-right (around a vertical axis) the original one. The method was tested on 640 simulated MUAP templates of the sphincter muscle and compared with previously developed algorithms (Radon Transform, RT; Template Match, TM). Experimental signals were detected from the EAS of 150 subjects using an intra-anal probe with 16 equally spaced circumferential electrodes. The results of the three algorithms were compared with the actual IZ location (simulated signal) and with IZ location provided by visual analysis (VA) (experimental signals). For simulated signals, the inter quartile error range (IQR) between the estimated and the actual locations of the IZ was 0.20, 0.23, 0.42, and 2.32 interelectrode distances (IED) for the VA, 2DCorr, RT and TM methods respectively. PMID:24948528

Ullah, Khalil; Cescon, Corrado; Afsharipour, Babak; Merletti, Roberto

2014-12-01

53

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

Microsoft Academic Search

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

S J Snooks; M M Henry; M Swash

1985-01-01

54

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

Microsoft Academic Search

In 40 women with idiopathic (neurogenic) faecal incontinence, 20 of whom also had stress urinary incontinence, single fibre EMG studies showed an increased fibre density in the external anal sphincter muscle. All these patients showed excessive descent of the pelvic floor on straining. The mean terminal motor latencies in the pudendal and perineal nerves, measured by a digitally-directed intrarectal stimulating

S J Snooks; P R Barnes; M Swash

1984-01-01

55

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

PubMed Central

BACKGROUND AND PURPOSE We have investigated the distribution of ?-adrenoceptors in sheep internal anal sphincter (IAS), as a model for the human tissue, and evaluated various imidazoline derivatives for potential treatment of faecal incontinence. EXPERIMENTAL APPROACH Saturation and competition binding with 3H-prazosin and 3H-RX821002 were used to confirm the presence and density of ?-adrenoceptors in sheep IAS, and the affinity of imidazoline compounds at these receptors. A combination of in vitro receptor autoradiography and immunohistochemistry was used to investigate the regional distribution of binding sites. Contractile activity of imidazoline-based compounds on sheep IAS was assessed by isometric tension recording. KEY RESULTS Saturation binding confirmed the presence of both ?1- and ?2-adrenoceptors, and subsequent characterization with sub-type-selective agents, identified them as ?1A- and ?2D-adrenoceptor sub-types. Autoradiographic studies with 3H-prazosin showed a positive association of ?1-adrenoceptors with immunohistochemically identified smooth muscle fibres. Anti-?1-adrenoceptor immunohistochemistry revealed similar distributions of the receptor in sheep and human IAS. The imidazoline compounds caused concentration-dependent contractions of the anal sphincter, but the maximum responses were less than those elicited by l-erythro-methoxamine, a standard non-imidazoline ?1-adrenoceptor agonist. Prazosin (selective ?1-adrenoceptor antagonist) significantly reduced the magnitude of contraction to l-erythro-methoxamine at the highest concentration used. Both prazosin and RX811059 (a selective ?2-adrenoceptor antagonist) reduced the potency (pEC50) of clonidine. CONCLUSIONS AND IMPLICATIONS This study shows that both ?1- and ?2-adrenoceptors are expressed in the sheep IAS, and contribute (perhaps synergistically) to contractions elicited by various imidazoline derivatives. These agents may prove useful in the treatment of faecal incontinence. PMID:20649575

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

2010-01-01

56

Fissurectomy combined with anoplasty and injection of botulinum toxin in treatment of anterior chronic anal fissure with hypertonia of internal anal sphincter: a pilot study  

Microsoft Academic Search

Background  In patients affected by anterior chronic anal fissure (CAAF) with hypertonia of the internal anal sphincter (IAS), the role\\u000a of IAS hypertonia remains unclear. The aim of this study was to evaluate the efficacy of fissurectomy combined with advancement\\u000a flap and IAS injection of botulinum toxin in healing the CAAF with hypertonia of IAS resistant to medical therapy.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Ten consecutive

R. Patti; F. Famà; A. Tornambè; G. Asaro; G. Di Vita

2010-01-01

57

Power flow control of TET system for a novel artificial anal sphincter system.  

PubMed

This paper presents an adaptive transcutaneous energy transfer system (TETS) integrated with a novel elastic scaling artificial anal sphincter system (ES-AASS) for treating severe faecal incontinence (FI). The ES-AASS is based on a novel executive mechanism that uses a spring scalable structure to clamp the rectum. To deliver the correct amount of power (i.e. to match the load demand under variable coupling conditions or different operation stages of the implanted device) for internal battery charging and ensure safety for the human body, theoretical analysis was conducted as a control rule with respect to the relationship between the phase of driver signals and output voltage. An easy regulating procedure to stabilize output voltage with a phase shift controller is also presented. To validate the phase control rules, a prototype of the TETS was constructed and its performance was validated across the whole coupling coefficient range (0.09???0.29) as well as load resistance (50???120??). The results show that the output voltage of the secondary side can be maintained at a constant 7?V with a phase regulation range of 78.7-178.2° and the proposed controller has reached a maximal end-to-end power efficiency of 74.2% at 1?W. PMID:25350041

Ke, Lei; Yan, Guozheng; Wang, Zhiwu; Yan, Sheng; Li, Xiyang

2015-01-01

58

Design and assessment of novel artificial anal sphincter with adaptive transcutaneous energy transfer system.  

PubMed

This paper presents the in vitro assessment of a novel elastic scaling artificial anal sphincter system (ES-AASS) with an adaptive transcutaneous energy transfer system (TETS) for treatment of severe faecal incontinence (FI). The proposed adaptive TETS has a phase control, which can maintain the output voltage at ?7?V across the full range of the coupling coefficient variation (from 0.09-0.31) during the whole process of charging with a phase shift of 177.5° to 79.1°. A maximum surface temperature of 42.2?°C was measured above the secondary coil during an energy transmission of 3.5?W in air. The specific absorption rate (SAR) and current density analysis of the biological three-layers structure, including the skin, fat and muscle) surrounding the coil pair were analysed and the results of simulation analysis showed that the value of SAR and current density were very small at any given transmission condition compared with the basic restrictions of the International Commission on Non-Ionizing Radiation Protection (ICNIRP). In conclusion, in vitro experimental results showed that the ES-AASS can control simulated faecal behaviour effectively and the performance of TETS was validated. PMID:25626127

Ke, Lei; Yan, Guozheng; Wang, Zhiwu; Yan, Sheng; Liu, Zhiqiang

2015-02-01

59

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

PubMed

This case-control study was designed to identify risk factors for anal sphincter lacerations (ASL) in a multicultural population where episiotomies and operative vaginal deliveries are rarely performed. Cases were subjects with ASL delivered between July 1997 and June 2003. Two controls were selected for each case matched for gestational age. Independent variables collected included age, race/ethnicity, parity, tobacco use, medical conditions, episiotomy, operative vaginal delivery, epidural use, and infant weight. One thousand and sixty-six subjects met the inclusion criteria. The risk of ASL increased with increasing maternal age (Odds ratio [OR] 1.09 per year, 95% confidence interval [CI] 1.06, 1.12) and increasing infant weight (OR 1.09 per 100 g, 95% CI 1.06, 1.13). Multiparity was protective (P1 vs P2 OR 0.19, 95% CI 0.13, 0.28, and > or =P3 vs P1 OR 0.04, 95% CI 0.02, 0.11). Hispanic and Native American women were at increased risk for ASL (OR 2.08, 95% CI 1.41, 3.09 and OR 1.92, 95% CI 1.07, 3.45, respectively). PMID:17554467

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

2008-01-01

60

Can the risk of obstetric anal sphincter injuries (OASIs) be predicted using a risk-scoring system?  

PubMed Central

Background Perineal trauma involving the anal sphincter is an important complication of vaginal delivery. Prediction of anal sphincter injuries may improve the prevention of anal sphincter injuries. Our aim was to construct a risk scoring model to assist in both prediction and prevention of Obstetric Anal Sphincter Injuries (OASIs). We carried out an analysis of factors involved with OASIs, and tested the constructed model on new patient data. Methods Data on all vaginal deliveries over a 5 year period (2004–2008) was obtained from the electronic maternity record system of one institution in the UK. All risk factors were analysed using logistic regression analysis. Odds ratios for independent variables were then used to construct a risk scoring algorithm. This algorithm was then tested on subsequent vaginal deliveries from the same institution to predict the incidence of OASIs. Results Data on 16,920 births were analysed. OASIs occurred in 616 (3.6%) of all vaginal deliveries between 2004 and 2008. Significant (p < 0.05) variables that increased the risk of OASIs on multivariate analysis were: African-Caribbean descent, water immersion in labour, water birth, ventouse delivery, forceps delivery. The following variables remained independently significant in decreasing the risk of OASIs: South Asian descent, vaginal multiparity, current smoker, home delivery. The subsequent odds ratios were then used to construct a risk-scoring algorithm that was tested on a separate cohort of patients, showing a sensitivity of 52.7% and specificity of 71.1%. Conclusions We have confirmed known risk factors previously associated with OASIs, namely parity, birth weight and use of instrumentation during delivery. We have also identified several previously unknown factors, namely smoking status, ethnicity and water immersion. This paper identifies a risk scoring system that fulfils the criteria of a reasonable predictor of the risk of OASIs. This supersedes current practice where no screening is implemented other than examination at the time of delivery by a single examiner. Further prospective studies are required to assess the clinical impact of this scoring system on the identification and prevention of third degree tears. PMID:25056485

2014-01-01

61

Internal anal sphincter function after total abdominal colectomy and stapled ileal pouch-anal anastomosis without mucosal proctectomy  

Microsoft Academic Search

A comparison, based on results from anal manometry and continence, was made between eight patients after circular stapled\\u000a ileal J-pouch-anal anastomosis without mucosectomy (Js) and seven patients after endoanal mucosal proctectomy and hand-sewn\\u000a ileal pouch-anal anastomosis (Jm). The mean and range from ileostomy closure were 3.5 months (1.5 to 12) and 21.7 months (13\\u000a to 32), respectively. The mean maximum

Ian C. Lavery; Wayne B. Tuckson; Kirk A. Easley

1989-01-01

62

Anal fissure - series (image)  

MedlinePLUS

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

63

Rle de l'innervation enkphalinergique dans la commande nerveuse du sphincter anal interne chez le chat, par J. C. GRIMAUD, M. BOUVIER, G. KIRSCHNER, et J. GONELLA.J. C. GRIMAUD, M. BOUVIER, G. KIRSCHNER, J. GONELLA.  

E-print Network

Rôle de l'innervation enképhalinergique dans la commande nerveuse du sphincter anal interne chez le-Aiguier, 13402 Mar- seille Cedex 9. Le sphincter anal interne (SA!), qui est la portion la plus extrême du muscle enképhalinergiques sont impliqués dans un réflexe inhibiteur vésico-anal Bouvier et Grimaud (1984). Dans le but d

Paris-Sud XI, Université de

64

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

Microsoft Academic Search

BACKGROUND: The occurrence of obstetric anal sphincter injuries (OASIS) - which may have serious, long-term effects on affected women, including faecal incontinence, despite primary repair - varies widely between countries and have been chosen one of the indicators for patient safety in Organisation for Economic Cooperation and Development (OECD) countries and in Nordic countries. FINDINGS: The aim of the study

Sari Räisänen; Katri Vehviläinen-Julkunen; Mika Gissler; Seppo Heinonen

2010-01-01

65

Role of hypogastric nerve activity in opossum internal anal sphincter function: influence of surgical and chemical denervation.  

PubMed

The exact role of the hypogastric nerve (HGN) in the regulation of basal internal anal sphincter pressures (IASP) and rectoanal reflex (RAR)-induced internal anal sphincter (IAS) relaxation is not known. The studies were performed to investigate the effect of electrical stimulation of HGN (HGNS) on IASP and RAR-induced fall in IASP, simultaneously record the HGN activity (HGNA) and IASP in response to different volumes of rectal balloon distension (RBD) to mimic RAR and determine the neural pathway involved in RBD-induced changes in HGNA. The recording of multifiber unit efferent HGNA was carried out after ipsilateral deafferentation in animals. HGNS produced a frequency-dependent rise in IASP and suppression of RBD-induced fall in IASP. Hexamethonium markedly attenuated the basal HGNA by 86% without causing a significant change in the basal IASP. Five cc of RBD caused a fall in IASP of 70.8 +/- 4.8% without any significant change in HGNA. Further increases in the RBD volume caused a volume-dependent increase in the basal HGNA and a biphasic systemic arterial pressure response (an initial fall followed by an elevation). These responses were suppressed by sympathectomy or sacral denervation. Sympathectomy plus sacral denervation caused complete obliteration of these responses. The data suggest that in the basal state, HGN may not play a significant role in the resting IASP and RAR-induced IAS relaxation. However, there was a significant sympathoexcitation in response to higher volumes of RBD (supramaximal stimulus for RAR). Hypogastric and sacral nerves may participate in the afferent pathways for the RBD-induced sympathoexcitation. PMID:7965725

Shibamoto, T; Chakder, S; Rattan, S

1994-10-01

66

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

PubMed

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

Huang, Shih-Che

2014-02-10

67

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

Microsoft Academic Search

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

M E Neill; M Swash

1980-01-01

68

Is a New High-Resolution Probe Better than the Standard Probe for 3D Anal Sphincter and Levator Ani Imaging?  

PubMed

The aim of our study was to determine the accuracy of a new three-dimensional (3D) endoluminal ultrasound probe in assessing the levator ani muscle and anal sphincter complex. A total of 85 patients who had undergone concurrent 3D endovaginal (EVUS) and 3D endoanal (EAUS) ultrasound with both the standard BK 2052 probe and the new high-definition BK 8838 probes were included. For EVUS volumes, the levator ani deficiency (LAD) scores were calculated for each probe. For the EAUS volumes, any defects in the external anal sphincter (EAS) and the internal anal sphincter (IAS) visualized with each probe were recorded. The 3D volumes were evaluated in a blinded fashion. Appropriate statistics were utilized to assess absolute agreements between each pair of imaging modalities. The mean age of the patient population was 59 years (SD ± 10.76), the mean body mass index (BMI) was 28.36 (SD ± 5.99), and the median parity was 2 (range 1, 7). In all, 93% of the patients were Caucasian, 31% had stage 0 or 1 prolapse, while 59% had stage 2 prolapse. The mean total LAD score obtained on EVUS with the standard and the new probes were 11.49 (SD ± 4.94) and 11.53 (SD ± 5.01), respectively, p = 0.3778. Among the 53 patients who had EAUS with both probes, exact agreement for visualization of EAS and IAS for the standard and the new probes was 83% and 98%, respectively. Both transducers can be used for endovaginal imaging of the levator ani muscles interchangeably. Both transducers can be used for endoanal imaging of anal sphincter complex interchangeably. PMID:24831299

Rostaminia, Ghazaleh; White, Dena; Quiroz, Lieschen; Shobeiri, S Abbas

2015-04-01

69

Anal Disorders  

MedlinePLUS

... through the muscular canal of the pelvis and anal sphincters. It is the final orifice through which ... 5 centimeters long. The lower half of the anal canal has sensitive nerve endings. There are blood ...

70

Correlation between gross anatomical topography, sectional sheet plastination, microscopic anatomy and endoanal sonography of the anal sphincter complex in human males  

PubMed Central

This study elucidates the structure of the anal sphincter complex (ASC) and correlates the individual layers, namely the external anal sphincter (EAS), conjoint longitudinal muscle (CLM) and internal anal sphincter (IAS), with their ultrasonographic images. Eighteen male cadavers, with an average age of 72 years (range 62–82 years), were used in this study. Multiple methods were used including gross dissection, coronal and axial sheet plastination, different histological staining techniques and endoanal sonography. The EAS was a continuous layer but with different relations, an upper part (corresponding to the deep and superficial parts in the traditional description) and a lower (subcutaneous) part that was located distal to the IAS, and was the only muscle encircling the anal orifice below the IAS. The CLM was a fibro-fatty-muscular layer occupying the intersphincteric space and was continuous superiorly with the longitudinal muscle layer of the rectum. In its middle and lower parts it consisted of collagen and elastic fibres with fatty tissue filling the spaces between the fibrous septa. The IAS was a markedly thickened extension of the terminal circular smooth muscle layer of the rectum and it terminated proximal to the lower part of the EAS. On endoanal sonography, the EAS appeared as an irregular hyperechoic band; CLM was poorly represented by a thin irregular hyperechoic line and IAS was represented by a hypoechoic band. Data on the measurements of the thickness of the ASC layers are presented and vary between dissection and sonographic imaging. The layers of the ASC were precisely identified in situ, in sections, in isolated dissected specimens and the same structures were correlated with their sonographic appearance. The results of the measurements of ASC components in this study on male cadavers were variable, suggesting that these should be used with caution in diagnostic and management settings. PMID:19486204

Al-Ali, S; Blyth, P; Beatty, S; Duang, A; Parry, B; Bissett, I P

2009-01-01

71

Correlation between gross anatomical topography, sectional sheet plastination, microscopic anatomy and endoanal sonography of the anal sphincter complex in human males.  

PubMed

This study elucidates the structure of the anal sphincter complex (ASC) and correlates the individual layers, namely the external anal sphincter (EAS), conjoint longitudinal muscle (CLM) and internal anal sphincter (IAS), with their ultrasonographic images. Eighteen male cadavers, with an average age of 72 years (range 62-82 years), were used in this study. Multiple methods were used including gross dissection, coronal and axial sheet plastination, different histological staining techniques and endoanal sonography. The EAS was a continuous layer but with different relations, an upper part (corresponding to the deep and superficial parts in the traditional description) and a lower (subcutaneous) part that was located distal to the IAS, and was the only muscle encircling the anal orifice below the IAS. The CLM was a fibro-fatty-muscular layer occupying the intersphincteric space and was continuous superiorly with the longitudinal muscle layer of the rectum. In its middle and lower parts it consisted of collagen and elastic fibres with fatty tissue filling the spaces between the fibrous septa. The IAS was a markedly thickened extension of the terminal circular smooth muscle layer of the rectum and it terminated proximal to the lower part of the EAS. On endoanal sonography, the EAS appeared as an irregular hyperechoic band; CLM was poorly represented by a thin irregular hyperechoic line and IAS was represented by a hypoechoic band. Data on the measurements of the thickness of the ASC layers are presented and vary between dissection and sonographic imaging. The layers of the ASC were precisely identified in situ, in sections, in isolated dissected specimens and the same structures were correlated with their sonographic appearance. The results of the measurements of ASC components in this study on male cadavers were variable, suggesting that these should be used with caution in diagnostic and management settings. PMID:19486204

Al-Ali, S; Blyth, P; Beatty, S; Duang, A; Parry, B; Bissett, I P

2009-08-01

72

Patterns of Fecal Incontinence After Anal Surgery  

Microsoft Academic Search

PURPOSE Conservative anal surgery, with maximum preservation of the anal sphincters and continence, is becoming increasingly possible with the emergence of new sphincter-sparing treatments. Many surgeons remain skeptical, however, of the nature and impact of incontinence after anal surgery. We aimed to characterize the patterns of anal sphincter injury in patients with fecal incontinence after anal surgery. METHODS We reviewed

Ian Lindsey; Oliver M. Jones; M. M. Smilgin-Humphreys; Chris Cunningham; Neil J. Mortensen

2004-01-01

73

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

2011-01-01

74

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

2014-01-01

75

Therapy of anal fissure using botulin toxin  

Microsoft Academic Search

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

Wolfgang H. Jost; Klaus Schimrigk

1994-01-01

76

Direct Repair vs. Overlapping Sphincter Repair  

Microsoft Academic Search

PURPOSE: The aim of this study was to compare the results of two surgical techniques (direct end-to-end vs. overlapping) of delayed repair of a localized anterior defect of external anal sphincter after an obstetric trauma. METHODS: During a five-year period, 23 patients were randomly assigned to direct end-to-end repair (n = 12) or overlapping sphincter repair (n = 11), using

J. J. Tjandra; W. R. Han; J. Goh; M. Carey; P. Dwyer

2003-01-01

77

Chronic anal fissure  

Microsoft Academic Search

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

Miguel Minguez; Belen Herreros; Adolfo Benages

2003-01-01

78

Sphincter-Sparing Treatment for Distal Rectal Adenocarcinoma  

Microsoft Academic Search

Background: Studies suggest that the anal sphincter can be preserved in some patients with distal rectal adenocarcinoma (DRA), but this has not been validated in any prospective multi-institutional trial.Methods: To test the hypothesis that the anal sphincter can be preserved in some patients with DRA, the Cancer and Leukemia Group B and collaborators reviewed 177 patients who had T1\\/T2 adenocarcinomas

Glenn D. Steele; James E. Herndon; Ron Bleday; Anthony Russell; Al Benson III; Maha Hussain; Anne Burgess; Joel E. Tepper; Robert J. Mayer

1999-01-01

79

Low anal sphincter tone in infantile-onset Pompe Disease: an emerging clinical issue in enzyme replacement therapy patients requiring special attention.  

PubMed

Pompe Disease (PD) is a lysosomal storage disease caused by acid ?-glucosidase deficiency. The infantile form typically results in death in the first year of life. Patient survival has improved with enzyme replacement therapy (ERT), but new complications are being recognized. We report three cases of infantile onset PD on ERT who present with a new finding of poor anal tone, a finding that requires special attention for further complications such as rectal prolapse. PMID:23266370

Tan, Queenie K-G; Cheah, Sue Mei; Dearmey, Stephanie M; Kishnani, Priya S

2013-02-01

80

Anal endosonography: Technique and normal anatomy  

Microsoft Academic Search

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

Penelope J. Law; Clive I. Bartram

1989-01-01

81

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

Microsoft Academic Search

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

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

1999-01-01

82

Modern management of anal fistula  

PubMed Central

Ideal surgical treatment for anal fistula should aim to eradicate sepsis and promote healing of the tract, whilst preserving the sphincters and the mechanism of continence. For the simple and most distal fistulae, conventional surgical options such as laying open of the fistula tract seem to be relatively safe and therefore, well accepted in clinical practise. However, for the more complex fistulae where a significant proportion of the anal sphincter is involved, great concern remains about damaging the sphincter and subsequent poor functional outcome, which is quite inevitable following conventional surgical treatment. For this reason, over the last two decades, many sphincter-preserving procedures for the treatment of anal fistula have been introduced with the common goal of minimising the injury to the anal sphincters and preserving optimal function. Among them, the ligation of intersphincteric fistula tract procedure appears to be safe and effective and may be routinely considered for complex anal fistula. Another technique, the anal fistula plug, derived from porcine small intestinal submucosa, is safe but modestly effective in long-term follow-up, with success rates varying from 24%-88%. The failure rate may be due to its extrusion from the fistula tract. To obviate that, a new designed plug (GORE BioA®) was introduced, but long term data regarding its efficacy are scant. Fibrin glue showed poor and variable healing rate (14%-74%). FiLaC and video-assisted anal fistula treatment procedures, respectively using laser and electrode energy, are expensive and yet to be thoroughly assessed in clinical practise. Recently, a therapy using autologous adipose-derived stem cells has been described. Their properties of regenerating tissues and suppressing inflammatory response must be better investigated on anal fistulae, and studies remain in progress. The aim of this present article is to review the pertinent literature, describing the advantages and limitations of new sphincter-preserving techniques. PMID:25574077

Limura, Elsa; Giordano, Pasquale

2015-01-01

83

Modern management of anal fistula.  

PubMed

Ideal surgical treatment for anal fistula should aim to eradicate sepsis and promote healing of the tract, whilst preserving the sphincters and the mechanism of continence. For the simple and most distal fistulae, conventional surgical options such as laying open of the fistula tract seem to be relatively safe and therefore, well accepted in clinical practise. However, for the more complex fistulae where a significant proportion of the anal sphincter is involved, great concern remains about damaging the sphincter and subsequent poor functional outcome, which is quite inevitable following conventional surgical treatment. For this reason, over the last two decades, many sphincter-preserving procedures for the treatment of anal fistula have been introduced with the common goal of minimising the injury to the anal sphincters and preserving optimal function. Among them, the ligation of intersphincteric fistula tract procedure appears to be safe and effective and may be routinely considered for complex anal fistula. Another technique, the anal fistula plug, derived from porcine small intestinal submucosa, is safe but modestly effective in long-term follow-up, with success rates varying from 24%-88%. The failure rate may be due to its extrusion from the fistula tract. To obviate that, a new designed plug (GORE BioA®) was introduced, but long term data regarding its efficacy are scant. Fibrin glue showed poor and variable healing rate (14%-74%). FiLaC and video-assisted anal fistula treatment procedures, respectively using laser and electrode energy, are expensive and yet to be thoroughly assessed in clinical practise. Recently, a therapy using autologous adipose-derived stem cells has been described. Their properties of regenerating tissues and suppressing inflammatory response must be better investigated on anal fistulae, and studies remain in progress. The aim of this present article is to review the pertinent literature, describing the advantages and limitations of new sphincter-preserving techniques. PMID:25574077

Limura, Elsa; Giordano, Pasquale

2015-01-01

84

[Acute anal pain].  

PubMed

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

Pittet, Olivier; Demartines, Nicolas; Hahnloser, Dieter

2013-07-01

85

Perineal nerve stimulation for urinary sphincter control  

Microsoft Academic Search

The effect of electrostimulation of the perineal nerve on the external urethral sphincter (EUS) and urethral pressure was studied in 9 dogs. The nerve was displayed in the ischiorectal fossa through a para-anal incision and an electrode was applied to it. Perineal nerve stimulation effected an increase of the urethral pressure (PPP>0.05). The greater the stimulus frequency, the higher the

A. Shafik

1994-01-01

86

Graciloplasty for internal and external sphincteric resection of lower rectal cancer.  

PubMed

Anal sphincteric resection for rectal cancer is most commonly followed by colostomy in the lower abdominal wall, which enforces quite a poor quality of life due to a permanent stoma. For surgeons treating lower rectal cancer, the goal is to achieve defecation via the anus without placing a stoma. Internal sphincteric resection, partial external sphincteric resection and coloanal anastomosis have been reported for the treatment of lower rectal cancer with avoiding a colostoma. Extended resection of the external sphincter, however, limits patient's daily activities because of poor functional results and necessitates reconstruction of damaged anal function. This paper describes a case of graciloplasty for postoperative anal dysfunction that yielded a good clinical outcome in a 65-year-old female who had undergone very low anterior resection with complete internal and partial external sphincteric resection for lower rectal cancer. PMID:15682837

Araki, Yasumi; Momosaki, Kazuya; Nozoe, Yasuhiro; Hayashi, Katsumi; Yamada, Katsuhiro; Kanazawa, Masamitsu; Inoue, Akemi; Noake, Toshihiro; Takano, Masahiro; Shirouzu, Kazuo

2004-01-01

87

Anorectal conditions: anal fissure and anorectal fistula.  

PubMed

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

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

2014-04-01

88

Neurophysiologic assessment of the anal sphincters  

Microsoft Academic Search

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

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

1991-01-01

89

Botulinum Toxin for the Treatment of Anal Fissure  

Microsoft Academic Search

Background: The classic treatment for uncomplicated anal fissure is surgical sphincterotomy, i.e. cutting of the internal anal sphincter, thus eliminating spasm of this muscle and breaking the vicious circle of pain, spasm and inflammation. Recently, however, botulinum toxin has become available for the treatment of muscular dystonias, and thus for anal fissure. In the present study, we investigated the effectiveness

F. Fernández López; R. Conde Freire; A. Rios Rios; J. García Iglesias; M. Caínzos Fernández; J. Potel Lesquereux

1999-01-01

90

Treatment of benign anal disease with topical nitroglycerin  

Microsoft Academic Search

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

Stephen R. Gorfine; Richard P. Billingham

1995-01-01

91

Sphincter denervation in anorectal incontinence and rectal prolapse  

Microsoft Academic Search

Biopsies of the external anal sphincter, puborectalis, and levator ani muscles have been examined in 24 women and one man with long-standing anorectal incontinence, 18 of whom also had rectal prolapse, and in two men with rectal prolapse alone. In 16 of the women anorectal incontinence was of unknown cause, but in eight there was a history of difficult labour.

A G Parks; M Swash; H Urich

1977-01-01

92

Complex Anal Fistula  

Microsoft Academic Search

\\u000a Complex fistula-in-ano is a frequent source of concern for both patients and surgeons because of its high rate of recurrence\\u000a and potential for postoperative anal incontinence. There remains a balance between total sphincter-preserving surgery that\\u000a may result in a high rate of fecal continence and the more radical approaches.

Avraham Belizon; Eric G. Weiss

93

Anal Fissure  

MedlinePLUS

ANAL FISSURE Michael A. Valente, DO WHAT IS AN ANAL FISSURE? An anal fissure (fissure-in-ano) is ... as hemorrhoids. WHAT ARE THE SYMPTOMS OF AN ANAL FISSURE? The typical symptoms of an anal fissure ...

94

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

1986-01-01

95

Sphincterolysis: A Novel Approach towards Chronic Anal Fissure  

Microsoft Academic Search

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

Pravin J. Gupta

2006-01-01

96

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

PubMed

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

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

2013-04-01

97

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

2014-01-01

98

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

Microsoft Academic Search

Background: Surgical sphincterotomy for chronic anal fissure can cause fecal incontinence. This has led to the investigation of nonsurgical treatment options that avoid permanent damage to the internal anal sphincter. Methods: We conducted a retrospective, ongoing chart review with telephone follow-up of 88 patients treated for chronic anal fissure between November 1996 and December 2002. During the first half of

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

2006-01-01

99

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)

1981-01-01

100

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

Microsoft Academic Search

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

D C Bartolo; J A Jarratt; N W Read

1983-01-01

101

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

Microsoft Academic Search

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

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

2009-01-01

102

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

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

2012-01-01

103

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

Microsoft Academic Search

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

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

1997-01-01

104

Biofeedback in the management of partial anal incontinence  

Microsoft Academic Search

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

James H. MacLeod

1983-01-01

105

Overlapping sphincteroplasty for acquired anal incontinence  

Microsoft Academic Search

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

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

1984-01-01

106

Intramural neural pathways between the duodenum and sphincter of Oddi in the Australian brush-tailed possum in vivo.  

PubMed Central

1. Balloon distension of the duodenum 2 cm oral or anal to the sphincter of Oddi-duodenal junction elevated the amplitude of spontaneous sphincter of Oddi phasic contractions by 37.7 +/- 8.5 or 120.1 +/- 79.8%, respectively (mean +/- S.E.M., both n = 6, P < 0.05, Wilcoxon test). To further investigate this response, this study aimed to determine if: (i) electrical field stimulation (EFS) of the duodenum influences sphincter of Oddi activity; (ii) intramural nerves mediate the response; and (iii) nicotinic and/or muscarinic receptors are involved. 2. Electrical field stimulation (70 V, 0.5 ms; 5-60 Hz, 10-20 s) of the duodenal anterior serosal surface 2-4 cm oral or anal to the sphincter of Oddi-duodenal junction, produced excitatory responses in the sphincter of Oddi in anaesthetized Australian brush-tailed possums (n = 45). 3. These responses were frequency dependent, maximal at 30 Hz (n = 4) and abolished by tetrodotoxin (9 micrograms kg-1 I.A.; n = 6), or by crushing the duodenum (n = 3). Hexamethonium bromide (30 mg kg-1 I.V.) did not significantly alter the response to duodenal EFS either oral (n = 6) or anal (n = 8) to the sphincter of Oddi-duodenal junction. Atropine sulphate (30 micrograms kg-1 I.V.) reduced the response to duodenal EFS oral and anal to the sphincter of Oddi-duodenal junction to 11.2 +/- 5.8 (n = 6) and 45.0 +/- 26.8% (n = 8), respectively (both P < 0.05). 4. Bilateral cervical vagotomy and guanethidine infusion (10 mg kg-1 over 15 min I.V.) did not significantly alter the responses to duodenal EFS (n = 7). 5. Excitatory intramural neural pathways between the sphincter of Oddi and the segment of duodenum 4 cm oral and anal to the sphincter of Oddi-duodenal junction have been demonstrated. These postganglionic pathways may involve muscarinic receptors. PMID:7738836

Saccone, G T; Harvey, J R; Baker, R A; Toouli, J

1994-01-01

107

One hundred cases of anal fissure treated with botulin toxin  

Microsoft Academic Search

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

W. H. Jost

1997-01-01

108

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

PubMed Central

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

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

2014-01-01

109

Anal Cancer  

MedlinePLUS

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 ...

110

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

2014-01-01

111

Cost considerations in the treatment of anal fissures.  

PubMed

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

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

2014-08-01

112

Oscillatory potentials recorded from walls of anal canal and urethrae in dogs.  

PubMed

1. Oscillatory potentials were recorded from internal anal sphincters and from internal urethral sphincters in similarity and difference in their characteristics. similarity and difference in their characteristics. 2. Unexpected finding was the appearance of burst-and-pause alternation in male urethrae in contrast to continuous oscillation in female urethrae. 3. Stimulation experiments revealed that the internal anal sphincter was controlled by reciprocal spinal outflow; lumbar accrelation and sacral inhibition. But the recto-anal reflex, constantly observable in decerebrate dogs, was predominantly inhibitory, which was identical with sacral action. 4. The effect of ventral root stimulation upon urethral oscillation was 'identical' for lumbar and for sacral activations, even if it was excitatory or inhibitory, depending upon ongoing level of activity and upon stimulus parameters. Nevertheless, reciprocal activation between detrusor spike and urethral oscillation was observed during 'isometric voiding contractions'. The reason for this inconsistency was discussed. PMID:2320626

Onoe, K; Tamura, K; Suda, S; Takahira, H

1990-01-01

113

What Is Anal Cancer?  

MedlinePLUS

... 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 ...

114

Describing a new syndrome in L5-S1 disc herniation: Sexual and sphincter dysfunction without pain and muscle weakness  

PubMed Central

Context: Little seems to be known about the sexual dysfunction (SD) in lumbar intervertebral disc herniation. Aims: Investigation of sexual and sphincter dysfunction in patient with lumbar disc hernitions. Settings and Design: A retrospective analysis. Materials and Methods: Sexual and sphincter dysfunction in patients admitted with lumbar disc herniations between September 2012-March 2014. Statistical Analysis Used: Statistical analysis was performed using the Predictive Analytics SoftWare (PASW) Statistics 18.0 for Windows (Statistical Package for the Social Sciences, SPSS Inc., Chicago, Illinois). The statistical significance was set at P < 0.05. The Wilcoxon signed ranks test was used to evaluate the difference between patients. Results: Four patients with sexual and sphincter dysfunction were found, including two women and two men, aged between 20 and 52 years. All of them admitted without low back pain. In addition, on neurological examination, reflex and motor deficit were not found. However, almost all patients had perianal sensory deficit and sexual and sphincter dysfunction. Magnetic resonance imaging (MRI) of three patients displayed a large extruded disc fragment at L5-S1 level on the left side. In fourth patient, there were not prominent disc herniations. There was not statistically significant difference between pre-operative and post-operative sexual function, anal-urethral sphincter function, and perianal sensation score. A syndrome in L5-S1 disc herniation with sexual and sphincter dysfunction without pain and muscle weakness was noted. We think that it is crucial for neurosurgeons to early realise that paralysis of the sphincter and sexual dysfunction are possible in patients with lumbar L5-S1 disc disease. Conclusion: A syndrome with perianal sensory deficit, paralysis of the sphincter, and sexual dysfunction may occur in patients with lumbar L5-S1 disc disease. The improvement of perianal sensory deficit after surgery was counteracted by a trend toward disturbed sexual function. Further researches are needed to explore the extent of this problem. PMID:25558144

Akca, Nezih; Ozdemir, Bulent; Kanat, Ayhan; Batcik, Osman Ersagun; Yazar, Ugur; Zorba, Orhan Unal

2014-01-01

115

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

Microsoft Academic Search

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

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

2005-01-01

116

Anal lesions presenting in a cohort of child gastroenterological examinations. Implications for sexual traumatic injuries.  

