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Sample records for anal sphincter rupture

  1. [Anal sphincter function and recto-anal continence].

    PubMed

    Kuhlbusch, R; Erckenbrecht, J F

    1987-07-01

    Recto-anal continence results from a complex interplay of motor, sensory and anatomical continence mechanisms. Accordingly, fecal incontinence may be due to motor defects, sensory defects, neurological defects, or defects of the reservoir function of the ano-rectum. In a study in 16 patients with fecal incontinence and 16 continent controls the question was examined, to which extent disturbances of the motor function of the internal and external anal sphincter contribute to the pathogenesis of fecal incontinence. Basal and squeeze anal sphincter pressures were not different in incontinent and continent patients. However, 8/16 incontinent patients showed no or only an insufficient increase of external anal sphincter function while squeezing. It is concluded that disturbances of the motor function of the anal sphincters contribute to fecal incontinence in only about one half of the patients. In addition, the pressure increase of the sphincters during squeezing is of more importance for recto-anal continence than the absolute height of the muscular force of the anal sphincters. PMID:3613812

  2. Quantitative anal sphincter electromyography in primiparous women with anal incontinence

    PubMed Central

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

    2010-01-01

    OBJECTIVE The purpose of this study was to determine whether evidence of denervation/reinnervation of the external anal sphincter is associated with anal incontinence symptoms immediately after delivery. STUDY DESIGN After a first vaginal delivery, 42 women completed an anal incontinence questionnaire. They also underwent concentric needle electromyography of the external anal sphincter. For each subject, motor unit action potential and interference pattern parameters were determined. RESULTS For the motor unit action potential, no difference was observed between patients with and without anal incontinence symptoms (t-test). For the interference pattern, the amplitude/turn was greater in subjects with fecal urgency (318 48 [SD] ?V) and fecal incontinence (332 48 ?V), compared with those without fecal urgency (282 38 ?V) and fecal incontinence (286 41 ?V; P = .02, t-test). CONCLUSION In this group of postpartum women with mild anal incontinence symptoms, interference pattern analysis shows evidence of denervation and subsequent reinnervation. PMID:18455531

  3. The role of nocturnal delivery and delivery during the holiday period in Finland on obstetric anal sphincter rupture rates- a population based observational study

    PubMed Central

    2010-01-01

    Background Obstetric anal sphincter rupture (OASR) is a serious complication of delivery, which frequently results in faecal incontinence despite primary repair and has serious implications for women's health. The objective of this study was to assess whether human factors, workload and staffing at night, at weekends and during holidays has an effect on the increasing OASR rates among all singleton vaginal deliveries (n = 514,741) having occurred between 1997 and 2007 in Finland. Women (n = 2,849) with OASR were compared in terms of possible risk factors to women without OASR using stepwise logistic regression analysis. Findings In Finland, the increase in OASR rate is striking, from 0.2% in 1997 to 0.9% in 2007. OASR rates varied from 0.49% to 0.58% (? 0.001) according to the time of day, and were lowest at night. After adjustment for patient-mix and the use of interventions, the risk of OASR was 11% lower (95% CI 3-18%) at night and 15% lower (95% CI 3-26%) in July - the main holiday month. Only 14% of the increased OASR risk during the day time (8-23.59) was attributable to vacuum assistance and birth weight, whereas the holiday period had no effect. Conclusions Decreased OASR rates at night and in July suggest that human factors such as decreased alertness due to fatigue or hospitals' administrative factors such as workload and staffing did not increase the rates of OASR. PMID:20205904

  4. Mesenchymal stem cells can improve anal pressures after anal sphincter injury?

    PubMed Central

    Salcedo, Levilester; Mayorga, Maritza; Damaser, Margot; Balog, Brian; Butler, Robert; Penn, Marc; Zutshi, Massarat

    2016-01-01

    Objective Fecal incontinence reduces the quality of life of many women but has no long-term cure. Research on mesenchymal stem cell (MSC)-based therapies has shown promising results. The primary aim of this study was to evaluate functional recovery after treatment with MSCs in two animal models of anal sphincter injury. Methods Seventy virgin female rats received a sphincterotomy (SP) to model episiotomy, a pudendal nerve crush (PNC) to model the nerve injuries of childbirth, a sham SP, or a sham PNC. Anal sphincter pressures and electromyography (EMG) were recorded after injury but before treatment and 10 days after injury. Twenty-four hours after injury, each animal received either 0.2 ml saline or 2 million MSCs labelled with green fluorescing protein (GFP) suspended in 0.2 ml saline, either intravenously (IV) into the tail vein or intramuscularly (IM) into the anal sphincter. Results MSCs delivered IV after SP resulted in a significant increase in resting anal sphincter pressure and peak pressure, as well as anal sphincter EMG amplitude and frequency 10 days after injury. MSCs delivered IM after SP resulted in a significant increase in resting anal sphincter pressure and anal sphincter EMG frequency but not amplitude. There was no improvement in anal sphincter pressure or EMG with in animals receiving MSCs after PNC. GFP-labelled cells were not found near the external anal sphincter in MSC-treated animals after SP. Conclusion MSC treatment resulted in significant improvement in anal pressures after SP but not after PNC, suggesting that MSCs could be utilized to facilitate recovery after anal sphincter injury. PMID:23147650

  5. Ultrasound imaging of the anal sphincter complex: a review

    PubMed Central

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

    2012-01-01

    Endoanal ultrasound is now regarded as the gold standard for evaluating anal sphincter pathology in the investigation of anal incontinence. The advent of three-dimensional ultrasound has further improved our understanding of the two-dimensional technique. Endoanal ultrasound requires specialised equipment and its relative invasiveness has prompted clinicians to explore alternative imaging techniques. Transvaginal and transperineal ultrasound have been recently evaluated as alternative imaging modalities. However, the need for technique standardisation, validation and reporting is of paramount importance. We conducted a MEDLINE search (1950 to February 2010) and critically reviewed studies using the three imaging techniques in evaluating anal sphincter integrity. PMID:22374273

  6. Challenges faced in the clinical application of artificial anal sphincters.

    PubMed

    Wang, Ming-hui; Zhou, Ying; Zhao, Shuang; Luo, Yun

    2015-09-01

    Fecal incontinence is an unresolved problem, which has a serious effect on patients, both physically and psychologically. For patients with severe symptoms, treatment with an artificial anal sphincter could be a potential option to restore continence. Currently, the Acticon Neosphincter is the only device certified by the US Food and Drug Administration. In this paper, the clinical safety and efficacy of the Acticon Neosphincter are evaluated and discussed. Furthermore, some other key studies on artificial anal sphincters are presented and summarized. In particular, this paper highlights that the crucial problem in this technology is to maintain long-term biomechanical compatibility between implants and surrounding tissues. Compatibility is affected by changes in both the morphology and mechanical properties of the tissues surrounding the implants. A new approach for enhancing the long-term biomechanical compatibility of implantable artificial sphincters is proposed based on the use of smart materials. PMID:26365115

  7. Challenges faced in the clinical application of artificial anal sphincters*

    PubMed Central

    Wang, Ming-hui; Zhou, Ying; Zhao, Shuang; Luo, Yun

    2015-01-01

    Fecal incontinence is an unresolved problem, which has a serious effect on patients, both physically and psychologically. For patients with severe symptoms, treatment with an artificial anal sphincter could be a potential option to restore continence. Currently, the Acticon Neosphincter is the only device certified by the US Food and Drug Administration. In this paper, the clinical safety and efficacy of the Acticon Neosphincter are evaluated and discussed. Furthermore, some other key studies on artificial anal sphincters are presented and summarized. In particular, this paper highlights that the crucial problem in this technology is to maintain long-term biomechanical compatibility between implants and surrounding tissues. Compatibility is affected by changes in both the morphology and mechanical properties of the tissues surrounding the implants. A new approach for enhancing the long-term biomechanical compatibility of implantable artificial sphincters is proposed based on the use of smart materials. PMID:26365115

  8. Thermal responses of shape memory alloy artificial anal sphincters

    NASA Astrophysics Data System (ADS)

    Luo, Yun; Takagi, Toshiyuki; Matsuzawa, Kenichi

    2003-08-01

    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.

  9. Sphincter Preservation in Anal Cancer: A Brief Review

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

    2010-01-01

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

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

    PubMed

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

    2004-01-01

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

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

    PubMed Central

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

    2012-01-01

    Aims Lower motor neuron damage to sacral roots or nerves can result in incontinence and a flaccid urinary bladder. We showed bladder reinnervation after transfer of coccygeal to sacral ventral roots, and genitofemoral nerves (L1, 2 origin) to pelvic nerves. This study assesses the feasibility of urethral and anal sphincter reinnervation using transfer of motor branches of the femoral nerve (L2–4 origin) to pudendal nerves (S1, 2 origin) that innervate the urethral and anal sphincters in a canine model. Methods Sacral ventral roots were selected by their ability to stimulate bladder, urethral sphincter, and anal sphincter contraction and transected. Bilaterally, branches of the femoral nerve, specifically, nervus saphenous pars muscularis [Evans HE. Miller’s anatomy of the dog. Philadelphia: W.B. Saunders; 1993], were transferred and end-to-end anastomosed to transected pudendal nerve branches in the perineum, then enclosed in unipolar nerve cuff electrodes with leads to implanted RF micro-stimulators. Results Nerve stimulation induced increased anal and urethral sphincter pressures in five of six transferred nerves. Retrograde neurotracing from the bladder, urethral sphincter, and anal sphincter using fluorogold, fast blue, and fluororuby, demonstrated urethral and anal sphincter labeled neurons in L2–4 cord segments (but not S1–3) in nerve transfer canines, consistent with rein-nervation by the transferred femoral nerve motor branches. Controls had labeled neurons only in S1–3 segments. Postmortem DiI and DiO labeling confirmed axonal regrowth across the nerve repair site. Conclusions These results show spinal cord reinnervation of urethral and anal sphincter targets after sacral ventral root transection and femoral nerve transfer (NT) to the denervated pudendal nerve. These surgical procedures may allow patients to regain continence. PMID:21953679

  13. Maternal Body Mass Index and Risk of Obstetric Anal Sphincter Injury

    PubMed Central

    2014-01-01

    Objective. To estimate the association between maternal obesity and risk of three different degrees of severity of obstetric anal sphincter injury. Methods. The study population consisted of 436,482 primiparous women with singleton term vaginal cephalic births between 1998 and 2011 identified in the Swedish Medical Birth Registry. Women were grouped into six categories of BMI. BMI 18.524.9 was set as reference. Primary outcome was third-degree perineal laceration, partial or total, and fourth-degree perineal laceration. Adjustments were made for year of delivery, maternal age, fetal head position at delivery, infant birth weight and instrumental delivery. Results. The overall prevalence of third- or four-degree anal sphincter injury was 6.6% (partial anal sphincter injury 4.6%, total anal sphincter injury 1.2%, unclassified as either partial and total 0.2%, or fourth degree lacerations 0.6%). The risk for a partial, total, or a fourth-degree anal sphincter injury decreased with increasing maternal BMI most pronounced for total anal sphincter injury where the risk among morbidly obese women was half that of normal weight women, OR 0.47 95% CI 0.280.78. Conclusion. Obese women had a favourable outcome compared to normal weight women concerning serious pelvic floor damages at birth. PMID:24839604

  14. Segmental and descending control of the external urethral and anal sphincters in the cat.

    PubMed Central

    Mackel, R

    1979-01-01

    1. The present work concerns the contribution of the somatic central nervous system to two viscero-somatic reflexes, micturition and defecation. Descending and segmental actions and properties of the motoneurones innervating the striated external urethral and external anal sphincters were studied with intracellular recording in male cats, under chloralose anaesthesia. 2. Motoneurones innervating the external urethral and external anal sphincters were intermingled and most strongly concentrated in the lateral part of the ventral horn in the S2 segment of the spinal cord. 3. Stimulation of the S1 to S3 ipsilateral dorsal roots or of the homonymous pudendal nerve branches showed that less than half of the sphincter motoneurons receive monosynaptic excitatory connexions from low threshold afferents. 4. The after-hyperpolarization recorded in the external urethral and external anal sphincter motoneurones was relatively short lasting, not long lasting as would have been expected for motoneurones innervating slow-twitch, tonic type muscles. 5. There was no evidence for recurrent inhibition in pudendal motoneurones innervating the external urethral and external anal sphincters. 6. Descending excitation and inhibition to the sphincter motoneurones originated in the nucleus reticularis gigantocellularis of the medullary reticular formation. The descending reticulospinal actions are comparable to those observed in hind limb motoneurones. 7. It is suggested that the segmental reflex connexions play a role in controlling bladder and rectal continence. The descending actions studied also modulate the segmental reflex actions and may provide voluntary control of the sphincter muscles. PMID:512936

  15. Injectable silicone biomaterial for faecal incontinence due to internal anal sphincter dysfunction

    PubMed Central

    Kenefick, N J; Vaizey, C J; Malouf, A J; Norton, C S; Marshall, M; Kamm, M A

    2002-01-01

    Background: A weak or disrupted internal anal sphincter can cause passive faecal incontinence. Conservative measures may help some patients but there is no simple surgical solution for those who fail conservative treatment. A successful technique using trans-sphincteric injection of a bulking agent to augment the internal anal sphincter was developed in a previous pilot study. Aim: To determine the clinical results and underlying physiological effects of biomaterial injection. Patients: Six patients (four males, median age 53 years (range 3665)) with faecal incontinence to solid or liquid stool related to poor internal anal sphincter function, of varied aetiology, were recruited. Methods: Silicone based biomaterial injections were performed, under local anaesthesia, with antibiotic cover. Three injections were placed circumferentially, trans-sphincterically, entering away from the anal margin and injecting at or just above the dentate line. Anorectal physiological studies, endoanal ultrasound, a bowel symptom diary, a validated incontinence score, and quality of life questionnaires were completed before treatment and on completion of follow up. Results: At a median follow up of 18 months (range 1519), five of six patients had marked symptom improvement. Faecal incontinence scores improved from a median of 14/24 (range 1120) before to 8/24 (615) after injection. Short form-36 quality of life physical and social function scores improved from a median of 26/100 (533) to 79/100 (25100) and from 10/100 (537) to 100/100 (50100), respectively. There was a corresponding physiological increase in maximum anal resting and squeeze pressures. Ultrasound showed the Bioplastique to be retained in the correct position in the improved patients without migration. There were no complications. Conclusion: Trans-sphincteric injection of silicone biomaterial can provide a marked improvement in faecal incontinence related to a weak or disrupted internal anal sphincter. This is associated with improved sphincter function and quality of life. PMID:12117884

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

    NASA Astrophysics Data System (ADS)

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

    2005-02-01

    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.

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

    PubMed Central

    Sim Gonzlez, Marta; Porta Roda, Oriol; Perell Cap, Josep; Gich Saladich, Ignasi; Calaf Alsina, Joaquim

    2015-01-01

    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

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

    SciTech Connect

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

    1992-08-01

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

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

    PubMed

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

    2014-06-01

    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

  20. Changes in anal sphincter tone at induction of anaesthesia.

    PubMed Central

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

    1988-01-01

    Changes in anal pressure have been monitored during the induction of anaesthesia. Falls in pressure accompany loss of consciousness following bolus doses of commonly used intravenous and inhalational anaesthetic agents. Subsequent rises in pressure towards pre-anaesthetic levels are usually associated with the time taken to correct responses and initial recovery. Premedication, including anticholinergic drugs in conventional dosage, does not affect anal pressure. PMID:3408160

  1. [Sclerosis of the anal sphincter from the point of view of mechanical ileus (author's transl)].

    PubMed

    Voster, C F; Tataru, V; Weustermann, E

    1975-09-26

    Anal sphincter sclerosis, which leads to recurrent subileus and finally to the complete picture of ileus, is presented in relation to 6 of our own observations. Ileus conditions are triggered off by: 1. years of abuse of laxatives, 2. intraperitoneal adhesions supporting the tendency to ileus (postoperative hernia, soft abdominal wall, intestinal atony), 3. viscerovisceral reflexes initiated by other diseases (heart, lung, gallbladder, liver, kidney etc.), 4. chronic recurrent changes with irritation of the terminal organ itself. Women seem predestined for this disease. The existing subileus or ileus condition can be eliminated in all cases by stretching the sphincter and partial sphincterotomy, so that the patients could be spared a laparotomy. PMID:809697

  2. [Sclerosis of the anal sphincter from the point of view of mechanical ileus (author's transl)].

    TOXLINE Toxicology Bibliographic Information

    Voster CF; Tataru V; Weustermann E

    1975-09-26

    Anal sphincter sclerosis, which leads to recurrent subileus and finally to the complete picture of ileus, is presented in relation to 6 of our own observations. Ileus conditions are triggered off by: 1. years of abuse of laxatives, 2. intraperitoneal adhesions supporting the tendency to ileus (postoperative hernia, soft abdominal wall, intestinal atony), 3. viscerovisceral reflexes initiated by other diseases (heart, lung, gallbladder, liver, kidney etc.), 4. chronic recurrent changes with irritation of the terminal organ itself. Women seem predestined for this disease. The existing subileus or ileus condition can be eliminated in all cases by stretching the sphincter and partial sphincterotomy, so that the patients could be spared a laparotomy.

  3. Biomechanical modeling of the rectum for the design of a novel artificial anal sphincter.

    PubMed

    Zan, Peng; Yan, Guozheng; Liu, Hua; Yang, Banghua; Zhao, Yujuan; Luo, Nianting

    2010-01-01

    This paper discusses biomechanical issues that are related to the option of a novel artificial anal sphincter around the human rectum. The prosthesis consists of a compression cuff system inside and a reservoir cuff system outside, which is placed around the debilitated sphincter muscle. The micropump shifts fluid between the cuffs and thus takes over the expansion and compression function of the sphincter muscle. However, the human rectum is not a rigid pipe, and motion in it is further complicated by the fact that the bowel is susceptible to damage. With the goal of engineering a safe and reliable machine, the biomechanical properties of the in-vivo porcine rectum are studied and the tissue ischemia is analyzed. PMID:20715360

  4. Determining the shape of the turnsamplitude cloud during anal sphincter quantitative EMG

    PubMed Central

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

    2010-01-01

    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 turnssecond and amplitudeturn. These confidence intervals were then transformed back into the original parameters to yield scatterplots with confidence curves. The mean turnssecond 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

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

    PubMed Central

    Farouk, Ridzuan

    2014-01-01

    Purpose To estimate the risk of recurrent fissure in ano after sphincter preserving treatments. Methods A retrospective case note review, combined with a telephone survey was conducted for all patients treated for a chronic anal fissure between 1998 and 2008. Results Six hundred and twelve patients (303 women: mean age, 39 years; range, 16-86 years) were treated for chronic anal fissure between 1998 and 2008. Topical diltiazem 2% was initially prescribed for 8 weeks. The fissure did not heal in 141 patients. These patients (61 women: mean age, 30 years; range, 15-86 years) were treated with 100 IU botulinum A toxin (Botox) injection combined with a fissurectomy under general anaesthesia. Thirty eight patients suffered a recurrence of their fissure within two years. Thirty-four healed with further medical or sphincter conserving surgical therapy while four required a lateral internal sphincterotomy. Conclusion The vast majority of patients with chronic anal fissure can be treated with sphincter conserving treatments. This may require several interventions before healing can be achieved. Assessment for recurrence after 'conservative' treatments requires a minimum of two-year follow-up. PMID:24999464

  6. Electrical activity of the external anal sphincter at different ages in childhood.

    PubMed Central

    Molander, M L; Frenckner, B

    1983-01-01

    In EMG recordings of the external anal sphincter there is a brief contraction in response to rapid rectal distension, and a preserved or increased activity during a prolonged substantial rectal distension in healthy adults. In order to determine if this activity develops during childhood 30 healthy children, aged 2 months to 15 years, were examined with their parents' consent. EMG of the external anal sphincter during rest and during rectal distension was performed. All those children who had gained voluntary anal control showed an EMG recording similar to the adults. The 10 youngest children who had not gained voluntary control showed another EMG pattern. Instead of a brief contraction they had a brief loss of activity in response to rectal distension. During a prolonged rectal distension the external sphincter activity decreased and finally ceased. An intermediate state was found in the two youngest children who had gained voluntary control. The EMG pattern showed a good correlation with the maturation and gain of voluntary control of defaecation. Images Fig. 1 Fig. 2 PMID:6826105

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

    PubMed Central

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

    2002-01-01

    Background We aim to establish the evidence base for the recognition and management of obstetric anal sphincter injury (OASI) and to compare this with current practice amongst UK obstetricians and coloproctologists. Methods A systematic review of the literature and a postal questionnaire survey of consultant obstetricians, trainee obstetricians and consultant coloproctologists was carried out. Results We found a wide variation in experience of repairing acute anal sphincter injury. The group with largest experience were consultant obstetricians (46.5% undertaking ? 5 repairs/year), whilst only 10% of responding colorectal surgeons had similar levels of experience (p < 0.001). There was extensive misunderstanding in terms of the definition of obstetric anal sphincter injuries. Overall, trainees had a greater knowledge of the correct classification (p < 0.01). Observational studies suggest that a new 'overlap' repair using PDS sutures with antibiotic cover gives better functional results. However, our literature search found only one randomised controlled trial (RCT) on the technique of repair of OASI, which showed no difference in incidence of anal incontinence at three months. Despite this, there was a wide variation in practice, with 337(50%) consultants, 82 (55%) trainees and 80 (89%) coloproctologists already using the 'overlap' method for repair of a torn EAS (p < 0.001). Although over 50% of colorectal surgeons would undertake long-term follow-up of their patients, this was the practice of less than 10% of obstetricians (p < 0.001). Whilst over 70% of coloproctologists would recommend an elective caesarean section in a subsequent pregnancy, only 22% of obstetric consultants and 14% of trainees (p < 0.001). Conclusion An agreed classification of OASI, development of national guidelines, formalised training, multidisciplinary management and further definitive research is strongly recommended. PMID:12006105

  8. Modified Plug Repair with Limited Sphincter Sparing Fistulectomy in the Treatment of Complex Anal Fistulas

    PubMed Central

    Kckerling, Ferdinand; von Rosen, Thomas; Jacob, Dietmar

    2014-01-01

    Purpose: New technical approaches involving biologically derived products have been used to treat complex anal fistulas in order to avoid the risk of fecal incontinence. The least invasive methods involve filling out the fistula tract with fibrin glue or introduction of an anal fistula plug into the fistula canal following thorough curettage. A review shows that the new techniques involving biologically derived products do not confer any significant advantages. Therefore, the question inevitably arises as to whether the combination of a partial or limited fistulectomy, i.e., of the extrasphincteric portion of the fistula, and preservation of the sphincter muscle by repairing the section of the complex anal fistula running through the sphincter muscle and filling it with a fistula plug produces better results. Methods: A modified plug technique was used, in which the extrasphincteric portion of the complex anal fistula was removed by means of a limited fistulectomy and the remaining section of the fistula in the sphincter muscle was repaired using the fistula plug with fixing button. Results: Of the 52 patients with a complex anal fistula, who had undergone surgery using a modified plug repair with limited fistulectomy of the extrasphincteric part of the fistula and use of the fistula plug with fixing button, there are from 40 patients (follow-up rate: 77%) some kind of follow-up informations, after a mean of 19.32??6.9?months. Thirty-two were men and eight were women, with a mean age of 52.97??12.22?years. Surgery was conducted to treat 36 transsphincteric, 1 intersphincteric, and 3 rectovaginal fistulas. In 36 of 40 patients (90%), the complex anal fistulas or rectovaginal fistulas were completely healed without any sign of recurrence. None of these patients complained about continence problems. Conclusion: A modification of the plug repair of complex anal fistulas with limited fistulectomy of the extrasphincteric part of the fistula and use of the plug with fixing button seems to increase the healing rate in comparison to the standard plug technique. PMID:25593941

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

    SciTech Connect

    Alsadius, David; Hedelin, Maria; Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm ; Lundstedt, Dan; Pettersson, Niclas; Wilderaeng, Ulrica; Steineck, Gunnar; Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm

    2012-10-01

    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.

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

    PubMed

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

    2014-12-01

    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

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

    PubMed Central

    AIKEN, Catherine E.; AIKEN, Abigail R.; PRENTICE, Andrew

    2014-01-01

    Background Duration of the second stage of labor has been suggested as an independent risk factor for clinically detectable obstetric anal sphincter injury in low-risk nulliparous women. Methods A retrospective 5-year cohort study in a UK obstetrics center including high-risk delivery unit and low-risk birthing center. 4831 nulliparous women with vertex-presenting, single, live-born infants at term were included. The cohort was stratified according to spontaneous or instrumental delivery. Binary logistic regression models were used to examine the association between duration of second stage and sphincter injury. Results 325 of 4831 women (6.7%) sustained sphincter injuries. In spontaneously delivering women, there was no association between duration of the second stage and the likelihood of sustaining sphincter injuries. Factors associated with increased likelihood of sustaining sphincter injury included older maternal age, higher birthweight and Southeast Asian ethnicity. By contrast, for women undergoing instrumental delivery, a longer second stage was associated with an increased sphincter injury risk of 6% per 15 minutes in the second stage of labor prior to delivery. Conclusions For spontaneous vaginal deliveries, duration of the second stage of labor is not an independent risk factor for obstetric anal sphincter injuries. The association between prolonged second stage and sphincter injury for instrumental deliveries is likely explained by the risk posed by the use of the instruments themselves or by delay in initiating instrumental assistance. Attempts to modify the duration of the second stage for prevention of sphincter injuries are unlikely to be beneficial and may be detrimental. PMID:25439012

  12. Intervention during labor: risk factors associated with complete tear of the anal sphincter.

    PubMed

    Moller Bek, K; Laurberg, S

    1992-10-01

    Among 41,200 consecutive deliveries there were 152 cases of complete tear of the anal sphincter (complete tear). In a case-control design, the association between interventions during labor (forceps, vacuum extraction, use of oxytocin and prostaglandins and mediolateral episiotomy) and complete tear, were evaluated by confounder control using multiple logistic regression analysis. Controls chosen were the patients delivering just before and after the index patient with complete tear. Use of Kielland forceps, mediolateral episiotomy, shoulder dystocia and nulliparity were significantly associated with complete tear. Maternal age, presentation in labor, duration of second stage of labor and the indication for instrumental deliveries and episiotomy had no significant association with complete tear. PMID:1332371

  13. Outcome of repair of obstetric anal sphincter injuries after three years

    PubMed Central

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

    2014-01-01

    Objective To prospectively assess change in bowel symptoms and quality of life (QoL) approximately 3years after primary repair of obstetric anal sphincter injuries (OASIS). Methods Between July 2002 and December 2007 women who attended the perineal clinic at Croydon University Hospital, UK, 9weeks following primary repair of OASIS were asked to complete the Manchester Health Questionnaire and a questionnaire to obtain a St Mark incontinence score. All women had endoanal scans at this visit. In June 2008 all women were asked to complete the questionnaires again. Results Of 344 patients who responded to the questionnaires and were included in the analysis, long-term symptoms of fecal urgency, flatus incontinence, and fecal incontinence occurred in 62 (18.0%), 52 (15.1%), and 36 (10.5%), respectively. Overall, there was a significant improvement in fecal urgency (P<0.001) and flatus incontinence (P<0.001) from 9weeks to 3years. Of 31 women with fecal incontinence symptoms at early follow-up, 28 were asymptomatic at 3years. However, 33 women developed de novo symptoms. The only predictors of fecal incontinence at 3years were fecal urgency at 9weeks (OR 4.65; 95% CI, 1.3815.70) and a higher St Mark score (OR 1.40; 95% CI, 1.091.80). Conclusion Following primary repair of OASIS, the majority of symptoms and QoL significantly improve, unless there is a persistent anal sphincter defect. This highlights the importance of adequate repair. PMID:25097141

  14. 3D Topography of the Young Adult Anal Sphincter Complex Reconstructed from Undeformed Serial Anatomical Sections

    PubMed Central

    Wu, Yi; Dabhoiwala, Noshir F.; Hagoort, Jaco; Shan, Jin-Lu; Tan, Li-Wen; Fang, Bin-Ji; Zhang, Shao-Xiang; Lamers, Wouter H.

    2015-01-01

    Background Pelvic-floor anatomy is usually studied by artifact-prone dissection or imaging, which requires prior anatomical knowledge. We used the serial-section approach to settle contentious issues and an interactive 3D-pdf to make the results widely accessible. Method 3D reconstructions of undeformed thin serial anatomical sections of 4 females and 2 males (21–35y) of the Chinese Visible Human database. Findings Based on tendinous septa and muscle-fiber orientation as segmentation guides, the anal-sphincter complex (ASC) comprised the subcutaneous external anal sphincter (EAS) and the U-shaped puborectal muscle, a part of the levator ani muscle (LAM). The anococcygeal ligament fixed the EAS to the coccygeal bone. The puborectal-muscle loops, which define the levator hiatus, passed around the anorectal junction and inserted anteriorly on the perineal body and pubic bone. The LAM had a common anterior attachment to the pubic bone, but separated posteriorly into puborectal and “pubovisceral” muscles. This pubovisceral muscle was bilayered: its internal layer attached to the conjoint longitudinal muscle of the rectum and the rectococcygeal fascia, while its outer, patchy layer reinforced the inner layer. ASC contraction makes the ano-rectal bend more acute and lifts the pelvic floor. Extensions of the rectal longitudinal smooth muscle to the coccygeal bone (rectococcygeal muscle), perineal body (rectoperineal muscle), and endopelvic fascia (conjoint longitudinal and pubovisceral muscles) formed a “diaphragm” at the inferior boundary of the mesorectum that suspended the anorectal junction. Its contraction should straighten the anorectal bend. Conclusion The serial-section approach settled contentious topographic issues of the pelvic floor. We propose that the ASC is involved in continence and the rectal diaphragm in defecation. PMID:26305117

  15. Intersphincteric resection with partial removal of external anal sphincter for low rectal cancer.

    PubMed

    Shelygin, Y A; Vorobiev, G I; Pikunov, D Yu; Markova, E V; Djhanaev, Y A; Fomenko, O Yu

    2008-01-01

    Abdominoperineal resection (APR) remains the standard procedure for rectal cancer located within 0.5 cm from dentate line (DL). In this study, we present a new type of restorative surgery: intersphincteric resection with partial removal of external anal sphincter (EAS) and anorectal reconstruction for-ultra low rectal cancer. Between March 2003 and May 2008 fifty patients (28 males, aged between 39 and 71) were operated on for ultra low rectal cancer uT2-3N0M0 with partial preservation of EAS and total anorectal reconstruction (smooth-muscle neosphincter and colonic pouch). A protective stoma was performed in all cases. Functional outcome and quality of life were recorded at 3, 6, 12, 18, 24 months after stoma closure using Wexner score and FIQL respectively. Anal manometry, vectrum volumetry and myography data were taken as well. Results. Postoperative complications developed in 2 patients, but no secondary surgery was required. Carcinomas were staged as pT2 (n = 14) and pT3 (n = 36). The distal clearance was 2.00.4 (range 1.5-2.8) cm, lateral clearance was 0.80.3 (range 0.2-1.4) cm. After a median follow-up of 24 (range 2-61) months, 2 local recurrences were occurred and salvaged by APR. Contractive activity of saved elements of EAS improved with a course of time and squeezing anal pressure increased as well. Perfect functional outcome was achieved in 25 of 34 patients at 12 months after stoma closure, and all the patients were satisfied with procedure. Good functional results of suggested surgery seems to be an acceptable alternative to APR with permanent stoma in selected patients. PMID:19069692

  16. Assessing the association of oxytocin augmentation with obstetric anal sphincter injury in nulliparous women: a population-based, casecontrol study

    PubMed Central

    Rygh, Astrid B; Skjeldestad, Finn Egil; Krner, Hartwig; Eggeb, Torbjrn M

    2014-01-01

    Objective To assess the association of oxytocin augmentation with obstetric anal sphincter injury among nulliparous women. Design Population-based, casecontrol study. Setting Primary and secondary teaching hospital serving a Norwegian region. Population 15?476 nulliparous women with spontaneous start of labour, single cephalic presentation and gestation ?37?weeks delivering vaginally between 1999 and 2012. Methods Based on the presence or absence of oxytocin augmentation, episiotomy, operative vaginal delivery and birth weight (<4000 vs ?4000?g), we modelled in logistic regression the best fit for prediction of anal sphincter injury. Within the modified model of main exposures, we tested for possible confounding, and interactions between maternal age, ethnicity, occiput posterior position and epidural analgaesia. Main outcome measure Obstetric anal sphincter injury. Results Oxytocin augmentation was associated with a higher OR of obstetric anal sphincter injuries in women giving spontaneous birth to infants weighing <4000?g (OR 1.8; 95% CI 1.5 to 2.2). Episiotomy was not associated with sphincter injuries in spontaneous births, but with a lower OR in operative vaginal deliveries. Spontaneous delivery of infants weighing ?4000?g was associated with a threefold higher OR, and epidural analgaesia was associated with a 30% lower OR in comparison to no epidural analgaesia. Conclusions Oxytocin augmentation was associated with a higher OR of obstetric anal sphincter injuries during spontaneous deliveries of normal-size infants. We observed a considerable effect modification between the most important factors predicting anal sphincter injuries in the active second stage of labour. PMID:25059967

  17. Neurotransmitter interactions in smooth muscles from cat internal anal sphincter (in vitro experiments).

    PubMed

    Todorov, L; Papasova, M

    1984-01-01

    The contractile activity of strips (15 X 2 mm) isolated from cat internal anal sphincter (IAS) has been studied under isometric conditions. Noradrenaline (above 10(-10) mol/l) induces contraction of IAS, antagonized by phentolamine. Isoprenaline (10(-8)-10(-5) mol/l) has no effect on IAS. Acetylcholine and carbachol (above 10(-6) mol/l) result in relaxation of the IAS preparations, which is blocked only by simultaneous administration of atropin (10(-6) mol/l) and hexamethonium (10(-4) mol/l). The acetylcholine-induced relaxation is not influenced by guanetidine and reserpine, but it is antagonized by tetrodotoxin (TTX) (10(-7) g/ml). Nicotine (10(-6)-10(-4) mol/l) also causes IAS relaxation which is not influenced by atropin, being blocked by hexamethonium and antagonized by TTX. The IAS relaxation induced by acetylcholine and nicotine is not associated with adrenergic mechanisms; it is assumed to be the result of a release of noncholinergic, nonadrenergic inhibitory neurotransmitter by means of presynaptic postganglionic cholinergic receptors. Data are also presented concerning the release of noradrenaline through presynaptic N-cholinergic receptors, when nicotine and high acetylcholine concentrations are applied after treatment of the preparations with scorpion venom or after increasing the K+-concentration in the nutrient solution to 16-20 mmol/l. The complex neurotransmitter interactions at IAS level are discussed. PMID:6146240

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

    PubMed

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

    2015-01-01

    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

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

    PubMed Central

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

    2013-01-01

    Objective To re-evaluate previously published findings from an uncontrolled beforeafter evaluation of an intervention programme to reduce the incidence of anal sphincter tears. A key component of the programme was the use of a hands-on technique where the birth attendant presses the neonate's head during the final stage of delivery while simultaneously supporting the woman's perineum with the other hand. Design Interrupted time-series analysis using segmented regression modelling. Setting Obstetric departments of five Norwegian hospitals. Participants All women giving births vaginally in the study hospitals, 20022008. Methods The main data source was the Medical Birth Registry of Norway. We estimated the change in incidence of anal sphincter tears before and after implementation of the intervention in the five intervention hospitals, taking into account the trends in incidence before and after implementation. Main outcome measures Incidence of anal sphincter tears and episiotomies. Results There were 75?543 registered births at the five included hospitals. We found a 2% absolute reduction in incidence of anal sphincter tears associated with the hospital intervention programme, representing almost a halving in the number of women experiencing serious anal sphincter tears. This is a substantially smaller estimate than previously reported. However, it does represent a highly significant decrease in anal sphincter injuries. The programme was also associated with a significant increase in episiotomies. Conclusions The intervention programme was associated with a significant reduction in the incidence of obstetric anal sphincter tears. Still, the findings should be interpreted with caution as they seem to contradict the findings from randomised controlled studies of similar interventions. PMID:24154515

  20. Does the Finnish intervention prevent obstetric anal sphincter injuries? A systematic review of the literature

    PubMed Central

    Poulsen, Mette stergaard; Madsen, Mia Lund; Skriver-Mller, Anne-Cathrine; Overgaard, Charlotte

    2015-01-01

    Objectives A rise in obstetric anal sphincter injuries (OASIS) has been observed and a preventive approach, originating in Finland, has been introduced in several European hospitals. The aim of this paper was to systematically evaluate the evidence behind the Finnish intervention. Design A systematic review of the literature conducted according to the Preferred Reporting for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Outcome measures The primary outcome was OASIS. Secondary outcomes were (perinatal): Apgar scores, pH and standard base excess in the umbilical cord, and (maternal): episiotomy, intact perineum, first and second-degree perineal lacerations, duration of second stage, birth position and women's perceptions/birth experiences. Methods Multiple databases (Cochrane, Embase, Pubmed and SveMed) were systematically searched for studies published up to December 2014. Both randomised controlled trials and observational studies were eligible for inclusion. Studies were excluded if a full-text article was not available. Studies were evaluated by use of international reporting guidelines (eg, STROBE). Results Overall, 1042 articles were screened and 65 retrieved for full-text evaluation. Seven studies, all observational and with a level of evidence at 2c or lower, were included and consistently reported a significant reduction in OASIS. All evaluated episiotomy and found a significant increase. Three studies evaluated perinatal outcomes and reported conflicting results. No study reported on other perineal outcomes, duration of the second stage, birth positions or women's perceptions. Conclusions A reduction in OASIS has been contributed to the Finnish intervention in seven observational studies, all with a low level of evidence. Knowledge about the potential perinatal and maternal side effects and women's perceptions of the intervention is extremely limited and the biological mechanisms underlying the Finnish intervention are not well documented. Studies with a high level of evidence are needed to assess the effects of the intervention before implementation in clinical settings can be recommended. PMID:26369797

  1. Optimal Design of Litz Wire Coils With Sandwich Structure Wirelessly Powering an Artificial Anal Sphincter System.

    PubMed

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

    2015-07-01

    Transcutaneous energy transfer system (TETS) is widely used to energize implantable biomedical devices. As a key part of the TETS, a pair of applicable coils with low losses, high unloaded Q factor, and strong coupling is required to realize an efficient TETS. This article presents an optimal design methodology of planar litz wire coils sandwiched between two ferrite substrates wirelessly powering a novel mechanical artificial anal sphincter system for treating severe fecal incontinence, with focus on the main parameters of the coils such as the wire diameter, number of turns, geometry, and the properties of the ferrite substrate. The theoretical basis of optimal power transfer efficiency in an inductive link was analyzed. A set of analytical expressions are outlined to calculate the winding resistance of a litz wire coil on ferrite substrate, taking into account eddy-current losses, including conduction losses and induction losses. Expressions that describe the geometrical dimension dependence of self- and mutual inductance are derived. The influence of ferrite substrate relative permeability and dimensions is also considered. We have used this foundation to devise an applicable coil design method that starts with a set of realistic constraints and ends with the optimal coil pair geometries. All theoretical predictions are verified with measurements using different types of fabricated coils. The results indicate that the analysis is useful for optimizing the geometry design of windings and the ferrite substrate in a sandwich structure as part of which, in addition to providing design insight, allows speeding up the system efficiency-optimizing design process. PMID:25808086

  2. Heme oxygenase-1 upregulation modulates tone and fibroelastic properties of internal anal sphincter

    PubMed Central

    Krishna, Chadalavada Vijay; Singh, Jagmohan; Kumar, Sumit

    2014-01-01

    A compromise in the internal anal sphincter (IAS) tone and fibroelastic properties (FEP) plays an important role in rectoanal incontinence. Herein, we examined the effects of heme oxygenase (HO)-1 upregulation on these IAS characteristics in young rats. We determined the effect of HO-1 upregulator hemin on HO-1 mRNA and protein expressions and on basal IAS tone and its FEP before and after HO-1 inhibitor tin protoporphyrin IX. For FEP, we determined the kinetics of the IAS smooth muscle responses, by the velocities of relaxation, and recovery of the IAS tone following 0 Ca2+ and electrical field stimulation. To characterize the underlying signal transduction for these changes, we determined the effects of hemin on RhoA-associated kinase (RhoA)/Rho kinase (ROCK) II, myosin-binding subunit of myosin light chain phosphatase 1, fibronectin, and elastin expression levels. Hemin increased HO-1 mRNA and protein similar to the increases in the basal tone, and in the FEP of the IAS. Underlying mechanisms in the IAS characteristics are associated with increases in the genetic and translational expressions of RhoA/ROCKII, and elastin. Fibronectin expression levels on the other hand were found to be decreased following HO-1 upregulation. The results of our study show that the hemin/HO-1 system regulates the tone and FEP of IAS. The hemin/HO-1 system thus provides a potential target for the development of new interventions aimed at treatment of gastrointestinal motility disorders, specifically the age-related IAS dysfunction. PMID:25035109

  3. The Association of Episiotomy with Obstetric Anal Sphincter InjuryA Population Based Matched Cohort Study

    PubMed Central

    Risnen, Sari; Selander, Tuomas; Cartwright, Rufus; Gissler, Mika; Kramer, Michael R.; Laine, Katariina; Heinonen, Seppo

    2014-01-01

    Objectives To estimate the independent association of episiotomy with obstetric anal sphincter injuries (OASIS) using first a cross-sectional and then a matched pair analysis. Design A matched cohort. Setting Data was gathered from the Finnish Medical Birth Register from 20042011. Population All singleton vaginal births (n?=?303,758). Methods Women resulting matched pairs (n?=?63,925) were matched based on baseline risk of OASIS defined based on parity (first or second/subsequent vaginal births), age, birth weight, mode of delivery, prior caesarean section, and length of active second stage of birth. Results In cross-sectional analysis episiotomy was associated with a 12% lower incidence of OASIS (adjusted odds ratio (aOR) 0.88, 95% confidence interval (CI) 0.80 to 0.98) in first vaginal births and with a 132% increased incidence of OASIS in second or subsequent vaginal births (aOR 2.32, 95% CI 1.77 to 3.03). In matched pair analysis episiotomy was associated with a 23% (aOR 0.77, 95% CI 0.69 to 0.86) lower incidence of OASIS in first vaginal births and a 61% (aOR 1.61, 95% CI 1.14 to 2.29) increased incidence of OASIS in second or subsequent vaginal births compared to women who gave birth without an episiotomy. The matched pair analysis showed a 12.5% and a 31.6% reduction in aORs of OASIS associated with episiotomy, respectively. Conclusions A matched pair analysis showed a substantial reduction in the aORs of OASIS with episiotomy, due to confounding by indication. This indicates that results of observational studies evaluating an association between episiotomy and OASIS should be interpreted with caution. PMID:25203655

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

    PubMed Central

    2014-01-01

    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 5year period (20042008) 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

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

    PubMed Central

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

    2012-01-01

    BACKGROUND & AIMS Patients with systemic sclerosis (SSc) have impairments in gastrointestinal smooth muscle function. The disorder has been associated with circulating antibodies to cholinergic muscarinic type-3 receptor (M3-R). We investigated whether it is possible to neutralize these antibodies with pooled human immunoglobulin (Ig)Gs (pooledhIgG). METHODS We studied the effects of IgGs purified from patients with SSc (SScIgGs) on cholinergic nerve stimulation in rat colon tissues. We also examined the effects of SScIgGs on M3-R activation by bethanechol (BeCh), M3-R occupancy, and receptor binding using mmunofluorescence, immunoblot, and ELISA analyses of human internal anal sphincter (IAS) smooth muscle cells (hSMCs), before and after administration of pooledhIgG. Functional displacement of M3-R occupancy by the SScIgGs was compared with that of other IgGs during the sustained phase of BeCh-induced contraction of intact smooth muscles from rats. RESULTS SScIgG significantly attenuated neutrally mediated contraction and acetylcholine release in rat colon as well as BeCh-induced sustained contraction of the IAS smooth muscle. In immunofluorescence analysis, SScIgG co-localized with M3-R. In immunoblot and ELISA analyses, M3-R loop-2 peptide and human IAS SMC membrane lysates bound significant amounts of SScIgG, compared with IgGs from healthy individuals and pooledhIgG. Binding was significantly attenuated by application of pooledhIgG, which by itself had no significant effect. Incubation of samples with pooledhIgG, or mixing pooledhIgG with SScIgG before administration to tissues, significantly reduced binding of SScIgG, indicating that pooledhIgG prevents SScIgG blockade of M3-R. CONCLUSIONS In studies of rat and human tissues, pooled human IgGs prevent and reverse the cholinergic dysfunctions associated with the progressive gastrointestinal manifestations of SSc, by neutralizing functional M3-R antibodies present in the circulation of patients with SSc. PMID:22864255

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

    PubMed

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

    2009-08-01

    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

  7. Nature of extracellular signal that triggers RhoA/ROCK activation for the basal internal anal sphincter tone in humans.