PubMed

The purpose of this study was to describe the anal lesions found in children during a pediatric gastroenterology consultation when the reason for the complaint was related to a digestive disease. This prospective descriptive study included 100 children under 15 years of age over a 13-month period, consulting due to digestive symptoms. The children were under 8 years old (90%) and 25% were under 3.1 years old. Constipation was the most frequent reason for consultation (69%). Fifty-one anal lesions were observed, of which 58.8% were anal fissures, 15.7% were skin tags and 5.8% were venous congestions related to straining. Anal fissures and skin tags were located at the median line, according to the clock-face method in supine position. No child had more than two anal lesions. No anal dilatation, sphincter hypotonia, anal scars, anal lacerations or bruises were found. The two most common anal lesions were anal fissures and skin tags. These anal lesions were mainly observed at the median line and were due to constipation. No cases of multiple anal lesions were found in terms of common digestive diseases. PMID:25882145

Rougé-Maillart, Clotilde; Houdu, Sora; Darviot, Estelle; Buchaillet, Céline; Baron, Céline

2015-05-01

117

Stages of Anal Cancer  

MedlinePLUS

Stages of Anal Cancer Key Points for This Section After anal cancer has been diagnosed, tests are done to find out ... II Stage IIIA Stage IIIB Stage IV After anal cancer has been diagnosed, tests are done to ...

118

Histo-topographic study of the longitudinal anal muscle.  

PubMed

The longitudinal anal muscle (LAM) has been described as a vertical layer of muscular tissue interposed between the circular layers of the internal (IAS) and external (EAS) anal sphincters. There is, however, no general agreement in the literature on its composition and attachments. The aim of this study was to investigate the histological structure, attachments, and topography of the LAM in order to evaluate its role in continence and defecation, thus enhancing knowledge of the surgical anatomy of this region. After in situ formalin fixation, the pelvic viscera were removed from eight male and eight female cadavers (age range: 52-72 years). Serial macrosections of the bladder base, lower rectum and anal canal, cervix and pelvic floor complex, cut in the transverse (six specimens) and coronal (six specimens) planes, underwent histological and immunohistochemical studies. Four specimens were studied using the E12 sheet plastination technique. The LAM was identified in 10/12 specimens (83%). Transverse and coronal sections made clear that it is a longitudinal layer of muscular tissue, marking the boundary between the internal and external anal sphincters. From the anorectal junction it extends along the anal canal, receives fibers from the innermost part of the puborectalis and the puboanalis muscles, and terminates with seven to nine fibro-elastic septa, which traverse the subcutaneous part of the external anal sphincter, reaching the perianal dermis. In the transverse plane, the mean thickness of the LAM was 1.68 +/- 0.27 mm. Immunohistochemical staining showed that the LAM consists of predominantly outer striated muscle fibers and smaller numbers of inner smooth muscle fibers, respectively coming from the levator ani muscle and from the longitudinal muscular layer of the rectum. The oblique fibers suggest that the LAM may represent the intermediate longitudinal course of small bridging muscle bundles going reciprocally from the striated EAS to the smooth IAS and vice versa. The spatial result is the helical course of striated and smooth muscle fibers between the EAS and IAS, which contribute not only to the narrowing but also to some shortening of the anal canal during sphincter contraction. Thus, rather than being a boundary, the LAM gives anatomical evidence of a functional connection between two muscle systems with different structures and topography. PMID:18561297

Macchi, Veronica; Porzionato, Andrea; Stecco, Carla; Vigato, Enrico; Parenti, Anna; De Caro, Raffaele

2008-07-01

119

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

2011-01-01

120

What is sphincter of Oddi dysfunction?  

PubMed Central

Ever since its description approximately 100 years ago, the sphincter of Oddi has been surrounded by controversy. First, whether it indeed existed, second, whether it had a significant physiological role in man and more recently whether abnormalities in its function give rise to a clinical syndrome. Data from animal and human studies, using sensitive techniques, have helped define the physiological role of the sphincter of Oddi, and more recent studies are determining the factors which control sphincter of Oddi function. These studies support Oddi's original description that the sphincter has a major role in the control of flow of bile and pancreatic juice into the duodenum, and equally importantly helps prevent the reflux of duodenal contents into the biliary and pancreatic ductal systems. The controversy of whether abnormalities in sphincter of Oddi motility result in clinical syndromes has not been totally resolved. Part of the difficulty has been inability to document normal and hence abnormal function of the sphincter. With the emergence of endoscopic biliary manometry as a sensitive and reproducible technique, however, the motility of the human sphincter of Oddi has come under closer scrutiny and allowed definition of possible disorders. We have used the term sphincter of Oddi dysfunction to define manometric abnormalities in patients who present with signs and symptoms consistent with a biliary or pancreatic ductal origin. Based on the manometry, we have subdivided the dysfunction into two groups; a group characterised by a stenotic pattern - that is, raised sphincter basal pressure - and a second group having a dyskinetic pattern - that is, paradoxical response to cholecystokinin injection, rapid contraction frequency, high percentage of retrograde contractions, or short periods of raised basal percentage of retrograde contractions, or short periods of raised basal pressure. It is apparent from the mamometry but also from the clinical data that the patients are a heterogeneous group and thus any therapy would need to be tailored for each patient and abnormality. The most recent therapeutic data suggest that patients with the stenotic pattern on manometry respond to division of the sphincter, however, those patients with the dyskinetic manometric pattern show no significant effect after sphincterotomy. Further prospective trials evaluating therapeutic options are under way and their results are eagerly awaited. Images Fig. 1 PMID:2666281

Toouli, J

1989-01-01

121

Anal Incontinence After Obstetric Third \\/Fourth-Degree Laceration. One-Year Follow-up After Pelvic Floor Exercises  

Microsoft Academic Search

:   The study was a 1-year follow-up of 48 women with obstetric third- \\/fourth-degree perineal laceration. After primary surgical\\u000a repair the symptomatic patients were treated with pelvic floor exercises with or without transanal electrical stimulation.\\u000a Various methods for assessing anal sphincter function were also evaluated. One month postpartum 10 women (21%) complained\\u000a of anal incontinence, 8 for flatus only; 1

P. Sander; J. Bjarnesen; L. Mouritsen; A. Fuglsang-Frederiksen

1999-01-01

122

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

Microsoft Academic Search

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

Maged Nasr; Hussin Ezzat; Magdy Elsebae

2010-01-01

123

MRI of anal cancer: assessing response to definitive chemoradiotherapy.  

PubMed

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

Gourtsoyianni, S; Goh, V

2014-02-01

124

Mucosal Advancement Flap Anoplasty for Chronic Anal Fissure Resistant to Conservative Therapy  

Microsoft Academic Search

Background  Sphincter-sparing procedures are increasingly advocated in the treatment of chronic anal fissures (CAF) resistant to conservative\\u000a management. Herein, we report about our results with sphincter-sparing transanal mucosal advancement flap anoplasty (MAAP)\\u000a to treat CAF.\\u000a \\u000a \\u000a \\u000a \\u000a Patients and Methods  The present study was a retrospective single-center analysis of patients in whom conservative management of CAF failed and\\u000a who subsequently underwent MAAP between January

M. Ouaïssi; U. Giger; I. Sielezneff; K. A. Yawovi; A. Pamela; N. Pirro; B. Sastre

2011-01-01

125

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

PubMed

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

2014-08-01

126

Mesenchymal stromal cells for sphincter regeneration.  

PubMed

Stress urinary incontinence (SUI), defined as the involuntary loss of considerable amounts of urine during increased abdominal pressure (exertion, effort, sneezing, coughing, etc.), is a severe problem to the individuals affected and a significant medical, social and economic challenge. SUI is associated with pelvic floor debility, absence of detrusor contraction, or a loss of control over the sphincter muscle apparatus. The pathology includes an increasing loss of muscle cells, replacement of muscular tissue with fibrous tissue, and general aging associated processes of the sphincter complex. When current therapies fail to cure or improve SUI, application of regeneration-competent cells may be an alternative therapeutic option. Here we discuss different aspects of the biology of mesenchymal stromal cells, which are relevant to their clinical applications and for regenerating the sphincter complex. However, there are reports in favor of and against cell-based therapies. We therefore summarize the potential and the risks of cell-based therapies for the treatment of SUI. PMID:25451135

Klein, Gerd; Hart, Melanie L; Brinchmann, Jan E; Rolauffs, Bernd; Stenzl, Arnulf; Sievert, Karl-Dietrich; Aicher, Wilhelm K

2014-10-27

127

Oscillatory firing of single human sphincteric alpha 2 and alpha 3-motoneurons reflexly activated for the continence of urinary bladder and rectum. Restoration of bladder function in paraplegia.  

PubMed

1. By recording with 2 pairs of wire electrodes from human sacral nerve roots (S3-S5) rhythmic as well as occasional firing was observed in alpha 2 and alpha 3-motoneurons in response to physiologic stimulation of the urinary bladder and the anal canal. The rhythmic firing consisted of periodically occurring impulse trains, most likely produced by true spinal oscillators which drove the motoneurons. 2. Alpha 2-motoneurons, innervating fast fatigue-resistant muscle fibres, were observed to fire with impulse trains of about 2 to 4 action potentials (Ap's). These impulse trains occurred every 110 to 170 msec (5-9 Hz). Alpha 3-motoneurons, innervating slow fatigue-resistant muscle fibres, fired about every 1400 msec (approximately 0.7 Hz) with impulse trains of about 11 to 60 Ap's. Alpha 1-motoneurons, innervating fast fatigue muscle fibres, and gamma-motoneurons were not observed in the continuous oscillatory firing mode. 3. Sphincteric motoneurons were observed most likely in the oscillatory firing mode in response to the sustained stretch (reflex) of the external and sphincter or to retrograde filling of the bladder (urethro-sphincteric guarding reflex), in order to preserve continence. A urethral sphincteric alpha 2-motoneuron increased its mean activity from 0.5 to 18 Ap's/sec during retrograde filling by changing its firing pattern from the occasional spike mode via the transient oscillatory firing mode to the continuous oscillatory mode. Up to a filling of the bladder of 500 ml the mean activity of the stretch receptors, measuring probably mural tension, increased roughly proportionally and the sphincteric motoneuron increased its activity to about 1 Ap/sec in the occasional spike mode. Up to 600 ml, the motoneuron responded in the transient oscillatory mode with mean activities of up to 5 Ap's/sec. With higher bladder fillings, the flow receptors afferents fired additionally, probably according to pressure symptoms, and the motoneuron switched into the continuous oscillatory firing mode and increased its activity up to 18 Ap's/sec at 700 ml. When the bladder was about 800 ml full, the stretch afferent activity decreased, the flow receptor activity increased strongly and the alpha 2-motoneuron activity decreased; the overflow incontinence had probably started. Micturition was not observed, probably because of brain death. 4. It is suggested that one adequate stimulus for an alpha 2-motoneuron of the external anal sphincter to jump into the oscillatory firing mode, was the activity from secondary spindle afferent (SP2) fibres from external anal sphincter muscle spindles.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:1935758

Schalow, G

1991-09-01

128

Adynamic and dynamic muscle transposition techniques for anal incontinence  

PubMed Central

Gracilis muscle transposition is well established in general surgery and has been the main muscle transposition technique for anal incontinence. Dynamization, through a schedule of continuous electrical stimulation, converts the fatigue-prone muscle fibres to a tonic fatigue-resistant morphology with acceptable results in those cases where there is limited sphincter muscle mass. The differences between gluteoplasty and graciloplasty, as well as the techniques and complications of both procedures, are outlined in this review. Overall, these techniques are rarely carried out in specialized units with experience, as there is a high revision and explantation rate. PMID:24759348

Bariši?, Goran; Krivokapi?, Zoran

2014-01-01

129

Anal cancer – a review  

PubMed Central

Anal cancer accounts for only 1.5% of gastrointestinal malignancies but this disease has shown a steady increase in incidence particularly in HIV positive males. The understanding of pathophysiology and treatment of anal cancer has changed radically over last thirty years. Risk factors have been identified and organ preservation by chemoradiotherapy has become a standard. This article aims to review the clinical presentation, diagnostic evaluation, and treatment options for anal cancer in the light of current literature. PMID:23580899

Salati, Sajad Ahmad; Al Kadi, Azzam

2012-01-01

130

JAMA Patient Page: Anal Fissure  

MedlinePLUS

... All rights reserved. JAMA PATIENT PAGE| Digestive System Anal Fissure An anal fissure is a tear in the opening of ... anus that can cause pain, itching, and bleeding. Anal fissures are common in infants but less so ...

131

An electrophysiological study of somatic and visceral convergence in the reflex control of the external sphincters.  

PubMed

1. Mass wave and single unit discharges have been recorded from pudendal efferents innervating the external anal and urethral sphincters in chloralose anaesthetized or decerebrate cats.2. Reflex discharges in these neurones were elicited by electrical stimulation of the contralateral pudendal nerve, the posterior cutaneous nerve of thigh, or the vesical or colonic branches of the pelvic nerve. The latencies of the evoked responses were 5.5-20 msec. The vesical branches of the pelvic nerve produced discharges less consistently than the other nerves.3. Irrespective of whether afferent stimulation produced an early evoked response there was always a prolonged period of depression of pudendal nerve excitability following the stimulus. Condition-test interactions showed that this depression began within 50 msec of the stimulus and that its duration varied between 150 and 2500 msec in single units, with a modal value of 500 msec.4. No evoked response or depression of excitability was seen when afferents in the hypogastric or lumbar colonic nerves were stimulated.5. Increasing intravesical or intracolonic pressure, within physiological limits, produced a graded reduction in the size of evoked discharges.6. Short trains of stimuli (four shocks in 20 msec) applied to the raphé nucleus, were capable of inhibiting test responses in pudendal efferents for periods of up to 800 msec.7. The possible functional roles of two groups of sphincteric reflex interneurones, with either excitatory or inhibitory receptive fields, are discussed. PMID:7131318

McMahon, S B; Morrison, J F; Spillane, K

1982-07-01

132

General Information about Anal Cancer  

MedlinePLUS

... 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 ( ...

133

Anal Warts and Anal Intradermal Neoplasia  

PubMed Central

For the last five millennia we have been dealing with the annoyance of verrucas. Anogenital human papillomavirus (HPV) infection is the most common sexually transmitted disease in the United States and is increasing in incidence. As in other gastrointestinal conditions, HPV infection can lead to a stepwise transition from normal cells to dysplastic cells and then to invasive anal cancer. Knowledge of the natural history of HPV infection, risk factors, diagnostic tools, and therapeutic methods gives us the tools to adequately prevent, evaluate, treat, and counsel our patients. In this review, the authors detail the diagnosis, management, and treatment of anal condyloma and anal intraepithelial neoplasia with a focus on prevention, early detection, and treatment using current data and technology. PMID:22379403

Echenique, Ignacio; Phillips, Benjamin R.

2011-01-01

134

Full Functional-Length Urethral Sphincter Preservation During Radical Prostatectomy  

Microsoft Academic Search

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

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

2011-01-01

135

HIV-associated anal cancer.  

PubMed

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

Newsom-Davis, Thomas; Bower, Mark

2010-01-01

136

Treatment Option Overview (Anal Cancer)  

MedlinePLUS

... are different types of treatment for patients with anal cancer. Different types of treatments are available for ... the human immunodeficiency virus can affect treatment of anal cancer. Cancer therapy can further damage the already ...

137

Designing micro- and nanostructures for artificial urinary sphincters  

NASA Astrophysics Data System (ADS)

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

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

2012-04-01

138

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

2012-01-01

139

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

PubMed

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

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

2013-09-01

140

The female urethral syndrome: external sphincter spasm as etiology.  

PubMed

Many women suffer a constellation of urinary and pelvic symptoms commonly referred to as the urethral syndrome. Numerous medical, surgical and psychological treatment modalities have been used to alleviate the symptoms. Urodynamic techniques were used to study a group of women with the urethral syndrome. Based on the findings of external urethral sphincter spasm and/or pelvic floor hyperactivity the institution of diazepam therapy not only has provided clinical relief but also sphincter synergy as demonstrated by post-treaatment urodynamics. PMID:7411719

Kaplan, W E; Firlit, C F; Schoenberg, H W

1980-07-01

141

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

Microsoft Academic Search

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

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

1995-01-01

142

Surgical treatment of anal stenosis  

PubMed Central

Anal stenosis is a rare but serious complication of anorectal surgery, most commonly seen after hemorrhoidectomy. Anal stenosis represents a technical challenge in terms of surgical management. A Medline search of studies relevant to the management of anal stenosis was undertaken. The etiology, pathophysiology and classification of anal stenosis were reviewed. An overview of surgical and non-surgical therapeutic options was developed. Ninety percent of anal stenosis is caused by overzealous hemorrhoidectomy. Treatment, both medical and surgical, should be modulated based on stenosis severity. Mild stenosis can be managed conservatively with stool softeners or fiber supplements. Sphincterotomy may be quite adequate for a patient with a mild degree of narrowing. For more severe stenosis, a formal anoplasty should be performed to treat the loss of anal canal tissue. Anal stenosis may be anatomic or functional. Anal stricture is most often a preventable complication. Many techniques have been used for the treatment of anal stenosis with variable healing rates. It is extremely difficult to interpret the results of the various anaplastic procedures described in the literature as prospective trials have not been performed. However, almost any approach will at least improve patient symptoms. PMID:19399922

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

2009-01-01

143

[Modification of rehabilitation stage after inter-sphincter resection of the rectum].  

PubMed

Endoscopic ultrasonic examination for diagnosis of malignant tumors of a lower-ampullar part of the rectum determined indications to inter-sphincter resection consisting in total mesorectumectomy, resection of the rectum and internal sphincter. The method of creation of a globe-shape reservoir with artificial muscular sphincter was developed. Fourteen patients underwent surgery, the follow-up was up to 3,5 years. It is demonstrated that a globe-shape extensible reservoir and autonomic bloching function of muscular sphincter are the main conditions of repair of defecation functions in long-term period after inter-sphincter resection. PMID:16044126

Zherlov, G K; Bashirov, S R; Pankratov, I V

2005-01-01

144

Total proctocolectomy and ileal - anal pouch  

MedlinePLUS

Restorative proctocolectomy; Ileal-anal resection; Ileal-anal pouch; J-pouch; S-pouch; Pelvic pouch; Ileal-anal pouch; Ileal ... RD, Mahmoud N, Maron DJ, Ross HM, Rombeau J. Colon and rectum. In: Townsend CM, Beauchamp RD, ...

145

Surgical management of anal cancer.  

PubMed

Squamous cell carcinoma (SCC) is the most common malignancy of the anal canal and anal region. The prevalence of transformation to SCC is much higher in patients with a concomitant human immundefficiency virus (HIV) infection. Historically, treatment of anal SCC consisted of surgical resection with wide local excision for small sized tumors and abdominoperineal resection (APR) for larger and locally invasive cancer. The introduction of chemoradiation by Nigro et al. revolutionized the treatment of SCC. It has improved local recurrence rates as well as survival and need for colostomy. Nowadays, primary surgical treatment is indicated for anal margin tumors that are smaller than 2 cm, and are not poorly differentiated. However, extensive surgery is reserved for those with persistent, progressing and recurrent disease after treatment with the Nigro protocol. Surgical approach for anal canal and margin cancer is to be discussed in this review. PMID:25690347

Gilshtein, H; Khoury, W

2015-04-01

146

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

PubMed Central

The resistance of the lower esophageal sphincter to reflux of gastric juice is determined by the integrated effects of radial pressures exerted over the entire length of the sphincter. This can be quantitated by three-dimensional computerized imaging of sphincter pressures obtained by a pullback of radially oriented pressure transducers and by calculating the volume of this image, in other words, the sphincter pressure vector volume. Validation studies showed that sphincter imaging based on a stepwise pullback of a catheter with four or eight radial side holes is superior to a rapid motorized pullback. Compared with 50 healthy volunteers, the total and abdominal sphincter pressure vector volume was lower in 150 patients with increased esophageal acid exposure (p less than 0.001) and decreased with increasing esophageal mucosal damage (p less than 0.01). Calculation of the sphincter pressure vector volume was superior to standard techniques in identifying a mechanically defective sphincter as the cause of increased esophageal acid exposure, particularly in patients without mucosal damage. The Nissen and Belsey fundoplication increased the total and intra-abdominal sphincter pressure vector volume (p less than 0.001) and normalized the three-dimensional sphincter image. Failure to do so was associated with recurrent or persistent reflux. These data indicate that three-dimensional imaging of the lower esophageal sphincter improves the identification of patients who would benefit from an antireflux procedure. Analysis of the three-dimensional sphincter pressure profile should become the standard for evaluation of the lower esophageal sphincter. PMID:1953093

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

1991-01-01

147

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

PubMed Central

Background Although lateral internal sphincterotomy is the gold-standard treatment for chronic anal fissure, intrasphincteric injection of botulinum toxin seems to be a reliable new option. The aim of this non-randomized study is to compare the effect of lateral internal sphincterotomy and botulinum toxin injection treatments on the outcome and reduction of anal sphincter pressures in patients with chronic anal fissure. Methods Patients with chronic anal fissure were treated with either botulinum toxin injection or lateral internal sphincterotomy by their own choice. Maximal resting pressure and maximal squeeze pressure measurements were performed before and 2 weeks after treatments by anal manometry. Patients were followed for fissure relapse during 14 months. Results Twenty-one consecutive outpatients with posterior chronic anal fissure were enrolled. Eleven patients underwent surgery and ten patients received botulinum toxin injection treatment. Before the treatment, anal pressures were found to be similar in both groups. After the treatment, the maximal resting pressures were reduced from 104 ± 22 mmHg to 86 ± 15 mmHg in the surgery group (p < 0.05) and from 101 ± 23 mmHg to 83 ± 24 mmHg in the botulinum toxin group (p < 0.05). The mean maximal squeeze pressures were reduced from 70 ± 27 mmHg to 61 ± 32 mmHg (p > 0.05) in the surgery group, and from 117 ± 62 mmHg to 76 ± 34 (p < 0.01) in the botulinum toxin group. The fissures were healed in 70 percent of patients in the botulinum group and 82 percent in the surgery group (p > 0.05). There were no relapses during the 14 months of follow up. Conclusion Lateral internal sphincterotomy and botulinum toxin injection treatments both seem to be equally effective in the treatment of chronic anal fissure. PMID:15035674

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

2004-01-01

148

Effects of aging on the anorectal sphincters and their innervation  

Microsoft Academic Search

The effects of aging on the pelvic floor musculature and its innervation are described in 102 women and 19 men without colorectal\\u000a or pelvic floor disease. In the women, a reduction in anorectal “squeeze” pressure was found in the fifth decade, but the\\u000a resting anal pressure remained unchanged. This reduction in squeeze anal pressure was accompanied by an increase in

Soren Laurberg; Michael Swash

1989-01-01

149

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

SciTech Connect

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

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

2010-09-01

150

Anal Pap smears and anal cancer: what dermatologists should know.  

PubMed

Squamous epithelial cells are susceptible to infection by the human papillomavirus. Infection of squamous epithelium with oncogenic human papillomavirus types is associated with development of dysplasia and potential malignant transformation. Historically, cervical cancer has been the most prevalent human papillomavirus-induced squamous neoplasia. However, because of widespread screening via Pap smear testing, rates of cervical cancer in the United States have decreased dramatically during the past 50 years. Rates of anal cancer, in contrast, have doubled during the past 30 years. The groups at highest risk for development of anal cancer are men who have sex with men, HIV-positive patients, and patients immunosuppressed as a result of solid-organ transplantation. By detecting dysplasia before it develops into invasive cancer, anal Pap smears may be a potentially useful screening tool for anal cancer, particularly in individuals known to be at increased risk. However, at this time, sufficient data supporting the benefit of anal Pap smear screening are lacking. With insufficient evidence, no national health care organizations currently recommend the use of anal Pap smears as a routine screening test, even among high-risk groups. PMID:25088812

Liszewski, Walter; Ananth, Amy T; Ploch, Lauren E; Rogers, Nicole E

2014-11-01

151

Supersonic Rupture of Rubber  

E-print Network

The rupture of rubber differs from conventional fracture. It is supersonic, and the speed is determined by strain levels ahead of the tip rather than total strain energy as for ordinary cracks. Dissipation plays a very important role in allowing the propagation of ruptures, and the back edges of ruptures must toughen as they contract, or the rupture is unstable. This article presents several levels of theoretical description of this phenomenon: first, a numerical procedure capable of incorporating large extensions, dynamics, and bond rupture; second, a simple continuum model that can be solved analytically, and which reproduces several features of elementary shock physics; and third, an analytically solvable discrete model that accurately reproduces numerical and experimental results, and explains the scaling laws that underly this new failure mode. Predictions for rupture speed compare well with experiment.

M Marder

2005-04-24

152

Anal cancer and human papillomaviruses  

Microsoft Academic Search

Epidemiologic and clinical evidence has suggested a possible association between anal cancer and human papillomavirus (HPV)\\u000a types that are known to be associated with cervical and other genital cancers. Using Southern blot and dot blot analysis,\\u000a the authors examined 45 primary anal malignancies for HPV DNA types 6,11,16, and 18. HPV 16, DNA was detected in 23 of 41\\u000a (56

J. G. Palmer; J. H. Scholffield; P. J. Coates; N. A. Shepherd; J. R. Jass; L. V. Crawford; J. M. A. Northover

1989-01-01

153

What Are the Risk Factors for Anal Cancer?  

MedlinePLUS

... anal cancer? What are the risk factors for anal cancer? A risk factor is anything that affects ... about HPV and HPV vaccines, see HPV Vaccines . Anal warts Anal warts (also known as condyloma acuminata ) ...

154

Can Sphincter Relaxing Drugs Combined with FES Improve Bowel and Bladder Function  

Microsoft Academic Search

In this paper we propose a new approach to assist voiding of the neurogenic bowel and bladder. The smooth muscle sphincter is temporarily relaxed using a drug. Whilst the sphincter is relaxed expulsion is promoted by raising rectal\\/bladder pressures with colorectal\\/detrusor contractions. Expulsive contractions may be induced or augmented using electrical stimulation. Here we present our preliminary experience involving two

Brian J. Andrews; Maureen Coggrave; Brian Gardner; John Reynard

155

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

Microsoft Academic Search

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

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

1998-01-01

156

A rare case of anal tumor: Anal carcinosarcoma  

PubMed Central

Sarcomatoid carcinoma is a rare tumor with a poor prognosis, otherwise known as carcinosarcoma. Gastrointestinal origin is very rare and only a limited number of anal carcinosarcomas have been reported in the literature. The management of this rare cancer type is controversial. The aim of this case report was to confirm that by combining treatment modalities we can achieve long disease free intervals. Concomitant chemoradiotherapy led to a good partial response and this was followed by a consolidation surgical endo-anal excision. PMID:21191539

Mikropoulos, Christos; Williams, Timothy; Munthali, Lamios; Summers, Jeff

2010-01-01

157

Can Anal Cancer Be Found Early?  

MedlinePLUS

... Cancer + - Text Size Download Printable Version [PDF] » Early Detection, Diagnosis, and Staging TOPICS Document Topics GO » SEE ... Anal Cancer? Causes, Risk Factors, and Prevention Early Detection, Diagnosis, and Staging Treating Anal Cancer Talking With ...

158

Influence of cholecystectomy on sphincter of Oddi motility  

PubMed Central

Background—Gall bladder and sphincter of Oddi (SO) function are coordinated by hormonal and neuronal mechanisms. Nerve fibres pass between the gall bladder and the SO via the cystic duct. It is therefore possible that cholecystectomy may alter SO motility. ?Aim—To investigate the effect of cholecystectomy on SO function ?Methods—SO manometry was performed in five women (median age 52 years), a few days before and six months after laparoscopic cholecystectomy which was undertaken for uncomplicated cholelithiasis. Basal and post-cholecystokinin (CCK) SO motility were measured. ?Results—All patients were symptom free after laparoscopic cholecystectomy. Prior to surgery common bile duct pressure, and tonic and phasic SO motility were normal and phasic contractions were inhibited by intravenous CCK (1 Ivy Dog Unit/kg). Six months later, common bile duct pressure and baseline tonic and phasic activity were unchanged but CCK failed to suppress phasic activity. ?Conclusion—Cholecystectomy, at least in the short term, suppresses the normal inhibitory effect of pharmacological doses of CCK on the SO. The mechanism of this effect is unknown but it could be due to SO denervation. ?? Keywords: sphincter of Oddi; cholecystectomy; cholecystokinin PMID:9378394

Luman, W; Williams, A; Pryde, A; Smith, G; Nixon, S; Heading, R; Palmer, K

1997-01-01

159

Anal fistula. Past and present.  

PubMed

Anal fistula is a common benign condition that typically describes a miscommunication between the anorectum and the perianal skin, which may present de novo, or develop after acute anorectal abscess. Athough anal fistulae are benign, the condition can still negatively influence a patient's quality of life by causing minor pain, social hygienic embarrassment, and in severe cases, frank sepsis. Despite its long history and prevalence, anal fistula management remains one of the most challenging and controversial topics in colorectal surgery today. The end goals of treatment include draining the local infection, eradicating the fistulous tract, and minimizing recurrence and incontinence rates. The goal of this review is to ensure surgeons and physicians are aware of the different imaging and treatment choices available, and to report expected outcomes of the various surgical modalities so they may select the most suitable treatment.  PMID:25228174

Zubaidi, Ahmad M

2014-09-01

160

Conservative treatment for anal incontinence  

PubMed Central

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

Carter, Dan

2014-01-01

161

CIVILAND ENVIRONMENTAL ENGINEERING 2012 Anal. Geom.  

E-print Network

CIVILAND ENVIRONMENTAL ENGINEERING 2012 FRESHMAN FALL SP English 1157 (3) Calculus & Anal. Geom. *2107 (3) Biology Elective (3) Progrm/ Graphics 2301 (4) English 1158 (3) Calculus & Anal. Geom. *2108) Calculus & Anal. Geom. *2109 (4) Physics 1062 (3) Statics 2350 (3) Humanities Elective (3) Diff. Equ. 2221

Kulp, Mark

162

Rupture of the diaphragm  

PubMed Central

Christiansen, L. A., Stage, P., Bille Brahe, E., and Bertelsen, S. (1974).Thorax, 29, 559-563. Rupture of the diaphragm. A 23-year series of 25 patients with rupture of the diaphragm is presented. Symptoms, diagnostic procedures, and treatment are mentioned. A high index of suspicion of the diagnosis of ruptured diaphragm is most important in patients with a history of trauma. Familiarity with the signs on the plain chest film is important. Furthermore, we advocate an additional examination, that is diagnostic pneumoperitoneum, in all cases of suspected rupture of the diaphragm. If doubt still exists, we consider the final diagnostic procedure of choice to be exploratory thoracotomy until proof of the complete reliability of diagnostic pneumoperitoneum has been established. Images PMID:4428456

Christiansen, L. A.; Stage, P.; Bille Brahe, E.; Bertelsen, S.

1974-01-01

163

Achilles tendon rupture - aftercare  

MedlinePLUS

Managing Your: Achilles Tendon Rupture. In: Ferri FF, ed. Ferri's Clinical Advisor 2015 . 1st ed. Philadelphia, PA: Mosby Elsevier; 2014: appendix V. Sokolove PE, Barnes DK. Extensor and Flexor Tendon Injuries ...

164

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

E-print Network

of pubovisceral muscle avulsion 281 (30), which may be associated with later pelvic floor dysfunction and pelvic organ prolapse. 282 Furthermore, not all OASIS are clinically detectable at the time of delivery (31). We have 283 limited our analysis to those...

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

2014-01-01

165

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

Microsoft Academic Search

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

Maeve Eogan; Leslie Daly; Colm O'Herlihy

2006-01-01

166

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

Technology Transfer Automated Retrieval System (TEKTRAN)

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

167

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

Microsoft Academic Search

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

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

1982-01-01

168

New Empirical Relationships among Magnitude, Rupture Length, Rupture Width, Rupture Area, and Surface Displacement  

Microsoft Academic Search

Source parameters for historical earthquakes worldwide are com- piled to develop a series of empirical relationships among moment magnitude (M), surface rupture length, subsurface rupture length, downdip rupture width, rupture area, and maximum and average displacement per event. The resulting data base is a significant update of previous compilations and includes the ad- ditional source parameters of seismic moment, moment

Donald L. Wells; Kevin J. Coppersmith

1994-01-01

169

Effects of morphine on the human sphincter of Oddi.  

PubMed Central

The effects of morphine on intraluminal pressures recorded from the sphincter of Oddi (SO) at endoscopic retrograde cholangiopancreatography in 19 patients who were without evidence of biliary or pancreatic disease were studied. Morphine was given in four successive doses of 2.5, 2.5, 5, and 10 micrograms/kg iv at five minute intervals. Morphine in subanalgesic doses increased the frequency of SO phasic pressure waves to a maximum of 10-12/min, caused the phasic waves to occur simultaneously along the sphincter segment, increased phasic wave amplitude from 72 (26) (SE) to 136 (31) mmHg, and increased SO basal pressure from 10 (1) to 29 (9) mmHg (p less than 0.05). The effects of morphine on the SO are mediated by more than one opioid receptor type, as naloxone competitively antagonised the increase in phasic wave frequency induced by morphine, but did not affect the increase in SO basal pressure elicited by morphine. When given after naloxone, morphine decreased phasic wave amplitude, an inhibitory effect that is normally masked by morphine's dominant naloxone sensitive excitatory effect. Mu receptors do not appear to be involved in control of spontaneous SO motor function, as naloxone alone did not affect SO motor activity. The excitatory effects of morphine on the SO are not mediated by cholinergic nerves, as they were not blocked by atropine. Cholinergic nerves, however, may have a role in regulating spontaneous SO motor function because atropine alone depressed phasic wave activity and basal pressure. Although morphine does cause 'spasm' of the human SO, its effects are more complex than is commonly believed. PMID:3197985

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

1988-01-01

170

Achilles Tendon Rupture  

PubMed Central

Context: Achilles tendon (AT) rupture in athletes is increasing in incidence and accounts for one of the most devastating sports injuries because of the threat to alter or end a career. Despite the magnitude of this injury, reliable risk assessment has not been clearly defined, and prevention strategies have been limited. The purpose of this review is to identify potential intrinsic and extrinsic risk factors for AT rupture in aerial and ground athletes stated in the current literature. Evidence Acquisition: A MEDLINE search was conducted on AT rupture, or “injury” and “risk factors” and “athletes” from 1980 to 2011. Emphasis was placed on epidemiology, etiology, and review articles focusing on the risk for lower extremity injury in runners and gymnasts. Thirty articles were reviewed, and 22 were included in this assessment. Results: Aerial and ground athletes share many intrinsic risk factors for AT rupture, including overuse and degeneration of the tendon as well as anatomical variations that mechanically put an athlete at risk. Older athletes, athletes atypical in size for their sport, high tensile loads, leg dominance, and fatigue also may increase risk. Aerial athletes tend to have more extrinsic factors that play a role in this injury due to the varying landing surfaces from heights and technical maneuvers performed at various skill levels. Conclusion: Risk assessment for AT rupture in aerial and ground athletes is multivariable and difficult in terms of developing prevention strategies. Quantitative measures of individual risk factors may help identify major contributors to injury. PMID:24427410

Wertz, Jess; Galli, Melissa; Borchers, James R.