    PubMed

    Rattan, Satish; Singh, Jagmohan; Kumar, Sumit; Phillips, Benjamin

    2015-06-01

    The extracellular signal that triggers activation of rho-associated kinase (RhoA/ROCK), the major molecular determinant of basal internal anal sphincter (IAS) smooth muscle tone, is not known. Using human IAS tissues, we identified the presence of the biosynthetic machineries for angiotensin II (ANG II), thromboxane A2 (TXA2), and prostaglandin F2? (PGF2?). These end products of the renin-angiotensin system (RAS) (ANG II) and arachidonic acid (TXA2 and PGF2?) pathways and their effects in human IAS vs. rectal smooth muscle (RSM) were studied. A multipronged approach utilizing immunocytochemistry, Western blot analyses, and force measurements was implemented. Additionally, in a systematic analysis of the effects of respective inhibitors along different steps of biosynthesis and those of antagonists, their end products were evaluated either individually or in combination. To further describe the molecular mechanism for the IAS tone via these pathways, we monitored RhoA/ROCK activation and its signal transduction cascade. Data showed characteristically higher expression of biosynthetic machineries of RAS and AA pathways in the IAS compared with the RSM. Additionally, specific inhibition of the arachidonic acid (AA) pathway caused ~80% decrease in the IAS tone, whereas that of RAS lead to ~20% decrease. Signal transduction studies revealed that the end products of both AA and RAS pathways cause increase in the IAS tone via activation of RhoA/ROCK. Both AA and RAS (via the release of their end products TXA2, PGF2?, and ANG II, respectively), provide extracellular signals which activate RhoA/ROCK for the maintenance of the basal tone in human IAS. PMID:25882611

  8. Comparative evaluation of immune response after laparoscopical and open total mesorectal excisions with anal sphincter preservation in patients with rectal cancer

    PubMed Central

    Hu, Jian-Kun; Zhou, Zong-Guang; Chen, Zhi-Xin; Wang, Lan-Lan; Yu, Yong-Yang; Liu, Jin; Zhang, Bo; Li, Li; Shu, Ye; Chen, Jia-Ping

    2003-01-01

    AIM: The study of immune response of open versus laparoscopical total mesorectal excision with anal sphincter preservation in patients with rectal cancer has not been reported yet. The dissected retroperitoneal area that contacts directly with carbon dioxide is extensive in laparoscopic total mesorectal excision with anal sphincter preservation surgery. It is important to clarify whether the immune response of laparoscopic total mesorectal excision with anal sphincter preservation (LTME with ASP) in patients with rectal cancer is suppressed more severely than that of open surgery (OTME with ASP). This study was designed to compare the immune functions after laparoscopic and open total mesorectal excision with anal sphincter preservation for rectal cancer. METHODS: This study involved 45 patients undergoing laparoscopic (n = 20) and open (n = 25) total mesorectal excisions with anal sphincter preservation for rectal cancer. Serum interleukin-2 (IL-2), interleukin-6 (IL-6), tumor necrosis factor ? (TNF?) were assayed preoperatively and on days 1 and 5 postoperatively. CD3+ and CD56+ T lymphocyte count, CD3- and CD56+ natural killer cell (NK) count and immunoglobulin (IgG/IgM/IgA) were assayed preoperatively and on day 5 postoperatively. The numbers of CD3+ and CD56+ T lymphocytes and CD3- and CD56+ NK cells were counted using flow cytometry. An enzyme-linked immunosorbent assay (ELISA) was used for IL-2, IL-6 and TNF? determination. And IgG, IgM, and IgA were assayed using immunonephelometry. RESULTS: The demographic data of the two groups had no difference. The preoperative levels of CD3+ and CD56+ T lymphocyte count, CD3- and CD56+ NK count, serum IgG, IgM, IgA, IL-2, IL-6 and TNF? also had no significant difference in the two groups (P > 0.05). The CD3+ and CD56+ T lymphocyte counts had no obvious changes after surgery in laparoscopic (d = -0.79% 3.83%) and open (d = 0.42% 2.09%) groups. The CD3- and CD56+ NK counts were decreased postoperatively in both laparoscopic (d = -7.23% 11.33%) and open (d = -9.21% 13.93%) groups. The differences of the determined values of serum IgG, IgM and IgA on the fifth day after operation subtracted those before operation were -2.56 2.14 g/L, -252.35 392.94 mg/L, -506.15 912.24 mg/L in laparoscopic group, and -1.81 2.10 g/L, -282.72 356.75 mg/L, -252.20 396.28 mg/L in open group, respectively. The levels of IL-2 were decreased after operation in both groups. However, the levels of IL-6 were decreased after laparoscopic surgery (d1 = -23.14 263.97 ng/L and d5 = -40.08 272.03 ng/L), and increased after open surgery (d1 = 27.38 129.14 ng/L and d5 = 21.67 234.31 ng/L). The TNF? levels were not elevated after surgery in both groups. There were no significant differences in the numbers of CD3+ and CD56+ T lymphocytes and CD3- and CD56+ NK cells, the levels of IgG, IgM, IgA, IL-2, IL-6 and TNF? between the two groups (P > 0.05). CONCLUSION: There are no differences in immune responses between the patients having laparoscopic total mesorectal excision with anal sphincter preservation and those undergone open surgery for rectal cancer. PMID:14669314

  9. Defensive anality and anal narcissism.

    PubMed

    Shengold, L

    1985-01-01

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

  10. Three Gaseous Neurotransmitters, Nitric oxide, Carbon Monoxide, and Hydrogen Sulfide, Are Involved in the Neurogenic Relaxation Responses of the Porcine Internal Anal Sphincter

    PubMed Central

    Folasire, Oladayo; Mills, Kylie A; Sellers, Donna J; Chess-Williams, Russ

    2016-01-01

    Background/Aims The internal anal sphincter (IAS) plays an important role in maintaining continence and a number of neurotransmitters are known to regulate IAS tone. The aim of this study was to determine the relative importance of the neurotransmitters involved in the relaxant and contractile responses of the porcine IAS. Methods Responses of isolated strips of IAS to electrical field stimulation (EFS) were obtained in the absence and presence of inhibitors of neurotransmitter systems. Results Contractile responses of the sphincter to EFS were unaffected by the muscarinic receptor antagonist, atropine (1 μM), but were almost completely abolished by the adrenergic neuron blocker guanethidine (10 μM). Contractile responses were also reduced (by 45% at 5 Hz, P < 0.01) following desensitisation of purinergic receptors with α,β-methylene-ATP (10 μM). In the presence of guanethidine, atropine, and α,β-methylene-ATP, the remaining relaxatory responses to EFS were examined. These responses were not altered by the cyclooxygenase inhibitor, indomethacin (5 μM), the vasoactive intestinal polypeptide receptor antagonist, [d-p-Cl-Phe6,Leu17]-vasoactive intestinal peptide (PheLeu-VIP; 100 nM), or the purinoceptor antagonists, 8-phenyltheophyline (P1 receptors) or suramin (P2 receptors). However, relaxation responses were reduced by Nω-nitro-L-arginine (L-NNA; 100 μM), an inhibitor of nitric oxide synthesis (40–50% reduction), zinc protoprophyrin IX (10 μM), an inhibitor of carbon monoxide synthesis (20–40% reduction), and also propargylglycine (30 μM) and aminooxyacetic acid (30 μM), inhibitors of hydrogen sulphide synthesis (15–20% reduction). Conclusions Stimulation of IAS efferent nerves releases excitatory and inhibitory neurotransmitters: noradrenaline is the predominant contractile transmitter with a smaller component from ATP, whilst 3 gases mediate relaxation responses to EFS, with the combined contributions being nitric oxide > carbon monoxide > hydrogen sulfide. PMID:26486177

  11. Anal Fissure.

    PubMed

    Beaty, Jennifer Sam; Shashidharan, M

    2016-03-01

    Anal fissure (fissure-in-ano) is a very common anorectal condition. The exact etiology of this condition is debated; however, there is a clear association with elevated internal anal sphincter pressures. Though hard bowel movements are implicated in fissure etiology, they are not universally present in patients with anal fissures. Half of all patients with fissures heal with nonoperative management such as high fiber diet, sitz baths, and pharmacological agents. When nonoperative management fails, surgical treatment with lateral internal sphincterotomy has a high success rate. In this chapter, we will review the symptoms, pathophysiology, and management of anal fissures. PMID:26929749

  12. Surgical Reconstruction of the Urinary Sphincter after Traumatic Longitudinal Disruption

    PubMed Central

    Rehder, Peter; Schillfahrt, Florian; Skradski, Viktor

    2014-01-01

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

  13. Comparison of obstetric anal sphincter injuries in nulliparous women before and after introduction of the EPISCISSORS-60 at two hospitals in the United Kingdom

    PubMed Central

    van Roon, Yves; Kirwin, Ciara; Rahman, Nadia; Vinayakarao, Latha; Melson, Louise; Kester, Nikki; Pathak, Sangeeta; Pradhan, Ashish

    2015-01-01

    Aim To assess whether the introduction of episiotomy scissors specially designed to achieve a cutting angle of 60, EPISCISSORS-60, in two hospitals in the UK would result in a reduction in obstetric anal sphincter injuries (OASIS) in nulliparous women. Methods A structured training program for all doctors and midwives provided a theoretical framework around OASIS including risk factors and the role of episiotomies and a practical hands-on training element to use EPISCISSORS-60 correctly and to measure perineal body length and post-suturing angles. Data for perineal body length, post-suturing angles, user feedback, episiotomy use, and incidence of OASIS were collected through specifically designed forms and the general hospital data collection system. Results Data were available for 838 nulliparous vaginal deliveries. Mean perineal body length was 37 mm in spontaneous vaginal delivery group (standard deviation [SD] =8.3, 95% confidence interval [CI] =3439) and 38 mm in the operative vaginal delivery group (SD=8, 95% CI=3540). Post-suturing episiotomy angles were 53 (SD=6.5, 95% CI=50.755.8) in spontaneous vaginal deliveries and 52 (SD=9.6, 95% CI=4954) in operative vaginal deliveries. EPISCISSORS-60 were rated as good to very good by 84% of users. There was a 47% increase in the number of episiotomies in nulliparous spontaneous vaginal deliveries at Poole (P=0.007) and a 16.5% increase in the number of episiotomies in nulliparous operative vaginal deliveries in Hinchingbrooke (P=0.003). There was an overall 11% increase in episiotomy numbers in nulliparous vaginal deliveries (P=0.08). There was a statistically significant OASIS reduction of 84% in nulliparous spontaneous vaginal deliveries in women who received an episiotomy (P=0.003). Conclusion Initial results after introduction of EPISCISSORS-60 show that the majority of health care professionals achieve post-suturing episiotomy angles between 40 and 60. The results also show a significant increase in the use of episiotomies in the delivery of nulliparous women. There has been a statistically significant reduction in OASIS in nulliparous spontaneous vaginal deliveries. PMID:26677344

  14. Electrophysiological aspects of human sphincter function

    PubMed Central

    Ustach, Thomas J.; Tobon, Fabio; Hambrecht, Terry; Bass, D. David; Schuster, Marvin M.

    1970-01-01

    In order to investigate the electrophysiology of the human internal anal sphincter and two current concepts of sphincter function, simultaneous manometric and electrical recordings were made from circular smooth muscle of the internal anal sphincter in the resting state and during reflexly induced sphincter relaxation. Three groups were studied: seven normal subjects, 25 patients with functional bowel disease, and seven patients with external sphincter paralysis due to spinal cord lesions. In the resting state slow waves of alternating potential (basic electrical rhythm or BER) were recorded in all subjects. Two types of waves were present, a constant sinusoidal pattern or a spindleshaped pattern. Either pattern was consistent for a given individual. Frequency of BER in the internal sphincter was higher than that recorded in any other gastrointestinal muscle. Our findings indicate that the BER recorded from the internal anal sphincter originates in this muscle. This activity may represent a specialized feature of sphincteric muscle since BER cannot be recorded from isolated nonsphincteric circular muscle. Reproduction of the two patterns of BER by an electronic model suggests that BER, as recorded by this technique, results from a summation of a number of electrically active cells in contact with the recording electrodes. Inhibition of BER occurred when sphincter relaxation was reflexly induced by rectal distension. Both inhibition of BER and degree of sphincter relaxation were proportional to the strength of rectal stimulation, suggesting that strength of stimulus determines the number of active cells which are inhibited. The associations of high frequency of BER with high resting pressure, and of inhibition of BER with sphincter relaxation suggests that maintenance of sphincter tone is an active process that is governed by BER. Images PMID:5409807

  15. [One-stage surgery of high trans- and supra-sphincter anal fistula using primary fistulectomy and occlusion of the internal fistula ostium. A prospective study of 169 patients].

    PubMed

    Athanasiadis, S; Lux, N; Fischbach, N; Meyer, B

    1991-08-01

    In a prospective study on 169 patients with a so-called high fistula-in-ano (147 transsphincteric, 22 suprasphincteric) the value of a sphincter-saving operation technique was assessed. This technique consists of one-stage fistulectomy as well as of drainage of the intersphincteric space by internal sphincterotomy. The site of the former primary orifice of the fistula is adapted by multiple peranally performed single stitches. The perianal part of the wound is left to heal by second intention. Post-operatively, 19 cases of suture leakage occurred (9.5% with the transsphincteric and 23% with the suprasphincteric fistula, resp.). 32 patients (19%) had to have repeated surgery because of recurrent abscess or fistula or because of suture leakage (mean follow-up 3.2 years). Anal manometry was carried out preoperatively as well as postoperatively. It revealed a decrease in anal resting and squeezing pressure of 10 to 40% with a mean about 30%. Of the patients who had not been operated on previously, an impairment of continence developed in 15% postoperatively. This percentage rose up to 40% according to the rising number of previous fistula operations. The main problem in these cases was soiling. Total anorectal incontinence for formed stool did not occur. PMID:1935396

  16. [Etiology, pathogenesis and classification of anal fissure].

    PubMed

    Wehrli, H

    1996-01-01

    Anal fissure is one of the most common causes of anal pain but its etiology and pathophysiology remain obscure. Many theories have been advanced to explain the origin of anal fissures but trauma of faecal mass and hypertonicity of the internal sphincter seem to be the most important factors. The initial lesion in anal fissure is a tear in the anoderm mostly in its posterior midline caused by overstretching of the anal canal. Secondary fissures may occur on a commonly lateral position as a result of inflammatory bowel disease, previous anal surgery, venereal, dermatologic, infectious or neoplastic disease. As the fissure becomes deeper and more chronic the sclerotic fibres of the internal anal sphincter are seen as well as a sentinel pile and a hypertrophied anal papilla. The disease enters in a vicious circle of anal pain, constipation, faecal trauma and sphincter spasm. PMID:8871258

  17. Clinical and physiological study of anal sphincter and ileal J pouch before preileostomy closure and 6 and 12 months after closure of loop ileostomy.

    PubMed

    Chaussade, S; Michopoulos, S; Hautefeuille, M; Valleur, P; Hautefeuille, P; Guerre, J; Couturier, D

    1991-02-01

    Spontaneous evolution of pouch and anal function, and absorption features has been assessed in 15 patients who underwent proctocolectomy with J ileal pouch anastomosis without conservation of a rectal muscular cuff. All the patients were studied before preileostomy closure and six and 12 months after the closure of the protection loop ileostomy. Stool frequency was identical at six and 12 months (mean +/- SEM: 5.0 +/- 0.4 and 5.3 +/- 0.5/day, respectively). Sixty-six percent of patients at six months and 40% of patients at 12 months need to defecate at least one time during night. Stool weight as well as steatorrhea decreased significantly six months after the closure of loop ileostomy (P less than 0.05). Mean resting anal pressure remained unchanged six and 12 months after closure of the loop ileostomy (41 +/- 6 and 45 +/- 5 cm H2O, respectively). Maximum squeeze anal pressures increased significantly at six (P less than 0.05) and 12 months (P less than 0.05). The rectoanal inhibitory reflex was always absent at the same period. The maximum pouch capacity increased significantly during the first six months (P less than 0.01) from 142 +/- 17 to 279 +/- 27 ml. The maximum infused volume during a saline continence test was not significantly different at six and 12 months; the percentage of evacuation of the reservoir and the volume at which the first ileal contraction appeared in the reservoir increased significantly (P less than 0.05) at six and 12 months. In conclusion, in patients with ileoanal anastomosis and pouch reservoir, the closure of the loop ileostomy is associated with spontaneous modifications of the anal and pouch parameters.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1988259

  18. Sphincter tears in primiparous women: Is age a factor?

    PubMed Central

    BOWLING, C. Bryce; WHEELER, Thomas L.; GERTEN, Kimberly A.; CHAPMAN, Victoria R.; BURGIO, Kathryn L.; RICHTER, Holly E.

    2011-01-01

    Introduction and Hypothesis Anal sphincter tears during vaginal delivery may result in serious sequelae. We examined whether younger primiparous patients were at increased risk for sphincter tears during vaginal delivery. Methods Data from an obstetric automated record were analyzed. Primiparous women delivering term infants (n = 5,937) were included to test for an association between age and sphincter tear rates. Three age groups were considered: young adolescents (?16 years), older adolescents (17-20 years) and adults (?21 years). Results No significant difference was found in tear rates among age cohorts (9.2%, 8.0%, and 9.6% respectively; p = 0.12). Logistic regression modeling revealed that young adolescents were not more likely to have sphincter tears compared to older cohorts. Conclusions Younger adolescents may not be at increased risk of anal sphincter tears. Decisions regarding interventions to decrease sphincter tears during vaginal delivery should not be made on the basis of maternal age alone. PMID:18985267

  19. Modern management of anal fistula

    PubMed Central

    Limura, Elsa; Giordano, Pasquale

    2015-01-01

    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

  20. Anorectal conditions: anal fissure and anorectal fistula.

    PubMed

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

    2014-04-01

    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

  1. Sphincter lesions observed on ultrasound after transanal endoscopic surgery

    PubMed Central

    Mora Lpez, Laura; Serra-Aracil, Xavier; Navarro Soto, Salvador

    2015-01-01

    AIM: To assess the morphological impact of transanal endoscopic surgery on the sphincter apparatus using the modified Starck classification. METHODS: A prospective, observational study of 118 consecutive patients undergoing Transanal Endoscopic Operation/Transanal Endoscopic Microsurgery (TEO/TEM) from March 2013 to May 2014 was performed. All the patients underwent an endoanal ultrasound prior to surgery and one and four months postoperatively in order to measure sphincter width, identify sphincter defects and to quantify them in terms of the level, depth and size of the affected anal canal. To assess the lesions, we used the modified Starck classification, which incorporates the variable sphincter fragmentation. The results were correlated with the Wexner incontinence questionnaire. RESULTS: Of the 118 patients, twelve (sphincter lesions) were excluded. The results of the 106 patients were as follows after one month: 31 (29.2%) lesions found on ultrasound after one month, median overall Starck score of 4 (range 3-6); 10 (9.4%) defects in the internal anal sphincter (IAS) and 3 (2.8%) in the external anal sphincter (EAS); 17 patients (16%) had fragmentation of the sphincter apparatus with both sphincters affected in one case. At four months: 7 (6.6%) defects, all in the IAS, overall median Starck score of 4 (range 3-6). Mean IAS widths were 3.5 mm (SD 1.14) preoperatively, 4.38 mm (SD 2.1) one month postoperatively and 4.03 mm (SD 1.46) four months postoperatively. The only statistically significant difference in sphincter width in the IAS measurements was between preoperatively and one month postoperatively. No incontinence was reported, even in cases of ultrasound abnormalities. CONCLUSION: TEO/TEM may produce ultrasound abnormalities but this is not accompanied by clinical changes in continence. The modified Starck classification is useful for describing and managing these disorders. PMID:26674666

  2. [Perianal fistula and anal fissure].

    PubMed

    Heitland, W

    2012-12-01

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

  3. Update on the management of anal fissure.

    PubMed

    Higuero, T

    2015-04-01

    Anal fissure is an ulceration of the anoderm in the anal canal. Its pathogenesis is due to multiple factors: mechanical trauma, sphincter spasm, and ischemia. Treatment must address these causative factors. While American and British scientific societies have published recommendations, there is no formal treatment consensus in France. Medical treatment is non-specific, aimed at softening the stool and facilitating regular bowel movements; this results in healing of almost 50% of acute anal fissures. The risk of recurrent fissure remains high if the causative factors persist. If non-specific medical treatment fails, specific medical treatment can be offered to reversibly decrease hypertonic sphincter spasm. Surgery remains the most effective long-term treatment and should be offered for cases of chronic or complicated anal fissure but also for acute anal fissure with severe pain or for recurrent fissure despite optimal medical treatment. Surgical treatment is based on two principles that may be combined: decreasing sphincter tone and excision of the anal fissure. Lateral internal sphincterotomy (LIS) is the best-evaluated technique and remains the gold standard in English-speaking countries. Since LIS is associated with some risk of irreversible anal incontinence, its use is controversial in France where fissurectomy combined with anoplasty is preferred. Other techniques have been described to reduce the risk of incontinence (calibrated sphincterotomy, sphincteroplasty). The technique of forcible uncalibrated anal dilatation is no longer recommended. PMID:25305752

  4. Anal fistula: Intraoperative difficulties and unexpected findings

    PubMed Central

    Abou-Zeid, Ahmed A

    2011-01-01

    Anal fistula surgery is a commonly performed procedure. The diverse anatomy of anal fistulae and their proximity to anal sphincters make accurate preoperative diagnosis essential to avoid recurrence and fecal incontinence. Despite the fact that proper preoperative diagnosis can be reached in the majority of patients by simple clinical examination, endoanal ultrasound or magnetic resonance imaging, on many occasions, unexpected findings can be encountered during surgery that can make the operation difficult and correct decision-making crucial. In this article we discuss the difficulties and unexpected findings that can be encountered during anal fistula surgery and how to overcome them. PMID:21876613

  5. New Techniques for Treating an Anal Fistula

    PubMed Central

    2012-01-01

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

  6. Conservative management of anal leiomyosarcoma

    SciTech Connect

    Minsky, B.D.; Cohen, A.M.; Hajdu, S.I. )

    1991-10-01

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

  7. [Proctectomy with external sphincter preservation: long-term functional results].

    PubMed

    Vorob'ev, G I; Shelygin, Iu A; Pikunov, D Iu; Rybakov, E G; Dzhanaev, Iu A; Fomenko, O Iu

    2009-01-01

    52 patients with the lower ampullary rectal cancer with tumor localization on the dentate line level had been operated with the use of the originally developed reconstructive technique, permitting preservation of the external anal sphincter elements and, consequently, partial continence. Colonic rectal pouch and smooth muscle cuff were performed during the neorectum and neoanus plasty. A protective stoma was performed in all cases. Contractive activity of saved elements of EAS improved with a course of time and squeezing anal pressure increased as well. Consequent continence improvement occurred during the first year after the stoma closure, biofeed-back therapy provided faster rehabilitation. The achieved long-term functional results (73,4% actuarial 5-year disease-free survival) prove the oncological efficacy of the method on the strict assumption of indications observance. Thus, proctectomy with partial external anal sphincter preservation allows to avoid permanent colostomy and provides a satisfactory quality of life of the operated patients. PMID:20032928

  8. Sphincter of Oddi Dysfunction

    MedlinePLUS

    ... GI Disorders The Digestive System Functional GI Disorders Motility Disorders Other Disorders Kids & Teens Manage Your Health ... Abdominal Pain Syndrome Globus Sphincter of Oddi Dysfunction Motility Disorders Other Disorders Kids & Teens Other IFFGD Sites ...

  9. Prosthetic Sphincter Controls Urination

    NASA Technical Reports Server (NTRS)

    Tenny, John B., Jr

    1986-01-01

    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.

  10. Anal cancer

    MedlinePLUS

    ... Sexual activity. Having many sexual partners and having anal sex are both major risks. This may be due ... have sex with many partners or have unprotected anal sex are at high risk of these infections. Using ...

  11. Anal Cancer

    MedlinePLUS

    ... is more common in smokers and people over 50. You are also at higher risk if you have HPV, have anal sex, or have many sexual partners. Symptoms include bleeding, pain, or lumps in the anal area. Anal itching and discharge can also be signs ...

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

    PubMed

    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

    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

  13. Inflatable artificial sphincter - series (image)

    MedlinePLUS

    An artificial urinary sphincter is used to treat stress incontinence in men that is caused by urethral dysfunction such ... An artificial sphincter consists of three parts: a cuff that fits around the bladder neck a pressure regulating balloon ...

  14. [Treatment of severe fecal incontinence with artificial sphincter. Report of two cases].

    PubMed

    Borda, Luis; Kcam, Eduardo; Alvarado-Ortiz Blanco, Eduardo

    2015-01-01

    To present two cases of severe fecal incontinence handled in EsSalud Almenara Hospital in Lima, Peru, with successful results using new technologies, in this case Artificial Anal sphincter. Observational study of first two cases of patients, who were selected randomly throughout 2006, and had a diagnosis of severe fecal incontinence. In these patients were placed on Artificial Anal Sphincter Neosphincter. The first patient with fecal incontinence neurological etiology after 2 months of implant the device was activated, with satisfactory results. In the second case, the etiologic factor was the severe injury to the anal sphincter, he had colostomy which, after implanted the device was closed, there were some difficulties in activating the second device that were resolved with a review, then activated with satisfactory results alternative for definitive treatment of severe fecal incontinence. PMID:26397284

  15. Influence of perineal prostatectomy on anal continence

    PubMed Central

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

    2011-01-01

    OBJECTIVE: Perineal prostatectomy has been proposed as a less invasive and safe procedure, but the risk of anal incontinence has been studied. This study aimed to evaluate the effects of perineal access on anal continence mechanisms after perineal prostatectomy. METHODS: From August 2008 to May 2009, twenty three patients underwent perineal prostatectomy. These patients were evaluated before surgery and eight months postoperatively using the Cleveland Clinic Anal Incontinence Score, the Fecal Incontinence Quality of Life Score, and anorectal manometry. RESULTS: The mean age of the subjects was 65 (range, 54-72) years, and the mean prostate weight was 34.5 (range, 24-54) grams. Gleason scores ranged from 6-7, and the mean Cleveland Clinic Anal Incontinence Score (meanstandard deviation) values were 0.91.9 and 0.71.2 (p>0.05) before and after surgery, respectively. The Fecal Incontinence Quality of Life Score did not change significantly after surgery. The mean values for anal manometric parameters before and after surgery were, respectively: Resting Pressures of 6423 mmHg and 6517 mmHg (p?=?0.763), Maximum Squeezing Pressures of 13041 mmHg and 11740 mmHg (p?=?0.259), High Pressure Zones of 3.00.9 cm and 2.70.8 cm (p?=?0.398), Rectal Sensory Thresholds of 7625 ml and 7135 ml (p?=?0.539), Maximum Tolerated Rectal Volumes of 15748 ml and 15656 ml (p?=?0.836), and Sphincter Asymmetry Indexes 22.49% and 14.45% (p?=?0.003). CONCLUSION: There was a significant decrease in the sphincter symmetry index after perineal prostatectomy. With the exception of the sphincter asymmetry index, perineal prostatectomy did not affect anal continence parameters. PMID:22189722

  16. Prosthetic urinary sphincter

    NASA Technical Reports Server (NTRS)

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

    1981-01-01

    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.

  17. Anal stenosis.

    PubMed

    Katdare, Mukta V; Ricciardi, Rocco

    2010-02-01

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

  18. 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 ...

  19. Anal fissure

    MedlinePLUS

    ... healing or cleansing. You should sit in the bath two to three times a day. The water should cover only your hips and buttocks. If the anal fissures do not go away with home care methods, treatment may involve: Botox injections into the muscle ...

  20. Anal erogeneity: the goose and the rat.

    PubMed

    Shengold, L

    1982-01-01

    A case is presented in which the patient's traumatically derived intense anal erogeneity (associated with traumatic anxiety as well as with castration anxiety) inhibited his phallic sensations and potency and also his power to sustain productive thought. His passive cravings were disguised and reacted against in his compulsive-exhibitionistically phallic role of a Don Juan. He described at least two levels of anal feelings: a dangerous but exciting, tolerable or even pleasurable tension associated with the imago of the goose; and an unbearable, terrifying overcharged level embodied in the imago of the rat. (He had read of, and had felt himself identified with, Freud's Rat Man.) Contrasts are presented with François Rabelais' account of the instinctual development and anal training of Gargantua, in which the connotations of the goose lead to a happy anal, phallic and intellectual control. Generalizations are ventured about the crucial attainment of command over the anal sphincter for the taming of 'primal affect'(Fliess). With early psychopathology there is a defensive overcathexis of anal control (and of anal mechanisms and character traits) to try to contain over-stimulation. In contrast true anal mastery contributes to the acquisition of optimal genital feelings and functioning and to the capacity for sustaining integrative thinking so necessary for 'owning' one's affects and impulses, and therefore for a feeling of identity. Finally, some remarks of Freud on Rabelais are reviewed in relation to levels of urethral erogeneity, seen as developmental way stations between the anal and the phallic, and partaking of both. PMID:6752066

  1. [Stretch sphincter of the esophagus : Paradoxical sphincter with angiomyoelastic architecture].

    PubMed

    Stelzner, F

    2015-08-01

    The investigations described in this article clearly show that the lower esophageal sphincter (LES) represents a variation of circular muscular occlusive mechanisms found elsewhere in the gastrointestinal tract. The LES is a double layer stretch sphincter that operates in an apparently paradoxical manner: it closes when under stretch but opens when the muscle fibers contract. Impedance manometry studies demonstrate that the entire esophagus is involved in the normal functioning of the esophagus as well as in esophageal disorders. The pronounced elasticity of esophageal tissue is a functional feature that has its basis in the singular architecture of elastic fibers located between the muscle layers. All traditional forms of operative treatment of gastroesophageal reflux disease (GERD) impede the natural functioning of the stretch sphincter to a greater or lesser degree by locking it up. The cause of GERD is mainly by contraction of the esophagus brought about by the cephalad transposition of the stretch sphincter segment into the chest. In a sense this is an incipient axial hernia that frequently remains undiagnosed in the early stages. The operative repositioning of the stretch sphincter segment into the abdominal cavity provides sufficient restoration of the natural topographic relationships to achieve a cure of GERD. Whether this straightforward repair restores the function of the entire esophagus remains to be elucidated. The concept of the stretch provides a good explanation of the pathophysiology of achalasia, a condition in which a paralyzed paradoxical ring sphincter remains occluded. Successful myotomy approaches only split the muscularis propria layer of the stretch sphincter while leaving subepithelial muscle fibers intact that remain paralyzed. This limited intervention provides a good relief of symptoms. PMID:25204425

  2. Stages of Anal Cancer

    MedlinePLUS

    ... tumors, not anal cancer . Being infected with the human papillomavirus (HPV) increases the risk of developing anal ... bag is attached to the stoma. Having the human immunodeficiency virus can affect treatment of anal cancer. ...

  3. Neo-adjuvant chemoradiotherapy; an opportunity in sphincter preserving procedure for rectal cancer

    PubMed Central

    Mozafar, Mohammad; Adhami, Farideh; Atqiaee, Khashayar; Lotfollahzadeh, Saran; Amraei, Razie; Baikpour, Maryam

    2014-01-01

    Aim The present study was designed to assess the impact of neo-adjuvant chemoradiotherapy on the possibility of utilizing sphincter preserving techniques in rectal cancer surgery. Background For both patients and surgeons anal sphincter preserving surgery serves as the ideal procedure to treat rectal cancer. Patients and methods Patients with rectal cancer who were admitted to Shohadaye Tajrish hospital between 2001 and 2011 and underwent sphincter preserving or non-preserving surgery were identified. They were divided into those who had received neo-adjuvant chemo-radiotherapy prior to surgery and those who didn't, and the type of surgical procedure they underwent was compared between the two arms. Data regarding tumor pathology, tumor size and distance from anal verge before and after neo-adjuvant therapy, together with the duration of chemo-radiotherapy were also assessed. Results 103 patients with documented rectal cancer were included in our analysis. Among 47 patients who had not received neo-adjuvant therapy, 26 (55%) underwent APR while 15(32%) and 6(13%) patients were treated with LAR and VLAR respectively. Of the 56 patients who had gone through chemo-radiotherapy prior to surgery, 30 (53%) underwent APR while 14 (25%) and 10 (18%) patients were treated with LAR and VLAR respectively. 2 patients had unresectable tumor. Tumor staging before and after neo-adjuvant therapy showed a statistically significant difference (p=0.0001). Conclusion Neo-adjuvant chemo-radiotherpy can decrease tumor size, increase the distance between the tumor and anal verge, and downgrade the staging. However, it does not necessarily increase the possibility of performing sphincter preserving surgery on patients suffering from low-lying tumors. PMID:25436095

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

    PubMed Central

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

    2014-01-01

    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

  5. Why do we have so much trouble treating anal fistula?

    PubMed Central

    Dudukgian, Haig; Abcarian, Herand

    2011-01-01

    Anal fistula is among the most common illnesses affecting man. Medical literature dating back to 400 BC has discussed this problem. Various causative factors have been proposed throughout the centuries, but it appears that the majority of fistulas unrelated to specific causes (e.g. Tuberculosis, Crohns disease) result from infection (abscess) in anal glands extending from the intersphincteric plane to various anorectal spaces. The tubular structure of an anal fistula easily yields itself to division or unroofing (fistulotomy) or excision (fistulectomy) in most cases. The problem with this single, yet effective, treatment plan is that depending on the thickness of sphincter muscle the fistula transgresses, the patient will have varying degrees of fecal incontinence from minor to total. In an attempt to preserve continence, various procedures have been proposed to deal with the fistulas. These include: (1) simple drainage (Seton); (2) closure of fistula tract using fibrin sealant or anal fistula plug; (3) closure of primary opening using endorectal or dermal flaps, and more recently; and (4) ligation of intersphincteric fistula tract (LIFT). In most complex cases (i.e. Crohns disease), a proximal fecal diversion offers a measure of symptomatic relief. The fact remains that an ideal procedure for anal fistula remains elusive. The failure of each sphincter-preserving procedure (30%-50% recurrence) often results in multiple operations. In essence, the price of preservation of continence at all cost is multiple and often different operations, prolonged disability and disappointment for the patient and the surgeon. Nevertheless, the surgeon treating anal fistulas on an occasional basis should never hesitate in referring the patient to a specialist. Conversely, an expert colorectal surgeon must be familiar with many different operations in order to selectively tailor an operation to the individual patient. PMID:21876616

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

    PubMed Central

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

    2007-01-01

    Background This report describes a new technique of sphincter saving anorectoplasty (SSARP) for the repair of anorectal malformations (ARM). Methods Twenty six males with high ARM were treated with SSARP. Preoperative localization of the center of the muscle complex is facilitated using real time sonography and computed tomography. A soft guide wire is inserted under image control which serves as the route for final pull through of bowel. The operative technique consists of a subcoccygeal approach to dissect the blind rectal pouch. The separation of the rectum from the fistulous communication followed by pull through of the bowel is performed through the same incision. The skin or the levators in the midline posteriorly are not divided. Postoperative anorectal function as assessed by clinical Wingspread scoring was judged as excellent, good, fair and poor. Older patients were examined for sensations of touch, pain, heat and cold in the circumanal skin and the perineum. Electromyography (EMG) was done to assess preoperative and postoperative integrity of external anal sphincter (EAS). Results The patients were separated in 2 groups. The first group, Group I (n = 10), were newborns in whom SSARP was performed as a primary procedure. The second group, Group II (n = 16), were children who underwent an initial colostomy followed by delayed SSARP. There were no operative complications. The follow up ranged from 4 months to 18 months. Group I patients have symmetric anal contraction to stimulation and strong squeeze on digital rectal examination with an average number of bowel movements per day was 35. In group II the rate of excellent and good scores was 81% (13/16). All patients have an appropriate size anus and regular bowel actions. There has been no rectal prolapse, or anal stricture. EAS activity and perineal proprioception were preserved postoperatively. Follow up computed tomogram showed central placement the pull through bowel in between the muscle complex. Conclusion The technique of SSARP allows safe and anatomical reconstruction in a significant proportion of patients with ARM's without the need to divide the levator plate and muscle complex. It preserves all the components contributing to superior faecal continence, and avoids the potential complications associated with the open posterior sagittal approach. PMID:17892560

  7. Anal cancer a review

    PubMed Central

    Salati, Sajad Ahmad; Al Kadi, Azzam

    2012-01-01

    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

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

    PubMed

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

    2013-05-01

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

  9. Video-Assisted Anal Fistula Treatment

    PubMed Central

    Saha, Sudipta; Andley, Manoj; Kumar, Ashok; Saurabh, Gyan; Pusuluri, Rahul; Bhise, Vikas; Kumar, Ajay

    2014-01-01

    Background and Objectives: Fistula in ano is a common disease seen in the surgical outpatient department. Many procedures are advocated for the treatment of fistula in ano. However, none of the procedures is considered the gold standard. The latest addition to the list of treatment options is video-assisted anal fistula treatment (VAAFT). It is a minimally invasive, sphincter-saving procedure with low morbidity. The aim of our study was to compare the results with a premier study done previously. Methods: The procedure involves diagnostic fistuloscopy and visualization of the internal opening, followed by fulguration of the fistulous tract and closure of the internal opening with a stapling device or suture ligation. The video equipment (Karl Storz, Tuttlingen, Germany) was connected to an illuminating source. Results: The study was conducted from July 2010 to March 2014. Eighty-two patients with fistula in ano were operated on with VAAFT and were followed up according to the study protocol. The recurrence rate was 15.85%, with recurrences developing in 13 cases. Postoperative pain and discomfort were minimal. Conclusion: VAAFT is a minimally invasive procedure performed under direct visualization. It enables visualization of the internal opening and secondary branches or abscess cavities. It is a sphincter-saving procedure and offers many advantages to patients. Our initial results with the procedure are quite encouraging. PMID:25419106

  10. Anal Warts and Anal Intradermal Neoplasia

    PubMed Central

    Echenique, Ignacio; Phillips, Benjamin R.

    2011-01-01

    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

  11. Treatment Option Overview (Anal Cancer)

    MedlinePLUS

    ... tumors, not anal cancer . Being infected with the human papillomavirus (HPV) increases the risk of developing anal ... bag is attached to the stoma. Having the human immunodeficiency virus can affect treatment of anal cancer. ...

  12. Diagnosis of hypertonic Oddi's sphincter dyskinesia

    SciTech Connect

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

    1983-11-01

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

  13. Magnetic lower esophageal sphincter augmentation device removal.

    PubMed

    Harnsberger, Cristina R; Broderick, Ryan C; Fuchs, Hans F; Berducci, Martin; Beck, Catherine; Gallo, Alberto; Jacobsen, Garth R; Sandler, Bryan J; Horgan, Santiago

    2015-04-01

    Implantation of a magnetic lower esophageal sphincter augmentation device is now an alternative to fundoplication in the surgical management of gastroesophageal reflux disease (GERD). Although successful management of GERD has been reported following placement of the device, there are instances when device removal is needed. The details of the technique for laparoscopic magnetic lower esophageal sphincter device removal are presented to assist surgeons should device removal become necessary. PMID:25119542

  14. Intramural distribution of regulatory peptides in the sigmoid-recto-anal region of the human gut.

    PubMed Central

    Ferri, G L; Adrian, T E; Allen, J M; Soimero, L; Cancellieri, A; Yeats, J C; Blank, M; Polak, J M; Bloom, S R

    1988-01-01

    The distribution of regulatory peptides was studied in the separated mucosa, submucosa and muscularis externa taken at 10 sampling sites encompassing the whole human sigmoid colon (five sites), rectum (two sites), and anal canal (three sites). Consistently high concentrations of VIP were measured in the muscle layer at most sites (proximal sigmoid: 286 (16) pmol/g, upper rectum: 269 (17), a moderate decrease being found in the distal smooth sphincter (151 (30) pmol/g). Values are expressed as mean (SE). Conversely, substance P concentrations showed an obvious decline in the recto-anal muscle (mid sigmoid: 19 (2.0) pmol/g, distal rectum: 7.1 (1.3), upper anal canal: 1.6 (0.6)). Somatostatin was mainly present in the sigmoid mucosa and submucosa (37 (9.3) and 15 (3.5) pmol/g, respectively) and showed low, but consistent concentrations in the muscle (mid sigmoid: 2.2 (0.7) pmol/g, upper anal canal: 1.5 (0.8]. Starting in the distal sigmoid colon, a distinct peak of tissue NPY was revealed, which was most striking in the muscle (of mid sigmoid: 16 (3.9) pmol/g, upper rectum: 47 (7.8), anal sphincter: 58 (14)). Peptide YY was confined to the mucosa and showed an earlier peak (upper sigmoid: 709 (186) pmol/g, mid-distal sigmoid: 1965 (484)). A clear differential distribution of regulatory peptides was thus shown in the region studied. A possible role is suggested for NPY and VIP containing nerves in the effector control of the human internal anal sphincter. PMID:2454876

  15. Application of YAG laser technique in the treatment of anal fistula

    NASA Astrophysics Data System (ADS)

    Liu, Jian-xun; Zhang, Xinrong

    1993-03-01

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

  16. 0.4% nitroglycerin ointment : in the treatment of chronic anal fissure pain.

    PubMed

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

    2006-01-01

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

  17. A novel method of anal fissure laser surgery: a pilot study.

    PubMed

    Esfahani, Mehran Nasr; Madani, Golnoush; Madhkhan, Sepideh

    2015-08-01

    Anal fissure is a common painful problem, affecting all age groups. Its pathophysiology is based on high sphincter pressures and reduced blood supplying and treatments which means that it generally reduces anal pressures and increases anodermal blood flow. Since each of the anal fissure's routine therapies has some limitations such as definite risk of permanent fecal incontinence and high recurrence rate, we tried to find a more effective and less invasive procedure. In this pilot study which was implemented on 25 male and female patients aged 20-75years, diagnosed clinically with chronic anal fissure, the Carbon Dioxide Laser Fractional was used to treat patients. In order to first remove fibrotic and granulation tissues, the base and the edges of the fissure were laser beamed. Eight spots were made on the sphincter by the laser on its continuous mode; somehow, they were passed through the full thickness of sphincter without interrupting its continuance. Afterwards, the area around the fissure ulcer was irradiated by deep fractional mode of the laser to stimulate the submucosa to regenerate and rejuvenate. After going through this procedure, patients were followed up within 6months to 1year. Pain, bleeding, and constipation were significantly improved. None of the patients had recurrence after a 1-year follow-up, and none of them had fecal incontinence and/or inability to control the passage of gas too. This study revealed that this new laser-based surgery is a simple, safe, and effective procedure to treat the anal fissure that can be performed with local anesthesia in an outpatient clinic with minimal postoperative morbidity. PMID:26067925

  18. 2D DIGE Does Not Reveal all: A Scotopic Report Suggests Differential Expression of a Single “Calponin Family Member” Protein for Tetany of Sphincters!

    PubMed Central

    Chaudhury, Arun

    2015-01-01

    Using 2D differential gel electrophoresis (DIGE) and mass spectrometry (MS), a recent report by Rattan and Ali (2015) compared proteome expression between tonically contracted sphincteric smooth muscles of the internal anal sphincter (IAS), in comparison to the adjacent rectum [rectal smooth muscles (RSM)] that contracts in a phasic fashion. The study showed the differential expression of a single 23 kDa protein SM22, which was 1.87 fold, overexpressed in RSM in comparison to IAS. Earlier studies have shown differences in expression of different proteins like Rho-associated protein kinase II, myosin light chain kinase, myosin phosphatase, and protein kinase C between IAS and RSM. The currently employed methods, despite its high-throughput potential, failed to identify these well-characterized differences between phasic and tonic muscles. This calls into question the fidelity and validatory potential of the otherwise powerful technology of 2D DIGE/MS. These discrepancies, when redressed in future studies, will evolve this recent report as an important baseline study of “sphincter proteome.” Proteomics techniques are currently underutilized in examining pathophysiology of hypertensive/hypotensive disorders involving gastrointestinal sphincters, including achalasia, gastroesophageal reflux disease (GERD), spastic pylorus, seen during diabetes or chronic chemotherapy, intestinal pseudo-obstruction, and recto-anal incontinence. Global proteome mapping may provide instant snapshot of the complete repertoire of differential proteins, thus expediting to identify the molecular pathology of gastrointestinal motility disorders currently labeled “idiopathic” and facilitating practice of precision medicine. PMID:26151053

  19. Can Anal Cancer Be Prevented?

    MedlinePLUS

    ... Overview + - Text Size Download Printable Version [PDF] » Causes, Risk Factors, and Prevention TOPICS Document Topics GO » SEE A LIST » What are the risk factors for anal cancer? Can anal cancer be prevented? ...

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

    PubMed

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

    2014-02-01

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

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

    PubMed

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

    2011-10-01

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

  2. Multivariate Analysis of Risk Factors Associated With the Nonreversal Ileostomy Following Sphincter-Preserving Surgery for Rectal Cancer

    PubMed Central

    Kim, Young Ah; Lee, Gil Jae; Park, Sung Won; Lee, Won-Suk

    2015-01-01

    Purpose A loop ileostomy is used to protect an anastomosis after anal sphincter-preserving surgery, especially in patients with low rectal cancer, but little information is available concerning risk factors associated with a nonreversal ileostomy. The purpose of this study was to identify risk factors of ileostomy nonreversibility after a sphincter-saving resection for rectal cancer. Methods Six hundred seventy-nine (679) patients with rectal cancer who underwent sphincter-preserving surgery between January 2004 and December 2011 were evaluated retrospectively. Of the 679, 135 (19.9%) underwent a defunctioning loop ileostomy of temporary intent, and these patients were divided into two groups, that is, a reversal group (RG, 112 patients) and a nonreversal group (NRG, 23 patients) according to the reversibility of the ileostomy. Results In 23 of the 135 rectal cancer patients (17.0%) that underwent a diverting ileostomy, stoma reversal was not possible for the following reasons; stage IV rectal cancer (11, 47.8%), poor tone of the anal sphincter (4, 17.4%), local recurrence (2, 8.7%), anastomotic leakage (1, 4.3%), radiation proctitis (1, 4.3%), and patient refusal (4, 17.4%). The independent risk factors of the nonreversal group were anastomotic leakage or fistula, stage IV cancer, local recurrence, and comorbidity. Conclusion Postoperative complications such as anastomotic leakage or fistula, advanced primary disease (stage IV), local recurrence and comorbidity were identified as risk factors of a nonreversal ileostomy. These factors should be considered when drafting prudential guidelines for ileostomy closure. PMID:26161377

  3. Modifications to installed Sphincter design gloveports

    SciTech Connect

    Shetty, S.S.; Gilkison, J.M.

    1993-02-01

    This paper presents the results of a study of alternative methods for replacing Sphincter designed gloveports in gloveboxes. In addition, the paper discusses modifications that are required on metal glovebox wall panels to allow replacement of the Sphincter gloveports. A review of Westinghouse Savannah River Co. (WSRC) maintenance records showed that gloveports manufactured by Central Research, Incorporated, provide the lowest risk for failure. This assessment is based on the records of glove-to-port seal life and air in-leakage. These records also indicate the glove changes are made in shorter times with fewer workers than required by alternate gloveport designs studied. These attributes culminate in a significant decrease in radiation exposure and assimilation risk of maintenance personnel replacing gloves. Further, the Central Research design reduces the number of expandable hardware parts required to achieve a glove replacement. This reduction in expendable materials can result in a significant reduction in contaminated waste volume generated during a glove replacement.

  4. High intermuscular anal abscess and fistula: analysis of 25 cases.

    PubMed

    Bernard, D; Tass, D; Morgan, S

    1983-03-01

    Although the majority of anal abscesses and fistulas are of the simple or low variety (intersphincteric or transsphincteric in Parks' classification), some of the simple, but high intermuscular, type are not recognized clinically and are not properly treated because they do not present the usual visible signs. Characteristically, there is no external swelling, induration or opening and there is high extension with a palpable mass or induration above the levator ani. Out of 350 patients with anal abscesses and fistulas treated by the first author, 25 (7%) patients had a high intermuscular abscess. Of these 25, 14 (56%) had a history of anal problems. Eight of these 14 had undergone anorectal surgery previously, and in 3 laparotomy was added, 2 being left with a diverting colostomy. On the other hand, 11 (44%) patients had no previous anal manifestation and 9 of them presented with an acute abscess. All patients had a palpable mass or induration above the levator ani and in all but one a primary opening was found on the dentate line. Fistulotomy was done in 22 of the 25 cases and incision and drainage into the anorectum in the other 3. The authors conclude that for prompt diagnosis and proper treatment the surgeon should be highly suspicious of the condition, have a perfect knowledge of the surgical anatomy of anal abscesses and fistulas and follow three steps: (a) look for a primary opening at the dentate line, (b) pass a cannula from this opening into the cavity or induration and (c) divide the circular muscle and internal sphincter until the upper end of the tract is reached. PMID:6825001

  5. Rupture disc

    DOEpatents

    Newton, Robert G.

    1977-01-01

    The intermediate heat transport system for a sodium-cooled fast breeder reactor includes a device for rapidly draining the sodium therefrom should a sodium-water reaction occur within the system. This device includes a rupturable member in a drain line in the system and means for cutting a large opening therein and for positively removing the sheared-out portion from the opening cut in the rupturable member. According to the preferred embodiment of the invention the rupturable member includes a solid head seated in the end of the drain line having a rim extending peripherally therearound, the rim being clamped against the end of the drain line by a clamp ring having an interior shearing edge, the bottom of the rupturable member being convex and extending into the drain line. Means are provided to draw the rupturable member away from the drain line against the shearing edge to clear the drain line for outflow of sodium therethrough.

  6. UPPER ESOPHAGEAL SPHINCTER RESTING PRESSURE VARIES DURING ESOPHAGEAL MANOMETRY

    PubMed Central

    REZENDE, Daniel Tavares; HERBELLA, Fernando A. M.; SILVA, Luciana C.; PANOCCHIA-NETO, Sebastio; PATTI, Marco G.

    2014-01-01

    Background The upper esophageal sphincter is composed of striated muscle. The stress of intubation and the need to inhibit dry swallows during an esophageal manometry test may lead to variations in basal pressure of this sphincter. Upper esophageal sphincter is usually only studied at the final part of the test. Was observed during the performance of high resolution manometry that sphincter pressure may vary significantly over the course of the test. Aim To evaluate the variation of the resting pressure of the upper esophageal sphincter during high resolution manometry. Methods Was evaluated the variation of the basal pressure of the upper esophageal sphincter during high resolution manometry. Were reviewed the high resolution manometry tests of 36 healthy volunteers (mean age 31 years, 55% females). The basal pressure of the upper esophageal sphincter was measured at the beginning and at the end of a standard test. Results The mean time of the test was eight minutes. The basal pressure of the upper esophageal sphincter was 100 mmHg at the beginning of the test and 70 mmHg at the end (p<0.001). At the beginning, one patient had hypotonic upper esophageal sphincter and 14 hypertonic. At the end of the test, one patient had hypotonic upper esophageal sphincter (same patient as the beginning) and seven hypertonic upper esophageal sphincter. Conclusion A significant variation of the basal pressure of the upper esophageal sphincter was observed in the course of high resolution manometry. Probably, the value obtained at the end of the test may be more clinically relevant. PMID:25184767

  7. Surgical treatment of anal stenosis

    PubMed Central

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

    2009-01-01

    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

  8. Treatment Options by Stage (Anal Cancer)

    MedlinePLUS

    ... tumors, not anal cancer . Being infected with the human papillomavirus (HPV) increases the risk of developing anal ... bag is attached to the stoma. Having the human immunodeficiency virus can affect treatment of anal cancer. ...

  9. 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, ...

  10. Management of Complex Anal Fistulas.

    PubMed

    Bubbers, Emily J; Cologne, Kyle G

    2016-03-01

    Complex anal fistulas require careful evaluation. Prior to any attempts at definitive repair, the anatomy must be well defined and the sepsis resolved. Several muscle-sparing approaches to anal fistula are appropriate, and are often catered to the patient based on their presentation and previous repairs. Emerging technologies show promise for fistula repair, but lack long-term data. PMID:26929751

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

    SciTech Connect

    Papillon, J.; Montbarbon, J.F.

    1987-05-01

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

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

    PubMed Central

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

    2013-01-01

    Purpose To maintain the patient's quality of life, surgeons strive to preserve the sphincter during rectal cancer surgery. This study evaluated the oncologic safety of a sphincter-saving resection with a distal resection margin (DRM) <1 cm without radiotherapy in T3, mid- or low-rectal cancer. Methods This retrospective study enrolled 327 patients who underwent a sphincter-saving resection for proven T3 rectal cancer located <10 cm from the anal verge and without radiotherapy between January 1995 and December 2011. The oncologic outcomes included the 5-year cancer-specific survival, the local recurrence, and the systemic recurrence rates. Results In groups A (DRM ?1 cm) and B (DRM >1 cm), the 5-year cancer-specific survival rates were 81.57% and 80.03% (P = 0.8543), the 5-year local recurrence rates were 6.69% and 9.52% (P = 0.3981), and the 5-year systemic recurrence rates were 19.46% and 23.11% (P = 0.5750), respectively. Conclusion This study showed that the close DRM itself should not be a contraindication for a sphincter-saving resection for T3 mid- or low-rectal cancer without radiotherapy. However, a prospective randomized controlled trial including the effect of adjuvant therapy will be needed. PMID:24466537

  13. Low rectal cancer: Sphincter preserving techniques-selection of patients, techniques and outcomes

    PubMed Central

    Dimitriou, Nikoletta; Michail, Othon; Moris, Dimitrios; Griniatsos, John

    2015-01-01

    Low rectal cancer is traditionally treated by abdominoperineal resection. In recent years, several new techniques for the treatment of very low rectal cancer patients aiming to preserve the gastrointestinal continuity and to improve both the oncological as well as the functional outcomes, have been emerged. Literature suggest that when the intersphincteric resection is applied in T1-3 tumors located within 30-35 mm from the anal verge, is technically feasible, safe, with equal oncological outcomes compared to conventional surgery and acceptable quality of life. The Anterior Perineal PlanE for Ultra-low Anterior Resection technique, is not disrupting the sphincters, but carries a high complication rate, while the reports on the oncological and functional outcomes are limited. Transanal Endoscopic MicroSurgery (TEM) and TransAnal Minimally Invasive Surgery (TAMIS) should represent the treatment of choice for T1 rectal tumors, with specific criteria according to the NCCN guidelines and favorable pathologic features. Alternatively to the standard conventional surgery, neoadjuvant chemo-radiotherapy followed by TEM or TAMIS seems promising for tumors of a local stage T1sm2-3 or T2. Transanal Total Mesorectal Excision should be performed only when a board approved protocol is available by colorectal surgeons with extensive experience in minimally invasive and transanal endoscopic surgery. PMID:26191350

  14. Can Anal Cancer Be Found Early?

    MedlinePLUS

    ... Next Topic Signs and symptoms of anal cancer Can anal cancer be found early? Many anal cancers can be found early in the course of the ... they reach an advanced stage. Other anal cancers can cause symptoms like those of diseases other than ...

  15. Electrocautery 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.

  16. Sphincter-saving procedures for distal carcinoma of the rectum.

    PubMed Central

    Yeatman, T J; Bland, K I

    1989-01-01

    Methods of sphincter preservation were developed more than a century ago. Combining these techniques with adequate anterior resection has permitted the resurrection of sphincter-saving procedures that are currently being applied in the therapy of cancer at every level of the rectum. Although Miles' abdominoperineal resection still remains the "gold standard" for the treatment of low rectal neoplasms, restorative resection may now be possible with equivalent oncologic disease control and survival. Further, current trends also suggest that the abdominoperineal resection is being used less frequently in the treatment of most rectal cancers and is being replaced with sphincter-preserving techniques that afford excellent functional results. In this review, the pertinent anorectal anatomy, current issues, and sphincter-saving surgical techniques presently available for the treatment of distal cancers of the rectum are presented. PMID:2642688

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

    PubMed

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

    2011-08-01

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

  18. Efficacy of magnetic resonance imaging in the diagnosis of perianal hidradenitis suppurativa, complicated by anal fistulae: A report of two cases and review of the literature

    PubMed Central

    Takiyama, Hirotoshi; Kazama, Shinsuke; Tanoue, Yusuke; Yasuda, Koji; Otani, Kensuke; Nishikawa, Takeshi; Tanaka, Toshiaki; Tanaka, Junichiro; Kiyomatsu, Tomomichi; Hata, Keisuke; Kawai, Kazushige; Nozawa, Hiroaki; Miyagawa, Takuya; Yamada, Daisuke; Yamaguchi, Hironori; Ishihara, Soichiro; Sunami, Eiji; Watanabe, Toshiaki

    2015-01-01

    Background Perianal hidradenitis suppurativa (PHS) is a chronic recurrent inflammatory disease of the apocrine glands present in the skin and soft tissue adjacent to the anus. It is often misdiagnosed or treatment is delayed, resulting in the formation of an abscess or, in the worst case, leading to sepsis. It is difficult to treat perianal lesions merged with fistulae completely due to its high recurrence rate. Therefore, we should diagnose it correctly and treat it with appropriate methods. Presentation of case We report two cases of PHS with anal fistulae that were examined preoperatively using magnetic resonance imaging (MRI) and treated safely by surgery without any recurrence. Discussion The anal sphincter area cannot be visualized and evaluated directly by fistulography. Also CT has only limited resolution, making it difficult to distinguish between soft tissues and inflammatory streaks. Endosonography is not suitable for the examination of supra-sphincteric or extra-sphincteric extensions, as it is limited by insufficient penetration of the ultrasonic beams. MRI can demonstrate the entire course of the fistulae owing to its high contrast resolution. Conclusion Our findings support the idea that PHS with complicated anal fistulae can be diagnosed accurately using MRI and treated safely and completely with surgery. PMID:26339787

  19. Surgery for Crohn's anal fistulas.

    PubMed

    Sugita, A; Koganei, K; Harada, H; Yamazaki, Y; Fukushima, T; Shimada, H

    1995-11-01

    The aim of this study was to analyze the features of Crohn's anal fistulas and to evaluate the efficacy of seton treatment. In 119 patients with Crohn's disease, the incidence of anal fistula was 56% (67/119), with no significant difference in the incidence among patients with ileitis, colitis, and ileocolitis. "Intractable" anal fistulas were found in 17% of patients with ileitis, compared to 64% of those with colitis (P = 0.051) and 68% of those with ileocolitis (P = 0.014). Seton treatment, i.e., non-cutting, long-term seton drainage, was performed for 21 patients (5 with intersphincteric, and 16 with transsphincteric fistulas). In the 16-month follow up, 9 patients required redrainage for recurrent fistulous abscess, mainly because of progressive colorectal disease. Finally, a good result was obtained in 17 of the 21 patients (81%) and no recurrent fistulous abscess developed in the 8 patients in whom all setons were removed. Anal continence was preserved in all the patients. These results indicate that anal fistulas with Crohn's ileitis were cured more easily than those with colitis or ileocolitis, and that seton treatment was effective for intersphincteric fistula with multiple fistula openings and for transphincteric fistulas in patients exhibiting remission of intestinal Crohn's disease. PMID:8563879

  20. Anal cushion lifting method is a novel radical management strategy for hemorrhoids that does not involve excision or cause postoperative anal complications

    PubMed Central

    Ishiyama, Gentaro; Nishidate, Toshihiko; Ishiyama, Yuji; Nishio, Akihiko; Tarumi, Ken; Kawamura, Maiko; Okita, Kenji; Mizuguchi, Toru; Fujimiya, Mineko; Hirata, Koichi

    2015-01-01

    AIM: To describe the anal cushion lifting (ACL) method with preliminary clinical results. METHODS: Between January to September 2007, 127 patients who received ACL method for hemorrhoid was investigated with informed consent. In this study, three surgeons who specialized in anorectal surgery performed the procedures. Patients with grade two or more severe hemorrhoids according to Golighers classification were considered to be indicated for surgery. The patients were given the choice to undergo either the ACL method or the ligation and excision method. ACL method is an original technique for managing hemorrhoids without excision. After dissecting the anal cushion from the internal sphincter muscle, the anal cushion was lifted to oral side and ligated at the proper position. Clinical characteristics and outcomes of patients were recorded including complications after surgery. RESULTS: A total of 127 patients were enrolled. Their median age was 42 (19-84) years, and 74.8% were female. In addition, more than 99% of the patients had grade 3 or worse hemorrhoids. The median follow-up period was 26 (0-88) mo, and the median operative time was 15 (4-30) min. After surgery, analgesics were used for a median period of three days (0-21). Pain control was achieved using extra-oral analgesic drugs, although some patients required intravenous injections of analgesic drugs. The median duration of the patients postoperative hospital stay was 7 (2-13) d. A total of 10 complications (7.9%) occurred. Bleeding was observed in one patient and was successfully controlled with manual compression. Urinary retention occurred in 6 patients, but it disappeared spontaneously in all cases. Recurrent hemorrhoids developed in 3 patients after 36, 47, and 61 mo, respectively. No anal stenosis or persistent anal pain occurred. CONCLUSION: We consider that the ACL method might be better than all other current methods for managing hemorrhoids. PMID:26525139

  1. Conservative treatment for anal incontinence

    PubMed Central

    Carter, Dan

    2014-01-01

    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

  2. Dynamic graciloplasty for anal atresia.

    PubMed

    Baeten, C G; Konsten, J; Heineman, E; Soeters, P B

    1994-07-01

    The aim of this study was to assess whether an electrically stimulated graciloplasty (dynamic graciloplasty) can achieve continence in nine patients with anal atresia (median age, 28 years; range, 18 to 40). As the first procedure, a gracilis muscle was transposed. Six weeks later, intramuscular electrodes were implanted and connected to a pulse generator. Eventually, the muscle was gradually trained, by electrical stimulation, to achieve fecal continence. Continence was obtained in five patients (55%). Manometry demonstrated an increase in mean anal pressure, from 36 mm Hg (without stimulation) to 52 mm Hg (with stimulation), after 8 weeks (mean increase, 16 mm Hg, [95% confidence interval, 8, 24 mm Hg; n = 9; P < .01). Failures resulted from a noncontracting distal part of the gracilis muscle (in three patients) and a nondistending rectum (in one patient). We conclude that dynamic graciloplasty can achieve continence in a substantial number of patients with thus-far untreatable incontinence after surgical correction for anal atresia. PMID:7931971

  3. Designing micro- and nanostructures for artificial urinary sphincters

    NASA Astrophysics Data System (ADS)

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

    2012-04-01

    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.

  4. Anal avulsion caused by abdominal crush injury.

    PubMed

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

    2011-12-01

    We report the case of a pelvic and lower abdomen crushing trauma in 37-year-old male patient. The patient had an open lumbar wound, laceration of the psoas muscle, pelvic fracture, a ruptured urogenital diaphragm, and extensive urogenital lacerations. An emergency laparotomy was performed with debridment, urethral reconstruction, and osteosynthesis of the pubic bone. The mobilization of the patient revealed a deep gap, about 8נ8cm, in the perineum, with the anus and rectum displaced from their original site. Anal reimplantation was performed, suturing the median raphe, inserting two pelvic drainage tubes, and fashioning a loop transverse colostomy. Closed rectal traumas account for only 4-11% of all rectal traumas. Crushing of the pelvis causes a sudden reduction in its anteroposterior diameter and a corresponding increase in its latero-lateral diameter, together with an abrupt rise in intra-abdominal pressure. The anus is pushed out of the perineal plane due to the divarication of the levator muscles. As suggested in the literature, the standard treatment is wound debridement with immediate or deferred repair, fashioning a diversion colostomy, and repair of the rectum, wherever possible. PMID:21556880

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

    PubMed Central

    Babaei, Arash; Bhargava, Valmik

    2010-01-01

    Although some studies show that the upper esophageal sphincter (UES) contracts during transient lower esophageal sphincter relaxation (TLESR), others show that it relaxes. We hypothesized that the posture of the subject and constituents of gastroesophageal reflux (GER) may determine the type of UES response during the TLESR. High-resolution manometry and esophageal pH/impedance recording were performed in 10 healthy volunteers in the right recumbent (1 h) and upright (1 h) positions following the ingestion of a 1,000-Kcal meal. The UES pressure response during TLESR and constituents of GER (liquid, air, and pH) were determined. 109 TLESRs (58 upright and 51 recumbent) were analyzed. The majority of TLESRs were associated with GER (91% upright and 88% recumbent) events. UES relaxation was the predominant response during upright position (81% of TLESRs), and it was characteristically associated with presence of air in the reflux (92%). On the other hand, UES contraction was the predominant response during recumbent position (82% of TLESRs), and it was mainly associated with liquid reflux (71%). The rate of esophageal pressure increase (dP/dt) during the GER, but not the pH, had major influence on the type of UES response during TLESR. The dP/dt during air reflux (127 ± 39 mmHg/s) was significantly higher than liquid reflux (31 ± 6 mmHg/s, P < 0.0001). We concluded that the nature of UES response during TLESR, relaxation or contraction, is related to the posture and the constituents of GER. We propose that the rapid rate of esophageal pressure increase associated with air reflux determines the UES relaxation response to GER. PMID:20167874

  6. Anal malignant proliferative trichilemmoma: report of a rare case with review of literature

    PubMed Central

    Cui, Ang; Mei, Zubing; Cui, Long

    2015-01-01

    Trichilemmoma is a rare type of benign cutaneous neoplasm, which derives from outer sheath of hair follicle. It barely develops malignant progression and has rarely been reported in anal cancer. In this article, we report a case of a 73-year-old woman who presented to the outer-patient department with complaints of a ruptured and longstanding anal phyma. All the appearances were atypical. Blood routine examination showed that neutrophilic granulocyte percentage was elevated and suggest it was a simple inflammation response. No evidence of malignancy was detected upon the laboratory examinations. Then we performed an abscess incision drainage for the patient. A few days later, the biopsy pathological report suggested the specimen is a malignant proliferative trichilemmoma. We decided to perform a wide local excision instead of an extended radical operation in order to preserve anus. After the surgery, we chose not to give chemoradio-treatment for fear of side effects and complications. Careful follow-up indicates that peri-anal malignant proliferative trichilemmoma may have a good prognosis and our treatment is a good choice for the patients with this tumor. Because of the low occurrence rate of anal cancer, especially malignant trichilemmoma, any clinical manifestation and experience are valuable. On one hand, our case may help to take the consideration of the diagnosis of malignant trichilemmoma in case of longtime-suffered peri-anal mass, on the other hand it propose a different treatment method from other anal cancers for clinical doctors. PMID:26045866

  7. Midline episiotomy and anal incontinence: retrospective cohort study

    PubMed Central

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

    2000-01-01

    Objective To evaluate the relation between midline episiotomy and postpartum anal incontinence. Design Retrospective cohort study with three study arms and six months of follow up. Setting University teaching hospital. Participants Primiparous women who vaginally delivered a live full term, singleton baby between 1 August 1996 and 8 February 1997: 209 who received an episiotomy; 206 who did not receive an episiotomy but experienced a second, third, or fourth degree spontaneous perineal laceration; and 211 who experienced either no laceration or a first degree perineal laceration. Main outcome measures Self reported faecal and flatus incontinence at three and six months postpartum. Results Women who had episiotomies had a higher risk of faecal incontinence at three (odds ratio 5.5, 95% confidence interval 1.8 to 16.2) and six (3.7, 0.9 to 15.6) months postpartum compared with women with an intact perineum. Compared with women with a spontaneous laceration, episiotomy tripled the risk of faecal incontinence at three months (95% confidence interval 1.3 to 7.9) and six months (0.7 to 11.2) postpartum, and doubled the risk of flatus incontinence at three months (1.3 to 3.4) and six months (1.2 to 3.7) postpartum. A non-extending episiotomy (that is, second degree surgical incision) tripled the risk of faecal incontinence (1.1 to 9.0) and nearly doubled the risk of flatus incontinence (1.0 to 3.0) at three months postpartum compared with women who had a second degree spontaneous tear. The effect of episiotomy was independent of maternal age, infant birth weight, duration of second stage of labour, use of obstetric instrumentation during delivery, and complications of labour. Conclusions Midline episiotomy is not effective in protecting the perineum and sphincters during childbirth and may impair anal continence. PMID:10625261

  8. Ultra slow wave pressure variations in the anal canal before and after lateral internal sphincterotomy.

    PubMed

    Schouten, W R; Blankensteijn, J D

    1992-09-01

    Ultra slow waves (USW's) in the anal canal are discrete pressure fluctuations with a low frequency (1-2/minute) and high amplitude (> or = 10% above or below baseline resting pressure). To investigate the nature of these USW's, anorectal manometry was performed in 20 control subjects as well as in 58 patients presenting with anal fissure or symptomatic hemorrhoids, before and 2 weeks after lateral internal sphincterotomy. USW's could be demonstrated in two control subjects and in 29 patients. The median value of maximum anal resting pressure (MARP) in the two control subjects with USW's was significantly higher than the median MARP in the 18 control subjects without USW's (181.5 vs. 92 cm H2O, p < 0.001, two-tailed Mann-Whitney test). The same difference was found between MARP in patients with and without USW's (158 vs. 138 cm H2O, p < 0.05, two-tailed Mann-Whitney test). All patients were treated by means of lateral internal sphincterotomy (LIS). Two weeks after this procedure USW's had disappeared in half of the patients. The MARP in these patients was reduced to a level found in control subjects without USW's. This pressure reduction was significantly greater than in patients with persistent USW's (40% vs. 15%, p < 0.02, two-tailed Mann-Whitney test). Because USW's are associated with high MARP and disappear when such a high anal canal resting pressure is reduced by LIS to a level found in control subjects without USW's, it can be concluded that USW's are the manifestation of increased activity of the internal anal sphincter. PMID:1402305

  9. Applications of computed tomography pelvimetry and clinical-pathological parameters in sphincter preservation of mid-low rectal cancer

    PubMed Central

    Zhou, Xiaocong; Su, Meng; Hu, Keqiong; Su, Yinfa; Ye, Yinghai; Huang, Chongquan; Yu, Zhenlei; Li, Xiaoyang; Zhou, Hong; Ni, Yaozhong; Jiang, Yi

    2015-01-01

    Background: This study aims to evaluate the predictive value of pelvic anatomical and clinical-pathological parameters that influence the success of sphincter preservation procedure (SPP). Methods: We studied 42 consecutive patients who underwent low anterior resection (LAR) with double stapling technique (DST) anastomosis or abdominoperineal resection (APR) for mid-low rectal cancer between June 2009 and April 2014. The surgical procedures were performed by the same surgeon and surgical team at the Department of Surgery of Wenzhou Central Hospital. Pelvic dimensions and angles were measured using three-dimensional reconstruction of spiral computed tomography (CT) images. A number of clinical-pathological parameters were also examined. Univariate and multivariate analyses were performed to determine the predictive significance of these variables that might affect a successful SPP for mid-low rectal cancer. Results: Body mass index (BMI), distance of tumor from anal verge, and diameter of upper pubis to coccyx affected the success of SPP. It was the higher distance of tumor from anal verge, the higher BMI, and the larger diameter of upper pubis to coccyx contributed most to the success of SPP. Conclusions: Diameter of upper pubis to coccyx is the only one of the pelvic anatomical parameters that could affect the success of SPP for mid-low rectal cancer patients. Furthermore, within the normal BMI range, higher BMI seemed to be a favorable factor for the success of SPP. PMID:25932148

  10. [Pathogenesis and morphology of anal fistulas].

    PubMed

    Jostarndt, L; Nitsche, D; Thiede, A; Schrder, D

    1984-06-14

    In a prospective consecutive study in 80 patients with anal fistulous disease we found characteristics in the morphology of the fistulous tracks, which correspond to the structure of anal glands. The theory of a cryptoglandular infection as the cause of anal fistulous disease seems to be realistic for this reason. The chronic fissure in ano represents likewise a pathogenetic factor in the genesis of anal fistula, especially in the posterior part of the anal canal. In this region we found trans- and suprasphincteric tracks with abscesses in the fossa ischiorectalis. Anal fistulas as a consequence of specific intestinal infections could be found only in 6%, whereas unspecific fistulas with inter- and transsphincteric tracks amounted to 90%. PMID:6469167

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

    PubMed Central

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

    2011-01-01

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

  12. Assessing Upper Esophageal Sphincter Function in Clinical Practice: a Primer.

    PubMed

    Ahuja, Nitin K; Chan, Walter W

    2016-01-01

    The upper esophageal sphincter constitutes an important anatomic and functional landmark in the physiology of pharyngeal swallowing. A variety of clinical circumstances may call for a dedicated evaluation of this mechanism, from the etiologic evaluation of indeterminate symptoms to the generation of complex locoregional therapeutic strategies. Multiple diagnostic tools exist for the assessment of pharyngeal swallowing generally and of upper esophageal sphincter function specifically, some well established and others not yet settled into routine practice. This report reviews five specific modalities for use in making this assessment, outlining the strengths, weaknesses, and logistical considerations of each with respect to its potential use in clinical settings. In many cases, these studies will provide complementary information regarding pharyngeal function, suggesting the relative advantage of a multimodal evaluation. PMID:26768897

  13. Management options for sphincteric deficiency in adults with neurogenic bladder.

    PubMed

    Myers, Jeremy B; Mayer, Erik N; Lenherr, Sara

    2016-02-01

    Neurogenic bladder is a very broad disease definition that encompasses varied disease and injury states affecting the bladder. The majority of patients with neurogenic bladder dysfunction do not have concomitant intrinsic sphincteric deficiency (ISD), but when this occurs the challenges of management of urinary incontinence from neurogenic bladder are compounded. There are no guidelines for surgical correction of ISD in adults and most of the literature on treatment of the problem comes from treatment of children with congenital diseases, such as myelomeningocele. Our goal, in this review, is to present some of the common surgical options for ISD [including artificial urinary sphincters, bladder slings, bladder neck reconstruction (BNR) and urethral bulking agents] and the evidence underlying these treatments in adults with neurogenic bladder. PMID:26904420

  14. Management options for sphincteric deficiency in adults with neurogenic bladder

    PubMed Central

    Mayer, Erik N.; Lenherr, Sara

    2016-01-01

    Neurogenic bladder is a very broad disease definition that encompasses varied disease and injury states affecting the bladder. The majority of patients with neurogenic bladder dysfunction do not have concomitant intrinsic sphincteric deficiency (ISD), but when this occurs the challenges of management of urinary incontinence from neurogenic bladder are compounded. There are no guidelines for surgical correction of ISD in adults and most of the literature on treatment of the problem comes from treatment of children with congenital diseases, such as myelomeningocele. Our goal, in this review, is to present some of the common surgical options for ISD [including artificial urinary sphincters, bladder slings, bladder neck reconstruction (BNR) and urethral bulking agents] and the evidence underlying these treatments in adults with neurogenic bladder. PMID:26904420

  15. Fistulotomy or fistulectomy and primary sphincteroplasty for anal fistula (FIPS): a systematic review.

    PubMed

    Ratto, C; Litta, F; Donisi, L; Parello, A

    2015-07-01

    There is still no clear consensus about surgical treatment of anal fistulas. Fistulotomy or fistulectomy and primary sphincter reconstruction is still regarded with skepticism. The aim of this systematic review was to evaluate the evidence in the literature supporting the use of this technique in the treatment of complex anal fistulas. MEDLINE, EMBASE and Cochrane Library databases were searched for the period between 1985 and 2015. The studies selected were peer-reviewed articles, with no limitations concerning the study cohort size, length of the follow-up or language. Technical notes, commentaries, letters and meeting abstracts were excluded. The major endpoints were the technique adopted, clinical efficacy, changes at anorectal manometry and assessment of quality of life after the procedure. Fourteen reports (666 patients) satisfied the inclusion criteria. The quality of the studies was low. Some differences about the surgical technique emerged; however, after a weighted average duration of follow-up of 28.9months, the overall success rate was 93.2%, with a low morbidity rate. The overall postoperative worsening continence rate was 12.4% (mainly post-defecation soiling). In almost all cases, the anorectal manometry parameters remained unchanged. The quality of life, when evaluated, improved significantly. Fistulotomy or fistulectomy and primary sphincteroplasty could be a therapeutic option for complex anal fistula. Success rates were very high and the risk of postoperative fecal incontinence was lower than after simple fistulotomy. Well-designed trials are needed to support the inclusion of this technique in a treatment algorithm for the management of complex anal fistulas. PMID:26062740

  16. LOWER ESOPHAGEAL SPHINCTER PRESSURE MEASUREMENT UNDER STANDARDIZED INSPIRATORY MANEUVEURS

    PubMed Central

    RIBEIRO, Jeany Borges e Silva; DIGENES, Esther Cristina Arruda Oliveira; BEZERRA, Patrcia Carvalho; COUTINHO, Tanila Aguiar Andrade; de ALMEIDA, Ccera Gergia Flix; SOUZA, Miguel ngelo Nobre e

    2015-01-01

    Background: Through rhythmic variations, the diaphragm influence lower esophageal sphincter (LES) pressure acting as an external sphincter. LES pressure recording is characterized by increased pressure in inspiration due to contraction of the diaphragmatic crura that involves the sphincter. Aim: To describe a method of measuring LES pressure during standardized inspiratory maneuvers with increasing loads. Methods: The study population comprised of eight healthy female volunteers (average age of 31.5 years). An esophageal high-resolution manometry and impedance system was used for measuring the LES pressure during 3-second inspiratory efforts under 12, 24 and 48 cm H2O loads (Threshold maneuvers). Results: There was a significant difference between the average maximum LES pressure and the average maximum basal LES pressure during the first (76.1917.92 difference, p=0.0008), second (86.9219.01 difference, p=0.0004), and third seconds of the maneuver (90.8617.93 difference, p=0.0002), with 12, 24 and 48 cmH2O loads. Conclusion: This maneuver is a standardization of the inspiratory LES pressure and may better differentiate patients with reflux disease from healthy individuals, and may also be useful for monitoring the treatment of these patients through inspiratory muscle training. PMID:26537140

  17. Oddi: the paradox of the man and the sphincter.

    PubMed

    Modlin, I M; Ahlman, H

    1994-05-01

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

  18. Glass rupture disk

    DOEpatents

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

    2002-01-01

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

  19. Cisplatin and Fluorouracil Compared With Carboplatin and Paclitaxel in Treating Patients With Inoperable Locally Recurrent or Metastatic Anal Cancer

    ClinicalTrials.gov

    2016-03-22

    Anal Basaloid Carcinoma; Anal Canal Cloacogenic Carcinoma; Anal Squamous Cell Carcinoma; Metastatic Anal Canal Carcinoma; Recurrent Anal Canal Carcinoma; Stage IIIB Anal Canal Cancer; Stage IV Anal Canal Cancer

  20. Nocturnal faecal soiling and anal masturbation.

    PubMed Central

    Clark, A F; Tayler, P J; Bhate, S R

    1990-01-01

    Two cases of late onset faecal soiling as a result of anal masturbation in children who were neither mentally handicapped nor psychotic were studied. The role of soiling in aiding the young person and his family to avoid separating and maturing is highlighted. We suggest that the association of anal masturbation and resistant nocturnal soiling may be unrecognised. PMID:2270946

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

    SciTech Connect

    Kim, Chan Wook; Kim, Jong Hoon; Yu, Chang Sik; Shin, Ui Sup; Park, Jin Seok; Jung, Kwang Yong; Kim, Tae Won; Yoon, Sang Nam; Lim, Seok-Byung; Kim, Jin Cheon

    2010-09-01

    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.