2013-01-01

171

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

PubMed Central

Motor activity of the sphincter of Oddi has been evaluated in 34 patients who underwent ERCP examination. Manometric recordings from the common bile duct and the sphincter of Oddi were performed with a polyethylene triple lumen catheter. At ERCP 16 patients had undamaged biliary ducts; six had undergone cholecystectomy and six had gall bladder stones; 18 patients had common bile duct stones; nine of whom had undergone cholecystectomy, and seven had gall bladder stones. Length and amplitude of the resting sphincter pressure as well as frequency, duration, amplitude, and propagating pattern of phasic contractions did not significantly differ in patients with and without common bile duct stones. Sphincter of Oddi motor activity did not appear to be influenced by the variation in the diameter of the common bile duct or by previous cholecystectomy. PMID:6698444

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

1984-01-01

172

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

2012-01-01

173

Comparison of artificial urinary sphincter and collagen for the treatment of postprostatectomy incontinence  

Microsoft Academic Search

Objectives. To compare how urinary symptoms affect the quality of life in groups of men with postprostatectomy incontinence treated with collagen versus artificial urinary sphincter implantation.Methods. Two cohorts of men, one which received urethral collagen injection and one artificial urinary sphincter (AUS) implantation, were surveyed with a validated quality-of-life questionnaire to assess how their urinary dysfunction impacted their daily activities.

Dimitri D Kuznetsov; Hyung L Kim; Rajesh V Patel; Gary D Steinberg; Gregory T Bales

2000-01-01

174

Adenocarcinoma of the anal ducts  

Microsoft Academic Search

The records of 21 patients treated for adenocarcinoma of the anal ducts between 1943 and 1982 were reviewed. The patients\\u000a were followed until death or current status in April 1987. The median follow-up period was eight months (range, 3 to 144 months).\\u000a Fifteen patients had an erroneous diagnosis made at first physician visit resulting in a media doctor's delay of

S. Lindkaer Jensen; M. H. Shokouh-Amiri; K. Hagen; H. Harling; O. Vagn Nielsen

1988-01-01

175

Hyperbaric levobupivacaine in anal surgery  

Microsoft Academic Search

Background  An ideal anesthetic technique for anal surgery on an outpatient basis should permit early mobilization without pain or residual\\u000a complications of anesthesia. The aim of this study was to analyze the reliability and efficacy of spinal perianal and spinal\\u000a saddle block by using two different doses of levobupivacaine for perianal surgery and their effects on voiding, first analgesic\\u000a requirement and

Z. Kazak; P. Ekmekci; K. Kazbek

2010-01-01

176

Anal Disorders - Multiple Languages: MedlinePlus  

MedlinePLUS

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

177

What Are the Key Statistics for Anal Cancer?  

MedlinePLUS

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

178

Sacral Neuromodulation Effects on Periurethral Sensation and Urethral Sphincter Activity  

PubMed Central

Aims To characterize the effect of sacral neuromodulation (SNM) on urethral neuromuscular function. Methods Following IRB approval, women with refractory overactive bladder (OAB) underwent standardized urethral testing prior to and after stage 1 SNM implantation. Periurethral sensation was measured using current perception thresholds (CPT). Striated urethral sphincter activity was quantified using concentric needle electromyography (CNE) and Multi-Motor Unit Action Potential (MUP) analysis software. Nonparametric analyses were used to characterize pre/post changes with intervention. Baseline CPT and CNE findings were compared between SNM responders and non-responders. Results 27 women were enrolled in this pilot study with a mean age of 61±13 years. Twenty of 26 women (76.9%) responded to SNM and went to stage 2 permanent implantation. Four (14.8%) withdrew after stage 1 implantation; 3 of the 4 withdrawals had not had therapeutic responses to SNM. CPT and CNE parameters did not significantly differ from baseline 2 weeks after SNM. Pre-SNM urethral sensation was not significantly different between responders and non-responders. However, responders had larger amplitude, longer duration and more turns and phases at baseline approaching significance, reflecting more successful urethral reinnervation, than non-responders. Conclusions SNM does not alter urethral neuromuscular function two weeks post Stage 1implantation. Women with more successful urethral reinnervation may be more responsive to SNM. PMID:23168535

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

2013-01-01

179

The double-stapled ileal reservoir and ileoanal anastomosis. A prospective review of sphincter function and clinical outcome.  

PubMed

Fifteen consecutive patients (nine males and six females) who underwent construction of a double-stapled ileoanal reservoir (DS-IAR) were prospectively evaluated. Mean and maximal resting pressures preoperatively, before ileostomy closure, and at 12 months, were 53 and 84 mm Hg, 39 and 62 mm Hg, and 62 and 81 mm Hg. Mean and maximal squeeze pressures at those same time periods were 96 and 153 mm Hg, 111 and 173 mm Hg, and 95 and 168 mm Hg. There were no significant decreases in either resting or squeeze pressure between preoperative values and those obtained 12 months after surgery. However, the length of the high pressure zone decreased from 3.8 cm preoperatively to 2.3 cm at 12 months. This reflects the sacrifice of the cephalad 1.5 cm of the internal anal sphincter necessary to effect this anastomosis at a mean of 1.4 cm from the dentate line. However, this maneuver did not result in poor continence. Eleven patients whose ileostomies were closed for a mean of 9 months, ranging from 3 to 15 months, were evaluated regarding functional outcome. Only one patient had any incontinence and this patient had incomplete circular-stapled tissue rings, which necessitated transanal suture repair of the anastomotic defect. Similarly, three of the four patients who sometimes or rarely use a pad at night had transanal-suture reinforcement. Ten of the 11 patients never wear a pad during the day. No pelvic or perianal sepsis occurred. Stratified squamous epithelium was found in 6 of the 13 distal stapler "donuts" that were examined. In addition, 10 patients underwent biopsy of the tissue immediately caudad to the circular staple line at the time of ileostomy closure; in five, only stratified squamous epithelium was noted. The DS-IAR is associated with excellent objective physiologic and subjective functional results. PMID:1645246

Wexner, S D; James, K; Jagelman, D G

1991-06-01

180

The Return of the Anal Character  

Microsoft Academic Search

The anal character is a central concept in the psychoanalytic theory of personality. It was originally described in the first decade of the 20th century, and quickly applied to the analysis of clinical cases, psychobiographies, and cultural phenomena. In midcentury a generation of psychoanalytically oriented psychologists found some evidence that anal traits cohere and that they are related to attitudes

Nick Haslam

2011-01-01

181

Neonatal bladder rupture.  

PubMed

Neonatal bladder rupture is rare as a complication of bladder obstruction due to abnormal anatomy or iatrogenic cause such as umbilical catheterization. The present study describes the case of a 27-day old infant with ascites due to bladder perforation secondary to bladder wall necrosis as a result of severe urinary tract infection. The baby was treated aggressively with antibiotics and underwent successful surgical repair of the perforation. PMID:19205633

Tran, Hoang; Nguyen, Ngoc; Nguyen, Tap

2009-04-01

182

Anal carcinoma in patients with Crohn's disease.  

PubMed Central

Three patients with Crohn's disease and carcinoma of the anus are reported and compared to a group of patients with anal cancer and no inflammatory bowel disease. The three patients with Crohn's disease were relatively young women with significant perianal disease. There were two squamous cell lesions and one cloacogenic tumor in this group. The relative incidence of anal cancer as a proportion of all colorectal cancer, in patients with Crohn's disease (14%) was found to be significantly higher than the incidence of anal cancer in patients without inflammatory bowel disease (1.4%). Possible reasons for the increased incidence of anal cancer in Crohn's disease mentioned were: an overall increase in malignancies in inflammatory bowel disease, the high incidence of perianal disease, and the chronic long-standing perianal inflammation present. All patients with Crohn's disease, especially if they have active perianal disease, should be observed for the occurrence of anal cancer. PMID:6703795

Slater, G; Greenstein, A; Aufses, A H

1984-01-01

183

Rupture of renal transplant.  

PubMed

Background. Rupture of renal allograft is a rare and serious complication of transplantation that is usually attributed to acute rejection, acute tubular necrosis, or renal vein thrombosis. Case Presentation. LD, a 26-year-old male with established renal failure, underwent deceased donor transplantation using kidney from a 50-year-old donor with acute kidney injury (Cr 430?mmol/L). LD had a stormy posttransplant recovery and required exploration immediately for significant bleeding. On day three after transplant, he developed pain/graft swelling and another significant haemorrhage with cardiovascular compromise which did not respond to aggressive resuscitation. At reexploration, the renal allograft was found to have a longitudinal rupture and was removed. Histology showed features of type IIa Banff 97 acute vascular rejection, moderate arteriosclerosis, and acute tubular necrosis. Conclusion. Possible ways of avoiding allograft rupture include use of well-matched, good quality kidneys; reducing or managing risk factors that would predispose to delayed graft function; ensuring a technically satisfactory transplant procedure with short cold and warm ischemia times; and avoiding large donor-recipient age gradients. PMID:25685589

Baker, Shona; Popescu, Maria; Akoh, Jacob A

2015-01-01

184

Rupture of Renal Transplant  

PubMed Central

Background. Rupture of renal allograft is a rare and serious complication of transplantation that is usually attributed to acute rejection, acute tubular necrosis, or renal vein thrombosis. Case Presentation. LD, a 26-year-old male with established renal failure, underwent deceased donor transplantation using kidney from a 50-year-old donor with acute kidney injury (Cr 430?mmol/L). LD had a stormy posttransplant recovery and required exploration immediately for significant bleeding. On day three after transplant, he developed pain/graft swelling and another significant haemorrhage with cardiovascular compromise which did not respond to aggressive resuscitation. At reexploration, the renal allograft was found to have a longitudinal rupture and was removed. Histology showed features of type IIa Banff 97 acute vascular rejection, moderate arteriosclerosis, and acute tubular necrosis. Conclusion. Possible ways of avoiding allograft rupture include use of well-matched, good quality kidneys; reducing or managing risk factors that would predispose to delayed graft function; ensuring a technically satisfactory transplant procedure with short cold and warm ischemia times; and avoiding large donor-recipient age gradients. PMID:25685589

Baker, Shona; Popescu, Maria; Akoh, Jacob A.

2015-01-01

185

Hypertensive lower esophageal sphincter: what does it mean?  

PubMed

The hypertensive lower esophageal sphincter (LES) (mean LES pressure greater than 45 mm Hg; LES relaxation greater than 75%; normal peristalsis) is a poorly characterized motility disorder associated with chest pain and dysphagia. Therefore, we carried out a multidisciplinary study to assess esophageal pressures and function in 15 symptomatic hypertensive LES patients (3 men, 12 women; mean age, 53 years). On-line computer analysis showed a significant (p less than 0.05) increase in LES pressure (55.5 versus 14.9 mm Hg) and residual pressure (6.8 versus 1.1 mm Hg) as well as a decrease in percentage of LES relaxation (87 versus 93%) in patients compared with age-matched controls. All patients had normal peristalsis but 7 of 15 had nutcracker esophagus (mean distal amplitude, 216 mm Hg). No patient had evidence of impaired liquid transport on barium esophagram. The emptying of solids as assessed by radionuclide scans was normal in 14 of 15 patients. Of the 12 patients who completed both psychological inventories, nine had elevated scores on scales assessing anxiety and somatization. The heterogenous nature of this disorder is illustrated by a patient with a changeable narrowing in the distal esophagus associated with the transient impaction of a marshmallow. Dysphagia but not chest pain improved after pneumatic dilatation. We conclude that the hypertensive LES is a heterogenous disorder. Despite abnormal LES parameters, most patients have normal esophageal function, and frequent psychological abnormalities may contribute to their report of symptoms. A minority have abnormal esophageal transit. PMID:2661657

Waterman, D C; Dalton, C B; Ott, D J; Castell, J A; Bradley, L A; Castell, D O; Richter, J E

1989-04-01

186

Medication Effects on Periurethral Sensation and Urethral Sphincter Activity  

PubMed Central

Aim To characterize urethral neuromuscular function before and 2 weeks after medication therapy. Methods Premenopausal women without lower urinary tract symptoms were randomly allocated to one of six medications for 2 weeks (pseudoephedrine ER 120mg, imipramine 25mg, cyclobenzaprine 10mg, tamsulosin 0.4mg, solifenacin 5mg or placebo). At baseline and after medication, participants underwent testing: quantitative concentric needle EMG (CNE) of the urethral sphincter using automated Multi-Motor Unit Action Potential (MUP) software; current perception threshold (CPT) testing to measure periurethral sensation; and standard urodynamic pressure flow studies (PFS). Nonparametric tests were used to compare pre-post differences. Results 56 women had baseline testing; 48 (85.7%) completed follow-up CNE, and 49 (87.5%) completed follow-up CPT and PFS testing. Demographics showed no significant differences among medication groups with respect to age (mean 34.3 ± 10.1), BMI (mean 31.8 ± 7.5), parity (median 1, range 0–7), or race (14% Caucasian, 80% African American). PFS parameters were not significantly different within medication groups. No significant pre-post changes in CNE values were noted; however, trends in amplitudes were in a direction consistent with the expected physiologic effect of the medications. With CPT testing, a trend toward increased urethral sensation at the 5 Hz stimulation level, was observed following treatment with pseudoephedrine (0.15 to 0.09 mA at 5Hz; P=0.03). Conclusion In women without LUTS, pseudoephedrine improved urethral sensation, but not urethral neuromuscular function on CNE or pressure flow studies. Imipramine, cyclobenzaprine, tamsulosin, solifenacin, and placebo did not change urethral sensation or neuromuscular function. PMID:25185603

Greer, W. Jerod; Gleason, Jonathan L.; Kenton, Kimberly; Szychowski, Jeff M.; Goode, Patricia S; Richter, Holly E

2014-01-01

187

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. PMID:25452775

LI, HE-FEI; LIU, JUN-FENG; ZHANG, KE; FENG, YONG

2015-01-01

188

Sphincter of Oddi dysfunction and bile duct microlithiasis in acute idiopathic pancreatitis  

PubMed Central

Although there are numerous causes of acute pancreatitis, an etiology cannot always be found. Two potential etiologies, microlithiasis and sphincter of Oddi dysfunction, are discussed in this review. Gallbladder microlithiasis, missed on transcutaneous ultrasound, is reported as the cause of idiopathic acute pancreatitis in a wide frequency range of 6%-80%. The best diagnostic technique for gallbladder microlithiasis is endoscopic ultrasound although biliary crystal analysis and empiric cholecystectomy remain as reasonable options. In contrast, in patients who are post-cholecystectomy, bile duct microlithiasis does not appear to have a role in the pathogenesis of acute pancreatitis. Sphincter of Oddi dysfunction is present in 30%-65% of patients with idiopathic acute recurrent pancreatitis in whom other diagnoses have been excluded. It is unclear if this sphincter dysfunction was the original etiology of the first episode of pancreatitis although it appears to have a causative role in recurring episodes since sphincter ablation decreases the frequency of recurrent attacks. Unfortunately, this conclusion is primarily based on small retrospective case series; larger prospective studies of the outcome of pancreatic sphincterotomy for SOD-associated acute pancreatitis are sorely needed. Another problem with this diagnosis and its treatment is the concern over potential procedure related complications from endoscopic retrograde cholangiopancreatography (ERCP), manometry and pancreatic sphincterotomy. For these reasons, patients should have recurrent acute pancreatitis, not a single episode, and have a careful informed consent before assessment of the sphincter of Oddi is undertaken. PMID:18286682

Elta, Grace H

2008-01-01

189

MEETING ABSTRACTS Open Access Persistence of anal squamous intraepithelial  

E-print Network

MEETING ABSTRACTS Open Access Persistence of anal squamous intraepithelial lesions and anal HPV Background A high prevalence of anal squamous intraepithelial lesions (ASIL) and HPV infection have been in a longitudinal study before starting a first-line regimen of cART. Each patient provided anal samples for cytol

Boyer, Edmond

190

Technical Notes Anal. Chem. 1994,66, 418-423  

E-print Network

Technical Notes Anal. Chem. 1994,66, 418-423 Iridium-Based Ultramicroelectrode Array Fabricated.; Wightman, R. M. Anal. Chem. 1985,57, 1989-1993. (5) Baranski, A. S.Anal. Chem. 1987, 59, 661666. (6) Daniele, S.;Baldo, M. A.; Ugo, P.; Mauocchin, A. Anal. Chem.Acto 1989, (7) Kounavcs, S . P. And. Chem

Kounaves, Samuel P.

191

116/126 numerical anal. computational PDEs, grad level topics  

E-print Network

116/126 numerical anal. computational PDEs, grad level topics ?W 43 complex anal. 20 prob. & stats F W F F S W XF 35/63 real anal. XFS WS W W F F FWS Markov models, derivatives 86 math. finance F 56, huge data analysis 76 topics in appl. W time series, special topics grad. func. anal., special topics

192

How the anal gland orifice could be found in anal abscess operations  

PubMed Central

Background: On an average 30-50% of patients who undergo incision and drainage (I and D) of anal abscess will develop recurrence or fistula formation. It is claimed that finding the internal orifice of anal abscess to distract the corresponding anal gland duct; will decline the rate of future anal fistula. Surgeons supporting I and D alone claim that finding the internal opening is hazardous. This study is conducted to assess short-term results of optional method to manage patients with anal abscess and fitula-in-ano at the same time. Materials and Methods: In this cross-sectional descriptive study 49 from 77 patients with anal abscess whose internal orifice was not identified by pressing on the abscess, diluted hydrogen peroxide (2%) and methylene blue was injected into the abscess cavity and the anal canal was inspected to find out the internal opening. Once the opening was distinguished, an incision was given from the anal verge to the internal opening. Results: The internal orifice was identified in 44 out of 49 patients (90%) who underwent this new technique. Up to 18 months during follow-up, only 2.5% of patients with primary fistulotomy developed fistula on the site of a previous abscess. Conclusion: Conventional method to seek the internal orifice of anal abscesses is successful in about one-third of cases. By applying this new technique, surgeons would properly find the internal opening in >90% of patients. Needless to say, safe identification of the anal gland orifice in anal abscess disease best helps surgeons to do primary fistulotomy and in turn it would significantly decrease the rate of recurrence in anal abscess and fistula formation.

Paydar, Shahram; Izadpanah, Ahmad; Ghahramani, Leila; Hosseini, Seyed Vahid; Bananzadeh, Alimohammad; Rahimikazerooni, Salar; Bahrami, Faranak

2015-01-01

193

Ruptured Intracranial Dermoid Cyst Associated with Rupture of Cerebral Aneurysm  

PubMed Central

Many tumors have been reported to coexist with cerebral aneurysm. However, intracranial dermoid cysts associated with cerebral aneurysm are very rare. We report a case in which rupture of a cerebral aneurysm resulted in a ruptured dermoid cyst. We present this interesting case and review current literature about the relationship between tumors and aneurysm formation. PMID:22259693

Kim, Ki Hong

2011-01-01

194

Neoplasms of Anal Canal and Perianal Skin  

PubMed Central

Tumors of the anus and perianal skin are rare. Their presentation can vary and often mimics common benign anal pathology, thereby delaying diagnosis and appropriate and timely treatment. The anatomy of this region is complex because it represents the progressive transition from the digestive system to the skin with many different co-existing types of cells and tissues. Squamous cell carcinoma of the anal canal is the most frequent tumor found in the anal and perianal region. Less-frequent lesions include Bowen's and Paget's disease, basal cell carcinoma, melanoma, and adenocarcinoma. This article aims to review the clinical presentation, diagnostic evaluation, and treatment options for neoplasms of the anal canal and perianal skin. PMID:22379406

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

2011-01-01

195

Anal Cancer: What Happens After Treatment?  

MedlinePLUS

... this phase of your treatment. For patients with colostomies Most people treated for anal cancer don’t ... APR, you will need to have a permanent colostomy. If you have a colostomy, follow-up is ...

196

The S ileal pouch-anal anastomosis  

Microsoft Academic Search

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

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

1987-01-01

197

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

2008-01-01

198

Plantar Fascia Ruptures in Athletes  

Microsoft Academic Search

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

Amol Saxena; Brian Fullem

2004-01-01

199

The regeneration process of the striated urethral sphincter involves activation of intrinsic satellite cells  

Microsoft Academic Search

The regeneration of adult skeletal muscle is mediated by satellite cells. Classically, these are considered to be somitically derived cells that colonize the limbs during early embryogenesis. The striated urethral sphincter presents specific developmental characteristics that distinguish it from skeletal muscles, such as the non-somitic origin of its precursor cells and the late formation of its myofibers. This prompted us

René Yiou; Jean-Pascal Lefaucheur; Anthony Atala

2003-01-01

200

Conditioning Stimulus Can In£uence an External Urethral Sphincter Contraction Evoked by a Magnetic Stimulation  

Microsoft Academic Search

Aims: To study the e¡ect of a conditioning stimulus on an external urethral sphincter (EUS) contraction evoked by a magnetic stimulation at di¡erent time intervals. Methods: Seven healthy male volunteers underwent EUS pressure measurement. At baseline, magnetic stimulation of the lumbosacral spinal cord above the motor threshold was performed and evoked EUS pressure responses were recorded. The lumbosacral magnetic stimulation

Bjoern Wefer; Peter A. Knapp; Andreas Bannowsky; Klaus-Peter Juenemann; Brigitte Schurch

201

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

PubMed Central

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 oophorectomies, one had shrunken ovaries and ovarian failure, and one had previously undergone oophorectomy and the other ovary could not be seen; in one neither ovary could be seen, and three had ovaries of normal appearance, although two of these women were taking the contraceptive pill. Thirteen of the group had endocrine symptoms and signs characteristic of the polycystic ovary syndrome. Videocystometrography in 17 of the women who were examined by ultrasonography showed low flow rates and high residual volumes of urine after micturition in 12 women who could void, the other five having chronic urinary retention. A speculative hypothesis for the observed association of impaired voiding, abnormal electromyographic activity of the urinary sphincter, and polycystic ovaries is advanced, based on the relative progesterone deficiency that characterises the polycystic ovary syndrome. Progesterone stabilises membranes, and its depletion might permit ephaptic transmission of impulses between muscle fibres in the muscle of the urethral sphincter, giving rise to the abnormal electromyographic activity. This may impair relaxation of the sphincter, resulting in low flow rates of urine, incomplete emptying of the bladder, and, finally, urinary retention. PMID:3147005

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

1988-01-01

202

Sphincter of Oddi dysfunction: Psychosocial distress correlates with manometric dyskinesia but not stenosis  

Microsoft Academic Search

AIM: To compare postcholecystectomy patients with Sphincter of Oddi (SO) dyskinesia and those with nor- mal SO motility to determine the psychosocial distress, gender and objective clinical correlates of dyskinesia, and contrast these findings with comparisons between SO stenosis and normal SO motility. METHODS: Within a cohort of seventy-two consecutive postcholecystectomy patients with suspected SO dys- function, manometric assessment identified

Ethelle Bennett; Peter Evans; John Dowsett; John Kellow

2009-01-01

203

Hypertrophy of the external and sphincter in haemorrhoids: a histometric study  

Microsoft Academic Search

Biopsies of the external and sphincter taken from 24 male patients with haemorrhoids were subjected to examination using histochemical techniques. Fibre size (type 1 mean: 33 micrometers +\\/- 11.0 SD and type 2 mean: 47.9 micrometers +\\/- 15.0 SD) was increased when compared with control subjects. The distribution of muscle fibre types in these patients showed markedly greater type 1

T Teramoto; A G Parks; M Swash

1981-01-01

204

Assessing outcome after a modified vaginal wall sling for stress incontinence with intrinsic sphincter deficiency  

Microsoft Academic Search

Forty women with stress incontinence, intrinsic sphincter deficiency (ISD), associated or not with urethral hypermobility, a Valsalva leak point pressure (VLLP) 20 and a maximum urethral closure pressure 20 underwent in situ vaginal wall sling. The main modification to the technique was the use of two small Marlex meshes placed at the lateral edges of the sling. Outcome was assessed

Elisabetta Costantini; Luigi Mearini; Ettore Mearini; Cinzia Pajoncini; Federico Guercini; Vittorio Bini; Massimo Porena

2005-01-01

205

[Is sphincter-plasty for treatment of fecal incontinence in patients older than 60 justified?].  

PubMed

Overlapping sphincteroplasty is the method of choice for isolated anterior sphincter defects. Patients over 60 years of age can undergo this operation with similar good results as in younger patients. However, preoperative physiologic assessment of the pelvic floor is necessary for a good postoperative outcome. PMID:9101903

Pfeifer, J; Rabl, H; Uranüs, S; Wexner, S D

1996-01-01

206

Traditional Chinese surgical treatment for anal fistulae with secondary tracks and abscess  

PubMed Central

AIM: To evaluate the efficacy and safety of traditional Chinese surgical treatment for anal fistulae with secondary tracks and abscess. METHODS: Sixty patients with intersphincteric or transsphincteric anal fistulas with secondary tracks and abscess were randomly divided into study group [suture dragging combined with pad compression (SDPC)] and control group [fistulotomy (FSLT)]. In the SDPC group, the internal opening was excised and incisions at external openings were made for drainage. Silk sutures were put through every two incisions and knotted in loose state. The suture dragging process started from the first day after surgery and the pad compression process started when all sutures were removed as wound tissue became fresh and without discharge. In the FSLT group, the internal opening and all tracts were laid open and cleaned by normal saline postoperatively till all wounds healed. The time of healing, postoperative pain score (visual analogue scale), recurrence rate, patient satisfaction, incontinence evaluation and anorectal manometry before and after the treatment were examined. RESULTS: There were no significant differences between the two groups regarding age, gender and fistulae type. The time of healing was significantly shorter (24.33 d in SDPC vs 31.57 d in FSLT, P < 0.01) and the patient satisfaction score at 1 mo postoperative follow-up was significantly higher in the SDPC group (4.07 in SDPC vs 3.37 in FSLT, P < 0.05). The mean maximal postoperative pain scores were 5.83 ± 2.5 in SDPC vs 6.37 ± 2.33 in FSLT and the recurrence rates were 3.33 in SDPC vs 0 in FSLT. None of the patients in the two groups experienced liquid and solid fecal incontinence and lifestyle alteration postoperatively. The Wexner score after treatment of intersphincter fistulae were 0.17 ± 0.41 in SDPC vs 0.40 ± 0.89 in FSLT and trans-sphincter fistulae were 0.13 ± 0.45 in SDPC vs 0.56 ± 1.35 in FSLT. The maximal squeeze pressure and resting pressure declined after treatment in both groups. The maximal anal squeeze pressures after treatment were reduced (23.17 ± 3.73 Kpa in SDPC vs 22.74 ± 4.47 Kpa in FSLT) and so did the resting pressures (12.36 ± 2.15 Kpa in SDPC vs 11.71 ± 1.87 Kpa in FSLT), but there were neither significant differences between the two groups and nor significant differences before or after treatment. CONCLUSION: Traditional Chinese surgical treatment SDPC for anal fistulae with secondary tracks and abscess is safe, effective and less invasive. PMID:23155310

Wang, Chen; Lu, Jin-Gen; Cao, Yong-Qing; Yao, Yi-Bo; Guo, Xiu-Tian; Yin, Hao-Qiang

2012-01-01

207

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

PubMed

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

Beedholm, Kirsten; Lomborg, Kirsten; Frederiksen, Kirsten

2014-04-01

208

Anal endosonography for recurrent anal fistulas: image enhancement with hydrogen peroxide.  

PubMed

Anal endosonography is a new technique that is useful in the preoperative assessment of patients with anal fistulas. Endosonographic images are created by the reflection of sound waves from the interfaces between tissues of varying densities. In order to accentuate tissue interface layers at the level of the fistula tract, we introduced hydrogen peroxide into the fistula tract through the external opening during anal ultrasonography in two patients with recurrent anal fistula. Hydrogen peroxide injection resulted in hyperechoic imaging of the preinjection hypoechoic horseshoe fistula tract. Endosonographic findings were confirmed at the time of surgery in both patients. We conclude that hydrogen peroxide enhancement of the fistula tract is a simple, effective, and safe method of improving the accuracy of endoanal ultrasound assessment of recurrent anal fistula. PMID:8253014

Cheong, D M; Nogueras, J J; Wexner, S D; Jagelman, D G

1993-12-01

209

Controlled, randomized trial of island flap anoplasty for treatment of trans–sphincteric fistula–in-ano: early results  

Microsoft Academic Search

Treatment of trans–sphincteric fistula is usually a\\u000acompromise between recurrence and incontinence.\\u000aDermal island flap anoplasty has been found to be useful\\u000ain the treatment of these fistulas. We performed a randomized\\u000atrial to compare dermal island flap anoplasty with\\u000aconventional treatment for trans–sphincteric fistula–in–ano.\\u000aSeventy nine patients with fistula–in–ano were recruited;\\u000atwenty patients with trans–sphincteric fistula confirmed by\\u000aendoanal

K. S. Ho; Y. H. Ho

2005-01-01

210

Rectal eversion and double-stapled ileal pouch anal anastomosis in familial adenomatous polyposis syndrome  

PubMed Central

INTRODUCTION Surgery is the only treatment option for familial adenomatous polyposis (FAP). Aim of surgery in FAP is to minimize colorectal cancer risk without need for permanent stoma. There are especially two operation options; Total colectomy with ileorectal anastomosis (IRA) and total proctocolectomy with ileo-pouch anal anastomosis (IPAA). We report here a patient with FAP who had resection via rectal eversion just over the dentate line under direct visualization and ileoanal-J pouch anastomosis by double-stapler technique. PRESENTATION OF CASE A 40 yr. old female patient with FAP underwent surgery. Firstly, colon and the rectum mobilized completely, and then from the 10 cm. proximal to the ileo-caecal valve to the recto-sigmoid junction total colectomy was performed. Rectum was everted by a grasping forceps which was introduced through the anus and then resection was performed by a linear stapler just over the dentate line. A stapled J-shaped ileal reservoir construction followed by intraluminal stapler-facilitated ileoanal anastomosis. Follow up at six months anal sphincter function was found normal. DISCUSSION There is only surgical management option for FAP patients up to now. Total colectomy with IRA and restorative proctocolectomy with IPAA is surgical options for FAP patients that avoid the need for a permanent stoma. Anorectal eversion may be used in the surgical treatment of FAP, chronic ulcerative colitis and early stage distal rectal cancer patients. CONCLUSION J-pouch ileoanal anastomosis can safely be performed by rectal eversion and double stapler technique in FAP patients. PMID:25305601

Aygar, Muhittin; Yeti?ir, Fahri; Salman, Ebru; Y?ld?r?m, Murat Baki; Özdedeo?lu, Mesut; Durak, Do?ukan; Yalç?n, Abdussamet

2014-01-01

211

Interstitial high-dose rate brachytherapy as boost for anal canal cancer.  

PubMed

AimTo assess clinical outcomes of patients treated with a high-dose rate brachytherapy boost for anal canal cancer (ACC).MethodsFrom August 2005 to February 2013, 28 patients presenting an ACC treated by split-course external beam radiotherapy (EBRT) and HDR brachytherapy with or without chemotherapy in a French regional cancer center in Nice were retrospectively analyzed.ResultsMedian age was 60.6 years [34 ¿ 83], 25 patients presented a squamous cell carcinoma and 3 an adenocarcinoma; 21 received chemotherapy. Median dose of EBRT was 45 Gy [43.2 ¿ 52]. Median dose of HDR brachytherapy was 12 Gy [10 - 15] with a median duration of 2 days. Median overall treatment time was 63 days and median delay between EBRT and brachytherapy was 20 days. Two-year local relapse free, metastatic free, disease free and overall survivals were 83%, 81.9%, 71.8% and 87.7% respectively. Acute toxicities were frequent but not severe with mostly grade 1 toxicities: 37% of genito-urinary, 40.7% of gastro-intestinal and 3.7% of cutaneous toxicities. Late toxicities were mainly G1 (43.1%) and G2 (22%). Two-year colostomy-free survival was 75.1%, one patient had a definitive sphincter amputation.ConclusionHigh-dose rate brachytherapy for anal canal carcinoma as boost represents a feasible technique compared to low or pulsed-dose rate brachytherapy. This technique remains an excellent approach to precisely boost the tumor in reducing the overall treatment time. PMID:25377886

Falk, Alexander; Claren, Audrey; Benezery, Karen; François, Eric; Gautier, Mathieu; Gerard, Jean-Pierre; Hannoun-Levi, Jean-Michel

2014-11-01

212

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

PubMed Central

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

2011-01-01

213

Ingestion of a carbonated beverage decreases lower esophageal sphincter pressure and increases frequency of transient lower esophageal sphincter relaxation in normal subjects.  

PubMed

Transient lower esophageal sphincter relaxation (tLESR) and decreased basal lower esophageal sphincter (LES) pressure are postulated mechanisms of gastroesophageal reflux (GER). There is conflicting evidence on the effect of carbonated drinks on lower esophageal sphincter function. This study was conducted to assess the effect of a carbonated beverage on tLESR and LES pressure. High resolution manometry tracings (16 channel water-perfused, Trace 1.2, Hebbard, Australia) were obtained in 18 healthy volunteers (6 men) for 30 min each at baseline, and after 200 mL of chilled potable water and 200 mL of chilled carbonated cola drink (Pepsi [Pepsico India Ltd]). The sequence of administration of the drinks was determined by random number method generated by a computer. The analysis of tracings was done using TRACE 1.2 software by a physician who was unaware of the sequence of administration of fluids. The mean (SD) age of the participant was 37.3 (12.9) years. The median (range) frequency of tLESr was higher after the carbonated beverage (10.5 [0-26]) as compared to baseline (0 [0-3], p?=?0.005) as well as after water (1 [0-14], p?=?0.010). The LES pressure decreased after ingestion of the carbonated beverage (18.5 [11-37] mmHg) compared to baseline (40.5 [25-66] mmHg, p?=?0.0001) and after water (34 [15-67] mmHg, p?=?0.003). Gastric pressure was not different in the three groups. Ingestion of a carbonated beverage increases tLESr and lowers LES pressure in healthy subjects. PMID:22791463

Shukla, Akash; Meshram, Megha; Gopan, Amrit; Ganjewar, Vaibhav; Kumar, Praveen; Bhatia, Shobna J

2012-06-01

214

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

1986-01-01

215

What's New in Anal Cancer Research and Treatment?  