  2. [Double sphincterostomy of pancreatic and choledochal sphincters in the treatment of chronic recurrent pancreatitis].

    PubMed

    Guelrud, M; Mendoza, S; Plaz, J; Mujica, V

    1991-01-01

    The treatment of recurrent chronic pancreatitis is controversial. Some patients may have sphincter of Oddi motor abnormalities. Although widely used in the biliary tree, little data is available on endoscopic sphincterotomy of the pancreatic sphincter. This report describes 5 patients with recurrent chronic pancreatitis, who had pancreatic sphincterotomy for hypertensive sphincter of Oddi. Four patients continue long-term follow-up with marked reduction of chronic pain of attacks of recurrent pancreatitis. It is concluded that endoscopic sphincterotomy of the pancreatic sphincter may improve pain in chronic pancreatitis and may obviate the need for surgery. PMID:1688212

  3. On the etiology of anal squamous carcinoma.

    PubMed

    Frisch, Morten

    2002-08-01

    The thesis is based on 13 publications in English and a review of the literature. The underlying work was done with the overall aim to describe incidence patterns for anal squamous carcinoma (anal SC) and to contribute new insight into the causes of this neoplasm. The work, supported by the Danish Cancer Society, was carried out in the period 1991-2000 while I was employed at 1) the Danish Cancer Registry, 2) Statens Serum Institute, Department of Epidemiology Research, and 3) the National Cancer Institute, Viral Epidemiology Branch, Maryland. Study designs employed include a ) population-based incidence studies in Denmark and the United States, b) register-based case-control studies and cohort studies for the scrutiny of multiple cancer patterns among patients with anal SC and for the study of anal SC risk among individuals with certain non-malignant diseases of the anal region as well as among persons with the acquired immuno-deficiency syndrome (AIDS), c) a nationwide interview-based case-control study of risk factors for anal SC and in Denmark and Sweden, and d) a combined molecular biological and histological analysis examining the association of human papillomavirus (HPV) status with histopathological and anatomical characteristics in anal SC tissues. The epidemiology of anal SC has changed remarkably during the second half of the 20th century. In Denmark, age-adjusted incidence rates per 100,000 person-years increased during the period 1943-1997 from around 0.2 among both men an women to 0.5 among men and 1.0 among women. Where systematically studied, incidence rates of anal SC have also been found to increase in a few other countries (Sweden and the United States). Register-based multiple cancer studies have shown an excess of previous and subsequent genital cancers of squamous histology among women with anal SC. This is likely to reflect common susceptibility toward infection with cancer-associated HPV types shared by all anogenital organs covered by squamous epithelium. A study based on data from the United States supports the possible role of anogenital SC-associated HPV types in the development of some tonsillar cancers. Observations in other register-based investigations and in the Danish-Swedish case-control study challenge the long held belief that benign anal lesions (e.g. hemorrhoids) and anal inflammation (e.g. in association with Crohn's disease) are linked to an increased risk of anal SC. The work documents strong links between a variety of sexual behavior measures and the risk of anal SC. The previously observed excess of anal SC among homosexual men is confirmed. Unlike in previous studies, an increased risk of anal SC associated with promiscuous heterosexual activity is also documented among both men and women. Measures of sexual extroversion, rather than sexual preference, are linked to the risk of anal SC presumably by means of higher rates of anal HPV infection in people with such behaviors. A new hypothesis is proposed to explain how smoking, the only consistently observed non-sexual risk factor in previous studies, might be associated with anal SC risk. A study of the short-term cancer profile among 309.365 AIDS patients in the United States provided no evidence to support immunosuppression as a major risk factor for anal SC in the first two years after the AIDS diagnosis. With the introduction around 1996 of highly active anti-retroviral therapy regimens, however, the future may hold a para-doxical increase in the incidence of anal SC along with the increased life expectancy in this population. Examination of tumor tissues from patients in Denmark and Sweden by the polymerase chain reaction techique showed a high proportion of anal SCs to be positive for types of HPV that are associated with high risk of cervical cancer (90%, 100%, and 58% among women, homosexual men, and heterosexual men, respectively). Tumor tissues from control subjects with adenocarcinoma of the rectum were consistently HPV-negative. A combined molecular biological and histological analysis showed that anal SCs with likely origin in the anal canal are 7.5 times more likely to be HPV-positive than anal SCs with likely origin in the perianal skin. Additionally, cancer of the anal canal are more likely than those of the perianal skin to be characterized histologically by small or medium-sized tumor cells, basaloid features, and little or no keratinization. Epidemiological studies from the past two decades have contributed imprtantly to our current understanding of anal SC and its causes. Most cases of this neoplasm can now be considered as a consequence of sexually or otherwise acquired infection in the anal mucosa with types of HPV already known to be involved in cancers of the uterine cervix. Expectedly, the upward trend in the incidence of anal SC seen over the past half century will continue in many years to come. However, there is currently widespread, yet cautious, optimism regarding the prospects for a prophylactic HPV vaccine. It this optimism is justified, the future may bring drastic reductions in the incidence of HPV-associated morbidities, including SC. PMID:12238281

  4. Ruptured abdominal aortic aneurysm.

    PubMed

    Sachs, T; Schermerhorn, M

    2010-06-01

    Ruptured abdominal aortic aneurysm (AAA) continues to be one of the most lethal vascular pathologies we encounter. Its management demands prompt and efficient evaluation and repair. Open repair has traditionally been the mainstay of treatment. However, the introduction of endovascular techniques has altered the treatment algorithm for ruptured AAA in most major medical centers. We present recent literature and techniques for ruptured AAA and its surgical management. PMID:20668419

  5. Investigation of cholecystokinin receptors in the human lower esophageal sphincter

    PubMed Central

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

    2014-01-01

    AIM: To compare the binding of cholecystokinin (CCK)-8 to CCK receptors in sling and clasp fibers of the human lower esophageal sphincter. METHODS: Esophageal sling and clasp fibers were isolated from eight esophagectomy specimens, resected for squamous cell carcinoma in the upper two thirds of the esophagus, which had been maintained in oxygenated Krebs solution. Western blot was used to measure CCK-A and CCK-B receptor subtypes in the two muscles. A radioligand binding assay was used to determine the binding parameters of 3H-CCK-8S to the CCK receptor subtypes. The specificity of binding was determined by the addition of proglumide, which blocks the binding of CCK to both receptor subtypes. RESULTS: There was no significant difference between the sling and clasp fibers of the human lower esophageal sphincter in the amount of CCK-A [integrated optical density (IOD) value: 22.65 0.642 vs 22.328 1.042, P = 0.806] or CCK-B receptor protein (IOD value: 13.20 0.423 vs 12.45 0.294, P = 0.224) as measured by Western blot. The maximum binding of radio-labeled CCK-8S was higher in the sling fibers than in the clasp fibers (595.75 3.231 cpm vs 500.000 10.087 cpm, P < 0.001) and dissociation constant was lower (Kd: 1.437 0.024 nmol/L vs 1.671 0.024 nmol/L, P < 0.001). The IC50 of the receptor specific antagonists were lower for the CCK-A receptors than for the CCK-B (P < 0.01). CONCLUSION: CCK binding modulates the contractile function of the lower esophageal sphincter through differential binding to the CCK-A receptor on the sling and clasp fibers. PMID:24914377

  6. Squamous cell carcinoma of the anal canal: treatment by external beam irradiation.

    PubMed

    Eschwege, F; Lasser, P; Chavy, A; Wibault, P; Kac, J; Rougier, P; Bognel, C

    1985-02-01

    External beam radiation therapy alone or in combination with curietherapy is the recommended treatment for anal canal carcinoma in some countries. In others, surgery is the sole accepted treatment. The results for 64 patients treated by external radiotherapy alone show excellent survival for stage T1T2 tumors but results are poor for large tumors (stage T4). The overall 5 year crude survival rate is 46%. The 5-year results are better for stage T1T2 (72%) than for stage T3T4 (35%). The presence of inguinal node involvement at first examination is a very poor prognostic sign. Local recurrences and metastases are infrequent for stage T1T2, but are more common for stage T3 and T4. Complications follow radiotherapy more frequently in those with stage T3 and T4 tumors. The analysis of local recurrences, complications and survival shows that radiation therapy may be sufficient treatment for stage T1 and T2 and for some stage T3 tumors. The importance of anal sphincter involvement and the poor quality of life for patients who are cured but develop complications, shows the need for combined treatment with surgery and perhaps with chemotherapy. For small tumors the results obtained by external radiotherapy alone are comparable with those obtained by external radiotherapy and curietherapy in terms of survival and complications. PMID:3920734

  7. In situ urethroplasty after artificial urinary sphincter cuff erosion.

    PubMed

    Siegel, Jordan A; Tausch, Timothy J; Morey, Allen F

    2015-02-01

    Artificial urinary sphincter (AUS) cuff erosion is a challenging complication traditionally managed with device removal and Foley catheter drainage. Urethral stricture can result secondary to the healing process, delaying AUS reimplantation. In situ urethroplasty (ISU) technique is a definitive repair at the time of device removal. Early results demonstrate a decreased rate of stricture formation compared to traditional management with little additional operative time and no additional complications. Patients undergoing ISU have less delay prior to AUS reimplantation, leading to possible benefit in health-related quality of life (HRQL) outcomes. PMID:26816810

  8. In situ urethroplasty after artificial urinary sphincter cuff erosion

    PubMed Central

    Siegel, Jordan A.; Tausch, Timothy J.

    2015-01-01

    Artificial urinary sphincter (AUS) cuff erosion is a challenging complication traditionally managed with device removal and Foley catheter drainage. Urethral stricture can result secondary to the healing process, delaying AUS reimplantation. In situ urethroplasty (ISU) technique is a definitive repair at the time of device removal. Early results demonstrate a decreased rate of stricture formation compared to traditional management with little additional operative time and no additional complications. Patients undergoing ISU have less delay prior to AUS reimplantation, leading to possible benefit in health-related quality of life (HRQL) outcomes.

  9. [Design of an artificial sphincter system with bio-feedback function based on MSP430].

    PubMed

    Wang, Yong-kan; Yan, De-tian

    2005-11-01

    In this paper, we advance a new treating method for rectectomy postoperative anus incontinence, which is called "artificial sphincter system with biofeedback-function". The system simulates the function of human's sphincter and has entered into a stage of simulation experiments on animals. PMID:16494055

  10. Endosonography and magnetic resonance imaging in the diagnosis of high anal fistulae a comparison

    PubMed Central

    Kucharczyk, Agnieszka; Ko?odziejczak, Ma?gorzata; Warczy?ska, Agnieszka; Praco?, Grzegorz; Wi?czek, Anna

    2014-01-01

    Anal fistula is a benign inflammatory disease with unclear etiology which develops in approximately 10 in 100 000 adult patients. Surgical treatment of fistulae is associated with a risk of damaging anal sphincters. This usually happens in treating high fistulae, branched fistulae, and anterior ones in females. In preoperative diagnosis of anal fistulae, endosonography and magnetic resonance imaging play a significant role in planning the surgical technique. The majority of fistulae are diagnosed in endosonography, but magnetic resonance is performed when the presence of high fistulae, particularly branched ones, and recurrent is suspected. The aim of this paper The aim of this paper was to compare the roles of the two examinations in preoperative assessment of high anal fistulae. Material and methods The results of endosonographic and magnetic resonance examinations performed in 20112012 in 14 patients (4 women and 10 men) with high anal fistulae diagnosed intraoperatively were subject to a retrospective analysis. The patients were aged from 23 to 66 (mean 47). The endosonographic examinations were performed with the use of a BK Medical Pro Focus system with endorectal 3D transducers with the frequency of 16 MHz. The magnetic resonance scans were performed using a Siemens Avanto 1.5 T scanner with a surface coil in T1, T1FS, FLAIR, T2 sequences and in T1 following contrast medium administration. The sensitivity and specificity of endosonography and magnetic resonance imaging were analyzed. A surgical treatment served as a method for verification. The agreement of each method with the surgery and the agreement of endosonography and magnetic resonance imaging were compared in terms of the assessment of the fistula type, localization of its internal opening and branches. The agreement level was determined based on the percentage of consistent assessments and Cohen's coefficient of agreement, ?. The integrity of the anal sphincters was assessed in each case. Results In determining the fistula type, magnetic resonance imaging agreed with intraoperative assessment in 79% of cases, and endosonography in 64% of cases. Endosonography agreed with magnetic resonance in 57% of cases. In the assessment of internal opening, the agreement between endosonography and intraoperative assessment was 65%, between magnetic resonance and intraoperative assessment 41% and between endosonography and magnetic resonance 53%. In the assessment of fistula branches, endosonography agreed with intraoperative assessment in 67% of cases, magnetic resonance in 87% of cases, and the agreement between the two methods tested was 67%. Conclusions Magnetic resonance is a more accurate method than endosonography in determining the type of high fistulae and the presence of branches. In assessing the internal opening, endosonography proved more accurate. The agreement between the two methods ranges from 5367%; the highest level of agreement was noted for the assessment of branching. PMID:26676232

  11. Spontaneous ruptured hepatocellular carcinoma.

    PubMed

    Yoshida, Hiroshi; Mamada, Yasuhiro; Taniai, Nobuhiko; Uchida, Eiji

    2016-01-01

    The incidence of hepatocellular carcinoma (HCC) is rising worldwide. Spontaneous rupture of HCC occasionally occurs, and ruptured HCC with intraperitoneal hemorrhage is potentially life-threatening. The most common symptom of ruptured HCC is acute abdominal pain. The tumor size in ruptured HCC is significantly greater than that in non-ruptured HCC, and HCC protrudes beyond the original liver margin. In the acute phase, hemostasis is the primary concern and tumor treatment is secondary. Transcatheter arterial embolization (TAE) can effectively induce hemostasis. The hemostatic success rate of TAE ranges 53-100%. A one-stage surgical operation is a treatment modality for selected patients. Conservative treatment is usually given to patients in a moribund state with inoperable tumors and thus has poor outcomes. Patients with severe ruptures of advanced HCC and poor liver function have high mortality rates. Liver failure occurs in 12-42% of patients during the acute phase. In the stable phase, tumor treatment, such as transarterial chemoembolization or hepatic resection should be concerned. The combination of acute hemorrhage and cancer in patients with ruptured HCC requires a two-step therapeutic approach. TAE followed by elective hepatectomy is considered an effective strategy for patients with ruptured HCC. PMID:25631290

  12. Intersphincteric anal lipofilling with micro-fragmented fat tissue for the treatment of faecal incontinence: preliminary results of three patients.

    PubMed

    Cestaro, Giovanni; De Rosa, Michele; Massa, Salvatore; Amato, Bruno; Gentile, Maurizio

    2015-07-01

    Faecal incontinence is a very debilitating problem. Many techniques have been proposed to treat this condition, with controversial results. Autologous transplant of fat tissue is an established procedure used for the repair of tissue damage, and recent studies revealed the potentiality of tissue regeneration by human adipose-derived stem cells. We treated this condition with the injection, in the intersphincteric anal groove, of lipoaspirate processed by an innovative technology (Lipogems). The aim of the study was to evaluate the efficacy of Lipogems injection for the treatment of faecal incontinence. In February 2014 we treated 3 patients with faecal incontinence. The surgical procedure required three phases: lipoaspiration, processing of lipoaspirate with the Lipogems system, and injection of the obtained product in the intersphincteric anal groove. An accurate proctological examination followed at 1 week, 1 month and 6 months after treatment. Each patient reported an improved Wexner incontinence score at 1 month after the procedure. We observed an increase of resting pressure (by at least 10 mm Hg) and thickness of the internal anal sphincter respectively at ano-rectal manometry and by ultrasound (US) evaluation at the sixth month of follow-up. Our preliminary results are encouraging, but multicentric studies with longer follow-up are needed to validate this novel technique for treatment of faecal incontinence. PMID:26240640

  13. Intersphincteric anal lipofilling with micro-fragmented fat tissue for the treatment of faecal incontinence: preliminary results of three patients

    PubMed Central

    De Rosa, Michele; Massa, Salvatore; Amato, Bruno; Gentile, Maurizio

    2014-01-01

    Faecal incontinence is a very debilitating problem. Many techniques have been proposed to treat this condition, with controversial results. Autologous transplant of fat tissue is an established procedure used for the repair of tissue damage, and recent studies revealed the potentiality of tissue regeneration by human adipose-derived stem cells. We treated this condition with the injection, in the intersphincteric anal groove, of lipoaspirate processed by an innovative technology (Lipogems). The aim of the study was to evaluate the efficacy of Lipogems injection for the treatment of faecal incontinence. In February 2014 we treated 3 patients with faecal incontinence. The surgical procedure required three phases: lipoaspiration, processing of lipoaspirate with the Lipogems system, and injection of the obtained product in the intersphincteric anal groove. An accurate proctological examination followed at 1 week, 1 month and 6 months after treatment. Each patient reported an improved Wexner incontinence score at 1 month after the procedure. We observed an increase of resting pressure (by at least 10 mm Hg) and thickness of the internal anal sphincter respectively at ano-rectal manometry and by ultrasound (US) evaluation at the sixth month of follow-up. Our preliminary results are encouraging, but multicentric studies with longer follow-up are needed to validate this novel technique for treatment of faecal incontinence. PMID:26240640

  14. Simultaneous penile prosthesis and male sling/artificial urinary sphincter

    PubMed Central

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

    2013-01-01

    Erectile dysfunction (ED) and stress urinary incontinence (SUI) from urethral sphincteric deficiency is not an uncommon problem. The commonest etiology is intervention for localized prostate cancer and/or radical cystoprostatectomy for muscle invasive bladder cancer. Despite advances in surgical technology with robotic assisted laparoscopic prostatectomy and nerve sparing techniques, the rates of ED and SUI remain relatively unchanged. They both impact greatly on quality of life domains and have been associated with poor performance outcomes. Both the artificial urinary sphincter and penile prosthesis are gold standard treatments with proven efficacy, satisfaction and durability for end-stage SUI and ED respectively. Simultaneous prosthesis implantation for concurrent conditions has been well described, mostly in small retrospective series. The uptake of combination surgery has been slow due in part to technical demands of the surgery and to an extent, a heightened anxiety over potential complications. This paper aims to discuss the technical aspect of concurrent surgery for both disease entity and the current published outcomes of the various surgical techniques with this approach. PMID:23202702

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

    PubMed Central

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

    2012-01-01

    Background: Treatment of high anal fistulas may be associated with a high risk of continence disorders. Beside traditional procedure of flap-reconstruction the occlusion of the fistula tract using fistula-plugs offers a new sphincter-saving treatment option. In this study for the first time results from Germany are described. Patients and method: 40 patients (30 male, 10 female, age 5112 years) underwent closure of a high trans-sphincteric (n=28) or supra-sphincteric (n=12) fistula with Gore BioA Fistula Plug in three surgical departments. The surgical procedures had been performed by five colorectal surgeons. Four patients had Crohns disease. Preoperatively 33 patients were completely continent; seven patients complained of minor continence disorders. Treatment of the patients was performed on a intent-to-treat basis and evaluation of the results was retrospective using pooled data from each center. Results: Postoperatively one patient developed an abscess, which had to be managed surgically. In two patients the plug had fallen out within the first two weeks postoperatively. Six months after surgery the fistula has been healed in 20 patients (50.0%). Three additional fistulas healed after 7, 9 rsp. 12 months. The overall healing-rate was 57.5% (23/40). The healing rate differs considerably between the surgeons from 0 to 75% and depends on the number of previous interventions. In patients having only drainage of the abscess success occurred in 63.6% (14/22) whereas in patients after one or more flap fistula reconstruction the healing rate decreased slightly to 50% (9/18). No patient complained about any impairment of his preoperative continence status. Conclusion: By occlusion of high anal fistulas with a plug technique definitive healing could be achieved in nearly every second patients. Previous surgery seems to have a negative impact on success rate. We have not observed any negative impact on anal continence. From that point of view anal fistula plugs might be discussed as a treatment option for high anal fistulas, but further studies are needed to gain conclusive evidence. PMID:22984363

  16. Cancers of the anal canal: diagnosis, treatment and future strategies.

    PubMed

    Bown, Emma; Shah, Vikas; Sridhar, Thiagarajan; Boyle, Kirsten; Hemingway, David; Yeung, Justin M

    2014-06-01

    Anal cancer is an uncommon cancer; however, it is rising in incidence. There is confusion regarding nomenclature and the distinction between anal canal cancer and anal margin cancer. This article discusses the modern definition, etiology and staging of anal canal and anal margin cancers. Modern chemotherapy and radiotherapy regimens are discussed, in addition to modern imaging and radiotherapy techniques. Future preventative strategies and potential novel treatments are discussed. PMID:25052753

  17. Triple cardiac rupture.

    PubMed

    Vazquez, Alejandro; Osa, Ana; Vicente, Rosario; Montero, Jose A

    2014-09-01

    Left ventricular free wall rupture and acute ischaemic mitral regurgitation are nowadays rare, but still potentially lethal mechanical complications after acute myocardial infarction. We report a case of a sequential left ventricular free wall rupture, anterolateral papillary muscle disruption, secondary severe mitral regurgitation and subsequent posteromedial papillary muscle head rupture in a single patient during the same ischaemic episode after myocardial infarction, and their related successful surgical procedures and management until discharge. Prompt bedside diagnosis and emergent consecutive surgical procedures, as well as temporary left ventricular assistance, were crucial in the survival of this patient. PMID:24876216

  18. Gracilis muscle as neoanal sphincter for faecal incontinence.

    PubMed

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

    2010-03-01

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

  19. Treatment of Gastrointestinal Sphincters Spasms with Botulinum Toxin A

    PubMed Central

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

    2015-01-01

    Botulinum toxin A inhibits neuromuscular transmission. It has become a drug with many indications. The range of clinical applications has grown to encompass several neurological and non-neurological conditions. One of the most recent achievements in the field is the observation that botulinum toxin A provides benefit in diseases of the gastrointestinal tract. Although toxin blocks cholinergic nerve endings in the autonomic nervous system, it has also been shown that it does not block non-adrenergic non-cholinergic responses mediated by nitric oxide. This has promoted further interest in using botulinum toxin A as a treatment for overactive smooth muscles and sphincters. The introduction of this therapy has made the treatment of several clinical conditions easier, in the outpatient setting, at a lower cost and without permanent complications. This review presents current data on the use of botulinum toxin A in the treatment of pathological conditions of the gastrointestinal tract. PMID:26035487

  20. Treatment of gastrointestinal sphincters spasms with botulinum toxin A.

    PubMed

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

    2015-06-01

    Botulinum toxin A inhibits neuromuscular transmission. It has become a drug with many indications. The range of clinical applications has grown to encompass several neurological and non-neurological conditions. One of the most recent achievements in the field is the observation that botulinum toxin A provides benefit in diseases of the gastrointestinal tract. Although toxin blocks cholinergic nerve endings in the autonomic nervous system, it has also been shown that it does not block non-adrenergic non-cholinergic responses mediated by nitric oxide. This has promoted further interest in using botulinum toxin A as a treatment for overactive smooth muscles and sphincters. The introduction of this therapy has made the treatment of several clinical conditions easier, in the outpatient setting, at a lower cost and without permanent complications. This review presents current data on the use of botulinum toxin A in the treatment of pathological conditions of the gastrointestinal tract. PMID:26035487

  1. Ruptured visceral artery aneurysms.

    PubMed

    Chiaradia, M; Novelli, L; Deux, J-F; Tacher, V; Mayer, J; You, K; Djabbari, M; Luciani, A; Rahmouni, A; Kobeiter, H

    2015-01-01

    Visceral artery aneurysms are rare but their estimated mortality due to rupture ranges between 25 and 70%. Treatment of visceral artery aneurysm rupture is usually managed by interventional radiology. Specific embolization techniques depend on the location, affected organ, locoregional arterial anatomy, and interventional radiologist skill. The success rate following treatment by interventional radiology is greater than 90%. The main complication is recanalization of the aneurysm, showing the importance of post-therapeutic monitoring, which should preferably be performed using MR imaging. PMID:26054246

  2. [Iatrogenic postintubation tracheal rupture].

    PubMed

    Parshin, V D; Pogodina, A N; Vyzhigina, M A; Rusakov, M A

    2006-01-01

    Iatrogenic damage to the trachea in its intubation and during artificial lung ventilation ,is a rare, severe and commonly fatal complication in resuscitative care. The risk for tracheal damage increases in emergency, time shortage and hypoxia in a patient, while intubating with a double-lumen tube, using rigid mandrin guides without a safety limit stop, and having difficulties in intubating the patient due to his/her anatomic features. Fibrotracheoscopy is the principal diagnostic techniques that may cause tracheal rupture, which may be transformed to a therapeutic measure, by placing an intubation tube caudally at the site of tracheal rupture. Among 33 patients, only 6 underwent surgical defect suturing. When the trachea is ruptured, surgery is indicated for respiratory hemorrhage unstopped by inflating the cuff of an intubation tube and, perhaps, associated with the damage to a large vessel; for progressive gas syndrome, extensive rupture of the membranous part with the involvement of the tracheal bifurcation and main bronchus or with the interposition of paratracheal tissues; for a concomitant damage to the esophagus; for rupture of the tracheal membranous part during intubation before thoracotomy or for rupture detected during thoracotomy for another cause. Correct and timely care may eliminate this life-threatening iatrogenic complication, by yielding a good effect. PMID:16758936

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

    PubMed Central

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

    2012-01-01

    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

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

    PubMed Central

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

    2012-01-01

    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

  5. 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 ...

  6. Achilles Tendon Rupture

    PubMed Central

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

    2013-01-01

    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

  7. Selective suppression of sphincter activation during sacral anterior nerve root stimulation.

    PubMed

    Bhadra, Narendra; Grnewald, Volker; Creasey, Graham; Mortimer, J Thomas

    2002-01-01

    The purpose of this work was to electrically activate small-diameter motor fibers in the sacral anterior roots innervating the urinary bladder, without activating the large-diameter fibers to the sphincter. Quasitrapezoidal current pulses were applied through tripolar spiral nerve electrodes on selected anterior sacral roots during acute experiments on eight dogs, maintained under pentobarbital anesthesia. Pressures were recorded from the bladder and sphincter with catheter-mounted gauges. Stimulation with biphasic quasitrapezoidal pulses showed decrease in sphincter recruitment with increasing pulse amplitudes. The minimum current amplitude that resulted in maximum sphincter suppression was used to stimulate the roots with trains of 20 Hz pulses, with 60 mL of saline filling the bladder. Pressures were also recorded when 100 micros rectangular pulse trains at 20 Hz, both continuous and intermittent, were applied. Trains of stimuli were applied before and after dorsal root rhizotomy. Suppression of sphincter activation was defined to be a percentage, [(Maximum pressure -Minimum pressure)/Maximum pressure x100. The results from 22 roots in eight animals show that with single pulses, the average percentage suppression of sphincter activation was 76.3% (+/-14.0). The minimum current for maximum sphincter suppression was 1.29 mA (+/-0.62). The average bladder pressure evoked was 50 cm of water during pulse train stimulation, with no significant difference due to pulse type. With pulse trains, the sphincter pressures were significantly higher when the bladder was filled. Evacuation of fluid occurred in three animals with average flow rates of 1.0 mL/s. PMID:11835425

  8. Introducing the operation method for curing anal fistula by laser

    NASA Astrophysics Data System (ADS)

    Ji, Bingzhi

    1993-03-01

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

  9. Midwestern Rural Adolescents' Anal Intercourse Experience

    ERIC Educational Resources Information Center

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

    2011-01-01

    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

  10. Surgical salvage therapy of anal canal cancer

    PubMed Central

    Bai, Yue-Kui; Cao, Wen-Lan; Gao, Ji-Dong; Liang, Jun; Shao, Yong-Fu

    2004-01-01

    AIM: To evaluate the results of salvage resection in the management of persistent or locally recurrent anal canal cancer. METHODS: Details of all patients with anal canal cancer treated from 1978 to 1994 at Cancer Hospital of Chinese Academy of Medical Sciences (CAMS) were reviewed retrospectively. Sixteen patients who presented with persistent or locally recurrent anal canal cancer received salvage surgery. Before surgery all of the patients had received radiotherapy alone as their primary treatments. RESULTS: Of the 16 patients, 14 received salvage abdominoperineal resection (APR) and two had transanal local excision. There were no deaths attributable to operation. Delayed healing of the perineal wound occurred in eight patients. Complications unrelated to the perineal wound were found in five patients. The median follow-up time was 120 (range 5 - 245) months after salvage surgery. Nine patients died of disease progression, with a median survival time of 16 (range 5 - 27) months. Six patients had a long-term survival. CONCLUSION: Salvage resection after radiotherapy can yield a long-time survival in selected patients with anal canal cancer. However it offers little hope to patients with T4 and/or N2-3 tumors. PMID:14760771

  11. Midwestern Rural Adolescents' Anal Intercourse Experience

    ERIC Educational Resources Information Center

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

    2011-01-01

    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…

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

    ERIC Educational Resources Information Center

    Branfman, Jonathan; Ekberg Stiritz, Susan

    2012-01-01

    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,

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

    ERIC Educational Resources Information Center

    Branfman, Jonathan; Ekberg Stiritz, Susan

    2012-01-01

    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,…

  14. Sacral Neuromodulation Effects on Periurethral Sensation and Urethral Sphincter Activity

    PubMed Central

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

    2013-01-01

    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 6113 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

  15. HOSPITAL VARIATION IN SPHINCTER PRESERVATION FOR ELDERLY RECTAL CANCER PATIENTS

    PubMed Central

    Dodgion, Christopher M.; Neville, Bridget A; Lipsitz, Stuart R.; Schrag, Deborah; Breen, Elizabeth; Zinner, Michael J.; Greenberg, Caprice C.

    2014-01-01

    Purpose To evaluate hospital variation in the use of low anterior resection (LAR), local excision (LE) and abdominoperineal resection (APR) in the treatment of rectal cancer in elderly patients. Methods Using SEER-Medicare linked data, we identified 4,959 stage IIII rectal cancer patients over age 65 diagnosed from 20002005 who underwent operative intervention at one of 370 hospitals. We evaluated the distribution of hospital-specific procedure rates and used generalized mixed models with random hospital effects to examine the influence of patient characteristics and hospital on operation type, using APR as a reference. Results The median hospital performed APR on 33% of elderly rectal cancer patients. Hospital was a stronger predictor of LAR receipt than any patient characteristic, explaining 32% of procedure choice, but not a strong predictor of LE, explaining only 3.8%. Receipt of LE was primarily related to tumor size and tumor stage, which, combined, explained 31% of procedure variation. Conclusions Receipt of local excision is primarily determined by patient characteristics. In contrast, the hospital where surgery is performed significantly influences whether a patient undergoes an LAR or APR. Understanding the factors that cause this institutional variation is crucial to ensuring equitable availability of sphincter preservation. PMID:24750983

  16. Normal anatomic relationship between urethral sphincter complex and zones of prostrate in young Chinese males on MRI

    PubMed Central

    Wang, Xiangdong; Liu, Tieyan; Zhao, Jing; Sun, Jingyi; Chen, Yuefeng; Sun, Pengyu; Wang, Xuesong; Liu, Sheng

    2015-01-01

    Objective In this research, the normal anatomic relationship between urethral sphincter complex and zones of prostrate in young Chinese males has been studied. Methods: The sagittal, coronal, and axial T2-weighted non-fat suppressed fast spin-echo images of pelvic cavities of 86 Chinese young males were studied. Result: Urethral sphincter complex threaded through the prostate and divided it into 2 parts: transition zone (TZ), periurethral glands internal to the urethral sphincter and peripheral zone (PZ), central zone (CZ), anterior fibromuscular stroma (AFS) zone external to the urethral sphincter. The length of urethral striated sphincter is 12.26-20.94 mm (mean 16.59 mm) at membranous urethra. Conclusions: In this paper, we summarized the normal anatomic relationship between urethral sphincter complex and zones of prostrate in young Chinese males with no urinary control problems. PMID:26629244

  17. Biofeedback Therapy Before Ileostomy Closure in Patients Undergoing Sphincter-Saving Surgery for Rectal Cancer: A Pilot Study

    PubMed Central

    Kim, Jeong-Ki; Jeon, Byeong Geon; Song, Yoon Suk; Seo, Mi Sun; Kwon, Yoon-Hye; Park, JI Won; Ryoo, Seung-Bum; Jeong, Seung-Yong

    2015-01-01

    Purpose This study prospectively investigated the effects of biofeedback therapy on objective anorectal function and subjective bowel function in patients after sphincter-saving surgery for rectal cancer. Methods Sixteen patients who underwent an ileostomy were randomized into two groups, one receiving conservative management with the Kegel maneuver and the other receiving active biofeedback before ileostomy closure. Among them, 12 patients (mean age, 57.5 years; range, 38 to 69 years; 6 patients in each group) completed the study. Conservative management included lifestyle modifications, Kegel exercises, and medication. Patients were evaluated at baseline and at 1, 3, 6, and 12 months after ileostomy closure by using anal manometry, modified Wexner Incontinence Scores (WISs), and fecal incontinence quality of life (FI-QoL) scores. Results Before the ileostomy closure, the groups did not differ in baseline clinical characteristics or resting manometric parameters. After 12 months of follow-up, the biofeedback group demonstrated a statistically significant improvement in the mean maximum squeezing pressure (from 146.3 to 178.9, P = 0.002). However, no beneficial effect on the WIS was noted for biofeedback compared to conservative management alone. Overall, the FI-QoL scores were increased significantly in both groups after ileostomy closure (P = 0.006), but did not differ significantly between the two groups. Conclusion Although the biofeedback therapy group demonstrated a statistically significant improvement in the maximum squeezing pressure, significant improvements in the WISs and the FI-QoL scores over time were noted in both groups. The study was terminated early because no therapeutic benefit of biofeedback had been demonstrated. PMID:26361615

  18. Anal cancer and screening guidelines for human papillomavirus in men.

    PubMed

    Ortoski, Richard A; Kell, Christine S

    2011-03-01

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

  19. Effects of sphincter of Oddi bypass on bile acid metabolism in fed and fasted intact and cholecystectomized dogs.

    PubMed

    Ramakrishnan, V R; Beher, W T; Lin, G J; Stradnieks, S; Samhouri, F; Toledo-Pereyra, L H; Block, M A

    1981-01-01

    The effects of cholecystectomy and sphincter of Oddi bypass on bile acid (BA) metabolism in dogs have been studied. Cholecystectomy and sphincter bypass decreased the BA pool half-life and increased the percent of taurodeoxycholic acid in the pool. A 48-hour fast had no effect on total BA pool size of intact and intact sphincter-of-Oddi-bypassed dogs but caused a marked decrease in cholecystectomized dogs. It was concluded that while the sphincter of Oddi is unnecessary to maintain bile acid pool size in fasting dogs, the gallbladder is. Alimentation is necessary to maintain pool size in cholecystectomized dogs. PMID:7215717

  20. Prevalence of anal human papillomavirus infection and anal HPV-related disorders in women: a systematic review.

    PubMed

    Stier, Elizabeth A; Sebring, Meagan C; Mendez, Audrey E; Ba, Fatimata S; Trimble, Debra D; Chiao, Elizabeth Y

    2015-09-01

    The aim of this study was to systematically review the findings of publications addressing the epidemiology of anal human papillomavirus (HPV) infection, anal intraepithelial neoplasia, and anal cancer in women. We conducted a systematic review among publications published from Jan. 1, 1997, to Sept. 30, 2013, to limit to publications from the combined antiretroviral therapy era. Three searches were performed of the National Library of Medicine PubMed database using the following search terms: women and anal HPV, women anal intraepithelial neoplasia, and women and anal cancer. Publications were included in the review if they addressed any of the following outcomes: (1) prevalence, incidence, or clearance of anal HPV infection, (2) prevalence of anal cytological or histological neoplastic abnormalities, or (3) incidence or risk of anal cancer. Thirty-seven publications addressing anal HPV infection and anal cytology remained after applying selection criteria, and 23 anal cancer publications met the selection criteria. Among HIV-positive women, the prevalence of high-risk (HR)-HPV in the anus was 16-85%. Among HIV-negative women, the prevalence of anal HR-HPV infection ranged from 4% to 86%. The prevalence of anal HR-HPV in HIV-negative women with HPV-related pathology of the vulva, vagina, and cervix compared with women with no known HPV-related pathology, varied from 23% to 86% and from 5% to 22%, respectively. Histological anal high-grade squamous intraepithelial lesions (anal intraepithelial neoplasia 2 or greater) was found in 3-26% of the women living with HIV, 0-9% among women with lower genital tract pathology, and 0-3% for women who are HIV negative without known lower genital tract pathology. The incidence of anal cancer among HIV-infected women ranged from 3.9 to 30 per 100,000. Among women with a history of cervical cancer or cervical intraepithelial neoplasia 3, the incidence rates of anal cancer ranged from 0.8 to 63.8 per 100,000 person-years, and in the general population, the incidence rates ranged from 0.55 to 2.4 per 100,000 person-years. This review provides evidence that anal HPV infection and dysplasia are common in women, especially in those who are HIV positive or have a history of HPV-related lower genital tract pathology. The incidence of anal cancer continues to grow in all women, especially those living with HIV, despite the widespread use of combined antiretroviral therapy. PMID:25797230

  1. VAAFT: Video Assisted Anal Fistula Treatment; Bringing revolution in Fistula treatment

    PubMed Central

    Zarin, Mohammad; Khan, Muhammad Imran; Ahmad, Mukhtar; Ibrahim, Muhammad; Khan, Muhammad Asim

    2015-01-01

    Objective: To share our findings that the new treatment modality Video Assisted Anal Fistula Treatment (VAAFT) is a better alternate to the conventional treatments of Fistula in Ano in our setup with minor changes in the initial method described by Meinero. Methods: Karl Storz Video equipment including Meinero Fistuloscope was used. Key steps are visualization of the fistula tract, correct localization of the internal fistula opening under direct vision and endoscopic treatment of the fistula. This is followed by an operative phase of fulguration of the fistula tract using glycine solution mixed with manitol, curetting the tract with curette and fistula brush. Internal opening is closed with a Vicryl 1 suture. Result: Total of 40 patients were operated using VAAFT from October 2013 to March 2014. Three were re-operated. The other 37 cases were followed up at 6 weeks, 3 months and 6 months. Primary healing took place in 20 (50%) cases at 6 weeks. In the remaining 17 (42.5%) cases, minor discharge occurred with itching which resolved till the next visit at 8 weeks and 12 weeks. Conclusion: As the main aim in treating fistula is proper identification of the internal opening, excision of the tract and sparing the sphincter function, VAAFT achieves all aims with additional benefits of patients satisfaction and negligible scaring. PMID:26649020

  2. Anal intraepitelial neoplasia: A narrative review.

    PubMed

    Elorza, Garazi; Saralegui, Yolanda; Enríquez-Navascués, Jose María; Placer, Carlos; Velaz, Leyre

    2016-01-01

    Anal intraepitelial neoplasia (AIN) constitutes a major health problem in certain risk groups, such as patients with immunosuppression of varied origin, males who have sexual relations with other males, and females with a previous history of vaginal or cervical abnormalities in cytology. Its relationship with the human papillomavirus (HPV) infection has been well documented; however, many of the factors involved in the progression and regression of the viral infection to dysplasia and anal carcinoma are unknown. AIN can be diagnosed through cytology of the anal canal or biopsy guided by high-resolution anoscopy. However, the need for these techniques in high-risk groups remains controversial. Treatment depends on the risk factors and given the high morbidity and high recurrence rates the utility of the different local treatments is still a subject of debate. Surgical biopsy is justified only in the case of progression suggesting lesions. The role of the vaccination in high-risk patients as primary prevention has been debated by different groups. However, there is no general consensus on its use or on the need for screening this population. PMID:26765233

  3. Anal Cancer: An Examination of Radiotherapy Strategies

    SciTech Connect

    Glynne-Jones, Rob; Lim, Faye

    2011-04-01

    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.

  4. 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

    Leung, Felix W

    2011-10-01

    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

  5. 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

    2011-01-01

    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

  6. Expression of serotonin receptors in human lower esophageal sphincter.

    PubMed

    Li, He-Fei; Liu, Jun-Feng; Zhang, Ke; Feng, Yong

    2015-01-01

    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

  7. Expression of serotonin receptors in human lower esophageal sphincter

    PubMed Central

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

    2015-01-01

    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

  8. Medication Effects on Periurethral Sensation and Urethral Sphincter Activity

    PubMed Central

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

    2014-01-01

    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 07), 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

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

    SciTech Connect

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

    1986-03-01

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

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

    PubMed Central

    Viceconte, G

    1983-01-01

    The effects of ethanol, given either intragastrically or intravenously, on the sphincter of Oddi was evaluated by endoscopic manometry. In 12 subjects intragastric ethanol (150 ml of 32%) was given over 10 minutes. In five control subjects saline solution (150 ml of 0.9%) was given intragastrically instead of ethanol. In five other subjects ethanol was infused intravenously (6 ml/kg of 10%) for 36 minutes. Ethanol given intragastrically produced a significant inhibitory effect on sphincter of Oddi pressure. Peak pressure fell from a control value of 75.7 +/- 26.35 mmHg to 39 +/- 15.39 mmHg (p less than 0.001) at 35 minutes. Basal pressure fell from a control value of 30.17 +/- 19.47 mmHg to 11.83 +/- 6.35 mmHg (p less than 0.01) at 35 minutes. Wave height fell from a control value of 41.33 +/- 15.4 mmHg to 27.16 +/- 11.25 mmHg (p less than 0.02) at 35 minutes. No effects on sphincter of Oddi wave frequency were observed. No significant modifications of sphincter motor activity were observed after intragastric saline infusion. Ethanol given intravenously also produced an appreciable inhibitory effect on sphincter of Oddi pressure, without affecting its wave frequency. PMID:6848429

  11. Anal canal duplication: a retrospective analysis of 12 cases from two European pediatric surgical departments.

    PubMed

    Lisi, Gabriele; Illiceto, M T; Rossi, C; Broto, J M; Jil-Vernet, J M; Lelli Chiesa, P

    2006-12-01

    Anal canal duplication (ACD) represents an extremely rare intestinal congenital anomaly of unknown origin. Usually evidenced within 2 years of age, nearly 45% of reported cases present associated malformations such as presacral mass, anorectal malformation (ARM) and genitourinary anomalies. The confirmative diagnosis is histopathological, with evidence of an anal mucosal lining (squamous +/- transitional epithelium), surrounded from a smooth muscle coat and anal glands. We review a conjoined experience from two European pediatric surgical departments. From 1970 to 2005, 12 patients were observed, seven in Pescara, Italy (1997-2005), five in Barcelona, Spain (1970-2004) - mean age at diagnosis 17.8 months, range 0-60; M:F = 1:11. Clinical presentation, diagnostic-surgical approach, and complications were reviewed. According to clinical presentation, patients could be divided in three age groups: asymptomatic (mean age 4.8 months, six patients - one with an associated complex genitourinary malformation, one with a presacral mature teratoma, one with ACD evidenced hysthologically on a retroanal mass removed during the correction of an ARM), mildly symptomatic - constipation, mucous discharge (mean age 29.2 months, four patients - one with associated presacral ependymoma and intestinal neuronal dysplasia type B, one with presacral mass) and complicated - perineal abscess, recurrent fistula (mean age 34 months, two patients). In 11 cases a perianal orifice was evident (ten posteriorly located). The pelvic-MRI was the preferred diagnostic tool in Pescara (5/7, with presacral mass in two patients), fistulography in Barcelona (5/5), where one presacral mass was discovered intraoperatively. Eleven patients underwent surgical removal of the ACD (five perineal approach, five posterior sagittal approach, and one PSARP). Histopathological findings confirmed the diagnosis in operated cases (11). The parents of the male patient denied the consent to surgical treatment. The only major post-operative complication was a sphincteric insufficiency (one case), surgically treated. When facing a perianal orifice, attention should be paid to ACD, particularly in female patients with coexistent genitourinary or intestinal malformations. Pelvic US and MRI are the gold standard to evidence the not rarely associated presacral mass. Surgical early removal (mucosectomy or perineal/posterior sagittal approach, depending on length of ACD and associated presacral mass) is warranted, also in asymptomatic patients, because of the risk of inflammatory complications and cancer (the latter reported in literature in adults). PMID:17061104

  12. Blunt traumatic pericardial rupture.

    PubMed Central

    Levine, A J; Collins, F J

    1995-01-01

    A 28-year-old man presented with left chest, head and limb injuries following a road traffic accident (RTA). Increasing haemodynamic instability necessitated an emergency left thoracotomy at which a complete rupture of the pericardium and herniation of the heart was found. After repair, the patient made an uneventful post-operative recovery. The aetiology, investigation and management of this rare injury is discussed. Images Fig. 1 PMID:7640832

  13. Iatrogenic tracheobronchial rupture

    PubMed Central

    Paraschiv, M

    2014-01-01

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

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

    PubMed

    Devesa, Jos Manuel; Vicente, Rosana

    2014-05-01

    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

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

    PubMed Central

    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

    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], 1.2810.40 and OR, 4.24; 95% CI, 1.1615.51, respectively). History of smoking (OR, 2.71 95% CI, 1.435.14), 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

  16. Heterosexual Anal Intercourse: A Neglected Risk Factor for HIV?

    PubMed Central

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

    2014-01-01

    Heterosexual anal intercourse confers a much greater risk of HIV transmission than vaginal intercourse, yet its contribution to heterosexual HIV epidemics has been under researched. In this article we review the current state of knowledge of heterosexual anal intercourse practice worldwide and identify the information required to assess its role in HIV transmission within heterosexual populations, including input measures required to inform mathematical models. We then discuss the evidence relating anal intercourse and HIV with sexual violence. PMID:23279040

  17. Anal squamous cell carcinoma: An evolution in disease and management

    PubMed Central

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

    2014-01-01

    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

  18. [Pelvic floor and anal incontinence. Conservative therapy].

    PubMed

    Kroesen, A J

    2013-01-01

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

  19. [Achilles tendon rupture].

    PubMed

    Thermann, H; Hfner, T; Tscherne, H

    2000-03-01

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

  20. Ruptured tubal molar pregnancy.

    PubMed

    Yakasai, I A; Adamu, N; Galadanchi, H S

    2012-01-01

    Molar pregnancies in most instances develop within the uterine cavity, but may occur at any site. Ectopic molar pregnancy is a rare event. The objective of this study was to present a case of ruptured tubal molar gestation, discuss its clinical features and ways to improve diagnostic accuracy. A 35-year-old woman presented with features suggestive of ruptured tubal ectopic pregnancy. There was neither any evidence at the time of presentation to suspect a molar gestation, nor ? human chorionic gonadotrophin (?hCG) hormone estimation was done, but only a clearview pregnancy test was carried out. She had total left salpingectomy and histological evaluation of the specimen revealed complete hydatidiform mole. The hCG level normalized within 3 weeks of follow-up. Clinical features of ectopic molar pregnancy may be indistinguishable from non-molar ectopic pregnancy. We recommend ?hCG estimation as well as histological examination of the surgical specimen for all patients coming with features suggestive of ectopic pregnancy. PMID:23238205

  1. Ruptured Spleen as a Differential Diagnosis in Ruptured Tubal Pregnancy

    PubMed Central

    Weekes, Leroy R.

    1984-01-01

    Two cases of traumatic biphasic or secondary splenic rupture are presented to demonstrate the clinical picture of an entity the obstetrician-gynecologist will be encountering more commonly in the future. The signs and symptoms of this condition figured prominently in the differential diagnosis of ruptured tubal pregnancy. PMID:6737489

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

    ERIC Educational Resources Information Center

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

    2012-01-01

    Background: The assessment of adequate upper oesophageal sphincter (UOS) opening during swallowing is an integral component of dysphagia evaluation. Aims: To ascertain speech and language therapists' (SLTs) satisfaction with current methods for assessing UOS function in people with dysphagia and to identify challenges encountered by SLTs with UOS…

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

    ERIC Educational Resources Information Center

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

    2012-01-01

    Background: The assessment of adequate upper oesophageal sphincter (UOS) opening during swallowing is an integral component of dysphagia evaluation. Aims: To ascertain speech and language therapists' (SLTs) satisfaction with current methods for assessing UOS function in people with dysphagia and to identify challenges encountered by SLTs with UOS

  4. Controversies in the treatment of common anal problems

    PubMed Central

    Sagap, Ismail; Remzi, Feza H

    2006-01-01

    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

  5. Gastrointestinal stromal tumor of the anal wall in a Nigerian

    PubMed Central

    Oluyemi, Aderemi; Keshinro, Samuel; Jimoh, Abimbola; Oshun, Philip

    2015-01-01

    Documented reports of gastrointestinal stromal tumors (GIST) are relatively few in the sub-Saharan continent. The body of evidence points towards anal wall involvement being a rarity indeed. In this article we document a 61 year old Nigerian man who presented with bleeding per rectum and in whom the histological features (including immunohistochemistry) of the biopsied anal lesion was GIST. PMID:26893795

  6. Anal cancer and intraepithelial neoplasia screening: A review

    PubMed Central

    Leeds, Ira L; Fang, Sandy H

    2016-01-01

    This review focuses on the early diagnosis of anal cancer and its precursor lesions through routine screening. A number of risk-stratification strategies as well as screening techniques have been suggested, and currently little consensus exists among national societies. Much of the current clinical rationale for the prevention of anal cancer derives from the similar tumor biology of cervical cancer and the successful use of routine screening to identify cervical cancer and its precursors early in the disease process. It is thought that such a strategy of identifying early anal intraepithelial neoplasia will reduce the incidence of invasive anal cancer. The low prevalence of anal cancer in the general population prevents the use of routine screening. However, routine screening of selected populations has been shown to be a more promising strategy. Potential screening modalities include digital anorectal exam, anal Papanicolaou testing, human papilloma virus co-testing, and high-resolution anoscopy. Additional research associating high-grade dysplasia treatment with anal cancer prevention as well as direct comparisons of screening regimens is necessary to develop further anal cancer screening recommendations. PMID:26843912

  7. Motilin agonist erythromycin increases human lower esophageal sphincter pressure by stimulation of cholinergic nerves.

    PubMed

    Chaussade, S; Michopoulos, S; Sogni, P; Guerre, J; Couturier, D

    1994-02-01

    During phases II and III of the migrating motor complex, there is an increase in plasma motilin level that is synchronous with phasic and tonic contractile activity of the lower esophageal sphincter and of the stomach. The action of motilin on human lower esophageal sphincter is proposed to be mediated by cholinergic mechanisms. Recently, it has been shown that erythromycin was a motilin agonist. This study evaluated the pharmacological effects and the mechanisms of action of intravenous erythromycin on esophageal motility in humans. Healthy volunteers were studied three times at seven-day intervals in a randomized, double-blind fashion. Subjects were first studied for 10 min before drug administration. Afterwards, they received blindly and randomly an intravenous injection of placebo or atropine (12 micrograms/kg) followed by a 20-min continuous intravenous administration of placebo or erythromycin (150 mg). The difference (delta) between lower esophageal sphincter pressure and the duration, amplitude, and velocity of peristaltic contractions during the control period and after administration of drugs was compared. Erythromycin significantly increased (P < 0.05) the lower esophageal sphincter pressure (16.8 +/- 4.7 mm Hg) compared to placebo (-0.029 +/- 1.4 mm Hg). Erythromycin significantly decreased peristaltic contraction velocity compared to placebo (P < 0.05). The effects of erythromycin on lower esophageal sphincter pressure were completely blocked by previous administration of intravenous atropine. Erythromycin increased the number of fundic contractions compared to the placebo, but this effect was not blocked by the previous administration of atropine.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8313822

  8. Morphometric Development of Sphincter of Oddi in Human Fetuses During Fetal Period: Microscopic Study

    PubMed Central

    Desdicio?lu, Kadir; Bozkurt, Kemal K.; U?uz, Ceren; Evcil, E. Hilal; Malas, Mehmet A.

    2012-01-01

    Objective: In this study, morphometric developments of the sphincter of Oddi in human fetuses were observed. Material and Methods: We observed 113 human fetuses consisting of 67 male and 46 female subjects, whose ages varied between 14 to 40 weeks who showed no signs of any pathology or anomaly externally. The common external measurements of fetuses were carried out, followed by abdominal dissection to determine where the sphincters of Oddi were localized within the duodenum and pancreas. Histological specimens of tissue samples were gathered from the inner wall of the duodenum where it was assumed that the sphincters of Oddi had been localized. The parameters of total external diameters, lumen diameters, wall thickness, diameters of ductus choledochus and ductus pancreaticus, and the distance between these two structures, which are also known as the origins of the sphincter of Oddi, were measured by using a light microscope. The standard deviations of the measurements were calculated for each gestational week and trimester. Results: The calculations suggested that there were statistically significant correlations between gestational age and all of the other parameters with the exception of the ductus choledochus (p<0.001). It was observed that the wall thickness of the ductus choledochus increased at the first half of the fetal stage and decreased at the second half, as the lumen diameter increased through the 40th week. The gender difference was not statistically significant (p>0.05). Conclusion: The data we collected in our study were considered as useful for the evaluation of the development of the sphincter of Oddi area and fetal stage. PMID:25207017

  9. [Multivariate analysis of risk factors of the anal functional disorders after abdominal-anal resection with delayed formation of colonic-anal anastomosis].

    PubMed

    Borota, A V; Miroshnichenko, E Iu; Sovpel', O V

    2014-01-01

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

  10. Spontaneous rupture on irregular faults

    NASA Astrophysics Data System (ADS)

    Liu, C.

    2014-12-01

    It is now know (e.g. Robinson et al., 2006) that when ruptures propagate around bends, the rupture velocity decrease. In the extreme case, a large bend in the fault can stop the rupture. We develop a 2-D finite difference method to simulate spontaneous dynamic rupture on irregular faults. This method is based on a second order leap-frog finite difference scheme on a uniform mesh of triangles. A relaxation method is used to generate an irregular fault geometry-conforming mesh from the uniform mesh. Through this numerical coordinate mapping, the elastic wave equations are transformed and solved in a curvilinear coordinate system. Extensive numerical experiments using the linear slip-weakening law will be shown to demonstrate the effect of fault geometry on rupture properties. A long term goal is to simulate the strong ground motion near the vicinity of bends, jogs, etc.

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

    PubMed

    Beedholm, Kirsten; Lomborg, Kirsten; Frederiksen, Kirsten

    2014-04-01

    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

  12. Advances in the Management of Anal Cancer.

    PubMed

    Julie, Diana R; Goodman, Karyn A

    2016-03-01

    Although anal squamous cell carcinoma (ASCC) is an uncommon malignancy, its incidence has been increasing markedly in recent decades due to its association with human papilloma virus (HPV) infection. The well-established standard of care for localized ASCC consists of the combination of 5-fluorouracil (5FU) and mitomycin (MMC) chemotherapy, concurrent with external beam radiation therapy (EBRT). However, newer techniques are being actively pursued, including the use of newer radiation therapy (RT) technologies, such as intensity-modulated radiation therapy (IMRT). The areas of debate and development include the dosing and timing of MMC delivery, the role of cisplatin chemotherapy as an alternative to MMC, the replacement of the standard 96-h infusion of5FU with oral capecitabine, the use of targeted chemotherapy agents, and the duration and dose of RT. PMID:26905274

  13. [Comparative study of morphometric parameters of the descending sigmoid sphincter according to the data of optical and virtual colonoscopy].

    PubMed

    Azarov, V F; Ignat'ev, Iu T; Putilova, I N; Skripkin, D A

    2014-01-01

    Morphometric parameters of a descending sigmoid sphincter (DSS) were defined in 32 patients of both sexes aged 20-71 years (average age: 48.0 +/- 2.2 years) with various forms of colon lumen at the site of sphincter. Densitometric indices of DSS and surrounding soft tissues were estimated. Vital morphological peculiarities of descending-sigmoid junction of the colon were demonstrated, and the diameter of the colon at the level of a sphincter was defined. The data obtained confirm the anatomical character of the colon sphincters and may be used as a basis for the interpretation of optical and virtual endoscopic images and DSS description for the application in differential diagnostics and precision surgery of various colon diseases. PMID:25282823

  14. Treatment of high anal fistulae by primary occlusion of the internal ostium, drainage of the intersphincteric space, and mucosal advancement flap.

    PubMed

    Athanasiadis, S; Khler, A; Nafe, M

    1994-08-01

    In a prospective study on 224 patients with so-called high-fistula in ano (189 transsphincteric, 35 suprasphincteric) the long-term results of a sphincter-saving operation technique were assessed. The follow-up period was 1 to 7.5 years. This technique consists of one-stage fistulectomy as well as of drainage of the intersphincteric space by internal sphincterotomy. The site of the former primary orifice of the fistula is adapted by multiple peranally performed single stitches, including mucosal advancement flap distal to the original fistulous opening. Postoperatively, 24 cases of suture leakage occurred (9% with the transsphincteric and 20% with the suprasphincteric fistula). 27 patients developed late complications like fistula recurrences or combinations of fistula and anal abscess (10.7% with the transsphincteric and 19.9% with the suprasphincteric fistula). Anal manometry was carried out preoperatively as well as postoperatively. A significant decrease in the postoperative resting pressure compared to the preoperative value was determined. The two fistula groups differed statistically both with regard to the resting pressure and the contraction pressure. Significant impairment of continence developed in 21% of patients with transsphincteric fistula but in 43% of patients with suprasphincteric fistula (intermittent fecal spoiling/use of perineal pads). The total percentage of complications rose with the number of previous fistula operations. PMID:7814990

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

    PubMed

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

    2006-10-01

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

  16. Dynamic and ultrastructural study of sphincter of Oddi in early-stage cholelithiasis in rabbits with hypercholesterolemia

    PubMed Central

    Wei, Jing-Guo; Wang, Yao-Cheng; Du, Fan; Yu, Hou-Jun

    2000-01-01

    AIM: To study the relationship between pre-formation of galls tone and the kinetics and ultra-structure of sphincter of Oddi. METHODS: Adult female rabbits were used and divided into 3 groups, and fed with either normal or high cholesterol diet for four or eight weeks. Each group contained eight rabbits. The manometry of sphincter of Oddi, biliary cineradiography, gallbladder volume measurement and ultrastructure observatio n under electron microscope were performed. RESULTS: In groups I and II, the basal pressure in low-pressu re ampulla or high pressure zone of sphincter of Oddi was elevated, the amplitude of phasic contraction was decreased and the volume of gallbladder were increased, with a significant difference (P < 0.01, from those of control. Gallstones were found in group II rabbits(7/8). Under cineradiography, low-press ure ampulla showed a spasmodic status without apparent peristaltic contraction. Under electron microscope, inside the muscular cells of sphincter of Oddi, loosening of microfilament and swelling of plasmosomes which congregated at the top were observed. The amount showed no obvious change under nitric oxide synthase (NOS) stain. CONCLUSION: Twisting of the microfilament and disarrangement of kink macula densa inside the muscular cells suggested that the sphincter of Oddi was under spasmodic status. The impaired diastolic function caused and aggravated the stasis of cystic bile. The swelling plasmosome could be one of the important factors in elevating the tonic pressure of sphincter of Oddi. PMID:11819533

  17. Bioengineered Human Pyloric Sphincters Using Autologous Smooth Muscle and Neural Progenitor Cells.

    PubMed

    Rego, Stephen Lee; Zakhem, Elie; Orlando, Giuseppe; Bitar, Khalil N

    2016-01-01

    Gastroparesis leads to inadequate emptying of the stomach resulting in severe negative health impacts. Appropriate long-term treatments for these diseases may require pyloric sphincter tissue replacements that possess functional smooth muscle cell (SMC) and neural components. This study aims to bioengineer, for the first time, innervated human pylorus constructs utilizing autologous human pyloric sphincter SMCs and human neural progenitor cells (NPCs). Autologous SMCs and NPCs were cocultured in dual-layered hydrogels and formed concentrically aligned pylorus constructs. Innervated autologous human pylorus constructs were characterized through biochemical and physiologic assays to assess the phenotype and functionality of SMCs and neurons. SMCs within bioengineered human pylorus constructs displayed a tonic contractile phenotype and maintained circumferential alignment. Neural differentiation within bioengineered constructs was verified by positive expression of βIII-tubulin, neuronal nitric oxide synthase (nNOS), and choline acetyltransferase (ChAT). Autologous bioengineered innervated human pylorus constructs generated a robust spontaneous basal tone and contracted in response to potassium chloride (KCl). Contraction in response to exogenous neurotransmitter acetylcholine (ACh), relaxation in response to vasoactive intestinal peptide (VIP), and electrical field stimulation (EFS) were also observed. Neural network integrity was demonstrated by inhibition of EFS-induced relaxation in the presence of a neurotoxin or nNOS inhibitors. Partial inhibition of ACh-induced contraction and VIP-induced relaxation following neurotoxin treatment was observed. These studies provide a proof of concept for bioengineering functional innervated autologous human pyloric sphincter constructs that generate a robust basal tone and contain circumferentially aligned SMCs, which display a tonic contractile phenotype and functional differentiated neurons. These autologous constructs have the potential to be used as (1) functional replacement organs and (2) physiologically relevant models to investigate human pyloric sphincter disorders. PMID:26563426

  18. Lower esophageal sphincter pressure in patients with gastroesophageal reflux diseases and posture and time patterns.

    PubMed

    Meining, A; Fackler, A; Tzavella, K; Storr, M; Allescher, H D; Klauser, A; Heldwein, W

    2004-01-01

    Gastroesophageal reflux disease is caused predominantly by lower esophageal sphincter insufficiency. Reports suggest that it is possible to distinguish between two main mechanisms causing reflux: low basal sphincter pressure leading to free reflux, mostly occurring at night in the supine position, and increased transient lower esophageal sphincter relaxations with normal or increased resting pressure leading to reflux during the day in an upright position. Lower esophageal sphincter pressure (LESP)-- s determined by stationary pull-through manometry--was compared to profiles of acidic reflux measured by 24-h pH monitoring in 207 patients with proven gastroesophageal reflux disease. Differences in LESP were not significant among patients with reflux predominantly during the day in an upright position and those with reflux predominantly at night in a supine position (16.1 +/- 7.4 mmHg versus 15.1 +/- 7.8 mmHg; t-test: P = 0.355). For both patterns of LESP, there was a slight negative correlation with the amount of acidic reflux (determined as a percentage of time with pH < 4). Pearson correlation coefficients were -0.196 for upright refluxers and -0.137 for bipositional/supine refluxers (P = 0.006 and P = 0.049, respectively). As there are no differences in LESP with regard to posture or time patterns of acidic reflux it seems unlikely that upright reflux is associated with increased LESP, whereas supine reflux manifests due to a hypotensive LESP. Alternatively, it may be concluded that stationary pull-through manometry is inadequate for determining the cause of gastroesophageal reflux disease and is therefore of limited use in its routine diagnosis. PMID:15230730

  19. The use of sling vs sphincter in post-prostatectomy urinary incontinence.

    PubMed

    Van Bruwaene, Siska; De Ridder, Dirk; Van der Aa, Frank

    2015-09-01

    The artificial urinary sphincter (AUS) is considered the 'gold standard' in post-prostatectomy urinary incontinence. However, in recent years, male slings have gained much popularity due to the ease of surgery, good functional results and low complications rates. This review systematically shows the evidence for the different sling systems, describes the working mechanism, and compares their efficacy against that of the AUS. Furthermore subgroups of patients are defined who are not suited to undergo sling surgery. PMID:25382641

  20. The expression of tachykinin receptors in the human lower esophageal sphincter.

    PubMed

    Zhang, Ke; Chen, Que T; Li, Jing H; Geng, Xian; Liu, Jun F; Li, He F; Feng, Yong; Li, Jia L; Drew, Paul A

    2016-03-01

    Mammalian tachykinins are a family of neuropeptides which are potent modulators of smooth muscle function with a significant contractile effect on human smooth muscle preparations. Tachykinins act via three distinct G protein-coupled neurokinin (NK) receptors, NK1, NK2 and NK3, coded by the genes TACR1, TACR2 and TACR3 respectively. The purpose of this paper was to measure the mRNA and protein expression of these receptors and their isoforms in the clasp and sling fibers of the human lower esophageal sphincter complex and circular muscle from the adjacent distal esophagus and proximal stomach. We found differences in expression between the different receptors within these muscle types, but the rank order of the receptor expression did not differ between the different muscle types. The rank order of the mRNA expression was TACR2 (? isoform)>TACR2 (? isoform)>TACR1 (short isoform)>TACR1 (long isoform)>TACR3. The rank order of the protein expression was NK2>NK1>NK3. This is the first report of the measurement of the transcript and protein expression of the tachykinin receptors and their isoforms in the muscles of the human lower esophageal sphincter complex. The results provide evidence that the tachykinin receptors could contribute to the regulation of the human lower esophageal sphincter, particularly the TACR2 ? isoform which encodes the functional isoform of the tachykinin NK2 receptor was the most highly expressed of the tachykinin receptors in the muscles associated with the lower esophageal sphincter. PMID:26852958

  1. Anal duplication in a one-year-old girl

    PubMed Central

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

    2015-01-01

    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. PMID:25774340

  2. Prostaglandin E1 effects on resting and cholinergically stimulated lower esophageal sphincter pressure in cats.

    PubMed

    Sinar, D R; Fletcher, J R; Castell, D O

    1981-04-01

    Intraluminal esophageal manometry with a sleeve catheter was used to compare the magnitude of decrease in lower esophageal sphincter (LES) pressure produced by an arterial or venous infusion of prostaglandin E1 in cats. Arterial PGE1 produced significantly lower LES pressures than venous PGE1 (p less than 0.05). Maximal decrease of 75% in basal LES pressure occurred with an associated 15% decrease in systolic blood pressure. The site of action of PGE1 in producing LES hypotension was studied by injection of either edrophonium, or bethanechol during the maximal PGE1 effect. Bethanechol, which acts directly on sphincteric smooth muscle, produced an increase in LES pressure during both saline and PGE1 infusion, while the increases in LES pressure seen with edrophonium during saline infusion were blocked during the PGE1 infusion. From these studies, we conclude that PGE1 produces LES hypotension in the cat by an inhibitory effect on the cholinergic pathway responsible for maintaining LES tone. These studies pharmacologically reproduce the LES pressure abnormality previously reported in the cat during acid-induced esophagitis and support the hypothesis that PGE1 may be involved in the pathogenesis of acute acid-induced lower esophageal sphincter abnormalities. PMID:6114513

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

    PubMed Central

    Islah, MAR; Cho, Sung Yong

    2013-01-01

    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

  4. Nerve conduction studies, skeletal muscle EMG, and sphincter EMG in multiple system atrophy.

    PubMed Central

    Pramstaller, P P; Wenning, G K; Smith, S J; Beck, R O; Quinn, N P; Fowler, C J

    1995-01-01

    Although autonomic failure, parkinsonism, and cerebellar and pyramidal signs are well documented in multiple system atrophy, much less is known about the frequency and severity of involvement of the peripheral nervous system. The frequency and nature of peripheral nerve involvement has therefore been determined in 74 patients with multiple system atrophy using nerve conduction studies and skeletal muscle EMG. These findings were compared with those on sphincter EMG. Ninety per cent of the patients had an abnormal sphincter EMG, indicating denervation and reinnervation consistent with anterior horn cell loss in Onuf's nucleus, but only 40% had either abnormal nerve conduction studies (mixed sensorimotor axonal neuropathy in 17.5%) or abnormal skeletal muscle EMG (suggesting partial denervation in 22.5%). These data indicate a remarkable selective vulnerability of the anterior horn cells of Onuf's nucleus innervating external sphincter muscles relative to those supplying skeletal muscle in patients with multiple system atrophy. If this selective pattern of involvement can be explained it may be a clue to pathogenetic mechanisms in multiple system atrophy. PMID:7745413

  5. The artificial urinary sphincter and male sling for postprostatectomy incontinence: Which patient should get which procedure?

    PubMed Central

    Dobberfuhl, Amy D.

    2016-01-01

    Surgery is the most efficacious treatment for postprostatectomy incontinence. The ideal surgical approach depends on a variety of patient factors including history of prior incontinence surgery or radiation treatment, bladder contractility, severity of leakage, and patient expectations. Most patients choose to avoid a mechanical device, opting for the male sling over the artificial urinary sphincter. The modern male sling has continued to evolve with respect to device design and surgical technique. Various types of slings address sphincteric incompetence via different mechanisms of action. The recommended surgery, however, must be individualized to the patient based on degree of incontinence, detrusor contractility, and urethral compliance. A thorough urodynamic evaluation is indicated for the majority of patients, and the recommendation for an artificial urinary sphincter, a transobturator sling, or a quadratic sling will depend on urodynamic findings and the patient's particular preference. As advancements in this field evolve, and our understanding of the pathophysiology of incontinence and mechanisms of various devices improves, we expect to see continued evolution in device design. PMID:26966721

  6. Unprotected anal Intercourse among Iranian Intra-Venous Drug Users

    PubMed Central

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

    2013-01-01

    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)?=?0.9160.992] was associated with a lower likelihood of unprotected anal intercourse, while being not married (OR?=?2.301, 95% CI?=?1.1514.601), and high perceived HIV risk (OR?=?1.776, 95% CI?=?1.3762.290) 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

  7. [Achilles tendon ruptures and tibialis anterior tendon ruptures].

    PubMed

    Pagenstert, G; Leumann, A; Frigg, A; Valderrabano, V

    2010-12-01

    Achilles tendon ruptures (ATR) are becoming the most frequent tendon rupture of the lower extremity, whereas less than 100 cases of tibialis anterior tendon ruptures (TATR) have been reported. Common in both tendons are the degenerative causes of ruptures in a susceptible tendon segment, whereas traumatic transections occur at each level. Triceps surae and tibialis anterior muscles are responsible for the main sagittal ankle range of motion and ruptures lead to a distinctive functional deficit. However, diagnosis is delayed in up to 25% of ATR and even more frequently in TATR. Early primary repair provides the best functional results. With progressive retraction and muscle atrophy delayed tendon reconstruction has less favourable functional results. But not all patients need full capacity, power and endurance of these muscles and non-surgical treatment should not be forgotten. Inactive patients with significant comorbidities and little disability should be informed that surgical treatment of TATR is complicated by high rates of rerupture and surgical treatment of ATR can result in wound healing problems rarely necessitating some kind of transplantation. PMID:21110002

  8. Fault Branching and Rupture Directivity

    NASA Astrophysics Data System (ADS)

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

    2002-12-01

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

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

    PubMed Central

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

    1997-01-01

    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

  10. Rupture of the tracheobronchial tree.

    PubMed Central

    Roxburgh, J C

    1987-01-01

    Eleven cases of tracheobronchial rupture are described. Nine were the result of external non-penetrating trauma and all but three had other serious injuries. The remaining two were caused by endobronchial intubation. Of the cases caused by external injury, respiratory tract injury was confined to the cervical trachea in three. Two required tracheostomy and repair and the third was managed conservatively; all made satisfactory recoveries. Intrathoracic rupture was recognised on or soon after admission in three cases. One patient died of uncontrollable pulmonary haemorrhage before he could be operated on; immediate repair gave good long term results in the other two. In three cases rupture of the main bronchus was not recognised until complete obstruction developed three, five, and 12 weeks after the accidents. The strictures were resected and the lung re-expanded. Robertshaw endobronchial tubes ruptured the left main bronchus in two patients undergoing oesophageal surgery. Uneventful recovery followed immediate repair. The difficulty of confirming rupture of a major airway is discussed and the importance of conserving the lung when the diagnosis has been missed is emphasised. Images PMID:3317977

  11. Current treatment options for management of anal intraepithelial neoplasia

    PubMed Central

    Weis, Stephen E

    2013-01-01

    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

  12. HPV DNA prevalence and type distribution in anal carcinomas worldwide

    PubMed Central

    Alemany, L; Saunier, M; Alvarado, I; Quirós, B; Salmeron, J; Shin, HR; Pirog, E; Guimerà, N; Hernández, GA; Felix, A; Clavero, O; Lloveras, B; Kasamatsu, E; Goodman, MT; Hernandez, BY; Laco, J; Tinoco, L; Geraets, DT; Lynch, CF; Mandys, V; Poljak, M; Jach, R; Verge, J; Clavel, C; Ndiaye, C; Klaustermeier, J; Cubilla, A; Castellsagué, X; Bravo, IG; Pawlita, M; Quint, W; Muñoz, N; Bosch, FX; Sanjosé, S

    2014-01-01

    Knowledge about the human papillomaviruses (HPV) types in anal cancers in some world regions is scanty. Here we describe the HPV DNA prevalence and type distribution in a series of invasive anal cancers and anal intraepithelial neoplasias (AIN) grades 2/3 from 24 countries. We analyzed 43 AIN 2/3 cases and 496 anal cancers diagnosed from 1986 to 2011. After histopathological evaluation of formalin-fixed paraffin-embedded samples, HPV DNA detection and genotyping was performed using SPF-10/DEIA/LiPA25 system (version 1). A subset of 116 cancers was further tested for p16INK4a expression, a cellular surrogate marker for HPV-associated transformation. Prevalence ratios were estimated using multivariate Poisson regression with robust variance in cancer dataset. HPV DNA was detected in 88.3% of anal cancers (95%CI:85.1–91.0%) and in 95.4% of AIN 2/3 (95%CI:84.2–99.4%). Among cancers, the highest prevalence was observed in warty-basaloid subtype of squamous cell carcinomas, in younger patients and in North American geographical region. There were no statistically significant differences in prevalence by gender. HPV16 was the most frequent HPV type detected in both cancers (80.7%) and AIN 2/3 lesions (75.4%). HPV18 was the second most common type in invasive cancers (3.6%). p16INK4a overexpression was found in 95% of HPV DNA positive anal cancers. In view of HPV DNA results and high proportion of p16INK4a overexpression, infection by HPV is most likely to be a necessary cause for anal cancers in both men and women. The large contribution of HPV16 reinforces the potential impact of HPV vaccines in the prevention of these lesions. PMID:24817381

  13. Spontaneous splenic rupture in pregnancy

    PubMed Central

    Elghanmi, Adil; Mohamed, Jou; Khabouz, Samira

    2015-01-01

    Splenic rupture during pregnancy is a rare and can frequently be a misdiagnosed pathology. This rupture is associated with a high maternal and fetal mortality rate. A 26 years old Moroccan woman para II gravida II presented at the third stage of pregnancy with acute onset of severe abdominal pain. She developed immediately a hypovolemic shock. After both a physical and sonographical exam, it was revealed that it was due to a massive hemoperitoneum. Therefore, an emergent laparotomy and cesarean delivery with abdominal exploration were performed; also, an active bleeding was identified at the splenic hilum consistent with splenic rupture. Through this case report, we want to raise awareness of this surgical emergency that requires immediate recognition because any delay can lead to catastrophic consequences PMID:26587160

  14. Non-popliteal synovial rupture.

    PubMed

    Sit, Michelle; Higgs, Jay B

    2009-06-01

    The ruptured popliteal synovial cyst is a common complication of chronic knee arthritis. In contrast, non-popliteal synovial rupture is less well recognized and may present a diagnostic dilemma. We report an 81-year-old woman who presented with chest wall pain and ecchymosis. Ultrasonography of the shoulder region readily diagnosed a dissecting parasynovial cyst. She developed the unusual complication of contralateral recurrence. Literature review revealed a small but important set of non-popliteal synovial ruptures in the regions of the shoulder, elbow, wrist, spine, hip, knee, and ankle. Local swelling, inflammation, ecchymosis, and nerve impingement may mimic other conditions. Awareness of the clinical presentations and a high index of suspicion are required to avoid diagnostic confusion. Management data are limited to case reports of arthrocentesis, injection, and very rarely, surgery. PMID:19390451

  15. Self-Rupturing Hermetic Valve

    NASA Technical Reports Server (NTRS)

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

    2011-01-01

    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.

  16. Enzymatically triggered rupture of polymersomes.

    PubMed

    Jang, Woo-Sik; Park, Seung Chul; Reed, Ellen H; Dooley, Kevin P; Wheeler, Samuel F; Lee, Daeyeon; Hammer, Daniel A

    2016-01-20

    Polymersomes are robust vesicles made from amphiphilic block co-polymers. Large populations of uniform giant polymersomes with defined, entrapped species can be made by templating of double-emulsions using microfluidics. In the present study, a series of two enzymatic reactions, one inside and the other outside of the polymersome, were designed to induce rupture of polymersomes. We measured how the kinetics of rupture were affected by altering enzyme concentration. These results suggest that protocells with entrapped enzymes can be engineered to secrete contents on cue. PMID:26616557

  17. Anal stricture following haemorrhoidectomy: early diagnosis and treatment.

    PubMed

    Eu, K W; Teoh, T A; Seow-Choen, F; Goh, H S

    1995-02-01

    Anal stricture is an uncommon but well recognized complication following haemorrhoidectomy. Twenty-seven (3.8%) out of 704 (500 elective and 204 emergency) cases of haemorrhoidectomy performed at the Singapore General Hospital over a 24 month period had clinical evidence of anal stricture post-haemorrhoidectomy. Of the 27 cases, 15 had haemorrhoidectomy as an elective procedure while 12 had it performed as an emergency procedure (chi 2 = 3.26, 1 d.f., P > 0.05, not significant). The mean interval between surgery and presentation of anal stricture was 6 weeks (range 3-12 weeks). Eighteen of the patients were managed by anal dilatation in the outpatient clinic combined with bulk laxatives and a local anaesthetic agent. The other nine patients required a minor surgical procedure comprising either a lateral internal sphincterotomy (five) or an anoplasty (four) procedure. All patients were well, following treatment. None of these patients developed a recurrent stricture at follow up 3 months after treatment. It was concluded that although anal stricture following haemorrhoidectomy is rare, it should be detected and treated early in order to avoid pain and suffering, and treatment is usually successful. PMID:7857219

  18. All's Well That Ends Well: Shakespeare's treatment of anal fistula.

    PubMed

    Cosman, B C

    1998-07-01

    Textual and contextual evidence suggests that the French king's fistula, a central plot device in Shakespeare's play All's Well That Ends Well, is a fistula-in-ano. Anal fistula was known to the lay public in Shakespeare's time. In addition, Shakespeare may have known of the anal fistula treatise of John Arderne, an ancestor on Shakespeare's mother's side. Shakespeare's use of anal fistula differs from all previous versions of the story, which first appeared in Boccaccio's Decameron and from its possible historical antecedent, the fistula of Charles V of France. This difference makes sense given the conventions of Elizabethan comedy, which included anal humor. It is also understandable when one looks at what wounds in different locations mean in European legend. In this light, it is not surprising that subsequent expurgations treat Boccaccio's and Shakespeare's fistulas differently, censoring only Shakespeare's. This reading has implications for the staging of All's Well That Ends Well, and for our view of the place of anal fistulas in cultural history. PMID:9678380

  19. Metachronous tubulovillous and tubular adenomas of the anal canal.

    PubMed

    Nozawa, Hiroaki; Ishihara, Soichiro; Morikawa, Teppei; Tanaka, Junichiro; Yasuda, Koji; Ohtani, Kensuke; Nishikawa, Takeshi; Tanaka, Toshiaki; Kiyomatsu, Tomomichi; Kawai, Kazushige; Hata, Keisuke; Kazama, Shinsuke; Yamaguchi, Hironori; Sunami, Eiji; Kitayama, Joji; Fukayama, Masashi; Watanabe, Toshiaki

    2015-01-01

    Anal canal adenoma is an extremely rare disease that has the potential to transform into a malignant tumor. We herein presented a rare case of metachronous multiple adenomas of the anal canal. A 48-year-old woman underwent total colonoscopy following a positive fecal blood test. A 9-mm villous polyp arising from the posterior wall of the anal canal was removed by snare polypectomy. Histologically, the tumor was tubulovillous adenoma with high-grade dysplasia and the cut end was negative for tumor cells. Six years later, an elevated lesion, macroscopically five millimeters in size, was detected in the left wall of the anal canal in a follow-up colonoscopy. Local excision of the tumor was performed, and the lesion was pathologically confirmed to be tubular adenoma with high-grade dysplasia limited to the mucosa. The patient is currently alive without any evidence of recurrence for six months after surgery. Although she had a past history of cervical cancer, the multiple tumors arising in the anal canal were unlikely to be related to human papilloma virus infection. Our case report underscores the importance of careful observations throughout colonoscopy to detect precancerous lesions, particularly in anatomically narrow segments. PMID:26249723

  20. [A case of primary carcinoma associated with anal fistula].