MedlinePLUS

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

216

ccsd00002493, Alguns fenomens de continuaci o anal tica  

E-print Network

ccsd­00002493, version 1 ­ 6 Aug 2004 Alguns fenomens de continuaci#19;o anal#19;#16;tica en una;#16; obtinguda #19;es una continuaci#19;o anal#19;#16;tica (o tamb#19;e un prolungament anal#19;#16;tic) de f p : C 1 ! C ; direm tamb#19;e que f q : C 2 ! C #19;es una continuaci#19;o anal#19;#16;tica de f p : C 1

217

Transurethral Implantation of Macroplastique® for the Treatment of Female Stress Urinary Incontinence Secondary to Urethral Sphincter Deficiency  

Microsoft Academic Search

Objective: To assess the results of transurethral implantation of Macroplastique® in women with stress incontinence secondary to urethral sphincter deficiency using subjective and objective outcome measures.Methods: A total of 60 women with genuine stress incontinence secondary to intrinsic urethral sphincter deficiency were treated with transurethral implantation of Macroplastique. The patients had undergone a mean of 1.9 (range 0–7) previous episodes

S. C. Radley; C. R. Chapple; I. C. Mitsogiannis; K. S. Glass

2001-01-01

218

[Management of locally advanced anal canal carcinoma with modulated arctherapy and concurrent chemotherapy].  

PubMed

The standard treatment of locally advanced (stage II and III) squamous cell carcinoma of the anal canal consists of concurrent chemoradiotherapy (two cycles of 5-fluoro-uracil, mitomycin C, on a 28-day cycle), with a dose of 45Gy in 1.8Gy per fraction in the prophylactic planning target volume and additional 14 to 20Gy in the boost planning target volume (5days per week) with a possibility of 15days gap period between the two sequences. While conformal irradiation may only yield suboptimal tumor coverage using complex photon/electron field junctions (especially on nodal areas), intensity modulated radiation therapy techniques (segmented static, dynamic, volumetric modulated arc therapy and helical tomotherapy) allow better tumour coverage while sparing organs at risk from intermediate/high doses (small intestine, perineum/genitalia, bladder, pelvic bone, etc.). Such dosimetric advantages result in fewer severe acute toxicities and better potential to avoid a prolonged treatment break that increases risk of local failure. These techniques also allow a reduction in late gastrointestinal and skin toxicities of grade 3 or above, as well as better functional conservation of anorectal sphincter. The technical achievements (simulation, contouring, prescription dose, treatment planning, control quality) of volumetric modulated arctherapy are discussed. PMID:25770884

Troussier, I; Huguet, F; Servagi-Vernat, S; Benahim, C; Khalifa, J; Darmon, I; Ortholan, C; Krebs, L; Dejean, C; Fenoglietto, P; Vieillot, S; Bensadoun, R-J; Thariat, J

2015-04-01

219

Anal fissure: the changing management of a surgical condition  

Microsoft Academic Search

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

A. G. Acheson; J. H. Scholefield

2005-01-01

220

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

ERIC Educational Resources Information Center

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

Branfman, Jonathan; Ekberg Stiritz, Susan

2012-01-01

221

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

E-print Network

Anal. Chem. 1007, 59, 2747-2749 2747 ACKNOWLEDGMENT The authors are grateful for the computer curve,3,657. (2) Armstrong, D. W. Sep. Purif. M e W s 1985, 74, 213. (3)Armstrong, D. W.; Nome. F. Anal. Chem. 1081,53,1662. (4) Arunyanart, M.; Cline Love, L. J. Anal. Chem. 1084,56, 1557. (5) Dorsey, J. G. A

Zare, Richard N.

222

Anal. Chem. 1990, 62, 443-446 443 (14) Martin, M.; Herman, D. P.; Gubchon,G. Anal. Chem. 1988. 58, 2200.  

E-print Network

Anal. Chem. 1990, 62, 443-446 443 (14) Martin, M.; Herman, D. P.; Gubchon,G. Anal. Chem. 1988. 58 CITED Davis, J. M.; Wings, J. C. Anal. Chem. 1983, 55, 418. Rosenthai, D. Anal. Chem. 1982, 54, 63. Nagels. L. J.; Creten. W. L.; Vanpeperstraete, P. M. Anal. Chem. 1983. 55, 216. Wings, J. C.; Davis, J. M

Zare, Richard N.

223

Urinary bladder and sphincter responses to stimulation of dorsal and ventral sacral roots.  

PubMed

The sacral spinal roots have a long intraspinal yet extradural pathway that makes them ideal for electrode implantation for the control of micturition. In the hope of identifying a specific motor pathway to the bladder within these roots, a study of 10 mongrel female dogs was undertaken: bladder and sphincter responses to stimulation of individual sacral roots, and to stimulation of the dorsal and ventral components of each root, were recorded urodynamically. The root producing greatest detrusor response was then divided into its motor and sensory components, and the central and peripheral ends of the latter were stimulated. We found that sphincter resistance to bladder emptying was diminished by removing the afferent dorsal roots from the stimulus field. The physiologic implications of this finding are discussed. PMID:429125

Schmidt, R A; Bruschini, H; Tanagho, E A

1979-01-01

224

Sphincters of canine hepatic sublobular veins respond to endothelin-1 and 3  

Microsoft Academic Search

The dog has been used repeatedly as a model in liver transplantation research. The microcirculation and its regulatory mechanisms\\u000a play a crucial role during ischemia and reperfusion. Little is known about the role of venous sphincters in regulating blood\\u000a flow in the dog liver. Hence, we performed this study to elucidate their potential role in regulating local blood flow. In

S. Aharinejad; F. Nourani; M. Egerbacher; E. K. Larson; A. Miksovsky; P. Böck; W. Firbas; R. S. McCuskey; S. C. Marks Jr.

1997-01-01

225

The promise of stem cell therapy to restore urethral sphincter function  

Microsoft Academic Search

The promise of stem cell therapy for the treatment of stress urinary incontinence is that transplanted stem cells may undergo\\u000a self-renewal and potential multipotent differentiation, leading to urethral sphincter regeneration. Cell-based therapies are\\u000a most often associated with the use of autologous multipotent stem cells, such as bone marrow cells. However, harvesting bone\\u000a marrow stromal stem cells is difficult, painful, and

Akira Furuta; Ron J. Jankowski; Ryan Pruchnic; Naoki Yoshimura; Michael B. Chancellor

2007-01-01

226

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

2013-01-01

227

Hydropneumatic anal dilation in conservative treatment of chronic anal fissure: clinical outcomes and randomized comparison with topical nitroglycerin  

Microsoft Academic Search

Background The surgical approach in chronic anal fissures (CAF) may, occasionally result in anal incontinence. The aim of this investigation was to study feasibility, effectiveness, and safety of hydropneumatic anal dilation (HAD) in conservative treatment of CAF and to compare it with local nitroglycerin (GTN) treatment. Methods Efficacy of HAD was evaluated in 109 patients (65 male, 44 female; mean

S. Boschetto; M. Giovannone; M. Tosoni; F. Barberani

2004-01-01

228

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

E-print Network

Abstract Background Human papillomavirus (HPV) is well known as the major etiological agent for ano-genital cancer. In contrast to cervical cancer, anal cancer is uncommon, but is increasing steadily in the community over the last few decades...

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

2012-09-08

229

Midwestern Rural Adolescents' Anal Intercourse Experience  

ERIC Educational Resources Information Center

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

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

2011-01-01

230

Measurement of anal pressure and motility  

Microsoft Academic Search

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

B D Hancock

1976-01-01

231

Surgical approaches to fecal incontinence in the adult.  

PubMed

Surgical treatment of anal incontinence is indicated only for patients who have failed medical treatment. Sphincterorraphy is suitable in case of external sphincter rupture. In the last decade, sacral nerve stimulation has proven to be a scientifically validated solution when no sphincter lesion has been identified and more recently has also been proposed as an alternative in cases of limited sphincter defect. Anal reconstruction using artificial sphincters is still under evaluation in the literature, while indications for dynamic graciloplasty are decreasing due to its complexity and high morbidity. Less risky techniques involving intra-sphincteric injections are being developed, with encouraging preliminary results that need to be confirmed especially in the medium- and long-term. Antegrade colonic enemas instilled via cecostomy (Malone) can be an alternative to permanent stoma in patients who are well instructed in the techniques of colonic lavage. Stomal diversion is a solution of last resort. PMID:24440057

Meurette, G; Duchalais, E; Lehur, P-A

2014-02-01

232

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

2011-01-01

233

Spontaneous Forniceal Rupture in Pregnancy  

PubMed Central

Forniceal rupture is a rare event in pregnancy. We report a case of a 26-year-old primigravid woman who experienced a forniceal rupture at 23 weeks of gestation with no inciting cause except for pregnancy. Pregnancy is associated with ureteral compression due to increase in pelvic vasculature with the right ureter more dilated due to anatomic reasons. Hormones such as prostaglandins and progesterone render the ureter more distensible to allow for pressure build-up and an obstructive picture at the collecting system. We will discuss physiologic changes in pregnancies that predispose to this uncommon phenomenon and the most up-to-date management strategies. PMID:25648411

Upputalla, Roshni; Moore, Robert M.; Jim, Belinda

2015-01-01

234

46 CFR 64.61 - Rupture disc.  

Code of Federal Regulations, 2010 CFR

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

2010-10-01

235

46 CFR 64.61 - Rupture disc.  

Code of Federal Regulations, 2012 CFR

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

2012-10-01

236

46 CFR 64.61 - Rupture disc.  

Code of Federal Regulations, 2011 CFR

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

2011-10-01

237

46 CFR 64.61 - Rupture disc.  

Code of Federal Regulations, 2014 CFR

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

2014-10-01

238

46 CFR 64.61 - Rupture disc.  

Code of Federal Regulations, 2013 CFR

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

2013-10-01

239

Quadriceps Tendon Rupture due to Postepileptic Convulsion  

PubMed Central

We present a case of quadriceps tendon (QT) rupture. QT ruptures can occur in all ages. The cause is mostly traumatic in origin. Spontaneous ruptures that are thought to result from predisposing conditions are rare. Post-convulsion QT ruptures lacking traumas in their history can be overlooked in clinical examinations. This should be born in mind by the attending physician, as early diagnosis and treatment of the condition can lead to satisfactory outcomes. PMID:24944977

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

2014-01-01

240

Distal biceps and triceps ruptures.  

PubMed

Biceps and triceps tendon ruptures are rather uncommon injuries and are most commonly diagnosed clinically. Magnetic resonance imaging can help the clinician to differentiate an incomplete tear and define any degeneration of the tendon. Surgical anatomical repair is typically performed in acute complete ruptures whereas nonoperative treatment can be used for partial ruptures, as well as for patients unfit for surgery. Single incision techniques are associated with a higher rate of nerve injuries, while double incision repairs have a higher prevalence of heterotopic ossification. Although various fixation methods have been applied including bone tunnels, interference screws, suture anchors, cortical button fixation, the current evidence does not support the superiority of one method over the other. A well-planned postoperative rehabilitation programme is essential for a good final outcome. As better fixation devices are being used, more aggressive rehabilitation programmes have been applied. Epidemiology, clinical evaluation, diagnosis, surgical and conservative management of these injuries are presented in this review along with the authors' preferred technique for the anatomical repair of acute complete ruptures. PMID:23352149

Kokkalis, Zinon T; Ballas, Efstathios G; Mavrogenis, Andreas F; Soucacos, Panayotis N

2013-03-01

241

NPR fuel rupture monitor system tests  

Microsoft Academic Search

The fuel rupture monitoring system at the New Production Reactor (NPR) has the following features and innovations which are not present on the rupture monitors at the other Hanford reactors: (1) each process tube is individually monitored for a fuel element rupture, (2) the electronics of the system are completely transistorized, and (3) the process water is monitored for gross

1964-01-01

242

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. PMID:25396188

Baek, Woo Yeol; Lew, Dae Hyun

2014-01-01

243

Prevention, chemoradiation and surgery for anal cancer.  

PubMed

Management of patients with squamous cell carcinoma of the anus (SCCA) has remained virtually unchanged since the 1980s. By contrast, the demographics of SCCA are evolving, with the emergence of a high-risk group of patients: HIV-positive male homosexuals are prone to develop anal intra-epithelial neoplasia and rapidly progress towards invasive SCCA. By many aspects, anal cancer is similar to uterine cervix cancer - a sexually transmitted disease driven by oncogenic human papillomavirus (HPV) infection. Thus, for many patients, SCCA results from the combination of two preventable diseases, HPV and HIV infection. This article reviews current evidence suggesting that a new, more preventive approach is needed in order to improve the clinical outcome of SCCA in HIV-positive patients. PMID:19374601

Buchs, Nicolas C; Allal, Abdelkarim S; Morel, Philippe; Gervaz, Pascal

2009-04-01

244

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; Pröls, M; Herold, A

2003-01-01

245

Risk Factors for Anal HPV Infection and Anal Precancer in HIV-Infected Men Who Have Sex With Men  

PubMed Central

Background.?Carcinogenic human papillomaviruses (HPVs) cause a large proportion of anal cancers. Human immunodeficiency virus (HIV)–infected men who have sex with men (MSM) are at increased risk of HPV infection and anal cancer compared with HIV-negative men. We evaluated risk factors for HPV infection and anal precancer in a population of HIV-infected MSM. Methods.?Our study included 305 MSM at an HIV/AIDS clinic in the Kaiser Permanente Northern California Health Maintenance Organization. Logistic regression was used to estimate associations of risk factors comparing men without anal HPV infection; men with anal HPV infection, but no precancer; and men with anal precancer. Results.?Low CD4 count (<350 cells/mm3) and previous chlamydia infection were associated with an increased risk of carcinogenic HPV infection (odds ratio [OR], 3.65; 95% confidence interval [CI], 1.28–10.40 and OR, 4.24; 95% CI, 1.16–15.51, respectively). History of smoking (OR, 2.71 95% CI, 1.43–5.14), duration, recency, and dose of smoking increased the risk of anal precancer among carcinogenic HPV-positive men but had no association with HPV infection. Conclusions.?We found distinct risk factors for anal HPV infection and anal precancer. Risk factors for HPV infection and anal precancer are similar to established risk factors for cervical cancer progression. PMID:23908478

Schwartz, Lauren M.; Castle, Philip E.; Follansbee, Stephen; Borgonovo, Sylvia; Fetterman, Barbara; Tokugawa, Diane; Lorey, Thomas S.; Sahasrabuddhe, Vikrant V.; Luhn, Patricia; Gage, Julia C.; Darragh, Teresa M.; Wentzensen, Nicolas

2013-01-01

246

Ileal pouch-anal anastomosis without ileostomy  

Microsoft Academic Search

Thirty-seven patients underwent construction of a J-ileal pouch-anal anastomosis (IPAA) without temporary diverting ileostomy for chronic ulcerative colitis (CUC) (20 patients), familial adenomatous polyposis (FAP) (15 patients), indeterminate colitis (1 patient) and nonhereditary polyposis coli (1 patient) between 1981 and 1990. Seven of 20 CUC patients (35 percent) were on steroids at the time of hospital admission. The postoperative course

Susan Galandiuk; Bruce G. Wolff; Roger R. Dozois; Robert W. Beart

1991-01-01

247

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

2012-01-01

248

The experience of artificial urinary sphincter implantation by a single surgeon in 15 years.  

PubMed

Artificial urinary sphincter (AUS) is the gold standard treatment for urinary incontinence owing to sphincter incompetence. We reviewed our experience in AUS implantation. From 1995 to 2009, 19 patients underwent 25 AUS implantations performed by a single surgeon. The cause of incontinence was sphincter incompetence, which was secondary to prostate surgery, neurogenic bladder, radiation, and post-traumatic urethral lesion. Twenty-three prostheses were placed in the bulbar urethra for male patients: 11 AUS cuffs were placed through the perineal approach and 12 through the penoscrotal approach. Two procedures were applied over the bladder neck for the female patients. Through a retrospective review of charts, continence and complications were analyzed. The mean follow-up time was 50.0 ± 42.9 months (range: 2-146 months). There were 16 successful surgeries (64%), and these patients were free from the need for a pad. In eight surgeries (32%), the devices were removed due to infection, while one implantation (4%) was unsuccessful due to perforation into the bulbar urethra. There was a statistically significant difference (p = 0.024) in failure rates between patients who received radiotherapy (100%) and other patients (22.7%). There was no statistically significant difference in dry and revision rates (p > 0.05) between the perineal and penoscrotal approach. Accordingly, over half of the patients with total incontinence benefitted from AUS implantation. In consideration of the high failure rate for patients receiving radiotherapy, caution should be exercised in the use of implantation. Secondary implantation has a satisfactory success rate in selected patients. The same success rate was noted for both perineal and penoscrotal approaches. PMID:23465419

Shen, Yuan-Chi; Chiang, Po-Hui

2013-03-01

249

Contribution of ATP and nitric oxide to NANC inhibitory transmission in rat pyloric sphincter.  

PubMed Central

1. Changes in isometric tension were recorded from circular muscle strips of rat pyloric sphincter in vitro, in response to electrical field stimulation and exogenously applied muscle relaxants. 2. Concentration-response relationships were studied for relaxation to exogenously applied adenosine 5'-triphosphate (ATP) and two analogues, 2-methylthioATP (2-MeSATP) and alpha,beta-methylene ATP (alpha,beta-MeATP). These drugs evoked concentration-dependent relaxation of rat pyloric sphincter with an order of potency 2-MeSATP > ATP >> alpha,beta-MeATP, indicating the presence of P2y-purinoceptors. The IC50 value of each nucleotide was: 2-MeSATP, 5.0 x 10(-8); ATP, 7.9 x 10(-6) M; alpha,beta-MeATP showed only slight activity at a concentration of 0.1 mM. 3. Frequency-response relationships for relaxations evoked by electrical field stimulation (EFS) were studied in the absence and presence of 10 microM NG-nitro-L-arginine methyl ester (L-NAME, an inhibitor of nitric oxide (NO) synthesis) and 20 microM reactive blue 2 (a P2y-purinoceptor antagonist). It was found that these substances significantly reduced the relaxant response of rat pyloric sphincter to EFS by 40% and 50% respectively. In the presence of both L-NAME and reactive blue 2 the responses were reduced by 75%. 4. Concentration-response relationships were studied for ATP and 2-MeSATP in the presence of L-NAME. It was found that L-NAME did not significantly inhibit the relaxant responses to these drugs. 5. Concentration-response relationships for ATP and noradrenaline were studied in the presence of reactive blue 2 (20 microM); the P2y-antagonist significantly inhibited the relaxant response to ATP, but not that to noradrenaline.(ABSTRACT TRUNCATED AT 250 WORDS) Images Figure 6 PMID:7532079

Soediono, P; Burnstock, G

1994-01-01

250

Anal Cancer: An Examination of Radiotherapy Strategies  

SciTech Connect

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

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

2011-04-01

251

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

252

Squamous cell carcinoma of the anal sacs in three dogs.  

PubMed

Anal sac squamous cell carcinoma is rare in dogs. Five cases have been previously reported, treatment of which involved surgery alone. This report describes three further cases of canine anal sac squamous cell carcinoma which underwent medical (meloxicam) management alone, resulting in survival of up to seven months. No metastases were identified. Squamous cell carcinoma, although extremely uncommon, should be considered as a possible differential diagnosis when a dog is presented for investigation of an anal sac mass. PMID:25208811

Mellett, S; Verganti, S; Murphy, S; Bowlt, K

2014-09-11

253

AcceleratedArticles Anal. Chem. 1995, 67, 3093-3100  

E-print Network

AcceleratedArticles Anal. Chem. 1995, 67, 3093-3100 Using Capillary ElectrophoresisTo Follow.T.Angew. Chem.,Int. Ed. Engl. (3) Kuhr, W. G.; Monnig, C. A. Anal. Chem. 1992,64, 389-407. (4) Novotny, M. V) Mazzeo,J. R; Martineau,J. A;Krull, I. S.Anal. Biochem. 1993,208,323- 329. (8) Cobb, K A; Novotny, M. V

Prentiss, Mara

254

Models for earthquake rupture propagation  

NASA Astrophysics Data System (ADS)

The basic processes associated with earthquake rupture propagation are poorly understood. In particular the crack-tip problem is singular when considered in terms of a stress-intensity factor. We introduce the Barenblatt cohesive zone to remove this singularity and consider a uniformly propagating, mode III crack that bisects a strip. Downstream of the crack tip we consider both a stress-free condition and a viscous resistance on the crack surface. The technique of matched asymptotic expansions is used to obtain solutions. However, with a stress-free boundary condition a Griffith energy balance for the initiation of rupture in terms of cohesive forces is obtained but the solution does not determine a rupture speed. The available elastic energy must be greater than the energy required to break the cohesive bond. With a viscous resistance to slip on the crack surface, the tip singularity associated with the outer solution is reduced from {1}/{2} to a smaller value and a velocity of crack propagation is found. The rupture initiation criterion is unaffected by the viscosity while, as the viscous or cohesive forces are decreased, the rupture velocity increases towards the shear-wave velocity. Our results are similar to those obtained by Nakanishi [Nakanishi, H., 1994. Continuum model of mode-III crack propagation with surface friction. Phys. Rev. E49, 5412-5419.] applying a Wiener-Hopf technique to a related problem. We believe that our solution provides an explanation for the observation of Heaton (slip) pulses during earthquakes. We suggest that there are two slip-mode regimes during an earthquake rupture. In the immediate vicinity of the crack tip, slip velocities are very small and cohesive forces dominate. This is the regime that has been studied experimentally in the laboratory; plastic deformation of the surfaces and gouge dominate and the drop in the frictional stress is small. At higher slip velocities, away from the crack tip, there is a second frictional mode with low frictional stresses. This may be due to the fluidization of the granular fault gauge and provides a rational basis for a transition from cohesion to viscous resistance on the crack surface. As the driving stress drops the slip velocity decreases, there is a return to the cohesive mode and the fault locks and heals.

Morgan, J. D.; Turcotte, D. L.; Ockendon, J. R.

1997-08-01

255

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, José Manuel; Vicente, Rosana

2014-01-01

256

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

PubMed

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, José Manuel; Vicente, Rosana

2014-05-01

257

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

2014-01-01

258

Environmental scan of anal cancer screening practices: worldwide survey results  

PubMed Central

Anal squamous cell carcinoma is rare in the general population but certain populations, such as persons with HIV, are at increased risk. High-risk populations can be screened for anal cancer using strategies similar to those used for cervical cancer. However, little is known about the use of such screening practices across jurisdictions. Data were collected using an online survey. Health care professionals currently providing anal cancer screening services were invited to complete the survey via email and/or fax. Information was collected on populations screened, services and treatments offered, and personnel. Over 300 invitations were sent; 82 providers from 80 clinics around the world completed the survey. Fourteen clinics have each examined more than 1000 patients. Over a third of clinics do not restrict access to screening; in the rest, eligibility is most commonly based on HIV status and abnormal anal cytology results. Fifty-three percent of clinics require abnormal anal cytology prior to performing high-resolution anoscopy (HRA) in asymptomatic patients. Almost all clinics offer both anal cytology and HRA. Internal high-grade anal intraepithelial neoplasia (AIN) is most often treated with infrared coagulation (61%), whereas external high-grade AIN is most commonly treated with imiquimod (49%). Most procedures are performed by physicians, followed by nurse practitioners. Our study is the first description of global anal cancer screening practices. Our findings may be used to inform practice and health policy in jurisdictions considering anal cancer screening. PMID:24740973

Patel, Jigisha; Salit, Irving E; Berry, Michael J; de Pokomandy, Alexandra; Nathan, Mayura; Fishman, Fred; Palefsky, Joel; Tinmouth, Jill

2014-01-01

259

[Guidelines for the treatment of non-neurological urinary incontinence in women using the artificial urinary sphincter].  

PubMed

The indication for artificial urinary sphincter implantation in women is based on several para meters: severity of incontinence, sphincter deficiency with negative urethral support maneuvers, the notion of postsurgery recurrence of incontinence, and absence of contraindication. Quality preoperative clinical and urodynamic assessment is indispensable. The factors for success depend on: implantation on tissue that has not been damaged by repeated interventions; well-codified technique based on regular surgical experience; sufficiently long deactivation; long-term monitoring with expertise in managing breakdowns and revisions. PMID:20403568

Richard, F

2010-02-01

260

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

PubMed

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

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

2013-07-01

261

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

E-print Network

Anal. Chem. 1990, 62, 875-877 075 Harris, Jr., W. C.; Chandra, S.; Morrison, G. H. Anal. Chem. 1983, M. J.; Briggs, D.; Yoon, S. C.; Ratner; B. D. SIA, Surf. Inter- face Anal. 1087, IO,524. Hues. S. M.; Gardella, J. A.. Jr.; Schultz, T. M.; Salvati, L., Jr.; Patil, D. G. Anal. Chem., in press. Clark, M. B

Weidner, John W.

262

Anal. Chem. 1981, 53,1509-1512 1509 (4) Fernandez, F. J.; Myers, S. A.; Slavln, W. Anal. Chem. 1080, 52,  

E-print Network

Anal. Chem. 1981, 53,1509-1512 1509 (4) Fernandez, F. J.; Myers, S. A.; Slavln, W. Anal. Chem. 1080, 52, (5) Manning D. C.; Slavin, W. Anal. Chim. Acta 1080, 118, 301-306. (6) Slavin, W.; Manning, E). C) Hageman, L. R.; Nlchols, J. A.; Viswanedham, P.; Woodriff, R. Anal. Chem. 1070, 51, 1406-1412. (9

Zare, Richard N.

263

Spontaneous rupture of the ureter.  

PubMed

Spontaneous rupture of the ureter is a very rare condition and usually results from ureteral obstruction by a calculus. Only theoretical mecha nisms have been proposed and no possible explanation has yet been reported in the literature. Intravenous contrast-enhanced computed tomography is the most informative study with high sensitivity. Treatment should be individualised, and depends on the state of the patient. Minimally invasive endourological procedures with double-J catheter placement and percutaneous drainage offer excellent results. Conservative management with analgesics and antibiotic coverage may be an alternative to surgery. Herein, we present a case of spontaneous rupture of the proximal ureter with no evidence of an underlying pathological condition. PMID:25715862

Eken, A; Akbas, T; Arpaci, T

2015-02-01

264

Safety analysis of first 1000 patients treated with magnetic sphincter augmentation for gastroesophageal reflux disease.  

PubMed

Antireflux surgery with a magnetic sphincter augmentation device (MSAD) restores the competency of the lower esophageal sphincter with a device rather than a tissue fundoplication. As a regulated device, safety information from the published clinical literature can be supplemented by tracking under the Safe Medical Devices Act. The aim of this study was to examine the safety profile of the MSAD in the first 1000 implanted patients. We compiled safety data from all available sources as of July 1, 2013. The analysis included intra/perioperative complications, hospital readmissions, procedure-related interventions, reoperations, and device malfunctions leading to injury or inability to complete the procedure. Over 1000 patients worldwide have been implanted with the MSAD at 82 institutions with median implant duration of 274 days. Event rates were 0.1% intra/perioperative complications, 1.3% hospital readmissions, 5.6% endoscopic dilations, and 3.4% reoperations. All reoperations were performed non-emergently for device removal, with no complications or conversion to laparotomy. The primary reason for device removal was dysphagia. No device migrations or malfunctions were reported. Erosion of the device occurred in one patient (0.1%). The safety analysis of the first 1000 patients treated with MSAD for gastroesophageal reflux disease confirms the safety of this device and the implantation technique. The overall event rates were low based on data from 82 institutions. The MSAD is a safe therapeutic option for patients with chronic, uncomplicated gastroesophageal reflux disease. PMID:24612509

Lipham, J C; Taiganides, P A; Louie, B E; Ganz, R A; DeMeester, T R

2015-05-01

265

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.

2014-01-01

266

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

2014-01-01

267

Influence of initial stress and rupture initiation parameters on forbidden zone rupture propagation  

NASA Astrophysics Data System (ADS)

Well established theoretical and numerical results of 2-D ruptures have been accepted for years to limit the speed of mode II cracks to be below the Rayleigh velocity or above the shear wave speed. However, recent work has numerically produced rupture speeds in this so-called `forbidden zone', that is the region of rupture velocities between the Rayleigh wave speed and the shear wave speed, for 3-D simulations. We verify that finding here and further examine the dependence of that behaviour on initial stress and rupture initiation parameters. Using a 3-D finite element model for dynamic rupture propagation, numerical experiments were performed for different initial stress conditions as well as different size initiation patches and forced rupture velocities. It is shown that the initial stress on the fault has a strong influence on the resulting rupture, specifically with regards to the distance at which the rupture transitions to supershear speeds, the maximum rupture velocity attained on the fault, and how rapidly the rupture passes through the forbidden zone. It is also demonstrated that for the same initial stress, increasing the size of the nucleation patch or the speed of forced rupture can artificially increase the gradient of the rupture velocity within the forbidden zone. This suggests that the rupture is uniquely predetermined by the stress state and material properties of the fault and surrounding medium in these models.

Payne, R. M.; Duan, B.

2015-04-01

268

Relationship characteristics associated with anal sex among female drug users  

PubMed Central

Background Anal sex is an important yet little studied HIV risk behavior for women. Methods Using information collected on recent sexual encounters, we examined the influence of sex partner and relationship characteristics on the likelihood of engaging in anal sex among women with a high risk of HIV infection. Results Anal sex was nearly three times more common among actively bisexual women (OR = 2.96, 95% CI 2.17 – 4.03). Women were more likely to have anal sex with partners who injected drugs (OR = 2.32, 95% CI 1.44 – 3.75), were not heterosexual (OR = 1.85, 95% CI 1.18 – 2.90), and with whom they exchanged money or drugs for sex (OR = 1.79, 95% CI 1.10 – 2.90). The likelihood of anal sex also increased with the number of nights sleeping together (OR = 1.15, 95% CI 1.06 – 1.24). In contrast, emotional closeness and social closeness were not associated with anal sex. Condom use during anal sex was uncommon, and did not vary according to partner or relationship characteristics. Conclusions Our findings support the need for HIV prevention interventions that target anal sex among heterosexuals, particularly in drug-using populations residing in neighborhoods with elevated levels of HIV prevalence. PMID:20065891

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

2012-01-01

269

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

2006-01-01

270

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

Microsoft Academic Search

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

Karl Hollows

2007-01-01

271

Oral Nifedipine in the Treatment of Chronic Anal Fissure  

Microsoft Academic Search

Background: The purpose of this study was to demonstrate the effect of oral nifedipine on maximal resting anal pressure (MRAP) in healthy volunteers and to evaluate its role in the treatment of chronic anal fissure (CAF). Methods: MRAP was measured in 10 healthy volunteers and 10 patients with CAF before and after oral nifedipine (20 mg b.i.d.). Patients were assessed

Salahattin Cengiz; Mithat Kerim Arslan

2003-01-01

272

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

2011-01-01

273

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.

1973-01-01

274

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)

2012-06-06

275

Incidence, risk factors, and treatment of dysplasia in the anal transitional zone after ileal pouch-anal anastomosis  

Microsoft Academic Search

Preservation of the anal transitional zone (ATZ) after restorative proctocolectomy and stapled ileal pouch-anal anastomosis (IPAA) for ulcerative colitis is controversial. PURPOSE: To evaluate the incidence, risk factors, and treatment options for dysplasia and\\/or cancer after restorative proctocolectomy and stapled IPAA. METHODS: We reviewed the records of all 254 patients operated on for ulcerative colitis who had a restorative proctocolectomy,

Yehiel Ziv; Victor W. Fazio; Mauro T. Sirimarco; Ian C. Lavery; John R. Goldblum; Robert E. Petras

1994-01-01

276

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.

1982-08-01

277

Influence of electrostimulation on the sphincteric compound muscle action potential in fecal incontinence  

Microsoft Academic Search

Summary  Continence scores and anal manometry are commonly used to assess the effect of electrostimulation in fecal incontinence. This\\u000a study determined the increase of muscular compound potentials in electroneurography of the pudendal nerve after 3 months of\\u000a electrostimulation treatment. Twenty–five women were tested, their average age being 46.7 years (SD 10.2). Electrostimulation\\u000a was applied twice daily for 15 min in each

W. H. Jost

1997-01-01

278

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

NASA Astrophysics Data System (ADS)

The goal of this study was to investigate whether real-time external urethral sphincter (EUS) EMG-controlled dorsal genital nerve (DGN) stimulation can suppress undesired detrusor bladder contractions in patients with both neurogenic detrusor overactivity (NDO) and detrusor sphincter dyssynergia (DSD). Detrusor pressure (Pdet) and EUS EMG were recorded in 12 neurogenic patients who underwent two filling cystometries. The first one was without stimulation and was intended to confirm the NDO and DSD and to set the EMG detection threshold. The second one was with real-time EMG-controlled stimulation of DGNs. Two detection methods were analyzed to detect bladder contractions. The first method was a Kurtosis-scaled root mean square (RMS) detector and was used on-line. The second was a simple RMS detector and was used off-line. Of 12 patients included, 10 patients showed both NDO and DSD. In nine of these ten patients relevant EMG concomitant to detrusor activity was detected and stimulation could suppress at least one detrusor contraction. The second filling compared to the first one showed an increase of 84% in bladder capacity (p = 0.002) and a decrease of 106% in Pdet (p = 0.002). Nine false-positive detections occurred during the ten fillings with electrical stimulation. The mean increases of both time and Pdet between stimulation and bladder contraction onsets for method 1 were 1.8 s and 4 cmH2O and for method 2 were 0.9 s and 2 cmH2O, respectively. This study shows that EUS EMG can be used in real time to detect the onset of a bladder contraction. In combination with DGN stimulation has been shown to be feasible to suppress undesired bladder contractions and in turn to increase bladder capacity in subjects with both NDO and DSD.

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

2011-06-01

279

Novel Artificial Urinary Sphincter in the Canine Model: The Tape Mechanical Occlusive Device (TMOD)  

PubMed Central

Objective To assess the functionality, occlusive efficiency and biocompatibility of a novel artificial urinary sphincter, the Tape Mechanical Occlusive Device (TMOD), [GT Urological, Minneapolis, MN], following implantation in a live canine model as well as its occlusive efficiency and sizing parameters in human cadavers. Materials and Methods Three female canines underwent implantation of the device at the level of the bladder neck. Functionality was assessed starting at two weeks post-implantation up to 9 weeks. The devices were activated at 2 weeks, then deactivated for three, thirty minute sessions per day to permit voiding. Urethral occlusion pressures (UOP) and biocompatibility for systemic toxicity and local tissue response were examined. Additionally, the TMOD was inserted in 3 male cadavers to determine sizing parameters and to assess UOP utilizing pressure profilometry. Results In the canine model, UOP increased from a range of 9-42 cm H2O with TMOD deactivated to a range of 57-82 cm H2O with the TMOD activated. Pathological examination revealed unremarkable pseudo-capsular tissues surrounding the device. No histological or structural evidence of systemic toxicity was observed. Sizing parameters similar to other urological implants were confirmed in the male cadavers and urethral occlusion pressures increased from 24-30 cm H2O with the device deactivated to 61-105 cm H2O with the device activated. Conclusion The TMOD meets the current standards for an artificial urinary sphincter in terms of functionality, biocompatibility and achieving desired occlusion pressures following chronic implantation. Additional testing in male canines followed by early human clinical trials is being contemplated. PMID:21067799

Malaeb, Bahaa S; Elliott, Sean P; Lee, Joseph; Anderson, David W; Timm, Gerald W

2010-01-01

280

Quadriceps and patellar tendon ruptures.  