    PubMed

    Nushijima, Youichirou; Nakano, Katsutoshi; Sugimoto, Keishi; Nakaguchi, Kazunori; Kan, Kazuomi; Maruyama, Hirohide; Doi, Sadayuki; Okamura, Shu; Murata, Kohei

    2014-11-01

    A 47-year-old man with no history of anal fistula was admitted to our hospital with a complaint of perianal pain. Computed tomography (CT) imaging revealed perianal abscess. Incision and drainage were performed under spinal anesthesia. Ten months after drainage, magnetic resonance imaging revealed anal fistula on the left side of the anus. Subsequently, core-out and seton procedures were performed for ischiorectalis type III anal fistula. Pathological examination of the resected specimen of anal fistula revealed a moderately differentiated adenocarcinoma, leading to the diagnosis of carcinoma associated with anal fistula. No distant metastases or enlarged lymph nodes were observed on positron emission tomography (PET)/CT. We performed abdominoperineal resection with wide resection of ischiorectalis fat tissue. The pathology results were tub2, A, ly0, v0, n0, PM0, DM0, RM0, H0, P0, M0, Stage II. Negative pressure wound therapy was performed for perineum deficiency, after which rapid wound healing was observed. Left inguinal lymph node recurrence was detected 8 months after surgery, for which radiotherapy was administered. Distant metastasis was detected 11 months after surgery. The patient died 21 months after surgery. PMID:25731359

  1. Lidocaine inhibition of esophageal peristalsis and lower esophageal sphincter pressure in baboons.

    PubMed

    Sinar, D R; Carey, L C; Cordova, C; Fletcher, J R; Castell, D O

    1985-11-01

    Intravenous lidocaine was infused at 0.82 ml/min in a concentration of 1.2 mg/ml (2.3 mg/kg) for 120 min in awake chair-restrained baboons (Papio anubis), and measurements of esophageal peristalsis and LES pressure were compared before and after lidocaine or control infusions. Lidocaine produced a progressive and significant (P less than 0.05) decrease in amplitude in the peristaltic wave in the smooth muscle portion of the distal esophagus during the 120-min infusion. Lower esophageal sphincter pressure was similarly significantly lower than control after the infusion of lidocaine (P less than 0.05). Velocity and duration of the peristaltic wave were unchanged during the infusion. The decreased amplitude occurred during therapeutic and stable serum concentrations of lidocaine. It did not appear that the inhibitory effect of lidocaine was due to an induction of prostaglandin synthesis, because pretreatment of animals with indomethacin did not change the inhibitory effect of lidocaine, and serum metabolites of prostacyclin decreased during the infusion. Furthermore, the inhibitory effect of lidocaine was not topical. The response to the muscarinic agonist, bethanechol was similar in lidocaine-treated animals and control animals. The preservation of a bethanechol response after lidocaine inhibition of LES pressure and distal esophageal amplitude suggests that lidocaine acts proximal to the muscarinic receptor in the esophageal body and smooth muscle portion of the lower esophageal sphincter. This study suggests that lidocaine produces an inhibitory effect on the peristaltic wave and lower esophageal sphincter pressure that is similar to inhibitory effects described after anticholinergic agents and calcium channel blocking drugs, but intravenous lidocaine infusion requires a longer period of time to produce inhibition of muscle function. PMID:2865090

  2. Regeneration of degenerated urinary sphincter muscles: improved stem cell-based therapies and novel imaging technologies.

    PubMed

    Amend, Bastian; Vaegler, Martin; Fuchs, Kerstin; Mannheim, Julia G; Will, Susanne; Kramer, Ulrich; Hart, Melanie L; Feitz, Wouter; Chapple, Christopher; Stenzl, Arnulf; Aicher, Wilhelm K

    2015-01-01

    Stress urinary incontinence (SUI) is a largely ousted but significant medical, social, and economic problem. Surveys suggest that nowadays approximately 10% of the male and 15% of the female population suffer from urinary incontinence at some stage in their lifetime. In women, two major etiologies contribute to SUI: degeneration of the urethral sphincter muscle controlling the closing mechanism of the bladder outflow and changes in lower pelvic organ position associated with degeneration of connective tissue or with mechanical stress, including obesity and load and tissue injury during pregnancy and delivery. In males, the reduction of the sphincter muscle function is sometimes due to surgical interventions as a consequence of prostate cancer treatment, benign prostate hyperplasia, or of neuropathical origin. Accordingly, for women and men different therapies were developed. In some cases, SUI can be treated by physical exercise, electrophysiological stimulation, and pharmacological interventions. If this fails to improve the situation, surgical interventions are required. In standard procedures, endoprostheses for mechanical support of the weakened tissue or mechanical valves for a bladder outflow control are implanted. In 20% of cases treated, repeat procedures are required as implants yield all sorts of side effects in time. Based on preclinical studies, the application of an advanced therapy medicinal product (ATMP) such as implantation of autologous cells may be a curative and long-lasting therapy for SUI. Cellular therapy could also be an option for men suffering from incontinence caused by injury of the nerves controlling the muscular sphincter system. Here we briefly report on human progenitor cells, especially on mesenchymal stromal cells (MSCs), their expansion and differentiation to smooth muscle or striated muscle cells in vitro, labeling of cells for in vivo imaging, concepts of improved, precise, yet gentle application of cells in muscle tissue, and monitoring of injected cells in situ. PMID:25608017

  3. Physioanatomic study of the diaphragmatic crura: the identification of autonomous "gastroesophageal sphincter".

    PubMed

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

    2005-01-01

    It is claimed that the right diaphragmatic crus forms a loop sphincter around the lower esophagus. We investigated the hypothesis that the loop-shaped muscle does not belong to the diaphragmatic crura either anatomically or physiologically and is considered an autonomous muscle. Thirty-two cadaveric specimens (20 males, 12 females, 22 adults, mean age 36.2 +/- 11.8 years, 10 mature neonatal deaths) fixed in 10% formalin were studied anatomically. Electrophysiologic study was performed in 14 subjects (8 men, 6 women, mean age 36.6 +/- 8.2 years) scheduled for laparatomy. The loop muscle was stimulated by needle electrode, and response from the muscle and right crus was recorded by two electrodes. The test was repeated using an electrode into the left crus. Response of the loop muscle to individual stimulation of right and left crus was also registered. Muscle bundles formed a U-shaped loop around the lower esophagus, with the two limbs inserted into the 1st lumbar vertebra. An "esophago-sphincteric space" existed between the two limbs anterior to the esophagus. Three patterns of loop insertion were identified: classic, limb fusion, and limb crossing. The two crura were tendinous from their vertebral attachment, became fleshy, and fanned out proximally to merge with the fleshy diaphragm proper. Stimulation of loop muscle affected significant increase of its electric activity but had no effect on right or left crus. Crural stimulation produced significant increase of their electric activity and no effect on the loop muscle. Muscle fibers surrounding the lower esophagus formed a U-shaped loop. The loop arrangement seems to play significant role in competent mechanism of the gastroesophageal junction. Anatomic and electrophysiologic evidence suggest that the loop muscle is an autonomous muscle that surrounds the lower esophagus and is not derived from the diaphragmatic crura. We call this muscle "striated gastroesophageal sphincter". PMID:16036785

  4. Rupture of spleen post colonoscopy.

    PubMed

    Younes, Nidal A; Al-Ardah, Mahmoud I; Daradkeh, Salam S

    2009-08-01

    We review an interesting case of elective colonoscopy for rectal bleeding in a 68-year-old woman complicated by splenic rupture. She was managed by aggressive fluid and blood resuscitation followed by splenectomy. She had a smooth recovery and was discharged home 4 days after admission. The extreme rarity and interesting clinical course of the patient are discussed. PMID:19668895

  5. Distal biceps and triceps ruptures.

    PubMed

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

    2013-03-01

    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

  6. Current Concepts in Infections Associated with Penile Prostheses and Artificial Sphincters.

    PubMed

    Hofer, Matthias D; Gonzalez, Chris M

    2015-11-01

    Implantation of penile prostheses and artificial urinary sphincters have gained widespread acceptance for the treatment of refractory erectile dysfunction and incontinence, respectively. In the past 3 decades, improved device design and an increased understanding of the pathophysiology of device infections have contributed to a decrease in infection rates. However, understanding the concepts related to infection prevention and management remains critical. In this article, the authors review and discuss these concepts and provide outlines for the practicing urologists for both infection prevention and treatment. PMID:26475945

  7. Ligation of Intersphincteric Fistula Tract: a Sphincter-Sparing Option for Complex Fistula-in-Ano.

    PubMed

    Lange, Erin O; Ferrari, Linda; Krane, Mukta; Fichera, Alessandro

    2016-02-01

    Fistulae-in-ano represent one of the more challenging anorectal diseases faced by surgeons, as appropriate management requires careful balance between the need for local sepsis control and patients' desire to maintain fecal continence. The ligation of intersphincteric fistula tract (LIFT) procedure, first described by Rojanasakul and colleagues in 2007, represents a sphincter-sparing technique for fistula management which has become our method of choice for transsphincteric fistulas. With this technique, patients frequently enjoy successful fistula healing., or, at worst, conversion to a less complex fistula tract. Here, we describe and illustrate our surgical approach and review success and recurrence rates presented in the published literature. PMID:26394877

  8. Treatment of peri-anal fistula in Crohn's disease

    PubMed Central

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

    2014-01-01

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

  9. Quadriceps Tendon Rupture due to Postepileptic Convulsion

    PubMed Central

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

    2014-01-01

    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

  10. Histopathological findings in spontaneous tendon ruptures.

    PubMed

    Jzsa, L; Kannus, P

    1997-04-01

    A spontaneous rupture of a tendon may be defined as a rupture that occurs during movement and activity, that should not and usually does not damage the involved musculotendinous units (1). Spontaneous tendon ruptures were uncommon before the 1950s. Bhler found only 25 Achilles tendon ruptures in Wien between 1925 and 1948 (2). Msender & Klatnek treated 20 Achilles tendon ruptures between 1953 and 1956, but 105 ruptures between 1964 and 1967 (3). Lawrence et al. found only 31 Achilles tendon ruptures in Boston during a period of 55 years (1900-1954) (4). During the recent decades tendon ruptures have, however, become relatively common in developed countries, especially in Europe and North America. A high incidence of tendon ruptures has been reported in Austria, Denmark, Finland, Germany. Hungary, Sweden, Switzerland and the USA; somewhat lower incidences have been reported in Canada, France, Great Britain and Spain. On the other hand, Greece, Japan, the Netherlands and Portugal have reported a clearly lower incidence. Interestingly, Achilles tendon ruptures are a rarity in developing countries, especially in Africa and East-Asia (5). In many developed countries, the increases in the rupture incidence have been dramatic. In the National Institute of Traumatology in Budapest, Hungary, the number of patients with an Achilles tendon rupture increased 285% in men and 500% in women between two successive 7-year periods, 1972-1978 and 1979-1985 (5). PMID:9211612

  11. 46 CFR 64.61 - Rupture disc.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 2 2014-10-01 2014-10-01 false Rupture disc. 64.61 Section 64.61 Shipping COAST GUARD, DEPARTMENT OF HOMELAND 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...

  12. 46 CFR 64.61 - Rupture disc.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 2 2013-10-01 2013-10-01 false Rupture disc. 64.61 Section 64.61 Shipping COAST GUARD, DEPARTMENT OF HOMELAND 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...

  13. 46 CFR 64.61 - Rupture disc.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 2 2011-10-01 2011-10-01 false Rupture disc. 64.61 Section 64.61 Shipping COAST GUARD, DEPARTMENT OF HOMELAND 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...

  14. 46 CFR 64.61 - Rupture disc.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 2 2010-10-01 2010-10-01 false Rupture disc. 64.61 Section 64.61 Shipping COAST GUARD, DEPARTMENT OF HOMELAND 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...

  15. 46 CFR 64.61 - Rupture disc.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 2 2012-10-01 2012-10-01 false Rupture disc. 64.61 Section 64.61 Shipping COAST GUARD, DEPARTMENT OF HOMELAND 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...

  16. Lack of effect of a 5-HT3 antagonist, pancopride, on lower oesophageal sphincter pressure in volunteers.

    PubMed Central

    Grande, L; Lacima, G; Prez, A; Zayas, J M

    1995-01-01

    Effects of pancopride (5 and 10 mg, intravenously), on lower oesophageal sphincter pressure (LOESP), were assessed in healthy volunteers by means of oesophageal manometry. After pancopride 10 mg, the LOESP was higher than placebo and 5 mg pancopride but there were no differences among the three treatments (P = 0.42). The areas under the curve were similar without differences, neither with absolute measurements (P = 0.53) nor after a baseline correction (P = 0.16). In conclusion, pancopride has no clinically relevant effect on lower oesophageal sphincter pressure. PMID:8554943

  17. Electrical and mechanical activity in the human lower esophageal sphincter during diaphragmatic contraction.

    PubMed Central

    Mittal, R K; Rochester, D F; McCallum, R W

    1988-01-01

    To determine the effect of contraction of the diaphragm on the lower esophageal sphincter (LES) pressure, we studied eight healthy volunteers during spontaneous breathing, maximal inspiration, and graded inspiratory efforts against a closed airway (Muller's maneuver). Electrical activity of the crural diaphragm (DEMG) was recorded from bipolar esophageal electrodes, transdiaphragmatic pressure (Pdi) was calculated as the difference between gastric and esophageal pressures, and LES pressure was recorded using a sleeve device. During spontaneous breathing, phasic inspiratory DEMG was accompanied by phasic increases in Pdi and LES pressure. With maximal inspiration, DEMG increased 15-20-fold compared with spontaneous inspiration, and LES pressure rose from an end-expiratory pressure of 21 to 90 mmHg. Similar values were obtained during maximal Muller's maneuvers. LES pressure fell promptly when the diaphragm relaxed. Graded Muller's maneuver resulted in proportional increases in the Pdi, LES pressure, and DEMG. The LES pressure was always greater than Pdi and correlated with it in a linear fashion (P less than 0.001). We conclude that the contraction of the diaphragm exerts a sphincteric action at the LES, and that this effect is an important component of the antireflux barrier. PMID:3350968

  18. On-line computer analysis of human lower esophageal sphincter relaxation.

    PubMed

    Castell, J A; Dalton, C B; Castell, D O

    1988-12-01

    Lower esophageal sphincter (LES) relaxation is usually interpreted by a subjective, mostly qualitative analysis. We studied sphincter relaxation in humans using a computer program for on-line analysis that provides objective measures of gastric pressure, resting LES pressure, percent of relaxation, residual pressure during relaxation, duration of relaxation, and area of relaxation. The program was validated by comparing computer-analyzed values to mean values obtained from manual readings by five individuals. Excellent correlation was obtained for all standard parameters. The parameters of LES relaxation for both wet and dry swallows were similar using either a carefully placed single recording orifice or a Dent sleeve. The one exception was the duration of LES relaxation, which was significantly shorter with the sleeve. All relaxation parameters and peristaltic velocity were then studied in 10 volunteers during 5 dry and 5 wet swallows under base-line conditions and after both atropine (10 micrograms/kg iv) and bethanechol (40 micrograms/kg sc). These studies showed that LES relaxation is affected by type of swallow (dry vs. wet). Percent of relaxation may not be the best measure of relaxation because it is too dependent on resting pressure. Residual pressure is not dependent on base-line pressure and may better define relaxation. Duration of the relaxation is dependent on the velocity of the peristaltic wave. PMID:3202172

  19. LINX() Reflux Management System: magnetic sphincter augmentation in the treatment of gastroesophageal reflux disease.

    PubMed

    Bonavina, Luigi; DeMeester, Tom R; Ganz, Robert A

    2012-12-01

    Gastroesophageal reflux disease (GERD), commonly manifested by heartburn or regurgitation, is a chronic, progressive condition in which failed sphincter function allows the contents of the stomach to reflux into the esophagus, the airways and the mouth. Chronic GERD affects 10% of Western society. The majority of patients receive adequate relief from proton pump inhibitors, but up to 40% have incomplete relief of symptoms that cannot be addressed by increasing the dose of medications. The laparoscopic Nissen fundoplication is the surgical gold standard; however, the level of technical difficulty and its side effects have limited its use to less than 1% of the GERD population. These factors have contributed to the propensity of patients to persist with medical therapy, even when inadequate to control symptoms and complications of the disease. Consequently, a significant gap in the treatment continuum for GERD remains evident in current clinical practice. The LINX() Reflux Management System (Torax Medical) is designed to provide a permanent solution to GERD by augmenting the physiologic function of the sphincter barrier with a simple and reproducible laparoscopic procedure that does not alter gastric anatomy and can be easily reversed if necessary. PMID:23237251

  20. Detrusor sphincter dyssynergia: a review of physiology, diagnosis, and treatment strategies.

    PubMed

    Stoffel, John T

    2016-02-01

    Detrusor sphincter dyssynergia (DSD) is the urodynamic description of bladder outlet obstruction from detrusor muscle contraction with concomitant involuntary urethral sphincter activation. DSD is associated with neurologic conditions such as spinal cord injury, multiple sclerosis, and spina bifida and some of these neurogenic bladder patients with DSD may be at risk for autonomic dysreflexia, recurrent urinary tract infections, or upper tract compromise if the condition is not followed and treated appropriately. It is diagnosed most commonly during the voiding phase of urodynamic studies using EMG recordings and voiding cystourethrograms, although urethral pressure monitoring could also potentially be used. DSD can be sub-classified as either continuous or intermittent, although adoption of this terminology is not widespread. There are few validated oral pharmacologic treatment options for this condition but transurethral botulinum toxin injection have shown temporary efficacy in reducing bladder outlet obstruction. Urinary sphincterotomy has also demonstrated reproducible long term benefits in several studies, but the morbidity associated with this procedure can be high. PMID:26904418

  1. Striated muscle and nerve fascicle distribution in the female rat urethral sphincter.

    PubMed

    Kim, Ronald J; Kerns, James M; Liu, Shirley; Nagel, Ted; Zaszczurynski, Paul; Lin, Dan Li; Damaser, Margot S

    2007-02-01

    The anatomical basis for urinary continence depends on a thorough understanding of the tissues in the urethra. The objective of this study was to evaluate the morphology and neuroanatomy of urethral striated muscle, called the rhabdosphincter or external urethral sphincter, in normal female rats. Urethras from 12 female rats were dissected from the bladder, fixed, embedded in paraffin or epon, and sectioned every 1 mm. Striated muscle content was taken as the ratio of the striated muscle area to net urethral area. Nerve fascicles containing myelinated axons near the rhabdosphincter were counted and mapped. Both striated muscle content and number of nerve fascicles peak in the proximal third of the urethra, with a secondary peak at the distal end of the urethra. This secondary peak may correspond to an analog of the combined compressor urethrae/urethrovaginal sphincter located in the distal urethra in human. The rhabdosphincter has a variable distribution along the length of the urethra. In the middle and distal thirds of the urethra, the dorsal striated muscle fibers between the urethra and vagina become more sparse. The majority of nerve fascicles are contained in the lateral quadrants of the urethra, similar to the lateral distribution of somatic nerves in humans. In conclusion, this study demonstrates the normal distribution of the striated musculature and neuroanatomy in the urethra, with similarities to the human. It thus supports and extends the usefulness of the rat as an experimental model for studying urinary incontinence. PMID:17441207

  2. A catheter-based acoustic interrogation device for monitoring motility dynamics of the lower esophageal sphincter.

    PubMed

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

    2014-01-01

    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

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

    PubMed Central

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

    2014-01-01

    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

  4. Variability of lower esophageal sphincter pressure in the fasted unanesthetized opossum.

    PubMed

    Holloway, R H; Blank, E; Takahashi, I; Dodds, W J; Hogan, W J; Dent, J

    1985-04-01

    The opossum has served as a useful animal model for in vivo studies of lower esophageal sphincter (LES) function. Previous investigations, however, have been confined to studies on anesthetized animals. In 10 opossums we investigated LES pressure during fasting cycles of the gastrointestinal migrating myoelectric complex (MMC) and examined the influences of anesthesia and feeding on LES pressure. Intraluminal pressure from the esophageal body, LES, and gastric antrum was recorded by a manometric assembly that incorporated a sleeve device. Myoelectric activity was recorded from the gastric antrum and duodenum via implanted electrodes. MMCs were readily recorded from all animals. MMC cycle length was 86 +/- 2.9 (SE) min. The LES exhibited cyclic changes in intraluminal pressure that occurred in synchrony with the gastric MMC cycle. During phase I of the gastric MMC cycle, LES pressure was essentially stable, although intermittent spontaneous oscillations at 3-4/min were sometimes noted. Forceful phasic LES contraction started during phase II of the gastric MMC, became maximal during phase III, and disappeared during phase I. The MMC-related phasic LES contraction occurred at a maximal rate of 1.4 +/- 0.05/min with amplitudes of 60-150 mmHg and were temporally associated with spike bursts and contractions in the gastric antrum. Pentobarbital sodium-induced anesthesia abolished MMC-related phasic LES activity and caused a transient rise in basal sphincter pressure. Phasic LES activity was also inhibited by atropine and feeding.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3985147

  5. Detrusor sphincter dyssynergia: a review of physiology, diagnosis, and treatment strategies

    PubMed Central

    2016-01-01

    Detrusor sphincter dyssynergia (DSD) is the urodynamic description of bladder outlet obstruction from detrusor muscle contraction with concomitant involuntary urethral sphincter activation. DSD is associated with neurologic conditions such as spinal cord injury, multiple sclerosis, and spina bifida and some of these neurogenic bladder patients with DSD may be at risk for autonomic dysreflexia, recurrent urinary tract infections, or upper tract compromise if the condition is not followed and treated appropriately. It is diagnosed most commonly during the voiding phase of urodynamic studies using EMG recordings and voiding cystourethrograms, although urethral pressure monitoring could also potentially be used. DSD can be sub-classified as either continuous or intermittent, although adoption of this terminology is not widespread. There are few validated oral pharmacologic treatment options for this condition but transurethral botulinum toxin injection have shown temporary efficacy in reducing bladder outlet obstruction. Urinary sphincterotomy has also demonstrated reproducible long term benefits in several studies, but the morbidity associated with this procedure can be high. PMID:26904418

  6. Lower esophageal sphincter pressure, acid secretion, and blood gastrin after coffee consumption.

    PubMed

    Van Deventer, G; Kamemoto, E; Kuznicki, J T; Heckert, D C; Schulte, M C

    1992-04-01

    This study tested the hypothesis that differences in the processing of raw coffee beans can account for some of the variability in gastric effects of coffee drinking. Coffees were selected to represent several ways that green coffee beans are treated, ie, processing variables. These included instant and ground coffee processing, decaffeination method (ethyl acetate or methylene chloride extraction), instant coffee processing temperature (112 degrees F or 300 degrees F), and steam treatment. Lower esophageal sphincter pressure, acid secretion, and blood gastrin was measured in eight human subjects after they consumed each of the different coffees. Consumption of coffee was followed by a sustained decrease in lower esophageal sphincter pressure (P less than 0.05) except for three of the four coffees treated with ethyl acetate regardless of whether or not they contained caffeine. Caffeinated ground coffee stimulated more acid secretion that did decaf ground coffees (P less than 0.05), but not more than a steam-treated caffeinated coffee. Instant coffees did not differ in acid-stimulating ability. Ground caffeinated coffee resulted in higher blood gastrin levels than other ground coffees (P less than 0.05). Freeze-dried instant coffee also tended toward higher gastrin stimulation. It is concluded that some of the observed variability in gastric response to coffee consumption can be traced to differences in how green coffee beans are processed. PMID:1551346

  7. Factors influencing maternal survival in ruptured uterus.

    PubMed

    Megafu, U

    1985-12-01

    Ruptured uterus continues to be a common obstetric hazard in under developed countries. The commonest cause is spontaneous rupture from obstructed labor in the multipara. There was not a single rupture in the primipara. Rupture following previous cesarean section scar is also common. The most effective way of management is to correct fluid and blood loss followed by laparotomy and subtotal hysterectomy. This method gave a lower mortality than either repair and sterilization or total hysterectomy. Adequate pre-operative resuscitation and time interval between rupture and operation also influences mortality rate. The experience of the surgeon is another vital factor in determining mortality rate. PMID:2868942

  8. Surgical treatment of chronic anal fissure. A retrospective study of 1753 cases.

    PubMed

    Hsu, T C; MacKeigan, J M

    1984-07-01

    This is a retrospective study of 1753 cases of chronic anal fissures treated by five varying methods over a five-year period from January 1976 to December 1980. Results showed that the incidence of recurrent fissures was higher in those treated by anal fissurectomy with sphincterotomy. There was also a significant difference in operative time, length of hospital stay, patient discomfort, and incidence of urinary retention among these operative methods. Generally, lateral anal sphincterotomy and multiple anal sphincterotomies showed a lesser incidence of these factors. A simpler procedure, such as lateral anal sphincterotomy or multiple anal sphincterotomies, is the treatment of choice for chronic anal fissure. However, a chronic anal fissure associated with symptomatic enlarged hemorrhoids may have a similar result when treated with hemorrhoidectomy and fissurectomy as a combined procedure. PMID:6745021

  9. 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

  10. Predicting the endpoints of earthquake ruptures.

    PubMed

    Wesnousky, Steven G

    2006-11-16

    The active fault traces on which earthquakes occur are generally not continuous, and are commonly composed of segments that are separated by discontinuities that appear as steps in map-view. Stress concentrations resulting from slip at such discontinuities may slow or stop rupture propagation and hence play a controlling role in limiting the length of earthquake rupture. Here I examine the mapped surface rupture traces of 22 historical strike-slip earthquakes with rupture lengths ranging between 10 and 420 km. I show that about two-thirds of the endpoints of strike-slip earthquake ruptures are associated with fault steps or the termini of active fault traces, and that there exists a limiting dimension of fault step (3-4 km) above which earthquake ruptures do not propagate and below which rupture propagation ceases only about 40 per cent of the time. The results are of practical importance to seismic hazard analysis where effort is spent attempting to place limits on the probable length of future earthquakes on mapped active faults. Physical insight to the dynamics of the earthquake rupture process is further gained with the observation that the limiting dimension appears to be largely independent of the earthquake rupture length. It follows that the magnitude of stress changes and the volume affected by those stress changes at the driving edge of laterally propagating ruptures are largely similar and invariable during the rupture process regardless of the distance an event has propagated or will propagate. PMID:17108963

  11. The Dose-Effect Safety Profile of Skeletal Muscle Precursor Cell Therapy in a Dog Model of Intrinsic Urinary Sphincter Deficiency

    PubMed Central

    Eckman, Delrae; Dean, Ashley; Moradi, Mahmoudreza; Allickson, Julie; Cline, J. Mark; Yoo, James J.; Atala, Anthony

    2015-01-01

    Locally injected skeletal muscle precursor cells (skMPCs) integrate into and restore the muscle layers, innervation, vasculature, and function of the sphincter complex in animal models of intrinsic urinary sphincter deficiency (ISD). The goal of the present study was to test the dose-effect safety profile of skMPC therapy in a dog model of ISD. Sphincter deficiency was created in 20 adult female dogs by surgically removing the skeletal muscle layer of the urinary sphincter complex. skMPCs isolated from the hind leg were expanded in culture and injected 4 weeks later into the sphincter complex at a dose of 25 million cells (n = 5), 50 million cells (n = 5), or 100 million cells (n = 5) per milliliter in a 2-ml volume. Five dogs received no sphincter injection. The measures of maximal sphincter pressure, complete blood count, and blood chemistry were performed monthly until their sacrifice at 9 months. At that point, full necropsy was performed to assess the safety of the skMPC injections. Injection of different doses of cells had no effects on the body weight, blood cell count, or kidney or liver function test results (p > .05 among the skMPC doses). Some incidental pathologic features were found in the lower urinary tract in all groups and were most likely associated with repeat catheterization. The maximal urinary sphincter pressure was higher in the 50 million cells per milliliter treatment group than in the other experimental groups (p < .05). The findings of the present study have confirmed that urinary sphincter injection of skMPCs results in no significant local or systemic pathologic features within the dose range that improves sphincter pressures. PMID:25637189

  12. [Ruptured cerebral artery blister aneurysm].

    PubMed

    Vega Valds, Pedro; Murias Quintana, Eduardo; Meiln Martnez, Angela; Gutirrez Morales, Julio; Lopez Garcia, Antonio

    2013-01-01

    We report the case of a young patient with subarachnoid haemorrhage secondary to a ruptured blister-like aneurysm. Since this kind of aneurysms have fragile walls without a well-defined neck, their treatment is difficult. We initially planned the deployment of a flow-diverter stent, but an angiogram obtained after 10 days revealed a morphological change of the aneurysm. Therefore, we finally deployed a conventional stent and introduced 2 micro coils into the point of rupture, obtaining a good morphological result without rebleeding. Follow-up at 1 and 6 months did not observe regrowth of the aneurysm. We offer a brief introduction and discussion of this pathology and its treatment. PMID:23517694

  13. Spontaneous rupture of the ureter

    PubMed Central

    Eken, Alper; Akbas, Tugana; Arpaci, Taner

    2015-01-01

    Spontaneous rupture of the ureter is a very rare condition and usually results from ureteral obstruction by a calculus. Only theoretical mechanisms 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

  14. Spontaneous hepatic rupture in pregnancy.

    PubMed

    Nelson, E W; Archibald, L; Albo, D

    1977-12-01

    Hepatic rupture as a late complication of toxemic pregnancy is a rare yet lethal condition requiring rapid recognition and surgical management. The clinical triad of toxemia, right upper quadrant pain, and sudden hypotension is the diagnostic hallmark of presentation. Most patients present near the time of delivery and are found to have subcapsular hematomas of the right hepatic lobe with free rupture into the peritoneal cavity and resultant exsanguinating hemorrhage. The association of toxemia and disseminated intravascular coagulation with secondary microembolic damage to the liver and other organs has been discussed. Basic surgical principles in the managment of hepatic subcapsular hematomas, and the prolonged postoperative course and frequent complications in these patients have been stressed. PMID:596550

  15. [SURGICAL TREATMENT OF POSTOPERATIVE STRICTURE OF ANAL CHANNELL].

    PubMed

    Shevchuk, I M; Sadoviy, I Ya; Novytskiy, O V

    2015-09-01

    The results of treatment of 50 patients, suffering postoperative stricture of anal channell (SACH), who were treated in Proctology Department of Ivano-Frankivskiy Rural Clinical Hospital in 2006-2014 yrs, were analyzed. After conduction of hemorrhoidectomy in accordance to Milligan-Morgan method for chronic hemorrhoids grades III-IV a SACH have occurred in 46 (92%) patients, excision of a chronic anal fissura was performed in 3 (6%) and excision of perianal pointed condylomas--in 1 patient. In 2006-2007 yrs 11 (22%) patients were operated in accordance to approaches, which were conventional at that time (comparison group). In 2008 - 2014 yrs 39 (78%) patients were admitted to hospital (main group), in whom new approaches for diagnosis, conservative and surgical treatment were applied, 30 (76.9%) of them were operated. The proposed method on isolated roentgen contrast investigation of anal channell have permitted to determine objectively a form, diameter and grade of the anal channel stricture, and it may be applied as a screening procedure, as additional objective criterion while choosing a surgical tactic. Application of the improved operative technique for SACH have permitted to lower its occurrence rate from 45.4 to 6.7%. PMID:26817078

  16. Primary radiation therapy in the treatment of anal carcinoma

    SciTech Connect

    Cantril, S.T.; Green, J.P.; Schall, G.L.; Schaupp, W.C.

    1983-09-01

    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.

  17. Achilles tendon rupture in badminton.

    PubMed Central

    Kaalund, S; Lass, P; Hgsaa, B; Nhr, M

    1989-01-01

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

  18. A Novel Method of Urinary Sphincter Deficiency: Serial Histopathology Evaluation in a Rat Model of Urinary Incontinence.

    PubMed

    Khorramirouz, Reza; Mozafarpour, Sarah; Kameli, Seyedeh Maryam; Ladi Seyedian, Seyedeh Sanam; Oveisi, Nasim; Rahimi, Zahra; Alijani, Maryam; Kajbafzadeh, Abdol-Mohammad

    2016-02-01

    In this study, a novel technique of irreversible sphincter deficiency by pudendal nerve transection (PNT) using 40 female rats for studying the pathophysiology of stress urinary incontinence associated with childbirth was developed. Of the 40 rats, 10 served as controls and the remaining underwent bilateral PNT at the anastomotic lumbosacral trunk level. Urethral morphological changes following bilateral PNT were assessed with serial hematoxylin and eosin (H&E) and immunohistochemistry (IHC) staining methods at 50, 90, and 130 days post-intervention. Leak point pressure (LPP) measurement was used to determine the effect of pudendal injury on urethral outlet resistance after the transection. H&E and IHC staining showed irreversible loss of striated muscle mass of the sphincter region and increase in collagen deposition compatible with muscle atrophy. LPP measurements also significantly decreased following bilateral PNT. In conclusion, a novel method of irreversible sphincter insufficiency was developed. This model effectively decreased urethral outlet resistance and caused irreversible striated muscle atrophy. It was suggested that this technique can be used to develop a permanent sphincter deficiency model for the preclinical testing of treatment modalities exclusively triggering the pudendal nerve. Anat Rec, 299:173-180, 2016. 2015 Wiley Periodicals, Inc. PMID:26574901

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

    PubMed

    Silva, Ninoska N; Eng, Cathy

    2012-05-01

    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

  20. Management of Refractory Metastatic Anal Squamous Cell Carcinoma Following Disease Progression on Traditional Chemoradiation Therapy

    PubMed Central

    Silva, Ninoska N.; Eng, Cathy

    2012-01-01

    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/m2 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 cm3) 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/m2/day, from Monday to Friday, on the days of radiation. She also received a weekly bolus dose of cisplatin at 20 mg/m2. 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

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

    PubMed

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

    2007-05-01

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

  2. Efficacy of nifedipine therapy in patients with sphincter of Oddi dysfunction: a prospective, double-blind, randomized, placebo-controlled, cross over trial.

    PubMed Central

    Khuroo, M S; Zargar, S A; Yattoo, G N

    1992-01-01

    1. Twenty-eight patients who fulfilled entry criteria for sphincter of Oddi dysfunction were randomly allocated to receive nifedipine and placebo in a cross over design with 12 week treatment periods separated by a 2 week wash-out. 2. All patients had episodic pain resembling biliary pain, had previously undergone cholecystectomy, had elevated alkaline phosphatase during episodes of pain and had elevated basal pressure on sphincter of Oddi manometry. 3. Compared with placebo, significant decreases in cumulative pain score, number of pain episodes, oral analgesic tablets consumed and emergency room visits were observed during nifedipine treatment. 4. Overall 21 patients improved during nifedipine therapy while seven patients did not. None of the following predicted response to nifedipine therapy: enzyme levels, morphine-Prostigmine test, fatty meal sonography, common duct diameter and pressure, sphincter of Oddi phasic pressure, frequency and duration of phasic waves and maximal fall in the basal pressure at sphincter of Oddi manometry after sublingual administration of nifedipine. However patients with predominant antegrade propagation of phasic contractions of sphincter of Oddi did significantly better on nifedipine than those with abnormal propagation of phasic contractions. 5. Nifedipine therapy orally in maximal tolerated doses relieves pain in patients with sphincter of Oddi dysfunction who have elevated basal pressure and sphincter of Oddi phasic contractions of predominantly antegrade nature. PMID:1524959

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

    SciTech Connect

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

    1982-08-01

    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.

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

    PubMed

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

    1982-08-01

    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 131I 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. PMID:7119407

  5. Neuro-regulation of lower esophageal sphincter function as treatment for gastroesophageal reflux disease

    PubMed Central

    Sidhu, Anupender Singh; Triadafilopoulos, George

    2008-01-01

    The junction between the esophagus and the stomach is a specialized region, composed of lower esophageal sphincter (LES) and its adjacent anatomical structures, the gastric sling and crural diaphragm. Together these structures work in a coordinated manner to allow ingested food into the stomach while preventing reflux of gastric contents across the esophago-gastric junction (EGJ) into the esophagus. The same zone also permits retrograde passage of air and gastric contents into esophagus during belching and vomiting. The precise coordination required to execute such a complicated task is achieved by a finely-regulated high-pressure zone. This zone keeps the junction between esophagus and stomach continuously closed, but is still able to relax briefly via input from inhibitory neurons that are responsible for its innervation. Alterations of the structure and function of the EGJ and the LES may predispose to gastroesophageal reflux disease (GERD). PMID:18286675

  6. Lower Esophageal Magnetic Sphincter Augmentation for Persistent Reflux After Roux-en-Y Gastric Bypass.

    PubMed

    Muoz-Largacha, Juan A; Hess, Donald T; Litle, Virginia R; Fernando, Hiran C

    2016-02-01

    Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a good option for the treatment of gastroesophageal reflux disease (GERD) in the obese population. However, some patients have significant reflux despite this procedure, and their treatment might be challenging. Laparoscopic lower esophageal magnetic sphincter augmentation (MSA) has been introduced into clinical practice with encouraging results. Currently, MSA is only approved for patients with hiatal hernias that are less than 3 cm and without history of antireflux procedures. We present two cases of MSA for the treatment of persistent GERD after LRYGB. Since this is an off-label use of this procedure, both patients underwent extensive evaluation before proceeding with surgery. Excellent results were obtained with a significant improvement in symptoms as well as their GERD Health-Related Quality of Life scores. PMID:26667163

  7. Early second trimester uterine scar rupture

    PubMed Central

    Bharatnur, Sunanda; Hebbar, Shripad; G, Shyamala

    2013-01-01

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

  8. Early second trimester uterine scar rupture.

    PubMed

    Bharatnur, Sunanda; Hebbar, Shripad; Shyamala, G

    2013-01-01

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

  9. Mesenchymal Stromal Cells for Sphincter Regeneration: Role of Laminin Isoforms upon Myogenic Differentiation

    PubMed Central

    Seeger, Tanja; Hart, Melanie; Patarroyo, Manuel; Rolauffs, Bernd; Aicher, Wilhelm K.; Klein, Gerd

    2015-01-01

    Multipotent mesenchymal stromal cells (MSCs) are well known for their tri-lineage potential and ability to differentiate in vitro into osteogenic, chondrogenic or adipogenic lineages. By selecting appropriate conditions MSCs can also be differentiated in vitro into the myogenic lineage and are therefore a promising option for cell-based regeneration of muscle tissue such as an aged or damaged sphincter muscle. For the differentiation into the myogenic lineage there is still a need to evaluate the effects of extracellular matrix proteins such as laminins (LM) which are crucial for different stem cell types and for normal muscle function. The laminin family consists of 16 functionally different isoforms with LM-211 being the most abundant isoform of adult muscle tissues. In the sphincter tissue a strong expression of the isoforms LM-211/221, LM-411/421 and LM-511/521 can be detected in the different cell layers. Bone marrow-derived MSCs in culture, however, mainly express the isoforms LM-411 and LM-511, but not LM-211. Even after myogenic differentiation, LM-211 can hardly be detected. All laminin isoforms tested (LM-211, LM-411, LM-511 and LM-521) showed a significant inhibition of the proliferation of undifferentiated MSCs but, with the exception of LM-521, they had no influence on the proliferation of MSCs cultivated in myogenic medium. The strongest cellular adhesion of MSCs was to LM-511 and LM-521, whereas LM-211 was only a weakly-adhesive substrate for MSCs. Myogenic differentiation of MSCs even reduced the interaction with LM-211, but it did not affect the interaction with LM-511 and LM-521. Since during normal myogenesis the latter two isoforms are the major laminins surrounding developing myogenic progenitors, α5 chain-containing laminins are recommended for further improvements of myogenic differentiation protocols of MSCs into smooth muscle cells. PMID:26406476

  10. Spontaneously hypertensive rats develop pulmonary hypertension and hypertrophy of pulmonary venous sphincters.

    PubMed Central

    Aharinejad, S.; Schraufnagel, D. E.; Bck, P.; MacKay, C. A.; Larson, E. K.; Miksovsky, A.; Marks, S. C.