PubMed

The diagnosis of quadriceps and patellar tendon ruptures requires a high index of suspicion and thorough history-taking to assess for medical comorbidities that may predispose patients to tendon degeneration. Radiographic assessment with plain films supplemented by ultrasound and magnetic resonance imaging when the work-up is equivocal further aids diagnosis; however, advanced imaging is often unnecessary in patients with functional extensor mechanism deficits. Acute repair is preferred, and transpatellar bone tunnels serve as the primary form of fixation when the tendon rupture occurs at the patellar insertion, with or without augmentation depending on surgeon preference. Chronic tears and disruptions following total knee arthroplasty are special cases requiring reconstructions with allograft, synthetic mesh, or autograft. Rehabilitation protocols generally allow immediate weight-bearing with the knee locked in extension and crutch support. Limited arc motion is started early with active flexion and passive extension and then advanced progressively, followed by full active range of motion and strengthening. Complications are few but include quadriceps atrophy, knee stiffness, and rerupture. Outcomes are excellent if repair is done acutely, with poorer outcomes associated with delayed repair. PMID:23955186

Lee, Dennis; Stinner, Daniel; Mir, Hassan

2013-10-01

281

Anal. Chem. 1994,66, 303-306 End-Column Chemiluminescence Detector for Capillary  

E-print Network

Anal. Chem. 1994,66, 303-306 End-Column Chemiluminescence Detector for Capillary Electrophoresis Ra of Chemistry, State University of New York, Buffalo, NY 14214. (1) Jorgenson, J. W.; Lukacs, K. D. Anal. Chem,S. L., Jr.; a r e ,R. N.; Quint,J. Anal. Chem. 1989,61, 1642-1647. (7) Kobayashi, S I . ; Imai, K. Anal

Zare, Richard N.

282

Fractal avalanche ruptures in biological membranes  

NASA Astrophysics Data System (ADS)

Bilayer membranes envelope cells as well as organelles, and constitute the most ubiquitous biological material found in all branches of the phylogenetic tree. Cell membrane rupture is an important biological process, and substantial rupture rates are found in skeletal and cardiac muscle cells under a mechanical load. Rupture can also be induced by processes such as cell death, and active cell membrane repair mechanisms are essential to preserve cell integrity. Pore formation in cell membranes is also at the heart of many biomedical applications such as in drug, gene and short interfering RNA delivery. Membrane rupture dynamics has been studied in bilayer vesicles under tensile stress, which consistently produce circular pores. We observed very different rupture mechanics in bilayer membranes spreading on solid supports: in one instance fingering instabilities were seen resulting in floral-like pores and in another, the rupture proceeded in a series of rapid avalanches causing fractal membrane fragmentation. The intermittent character of rupture evolution and the broad distribution in avalanche sizes is consistent with crackling-noise dynamics. Such noisy dynamics appear in fracture of solid disordered materials, in dislocation avalanches in plastic deformations and domain wall magnetization avalanches. We also observed similar fractal rupture mechanics in spreading cell membranes.

Gözen, Irep; Dommersnes, Paul; Czolkos, Ilja; Jesorka, Aldo; Lobovkina, Tatsiana; Orwar, Owe

2010-11-01

283

Ruptured abdominal aortic aneurysm after endovascular repair  

Microsoft Academic Search

Objective: The purpose of this study was to present the experience with aneurysm rupture after deployment of Guidant\\/EVT (Guidant) endografts and review previously reported cases with other devices. Methods: Records from Guidant\\/EVT clinical trials and postmarket approval databases from February 1993 to August 2000 were analyzed to identify patients with rupture and to extract pertinent data. Previously reported cases were

Victor M. Bernhard; R. Scott Mitchell; Jon S. Matsumura; David C. Brewster; Maria Decker; Patrick Lamparello; Dieter Raithel; Jack Collin

2002-01-01

284

Free wall rupture after arterial switch operation.  

PubMed

A neonate underwent arterial switch operation, supported on extracorporeal membrane oxygenation for 3 days. Two weeks later, a pseudoaneurysm was seen on an echocardiogram, and a free wall rupture was suggested. Prompt surgery was performed, a free wall rupture assessed, and a patch with BioGlue was applied successfully. One year later, the child is in good condition. PMID:25468102

Gil-Jaurena, Juan-Miguel; Aroca, Ángel; Pérez-Caballero, Ramón; Pita, Ana

2014-12-01

285

Neonatal splenic rupture: an unusual manifestation  

Microsoft Academic Search

Neonatal splenic rupture is relatively rare [4] and is usually associated with a traumatic delivery [3]. The clinical manifestation are those of hemorrhage and hypovolemic shock. We present two unusual cases of spontaneous neonatal splenic rupture whose initial clinical manifestation was a hematocele of the scrotal sac. The clinical presentation, diagnostic approach, and management of such cases is discussed with

David Bader; Jorge G. Mogilner; Anna Berger; Samuel Eldar; Daniel Reich; Leonardo Siplovich

1993-01-01

286

Spontaneous intraventricular rupture of craniopharyngioma cyst  

Microsoft Academic Search

BACKGROUNDRupture of a cystic craniopharyngioma is a rare phenomenon. The rupture of the cyst causes decompression of the adjacent neural structures resulting in spontaneous improvement of the visual symptoms or level of sensorium. The leakage of its contents into the subarachnoid space gives rise to meningismus. We report an extremely rare phenomenon of an intraventricular rupture of a cystic craniopharyngioma,

Vaijayantee Kulkarni; Roy Thomas Daniel; Ramachandra Pranatartiharan

2000-01-01

287

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

1976-01-01

288

Do buried-rupture earthquakes trigger less landslides than surface-rupture earthquakes for reverse faults?  

NASA Astrophysics Data System (ADS)

Gorum et al. (2013, Geomorphology 184, 127-138) carried out a study on inventory compilation and statistical analyses of landslides triggered by the 2010 Mw 7.0 Haiti earthquake. They revealed that spatial distribution patterns of these landslides were mainly controlled by complex rupture mechanism and topography. They also suggested that blind-rupture earthquakes trigger fewer landslides than surface-rupture earthquakes on thrust reverse faults. Although a few lines of evidence indicate that buried-rupture earthquakes might trigger fewer landslides than surface-rupture earthquakes on reverse faults, more careful comparisons and analyses indicate that it is not always true. Instead, some cases show that a buried-rupture earthquake can trigger a larger quantity of landslides that are distributed in a larger area, whereas surface-rupture earthquakes can trigger larger but a fewer landslides distributed in a smaller area.

Xu, Chong

2014-07-01

289

Comparative Study of Glyceryl Trinitrate Ointment Versus Surgical Management of Chronic Anal Fissure  

Microsoft Academic Search

Chronic Anal Fissure (CAF) is common perineal condition and well-known painful entity. Standard surgical treatment even though\\u000a available, may require long hospital stay and sometimes have worrying complications like anal incontinence. So non-surgical\\u000a treatment, Glyceryl Trinitrate has been shown to be an effective for chronic anal fissure. It decreases anal tone and ultimately\\u000a heals the anal fissure. The present study

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

290

Post-Prostatectomy incontinence and the Artificial Urinary Sphincter: A Long-Term Study of Patient Satisfaction and Criteria for Success  

Microsoft Academic Search

PurposeWe investigated patient satisfaction with the artificial urinary sphincter and established criteria for a successful outcome by inquiring about patient perceived satisfaction, continence achieved and comparison with the surgeon office records.

Scott E. Litwiller; Kap B. Kim; Patricia D. Fone; Ralph W. deVere White; Anthony R. Stone

1996-01-01

291

Electrocautery Superior to Topical Treatments for Precancerous Anal Lesions  

Cancer.gov

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

292

Anal duplication in a one-year-old girl  

PubMed Central

We report a case of a patient with anal duplication discovered incidentally at 1 year of age. Pre-operative evaluation excluded any complications or associated anomalies. She underwent surgical excision with an excellent outcome.

Cheng, Lily S.; Courtier, Jesse; MacKenzie, Tippi C.

2015-01-01

293

Extraneural rupture of intraneural ganglion cysts.  

PubMed

Rupture of simple (extraneural) cysts such as popliteal cysts (Baker's cysts) is a well-known occurrence. The purpose of this report is to introduce the similar occurrence of extraneural rupture of peroneal and tibial intraneural cysts in the knee region, describe the associated magnetic resonance imaging (MRI) findings, and identify risk factors. There was MRI evidence of rupture in 20 of 38 intraneural cases reviewed, mainly in the region of the fibular head and popliteal fossa. Ruptured intraneural cysts and simple cysts share these MRI findings: T2 hyperintense fluid within surrounding intermuscular fascial planes and enhancement with intravenous contrast consistent with inflammation. The mean maximal diameter of the ruptured intraneural cysts was statistically significantly smaller than that of the unruptured cysts. The authors believe that extraneural rupture of an intraneural cyst is due to increased intraarticular pressures transmitted within the cyst and/or elevated extrinsic pressure delivered to the cyst, such as by trauma, akin to the etiology of rupture of extraneural ganglion cysts. PMID:21838077

Shahid, Kameron R; Hébert-Blouin, Marie-Noëlle; Amrami, Kimberly K; Spinner, Robert J

2011-01-01

294

Metrics for comparing dynamic earthquake rupture simulations  

USGS Publications Warehouse

Earthquakes are complex events that involve a myriad of interactions among multiple geologic features and processes. One of the tools that is available to assist with their study is computer simulation, particularly dynamic rupture simulation. A dynamic rupture simulation is a numerical model of the physical processes that occur during an earthquake. Starting with the fault geometry, friction constitutive law, initial stress conditions, and assumptions about the condition and response of the near?fault rocks, a dynamic earthquake rupture simulation calculates the evolution of fault slip and stress over time as part of the elastodynamic numerical solution (? see the simulation description in the electronic supplement to this article). The complexity of the computations in a dynamic rupture simulation make it challenging to verify that the computer code is operating as intended, because there are no exact analytic solutions against which these codes’ results can be directly compared. One approach for checking if dynamic rupture computer codes are working satisfactorily is to compare each code’s results with the results of other dynamic rupture codes running the same earthquake simulation benchmark. To perform such a comparison consistently, it is necessary to have quantitative metrics. In this paper, we present a new method for quantitatively comparing the results of dynamic earthquake rupture computer simulation codes.

Barall, Michael; Harris, Ruth A.

2014-01-01

295

[ 44] G.R. Long, S.E. Bialkowski, Anal. Chem. 56 (1984) [ 45] S.E. Bialkowski, G.R. Long, Anal. Chem. 59 (1987) 873.  

E-print Network

[ 44] G.R. Long, S.E. Bialkowski, Anal. Chem. 56 (1984) 2806. [ 45] S.E. Bialkowski, G.R. Long, Anal. Chem. 59 (1987) 873. [ 46] X.R. Zu, J.M. Harris, J. Phys. Chem. 93 (1989) 75. [ 47] X.R. Zu, D.J. McGraw, J.M. Harris, Anal. Chem. 64 (1992) 710A. [ 48] A. Chartier, S.E. Biakowski, Anal. Chem. 67

Michel, Robert G.

296

Perceptions of anal sex in rural South Africa  

Microsoft Academic Search

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

Catherine Ndinda; Chiweni Chimbwete; Nuala McGrath; Robert Pool

2008-01-01

297

Temporary ileostomy for ileal pouch-anal anastomosis  

Microsoft Academic Search

The function and complications associated with temporary ileostomies were reviewed in patients undergoing ileal pouch-anal\\u000a anastomosis. A series of 180 patients had temporary ileostomies established (157 loop, 23 Brooke). Patients with incomplete\\u000a fecal diversion had a significantly higher incidence of pouch-anal anastomotic complications (44 percent) than did those with\\u000a complete diversion (14 percent). Patients with loop ileostomies were more likely

Amanda M. Metcalf; Roger R. Dozois; Robert W. Beart; Ketth A. Kelly; Bruce G. Wolff

1986-01-01

298

Ileal pouch-anal anastomosis without temporary, diverting ileostomy  

Microsoft Academic Search

Of two hundred patients undergoing proctocolectomy with ileal pouch-anal anastomosis, all but nine have had temporary diverting\\u000a ileostomies. Of these nine patients, eight had successful results. One patient developed abdominal sepsis due to jejunal volvulus\\u000a and perforation after she had returned home, and at surgery the pouch was excised. Ileal pouch-anal anastomosis without a\\u000a temporary diverting ileostomy can be performed

Amanda M. Metcalf; Roger R. Dozois; Keith A. Kelly; Bruce G. Wolff

1986-01-01

299

Mucosal advancement in the treatment of anal fistula  

Microsoft Academic Search

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

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

1985-01-01

300

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

2009-01-01

301

Proximal and Distal Segments of the Possum Sphincter of Oddi Respond Differently to Neural and Cholecystokinin Octapeptide Stimulation in vitro  

Microsoft Academic Search

Background\\/Aims: Previous studies have demonstrated separate pancreatic duct (PD) and bile duct (BD) components of the sphincter of Oddi (SO) and suggested distinct proximal and distal functional segments. This study was designed to determine if proximal and distal segments of the BD component of the SO (BD-SO) and PD component of the SO (PD-SO) responded equally to (1) activation of

C. M. Woods; A. C. Schloithe; M. E. Simula; J. Toouli; G. T. P. Saccone

2000-01-01

302

Muscarine receptor types mediating autoinhibition of acetylcholine release and sphincter contraction in the guinea-pig iris  

Microsoft Academic Search

The potencies of several muscarine receptor antagonists in blocking either the autoinhibition of acetylcholine release or the muscarinic contraction of the sphincter muscle upon acetylcholine release were investigated in the guinea-pig iris. The agonist at pre- or postjunctional muscarine receptors was acetylcholine released upon field stimulation (5.5 Hz, 2 min) of the irides preloaded with 14C-choline. The stimulation-evoked 14C-overflow was

I. T. Bognar; M. T. Wesner; H. Fuder

1990-01-01

303

[Specifics of sphincter-preserving surgery in patients with extensive colorectal carcinoma].  

PubMed

The results of combined abdomino-anal resection performed in 56 patients with locally extended cancer of the rectum have been evaluated. Indications for combined and organ-saving operations for extensive rectal cancers have been evolved. If the uterus and even cervix uteri and the vault of the vagina are involved, leaving the lower part of the vagina intact does not affect the radical nature of surgery. Simultaneously, this procedure assures complete rehabilitation of patients because sexual function is not impaired. PMID:8815644

Guliaev, A V

1996-01-01

304

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

2013-01-01

305

Thyroid rupture secondary to blunt neck trauma.  

PubMed

Rupture of the thyroid gland is uncommon in cases of blunt neck trauma. We report a case of thyroid rupture after a motor vehicle accident in a patient without a preexisting goiter. He presented with a painful anterior neck swelling associated with dysphagia and hoarseness of voice. Computed tomographic scans showed lacerations of the right thyroid lobe and isthmus with features suggestive of slow active bleeding. Neck exploration was subsequently performed, and a ruptured right thyroid lobe was found with ongoing venous hemorrhage. A right hemithyroidectomy was performed, and the patient recovered without complications. PMID:23399341

Sow, Yih-Liang; Aziz, Nora Abdul; Ng, Khoon-Leong

2013-04-01

306

CT diagnosis of ruptured abdominal aortic aneurysm  

SciTech Connect

Abdominal computed tomography was performed in six patients with suspected ruptured abdominal aortic aneurysm but in whom an alternate clinical diagnosis was seriously considered. In each patient, a large aortic aneurysm was demonstrated in association with a retroperitoneal accumulation of high-density blood. The retroperitoneal blood was primarily confined to the extracapsular perinephric space. In four of the six patients, a focal area of the aortic wall was indistinct on the side of the retroperitoneal hemorrhage at the presumed site of rupture. Five of the six patients underwent emergency surgery, which confirmed the site of aneurysm, presence of rupture and the location of fresh retroperitoneal blood.

Rosen, A.; Korobkin, M.; Silverman, P.M.; Moore, A.V. Jr.; Dunnick, N.R.

1984-08-01

307

Anal. Chem. 1906, 58, 3199-3202 3199 (11) Zhang, M. Y.; Liang, X. Y.; Chen, Y. Y.; Liang, X. G. Anal. Chem. 56,  

E-print Network

Anal. Chem. 1906, 58, 3199-3202 3199 (11) Zhang, M. Y.; Liang, X. Y.; Chen, Y. Y.; Liang, X. G. Anal. Chem. 56, (12) Tabet, J. C.; Jablonskl, M.; Cotter, R. J.; Hunt, J. E. Int. J. Mass (13) Brown, R-13, 1986. (18) Tembrueii, R.; Lubman, D. M. Anal. Chem. 1986, 58,1299-1303. (19) Johnson, J. V.;Britton, E

Kounaves, Samuel P.

308

Vasoactive intestinal polypeptide and non-adrenergic, non-cholinergic inhibition in lower oesophageal sphincter of opossum.  

PubMed

1. Field stimulation or vasoactive intestinal polypeptide (VIP) relaxed lower oesophageal sphincter (LOS) from North American opossum. Pretreatment with carbachol in Cl-ion-containing or Cl-ion-free Krebs solution or with 10(-3) M 9-aminoacridine abolished or markedly reduced relaxation due to VIP applied exogenously but not that elicited by field stimulation of non-adrenergic, non-cholinergic nerves. 2. Inhibitory junction potentials (7.5 +/- 1.2 mV, n = 5) could be recorded in LOS strips with the sucrose gap technique. They lacked significant after-depolarizations but were accompanied by decreased membrane resistance (61 +/- 6%, n = 3). In these strips, VIP (10(-6) M) produced small hyperpolarizations (2.1 +/- 1.1 mV, n = 5) sometimes followed by membrane potential oscillations but no change in conductance. 3. Removal of external chloride depolarized the membranes (7.6 +/- 1.7 mV) but did not prevent the hyperpolarization to VIP or the occurrence of inhibitory junction potentials. Restoration of external chloride repolarized the cells. It appears that an appreciable chloride conductance may be present in sphincter muscle cells and this may cause them to be more depolarized than non-sphincter muscle. 4. We conclude that it is very unlikely that VIP is the inhibitory NANC neurotransmitter since it does not mimic the inhibitory junction potential. PMID:2720302

Daniel, E E; Jager, L P; Jury, J

1989-03-01

309

Anal cytological abnormalities and anal HPV infection in men with Centers for Disease Control group IV HIV disease.  

PubMed Central

OBJECTIVE: To characterise risk factors for abnormal and cytology and anal human papilloma virus (HPV) infection in homosexual/bisexual men with advanced HIV related immunosuppression. DESIGN: Cross sectional study of men with Centers for Disease Control group IV HIV disease. SETTING: The University of California San Francisco, AIDS Clinic. PATIENTS: 129 homosexual or bisexual men with group IV HIV disease. METHODS: A questionnaire was administered detailing tobacco, alcohol and recreational drug use, medical history, and sexual practices. Anal swabs for cytology and HPV studies were obtained, as was blood for CD4 levels. MAIN OUTCOME MEASURES: Abnormal anal cytology and anal HPV infection. RESULTS: Abnormal anal cytology was detected in 39% of subjects and anal HPV infection in 93% as measured by polymerase chain reaction (PCR). Risk factors for abnormal cytology in multivariate analysis included HPV 16/18 infection (measured by PCR, RR = 2.1, 95% CI = 1.2-3.5) and intravenous drug use (RR = 1.8, 95% CI = 1.2-2.7). Infection with HPV 6/11 also had significantly elevated RRs in a separate model. Cigarette smoking, alcohol use, recreational drug use, and low CD4 level were associated with abnormal anal cytology in univariate analysis, as was infection with multiple HPV types and high levels of hybrid capture group B viral DNA. CONCLUSIONS: Anal cytological abnormalities and HPV infection are common among homosexual/bisexual men with group IV HIV disease. In this study population, the main risk factors for abnormal cytology were HPV infection and intravenous drug use. Images PMID:9306896

Palefsky, J M; Holly, E A; Ralston, M L; Arthur, S P; Hogeboom, C J; Darragh, T M

1997-01-01

310

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.

2009-01-01

311

Plantaris rupture: why is it important?  

PubMed Central

Plantaris muscle is accessory plantar flexor of calf, a vestigial muscle of triceps surae complex. Its importance lies in the fact that its rupture cans mimic deep vein thrombosis (DVT). Sometimes when there is rupture of Achilles tendon, intact plantaris can still cause plantar flexion at ankle presenting a confusing picture. We present one such case of plantaris rupture confused by radiology resident with DVT. A 51-year-old man had a feeling as if kicked in back of calf along with a snapping sound and severe pain while playing tennis. On seeing fluid between muscle plane and a hypoechoic structure radiology resident labelled it DVT. MRI suggested ruptured plantaris as fluid and muscle stump were seen between gastronemius and soleus. Patient was treated conservatively with rest, ice compression and elevated leg and showed significant reduction in pain and swelling. PMID:23345486

Rohilla, Seema; Jain, Nitin; Yadav, Rohtas

2013-01-01

312

Acute Iliac Artery Rupture: Endovascular Treatment  

SciTech Connect

The authors present 7 patients who suffered iliac artery rupture over a 2 year period. In 5 patients, the rupture was iatrogenic: 4 cases were secondary to balloon angioplasty for iliac artery stenosis and 1 occurred during coronary angioplasty. In the last 2 patients, the rupture was secondary to iliac artery mycotic aneurysm. Direct placement of a stent-graft was performed in all cases, which was dilated until extravasation was controlled. Placement of the stent-graft was successful in all the cases, without any complications. The techniques used, results, and mid-term follow-up are presented. In conclusion, endovascular placement of a stent-graft is a quick, minimally invasive, efficient, and safe method for emergency treatment of acute iliac artery rupture, with satisfactory short- and mid-term results.

Chatziioannou, A.; Mourikis, D.; Katsimilis, J.; Skiadas, V., E-mail: bill_skiadas@yahoo.gr; Koutoulidis, V.; Katsenis, K.; Vlahos, L. [University of Athens, Radiology Department, Areteion Hospital (Greece)

2007-04-15

313

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: lgrimard@ottawahospital.on.ca; 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)

2009-07-01

314

Effect of caffeine on lower esophageal sphincter pressure in Thai healthy volunteers.  

PubMed

Caffeine affects many aspects of body function including the gastrointestinal system. A single-blinded experimental study was performed to evaluate the effect of caffeine on lower esophageal sphincter (LES) and esophageal peristaltic contractions in healthy Thai adults. The volunteers were six men and six women aged 19-31 years. Subjects drank 100 mL of water. Five wet swallows were performed 30 min after the drink. The basal LES pressure was continuously measured using esophageal manometric technique. They then consumed another 100 mL of water containing caffeine at the dose of 3.5 mg/kg body weight. The swallows and basal LES pressure monitoring were repeated. The results showed no change in basal LES pressure after a water drink while caffeine consumption significantly lowered the pressure at 10, 15, 20 and 25 min. The mean amplitude of contractions and peristaltic velocity were decreased at the distal esophagus at 3 and 8 cm above LES. The mean duration of contraction was decreased at the distal part but increased at the more proximal esophagus. The heart rate, systolic and diastolic blood pressures were increased significantly at 10-20 min after caffeine ingestion. This study indicated that caffeine 3.5 mg/kg affected esophageal function, resulting in a decrease in basal LES pressure and distal esophageal contraction, which is known to promote the reflux of gastric contents up into the esophagus. PMID:16722996

Lohsiriwat, S; Puengna, N; Leelakusolvong, S

2006-01-01

315

Characterization of NK3 receptors in rabbit isolated iris sphincter muscle  

PubMed Central

Tachykinin NK3 receptors were characterized in the rabbit isolated iris sphincter muscle by use of autoradiography and in vitro functional studies.[125I]-[MePhe7]-neurokinin B (NKB) (1?nM), a selective NK3 receptor agonist, specifically labelled a population of NK3 receptors that were uniformly distributed throughout the rabbit iris sphincter muscle. This labelling was inhibited by unlabelled [MePhe7]-NKB (1??M) but not by the NK1 receptor antagonist CP 99994 (1??M).In the presence of CP 99994 (1??M), the selective NK3 receptor agonists senktide (n=14) and [Pro7]-NKB (n=4), and the natural preferred ligand for the NK3 receptor, NKB (n=8), were potent contractile agents in the rabbit iris sphincter muscle. They all produced monophasic concentration-effect curves with pD2 values of 9.53±0.08, 8.56±0.09 and 9.75±0.09, and nH values of 0.93±0.03, 1.53±0.17 and 0.76±0.06, respectively. [MePhe7]-NKB (n=12) was also a potent agonist, but produced shallow concentration-effect curves which appeared biphasic (nH=0.45±0.04).Contractile responses to senktide were surmountably antagonized in a concentration-dependent manner by the selective non-peptide NK3 receptor antagonist, SR 142801 (3–30?nM; pA2= 8.9; slope = 0.99) and the non-peptide NK2/NK3 receptor antagonist, SR 48968 (3–30??M; pA2 =6.1; slope=1.5). These pA2 values were consistent with functional rabbit NK3 receptors more closely resembling guinea-pig and human NK3 receptors, than rat NK3 receptors. SR 142801 (10–100?nM) and SR 48968 (3 and 30??M) inhibited responses to low (?1?nM) but not higher (>1?nM) concentrations of [MePhe7]-NKB, and concentration-effect curves to [MePhe7]-NKB became steeper and monophasic in the presence of either antagonist.SR 142801 (3–30 nM) and SR 48968 (3–30??M) also surmountably antagonized concentration-effect curves to [Pro7]-NKB and NKB, although results were more difficult to interpret, since the relationship between log concentration-ratios and the concentration of antagonist used did not adhere to the Schild equation. However, analysis of data with the lowest concentration of SR 142801 (3?nM) tested against NKB, and SR 48968 (3??M) tested against [Pro7]-NKB and NKB, yielded apparent pA2 estimates of 9.3, 6.8 and 6.4, respectively, consistent with blockade of NK3 receptors.SR 142801 (100?nM) had no effect on contractions induced by transmural nerve stimulation (2?Hz, 0.3?ms, 20?V for 30?s), whereas CP 99994 (1??M) abolished these responses.Phenoxybenzamine pretreatment (20??M, 10?min) markedly reduced maximum responses to [MePhe7]-NKB (from 101±6.2% to 38±9.5% reference contraction, n=4) and induced a marked (10?fold) rightward shift in the concentration-effect curve. The residual responses to [MePhe7]-NKB after phenoxybenzamine pretreatment were unaffected by 1??M CP 99994 (maximum response=41±9.4%, n=4).These results demonstrate autoradiographically and functionally, the presence of NK3 receptors in rabbit iris sphincter muscle that mediate contractile responses to NK3 receptor agonists, but not to sensory trigeminal nerve stimulation. The present data with senktide and selective NK3 receptor antagonists suggest that functional rabbit NK3 receptors more closely resemble human and guinea-pig NK3 receptors than rat NK3 receptors. However, the pharmacological profiles of [MePhe7]-NKB, SR 142801 and SR 48968 suggest the presence of an ‘atypical' NK3 receptor or a heterogeneous population of NK3 receptors in this tissue. PMID:9117105

Medhurst, Andrew D; Parsons, Andrew A; Roberts, Jennifer C; Hay, Douglas W P

1996-01-01

316

Tension receptors with vagal afferent fibres in the proximal duodenum and pyloric sphincter of sheep.  

PubMed Central

Single-unit afferent activity was recorded from the hepatic-duodenal branch of the vagus nerve of chloralose-anaesthetized sheep during acute electrophysiological experiments. The impulse activity of sixty-seven slowly adapting mechanoreceptors situated in the muscularis externa of the proximal duodenum and pyloric sphincter was synchronous with alterations in electromyographic and tension records. Afferent units were excited during passive distension, compression and drug-induced increases in muscle tension, thus satisfying the criteria for 'in series' tension receptors (Iggo, 1955). From the responses to compression some evidence was found for the existence of separate populations of tension receptors with different mechanical thresholds. Two fibre populations were found: non-myelinated (0.70 +/- 0.26 S.D. ms-1) and myelinated (7.6 +/- 1.6 S.D. m s-1). Mucosal application of solutions of hydrochloric acid, volatile fatty acids, alkali and amino acids, and mucosal probing modified the activity of most units. These changes were reduced by anaesthesia of the mucosa. It is concluded that tension receptors in the sheep duodenum occupy a position 'in series' with longitudinal muscle, and that their activity can be modified by the particulate and chemical composition of chyme by a mechanism involving local nerve plexuses. The activity of tension receptors is compared with that of two other mechanoreceptor classes located serosally (five units) and in the lesser omentum (eleven units). Receptors in neither of these two classes were directly excited by active contraction of the duodenum. PMID:6481643

Cottrell, D F; Iggo, A

1984-01-01

317

Risk Factors for Erosion of Artificial Urinary Sphincters: A Multicenter Prospective Study  

PubMed Central

OBJECTIVE To evaluate the short- to medium-term outcomes after artificial urinary sphincter (AUS) placement from a large, multi-institutional, prospective, follow-up study. We hypothesize that along with radiation, patients with any history of a direct surgery to the urethra will have higher rates of eventual AUS explantation for erosion and/or infection. MATERIALS AND METHODS A prospective outcome analysis was performed on 386 patients treated with AUS placement from April 2009 to December 2012 at 8 institutions with at least 3 months of follow-up. Charts were analyzed for preoperative risk factors and postoperative complications requiring explantation. RESULTS Approximately 50% of patients were considered high risk. High risk was defined as patients having undergone radiation therapy, urethroplasty, multiple treatments for bladder neck contracture or urethral stricture, urethral stent placement, or a history of erosion or infection in a previous AUS. A total of 31 explantations (8.03%) were performed during the follow-up period. Overall explantation rates were higher in those with prior radiation and prior UroLume. Men with prior AUS infection or erosion also had a trend for higher rates of subsequent explantation. Men receiving 3.5-cm cuffs had significantly higher explantation rates than those receiving larger cuffs. CONCLUSION This outcomes study confirms that urethral risk factors, including radiation history, prior AUS erosion, and a history of urethral stent placement, increase the risk of AUS explantation in short-term follow-up. PMID:25109562

Brant, William O.; Erickson, Bradley A.; Elliott, Sean P.; Powell, Christopher; Alsikafi, Nejd; McClung, Christopher; Myers, Jeremy B.; Voelzke, Bryan B.; Smith, Thomas G.; Broghammer, Joshua A.

2015-01-01

318

Surgical treatment of tumors of the distal rectum with sphincter preservation.  

PubMed Central

One hundred one patients with villous adenoma or invasive carcinoma of the distal rectum treated with local excision or coloanal anastomosis were studied. Twenty-three (45%) of the 51 patients with villous adenomas had transanal excision, another 23 (45%) had a posterior proctotomy, and five (10%) had a coloanal anastomosis. Only two patients with a villous adenoma developed a recurrence requiring repeat local excision. Fifteen (30%) of the 50 patients with invasive cancer were treated by transanal excision. All had tumors confined to the submucosa or superficial muscularis. Eighteen (85%) of 21 patients having posterior proctotomy also had tumors with similar depth of invasion. Six (43%) of the 14 patients having coloanal anastomosis had Dukes' B tumors, six (43%) were Dukes' C, and another two (14%) underwent palliative resection. The overall actuarial 5-year survival was 77%. Only four patients treated by transanal excision or posterior proctotomy died of metastatic disease. In the coloanal group, two of 12 patients undergoing curative resection died of recurrent cancer, and another has a pelvic recurrence. Villous adenomas of the distal rectum and selected carcinomas may be treated with local excision and coloanal anastomosis with preservation of sphincter function with good results. PMID:1417192

Heimann, T M; Oh, C; Steinhagen, R M; Greenstein, A J; Perez, C; Aufses, A H

1992-01-01

319

Regional differences in nitrergic innervation of the smooth muscle of murine lower oesophageal sphincter  

PubMed Central

Background and purpose: Anatomical and pharmacological studies have demonstrated that the lower oesophageal sphincter (LES) is not a simple homogenous circular muscle with uniform innervation. Regional differences have been demonstrated in several species including humans. We investigated, for the first time in mice LES, regionally distinct physiological and pharmacological characteristics of the neuromusculature. Experimental approach: Conventional intracellular recordings and pharmacological techniques were employed to evaluate electrical properties and functional innervation of smooth muscle cells. Results from CD1 (control), nNOS(?/?) and eNOS(?/?) genetic knockout mice were compared. Key results: Smooth muscle of sling and clasp LES displayed unitary membrane potentials of 1– 4?mV. Transmural nerve stimulation produced a monophasic inhibitory junction potential (IJP) in the sling, whereas in the clasp a biphasic IJP, consisting of a brief IJP followed by a long-lasting slow IJP (lsIJP), was induced. Pharmacological interventions and genetically modified mice were used to demonstrate a monophasic apamin-sensitive (purinergic) component in both LES regions. However, the nitrergic IJP was monophasic in the sling and biphasic in the clasp. Unitary membrane potentials and IJPs were not different in CD1 and eNOS(?/?) mice, suggesting no involvement of myogenic NOS. Conclusion and implications: These data in mouse LES indicate that there are previously unreported regional differences in the IJP and that both the apamin-resistant monophasic and biphasic IJPs are mediated primarily by nitrergic innervation. PMID:18037919

Zhang, Y; Mashimo, H; Paterson, W G

2007-01-01

320

The genesis of lower esophageal sphincter pressure: its identification through the use of gastrin antiserum.  

PubMed

The purpose of this study was to evaluate the role of gastrin in the genesis of lower esophageal sphincter (LES) pressure by the use of a high titer gastrin antiserum. Intravenous infusions of increasing amounts of rabbit gastrin antiserum, but not control antiserum, produced graded reductions in the resting LES pressure in anesthetized opossums. A maximal inhibition in LES pressure of 80.0+/-3.1% (mean +/-SE) was achieved when gastrin antiserum was administered in an amount estimated to bind almost all endogenous circulating gastrin in the opossum. Gastrin antiserum also inhibited the LES response to endogenous gastrin release (gastric deacidification) and to exogenous intravenous administration of gastrin I. The inhibition of the LES response to exogenous gastrin I by gastrin antiserum could be eliminated by giving excess gastrin I. Studies performed in vitro showed that gastrin antiserum inhibited the contractile response of LES circular muscle to gastrin I, but not to acetylcholine. These studies indicate that gastrin antiserum: (a) specifically antagonized the response of LES circular muscle to gastrin, in vitro; (b) diminished the LES response to the endogenous release and to the exogenous administration of gastrin; and (c) markedly reduced the resting level of LES pressure. We conclude that endogenous gastrin is the major determinant of resting LES pressure. PMID:5011098

Lipshutz, W; Hughes, W; Cohen, S

1972-03-01

321

Effect of Transdermal Fentanyl Patches on the Motility of the Sphincter of Oddi  

PubMed Central

Background/Aims Pain is one of the most troublesome symptoms of pancreatitis. Transdermal fentanyl patches (TFPs) are long-acting analgesics with a reduced risk of dependency. This prospective study evaluated the effect of TFPs on sphincter of Oddi (SO) motility for the management of pain in pancreatitis. Methods SO manometry (SOM) was performed using triple-lumen catheters anterogradely inserted through the percutaneous transhepatic route during cholangioscopy in 16 patients. The basal pressure, amplitude, and frequency of the SO were assessed before and after applying a TFP at 24 hour at doses of 25 and 12.5µg/hr, respectively. Results Two of 16 patients receiving a 25µg/hr. TFP were excluded because of adverse side effects (headache and/or nausea). The mean basal pressure, amplitude, and frequency of SOM did not change significantly in the 25µg/hr TFP group (n=4 patients). Parameters of SO function also did not significantly change in the 12.5µg/hr TFP group (n=11 patients). Conclusions TFPs below a dose of 25µg/hr may not affect the motility of the SO. Administration of TFPs at lower dosages seems to be a safe analgesic treatment for the pain control of patients with pancreatitis without affecting the function of the SO. PMID:20981215

Koo, Hyun Cheol; Choi, Hyun Jong; Hwang, Kyoung Hwa; Maeng, Hyo Jin; Kim, Hyung Ki; Park, Jong Kyu; Hong, Su Jin; Cheon, Young Koog; Cho, Young Deok; Lee, Joon Seong; Lee, Moon Sung

2010-01-01

322

Creep-rupture reliability analysis  

NASA Technical Reports Server (NTRS)

A probabilistic approach to the correlation and extrapolation of creep-rupture data is presented. Time temperature parameters (TTP) are used to correlate the data, and an analytical expression for the master curve is developed. The expression provides a simple model for the statistical distribution of strength and fits neatly into a probabilistic design format. The analysis focuses on the Larson-Miller and on the Manson-Haferd parameters, but it can be applied to any of the TTP's. A method is developed for evaluating material dependent constants for TTP's. It is shown that optimized constants can provide a significant improvement in the correlation of the data, thereby reducing modelling error. Attempts were made to quantify the performance of the proposed method in predicting long term behavior. Uncertainty in predicting long term behavior from short term tests was derived for several sets of data. Examples are presented which illustrate the theory and demonstrate the application of state of the art reliability methods to the design of components under creep.