    1996-01-01

    This study explored the spontaneously hypertensive rat as an animal model of pulmonary hypertension and sought to identify anatomic changes in its pulmonary microvasculature, especially focal constrictions of pulmonary veins (sphincters). The average systemic and pulmonary artery blood pressures were 172/139 (+/- 9/9) and 36/14 (+/- 4/3), respectively, for spontaneously hypertensive Wistar Kyoto rats (SHR), and 134/83 (+/- 8/2) and 20/10 (+/- 2/2) for normotensive Wistar Kyoto rats (WKY) (P < 0.01 for both). Light microscopy of the lungs in SHR showed muscularization of both arteries and veins, but this was more pronounced in the small pulmonary veins. Perivascular edema was also present. There were 20 (+/- 4) leukocytes per 100 microns of capillary length in SHR and 9 (+/- 2) in WKY (P < 0.001). Transmission electron microscopy showed focal venous smooth muscle was greater in SHR than in WKY. Scanning electron microscopy of vascular casts showed the average maximal focal venous contraction (sphincter) was 54% (+/- 10) of its diameter in SHR, but was only 6% (+/- 4) in WKY (P < 0.01). Arterial contraction occurred in the hypertensive rats as bourglass narrowings of the casts, but was less conspicuous than venous constrictions. The mean alveolar capillary diameter was 8.1 microns (+/- 1.6) in SHR, compared with 6.3 microns (+/- 1.0) in WKY (P < 0.01). The central interspace between capillaries was 3.2 microns (+/- 1.6) in SHR and 6.0 microns (+/- 3.6) in WKY (P < 0.01). The venous contraction, capillary size, and capillary interspace distance correlated with the pulmonary blood pressure. The spontaneously hypertensive rat can be a model of pulmonary hypertension with its most notable structural change being increased muscularity in the small pulmonary veins. Images Figure 1 Figure 2 Figure 3 and 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 to 13 Figure 14 and 15 PMID:8546217

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

    NASA Astrophysics Data System (ADS)

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

    2011-06-01

    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.

  12. Histomorphology and immunohistochemistry of the lower esophageal sphincter of the least shrew (Cryptotis parva).

    PubMed

    Al-Tikriti, Mohammed S; Khamas, Wael; Chebolu, Seetha; Darmani, Nissar A

    2013-01-01

    The biochemical and histopathological changes in the lower esophageal sphincter (LES) in the pathogenesis of gastroesophageal reflux disease have gained interest. The least shrew is able to vomit in response to emetogens and provides a good model to study the histology of this phenomenon relative to the published reports in the commonly used but vomit-incompetent laboratory species. The LES is located at the junction of the esophagus and stomach. It typically closes at rest and opens in response to swallowing. Our findings demonstrate that the least shrew does not have a well-defined LES, lacks esophageal glands and has a mucosal valve-like projection from the terminal end of the esophagus before joining the gastric epithelium at the lesser curvature. In addition, the least shrew has thoracic and abdominal components prior to joining the gastric epithelium. The mucosal lining of the esophagus is folded, becoming clearly convoluted and forming a bucket-like structure at the level of the esophageocardiac junction (ECJ). No significant differences are to be found between the structure and thickness of the wall before and after the ECJ. Thus, the ECJ forming the LES is relatively less complex than those of other mammals including man. The distribution of enterochromaffin (EC) cells is confined to the lamina propria of the junction and is not associated with the cardiac glands, suggesting its functional involvement with the smooth muscle in and around the ECJ. In conclusion, the least shrew's anatomical sphincter appears ill-defined and is replaced by a less sturdy valve-like mucosal flap. PMID:24662490

  13. Oddi sphincter preserved cholangioplasty with hepatico-subcutaneous stoma for hepatolithiasis

    PubMed Central

    Lian, Yu-Gui; Zhang, Wei-Tao; Xu, Zhi; Ling, Xiao-Feng; Wang, Li-Xin; Hou, Chun-Sheng; Wang, Gang; Cui, Long; Zhou, Xiao-Si

    2015-01-01

    AIM: To evaluate the long-term outcomes of Oddi sphincter preserved cholangioplasty with hepatico-subcutaneous stoma (OSPCHS) and risk factors for recurrence in hepatolithiasis. METHODS: From March 1993 to December 2012, 202 consecutive patients with hepatolithiasis underwent OSPCHS at our department. The Oddi sphincter preserved procedure consisted of common hepatic duct exploration, stone extraction, hilar bile duct plasty, establishment of subcutaneous stoma to the bile duct. Patients with recurrent stones can undergo stone extraction and/or biliary drainage via the subcutaneous stoma which can be incised under local anesthesia. The long-term results were reviewed. Cox regression model was employed to analyze the risk factors for stone recurrence. RESULTS: Ninety-seven (48.0%) OSPCHS patients underwent hepatic resection concomitantly. The rate of surgical complications was 10.4%. There was no perioperative death. The immediate stone clearance rate was 72.8%. Postoperative cholangioscopic lithotomy raised the clearance rate to 97.0%. With a median follow-up period of 78.5 mo (range: 2-233 mo), 24.8% of patients had recurrent stones, 2.5% had late development of cholangiocarcinoma, and the mortality rate was 5.4%. Removal of recurrent stones and/or drainage of inflammatory bile via subcutaneous stoma were conducted in 44 (21.8%) patients. The clearance rate of recurrent stones was 84.0% after subsequent choledochoscopic lithotripsy via subcutaneous stoma. Cox regression analysis showed that residual stone was an independent prognostic factor for stone recurrence. CONCLUSION: In selected patients with hepatolithiasis, OSPCHS achieves excellent long-term outcomes, and residual stone is an independent prognostic factor for stone recurrence. PMID:26668511

  14. Association Between Smoking and Size of Anal Warts in HIV-infected Women

    PubMed Central

    Luu, HN; Amirian, ES; Beasley, RP; Piller, L; Chan, W; Scheurer, ME

    2015-01-01

    While the association between smoking and HPV infection, cervical cancer, and anal cancer has been well studied, evidence on the association between cigarette smoking and anal warts is limited. The purpose of this study was to investigate if cigarette smoking status influences the size of anal warts over time in HIV-infected women in a sample of 976 HIV-infected women from the Womens Interagency HIV Study (WIHS). A linear mixed model was used to determine the effect of smoking on anal wart size. Even though women who were currently smokers had larger anal warts at baseline and slower growth rate of anal wart size after each visit than women who were not current smokers, there was no association between size of anal wart and current smoking status over time. Further studies on the role of smoking and interaction between smoking and other risk factors, however, should be explored. PMID:23155099

  15. Investigation of cryogenic rupture disc design

    NASA Technical Reports Server (NTRS)

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

    1973-01-01

    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.

  16. Spontaneous rupture of a splenotic nodule.

    PubMed Central

    Lanigan, D. J.

    1990-01-01

    A case is presented of spontaneous rupture of splenic tissue occurring 14 years after a splenectomy was carried out for trauma. Spontaneous rupture of a splenotic nodule has not previously been described and it may be added to the list of causes of spontaneous haemoperitoneum. The incidence and function of residual splenic tissue are briefly discussed and other causes of splenic rupture are outlined. PMID:2267217

  17. Neck curve polynomials in neck rupture model

    SciTech Connect

    Kurniadi, Rizal; Perkasa, Yudha S.; Waris, Abdul

    2012-06-06

    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.

  18. Anal cancer treatment: current status and future perspectives.

    PubMed

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

    2015-02-28

    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

  19. Trans-anal endoscopic microsurgery for internal rectal prolapse.

    PubMed

    Bloemendaal, A L A; De Schepper, M; Mishra, A; Hompes, R; Jones, O M; Lindsey, I; Cunningham, C

    2016-02-01

    Internal rectal prolapse can lead to obstructed defecation, faecal incontinence and pain. In treatment of frail or technically difficult patients, a perineal approach is often used, such as a Delorme's or a STARR. However, in case of very high take-off prolapse, these procedures are challenging if not unsuitable. We present trans-anal endoscopic microsurgery as surgical option for management of this uncommon type of rectal prolapse in specific cases. PMID:26690927

  20. Anal intraepithelial dysplasia and squamous carcinoma in immunosuppressed patients

    PubMed Central

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

    2001-01-01

    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

  1. Anal intraepithelial neoplasia--is treatment better than observation?

    PubMed

    Orchard, M; Roman, A; Parvaiz, A C

    2013-01-01

    Anal Intraepithelial Neoplasia (AIN) is an increasingly common condition for which the best treatment has not been well established. Traditional management was based on a 'watch and wait' strategy, but as the natural history of AIN and its progression to anal cancer is becoming better understood, more active treatment strategies are warranted. A best evidence topic in surgery was written according to a structured protocol to address the question whether treatment is indicated in patients with AIN. A total of 169 papers were identified using the defined search criteria. This included only one randomised controlled trial. Case series were therefore also included to help answer the question. The details of the papers were tabulated including relevant outcomes and study weaknesses. We conclude that treatment of high grade AIN, particularly in high risk groups is recommended to try to avoid progression to anal cancer. Treatment options that have shown some benefit include topical use of imiquimod cream or ablation directed by high resolution anoscopy. PMID:23643642

  2. Hemorrhoids and anal fissures in inflammatory bowel disease.

    PubMed

    D'Ugo, S; Stasi, E; Gaspari, A L; Sileri, P

    2015-12-01

    Perianal disease is a common complication of inflammatory bowel disease (IBD). It includes different conditions from more severe and potentially disabling ones, such as abscesses and fistulas, to more benign conditions such as hemorrhoids, skin tags and fissures. Most literature has been focused on anal sepsis and fistulae, as they carry the majority of disease burden and often alter the natural course of the disease. Hemorrhoids and anal fissures in patients with IBD have been overlooked, although they can represent a challenging problem. The management of hemorrhoids and fissures in IBD patients may be difficult and may significantly differ compared to the non-affected population. Historically surgery was firmly obstructed, and hemorrhoidectomy or sphincterotomy in patients with associated diagnosis of IBD was considered harmful, although literature data is scant and based on small series. Various authors reported an incidence of postoperative complications higher in IBD than in the general populations, with potential severe events. Considering that a spontaneous healing is possible, the first line management should be a medical therapy. In patients non-responding to conservative measures it is possible a judicious choice of surgical options on a highly selective basis; this can lead to acceptable results, but the risk of possible complications needs to be considered. In this review it is analyzed the current literature on the incidence, symptoms and treatment options of hemorrhoids and anal fissures in patients with Crohn's disease and ulcerative colitis. PMID:26446683

  3. Screening, Surveillance, and Treatment of Anal Intraepithelial Neoplasia.

    PubMed

    Long, Kevin C; Menon, Raman; Bastawrous, Amir; Billingham, Richard

    2016-03-01

    The prevalence of anal intraepithelial neoplasia has been increasing, especially in high-risk patients, including men who have sex with men, human immunodeficiency virus positive patients, and those who are immunosuppressed. Several studies with long-term follow-up have suggested that rate of progression from high-grade squamous intraepithelial lesions to invasive anal cancer is ∼ 5%. This number is considerably higher for those at high risk. Anal cytology has been used to attempt to screen high-risk patients for disease; however, it has been shown to have very little correlation to actual histology. Patients with lesions should undergo history and physical exam including digital rectal exam and standard anoscopy. High-resolution anoscopy can be considered as well, although it is of questionable time and cost-effectiveness. Nonoperative treatments include expectant surveillance and topical imiquimod or 5-fluorouracil. Operative therapies include wide local excision and targeted ablation with electrocautery, infrared coagulation, or cryotherapy. Recurrence rates remain high regardless of treatment delivered and surveillance is paramount, although optimal surveillance regimens have yet to be established. PMID:26929753

  4. Second-Trimester Uterine Rupture: Lessons Learnt

    PubMed Central

    F. ABDULWAHAB, Dalia; ISMAIL, Hamizah; NUSEE, Zalina

    2014-01-01

    Uterine rupture is a rare life-threatening complication. It mainly occurs in the third trimester of pregnancy and is rarely seen during the first or second trimesters. Our centre experienced three important cases of uterine rupture. First case: spontaneous uterine rupture at 14 weeks of pregnancy, which was diagnosed at autopsy. It was misled by the ultrasound finding of an intrauterine pregnancy, and searching for other non-gynaecological causes delayed the urgent obstetric surgical management. Second case: ruptured uterus at 24 weeks following medical termination due to foetal anomaly. It was diagnosed only at laparotomy indicated for failed medical termination and chorioamnionitis. Third case: uterine rupture at 21 weeks of pregnancy in a patient with gastroenterology symptoms. In these reports, we have discussed the various risk factors, presentations, course of events and difficulties in diagnosing uterine rupture. The study concludes that the clinical presentation of uterine ruptures varies. It occurs regardless of gestational age. Ultrasound findings of intrauterine pregnancy with free fluid do not exclude uterine rupture or ectopic pregnancy. Searching for non-gynaecological causes in such clinical presentations might delay crucial surgical intervention, which leads to unnecessary morbidity, mortality or loss of obstetrics function. PMID:25977625

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

    PubMed

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

    2006-11-01

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

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

    NASA Astrophysics Data System (ADS)

    Xu, Chong

    2014-07-01

    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.

  7. Resolution of Fundic Gland Polyposis following Laparoscopic Magnetic Sphincter Augmentation and Subsequent Cessation of Proton Pump Inhibitors.

    PubMed

    Brockmeyer, Joel R; Connolly, Erin E; Wittchow, Richard J; Kothari, Shanu N

    2015-01-01

    Gastric polyps occur from a variety of sources and are found commonly on upper endoscopy. We present the case of a 49-year-old female who presented for evaluation for antireflux surgery with a history of fundic gland polyposis who required twice-daily proton pump inhibitors (PPIs) for control of her gastric reflux. After verifying that she met criteria for surgery, she underwent an uncomplicated laparoscopic magnetic sphincter augmentation placement. With the cessation of PPIs following surgery, the fundic gland polyposis resolved. Fundic gland polyps may occur sporadically or within certain syndromes, such as familial adenomatous polyposis. Multiple possible inciting factors exist, including the use of PPIs. This is the first reported case of the resolution of numerous fundic gland polyps following the completion of laparoscopic magnetic sphincter augmentation. PMID:26600954

  8. Resolution of Fundic Gland Polyposis following Laparoscopic Magnetic Sphincter Augmentation and Subsequent Cessation of Proton Pump Inhibitors

    PubMed Central

    Brockmeyer, Joel R.; Connolly, Erin E.; Wittchow, Richard J.; Kothari, Shanu N.

    2015-01-01

    Gastric polyps occur from a variety of sources and are found commonly on upper endoscopy. We present the case of a 49-year-old female who presented for evaluation for antireflux surgery with a history of fundic gland polyposis who required twice-daily proton pump inhibitors (PPIs) for control of her gastric reflux. After verifying that she met criteria for surgery, she underwent an uncomplicated laparoscopic magnetic sphincter augmentation placement. With the cessation of PPIs following surgery, the fundic gland polyposis resolved. Fundic gland polyps may occur sporadically or within certain syndromes, such as familial adenomatous polyposis. Multiple possible inciting factors exist, including the use of PPIs. This is the first reported case of the resolution of numerous fundic gland polyps following the completion of laparoscopic magnetic sphincter augmentation. PMID:26600954

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

    PubMed Central

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

    2014-01-01

    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

  10. Somatostatin prevents acute pancreatitis after pancreatic duct sphincter hydrostatic balloon dilation in patients with idiopathic recurrent pancreatitis.

    PubMed

    Guelrud, M; Mendoza, S; Viera, L; Gelrud, D

    1991-01-01

    The purpose of this study was to determine whether prophylactic somatostatin infusion can prevent pancreatitis after hydrostatic balloon dilation of the pancreatic duct sphincter segment in 16 patients with idiopathic recurrent pancreatitis. This study demonstrated that prophylactic administration of somatostatin before, during, and after the procedure diminished the incidence and severity of acute pancreatitis. We recommend consideration of such prophylaxis in patients undergoing this procedure. PMID:1672278

  11. Viability and MR detectability of iron labeled mesenchymal stem cells used for endoscopic injection into the porcine urethral sphincter.

    PubMed

    Will, Susanne; Martirosian, Petros; Eibofner, Frank; Schick, Fritz; Bantleon, Rdiger; Vaegler, Martin; Grzinger, Gerd; Claussen, Claus D; Kramer, Ulrich; Schmehl, Jrg

    2015-08-01

    Direct stem cell therapies for functionally impaired tissue require a sufficient number of cells in the target region and a method for verifying the fate of the cells in the subsequent time course. In vivo MRI of iron labeled mesenchymal stem cells has been suggested to comply with these requirements. The study was conducted to evaluate proliferation, migration, differentiation and adhesion effects as well as the obtained iron load of an iron labeling strategy for mesenchymal stem cells. After injection into the porcine urethral sphincter, the labeled cells were monitored for up to six months using MRI. Mesenchymal stem cells were labeled with ferucarbotran (60/100/200 g/mL) and ferumoxide (200 g/mL) for the analysis of migration and viability. Phantom MR measurements were made to evaluate effects of iron labeling. For short and long term studies, the iron labeled cells were injected into the porcine urethral sphincter and monitored by MRI. High resolution anatomical images of the porcine urethral sphincter were applied for detection of the iron particles with a turbo-spin-echo sequence and a gradient-echo sequence with multiple TE values. The MR images were then compared with histological staining. The analysis of cell function after iron labeling showed no effects on proliferation or differentiation of the cells. Although the adherence increases with higher iron dose, the ability to migrate decreases as a presumed effect of iron labeling. The iron labeled mesenchymal stem cells were detectable in vivo in MRI and histological staining even six months after injection. Labeling with iron particles and subsequent evaluation with highly resolved three dimensional data acquisition allows sensitive tracking of cells injected into the porcine urethral sphincter for several months without substantial biological effects on mesenchymal stem cells. PMID:26147577

  12. Gender Differences in Factors Associated With Anal Intercourse Among Heterosexual Adolescents in Singapore.

    PubMed

    Ng, Junice Y S; Wong, Mee-Lian; Chan, Roy K W; Sen, Priya; Chio, Martin T W; Koh, David

    2015-08-01

    Using a cross-sectional survey, we examined the gender differences in prevalence of and factors associated with anal sex among adolescents attending the only public STI clinic in Singapore. Data were collected from 1035 sexually active adolescents aged 14 to 19 and analyzed using Poisson regression. Prevalence of anal intercourse was 28%, with significantly more females (32%) than males (23%) ever engaged in it. On multivariate analysis, the factors associated with anal intercourse for both genders were oral sex and the nonuse of contraception at last sex. For males, anal intercourse was associated with younger age of sexual debut and greater perceived external control. Among females, it was associated with higher rebellious scores and lack of confidence to resist peer pressure to engage in sex. Consistent condom use for anal sex was 22% and 8% for males and females, respectively. STI prevention programs for adolescents should address anal sex, be gender-specific, and take into consideration individual personality characteristics. PMID:26241386

  13. Evidence for the secondary sexual development of the anal fin in female kokanee salmon Oncorhynchus nerka.

    PubMed

    Thorn, M W; Morbey, Y E

    2016-02-01

    This study examines whether the anal fin undergoes secondary sexual development similar to other reproductive traits in salmonids. This hypothesis was tested by comparing the anal-fin size of female kokanee salmon Oncorhynchus nerka that were in the early and late stages of sexual development. Females in an advanced stage of maturation had significantly larger anal fins relative to females in an early state of maturation (+4-7%), indicating that the anal fin undergoes secondary sexual development. The magnitude of this secondary growth was comparable with snout length (+9-10%), which is known to undergo secondary sexual development in female salmonids. When morphological trait dimensions were compared between the sexes, the anal fin was the only morphological trait found to have a female-biased sexual size dimorphism. This is the first study to show that the anal fin of female salmonids undergoes secondary sexual development. PMID:26506902

  14. Bougie dilators: simple, safe and cost-effective treatment for Crohn's-related fibrotic anal strictures.

    PubMed

    Kashkooli, Soleiman B; Samanta, Sujon; Rouhani, Mehrdad; Akbarzadeh, Shoaleh; Saibil, Fred

    2015-10-01

    Anal strictures with fibrotic induration have been shown to develop in up to 50% of all patients with Crohn's disease (CD) with anal ulceration. We evaluate the technical feasibility, safety and long-term efficacy of bougie dilation for a subgroup of patients with symptomatic Crohn's-related fibrotic anal strictures. Bougie dilation is simple to perform, relatively inexpensive and has a low risk of complications. PMID:26204140

  15. Spontaneous rupture of the spleen operated in gynecological unit mistaken for ruptured hemorrhagic ovarian cyst: total splenectomy

    PubMed Central

    Eko, Filbert Eko; Fouelifack, Florent Ymele; de Paul, Elanga Vincent

    2014-01-01

    Spontaneous splenic rupture is always neglected when consulting acute abdominal pains in gynecological emergencies. It constitutes about 1% of all splenic ruptures and can be managed by abstention, surgery or embolization. We present the case of a young lady who was diagnosed of spontaneous rupture during surgery that was mistaken for ruptured hemorrhagic ovarian cyst and finally treated by total splenectomy. The pre-operative work up was absolute for a rupturred hemorrhagic cyst and secondariy for a ruptured ectopic gestation. PMID:25918564

  16. Dynamic Interface Rupture in Extremely Heterogeneous Media

    NASA Astrophysics Data System (ADS)

    Uenishi, K.; Tsuji, K.

    2007-12-01

    Fracture experiments of monolithic brittle materials usually show the maximum speed of smooth rupture at some 30 % of the relevant shear wave speed. This experimental maximum rupture speed is by far lower than those predicted by theories and inferred from inversions of seismograms, and some seismic inversions (e.g., the 1979 Imperial Valley, 1992 Landers, 1999 Izmit, 2001 the central Kunlunshan and 2002 Denali earthquakes) even suggest the existence of supershear rupture speeds (i.e., rupture propagating faster than the relevant shear wave). Recently, Uenishi et al. ( SSJ Fall Meeting, 2004, 2005; AGU Fall Meeting, 2006) experimentally investigated dynamic fracture in monolithic hyperelastic materials under static mode- loading conditions with relatively high crack-parallel stresses. Using a high-speed digital video camera system, they showed that cracks may propagate supersonically even in homogeneous materials. However, the exact mechanism for rupture nucleation and the transition of a nucleated rupture from sub-Rayleigh to super-shear rupture speed has not been identified yet. In this contribution, we further develop our experimental system and investigate dynamic fracture in extremely heterogeneous media, consisting of thin fluid and solid films: Inside a wire frame (50mm high, 50mm wide), a flat soap film contacts a flat thin solid plastic film (20mm high, 20mm wide), under static tensile loading conditions. The rupture (crack), initiated at a point, propagates subsonically in the linear elastic fluid film (see e.g., Uenishi et al., SSJ Fall Meeting, 2006, for the dynamic rupture in monolithic fluid films). When the circular rupture front reaches the interface, the rupture advances along the interface and then it is "diffracted" at the two corners of the interface. We record the rupture propagation process utilizing our high-speed digital video camera at a frame rate of 20 ?s (2010-6s). The observed results show that interface rupture propagation may accelerate (or even decelerate) and the dynamic rupture behavior is very sensitive to the geometry of the interface between the two films: (1) When the subsonic rupture front reaches the first rectangular corner, it accelerates around the corner and then advances supersonically along the interface; and (2) when the supersonic interface rupture front approaches the second corner (obtuse with respect to the rupture front in fluid), it bifurcates for a short period (400 ?s): the first branch unexpectedly expands rather straight into the bulk and the second one propagates along the interface at a lower speed; At a later stage, again unexpectedly, the first branched crack decelerates significantly in the bulk and the two cracks eventually merge into a single crack. The overall behavior is - in some sense - similar to that of the oblique shock and Prandtl- Meyer expansion waves in fluid mechanics, and it might give new insights not only into the question of high rupture speeds of natural earthquakes but also into the generation mechanism of tsunamis. u.ac.jp/~uenishi/

  17. Recurrent anal fistulae: Limited surgery supported by stem cells

    PubMed Central

    Garcia-Olmo, Damian; Guadalajara, Hector; Rubio-Perez, Ines; Herreros, Maria Dolores; de-la-Quintana, Paloma; Garcia-Arranz, Mariano

    2015-01-01

    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-Crohns fistulae, and three were Crohns-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. PMID:25805941

  18. FDG-PET/CT in the evaluation of anal carcinoma

    SciTech Connect

    Cotter, Shane E.; Grigsby, Perry W. . E-mail: pgrigsby@wustl.edu; Siegel, Barry A.

    2006-07-01

    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.

  19. Metrics for comparing dynamic earthquake rupture simulations

    USGS Publications Warehouse

    Barall, Michael; Harris, Ruth A.

    2014-01-01

    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 codes 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.

  20. Biomaterials in the Treatment of Anal Fistula: Hope or Hype?

    PubMed Central

    Scoglio, Daniele; Walker, Avery S.; Fichera, Alessandro

    2014-01-01

    Anal fistula (AF) presents a chronic problem for patients and colorectal surgeons alike. Surgical treatment may result in impairment of continence and long-term risk of recurrence. Treatment options for AFs vary according to their location and complexity. The ideal approach should result in low recurrence rates and minimal impact on continence. New technical approaches involving biologically derived products such as biological mesh, fibrin glue, fistula plug, and stem cells have been applied in the treatment of AF to improve outcomes and decrease recurrence rates and the risk of fecal incontinence. In this review, we will highlight the current evidence and describe our personal experience with these novel approaches. PMID:25435826

  1. [Follow-up after radiotherapy of anal canal carcinoma].

    PubMed

    Meillan, N; Huguet, F; Peiffert, D

    2015-10-01

    Anal canal carcinoma is a rare and curable disease for which the standard of care is radiation therapy with concurrent 5-fluoro-uracil and mitomycine-based chemotherapy. Post-treatment follow-up however is rather poorly defined. This article offers a review of the various post-treatment surveillance options both for early diagnosis of relapse and care for late treatment effects. While follow-up remains mostly clinical, we will discuss morphologic (endorectal echoendoscopy, pelvic magnetic resonance imaging, tomodensitometry and positron emission tomography) and biologic (squamous cell carcinoma antigen and pathology) follow-up so as to determine their diagnostic and prognostic value. PMID:26323891

  2. A rare case of myeloid sarcoma presenting as anal fissure

    PubMed Central

    VECCHIO, R.; INTAGLIATA, E.; FIUMARA, P.F.; VILLARI, L.; MARCHESE, S.; CACCIOLA, E.

    2015-01-01

    Myeloid sarcoma is a tumor composed of myeloblasts occurring at an extramedullary site. It may develop in patients with acute myeloid leukemia, myeloproliferative or myelodysplastic syndrome, sometimes preceding onset of the systemic disease. Frequent sites of myeloid sarcoma are bones or various soft tissues. Gastrointestinal involvement is very rare. We report a unique case of myeloid sarcoma presenting as a painful anal fissure, in a patient with a history of acute myeloid leukemia. The diagnosis was achieved by a surgical excisional biopsy and immunoistochemical staining. PMID:26712260

  3. Age at intracranial aneurysm rupture among generations

    PubMed Central

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

    2009-01-01

    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

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

    PubMed Central

    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

    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

  5. Pudendal denervation affects the structure and function of the striated, urethral sphincter in female rats.

    PubMed

    Heidkamp, M C; Leong, F C; Brubaker, L; Russell, B

    1998-01-01

    Our aim was to examine the effects of denervation on urethral anatomy and urine voiding pattern. Rats usually void at one end of their cage, which gives a behavioral index of continence. The voiding preference for denervated rats was decreased to 88.8 + 4.7%, n = 32, P < 0.001, compared to improvements with time for unoperated (117 +/- 10%, n = 16) or sham-operated rats (105 +/- 8%, n = 5). The volume of urine or the frequency of voidings between denervated, unoperated or sham-operated rats did not differ significantly. Urethral sections were analyzed immunochemically and quantified morphometrically. Smooth muscle volume remained constant but skeletal muscle volume decreased after denervation, from 43 +/- 2% to 36 +/- 3% (P < 0.05, n = 5). Fiber diameter decreased from 14.3 +/- 1.4 microm to 8.5 +/- 0.7 microm (P < 0.005). We concluded that pudendal nerve transection in female rats causes behavioral alterations in voiding and muscular atrophy of the striated sphincter. PMID:9694137

  6. Achalasia in Pregnancy: Botulinum Toxin A Injection of Lower Esophageal Sphincter

    PubMed Central

    Hooft, Nicole; Schmidt, Emily S.; Bremner, Ross M.

    2015-01-01

    Background. Achalasia, a rare esophageal motility disorder that may cause malnutrition during pregnancy, can result in fetal and maternal morbidity and mortality. Many medical treatment regimens are contraindicated or not tolerated during pregnancy, and surgery is generally avoided due to potential risks to the fetus. Case Report. Severe, medically refractory achalasia in a 23-year-old pregnant woman that caused malnutrition was successfully managed by administering a botulinum toxin A injection to the lower esophageal sphincter. The injection was performed at approximately 14 weeks' gestation and the patient reported clinically significant relief from dysphagia. She gained weight and ultimately delivered a healthy baby girl at term, but her symptoms returned a few months postpartum. She underwent a second treatment of botulinum toxin A injection, but it offered only one month of relief. Roughly eight months after delivery, the patient underwent a laparoscopic extended Heller myotomy and Dor fundoplication. The patient resumed a normal diet one week postoperatively, and her baby has had no complications. Conclusion. This is only the second reported case of botulinum toxin A injection being used to treat achalasia in pregnancy. This treatment proved to be a safe temporary alternative without the risks of surgery and anesthesia during pregnancy. PMID:26229704

  7. Lubrication Theory Model to Evaluate Surgical Alterations in Flow Mechanics of the Lower Esophageal Sphincter

    NASA Astrophysics Data System (ADS)

    Ghosh, Sudip K.; Brasseur, James G.; Zaki, Tamer; Kahrilas, Peter J.

    2003-11-01

    Surgery is commonly used to rebuild a weak lower esophageal sphincter (LES) and reduce reflux. Because the driving pressure (DP) is proportional to muscle tension generated in the esophagus, we developed models using lubrication theory to evaluate the consequences of surgery on muscle force required to open the LES and drive the flow. The models relate time changes in DP to lumen geometry and trans-LES flow with a manometric catheter. Inertial effects were included and found negligible. Two models, direct (opening specified) and indirect (opening predicted), were combined with manometric pressure and imaging data from normal and post-surgery LES. A very high sensitivity was predicted between the details of the DP and LES opening. The indirect model accurately captured LES opening and predicted a 3-phase emptying process, with phases I and III requiring rapid generation of muscle tone to open the LES and empty the esophagus. Data showed that phases I and III are adversely altered by surgery causing incomplete emptying. Parametric model studies indicated that changes to the surgical procedure can positively alter LES flow mechanics and improve clinical outcomes.

  8. Mechanism of bombesin-induced tonic contraction of the porcine lower esophageal sphincter.

    PubMed

    Tsai, Ching-Chung; Chang, Li-Ching; Lin, Kai-Jen; Tey, Shu-Leei; Su, Yu-Tsun; Liu, Ching-Wen; Tsai, Tong-Rong; Huang, Shih-Che

    2015-01-01

    Gastroesophageal reflux disease (GERD) is a disorder that is related to an incompetent lower esophageal sphincter (LES). Previous studies showed that bombesin could increase LES pressure in humans and opossums. The aim of the present study was to characterize the effects of bombesin on porcine LES contraction. We used the selective agonists, neuromedin B (NMB), gastrin-releasing peptide (GRP), and [D-Tyr(6),Apa-4Cl(11),Phe(13),Nle(14)]bombesin-(6-14) (DTACPN-BN), as well as receptor antagonists of bombesin receptor subtype 2 (BB2), and 3 (BB3) for ex vivo contraction studies. Atropine, nifedipine, tetrodotoxin, and ω-conotoxin GVIA were used to explore the agonist-induced LES contraction mechanism. Reverse transcription polymerase chain reaction and immunohistochemistry were applied to detect bombesin receptor expression. Our results indicate that GRP and DTACPN-BN, but not NMB, induced tonic contractions of the porcine LES in a dose-dependent manner, and the contractions were inhibited with selective BB2 and BB3 antagonists. The GRP-induced contraction is mainly caused by L-type Ca(2+) channel-mediated Ca(2+) influx. However, DTACPN-BN-induced contractions are associated with neuronal conduction. RT-PCR and immunohistochemistry revealed that BB2 and BB3 were expressed in the porcine LES. Bombesin-induced tonic contraction of the LES is mediated through BB2 and BB3. Bombesin, BB2, and BB3 agonists might have the potential to treat GERD. PMID:26522854

  9. Long-Term Results of External Upper Esophageal Sphincter Myotomy for Oropharyngeal Dysphagia

    PubMed Central

    David, Eric F.; Klinkenberg-Knol, Elly C.; Mahieu, Hans F.

    2009-01-01

    The aim of this work was to assess the efficacy of external myotomy of the upper esophageal sphincter (UES) for oropharyngeal dysphagia. In the period 1991–2006, 28 patients with longstanding dysphagia and/or aspiration problems of different etiologies underwent UES myotomy as a single surgical treatment. The main symptoms were difficulties in swallowing of a solid-food bolus, aspiration, and recurrent incidents of solid-food blockages. Pre- and postoperative manometry and videofluoroscopy were used to assess deglutition and aspiration. Outcome was defined as success in the case of complete relief or marked improvement of dysphagia and aspiration and as failure in the case of partial improvement or no improvement. Initial results showed success in 21 and failure in 7 patients. The best outcomes were observed in patients with dysphagia of unknown origin, noncancer-related iatrogenic etiology, and neuromuscular disease. No correlation was found between preoperative constrictor pharyngeal muscle activity and success rate. After follow-up of more than 1 year, 20 patients were marked as success and 3 as failure. All successful patients had full oral intake with a normal bolus consistency without clinically significant aspiration. We conclude that in select cases of oropharyngeal dysphagia success may be achieved by UES myotomy with restoration of oral intake of normal bolus consistency. PMID:19760460

  10. Mechanism of bombesin-induced tonic contraction of the porcine lower esophageal sphincter

    PubMed Central

    Tsai, Ching-Chung; Chang, Li-Ching; Lin, Kai-Jen; Tey, Shu-Leei; Su, Yu-Tsun; Liu, Ching-Wen; Tsai, Tong-Rong; Huang, Shih-Che

    2015-01-01

    Gastroesophageal reflux disease (GERD) is a disorder that is related to an incompetent lower esophageal sphincter (LES). Previous studies showed that bombesin could increase LES pressure in humans and opossums. The aim of the present study was to characterize the effects of bombesin on porcine LES contraction. We used the selective agonists, neuromedin B (NMB), gastrin-releasing peptide (GRP), and [D-Tyr6,Apa-4Cl11,Phe13,Nle14]bombesin-(6-14) (DTACPN-BN), as well as receptor antagonists of bombesin receptor subtype 2 (BB2), and 3 (BB3) for ex vivo contraction studies. Atropine, nifedipine, tetrodotoxin, and ω-conotoxin GVIA were used to explore the agonist-induced LES contraction mechanism. Reverse transcription polymerase chain reaction and immunohistochemistry were applied to detect bombesin receptor expression. Our results indicate that GRP and DTACPN-BN, but not NMB, induced tonic contractions of the porcine LES in a dose-dependent manner, and the contractions were inhibited with selective BB2 and BB3 antagonists. The GRP-induced contraction is mainly caused by L-type Ca2+ channel-mediated Ca2+ influx. However, DTACPN-BN-induced contractions are associated with neuronal conduction. RT-PCR and immunohistochemistry revealed that BB2 and BB3 were expressed in the porcine LES. Bombesin-induced tonic contraction of the LES is mediated through BB2 and BB3. Bombesin, BB2, and BB3 agonists might have the potential to treat GERD. PMID:26522854

  11. Medical treatment for sphincter of oddi dysfunction: Can it replace endoscopic sphincterotomy?

    PubMed Central

    Vitton, Véronique; Ezzedine, Salah; Gonzalez, Jean-Michel; Gasmi, Mohamed; Grimaud, Jean-Charles; Barthet, Marc

    2012-01-01

    AIM: To report the results of a medical management of sphincter of oddi dysfunction (SOD) after an intermediate follow-up period. METHODS: A total of 59 patients with SOD (2 men and 57 women, mean age 51 years old) were included in this prospective study. After medical treatment for one year, the patients were clinically re-evaluated after an average period of 30 mo. RESULTS: The distribution of the patients according to the Milwaukee’s classification was the following: 11 patients were type 1, 34 were type 2 and 14 were type 3. Fourteen patients underwent an endoscopic sphincterotomy (ES) after one year of medical treatment. The median intermediate follow-up period was 29.8 ± 3 mo (3-72 mo). The initial effectiveness of the medical treatment was complete, partial and poor among 50.8%, 13.5% and 35%, respectively, of the patients. At the end of the follow-up period, 37 patients (62.7%) showed more than 50% improvement. The rate of improvement in patients who required ES was not significantly different compared with the patients treated conservatively (64.2% vs 62.2%, respectively). CONCLUSION: Our study confirms that conservative medical treatment could be an alternative to endoscopic sphincterotomy because, after an intermediate follow-up period, the two treatments show the same success rates. PMID:22529689

  12. Distribution and effects of pituitary adenylate cyclase activating peptide in cat and human lower oesophageal sphincter.

    PubMed Central

    Ny, L.; Larsson, B.; Alm, P.; Ekstrm, P.; Fahrenkrug, J.; Hannibal, J.; Andersson, K. E.

    1995-01-01

    1. The localization, tissue concentrations, and effects of pituitary adenylate cyclase activating peptide (PACAP) 27 and 38 were investigated in cat and human lower oesophageal sphincter (LOS), and compared with those of vasoactive intestinal peptide (VIP) and helospectin. 2. PACAP-immunoreactive nerve structures were found in the cat and human LOS, with an abundance in the circular smooth muscle layer. PACAP 27-immunoreactivity was often co-localized with VIP-immunoreactivity. 3. In cat tissue, PACAP (PACAP 27 plus PACAP 38) concentrations were 50 fold lower than VIP concentrations; in human tissue they were 10 fold lower. 4. PACAP 27, PACAP 38, helospectin I, and VIP induced concentration-dependent relaxations in circular smooth muscle preparations from cat and human LOS. The order of potency was: VIP > helospectin I > or = PACAP 27 > PACAP 38. NG-nitro-L-arginine, scopolamine, or apamin, did not influence the relaxant effects of PACAP 27 or VIP. 5. In cat preparations, both cyclic AMP and cyclic GMP levels were increased after exposure to PACAP 27 and helospectin I, whereas exposure to VIP was followed by an increase in cyclic AMP levels only. In human preparations, there was an increase in cyclic AMP levels without any change in cyclic GMP levels. 6. These results suggest that in the cat and human LOS, PACAP 27 and VIP can occur within the same nerve structures. PACAP 27 has a potent relaxant action, but its functional importance has to be established. Images Figure 1 Figure 2 Figure 3 PMID:8680719

  13. Circular and longitudinal muscles shortening indicates sliding patterns during peristalsis and transient lower esophageal sphincter relaxation.