Peralta-Duran, A.; Wirsching, P. H.

1984-01-01

323

Dynamic rupture activation of backthrust fault branching  

NASA Astrophysics Data System (ADS)

We perform dynamic rupture simulations to investigate the possible reactivation of backthrust branches triggered by ruptures along a main thrust fault. Simulations with slip-weakening fault friction and uniform initial stress show that fast propagation speed or long propagation distance of the main rupture promotes reactivation of backthrust over a range of branch angles. The latter condition may occur separately from the former if rupture speed is limited by an increasing slip-weakening distance towards the junction direction. The results suggest a trade-off between the amplitude and duration of the dynamic stress near the main rupture front for backthrust reactivation. Termination of the main rupture by a barrier can provide enhanced loading amplitude and duration along a backthrust rooted near the barrier, facilitating its reactivation especially with a high frictional resistance. The free surface and depth-dependent initial stress can have several additional effects. The sign of the triggered motion along the backthrust can be reversed from thrust to normal if a deeply nucleated main rupture breaks the free surface, while it is preserved as thrust if the main rupture is terminated by a barrier at depth. The numerical results are discussed in relation to several recent megathrust earthquakes in Sumatra, Chile, and Japan, and related topics such as branch feedbacks to the main fault. The dynamic view on backthrust fault branching provided by the study fills a gap not covered by quasi-static models or observations. A specific examined case of antithetic fault branching may be useful for indicating a barrier-like behavior along the main fault.

Xu, Shiqing; Fukuyama, Eiichi; Ben-Zion, Yehuda; Ampuero, Jean-Paul

2015-03-01

324

[Anal symptoms of gastro-intestinal diseases].  

PubMed

In most cases the ano-cutaneous clinical symptoms correlated to diseases of the gastro-intestinal tract are not specific (erythema, itching, wounds or scarring). However in the following diseases occasional dermatological lesions may directly contribute to their diagnosis: in Crohn's disease, tuberculosis of bowel, chronic entamoebiasis and bilharziosis, the skin lesions of the anal area have the same histological structure as the gut lesions. Perianal fistulas and ulcers are frequent in Crohn's disease especially if there is a colonic and rectal spreading; they respond badly to steroid therapy and are often correlated with a worse prognosis. Perianal specific lesions occur often in oxyuriasis in children, in candidiasis of the digestive tract, in systemic aphthosis and in some malignancies. In other gastro-intestinal disturbances, the dermatological and features are less specific and can only be suggestive: iatrogenic and microbial diarrheas, side-effects of laxatives, proctological diseases. It has to be emphasized that pruritus ani is only induced by deeper lesions when they spread to the perianal skin. In proctological practice, contact dermatitis by sensitivity to anaesthetics or suppository balsams (Peruvian balsam), itching or burning atrophy by topical steroid abuse, non-diagnosed fungal (candidiasis), bacterial (erythrasma) or psoriatic intertrigos (flexural psoriasis) may sometimes explain the failure of therapy. PMID:485013

Grosshans, E; Jenn, P; Baumann, R; Weill, J P; Basset, A

1979-01-01

325

Current treatment options for management of anal intraepithelial neoplasia  

PubMed Central

Anal squamous cell cancer is an uncommon malignancy caused by infection with oncogenic strains of Human papilloma virus. Anal cancer is much more common in immunocompromised persons, including those infected with Human immunodeficiency virus. High-grade anal intraepithelial neoplasia (HGAIN), the precursor of anal cancer, is identified by clinicians providing care for patients with anorectal disease, and is increasingly being identified during screening of immunosuppressed patients for anal dysplasia. The traditional treatment for HGAIN has been excision of macroscopic disease with margins. This approach is effective for patients with small unifocal HGAIN lesions. Patients with extensive multifocal HGAIN frequently have recurrence of HGAIN after excision, and may have postoperative complications of anal stenosis or fecal incontinence. This led to the suggestion by some that treatment for HGAIN should be delayed until patients developed anal cancer. Alternative approaches in identification and treatment have been developed to treat patients with multifocal or extensive HGAIN lesions. High-resolution anoscopy combines magnification with anoscopy and is being used to identify HGAIN and determine treatment margins. HGAIN can then be ablated with a number of modalities, including infrared coagulation, CO2 laser, and electrocautery. These methods for HGAIN ablation can be performed with local anesthesia on outpatients and are relatively well tolerated. High-resolution anoscopy-directed HGAIN ablation is evolving into a standard approach for initial treatment and then subsequent monitoring of a disease which should be expected to be recurrent. Another treatment approach for HGAIN is topical treatment, principally with 5-fluorouracil or imiquimod. Topical therapies have the advantage of being nonsurgical and are well suited for treating widespread multifocal disease. Topical treatments have the disadvantage of requiring extended treatment courses and causing a symptomatic inflammatory response. Successful treatment requires adherence to a regime that is uncomfortable at best and at worst painful. Topical treatments can be successful in motivated adherent patients willing to accept these side effects. PMID:23788834

Weis, Stephen E

2013-01-01

326

Appl. Comput. Harmon. Anal. 33 (2012) 388400 Contents lists available at SciVerse ScienceDirect  

E-print Network

Appl. Comput. Harmon. Anal. 33 (2012) 388­400 Contents lists available at SciVerse Science folders, Appl. Comput. Harmon. Anal. (2011), in press] hierarchical clustering algorithm. We show. Anal. 33 (2012) 388­400 389

Averbuch, Amir

327

General Considerations of Ruptured Abdominal Aortic Aneurysm: Ruptured Abdominal Aortic Aneurysm  

PubMed Central

Although development of surgical technique and critical care, ruptured abdominal aortic aneurysm still carries a high mortality. In order to obtain good results, various efforts have been attempted. This paper reviews initial management of ruptured abdominal aortic aneurysm and discuss the key point open surgical repair and endovascular aneurysm repair. PMID:25705591

Lee, Chung Won; Bae, Miju; Chung, Sung Woon

2015-01-01

328

Rupture progression along discontinuous oblique fault sets: implications for the Karadere rupture segment of the 1999 Izmit earthquake, and future rupture in the Sea of Marmara  

Microsoft Academic Search

Large earthquakes in strike-slip regimes commonly rupture fault segments that are oblique to each other in both strike and dip. This was the case during the 1999 Izmit earthquake, which mainly ruptured E–W-striking right-lateral faults but also ruptured the N60°E-striking Karadere fault at the eastern end of the main rupture. It will also likely be so for any future large

Jordan R. Muller; Atilla Aydin

2004-01-01

329

Anale. Seria Informatic. Vol. VII fasc. 1 2009 Annals. Computer Science Series. 7th  

E-print Network

Anale. Seria Informatic. Vol. VII fasc. 1 ­ 2009 Annals. Computer Science Series. 7th Tome 1st Fasc'Echo de Paris for about a decade but disappeared about the time of the First World War. #12;Anale. Seria

Paris-Sud XI, Université de

330

Appl. Comput. Harmon. Anal. 30 (2011) 407422 Contents lists available at ScienceDirect  

E-print Network

Appl. Comput. Harmon. Anal. 30 (2011) 407­422 Contents lists available at ScienceDirect Applied. / Appl. Comput. Harmon. Anal. 30 (2011) 407­422 The literature offers several automatic ways for choosing

Eldar, Yonina

331

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 on the Basis of the Capillary Wavelength J.-M. Menet,. D. Thlgbaut, and R. Rosset Laboratoire de Chimie Anal

Wesfreid, José Eduardo

332

1660 Anal. Chem. 1991, 63,1660-1664 with the electrospray source installed.  

E-print Network

1660 Anal. Chem. 1991, 63,1660-1664 with the electrospray source installed. The protein samples.; Straub. K. M.; Burlingame, A. L. Anal. Chem. 1982, 54, 2029-2034. (4) Chowdhuy, S. K.;Katta, V.; Chalt,

Chait, Brian T.

333

Anal Bioanal Chem (2006) 386: 12671272 DOI 10.1007/s00216-006-0623-y  

E-print Network

Anal Bioanal Chem (2006) 386: 1267­1272 DOI 10.1007/s00216-006-0623-y ORIGINAL PAPER R. Bernini . E/detection system. The sample liquid, con- taining the fluorescent marked particles/cells under anal- ysis

Technische Universiteit Delft

334

Appl. Comput. Harmon. Anal. 26 (2009) 249269 Contents lists available at ScienceDirect  

E-print Network

Appl. Comput. Harmon. Anal. 26 (2009) 249­269 Contents lists available at ScienceDirect Applied. Harmon. Anal. 26 (2009) 249­269 This decomposition is straightforward in (L2 (Rn ))n thanks to the Leray

Starck, Jean-Luc

335

Biochemistry 1983,22, 2923-2933 2923 Deutschmann, G., & Ullrich, V. (1979)Anal. Biochem. 94,  

E-print Network

Biochemistry 1983,22, 2923-2933 2923 Deutschmann, G., & Ullrich, V. (1979)Anal. Biochem. 94, Geraci Derivatives,Royal Van Gorcum, Ltd., Assen, The Netherlands. Van Assendelft, 0.W., & Zijlstra, W. G. (1975)Anal

Boxer, Steven G.

336

Comparing Argus sling and artificial urinary sphincter in patients with moderate post-prostatectomy incontinence  

PubMed Central

Post-prostatectomy incontinence (PPI) is a main complication of radical prostatectomy. The purpose of this study was to compare the efficacy and safety of the Argus male sling (Argus) with that of artificial urinary sphincters (AUS) in patients with moderate PPI. A total of 33 moderate PPI patients underwent AUS or Argus implantation from January 2009 to June 2013 (13 AUS, 20 Argus). We defined moderate PPI as the use of 2–4 pads per day. To compare efficacy, we assessed the success rate between the two groups. Success was defined as the daily need for no pads or one small safety pad that remained dry most of the day. The mean patient age was 73.5±6.3 yr in the AUS group and 70.9±5.1 yr in the Argus group, and the mean follow-up period was 29.8±14.9 months in the AUS group and 24.7±11.8 months in the Argus group. The success rate was 72.7% in the AUS group and 85.0% in the Argus group (P=0.557). Abnormal postoperative pain persisted in more patients in the Argus group (6/20, 30%) than in the AUS group (1/13, 7.7%) (P=0.126). However, the rate of other complications was not different between the two groups (7.7% and 15.0% for AUS and Argus, respectively, P=0.822). Argus surgery showed similar success and complication rates to those of AUS in moderate PPI patients, indicating that it could be an alternative surgical option for the treatment of moderate PPI. PMID:25426474

Lim, Bumjin; Kim, Aram; Song, Miho; Chun, Ji-Youn; Park, Junsoo; Choo, Myung-Soo

2014-01-01

337

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

2014-01-01

338

Prevention of Esophagopharyngeal Reflux by Augmenting the Upper Esophageal Sphincter Pressure Barrier  

PubMed Central

Objectives/Hypothesis Incompetence of the upper esophageal sphincter (UES) is fundamental to the occurrence of esophagopharyngeal reflux (EPR), and development of supraesophageal manifestations of reflux disease (SERD). However, therapeutic approaches to SERD have not been directed to strengthening of the UES barrier function. Our aims were to demonstrate that EPR events can be experimentally induced in SERD patients and not in healthy controls, and ascertain if these events can be prevented by application of a modest external cricoid pressure. Study Design Individual case control study. Methods We studied 14 SERD patients (57±13 years, 8 females) and 12 healthy controls (26±3 years, 7 females) by concurrent intraesophageal slow infusion and pharyngoscopic and manometric technique without and with the application of a sustained predetermined cricoid pressure to induce, detect, and prevent EPR, respectively. Results Slow esophageal infusion (1 mL/s) of 60 mL of HCl resulted in a total of 16 objectively confirmed EPR events in none patients and none in healthy controls. All patients developed subjective sensation of regurgitation. Sustained cricoid pressure resulted in a significant UES pressure augmentation in all participants. During application of sustained cricoid pressure, slow intraesophageal infusion resulted in only one EPR event (P<.01). Conclusions Slow esophageal liquid infusion unmasks UES incompetence evidenced as the occurrence of EPR. Application of 20 to 30 mm Hg cricoid pressure significantly increases the UES intraluminal pressure and prevents pharyngeal reflux induced by esophageal slow liquid infusion. These techniques can be useful in diagnosis and management of UES incompetence in patients suffering from supraesophageal manifestations of reflux disease. PMID:24782387

Shaker, Reza; Babaei, Arash; Naini, Sohrab R.

2015-01-01

339

Brain metastasis in basaloid undifferentiated anal carcinoma: A case report  

PubMed Central

Anal cancer is a rare tumor that accounts for 2% of all colorectal neoplasms. The brain is a rarely affected organ. The aim of the present study was to the review the only four cases of anal cancer brain metastases previously published in the literature. In addition, the current study presents the case of a 69-year-old male diagnosed with basaloid undifferentiated carcinoma of the anal canal (stage IV with liver, lung and bone metastasis). Despite the patient’s good response to chemotherapy and the achievement of a partial response that was maintained for 14 months, brain metastases developed. Although radiotherapy was administered, the patient succumbed to the condition 12 weeks after the diagnosis of brain metastasis. PMID:24944707

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

2014-01-01

340

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,134,1191- 1193. (3) Pendley, P. D.; Abruiia, H. D. Anal. Chem. 1990, 62,782-784. (4) Singleton, S. T.;O'Dea, J. J.;Osteryoung,J.Anal.Chen.1989,61, (5) Penner, R. M.; Heben, M. J.; Lewis,N. S. Anal. Chem. 1989, 61, (6) Wightman, R. M. Science

Kounaves, Samuel P.

341

Anal high-risk human papillomavirus infection and high-grade anal intraepithelial neoplasia detected in women and heterosexual men infected with human immunodeficiency virus  

PubMed Central

Background Although anal high-risk human papillomavirus (HR-HPV) infection and anal cytological abnormalities are highly prevalent among human immunodeficiency virus (HIV)-infected men who have sex with men (MSM), there are insufficient data on these abnormalities among HIV-infected heterosexual men (HSM) and women. In this study, we evaluated the prevalence of anal HR-HPV, cytological abnormalities, and performance of these screening tests in detecting high-grade anal intraepithelial neoplasia (AIN2+) among our cohort of HIV-infected MSM and non-MSM (HSM and women). Methods A single-center, retrospective cohort study was conducted with HIV-infected individuals who underwent anal cancer screening with anal cytology and HR-HPV testing from January 2011 to January 31, 2013. Results Screening of 221 HIV-infected individuals for both HR-HPV and anal cytology showed the presence of HR-HPV in 54% (abnormal anal cytology 48%) of MSM, 28% (abnormal anal cytology 28%) of HSM, and 27% (abnormal anal cytology 34%) of women. Among 117 (53%) individuals with abnormal results (HR-HPV-positive and/or cytology was atypical squamous cells of undetermined significance or above), 67 underwent high resolution anoscopy. Of these 67 individuals, 22 individuals had AIN2+ (17 MSM, four women, and one HSM). HR-HPV correlated better with AIN2+ than with anal cytology on biopsy in both MSM (r=0.29 versus r=0.10; P=0.05 versus P=0.49) and non-MSM (r=0.36 versus r=?0.34; P=0.08 versus P=0.09). Conclusion Given the presence of AIN2+ in screened HIV-infected HSM and women, routine anal cancer screening in all HIV-infected individuals should be considered. HR-HPV merits further evaluation for anal cancer screening among non-MSM. PMID:25670914

Gandra, Sumanth; Azar, Aline; Wessolossky, Mireya

2015-01-01

342

Steinert's syndrome presenting as anal incontinence: a case report  

PubMed Central

Introduction Myotonic dystrophy (MD) or Steinert's syndrome is a rare cause of chronic diarrhea and anal incontinence. In the presence of chronic diarrhea and fecal incontinence with muscle weakness, neuromuscular disorders such as myotonic dystrophy should be considered in the differential diagnosis. Case Presentation We present the case of a 45-year-old Turkish man with Steinert's syndrome, who was not diagnosed until the age of 45. Conclusions In clinical practice, the persistence of diarrhea and fecal incontinence with muscle weakness should suggest that the physician perform an anal manometric study and electromyography. Neuromuscular disorders such as myotonic dystrophy should be considered in the differential diagnosis. PMID:21838873

2011-01-01

343

A new minimally invasive treatment for anal fistula.  

PubMed

In colorectal surgery, eradicating the fistula and maintaining continence are still complex challenges for a colorectal surgeon. A minimally invasive method using a novel device was performed to consecutively treat 14 patients with anal fistula from August 2008 to November 2009. After a follow-up period of 36 months, 13 patients achieved successful closure of their fistula tracts, and recurrence occurred only in one patient. Recurrence was due to the delay of dressing change. No patient had interference with continence, and no major intra- and postoperative complications were identified. Using the novel device with invasive methods can be a promising alternative for managing anal fistulas. PMID:25238933

Zhu, Rui; Shen, Lin; Wang, Caoyuan; Yang, Yanping; Chen, Rui; Fang, Hen; Xu, Xiaojuan

2015-03-01

344

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

2004-01-01

345

Therapeutic effects of different doses of botulinum toxin in chronic anal fissure  

Microsoft Academic Search

PURPOSE: The aim of this study was to evaluate the clinical and manometric results of three different doses of botulinum toxin and two methods of injection for the treatment of chronic idiopathic anal fissure. METHODS: Sixty-nine patients with chronic anal fissure were included in a nonrandomized, prospective trial of intrasphincteric injection of botulinum toxin. All patients reported postdefecatory anal pain

Miguel Mínguez; Francisco Melo; Alejandro Espí; Eduardo García-Granero; Francisco Mora; Salvador Lledó; Adolfo Benages

1999-01-01

346

Topical Nifedipine vs. Topical Glyceryl Trinitrate for Treatment of Chronic Anal Fissure  

Microsoft Academic Search

PURPOSE: Nifedipine (administered orally or applied topically) has been effective for nonsurgical treatment of anal fissure. We compared the efficacy of nifedipine vs. glyceryl trinitrate for chemical sphincterotomy of anal fissure. METHODS: In a prospective, double-blind trial, 52 patients suffering from chronic anal fissure were randomly and equally allocated to receive either glyceryl trinitrate or nifedipine, both applied topically to

Tiberiu Ezri; Sergio Susmallian

2003-01-01

347

Intro Comb Anal Prob Higher Dim Other Problems Moments and Densities of Short Random Walks  

E-print Network

Intro Comb Anal Prob Higher Dim Other Problems Moments and Densities of Short Random Walks New, 2014 Revised: 27-11-14 JMB/JW Short Random Walks #12;Intro Comb Anal Prob Higher Dim Other Problems and early career researchers. JMB/JW Short Random Walks #12;Intro Comb Anal Prob Higher Dim Other Problems

Borwein, Jonathan

348

Breu introducci'o a la geometria anal'itica r'igida Xavier Xarles  

E-print Network

Breu introducci'o a la geometria anal'itica r'igida Xavier geometria r'igida anal'itica 'es desenvolupar una "geometria" sobre un cos complet respecte un valor absolut de tipus finit) tingui una 'unica varietat anal'itica V an associada. A m'es, si V 'es connexa

Xarles, Xavier

349

Anal. Chem. 1995, 67, 4542-4548 Noncovalent Protein-Oligonbicleotide Interactions  

E-print Network

Anal. Chem. 1995, 67, 4542-4548 Noncovalent Protein-Oligonbicleotide Interactions Monitored. $Naval Research Laboratory. s Cruachem, Inc. (1) Karas, M.; Hillenkamp, F. Anal. Chem. 1988, 60, 2299-2301. (2) Mann, M.; Meng, C. K; Fenn, J. B. Anal. Chem. 1989, 61, 1702-1708. (3) Beavis, R C.; Chait, B. T

Vertes, Akos

350

Anal. Chem. 1995,67,4452-4457 Control of the Specific Adsorption of Proteins onto  

E-print Network

Articles Anal. Chem. 1995,67,4452-4457 Control of the Specific Adsorption of Proteins onto Gold;Oxford University Press: Oxford, 1987. (2) Scott, D. L.; Bowden, E. F. Anal. Chem. 1994,66,1217-1223. (3) Hoshi, T.; Anzai, J.; Osa, T. Anal. Chem. 1995,67,770-774. Wisconsin-Madison, 1500 Highland Ave., Madison, WI 53706

351

J. Math. Anal. Appl. 355 (2009) 180194 Contents lists available at ScienceDirect  

E-print Network

J. Math. Anal. Appl. 355 (2009) 180­194 Contents lists available at ScienceDirect Journal exchange in a spatio-temporal material composite with rectangular microstructure, J. Math. Anal. Appl. 314- temporal material composite with rectangular microstructure, J. Math. Anal. Appl. 314 (2006) 286

Weekes, Suzanne L.

352

Anal. Chem. 1990, 62,1705-1709 1705 distinguished. Conversely, a PDMS or FAB mass spectrum  

E-print Network

Anal. Chem. 1990, 62,1705-1709 1705 distinguished. Conversely, a PDMS or FAB mass spectrum, R. J.; Stults,J. T. Anal. Biochem. 1989, 783, 190. Nielsen, P. F.; Klarskov, K.; Hojrup, P.; Becker, G.W.; Occolowitz,J. L.; Jardine, I. Anal. Biochem. 1988, 171, 113.(1) Biemann, K. In Methods

van Geen, Alexander

353

Breu introducci'o a la geometria anal'itica r'igida Xavier Xarles  

E-print Network

Breu introducci'o a la geometria anal'itica r'igida Xavier Xarles Gener del 1999 Introducci'o Objectiu L'objectiu de la geometria r'igida anal'itica 'es desenvolupar una ``geometria'' sobre un cos'es en general, tot esquema localment de tipus finit) tingui una ' unica varietat anal'itica V

Xarles, Xavier

354

Anal. Chem. 1993, 65, 3571-3575 3571 Ultrasensitive Fluorescence Detection of Polycyclic Aromatic  

E-print Network

Anal. Chem. 1993, 65, 3571-3575 3571 Ultrasensitive Fluorescence Detection of Polycyclic Aromatic, J. A,; Leszczyszyn, D. J.; Wightman, R. (4) Lee, T. T.; Yeung, E. S. Anal. Chem. 1992,64, 3045. Anal. Chem. 1992, 64, 2985- (7) Malinski, T.; Taha, Z. Nature 1992,358,676-678. (8) Lau, Y. Y.; Abe, T

Zare, Richard N.

355

Case report of deep vein thrombosis caused by artificial urinary sphincter reservoir compressing right external iliac vein  

PubMed Central

Artificial urinary sphincters (AUSs) are commonly used after radical prostatectomy for those who are incontinent of urine. However, they are associated with complications, the most common being reservoir uprising or migration. We present a unique case of occlusive external iliac and femoral vein obstruction by the AUS reservoir causing thrombosis. Deflation of the reservoir and anticoagulation has, thus far, not been successful at decreasing thrombus burden. We present this case as a rare, but significant surgical complication; explore the risk factors that may have contributed, and other potential endovascular therapies to address this previously unreported AUS complication. PMID:25657561

Yip, Marcus J.; Jhamb, Ashu; Goad, Jeremy R.

2015-01-01

356

[Familial ectodermal dysplasia with agenesis of the breasts and the external urethral sphincter. Description of a case].  

PubMed

The Authors report a case of athelia and amastia observed in a 28-year-old woman. The association of severe dental alterations, nail dystrophies and irregular cutaneous hyperpigmentation with normal sweating, make it possible to catalogue the anomaly in the hydrotic ectodermal dysplasia, an autosomal dominant hereditary disease. The syndrome, transmitted by the father, is also present in two brothers of the patient: the association of sphincter urethrae agenesis, responsible for urinary incontinence unsuccessful treated with two surgical operations, is to be considered quite fortuitous. PMID:8332280

Triolo, O; Allegra, A; Stella Brienza, L; De Meo, A; Tropea, G

1993-03-01

357

Acoustic levels of heavy truck tire ruptures.  

PubMed

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

2013-05-01

358

Consequences of expansion joint bellows rupture  

SciTech Connect

Expansion joints are used in piping systems to accommodate pipe deflections during service and to facilitate fitup. Typically, the expansion joint bellows is the thinnest part of the pressure boundary, bellows rupture frequencies are typically several orders of magnitude higher than pipe rupture frequencies. This paper reviews an effort to estimate the flow rates associated with bellows rupture. The Level I PRA (probabilistic risk assessment) for the Savannah River Site production reactors made the bounding assumption that bellows rupture would produce the maximum possible leakage - that of a double-ended guillotine break (DEGB). This assumption resulted in predictions of flooding of the reactor building with a high conditional probability that a Loss of Pumping Accident and core melting would follow. This paper describes analyses that were performed to develop a realistic break area and leak rate resulting from bellows rupture and therefore reduce the impact that bellows rupture can have on the estimated total core melt frequency. In the event of a 360 degree circumferential break of the bellows the resulting two sections will separate to the point where the force from the internal pressure acting to push the bellows open is just balanced by the spring force of the bellows itself. For the bellows addressed in this analysis, the equilibrium separation distance is 0.7 inches with normal pump lineup. The opening area is influenced by any initial compression or extension due to installation alignment, and by any operational displacements such as thermal expansion of the adjoining pipe. The influence of such factors is considered and the impact on the flooding rate and, hence, core melt frequency is reviewed.

Daugherty, W.L.; Miller, R.F.; Cramer, D.S.

1992-11-01

359

Consequences of expansion joint bellows rupture  

SciTech Connect

Expansion joints are used in piping systems to accommodate pipe deflections during service and to facilitate fitup. Typically, the expansion joint bellows is the thinnest part of the pressure boundary, bellows rupture frequencies are typically several orders of magnitude higher than pipe rupture frequencies. This paper reviews an effort to estimate the flow rates associated with bellows rupture. The Level I PRA (probabilistic risk assessment) for the Savannah River Site production reactors made the bounding assumption that bellows rupture would produce the maximum possible leakage - that of a double-ended guillotine break (DEGB). This assumption resulted in predictions of flooding of the reactor building with a high conditional probability that a Loss of Pumping Accident and core melting would follow. This paper describes analyses that were performed to develop a realistic break area and leak rate resulting from bellows rupture and therefore reduce the impact that bellows rupture can have on the estimated total core melt frequency. In the event of a 360 degree circumferential break of the bellows the resulting two sections will separate to the point where the force from the internal pressure acting to push the bellows open is just balanced by the spring force of the bellows itself. For the bellows addressed in this analysis, the equilibrium separation distance is 0.7 inches with normal pump lineup. The opening area is influenced by any initial compression or extension due to installation alignment, and by any operational displacements such as thermal expansion of the adjoining pipe. The influence of such factors is considered and the impact on the flooding rate and, hence, core melt frequency is reviewed.

Daugherty, W.L.; Miller, R.F.; Cramer, D.S.

1992-01-01

360

Shock wave theory for rupture of rubber  

E-print Network

This article presents a theory for the rupture of rubber. Unlike conventional cracks, ruptures in rubber travel faster than the speed of sound, and consist in two oblique shocks that meet at a point. Physical features of rubber needed for this phenomenon include Kelvin dissipation and an increase of toughness as rubber retracts. There are three levels of theoretical description: an approximate continuum theory, an exact analytical solution of a slightly simplified discrete problem, and numerical solution of realistic and fully nonlinear equations of motion.

M. Marder

2004-07-09

361

Thoracic Outlet Syndrome Following Breast Implant Rupture  

PubMed Central

Summary: We present a patient with bilateral breast implant rupture who developed severe locoregional silicone granulomatous lymphadenopathy. Poly Implant Prothese silicone implants had been used for bilateral breast augmentation 5 years prior. Extracapsular implant rupture and bilateral axillary lymphadenopathy indicated explantation, capsulectomy, and selective lymph node excision. Histology demonstrated silicone lymphadenopathy with no evidence of malignancy. Over the subsequent 12 months, she developed progressive locoregional lymphadenopathy involving bilateral cervical, axillary, and internal mammary groups, resulting in bilateral thoracic outlet syndrome. We report the unusual presentation, progression, and the ultimate surgical management of this patient. PMID:25878942

Caplash, Yugesh; Giri, Pratyush; Kearney, Daniel; Wagstaff, Marcus

2015-01-01

362

Management of refractory metastatic anal squamous cell carcinoma following disease progression on traditional chemoradiation therapy.  

PubMed

Case Study Ms. S.G., a 56-year-old woman with a poorly differentiated squamous cell carcinoma of the anal canal, American Joint Committee on Cancer stage III (T2, N1, M0), was initially diagnosed in December, 2007 at an outside institution after she had noted blood in her stool for approximately 6 months. Her medical history was unremarkable. She had no known history of HIV or other sexually transmitted diseases. At the time of presentation, Ms. S.G. had an Eastern Cooperative Oncology Group performance status of 1 related to cancer-related pain. Her appetite and weight were both stable. A complete colonoscopy demonstrated a large, immobile, ulcerated, firm, 4-cm lesion in the distal rectum, arising from the anal canal. Initial staging positron emission tomography/computed tomography (PET/CT) scan revealed a hypermetabolic inferior anorectal mass with left perirectal and presacral nodal metastases. There was no definite evidence of distant metastatic disease. Ms. S.G. received chemoradiation treatment following her diagnostic studies, with a total dose of 45 Gy over 26 fractions to the pelvis with concurrent infusional fluorouracil (5-FU; 2, 450 mg over 7 days) and mitomycin C (12 mg/m(2) on day 1) at an outside institution. However, during her chemoradiation therapy, Ms. S.G. experienced a 3-week treatment break due to severe radiation dermatitis, as recommended by her outside treating oncologist. Upon treatment completion, Ms. S.G. underwent a biopsy of the anal canal, which revealed no evidence of residual malignancy. As recommended by her treating oncologist, she received four additional cycles of adjuvant infusional 5-FU in combination with leucovorin. Shortly thereafter, Ms. S.G. developed progressive pelvic pain. She underwent a second PET/CT scan, revealing mixed findings: interval resolution of abnormal standardized uptake value (SUV) activity at the primary tumor in the anal canal, but an increase in the size and SUV of nodal disease within the left perirectal and presacral regions. A CT-guided biopsy noted a perirectal abscess requiring drainage but was inconclusive for disease recurrence; Ms. S.G. was treated with IV antibiotics. Six weeks later, repeat radiographic imaging noted additional changes suspicious for regional recurrence, which was biopsy-confirmed. Ms. S.G. was subsequently referred to MD Anderson Cancer Center for consideration of salvage pelvic exenteration. On physical exam a mass was palpated in the left lower quadrant, but there was no evidence of inguinal adenopathy. On digital rectal exam there was notable external erythema with a fixed mass and moderate sphincter tone. A chest CT scan showed no definite evidence of metastatic disease, but an MRI of the abdomen/pelvis indicated the presence of a complex partially necrotic mass (7.6 × 4.9 × 7.3 cm(3)) extending to the rectosigmoid junction, inseparable from the left lateral bowel wall, with partial encasement of the bowel. In addition, there was infiltration of the left piriformis muscle and cervix consistent with local recurrence. She was referred to medical oncology and radiation oncology for consideration of reirradiation with concurrent neoadjuvant chemotherapy for palliation and possible surgical resection. In early December 2008, Ms. S.G. received intensity-modulated radiation therapy (IMRT), with a total dose of 27 Gy over 18 fractions. She received concurrent infusional 5-FU at 300 mg/m(2)/day, from Monday to Friday, on the days of radiation. She also received a weekly bolus dose of cisplatin at 20 mg/m(2). The intent was to treat to 30 Gy, but the patient deferred further treatment early due to anorectal irritation. She then underwent restaging with a PET/CT scan and a pelvic MRI in February 2009, revealing radiographic partial response of the known pelvic recurrence and reduced pelvic pain (Figures 1A and 1B). Figure 1 Figure 1. Contrast-enhanced axial MRI image of the lower pelvis. (A) Pretreatment, complex mass at the rectosigmoid junction measuring approximately 7.6 × 4.9 × 7.3 cm3. (B) Posttreatment, large necrotic mass me

Silva, Ninoska N; Eng, Cathy

2012-05-01

363

Upper esophageal sphincter mechanical states analysis: a novel methodology to describe UES relaxation and opening  

PubMed Central

The swallowing muscles that influence upper esophageal sphincter (UES) opening are centrally controlled and modulated by sensory information. Activation of neural inputs to these muscles, the intrinsic cricopharyngeus muscle and extrinsic suprahyoid muscles, results in their contraction or relaxation, which changes the diameter of the lumen, alters the intraluminal pressure and ultimately inhibits or promotes flow of content. This relationship that exists between the changes in diameter and concurrent changes in intraluminal pressure has been used previously to calculate the “mechanical states” of the muscle; that is when the muscles are passively or actively, relaxing or contracting. Diseases that alter the neural pathways to these muscles can result in weakening the muscle contractility and/or decreasing the muscle compliance, all of which can cause dysphagia. Detecting these changes in the mechanical state of the muscle is difficult and as the current interpretation of UES motility is based largely upon pressure measurement (manometry), subtle changes in the muscle function during swallow can be missed. We hypothesized that quantification of mechanical states of the UES and the pressure-diameter properties that define them, would allow objective characterization of the mechanisms that govern the timing and extent of UES opening during swallowing. To achieve this we initially analyzed swallows captured by simultaneous videofluoroscopy and UES pressure with impedance recording. From these data we demonstrated that intraluminal impedance measurements could be used to determine changes in the internal diameter of the lumen when compared to videofluoroscopy. Then using a database of pressure-impedance studies, recorded from young and aged healthy controls and patients with motor neuron disease, we calculated the UES mechanical states in relation to a standardized swallowed bolus volume, normal aging and dysphagia pathology. Our results indicated that eight different mechanical states were almost always seen during healthy swallowing and some of these calculated changes in muscle function were consistent with the known neurally dependent phasic discharge patterns of cricopharyngeus muscle activity during swallowing. Clearly defined changes in the mechanical states were observed in motor neuron disease when compared to age matched healthy controls. Our data indicate that mechanical state predictions were simple to apply and revealed patterns consistent with the known neural inputs activating the different muscles during swallowing. PMID:25610376

Omari, Taher I.; Wiklendt, Lukasz; Dinning, Philip; Costa, Marcello; Rommel, Nathalie; Cock, Charles

2015-01-01

364

Cannabinoid1 receptor in the dorsal vagal complex modulates lower oesophageal sphincter relaxation in ferrets.  

PubMed

Delta9-tetrahydrocannabinol (delta9-THC) is an effective anti-emetic; however, other potential gastrointestinal therapeutic effects of delta9-THC are less well-known. Here, we report a role of delta9-THC in a vago-vagal reflex that can result in gastro-oesophageal reflux, that is, gastric distension-evoked lower oesophageal sphincter (LOS) relaxation. Oesophageal, LOS and gastric pressures were measured using a miniaturized, manometric assembly in decerebrate, unanaesthetized ferrets.Gastric distension (30 ml) evoked LOS relaxation (70 +/- 8% decrease from baseline). Delta9-THC administered systemically (0.2 mg kg-1, iv.) or directly to the dorsal hindbrain surface (0.002 mg),significantly attenuated the nadir of the gastric distention-evoked LOS relaxation, and time to reach maximal response. Similar increases to maximal effect were observed after treatment with the cannabinoid receptor agonist WIN 55,212-2 (0.2 mg kg-1 iv.). The effect of systemic delta9-THC on gastric distention-evoked LOS relaxation was reversed by a selective cannabinoid1 (CBI) receptor antagonist, SR141617A (1 mg kg-1 i.v.). Since this reflex is vagally mediated, we used a CB1 receptor antiserum and immunocytochemistry to determine its distribution in ferret vagal circuitry. CBI receptor staining was present in cell bodies within the area postrema, nucleus tractus solitarius (NTS) and nodose ganglion. Intense terminal-like staining was noted within the NTS and dorsal motor vagal nucleus (DMN). Neither nodose ganglionectomy nor vagotomy altered the CB1 receptor terminal-like staining in the dorsal vagal complex. Retrogradely labelled gastric- or LOS-projecting DMN neurones did not express CBI receptors within their soma. Therefore, CBI receptor staining in the NTS and DMN is not due to primary vagal afferents or preganglionic neurones. These novel findings suggest that delta9-THC can modulate reflex LOS function and that the most likely site of action is via the CBI receptor within the NTS. This effect of delta9-THC may have implications in treatment of gastro-oesophageal reflux and other upper gut disorders. PMID:12879865

Partosoedarso, E R; Abrahams, T P; Scullion, R T; Moerschbaecher, J M; Hornby, P J

2003-07-01

365

Earthquake Early Warning and the Physics of Earthquake Rupture  

E-print Network

mapping or other) data, and (c) inversions incorporating both seismic andseismic, teleseismic, trilateration, leveling, GPS, InSAR, surface rupture mapping,rupture mapping and other data. In other words, “seismic”

Wurman, Gilead

2010-01-01

366

Source rupture process of the 2011 Fukushima-ken Hamadori earthquake: how did the two subparallel faults rupture?  

NASA Astrophysics Data System (ADS)

The 2011 Fukushima-ken Hamadori earthquake (MW 6.6) occurred about a month after the 2011 Great Tohoku earthquake (MW 9.0), and it is thought to have been induced by the 2011 Tohoku earthquake. After the 2011 Hamadori earthquake, two subparallel faults (the Itozawa and Yunodake faults) were identified by field surveys. The hypocenter was located nearby the Itozawa fault, and it is probable that the Itozawa fault ruptured before the Yunodake fault rupture. Here, we estimated the source rupture process of the 2011 Hamadori earthquake using a model with two subparallel faults based on strong motion data. The rupture starting point and rupture delay time of the Yunodake fault were determined based on Akaike's Bayesian Information Criterion (ABIC). The results show that the Yunodake fault started to rupture from the northern deep point 4.5 s after the Itozawa fault started to rupture. The estimated slip distribution in the shallow part is consistent with the surface slip distribution identified by field surveys. Time-dependent Coulomb failure function changes (?CFF) were calculated using the stress change from the Itozawa fault rupture in order to evaluate the effect of the rupture on the Yunodake fault. The ?CFF is positive at the rupture starting point of the Yunodake fault 4.5 s after the Itozawa fault started to rupture; therefore, it is concluded that during the 2011 Hamadori earthquake, the Yunodake fault rupture was triggered by the Itozawa fault rupture.

Tanaka, Miho; Asano, Kimiyuki; Iwata, Tomotaka; Kubo, Hisahiko

2014-12-01

367

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

2005-01-01

368

Alternativas en el tratamiento quirúrgico de los abscesos anales  

Microsoft Academic Search

Summary Introduction: Anal abscess is a pus collection localized in some of the regions around the anus and rectum. We reviewed the experience in the management of abscesses in the Coloproctology Unit at the Gastroenterology Service in the General Hospital of Mexico. Material and methods: This is a retrospective, longitudinal and descriptive study in patients diagnosed as carriers of an

Luis Charúa-Guindic; José Ángel Cantú-Marroquín; Rosa Martha Osorio-Hernández; Octavio Avendaño-Espinosa

369

Ileal pouch\\/anal anastomosis for Crohn's disease  

Microsoft Academic Search

SummaryBackground Patients with Crohn's disease (CD) are not commonly considered as candidates for ileal pouch\\/anal anastomosis (IPAA). This approach has been avoided because of the poor results observed, retrospectively, in patients with an initial diagnosis of ulcerative colitis who were found to have CD on examination of the resected specimen. However, in 1985, we decided to investigate an alternative to

Y Panis; B Poupard; P Hautefeuille; P Valleur; J Nemeth; A Lavergne

1996-01-01

370

Exzision einer Perianalthrombose oder eines segmentären thrombosierten Anal\\/Hämorrhoidalprolapses  

Microsoft Academic Search

Zusammenfassung Ziel: Eine retrospektive Studie wurde durchgeführt um die Rezidivrate, Komplikationsrate, Langzeitergebnisse und Patientenzufriedenheit nach ambulanter Operation (in Lokalanästhesie) einer Perianalthrombose bzw. segmentären thrombosierten Anal-\\/Hämorrhoidalprolapses festzustellen. Patienten und Methode: 1995 bis 1999 wurden 340 Patienten operiert. Mindestens 9 Monate nach der Operation erhielt jeder Patient einen Fragebogen, in dem nach Rezidivoperationen, Restbeschwerden, Zufriedenheit mit der Lokalanästhesie\\/Wundbehandlung gefragt wurde. Ergebnisse: 20

Johannes Jongen; Sebastian Bach; Sven Henrik Stübinger; Jens-Uwe Bock

2002-01-01

371

Lateral Subcutaneous Internal Sphincterotomy in Treatment of Anal Fissure  

Microsoft Academic Search

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

D. C. Hoffmann; J. C. Goligher

1970-01-01

372

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

Microsoft Academic Search

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

Sean M. McHugh; Nicholas E. Diamant

1987-01-01

373

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.

1983-09-01

374

The neck constriction in plasmodesmata : Evidence for a peripheral sphincter-like structure revealed by fixation with tannic acid.  

PubMed

Simple plasmodesmata between mesophyll and bundle sheath cells in actively expanding leaves of Salsola kali L. and roots of Epilobium hirsutum L. are shown to possess specialized structures, called sphincters, around their neck regions. The sphineters are made visible by the combined effects of tannic acid and heavy metal staining; they are localized just outside that area of the plasmalemma, which forms the collar around the entrance to each plasmodesmos. This localization corresponds to a very active area of the plasmodesmos/olasmalemma complex (i.e. enzyme activity and/or presence of strongly reducing substances).Evidence is presented that these ring structures are structural equivalents to hypothetical sphincters performing some valve function; i.e. participating in the control of rates and directions of symplastic transport of solutes through plasmodesmata. The middle layer of the plasmalemma in the neck region is composed of closely-packed, globular subunits appearing in negative contrast. Apparently, these subunits correspond to particle clusters observed at the plasmodesmatal entrance in freeze-fracture preparations. They appear similar to particle clusters in animal tight junctions, and their possible function in providing electrical coupling via low resistance junctions between plant cells is discussed. PMID:24407324

Olesen, P

1979-01-01

375

[Long-term results of formation of smooth muscle sphincter in the perineal colostomy area in patients after rectal extirpation].  

PubMed

The authors discuss an original method for formation of a smooth-muscle cuff from the wall of a pulled-through colon in the region of a perineal colostoma. It was applied in 89 patients who had undergone extirpation of the rectum for malignant neoplasms. The smooth-muscle sphincter was formed during removal of the rectum in 72 patients and no earlier than 2 years after the extirpation in 17 patients. Inflammatory complications developed in the region of the perineal colostoa in the early postoperative period in 13.5% of cases. They were due to necrosis of the distal part of the pulled-through intestine in 3.4% of cases. There were no fatal outcomes. The late-term results were studied in follow-up periods of up to 7.5 years. Satisfactory functional results were produced in 83% of the patients. Physiological examination showed the presence of a functioning sphincter in the region of the perineal colostoma. PMID:7723259

Odariuk, T S; Kapuller, L L; Podmarenkova, L F; Tsar'kov, P V; Frolov, S A

1994-10-01

376

A Randomized Clinical Trial on the Effect of Oral Metronidazole on Wound Healing and Pain after Anal Sphincterotomy and Fissurectomy  

Microsoft Academic Search

Chronic anal fissure is one of the most common causes of anal pain and surgical therapy is the treatment of choice. There is scarce information regarding the prophylactic effects of oral metronidazole on postoperative complications of anal fissure. The objective of this study was to determine the effects of metronidazole as a prophylactic measure for postoperative anal fissure complications. In

Seyed Vahid Hosseini; Babak Sabet; Mohamoud Nouri; Shahram Bolandparvaz

377

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

E-print Network

766 Anal. Chem. $909, citive current at the ensemble (ic,,) is given by i , , = vC~A,, where A.; Martin, C. R. Anal. Chem. 1987, 59, 2625. Cheng, I. F.; Martin, C. R. Anal. Chem. 1988, 60, 2163. Wang. J, unpublishedresults, July 1988. Wehmeyer, K. R.; Deakln, M. R.; Wightman, R. M. Anal. Chem. 1985, 57, 1913

Zare, Richard N.

378

Anal. Chem. 1982, 54, 2117-2120 2117 validity of the ASV titration method. We are confident that  

E-print Network

Anal. Chem. 1982, 54, 2117-2120 2117 validity of the ASV titration method. We are confident. H. Anal. Chem.,preceding paper in this issue. Tuschall, J. R., Jr.; Brezonik, P. L. Anal. Chem. 1981, 53, 1986-1989. Shuman, M. S. Anal. Chem. 1982, 54, 998-1000. Brezonlk, P. L; Tuschall, J. R., Jr

Zare, Richard N.

379

Progress in the treatment of ruptured abdominal aortic aneurysm  

Microsoft Academic Search

This report summarizes the clinical, pathological, and surgical aspects of ruptured abdominal aortic aneurysm. The significant\\u000a risk of rupture of these aneurysms is well documented. Although large aneurysms are more prone to rupture, the risk of rupture\\u000a of small aneurysms less than 4 cm in diameter is well established. While most aneurysms are a result of atherosclerosis, a\\u000a small number

Gerald M. Lawrie; E. Stanley Crawford; George C. Morris; Jimmy F. Howell

1980-01-01

380

Star polymers rupture induced by constant forces.  

PubMed

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

2014-10-28

381

Surgical Resection of Ruptured Fibrolamellar Hepatocellular Carcinoma  

PubMed Central

Fibrolamellar hepatocellular carcinoma (FLH) is a rare primary tumor of the liver, which typically arises from noncirrhotic livers and affects patients below the age of 35. We report on a 29-year-old male patient who presented with a ruptured FLH and was treated with surgical resection. Options for treatment and review of the management are described. PMID:23956918

Minutolo, Vincenzo; Licciardello, Alessio; Arena, Manuel; Minutolo, Orazio; Lanteri, Raffaele; Arena, Goffredo

2013-01-01

382

Laparoscopic splenectomy for atraumatic splenic rupture.  

PubMed

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

2011-01-01

383

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...

384

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.

385

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

2011-01-01

386

Rupture Zones of Large South American Earthquakes and Some Predictions  

Microsoft Academic Search

This study attempts to forecast likely locations for large shallow South American earthquakes in the near future by examining the past space-time pattern of occurrence of large (M _ 7.7) earthquakes, the lateral extent of their rupture zones, and, where possible, the direction of rupture propagation. Rupture zones of large shallow earthquakes generally abut and do not overlap. Patterns of

John A. Kelleher

1972-01-01

387

Ruptured rectal duplication with urogenital abnormality: Unusual presentation  

PubMed Central

Rectal duplication (RD) accounts for 5% of alimentary tract duplication. A varied presentation and associated anomalies have been described in the literature. Antenatal rupture of the RD is very rare. We present an unusual case of a ruptured RD associated with urogenital abnormalities in newborn male. We are discussing diagnosis, embryology, management and literature review of ruptured RD. PMID:25552833

Solanki, Shailesh; Babu, M Narendra; Jadhav, Vinay; Shankar, Gowri; Santhanakrishnan, Ramesh

2015-01-01

388

Creep and rupture of an ods alloy with high stress rupture ductility  

Microsoft Academic Search

The creep and stress rupture properties of an oxide (Y2O3) dispersion strengthened nickel-base alloy, which also is strengthened by ?? precipitates, was studied at 760 °C and 1093\\u000a °C. At both temperatures the alloy YDNiCrAl exhibits unusually high stress rupture ductility as measured by both elongation\\u000a and reduction in area. Failure was transgranular, and different modes of failure were observed

Mona E. McAlarney; Richard M. Arons; Tim E. Howson; John K. Tien; Sanford Baranow

1982-01-01

389

Creep and rupture of an ods alloy with high stress rupture ductility  

Microsoft Academic Search

The creep and stress rupture properties of an oxide (Y2O3) dispersion strengthened nickel-base alloy, which also is strengthened by gamma' precipitates, was studied at 760 °C and 1093 °C. At both temperatures the alloy YDNiCrAl exhibits unusually high stress rupture ductility as measured by both elongation and reduction in area. Failure was transgranular, and different modes of failure were observed

Mona E. McAlarney; Richard M. Arons; Tim E. Howson; John K. Tien; Sanford Baranow

1982-01-01

390

Posterior communicating artery aneurysm rupture mimicking apoplexy  

PubMed Central

Background: Cerebral aneurysm rupture can lead to devastating neurological complications and present a complex problem to treat. We report a unique case of a ruptured posterior communicating artery (PCoA) aneurysm presenting with sudden and complete vision loss. Case Description: A 39-year-old man presented with the acute onset of severe headache and complete bilateral vision loss. The patient described headaches for several months prior to presentation. However, prior to the day of presentation, he had no visual disturbance. A CT angiogram (CTA) and magnetic resonance imaging (MRI) of the brain revealed a 1.6-cm, non-contrast enhancing suprasellar mass, eccentric to the left side, consistent with hemorrhagic mass. There was no obvious aneurysm or vascular malformation. The sella tursica was normal in appearance. The patient was taken for an immediate endoscopic endonasal transtuberculum approach for optic nerve decompression. Hematoma without an associated tumor was encountered and partially evacuated before aborting with resultant partial improvement in vision. A subsequent cerebral angiogram revealed an irregularly shaped, postero-laterally pointing, 2.5-mm left PCoA aneurysm. The patient was then taken for open clipping of the ruptured aneurysm. A large, fibrinous capsule was found over the superolateral aspect of the aneurysm. The ruptured aneurysm was secured with clips and the surrounding hematoma was evacuated. Conclusion: In the immediate postoperative period, the patient regained vision in the nasal field of his right eye. This case illustrates a unique presentation of a ruptured PCoA aneurysm, and thus must be considered in the differential diagnosis of a suprasellar hemorrhage resulting in visual loss in absence of a recognizable associated tumor. PMID:22145088

Bonfield, Christopher M.; Gardner, Paul A.

2011-01-01

391

Acute subdural hematoma from bridging vein rupture: a potential mechanism for growth.  

PubMed

Most acute subdural hematomas (ASDHs) develop after rupture of a bridging vein or veins. The anatomy of the bridging vein predisposes to its tearing within the border cell layer of the dura mater. Thus, the subdural hematoma actually forms within the dura. The hematoma grows by continued bleeding into the border cell layer. However, the venous pressure would not be expected to cause a large hematoma. Therefore, some type of mechanism must account for the hematoma's expansion. Cerebral venous pressure (CVP) has been demonstrated in animal models to be slightly higher than intracranial pressure (ICP), and CVP tracks the ICP as pressure variations occur. The elevation of CVP as the ICP increases is thought to result from an increase in outflow resistance of the terminal portion of the bridging veins. This probably results from a Starling resistor model or, less likely, from a muscular sphincter. A hypothesis is derived to explain the mechanism of ASDH enlargement. Tearing of one or more bridging veins causes these vessels to bleed into the dural border cell layer. Subsequent ICP elevation from the ASDH, cerebral swelling, or other cause results in elevation of the CVP by increased outflow resistance in the intact bridging veins. The increased ICP causes further bleeding into the hematoma cavity via the torn bridging veins. Thus, the ASDH enlarges via a positive feedback mechanism. Enlargement of an ASDH would cease as blood within the hematoma cavity coagulates. This would stop the dissection of the dural border cell layer, and pressure within the hematoma cavity would equalize with that in the torn bridging vein or veins. PMID:24313607

Miller, Jimmy D; Nader, Remi

2014-06-01

392

Pseudodyssynergia (Contraction of the External Sphincter During Voiding) Misdiagnosed as Chronic Nonbacterial Prostatitis and the Role of Biofeedback as a Therapeutic Option  

Microsoft Academic Search

PurposeChronic lower urinary tract symptoms in young men are often attributed to misdiagnosed chronic nonbacterial prostatitis. We analyzed contraction of the external urinary sphincter during voiding (pseudodyssynergia) as an etiology of voiding dysfunction in men with misdiagnosed chronic prostatitis.

Steven A. Kaplan; Richard P. Santarosa; Patricia Meade D'Alisera; Brenda J. Fay; Edward F. Ikeguchi; James Hendricks; Lonnie Klein; Alexis E. Te

1997-01-01

393

Somatic Electrical Nerve Stimulation Regulates the Motility of Sphincter of Oddi in Rabbits and Cats (Evidence for a Somatovisceral Reflex Mediated by Cholecystokinin)  

Microsoft Academic Search

Cholecystokinin (CCK) plays an important role inregulating the biliary motility in herbivorous andcarnivorous animals. Little is known about how themotility of the sphincter of Oddi (SO) is regulated through a somatic stimulation. It was our aimto test the hypothesis that somatic electrical nervestimulation (SENS) affects SO motility in animals withdifferent types of SO through CCK-related mechanisms. The activity of SO

Jen-Hwey Chiu; Yung-Ling Kuo; Wing-Yiu Lui; Chew-Wun Wu; Chuang-Ye Hong

1999-01-01

394

The arrangement of the muscle at the ileo-caeco-rectal junction of the domestic duck (Anas platyrhynchos) and the presence of anatomical sphincters.  

PubMed Central

The arrangement of the muscle at the ileo-caeco-rectal junction of the domestic duck (Anas platyrhynchos) was studied using light microscopy, three-dimensional reconstruction models and scanning and transmission electron microscopy. The junction consists of a papilla-like protrusion of the ileum into the rectum, the 'ileal papilla', lateral to which are the openings of the large right and left caeca. The ileal papilla consists entirely of circular muscle which is not divided into an inner electron-dense portion and an outer electron-lucent portion as is the rest of the ileum. The longitudinal muscle layer does not enter the ileal papilla. The circular muscle at the junction forms three thickenings or sphincters which are continuous with one another: an ileal sphincter in the ileal papilla, and right and left caecal sphincters around the orifices of the caeca. The majority of nerve bundles are found in the circular muscle layer and consist of axons with small granular vesicles, axons with small agranular vesicles and axons with many large granular vesicles. The density of innervation, including the total number of axon profiles and the number of vesiculated axon profiles, is significantly higher in the circular muscle of the sphincters than in the ileum, caecum and rectum 5 mm from the junction. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 PMID:3254886

Mahdi, A H; McLelland, J

1988-01-01

395

SORD: A New Rupture Dynamics Modeling Code  

NASA Astrophysics Data System (ADS)

We report on our progress in validating our rupture dynamics modeling code, capable of dealing with nonplanar faults and surface topography. The method uses a "mimetic" approach to model spontaneous rupture on a fault within a 3D isotropic anelastic solid, wherein the equations of motion are approximated with a second order Support-Operator method on a logically rectangular mesh. Grid cells are not required to be parallelepipeds, however, so that non-rectangular meshes can be supported to model complex regions. However, for areas in the mesh which are in fact rectangular, the code uses a streamlined version of the algorithm that takes advantage of the simplifications of the operators in such areas. The fault itself is modeled using a double node technique, and the rheology on the fault surface is modeled through a slip-weakening, frictional, internal boundary condition. The Support Operator Rupture Dynamics (SORD) code, was prototyped in MATLAB, and all algorithms have been validated against known (including analytical solutions, eg Kostrov, 1964) solutions or previously validated solutions. This validation effort is conducted in the context of the SCEC Dynamic Rupture model validation effort led by R. Archuleta and R. Harris. Absorbing boundaries at the model edges are handled using the perfectly matched layers method (PML) (Olsen & Marcinkovich, 2003). PML is shown to work extremely well on rectangular meshes. We show that our implementation is also effective on non-rectangular meshes under the restriction that the boundary be planar. For validation of the model we use a variety of test cases using two types of meshes: a rectangular mesh and skewed mesh. The skewed mesh amplifies any biases caused by the Support-Operator method on non-rectangular elements. Wave propagation and absorbing boundaries are tested with a spherical wave source. Rupture dynamics on a planar fault are tested against (1) a Kostrov analytical solution, (2) data from foam rubber scale models, and (3) numerical results from other types rupture dynamics codes. We also test the case of a simple kinked fault that has a known analytical solution. SORD has now been ported to Fortran 95 for multi-processor execution, with parallelization implemented using MPI. This provides a modeling capability on large scale platforms such as the SDSC DataStar machine, the various Teragrid platforms, or the SCEC High-performance computing facility. We will report on progress in validating that version of the code.

Ely, G.; Minster, B.; Day, S.

2005-12-01

396

Earthquake ruptures modulated by waves in damaged fault zones  

NASA Astrophysics Data System (ADS)

Faults are usually surrounded by damaged zones of lower elastic moduli and seismic wave velocities than their host rocks. If the interface between the damaged rocks and host rocks is sharp enough, earthquakes happening inside the fault zone generate reflected waves and head waves, which can interact with earthquake ruptures and modulate rupture properties such as rupture speed, slip rate, and rise time. We find through 2-D dynamic rupture simulations the following: (1) Reflected waves can induce multiple slip pulses. The rise time of the primary pulse is controlled by fault zone properties, rather than by frictional properties. (2) Head waves can cause oscillations of rupture speed and, in a certain range of fault zone widths, a permanent transition to supershear rupture with speeds that would be unstable in homogeneous media. (3) Large attenuation smears the slip rate function and delays the initial acceleration of rupture speed but does not affect significantly the rise time or the period of rupture speed oscillations. (4) Fault zones cause a rotation of the background stress field and can induce plastic deformations on both extensional and compressional sides of the fault. The plastic deformations are accumulated both inside and outside the fault zone, which indicates a correlation between fault zone development and repeating ruptures. Spatially periodic patterns of plastic deformations are formed due to oscillating rupture speed, which may leave a permanent signature in the geological record. Our results indicate that damaged fault zones with sharp boundaries promote multiple slip pulses and supershear ruptures.

Huang, Yihe; Ampuero, Jean-Paul; Helmberger, Don V.

2014-04-01

397

Complications after ileal pouch-anal anastomosis in Korean patients with ulcerative colitis  

PubMed Central

AIM: To investigate the outcomes of treatments for complications after ileal pouch-anal anastomosis (IPAA) in Korean patients with ulcerative colitis. METHODS: Between March 1998 and February 2013, 72 patients (28 male and 44 female, median age 43.0 years ± 14.0 years) underwent total proctocolectomy with IPAA. The study cohort was registered prospectively and analyzed retrospectively. Patient characteristics, medical management histories, operative findings, pathology reports and postoperative clinical courses, including early postoperative and late complications and their treatments, were reviewed from a medical record system. All of the ileal pouches were J-pouch and were performed with either the double-stapling technique (n = 69) or a hand-sewn (n = 3) technique. RESULTS: Thirty-one (43.1%) patients had early complications, with 12 (16.7%) patients with complications related to the pouch. Pouch bleeding, pelvic abscesses and anastomosis ruptures were managed conservatively. Patients with pelvic abscesses were treated with surgical drainage. Twenty-seven (38.0%) patients had late complications during the follow-up period (82.5 ± 50.8 mo), with 21 (29.6%) patients with complications related to the pouch. Treatment for pouchitis included antibiotics or anti-inflammatory drugs. Pouch-vaginal fistulas, perianal abscesses or fistulas and anastomosis strictures were treated surgically. Pouch failure developed in two patients (2.8%). Analyses showed that an emergency operation was a significant risk factor for early pouch-related complications compared to elective procedures (55.6% vs 11.1%, P < 0.05). Pouchitis was related to early (35.3%) and the other late pouch-related complications (41.2%) (P < 0.05). The complications did not have an effect on pouch failure nor pouch function. CONCLUSION: The complications following IPAA can be treated successfully. Favorable long-term outcomes were achieved with a lower pouch failure rate than reported in Western patients. PMID:24966620

Ryoo, Seung-Bum; Oh, Heung-Kwon; Han, Eon Chul; Ha, Heon-Kyun; Moon, Sang Hui; Choe, Eun Kyung; Park, Kyu Joo

2014-01-01

398

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.

1985-01-01

399

Early diagnosis and management of myocardial rupture.  

PubMed

Left ventricular free wall rupture is a catastrophic mechanical complication of myocardial infarction. We present an 82-year-old woman with an anterolateral ST segment elevation myocardial infarction treated with thrombolysis. Because of unexplained hypotension, echocardiography was performed and contrast (Definity; Lantheus Medical Imaging) was used to improve visualization. Findings included a small- to moderate-sized circumferential pericardial effusion without frank tamponade, however, there was significant intramyocardial tracking of the contrast into the epicardial space, localized to the mid to apical portion of the anterior septum, consistent with rupture or disruption of the wall segment. The patient was promptly taken to the operating room where fresh blood and clots were evacuated from the pericardial space with immediate hemodynamic improvement. The patient underwent successful surgical repair. PMID:25547556

Liu, Shuangbo; Glavinovic, Tamara; Tam, James W

2015-01-01

400

Anal cancer treatment: current status and future perspectives.  

PubMed

Anal cancers (AC) are relatively rare tumors. Their incidence is increasing, particularly among men who have sex with other men due to widespread infection by human papilloma virus. The majority of anal cancers are squamous cell carcinomas, and they are treated according to stage. In local and locally advanced AC, concomitant chemoradiation therapy based on mitomycin C and 5-Fluorouracil (5-FU) is the current best treatment, while metastatic AC, chemotherapy with 5-FU and cisplatin remains the gold standard. There are no indications for induction or maintenance therapies in locally advanced tumors. Many novel strategies, such as targeted therapies, vaccination, immunotherapy and photodynamic therapy are in clinical trials for the treatment of AC, with promising results in some indications. PMID:25741135

Ghosn, Marwan; Kourie, Hampig Raphael; Abdayem, Pamela; Antoun, Joelle; Nasr, Dolly

2015-02-28

401

Rectal Perforation Caused by Anal Stricture After Hemorrhoid Treatment  

PubMed Central

Inappropriate therapies for hemorrhoids can lead to various complications including anorectal stricture. We report a patient presenting with catastrophic rectal perforation due to severe anal stricture after inappropriate hemorrhoid treatment. A 67-years old man with perianal pain visited the emergency room. The hemorrhoids accompanied by constipation, had tortured him since his youth. Thus he had undergone injection sclerotherapy several times by an unlicensed therapist and hemorrhoidectomy twice at the clinics of private practitioners. His body temperature was as high as 38.5?. The computed tomographic scan showed a focal perforation of posterior rectal wall. The emergency operation was performed. The fibrotic tissues of the anal canal were excised. And then a sigmoid loop colostomy was constructed. The patient was discharged four days following the operation. This report calls attention to the enormous risk of unlicensed injection sclerotherapy and overzealous hemorrhoidectomy resulting in scarring, progressive stricture, and eventual rectal perforation. PMID:23586012

Suh, Yong Joon; Ha, Heon-Kyun; Oh, Heung-Kwon; Shin, Rumi; Jeong, Seung-Yong

2013-01-01

402

Anal cancer treatment: Current status and future perspectives  

PubMed Central

Anal cancers (AC) are relatively rare tumors. Their incidence is increasing, particularly among men who have sex with other men due to widespread infection by human papilloma virus. The majority of anal cancers are squamous cell carcinomas, and they are treated according to stage. In local and locally advanced AC, concomitant chemoradiation therapy based on mitomycin C and 5-Fluorouracil (5-FU) is the current best treatment, while metastatic AC, chemotherapy with 5-FU and cisplatin remains the gold standard. There are no indications for induction or maintenance therapies in locally advanced tumors. Many novel strategies, such as targeted therapies, vaccination, immunotherapy and photodynamic therapy are in clinical trials for the treatment of AC, with promising results in some indications. PMID:25741135

Ghosn, Marwan; Kourie, Hampig Raphael; Abdayem, Pamela; Antoun, Joelle; Nasr, Dolly

2015-01-01

403

Dietary habits after ileal pouch-anal anastomosis.  

PubMed

Dietary habits of patients who had undergone ileal pouch-anal anastomosis were assessed and correlated with bowel function. Twenty-four well-adapted patients (11 women, 13 men; mean age 32 years) voluntarily entered the study 30 +/- 4 months after closure of the diverting ileostomy. A standardized questionnaire on 108 food items and a 3-day food journal were used in the assessment. Twenty-one patients had no difficulty in selecting an appropriate diet. Caloric intake was adequate. Specific symptoms associated with several foods were as follows: increased stool frequency (beer, spirits, chinese food), decreased stool consistency (beer, wine, fried fish), perianal irritation (spicy foods), undigested particles (grapefruit, lettuce), odours (eggs). Pasta and bananas were associated with increased stool consistency. The authors believe that these observations may help in dietary counselling after ileal pouch-anal anastomosis. PMID:2268807

Chartrand-Lefebvre, C; Heppell, J; Davignon, I; Dubé, S; Pomp, A

1990-04-01

404

Familial craniosynostosis, anal anomalies, and porokeratosis: CAP syndrome.  

PubMed Central

We report on the occurrence of coronal craniosynostosis, anal anomalies, and porokeratosis in two male sibs. A third male sib was phenotypically normal as were the parents. The occurrence of these three clinical features has, to our knowledge, not been reported before. Cutaneous or anal anomalies or both have been reported in a number of syndromes associated with craniosynostosis, including Crouzon, Pfeiffer, Apert, and Beare-Stevenson syndromes. These syndromes are associated with mutations in the fibroblast growth factor receptor genes FGFR1, FGFR2, and FGFR3. They are inherited in an autosomal dominant fashion. In contrast, the cases we report do not carry any of the common FGFR mutations and the pedigree suggests autosomal or X linked recessive inheritance. Images PMID:9733036

Flanagan, N; Boyadjiev, S A; Harper, J; Kyne, L; Earley, M; Watson, R; Jabs, E W; Geraghty, M T

1998-01-01

405

Transient gravity perturbations induced by earthquake rupture  

NASA Astrophysics Data System (ADS)

The static and transient deformations produced by earthquakes cause density perturbations which, in turn, generate immediate, long-range perturbations of the Earth's gravity field. Here, an analytical solution is derived for gravity perturbations produced by a point double-couple source in homogeneous, infinite, non-self-gravitating elastic media. The solution features transient gravity perturbations that occur at any distance from the source between the rupture onset time and the arrival time of seismic P waves, which are of potential interest for real-time earthquake source studies and early warning. An analytical solution for such prompt gravity perturbations is presented in compact form. We show that it approximates adequately the prompt gravity perturbations generated by strike-slip and dip-slip finite fault ruptures in a half-space obtained by numerical simulations based on the spectral element method. Based on the analytical solution, we estimate that the observability of prompt gravity perturbations within 10 s after rupture onset by current instruments is severely challenged by the background microseism noise but may be achieved by high-precision gravity strainmeters currently under development. Our analytical results facilitate parametric studies of the expected prompt gravity signals that could be recorded by gravity strainmeters.

Harms, J.; Ampuero, J.-P.; Barsuglia, M.; Chassande-Mottin, E.; Montagner, J.-P.; Somala, S. N.; Whiting, B. F.

2015-06-01

406

Clinical evaluation of a single daily dose of phenylpropanolamine in the treatment of urethral sphincter mechanism incompetence in the bitch  

PubMed Central

The objective of this retrospective study was to determine the efficacy of a single daily oral dose of phenylpropanolamine (PPA) in the treatment of urethral sphincter mechanism incompetence (USMI) in bitches. Nine bitches diagnosed with USMI were treated with a single daily dose [1.5 mg/kg body weight (BW)] of PPA for at least 1 month. Urethral pressure profiles (UPP) were performed in 7 dogs before treatment and repeated in 4 of them after treatment. Treatment with PPA resulted in long-term continence in 8/9 bitches. One dog did not respond to PPA and was treated surgically later. Recheck UPPs showed a significant increase in maximal urethral closure pressure in the 4 bitches after treatment with PPA compared to before treatment. In conclusion, long-term continence can be achieved in bitches affected with USMI after administration of a single daily dose of PPA (1.5 mg/kg BW). PMID:22043069

Claeys, Stéphanie; Rustichelli, Frederico; Noël, Stéphanie; Hamaide, Annick

2011-01-01

407

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: bilginaribas@hotmail.com; 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)

2011-02-15

408

Anal gland secretion codes for family membership in the beaver  

Microsoft Academic Search

We investigated how information about family membership is coded by the individually specific anal gland secretion (AGS)\\u000a in the beaver, Castor canadensis. Because beavers live in strict family units and relatives share more features in the AGS profile than non-relatives, family\\u000a members share more AGS features than non-family members. Therefore, family recognition seems to be a natural consequence of\\u000a the

Lixing Sun; Dietland Müller-Schwarze

1998-01-01

409

Effect of Isosorbide Dinitrate Ointment on Anal Fissure  

Microsoft Academic Search

Background\\/Aims: Until recently, the treatment of choice for anal fissure was surgery, consisting of a partial lateral internal sphincterotomy. This treatment has a high complication rate: impaired continence is reported in 8–30% of the patients in the literature. Therefore, recently nonsurgical treatment modalities have been developed, such as local application of isosorbide dinitrate (ISDN) ointment. This treatment has comparable effectiveness

I. Songun; H. Boutkan; J. B. V. M. Delemarre; P. J. Breslau

2003-01-01

410

Oral lacidipine in the treatment of anal fissure  

Microsoft Academic Search

.   The aim of this prospective study was to assess the effectiveness in healing anal fissure (AF) of lacidipine, a calcium channel\\u000a blocker with a better tolerability in comparison to other calcium antagonists. Twenty-one consecutive patients (16 women,\\u000a 76.2%) with AF (16 chronic, situated posteriorly in 17 patients (81.0%), anteriorly in 4) with a mean age of 37.1 years (SD,

L. Ansaloni; A. Bernabè; R. Ghetti; R. Riccardi; R. M. Tranchino; G. Gardini

2002-01-01

411

Outcome of “indeterminant” colitis following ileal pouch-anal anastomosis  

Microsoft Academic Search

To establish whether patients with indeterminant colitis (patients with ulcerative colitis whose surgical specimens also show\\u000a features of Crohn's colitis) have an adverse outcome after ileal pouch-anal anastomosis (IPAA), the authors reviewed the pathologic\\u000a reports and postoperative status of 514 consecutive patients who underwent IPAA for chronic ulcerative colitis (CUC). Twenty-five\\u000a patients (5 percent) had features of indeterminant colitis (IC),

Michael E. Pezim; John H. Pemberton; Robert W. Beart; Bruce G. Wolff; Roger R. Dozois; Santhat Nivatvongs; Richard Devine; Duane M. Ilstrup

1989-01-01

412

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

2011-01-01

413

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

1981-01-01

414

Consequences of ileal pouch-anal anastomosis for Crohn's colitis  

Microsoft Academic Search

Patients with Crohn's colitis are generally not considered candidates for the ileal pouch-anal anastomosis (IPAA). procedure. We reviewed 362 consecutive patients undergoing IPAA and analyzed the outcome of this procedure on 25 patients with a preoperative diagnosis of mucosal ulcerative colitis who were subsequently proven to have Crohn's disease. The mean follow-up was 38.1 months. Sixteen patients have a functioning

Neil H. Hyman; Victor W. Fazio; Wayne B. Tuckson; Ian C. Lavery

1991-01-01

415

Anal Human Papillomavirus (HPV) Prevalences and Factors Associated with Abnormal Anal Cytology in HIV-Infected Women in an Urban Cohort from Rio de Janeiro, Brazil  

PubMed Central

Abstract Identifying factors, including human papillomavirus (HPV) genotypes, associated with abnormal anal cytology in HIV-infected women have implications for anal squamous cell cancer (SCC) prevention in HIV-infected women. Anal and cervical samples were collected for cytology, and tested for high-(HR-HPV) and low-risk HPV (LR-HPV) genotypes in a cross-sectional analysis of the IPEC Women's HIV Cohort (Rio de Janeiro, Brazil). Multivariate log-binomial regression models estimated prevalence ratios for factors associated with abnormal anal cytology [?atypical squamous cells of undetermined significance, (ASC-US)]. Characteristics of the 863 participants included: median age 42 years, 57% non-white, 79% current CD4+ T-cell count >350 cells/mm3, 53% HIV-1 viral load <50 copies/mL, median ART duration 5.8 years. Fifty-one percent of anal specimens contained ?1 HR-HPV genotype; 31% had abnormal anal cytology [14% ASC-US, 11% low-grade squamous intra-epithelial lesion, (LSIL); 2% atypical squamous cells-cannot exclude high-grade SIL (ASC-H); 4% high-grade SIL/cancer (HSIL+)]. In multivariate analysis, cervical LSIL+, nadir CD4+ T-cell count ?50 cells/mm3, HIV-1 viral load ?50 copies/mL, and anal HPV 6, 11, 16, 18, 33, 45, 52, 56, and 58 were associated with ?anal ASC-US (p<0.05). Abnormal anal cytology and HR-HPV prevalences were high. HIV-infected women with cervical LSIL+, low nadir CD4+ counts, or detectable HIV-1 viral loads should be a particular focus for enhanced anal SCC screening efforts. PMID:25361401

Luz, Paula M.; Lake, Jordan E.; Levi, José Eduardo; Coutinho, José Ricardo; de Andrade, Angela; Heinke, Thais; Derrico, Mônica; Veloso, Valdilea G.; Friedman, Ruth K.; Grinsztejn, Beatriz

2015-01-01

416

Anal human papillomavirus (HPV) prevalences and factors associated with abnormal anal cytology in HIV-infected women in an urban cohort from Rio de Janeiro, Brazil.  

PubMed

Identifying factors, including human papillomavirus (HPV) genotypes, associated with abnormal anal cytology in HIV-infected women have implications for anal squamous cell cancer (SCC) prevention in HIV-infected women. Anal and cervical samples were collected for cytology, and tested for high-(HR-HPV) and low-risk HPV (LR-HPV) genotypes in a cross-sectional analysis of the IPEC Women's HIV Cohort (Rio de Janeiro, Brazil). Multivariate log-binomial regression models estimated prevalence ratios for factors associated with abnormal anal cytology [? atypical squamous cells of undetermined significance, (ASC-US)]. Characteristics of the 863 participants included: median age 42 years, 57% non-white, 79% current CD4+ T-cell count >350 cells/mm(3), 53% HIV-1 viral load <50 copies/mL, median ART duration 5.8 years. Fifty-one percent of anal specimens contained ? 1 HR-HPV genotype; 31% had abnormal anal cytology [14% ASC-US, 11% low-grade squamous intra-epithelial lesion, (LSIL); 2% atypical squamous cells-cannot exclude high-grade SIL (ASC-H); 4% high-grade SIL/cancer (HSIL+)]. In multivariate analysis, cervical LSIL+, nadir CD4+ T-cell count ? 50 cells/mm(3), HIV-1 viral load ? 50 copies/mL, and anal HPV 6, 11, 16, 18, 33, 45, 52, 56, and 58 were associated with ? anal ASC-US (p<0.05). Abnormal anal cytology and HR-HPV prevalences were high. HIV-infected women with cervical LSIL+, low nadir CD4+ counts, or detectable HIV-1 viral loads should be a particular focus for enhanced anal SCC screening efforts. PMID:25361401

Cambou, Mary C; Luz, Paula M; Lake, Jordan E; Levi, José Eduardo; Coutinho, José Ricardo; de Andrade, Angela; Heinke, Thais; Derrico, Mônica; Veloso, Valdilea G; Friedman, Ruth K; Grinsztejn, Beatriz

2015-01-01

417

Nitinol Stents for Palliative Treatment of Malignant Obstructive Jaundice: Should We Stent the Sphincter of Oddi in Every Case?  

SciTech Connect

Purpose: To evaluate the necessity of metallic stenting of the sphincter of Oddi in malignant obstructive jaundice when the tumor is more than 2 cm from the papilla of Vater.Methods: Sixty-seven self-expandable biliary stents were used in 60 patients with extrahepatic lesions of the common hepatic or common bile duct and with the distal margin of the tumor located more than 2 cm from the papilla of Vater. Stents were placed above the papilla in 30 cases (group A) and in another 30 with their distal part protruding into the duodenum (group B).Results: The 30-day mortality was 15%, due to the underlying disease. The stent occlusion rate was 17% after a mean period of 4.3 months. No major complications were noted. Average survival was 132 days for group A and 140 days for group B. In group A, 19 patients survived {<=} 90 days and in eight of these, cholangitis occurred at least once. Of 11 patients in group A with survival > 90 days, only two developed cholangitis. In group B, 13 patients who survived {<=} 90 days had no episodes of cholangitis and in 17 with survival > 90 days, cholangitis occurred in three. There is a statistically significant difference (p < 0.05) regarding the incidence of cholangitis in favor of group A.Conclusions: In patients with extrahepatic lesions more than 2 cm from the papilla and with a relative poor prognosis ({<=} 3 months), due to more advanced disease or to a worse general condition, the sphincter of Oddi should also be stented in order to reduce the postprocedural morbidity.

Hatzidakis, Adam A.; Tsetis, Dimitris; Chrysou, Evangelia [Department of Radiology, University Hospital Heraklion, Medical School of Crete, 71500 Heraklion-Stavrakia, Crete (Greece); Sanidas, Elias [Clinic for Surgical Oncology, University Hospital Heraklion, Medical School of Crete, 71500 Heraklion, Crete (Greece); Petrakis, John [Clinic for General Surgery, University Hospital Heraklion, Medical School of Crete, 71500 Heraklion, Crete (Greece); Gourtsoyiannis, Nicholas C. [Department of Radiology, University Hospital Heraklion, Medical School of Crete, 71500 Heraklion-Stavrakia, Crete (Greece)

2001-07-15

418

The possum sphincter of Oddi pumps or resists flow depending on common bile duct pressure: a multilumen manometry study  

PubMed Central

The sphincter of Oddi (SO) regulates trans-sphincteric flow (TSF) by acting primarily as a pump or as a resistor in specific species. We used the Australian possum SO, which functions similarly to the human SO, to characterize SO motility responses to different common bile duct (CBD) and duodenal pressures. Possum CBD, SO and attached duodenum (n = 18) was mounted in an organ bath. External reservoirs were used to impose CBD (0–17 mmHg) and duodenal (0, 4, 7 mmHg) pressure. Spontaneous SO activity was recorded using four-lumen pico-manometry and TSF was measured gravimetrically. Temporal analysis of manometric and TSF recordings identified three functionally distinct biliary-SO regions, the proximal-SO (juxta-CBD), body-SO and papilla-SO. At CBD pressures < 3 mmHg the motor activity of these regions was coordinated to pump fluid. Proximal-SO contractions isolated fluid within the body-SO. Peristaltic contraction through the body-SO pumped this fluid through the papilla-SO (17–27 ?l contraction), which opened to facilitate flow. CBD pressure > 3.5 mmHg resulted in progressive changes in TSF to predominantly passive ‘resistor’-type flow, occurring during proximal-SO–body-SO quiescence, when CBD pressure exceeded the pressure at the papilla-SO. Progression from pump to resistor function commenced when CBD pressure was 2–4 mmHg greater than duodenal pressure. These results imply that TSF is dependent on the CBD–duodenal pressure difference. The papilla-SO is pivotal to TSF, relaxing during proximal-SO–body-SO pumping and closing during proximal-SO–body-SO quiescence. The pump function promotes TSF at low CBD pressure and prevents bile stasis. At higher CBD pressure, the papilla-SO permits TSF along a pressure gradient, thereby maintaining a low pressure within the biliary tract. PMID:15169843

Grivell, Marlene B; Woods, Charmaine M; Grivell, Anthony R; Neild, Timothy O; Craig, Alexander G; Toouli, James; Saccone, Gino T P

2004-01-01

419

Anal intraepithelial dysplasia and squamous carcinoma in immunosuppressed patients  

PubMed Central

Objective To describe a treatment and follow-up protocol for HIV patients with anal dysplasia or warts, which are at risk of malignant change. Design An ongoing study of highly selected patients referred to a single surgeon. Setting The Colorectal and HIV/AIDS Clinics, University of Ottawa, General Campus. Patients Ninteen young men who presented with suspicious anal lesions and were referred to the Colorectal Clinic by the HIV/AIDS Clinic, which sees approximately 800 patients per year. Outcome measure Significance of dysplasia or carcinoma. Results Of the 19 patients, 14 had dysplasia, carcinoma-in-situ or invasive carcinoma. All were treated with multiple mapped cold biopsies and local or wide excision as indicated. Two patients with invasive carcinoma received radiotherapy or chemotherapy, or both. Conclusions The incidence of dysplasia or the sequence by which dysplasia progresses to invasive carcinoma is unknown. Surveillance of HIV patients, especially those with nodules or warts, by flexible sigmoidoscopy and Papanicolaou smears every 3 to 12 months is recommended, depending on the severity of the anal lesion. PMID:11764880

Kotlarewsky, Mark; Freeman, Joel B.; Cameron, William; Grimard, Laval J.

2001-01-01

420

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

2010-01-01

421

Surgical correction of chronic anal fissure: Results of lateral internal sphincterotomy vs. Fissurectomy—Midline sphincterotomy  

Microsoft Academic Search

A retrospective study of 300 patients with chronic anal fisure is presented. Lateral internal sphincterotomy offers shorter\\u000a hospital stay, rapid wound healing, low recurrence rate, and no permanent defect in continence, and is, therefore, the procedure\\u000a of choice in uncomplicated anal fissures. Fissurectomy-midline sphincterotomy should be reserved for patients in whom local\\u000a fistulization has complicated anal fissure.

Herand Abcarian

1980-01-01

422

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

Govindjee

423

Anal. Chem. 1994,66, 2318-2329 Spontaneous Injection In Wrocotumn Separations  

E-print Network

Anal. Chem. 1994,66, 2318-2329 Spontaneous Injection In Wrocotumn Separations Harvey A. Fkhman.; Jorgenwm,J. W. (3) Ewing, A. 0.;Wallingford, R. A.; OlefirowiczT. M.Anal. C%m.1u19.61, (4) Lee,T. T.; Yeung. E. S.Anal. Chrm. 199264, 3045-3051. (5) Hogan, 8.;Yeung, E. S. Anat. Chem. 1992,64,2841-2845. (6)C00

Zare, Richard N.

424

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.;Sheeley,D. M., Kuei, J.; Her, G. R. Anal. Chem. 1988,60, 2719-2722. (3)Shaw,P. E.;Wilson,C. W. J. Chromatogr.Sci. 1982,20,209-212. (4)Johnson, D. C.; Lacourse, W. R. Anal. Chem. 1990, 62, 589A- 597A. (5)Santos

Zare, Richard N.

425

Anal signs of child sexual abuse: a case–control study  

PubMed Central

Background There is uncertainty about the nature and specificity of physical signs following anal child sexual abuse. The study investigates the extent to which physical findings discriminate between children with and without a history of anal abuse. Methods Retrospective case note review in a paediatric forensic unit. Cases: all eligible cases from1990 to 2007 alleging anal abuse. Controls: all children examined anally from 1998 to 2007 with possible physical abuse or neglect with no identified concern regarding sexual abuse. Fisher’s exact test (two-tailed) was performed to ascertain the significance of differences for individual signs between cases and controls. To explore the potential role of confounding, logistic regression was used to produce odds ratios adjusted for age and gender. Results A total of 184 cases (105 boys, 79 girls), average age 98.5 months (range 26 to 179) were compared with 179 controls (94 boys, 85 girls) average age 83.7 months (range 35–193). Of the cases 136 (74%) had one or more signs described in anal abuse, compared to 29 (16%) controls. 79 (43%) cases and 2 (1.1%) controls had >1 sign. Reflex anal dilatation (RAD) and venous congestion were seen in 22% and 36% of cases but <1% of controls (likelihood ratios (LR) 40, 60 respectively), anal fissure in 14% cases and 1.1% controls (LR 13), anal laxity in 27% cases and 3% controls (LR 10). Novel signs seen significantly more commonly in cases were anal fold changes, swelling and twitching. Erythema, swelling and fold changes were seen most commonly within 7 days of last reported contact; RAD, laxity, venous congestion, fissure and twitching were observed up to 6 months after the alleged assault. Conclusions Anal findings are more common in children alleging anal abuse than in those presenting with physical abuse or neglect with no concern about sexual abuse. Multiple signs are rare in controls and support disclosed anal abuse. PMID:24884914

2014-01-01

426

Risk Factors for Abnormal Anal Cytology over Time in HIV-infected Women  

PubMed Central

Objectives To assess incidence of, and risk factors for abnormal anal cytology and anal intraepithelial neoplasia (AIN) 2–3 in HIV-infected women. Study Design This prospective study assessed 100 HIV-infected women with anal and cervical specimens for cytology and high risk HPV testing over three semi-annual visits. Results Thirty-three women were diagnosed with an anal cytologic abnormality at least once. Anal cytology abnormality was associated with current CD4 count <200 cells/mm3, anal HPV infection and history of other sexually transmitted infections (STIs). Twelve subjects were diagnosed with AIN2-3: four after AIN1 diagnosis and four after ?1 negative anal cytology. AIN2-3 trended towards an association with history of cervical cytologic abnormality and history of STI. Conclusions Repeated annual anal cytology screening for HIV-infected women, particularly for those with increased immunosuppression, anal and/or cervical HPV, history of other STIs, or abnormal cervical cytology, will increase the likelihood of detecting AIN2-3. PMID:22520651

BARANOSKI, Amy S; TANDON, Richa; WEINBERG, Janice; HUANG, Faye; STIER, Elizabeth A

2012-01-01

427

Femoral pseudoaneurysm rupturing into urinary bladder: A rare presentation.  

PubMed

Femoral pseudoaneurysm is a common occurrence in intravenous drug abuser due to repeated trauma to the femoral artery causing arterial leak contained by the surrounding tissue and does not contain all the layers of arterial wall. Rupture of these aneurysm to exterior is a common presentation while rupture into surrounding structure deemed an emergency surgical attention. Hence, we report an unusual case of rupture of femoral pseudoaneurysm into urinary bladder who presented us with history of hematuria and was successfully managed. PMID:25887167

Shrestha, Kajan Raj; Luitel, Bhoj Raj; Shrestha, Ujma; Shrestha, Uttam Krishna

2015-01-01

428

Dynamic stress changes during earthquake rupture  

USGS Publications Warehouse

We assess two competing dynamic interpretations that have been proposed for the short slip durations characteristic of kinematic earthquake models derived by inversion of earthquake waveform and geodetic data. The first interpretation would require a fault constitutive relationship in which rapid dynamic restrengthening of the fault surface occurs after passage of the rupture front, a hypothesized mechanical behavior that has been referred to as "self-healing." The second interpretation would require sufficient spatial heterogeneity of stress drop to permit rapid equilibration of elastic stresses with the residual dynamic friction level, a condition we refer to as "geometrical constraint." These interpretations imply contrasting predictions for the time dependence of the fault-plane shear stresses. We compare these predictions with dynamic shear stress changes for the 1992 Landers (M 7.3), 1994 Northridge (M 6.7), and 1995 Kobe (M 6.9) earthquakes. Stress changes are computed from kinematic slip models of these earthquakes, using a finite-difference method. For each event, static stress drop is highly variable spatially, with high stress-drop patches embedded in a background of low, and largely negative, stress drop. The time histories of stress change show predominantly monotonic stress change after passage of the rupture front, settling to a residual level, without significant evidence for dynamic restrengthening. The stress change at the rupture front is usually gradual rather than abrupt, probably reflecting the limited resolution inherent in the underlying kinematic inversions. On the basis of this analysis, as well as recent similar results obtained independently for the Kobe and Morgan Hill earthquakes, we conclude that, at the present time, the self-healing hypothesis is unnecessary to explain earthquake kinematics.

Day, S.M.; Yu, G.; Wald, D.J.

1998-01-01

429

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

2014-05-01

430

Isolated unilateral rupture of the alar ligament.  

PubMed

Only 6 cases of isolated unilateral rupture of the alar ligament have been previously reported. The authors report a new case and review the literature, morbid anatomy, and pathogenesis of this rare injury. The patient in their case, a 9-year-old girl, fell head first from a height of 5 feet off the ground. She presented with neck pain, a leftward head tilt, and severe limitation of right rotation, extension, and right lateral flexion of the neck. Plain radiographs and CT revealed no fracture but a shift of the dens toward the right lateral mass of C-1. Magnetic resonance imaging of the cervical spine showed signal hyperintensity within the left dens-atlas space on both T1- and T2-weighted sequences and interruption of the expected dark signal representing the left alar ligament, suggestive of its rupture. After 12 weeks of immobilization in a Guilford brace, MRI showed lessened dens deviation, and the patient attained full and painless neck motion. Including the patient in this case, the 7 patients with this injury were between 5 and 21 years old, sustained the injury in traffic accidents or falls, presented with marked neck pain, and were treated with external immobilization. All patients had good clinical outcome. The mechanism of injury is hyperflexion with rotation. Isolated unilateral alar ligament rupture is a diagnosis made by excluding associated fracture, dislocation, or disruption of other major ligamentous structures in the craniovertebral junction. CT and MRI are essential in establishing the diagnosis. External immobilization is adequate treatment. PMID:24679079

Wong, Sui-To; Ernest, Kimberly; Fan, Grace; Zovickian, John; Pang, Dachling

2014-05-01

431

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.

2013-12-01

432

Tendon rupture associated with simvastatin/ezetimibe therapy.  

PubMed

A case of spontaneous biceps tendon rupture in a physician during therapy with the combination of simvastatin and ezetimibe (Vytorin) is reported. Rechallenge produced tendinopathy in the contralateral biceps tendon that abated with drug discontinuation. Tendon rupture generally occurs in injured tendons. Physiological repair of an injured tendon requires degradation and remodeling of the extracellular matrix through matrix metalloproteinases (MMPs). Statins are known to inhibit MMPs. It was hypothesized that statins may increase the risk of tendon rupture by altering MMP activity. In conclusion, statins may increase the risk of tendon rupture by altering MMP activity. PMID:17599460

Pullatt, Raja C; Gadarla, Mamatha Reddy; Karas, Richard H; Alsheikh-Ali, Alawi A; Thompson, Paul D

2007-07-01

433

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.

434

Complex earthquake rupture and local tsunamis  

USGS Publications Warehouse

In contrast to far-field tsunami amplitudes that are fairly well predicted by the seismic moment of subduction zone earthquakes, there exists significant variation in the scaling of local tsunami amplitude with respect to seismic moment. From a global catalog of tsunami runup observations this variability is greatest for the most frequently occuring tsunamigenic subduction zone earthquakes in the magnitude range of 7 < Mw < 8.5. Variability in local tsunami runup scaling can be ascribed to tsunami source parameters that are independent of seismic moment: variations in the water depth in the source region, the combination of higher slip and lower shear modulus at shallow depth, and rupture complexity in the form of heterogeneous slip distribution patterns. The focus of this study is on the effect that rupture complexity has on the local tsunami wave field. A wide range of slip distribution patterns are generated using a stochastic, self-affine source model that is consistent with the falloff of far-field seismic displacement spectra at high frequencies. The synthetic slip distributions generated by the stochastic source model are discretized and the vertical displacement fields from point source elastic dislocation expressions are superimposed to compute the coseismic vertical displacement field. For shallow subduction zone earthquakes it is demonstrated that self-affine irregularities of the slip distribution result in significant variations in local tsunami amplitude. The effects of rupture complexity are less pronounced for earthquakes at greater depth or along faults with steep dip angles. For a test region along the Pacific coast of central Mexico, peak nearshore tsunami amplitude is calculated for a large number (N = 100) of synthetic slip distribution patterns, all with identical seismic moment (Mw = 8.1). Analysis of the results indicates that for earthquakes of a fixed location, geometry, and seismic moment, peak nearshore tsunami amplitude can vary by a factor of 3 or more. These results indicate that there is substantially more variation in the local tsunami wave field derived from the inherent complexity subduction zone earthquakes than predicted by a simple elastic dislocation model. Probabilistic methods that take into account variability in earthquake rupture processes are likely to yield more accurate assessments of tsunami hazards.

Geist, E.L.

2002-01-01

435

Traumatic rupture of healed cataract wounds.  

PubMed

Three patients suffered blunt trauma that caused rupture of the site of cataract incision three to 12 years after surgery. Epithelial cells were noted in the old cataract would of a 79-year-old white man. The second patient, a 25-year-old black women, had bilateral ocular toxoplasmosis and loss of vitreous humor at the time of lens extraction. The third patient, a 63-year-old white woman, had open-angle glaucoma treated previously with filtering procedures and cyclocryotherapy. The ultimate outcome was poor in each case. PMID:937423

Kass, M A; Lahav, M; Albert, D M

1976-06-01

436

Rupture of lipid vesicles near solid surfaces  

NASA Astrophysics Data System (ADS)

The behavior of lipid vesicles near solid surfaces, despite its scientific and technological significance, is poorly understood. By simultaneously taking into account (i) the dynamics of spontaneous pore opening and closing in surface bound vesicles; (ii) their volume loss via leakage through the pores; (iii) and the propagation of their contact line, we have developed a simple model that can fully describe the detailed mechanism of and provide the necessary conditions for the rupture of vesicles and the subsequent formation of supported lipid bilayers. The predictions of the model are in qualitative agreement with many of the experimental observations.

Takáts-Nyeste, Annamária; Derényi, Imre

2014-11-01

437

Arch. Rational Mech. Anal. 121, 187 -203 (1992) A stability result for the relativistic Vlasov-Maxwell system  

E-print Network

Arch. Rational Mech. Anal. 121, 187 - 203 (1992) A stability result for the relativistic Vlasov stability result for the Vlasov-Poisson system in three dimensions, Anal. di Mat. Pura ed Appl. 164, 133

Dettweiler, Michael

438

SIAM J. MATH. ANAL. c 2011 Society for Industrial and Applied Mathematics Vol. 43, No. 1, pp. 149  

E-print Network

SIAM J. MATH. ANAL. c 2011 Society for Industrial and Applied Mathematics Vol. 43, No. 1, pp. 1-periodic sound wave propagation in the compressible Euler equations, Methods Appl. Anal., 16 (2009), pp. 341

Temple, Blake

439

54 BULLETIN OF TEE UNITED STATES FISH COMMISSION. scarcely longest, 16 in head. Anal comparatively long and high, its  

E-print Network

54 BULLETIN OF TEE UNITED STATES FISH COMMISSION. scarcely longest, 16 in head. Anal comparatively nearer base of ventral8 than anal. Color rather dull grayish brown, with bluish and purple reflections

440

SIAM J. MATRIX ANAL. APPL. c XXXX Society for Industrial and Applied Mathematics Vol. 0, No. 0, pp. 000000  

E-print Network

SIAM J. MATRIX ANAL. APPL. c XXXX Society for Industrial and Applied Mathematics Vol. 0, No. 0, pp it to a four-way array to perform a blind identification of an under-determined mixture (UDM). Since anal- ysis

Paris-Sud XI, Université de

441

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.

2013-01-01

442

Recurrent anal fistulae: Limited surgery supported by stem cells  

PubMed Central

AIM: To study the results of stem-cell therapy under a Compassionate-use Program for patients with recurrent anal fistulae. METHODS: Under controlled circumstances, and approved by European and Spanish laws, a Compassionate-use Program allows the use of stem-cell therapy for patients with very complex anal fistulae. Candidates had previously undergone multiple surgical interventions that had failed to resolve the fistulae, and presented symptomatic recurrence. The intervention consisted of limited surgery (with closure of the internal opening), followed by local implant of stem cells in the fistula-tract wall. Autologous expanded adipose-derived stem cells were the main cell type selected for implant. The first evaluation was performed on the 8th postoperative week; outcome was classified as response or partial response. Evaluation one year after the intervention confirmed if complete healing of the fistula was achieved. RESULTS: Ten patients (8 male) with highly recurrent and complex fistulae were treated (mean age: 49 years, range: 28-76 years). Seven cases were non-Crohn’s fistulae, and three were Crohn’s-associated fistulae. Previous surgical attempts ranged from 3 to 12. Two patients presented with preoperative incontinence (Wexner scores of 12 and 13 points). After the intervention, six patients showed clinical response on the 8th postoperative week, with a complete cessation of suppuration from the fistula. Three patients presented a partial response, with an evident decrease in suppuration. A year later, six patients (60%) remained healed, with complete reepithelization of the external opening. Postoperative Wexner Scores were 0 in six cases. The two patients with previous incontinence improved their scores from 12 to 8 points and from 13 to 5 points. No adverse reactions or complications related to stem-cell therapy were reported during the study period. CONCLUSION: Stem cells are safe and useful for treating anal fistulae. Healing can be achieved in severe cases, sparing fecal incontinence risk, and improving previous scoring.

Garcia-Olmo, Damian; Guadalajara, Hector; Rubio-Perez, Ines; Herreros, Maria Dolores; de-la-Quintana, Paloma; Garcia-Arranz, Mariano

2015-01-01

443

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: pgrigsby@wustl.edu; 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)

2006-07-01

444

Ruptures of the distal biceps tendon.  

PubMed

Distal biceps ruptures occur most commonly in middle-aged males and result from eccentric contraction of the biceps tendon. The injury typically presents with pain and a tearing sensation in the antecubital fossa with resultant weakness in flexion and supination strength. Physical exam maneuvers and diagnostic imaging aid in determining the diagnosis. Nonoperative management is reserved for elderly, low demand patients, while operative intervention is generally pursued for younger patients and can consist of nonanatomic repair to the brachialis or anatomic repair to the radial tuberosity. Anatomic repair through a one-incision or two-incision approach is commonplace, while the nonanatomic repairs are rarely performed. No clear advantage exists in operative management with a one-incision versus two-incision techniques. Chronic ruptures present a more difficult situation, and allograft augmentation is often necessary. Common complications after repair include transient nerve palsy, which often resolves, and heterotopic ossification. Despite these possible complications, most studies suggest that better patient outcomes are obtained with operative, anatomic reattachment of the distal biceps tendon. PMID:25150334

Ward, James P; Shreve, Mark C; Youm, Thomas; Strauss, Eric J

2014-01-01

445

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.

2010-12-01

446

Roles of hypertension in the rupture of intracranial aneurysms  

PubMed Central

Background and Purpose Systemic hypertension has long been considered as a risk factor of aneurysmal rupture. However, a causal link between systemic hypertension and the development of aneurysmal rupture has not been established. In this study, using a mouse model of intracranial aneurysm rupture, we examined the roles of systemic hypertension in the development of aneurysmal rupture. Methods Aneurysms were induced by a combination of deoxycorticosterone acetate (DOCA)-salt induced hypertension and a single injection of elastase into the cerebrospinal fluid in mice. Anti-hypertensive treatment was started six days after aneurysm induction. Aneurysmal rupture was detected by neurological symptoms and confirmed by the presence of intracranial aneurysm with subarachnoid hemorrhage. Hydralazine (direct vasodilator) or the discontinuation of the DOCA-salt treatment was used to assess the roles of systemic hypertension. Captopril (angiotensin converting enzyme inhibitor) or losartan (angiotensin II type 1 receptor antagonist) was used to assess the roles of the local renin-angiotensin system in the vascular wall. Results Normalization of blood pressure by hydralazine significantly reduced the incidence of ruptured aneurysms and the rupture rate. There was a dose dependent relationship between the reduction of blood pressure and the prevention of aneurysmal rupture. Captopril and losartan were able to reduce the rupture rates without affecting systemic hypertension induced by DOCA-salt treatment. Conclusions Normalization of blood pressure after aneurysm formation prevented aneurysmal rupture in mice. In addition, we found that the inhibition of the local renin-angiotensin system independent from the reduction of blood pressure can prevent aneurysmal rupture. PMID:24370755

Tada, Yoshiteru; Wada, Kosuke; Shimada, Kenji; Makino, Hiroshi; Liang, Elena I.; Murakami, Shoko; Kudo, Mari; Kitazato, Keiko T.; Nagahiro, Shinji; Hashimoto, Tomoki

2014-01-01

447

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

2009-01-01

448

Sliding skin grafts in the treatment of anal fissures  

Microsoft Academic Search

Summary  The basic principles of plastic surgery for sliding skin graft have been employed routinely in and about the anal canal. In\\u000a 2,072 patients operated upon by the authors the infected fissure and crypt-bearing hemorrhoidal tissue was excised and the\\u000a defect closed primarily with a broad-based sliding skin graft. Any associated disease—hemorrhoids, cryptitis, etc.—was also\\u000a removed, employing the closed technic.\\u000a \\u000a Excision

Ralph B. Samson; William R. C. Stewart

1970-01-01

449

Specific obstetrical risk factors for urinary versus anal incontinence four years after first1 Aim: delivery can be complicated by urinary or anal incontinence (UI or AI). We4  

E-print Network

Specific obstetrical risk factors for urinary versus anal incontinence four years after first1 delivery.2 Abstract3 Aim: delivery can be complicated by urinary or anal incontinence (UI or AI). We4 found specific associations between obstetrical risk factors and urinary21 versus anal incontinence four

Paris-Sud XI, Université de

450

Manometric and radiologic investigations and biofeedback treatment of chronic idiopathic anal pain  

Microsoft Academic Search

In 12 patients suffering from chronic idiopathic anal pain, the rectosphincteric function was studied using manometric and x-ray techniques. The results of manometric investigations were compared with those obtained in 12 healthy volunteers. In all patients, the resting pressure in the anal canal was significantly higher than in control subjects. In 10 patients, defecography revealed abnormalities of the pelvic muscles.

Jean-Charles Grimaud; Michel Bouvier; Bernard Naudy; Claude Guien; Jacques Salducci

1991-01-01

451

HIV infection connected to rising anal cancer rates in men in the U.S.  

Cancer.gov

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. Chart shows overall incidence rates of anal cancers in general population with dashed line showing those with HIV infection.

452

Chemical investigations of wolf ( Canis lupus ) anal-sac secretion in relation to breeding season  

Microsoft Academic Search

The volatile constituents of wolf anal-sac secretions were examined via capillary gas chromatography and compared among intact males, females, castrate males, ovariectomized females, and anosmic and pinealectomized males and females. Some chemical compounds were deemed significantly different (t test, 95% confidence level) among the groups both during and outside of the mating season, implying that the volatile components of anal-sac

J. Raymer; D. Wiesler; M. Novotny; C. Asa; L. D. Mech

1985-01-01

453

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

PubMed Central

We present a case of a transsexual patient who underwent 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. PMID:19533817

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

2009-01-01

454

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

2000-01-01

455

Persistent orocutaneous and anal fistulae induced by nicorandil: a case report  

Microsoft Academic Search

INTRODUCTION: Although nicorandil is prescribed widely, awareness of its potential to cause serious complications to the gastrointestinal tract mucosa is limited. Whilst nicorandil-induced oral and anal ulceration is well documented in the literature, nicorandil-induced fistulation is not. This is the first report in the literature of a single patient demonstrating simultaneous orocutaneous and anal fistulae during nicorandil therapy. Two separate

Cyndi Goh; Sally CY Wong; Colin Borland

2009-01-01

456

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

2010-01-01

457

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

2005-01-01

458

Cervical and Anal Human Papillomavirus Infection in Adult Women in American Samoa  

PubMed Central

The prevalence of cervical and anal human papillomavirus (HPV) and risk factors associated with infections were evaluated in a cross-sectional study of 211 adult women in American Samoa. Overall, 53% of women reported ever having a Pap smear. Cervical and anal HPV was detected in 10% and 16% of women, respectively; 4% of women had concurrent cervical and anal HPV. The most common cervical genotypes were HPV 6, HPV 16, and HPV 53. Cutaneous HPV types were detected in 40% of anal infections. Cervical HPV infection was associated with anal HPV (age-adjusted odds ratio = 3.32, 1.10–10.00). After age adjustment, cervical HPV was associated with being unmarried, postsecondary education, hot running water at home, multiple sexual partners, nulliparity, condom use, and other contraceptive methods. In multivariate analyses, only age remained associated with cervical HPV and anal HPV. Cervical and anal HPV was more prevalent among younger women; only anal HPV was detected in older women. PMID:22652246

Hernandez, Brenda Y.; Ka’opua, Lana S.; Scanlan, Luana; Ah Ching, John; Kamemoto, Lori E.; Thompson, Pamela J.; Zhu, Xuemei; Shvetsov, Yurii B.; Tofaeono, Jennifer; Williams, Victor Tofaeono

2015-01-01

459

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 has also been completed Prevention Preventing Chlamydia · Use condoms every time you have sex sex (oral, vaginal, anal or using sex toys) with a partner until their treatment has also been

Talbot, James P.

460

La revista Anales de Psicología desde una perspectiva de redes sociales  

Microsoft Academic Search

Title: Anales de Psicologia journal from a social networks framework. Abstract: This paper shows the results obtained on the analysis of the journal Anales de Psicología. In this article, authors analyze the collaboration between authors, institutions and countries for this journal. This collabo- rational analysis is made on the basis of the Social Network Analysis (SNA) with the software Pajek

María Peñaranda-Ortega; Elena Quiñones-Vidal; Julia Osca-Lluch

2009-01-01

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