    PubMed

    Patel, Nirali; Jiang, Yanfen; Mittal, Ravinder K; Kim, Tae Ho; Ledgerwood, Melissa; Bhargava, Valmik

    2015-09-01

    Esophageal axial shortening is caused by longitudinal muscle (LM) contraction, but circular muscle (CM) may also contribute to axial shortening because of its spiral morphology. The goal of our study was to show patterns of contraction of CM and LM layers during peristalsis and transient lower esophageal sphincter (LES) relaxation (TLESR). In rats, esophageal and LES morphology was assessed by histology and immunohistochemistry, and function with the use of piezo-electric crystals and manometry. Electrical stimulation of the vagus nerve was used to induce esophageal contractions. In 18 healthy subjects, manometry and high frequency intraluminal ultrasound imaging during swallow-induced esophageal contractions and TLESR were evaluated. CM and LM thicknesses were measured (40 swallows and 30 TLESRs) as markers of axial shortening, before and at peak contraction, as well as during TLESRs. Animal studies revealed muscular connections between the LM and CM layers of the LES but not in the esophagus. During vagal stimulated esophageal contraction there was relative movement between the LM and CM. Human studies show that LM-to-CM (LM/CM) thickness ratio at baseline was 1. At the peak of swallow-induced contraction LM/CM ratio decreased significantly (<1), whereas the reverse was the case during TLESR (>2). The pattern of contraction of CM and LM suggests sliding of the two muscles. Furthermore, the sliding patterns are in the opposite direction during peristalsis and TLESR. PMID:26045610

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

    PubMed Central

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

    1992-01-01

    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

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

    PubMed

    Deng, J; Hall-Craggs, M A; Craggs, M D; Richards, R; Knight, S L; Linney, A D; Mundy, A R

    2006-06-01

    The aim of this study was to develop a method for simultaneous 3D visualization of a new type of artificial urethral sphincter (AUS) and adjacent urinary structures. Serial MR tomograms were acquired from seven men after AUS implantation. 3D reconstruction was performed by thresholding original (positive) and inverted (negative) image intensity and by subsequently fusing positive and negative images. Results show that the bladder, cuff and balloons of the AUS of originally high intensity were imaged in 3D by thresholding the positive datasets. The urethrae and corpora cavernosa penis of originally low intensity were displayed in 3D by thresholding the negative datasets. Fusion of the positive and negative datasets allowed simultaneous visualization of the AUS complex and adjacent urinary structures. All the structures of interest were also clearly seen by interactive multiplanar reformatting. Coronal tomographic datasets provided better 3D and reformatted 2D images than sagittal and transverse datasets. This technique offers a simple means for evaluating the complex urethral anatomy and the AUS, and has potential for improved 3D visualization of many other complex morphological and pathological conditions. PMID:16714745

  16. [Treatment of complex cryptoglandular anal fistulas. Does it still require an experienced surgeon?].

    PubMed

    Roig, Jos V; Garca-Armengol, Juan

    2013-02-01

    There is still controversy on the management of complex cryptoglandular fistulas, even after employing the newest, theoretically simple, techniques. A critical review of the literature was performed, in order to clarify the role of the surgeon, where the precarious balance between eradicating sepsis and maintaining anorectal influences the choice. Techniques, such as fistulotomy, immediate sphincter repair or ligature of the inter-sphincter trajectory, are discussed. The new sphincter preserving techniques, such as sealing, use of plugs and cell therapy are also analysed. However, with a few exceptions, the scientific evidence is low or zero, due to the lack of clinical trials and to the large variation in the presentations and technical details that could influence the results. For this reason, experience in treating complex cryptoglandular fistulas is still essential. PMID:22425511

  17. CT diagnosis of ruptured abdominal aortic aneurysm

    SciTech Connect

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

    1984-08-01

    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.

  18. Gastric rupture after the Heimlich maneuver.

    PubMed

    Bintz, M; Cogbill, T H

    1996-01-01

    Since 1975, the Heimlich maneuver has been widely applied to relieve upper airway obstruction caused by aspirated material. Life-threatening complications have been documented following this simple procedure. We report two cases of gastric rupture after use of the Heimlich maneuver. Both patients experienced pulmonary and abdominal symptoms. The diagnosis was confirmed in each case by the demonstration of free intraperitoneal air on an upright chest roentgenogram. Full-thickness gastric rupture along the lesser curvature of the stomach was repaired in both patients; one patient died. Abdominal pain or persistent abdominal distention despite nasogastric suction after the Heimlich maneuver should prompt evaluation for possible gastric rupture. PMID:8576987

  19. Magnetic resonance imaging in assessment of stress urinary incontinence in women: Parameters differentiating urethral hypermobility and intrinsic sphincter deficiency

    PubMed Central

    Macura, Katarzyna Jadwiga; Thompson, Richard Eugene; Bluemke, David Alan; Genadry, Rene

    2015-01-01

    AIM: To define the magnetic resonance imaging (MRI) parameters differentiating urethral hypermobility (UH) and intrinsic sphincter deficiency (ISD) in women with stress urinary incontinence (SUI). METHODS: The static and dynamic MR images of 21 patients with SUI were correlated to urodynamic (UD) findings and compared to those of 10 continent controls. For the assessment of the urethra and integrity of the urethral support structures, we applied the high-resolution endocavitary MRI, such as intraurethral MRI, endovaginal or endorectal MRI. For the functional imaging of the urethral support, we performed dynamic MRI with the pelvic phased array coil. We assessed the following MRI parameters in both the patient and the volunteer groups: (1) urethral angle; (2) bladder neck descent; (3) status of the periurethral ligaments, (4) vaginal shape; (5) urethral sphincter integrity, length and muscle thickness at mid urethra; (6) bladder neck funneling; (7) status of the puborectalis muscle; (8) pubo-vaginal distance. UDs parameters were assessed in the patient study group as follows: (1) urethral mobility angle on Q-tip test; (2) Valsalva leak point pressure (VLPP) measured at 250 cc bladder volume; and (3) maximum urethral closure pressure (MUCP). The UH type of SUI was defined with the Q-tip test angle over 30 degrees, and VLPP pressure over 60 cm H2O. The ISD incontinence was defined with MUCP pressure below 20 cm H2O, and VLPP pressure less or equal to 60 cm H2O. We considered the associations between the MRI and clinical data and UDs using a variety of statistical tools to include linear regression, multivariate logistic regression and receiver operating characteristic (ROC) analysis. All statistical analyses were performed using STATA version 9.0 (StataCorp LP, College Station, TX). RESULTS: In the incontinent group, 52% have history of vaginal delivery trauma as compared to none in control group (P < 0.001). There was no difference between the continent volunteers and incontinent patients in body habitus as assessed by the body mass index. Pubovaginal distance and periurethral ligament disruption are significantly associated with incontinence; periurethral ligament symmetricity reduces the odds of incontinence by 87%. Bladder neck funneling and length of the suprapubic urethral sphincter are significantly associated with the type of incontinence on UDs; funneling reduced the odds of pure UH by almost 95%; increasing suprapubic urethral sphincter length at rest is highly associated with UH. Both MRI variables result in a predictive model for UDs diagnosis (area under the ROC = 0.944). CONCLUSION: MRI may play an important role in assessing the contribution of hypermobility and sphincteric dysfunction to the SUI in women when considering treatment options. PMID:26644825

  20. Creep-rupture reliability analysis

    NASA Technical Reports Server (NTRS)

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

    1985-01-01

    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.

  1. Creep-rupture reliability analysis

    NASA Technical Reports Server (NTRS)

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

    1984-01-01

    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.

  2. Comprehensive multiplatform biomarker analysis of 199 anal squamous cell carcinomas

    PubMed Central

    Smaglo, Brandon G.; Tesfaye, Anteneh; Halfdanarson, Thorvardur R.; Meyer, Joshua E.; Wang, Jue; Gatalica, Zoran; Reddy, Sandeep; Arguello, David; Boland, Patrick M.

    2015-01-01

    Anal squamous cell carcinoma (ASCC) is a rare, HPV-associated malignancy typically diagnosed in early stages and definitively treated with chemoradiation. In situations where patients exhibit metastatic or recurrent disease, treatment options are severely limited. In this study, molecular alterations were identified that could be used to aid in therapeutic decisions for patients with metastatic or recurrent anal squamous cell carcinoma. Specimens from patients with this cancer were tested via a multiplatform profiling service (Caris Life Sciences, Phoenix, AZ) consisting of gene sequencing, protein expression by immunohistochemistry, and gene amplification with in situ hybridization. Utilizing these techniques, novel treatment strategies that could be explored were identified, including potential benefit with anti-EGFR therapies, immune checkpoint inhibitors, topoisomerase inhibitors, and taxanes. The frequency of overexpression of proteins that mark resistance to chemotherapeutic drugs, such as MRP1 (chemotherapy efflux pump), ERCC1 (resistance to platinum-based chemotherapy), and thymidylate synthase (resistance to fluoropyrimidines) were also identified, suggesting a lack of benefit. This multiplatform strategy could be explored for its potential to generate a personalized treatment selection for patients with advanced ASCC, provide a guide for future therapeutic development for this cancer, and be extended to other rare cancer types as well. PMID:26498363

  3. The hero, the anima and the claustrum: anality and idealization.

    PubMed

    Meredith-Owen, William

    2012-04-01

    Joe Redfearn's (1979) classic paper 'The captive, the treasure, the hero and the anal stage of development' is recognized as seminal to the development of Jungian thought about anality, particularly its integration with mainstream (Freudian, Kleinian) psychoanalytic perspectives. This paper develops such an approach through drawing on contributions from Meltzer, Green, Bion, Chasseguet-Smirgel and Kernberg. More specifically, it is argued that over-investment in hero and anima archetypal configurations may represent an attempt to replace the resource of the internal parental couple that, at the level of unconscious phantasy, has been destroyed by the aggrieved child's attack on the primal scene. Unless this usually dissociated sadism can be integrated, the creative epistemophilic instinct may remain blunted, giving rise, through projective identification, to the adoption of a pseudo-adult identity based on appropriation or assertion. This in turn may lead to manic attempts to reach authentic ('animating') experience through the (often erotized) excitement of heroic endeavour. Consideration of both Redfearn's and the author's own clinical material demonstrates how close attention to process as well as content is fundamental to revealing and addressing such likely-to-be dissociated scenarios. PMID:22444354

  4. Comprehensive multiplatform biomarker analysis of 199 anal squamous cell carcinomas.

    PubMed

    Smaglo, Brandon G; Tesfaye, Anteneh; Halfdanarson, Thorvardur R; Meyer, Joshua E; Wang, Jue; Gatalica, Zoran; Reddy, Sandeep; Arguello, David; Boland, Patrick M

    2015-12-22

    Anal squamous cell carcinoma (ASCC) is a rare, HPV-associated malignancy typically diagnosed in early stages and definitively treated with chemoradiation. In situations where patients exhibit metastatic or recurrent disease, treatment options are severely limited. In this study, molecular alterations were identified that could be used to aid in therapeutic decisions for patients with metastatic or recurrent anal squamous cell carcinoma. Specimens from patients with this cancer were tested via a multiplatform profiling service (Caris Life Sciences, Phoenix, AZ) consisting of gene sequencing, protein expression by immunohistochemistry, and gene amplification with in situ hybridization. Utilizing these techniques, novel treatment strategies that could be explored were identified, including potential benefit with anti-EGFR therapies, immune checkpoint inhibitors, topoisomerase inhibitors, and taxanes. The frequency of overexpression of proteins that mark resistance to chemotherapeutic drugs, such as MRP1 (chemotherapy efflux pump), ERCC1 (resistance to platinum-based chemotherapy), and thymidylate synthase (resistance to fluoropyrimidines) were also identified, suggesting a lack of benefit. This multiplatform strategy could be explored for its potential to generate a personalized treatment selection for patients with advanced ASCC, provide a guide for future therapeutic development for this cancer, and be extended to other rare cancer types as well. PMID:26498363

  5. A case of syphilitic anal condylomata lata mimicking malignancy

    PubMed Central

    Tayal, Sarup; Shaban, Fadlo; Dasgupta, Kaushik; Tabaqchali, Mohamed A.

    2015-01-01

    Introduction Condylata lata in secondary syphilis is well known presentation and needs to be considered in differential diagnosis of perianal lesions. In England between 2013 and 2014 the overall incidence of infectious syphilis increased by 33% and is mainly seen in men who have sex with men. Presentation of case We report the management of a 49-years-old Caucasian homosexual man with perianal lesions that were suspicious of malignancy. After biopsies, colonoscopy, staging with computed tomography, magnetic resonance imaging and syphilis serology anal cancer was excluded and a diagnosis of syphilis was confirmed. He was referred to the sexual health clinic for the appropriate investigations and treatment. Discussion This case highlights the consideration of treatable infectious syphilis pathology. The main differential diagnosis of perianal growths to consider is condylomata acuminata (warts caused by human papillomavirus), anal cancer, syphilis, chancroid, haemorrhoids, tuberculosis and lymphogranuloma venereum. To differentiate a biopsy is needed for histopathological examination. A dense plasma cell infiltrate and numerous spirochetes visualised by immunostaining confirms condylomata lata. Conclusion In UK, it is important for colorectal surgeons to be aware of syphilitic condylomata lata and consider this when dealing with perianal lesions. It is advisable to refer patients suspected of or diagnosed with syphilis to sexual health clinics to help improve outcome. In sexual health clinics additional investigations and treatment are available in addition to partner notification and follow-up can be offered. PMID:26555060

  6. Hydrodynamic function of dorsal and anal fins in brook trout (Salvelinus fontinalis).

    PubMed

    Standen, E M; Lauder, G V

    2007-01-01

    Recent kinematic and hydrodynamic studies on fish median fins have shown that dorsal fins actively produce jets with large lateral forces. Because of the location of dorsal fins above the fish's rolling axis, these lateral forces, if unchecked, would cause fish to roll. In this paper we examine the hydrodynamics of trout anal fin function and hypothesize that anal fins, located below the fish's rolling axis, produce similar jets to the dorsal fin and help balance rolling torques during swimming. We simultaneously quantify the wake generated by dorsal and anal fins in brook trout by swimming fish in two horizontal light sheets filmed by two synchronized high speed cameras during steady swimming and manoeuvring. Six major conclusions emerge from these experiments. First, anal fins produce lateral jets to the same side as dorsal fins, confirming the hypothesis that anal fins produce fluid jets that balance those produced by dorsal fins. Second, in contrast to previous work on sunfish, neither dorsal nor anal fins produce significant thrust during steady swimming; flow leaves the dorsal and anal fins in the form of a shear layer that rolls up into vortices similar to those seen in steady swimming of eels. Third, dorsal and anal fin lateral jets are more coincident in time than would be predicted from simple kinematic expectations; shape, heave and pitch differences between fins, and incident flow conditions may account for the differences in timing of jet shedding. Fourth, relative force and torque magnitudes of the anal fin are larger than those of the dorsal fin; force differences may be due primarily to a larger span and a more squarely shaped trailing edge of the anal fin compared to the dorsal fin; torque differences are also strongly influenced by the location of each fin relative to the fish's centre of mass. Fifth, flow is actively modified by dorsal and anal fins resulting in complex flow patterns surrounding the caudal fin. The caudal fin does not encounter free-stream flow, but rather moves through incident flow greatly altered by the action of dorsal and anal fins. Sixth, trout anal fin function differs from dorsal fin function; although dorsal and anal fins appear to cooperate functionally, there are complex interactions between other fins and free stream perturbations that require independent dorsal and anal fin motion and torque production to maintain control of body position. PMID:17210968

  7. Descriptive epidemiology of isolated anal anomalies: a survey of 4.6 million births in Europe.

    PubMed

    Cuschieri, A

    2001-10-15

    The prevalence of anal anomalies among 4,618,840 births recorded in 33 EUROCAT registries between 1980 and 1994 was 4.05 per 10,000 births. Of the 1,846 recorded cases, 672 (36.4%) were isolated anal anomalies while 1,174 (63.6%) occurred together with other anomalies. Only isolated anal anomalies were analyzed in this study: 75.5% were atresias, 10.1% of which were above and 89.9% were below the level of the levator ani muscle. Fistula occurred in 53% of supralevator and 37% of infralevator atresia. Other anal anomalies were ectopic anus (3.4%), congenital anal fistula (14.7%), and persistent cloaca (0.9%). There was a predominance of males in anal atresia without fistula (male to female (M:F) ratio was 6.7 for supralevator and 2.3 for infralevator atresia), but no significant sex difference in atresias with fistula. There was a predominance of females in ectopic anus and congenital anal fistula (M:F = 0.11 and 0.36 respectively). High frequencies of fetal deaths were recorded in supralevator atresia without fistula (8.3%) and in persistent cloaca (11.1%). Mean gestational length and mean birth weights were reduced for persistent cloaca but were within normal limits for other isolated anal anomalies. Odds ratios (ORs) for mothers above 35 years were increased for supralevator atresia without fistula, supralevator atresia with fistula, and congenital anal fistula. ORs for mothers below 30 years were slightly increased for supralevator atresia without fistula and decreased for persistent cloaca. There were marked differences in prevalence and distribution of anal anomalies among the EUROCAT registries. The results indicated that there are epidemiological differences among the various types of anal anomalies which might reflect different embryological origins. PMID:11745992

  8. Spontaneous rupture of ovarian cystadenocarcinoma: pre- and post-rupture computed tomography evaluation*

    PubMed Central

    Salvadori, Priscila Silveira; Bomfim, Lucas Novais; von Atzingen, Augusto Castelli; DIppolito, Giuseppe

    2015-01-01

    Epithelial ovarian tumors are the most common malignant ovarian neoplasms and, in most cases, eventual rupture of such tumors is associated with a surgical procedure. The authors report the case of a 54-year-old woman who presented with spontaneous rupture of ovarian cystadenocarcinoma documented by computed tomography, both before and after the event. In such cases, a post-rupture staging tends to be less favorable, compromising the prognosis. PMID:26543286

  9. Achilles tendon rupture in atypical patient populations.

    PubMed

    Kingsley, Peter

    2016-03-01

    Rupture of the Achilles tendon is a significant injury, and the likelihood of a good recovery is directly associated with early diagnosis and appropriate referral. Such injuries are commonly assessed and identified by practitioners working in 'minors' areas of emergency departments or urgent care settings. The literature frequently describes rupture of the Achilles tendon as 'typically sport-related' affecting 'middle-aged weekend warriors', but this aetiology accounts for only about 70% of such injuries. Factors such as the natural ageing process, obesity and use of some commonly prescribed medications, can increase the risk of developing a tendinopathy and subsequent rupture, often from a seemingly insignificant incident. However, research suggests that injuries in this patient population are more likely be missed on first examination. This article describes risk factors that should alert clinicians to the possibility of Achilles tendon rupture in 'atypical' patient populations. PMID:26948227

  10. Pregnancy-related rupture of arterial aneurysms.

    PubMed

    Barrett, J M; Van Hooydonk, J E; Boehm, F H

    1982-09-01

    Over 50 per cent of ruptured arterial aneurysms in women under the age of 40 are pregnancy-related. The hemodynamic and endocrine changes of pregnancy appear to be the cause of arterial alterations which may lead to new aneurysm formation and/or weakening of preexisting aneurysms. The most commonly reported arteries to have aneurysms rupture during pregnancy are the aorta, cerebral arteries, splenic artery, renal artery, coronary artery, and ovarian artery. In many instances, the rupture of an arterial aneurysm will initially simulate other less serious disease processes, thus delaying the correct diagnosis until a catastrophic event occurs. Early diagnosis and treatment of a ruptured arterial aneurysm are imperative in order to give optimal chances of survival to the mother and fetus. PMID:6752786

  11. Ruptured celiac artery aneurysm mimicking Boerhaave syndrome.

    PubMed

    Liu, Chien-Yu; Yang, Kai-Wei; Chen, Wei-Kung; Huang, Chen-Hsiung

    2013-09-01

    Ruptured celiac artery aneurysm is a rare cause for epigastric pain and is usually detected incidentally. Atypical presentation with postemetic epigastralgia and pleural effusion usually leads physicians to make the diagnosis of Boerhaave syndrome. Herein, we report a 32-year-old woman who was diagnosed with Boerhaave syndrome initially after presenting with acute postemetic epigastralgia and predominant left side pleural effusion. Diagnostic left thoracentesis yielded bloody fluid with similar amylase level to serum. The chest computed tomographic scan showed no evidence of esophageal rupture. However, a ruptured celiac artery aneurysm with retroperitoneal hematoma extending to the posterior mediastinum and bilateral pleural space was found incidentally. Although ruptured celiac artery aneurysm is an uncommon cause for postemetic epigastralgia, acute vascular events such as the previously stated cause should be the first impression rather than Boerhaave syndrome if the patient also presents with isolated pleural effusion containing unelevated amylase. PMID:23773770

  12. [Left Ventricular Rupture following Mitral Valve Replacement].

    PubMed

    Yamaguchi, Atsushi

    2015-07-01

    Left ventricular rupture is a rare but lethal complication after mitral valve replacement (MVR). Between 1989 and 2014, of 850 patients who underwent MVR, 6 developed left ventricular rupture in Saitama Medical Center, Jichi Medical University. Treasure type I rupture occurred in 5 patients and Miller type III in 1. Four cases developed ventricular rupture right after declamping of the ascending aorta, and the remaining 2 after the transfer to the intensive care unit( ICU). Prompt surgical therapy was achieved for the instant closure of the muscular wall defect under the cardiopulmonary bypass and cardiac arrest, however, leading to the disappointing result of 66.7% of hospital death. It is the most important to relieving the stress of the posterior wall of the left ventricle during mitral surgery by using the modification techniques with the preservation of posterior mitral leaflet and avoiding pre and afterload of the left ventricle right after the MVR. PMID:26197900

  13. Acute Iliac Artery Rupture: Endovascular Treatment

    SciTech Connect

    Chatziioannou, A.; Mourikis, D.; Katsimilis, J.; Skiadas, V. Koutoulidis, V.; Katsenis, K.; Vlahos, L.

    2007-04-15

    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.

  14. Dynamic rupture activation of backthrust fault branching

    NASA Astrophysics Data System (ADS)

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

    2015-03-01

    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.

  15. Biomechanical rupture risk assessment of abdominal aortic aneurysms based on a novel probabilistic rupture risk index.

    PubMed

    Polzer, Stanislav; Gasser, T Christian

    2015-12-01

    A rupture risk assessment is critical to the clinical treatment of abdominal aortic aneurysm (AAA) patients. The biomechanical AAA rupture risk assessment quantitatively integrates many known AAA rupture risk factors but the variability of risk predictions due to model input uncertainties remains a challenging limitation. This study derives a probabilistic rupture risk index (PRRI). Specifically, the uncertainties in AAA wall thickness and wall strength were considered, and wall stress was predicted with a state-of-the-art deterministic biomechanical model. The discriminative power of PRRI was tested in a diameter-matched cohort of ruptured (n = 7) and intact (n = 7) AAAs and compared to alternative risk assessment methods. Computed PRRI at 1.5 mean arterial pressure was significantly (p = 0.041) higher in ruptured AAAs (20.21(s.d. 14.15%)) than in intact AAAs (3.71(s.d. 5.77)%). PRRI showed a high sensitivity and specificity (discriminative power of 0.837) to discriminate between ruptured and intact AAA cases. The underlying statistical representation of stochastic data of wall thickness, wall strength and peak wall stress had only negligible effects on PRRI computations. Uncertainties in AAA wall stress predictions, the wide range of reported wall strength and the stochastic nature of failure motivate a probabilistic rupture risk assessment. Advanced AAA biomechanical modelling paired with a probabilistic rupture index definition as known from engineering risk assessment seems to be superior to a purely deterministic approach. PMID:26631334

  16. Describing Soils: Calibration Tool for Teaching Soil Rupture Resistance

    ERIC Educational Resources Information Center

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

    2009-01-01

    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…

  17. Describing Soils: Calibration Tool for Teaching Soil Rupture Resistance

    ERIC Educational Resources Information Center

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

    2009-01-01

    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

  18. Yield Stress Effects on Mucus Plug Rupture

    NASA Astrophysics Data System (ADS)

    Hu, Yingying; Bian, Shiyao; Grotberg, John C.; Takayama, Shuichi; Grotberg, James B.

    2012-11-01

    Mucus plugs can obstruct airways, resulting in lost gas exchange and inflammation. Yield stress, one of the significant rheological properties of mucus, plays a significant role in plug rupture. We use carbopol 940 gels as mucus simulants to study dynamics of mucus plug rupture in experiments. Yield stress increases with gel concentration increasing (0.1% ~0.3%). The yield stress of the 0.2% gel is about 530 dyn/cm2, which can simulate normal mucus. A 2D PDMS channel is used to simulate a collapsed airway of the 12th generation in a human lung. Plug rupture is driven by a pressure drop of 1.6 104 ~ 2.0 104 dyn/cm2. Initial plug length varies from half to two times the half channel width. A micro-PIV technique is used to acquire velocity fields during rupture, from which wall shear stress is derived. Plug shortening velocity increases with the pressure drop, but decreases with yield stress or the initial plug length. Wall shear stress increases with yield stress, which indicates more potential damage may occur to epithelial cells when pathologic mucus has a high yield stress. Near the rupture moment, a wall shear stress peak appears at the front of the film deposited by the plug during rupture. This work is supported by NIH: HL84370 and HL85156.

  19. Cervical and Anal Human Papillomavirus Infection in Adult Women in American Samoa

    PubMed Central

    Hernandez, Brenda Y.; Kaopua, 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

    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, 1.1010.00). 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

  20. Natural History of Anal vs Oral HPV Infection in HIV-Infected Men and Women

    PubMed Central

    Beachler, Daniel C.; D'Souza, Gypsyamber; Sugar, Elizabeth A.; Xiao, Wiehong; Gillison, Maura L.

    2013-01-01

    Background.?Human immunodeficiency virus (HIV)infected individuals are at greater risk for human papillomavirus (HPV)associated anal than oropharyngeal cancers. The prevalence of anal vs oral HPV infections is higher in this population, but whether this is explained by higher incidence or persistence is unknown. Methods.?Oral rinse and anal swab samples were collected semiannually from 404 HIV-infected adults in Baltimore, Maryland. Samples were tested for 37 HPV types using PGMY09/11 primers and reverse line-blot hybridization. Risk factors for HPV persistence were explored using adjusted Wei-Lin-Weissfeld models. Results.?The prevalence (84% vs 28%), incidence (145 vs 31 per 1000 person-months), and 12-month persistence (54% vs 29%) were higher for anal vs oral HPV infections, respectively (each P < .001). Heterosexual men had lower incidence of anal HPV than men who have sex with men and women, but a higher incidence of oral HPV infection (test of interaction P < 0.001). In adjusted analyses, risk factors for HPV persistence included prevalent vs incident (adjusted hazard ratio [aHR] = 4.0; 95% confidence interval [CI], 3.54.8) and anal vs oral HPV infections (aHR = 1.5; 95% CI, 1.21.9). Conclusions.?The higher incidence and persistence of anal vs oral HPV infections likely contributes to the higher burden of anal as compared to oral HPV-associated cancers in HIV-infected individuals. PMID:23596319

  1. Laser ablation of squamous cell carcinoma in situ of the anal canal. A case report.

    PubMed

    Brittain, P C; Carlson, J W; Hawley-Bowland, C

    1994-11-01

    A case of squamous cell carcinoma in situ of the anal canal was discovered incidentally during a hemorrhoidectomy in a man. The anal canal was evaluated by colposcopy prior to ablation of the lesion with a CO2 laser. To our knowledge, this technique has not been reported previously. PMID:7853286

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

    ERIC Educational Resources Information Center

    Adams, Jeffery; Neville, Stephen

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Adams, Jeffery; Neville, Stephen

    2012-01-01

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

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

    PubMed Central

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

    2014-01-01

    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

  5. Videofluoroscopic and Manometric Evaluation of Pharyngeal and Upper Esophageal Sphincter Function During Swallowing

    PubMed Central

    Yoon, Kyung Jae; Park, Jung Ho; Park, Jung Hwan; Jung, Il Seok

    2014-01-01

    Background/Aims The purpose of this study was to determine important manometric metrics for the analysis of pharyngeal and upper esophageal sphincter (UES) function and to investigate the effect of viscosity and other confounding factors on manometric results. Methods Manometric studies were performed on 26 asymptomatic volunteers (12 men and 14 women; age, 1981 years). The manometric protocol included 5 water swallows (5 mL), 5 barium swallows (5 mL) and 5 yogurt swallows (5 mL). Evaluation of high-resolution manometry parameters including basal pressure of the UES, mesopharyngeal contractile integral (mesopharyngeal CI, mmHg cm sec), CI of the hypopharynx and UES (hypopharyngeal CI), relaxation interval of UES, median intrabolus pressure and nadir pressure at UES was performed using MATLAB. Results Mesopharyngeal CIs for barium and yogurt swallows were significantly lower than those for water swallows (both P < 0.05). Hypopharyngeal CIs for water swallows were significantly lower than those for barium swallows (P = 0.004), and median bolus pressure at UES for barium swallows was significantly higher than that for water and yogurt swallows (both P < 0.05). Furthermore, hypopharyngeal CI and median intrabolus pressure at UES were significantly related to age for 3 swallows (all P < 0.01 and P < 0.05, respectively). A significant negative correlation was also noted between nadir pressure at UES and age for water and yogurt swallows (all P < 0.05). Conclusions Manometric measurement of the pharynx and UES varies with respect to viscosity. Moreover, age could be a confounding variable in the interpretation of pharyngeal manometry. PMID:24847841

  6. Oddi sphincter function after canine auto-pancreas transplantation with bladder drainage

    PubMed Central

    Li, Gui-Chen; Yuan, Chun-Hui; Cheng, Ying; Liu, Yong-Feng

    2003-01-01

    AIM: Several neural and hormonal factors are known to affect motility of sphincter of Oddi (SO). The major roles of SO are to regulate the flow of bile and pancreatic juice into the duodenum and to prevent the reflux of duodenal contents into the biliary and pancreatic duct. After pancreas transplantation, graft SO was denervated and graft pancreatitis might have relations to SO motility. The motility of SO after canine pancreas transplantation with bladder drainage was investigated. METHODS: Normal canine SO manometry and pancreas graft SO manometry after pancreas transplantation with bladder drainage were performed in seven dogs respectively before and after cholecystokinin (CCK) administration. Data of SO basal pressure, contraction frequency, amplitude and motility index after transplantation and CCK administration were compared with that in controls and before CCK administration. RESULTS: SO showed regular contractions with a certain basal pressure in control dogs. After transplantation, the graft SO basal pressure and contraction frequency were higher than that in controls, but the amplitude decreased (P < 0.01). There was no great difference in SO motility index. CCK administration could relax normal SO but stimulate graft SO after pancreas transplantation with bladder drainage. After CCK administration, SO basal pressure, frequency and motility index were increased significantly (P < 0.05), in comparison with that before administration. The amplitude remained unchanged (P > 0.05), in comparison with that before CCK administration. CONCLUSION: After auto-pancreas transplantation with bladder drainage, canine SO motility was inhibited. Basal pressure and frequency increased but amplitude decreased. CCK administration after transplantation had an inhibitory effect on canine SO instead of a relaxation effect observed in normal canine SO. This will increase the resistance of SO to the pancreatic juice flow and induce pancreatic juice stagnation and can not prevent reflux of urine and duodenal contents when the bladder pressure is increased to a certain extent, which may cause graft pancreatitis. PMID:14669350

  7. Artificial urinary sphincter erosion after radical prostatectomy in patients treated with and without radiation

    PubMed Central

    Hird, Amanda E.; Radomski, Sidney B.

    2015-01-01

    Introduction: There has been increasing evidence supporting the use of adjuvant radiotherapy after radical prostatectomy (RP) for prostate cancer. Significant stress incontinence after RP is not uncommon and the artificial urinary sphincter (AUS) is the gold standard of treatment. Our objective was to assess if increased use of radiotherapy after RP has changed the rate of erosion and infection in the face of improvement in radiation technique and equipment in men who had an AUS implanted in the last 10 years. Methods: We retrospectively examined 118 patients from December 2001 to January 2012 who underwent a RP with or without postoperative radiotherapy and subsequently had an AUS implanted. We divided the patients into two cohorts (Group 1: December 2001December 2006 and Group 2: January 2007January 2012). We reviewed all patient records for age, cuff size implanted, history of postoperative radiotherapy, previous incontinence surgery, revisions, and complications (erosion/infection). Results: There were 36 and 82 patients in Groups 1 and 2, respectively. The mean age was similar between groups, 67 years both groups (p = 0.980). The number of patients treated with postoperative radiotherapy was similar between groups (36% vs. 32%, p = 0.640, respectively). There was no difference in the incidence of erosion or infection between Group 1 and 2 (p = 0.848 and p = 0.178, respectively). The overall relative risk (RR) of erosion was significantly higher in those who had radiotherapy compared to those who did not (RR 4.05, 95% confidence interval 1.115.3). Conclusions: Over the last 10 years, there has not been an increase in the number of patients receiving an AUS after RP and radiotherapy at our centre. During this time, the incidence of erosion and infection has not increased. However, our study reaffirms that the relative risk of erosion remains higher in patients who have had radiotherapy despite improvement in radiation treatment techniques and equipment. PMID:26225177

  8. Typical and atypical NK1 tachykinin receptor characteristics in the rabbit isolated iris sphincter.

    PubMed Central

    Hall, J. M.; Mitchell, D.; Morton, I. K.

    1994-01-01

    1. A contraction of the rabbit isolated iris sphincter smooth muscle follows activation of either tachykinin NK1 or NK3 receptors. We have here characterized the pharmacological activity profiles of various tachykinin receptor agonists considered to have NK1-receptor-preferring activity in this preparation. 2. Two groups of NK1-receptor-preferring agonists could be distinguished in terms of a common pharmacological profile. The first group (Group 1) included [Glp6,L-Pro9]-SP(6-11) (septide), [Glp6]-SP (6-11), substance P methyl ester, delta-aminovaleryl-[L-Pro9, N-MeLeu10]-SP(7-11) (GR73632), and [Apa9-10]-SP. The second group (Group 2) included [Pro9]-SP, substance P, physalaemin and ranamargarin. 3. Under control conditions, the responses to Group 1 agonists were relatively fast in offset (time for reversal of maximal responses, 11.2-18.2 min), and were antagonized by NK1-receptor-selective antagonists (range of pKB estimates vs various agonists; GR82334, 7.1-8.2; (+/-)-CP-96,345, 8.9-9.5; RP67580, 7.0-7.4). Following incubation of the tissue with phenoxybenzamine (20 microM, 10 min), the affinity of GR82334, tested against the Group 1 agonists, substance P methyl ester and septide, was not significantly different (P < 0.05; n = 7-18) to that determined in untreated tissues (substance P methyl ester pKB 7.5 +/- 0.1 and 7.2 +/- 0.2, respectively; septide 7.7 +/- 0.2 and 7.9 +/- 0.2, respectively). Further, response offset times (5.0-8.5 min) were little reduced as compared to those observed in untreated tissues.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7522864

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

    PubMed Central

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

    2015-01-01

    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

  10. Anatomic-manometric correlation of the upper esophageal sphincter: a concurrent US and manometry study

    PubMed Central

    Hernandez, Lyndon V.; Dua, Kulwinder S.; Surapaneni, Sri Naveen; Rittman, Tanya; Shaker, Reza

    2014-01-01

    Background The pharyngoesophageal segment commonly referred to as the upper esophageal sphincter (UES) generates a high-pressure zone (HPZ) between the pharynx and the esophagus. However, the exact anatomical components of the UES-HPZ remain incompletely determined. Objective To systematically define the US signature of various components of the pharyngoesophageal junction and to determine how these structures contribute to the development of the UES-HPZ. Design Prospective, experimental study. Setting Tertiary Academic Medical Center. Patients This study involved 18 healthy volunteers. Intervention We studied 5 participants by using a high-frequency US miniprobe (US-MP) and concurrent fluoroscopy and another 13 participants by using the US-MP and concurrent manometry. Main Outcome Measurements Relative contribution of various muscles in the UES-HPZ. Results Manometrically, the UES-HPZ had a median length of 4.0 cm (range 3.04.5 cm). A C-shaped muscle, believed to represent the cricopharyngeus muscle, was observed for a median length of 3.5 cm (range 2.04.0 cm). The oval configuration representing the esophageal contribution to the UES was seen in 10 of 13 participants (77%) at the distal HPZ (esophagus to UES transition zone). The flat configuration of the inferior constrictor muscle was noted in 7 of 13 participants (54%) at the proximal HPZ (UES to pharynx transition zone). There were 4 to 5 wall layers versus 3 layers in the distal and proximal HPZ, respectively. The mean ( SD) muscle thickness was relatively constant along the length of the UES-HPZ. Limitations Air artifacts in the UES-HPZ. Conclusion The configuration and layers of the UES-HPZ vary along its length. The upper esophagus is a significant contributor to the distal UES-HPZ. PMID:20579650

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

    PubMed Central

    LaPallo, Brandon K.; Wolpaw, Jonathan R.; Chen, Xiang Yang

    2014-01-01

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

  12. The reporting of anal cytology and histology samples: establishing terminology and criteria.

    PubMed

    Roberts, Jennifer Margaret; Ekman, Deborah

    2012-12-01

    Our understanding of the human papillomavirus (HPV) related cytomorphology and histopathology of the anal canal is underpinned by our knowledge of HPV infection in the cervix. In this review, we utilise cervical reporting of cytological and histological specimens as a foundation for the development of standardised and evidence-based terminology and criteria for reporting of anal specimens. We advocate use of the Australian Modified Bethesda System 2004 for reporting anal cytology. We propose the use of a two-tiered histological reporting system for noninvasive disease - low-grade and high-grade anal intraepithelial neoplasia. These classification systems reflect current understanding of the biology of HPV and enhance diagnostic reproducibility. Biomarkers such as p16(INK4A) may prove useful in further improving diagnostic accuracy. Standardisation is important because it will increase the value of the data collected as Australian centres develop programs for screening for anal neoplasia. PMID:22951231

  13. The Role of EGFR Inhibitors in the Treatment of Metastatic Anal Canal Carcinoma: A Case Series

    PubMed Central

    Saif, Muhammad W.; Kontny, Ewa; Syrigos, Kostas N.; Shahrokni, Armin

    2011-01-01

    Anal cancer patients who have exhibited disease progression after having received all approved drugs pose a major therapeutic challenge. In addition to cytotoxic agents, novel targeted agents are being developed and have an established role in the treatment of many solid tumors, including colon cancer. However, their role in anal cancer is yet to be determined. Most anal malignancies are squamous cell carcinomas often strongly expressing epidermal growth factor receptors (EGFRs). Targeting the latter seems to result in favorable changes in tumor growth. We present three cases of refractory anal cancers, treated with EGFR inhibitors, after having received the recommended chemotherapy regimens. We conclude that EGFR inhibitors may play a vital role in the treatment of anal cancer and we suggest that large trials are be conducted in order to clarify their efficacy and to improve therapeutic management. PMID:21772841

  14. The Role of EGFR Inhibitors in the Treatment of Metastatic Anal Canal Carcinoma: A Case Series.

    PubMed

    Saif, Muhammad W; Kontny, Ewa; Syrigos, Kostas N; Shahrokni, Armin

    2011-01-01

    Anal cancer patients who have exhibited disease progression after having received all approved drugs pose a major therapeutic challenge. In addition to cytotoxic agents, novel targeted agents are being developed and have an established role in the treatment of many solid tumors, including colon cancer. However, their role in anal cancer is yet to be determined. Most anal malignancies are squamous cell carcinomas often strongly expressing epidermal growth factor receptors (EGFRs). Targeting the latter seems to result in favorable changes in tumor growth. We present three cases of refractory anal cancers, treated with EGFR inhibitors, after having received the recommended chemotherapy regimens. We conclude that EGFR inhibitors may play a vital role in the treatment of anal cancer and we suggest that large trials are be conducted in order to clarify their efficacy and to improve therapeutic management. PMID:21772841

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

    PubMed

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

    2014-07-01

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

  16. Individual, partner, and partnership level correlates of anal sex among youth in Baltimore City.

    PubMed

    Hebert, Luciana E; Lilleston, Pamela S; Jennings, Jacky M; Sherman, Susan G

    2015-04-01

    Anal sex is an efficient mode of STI transmission and studies indicate that anal sex is common among heterosexuals, including adolescents. We examined the association between individual, partner, and sexual partnership-level characteristics with anal sex among a household survey of 263 individuals aged 15-24 years in Baltimore City, Maryland. We used weighted multiple logistic regression to examine correlates of anal sex in a heterosexual partnership by gender. Twenty-nine percent of males and 15% of females reported anal sex in a partnership in the past 6 months. For males, anal sex was associated with having two or more partners in the past 3 months (AOR = 13.93, 95% CI 3.87-50.12), having been tested for HIV (AOR = 0.30, 95% CI 0.12-0.72), and oral sex with a partner (AOR = 8.79, 95% CI 1.94-39.78). For females, anal sex was associated with reporting having a main partner (AOR = 6.74, 95% CI 1.74-23.65), partner meeting place (AOR = 3.03, 95% CI 1.04-8.82), partner history of STI (AOR = 0.20, 95% CI 0.05-0.85), and oral sex with a partner (AOR = 8.47, 95% CI 1.08-66.25). Anal sex was associated with inconsistent condom use for both males (OR = 5.77, 95% CI 1.68-19.79) and females (OR = 5.16, 95% CI 1.46-18.30). We conclude that anal sex is a prevalent risk behavior among heterosexual youth and is associated with a range of factors at the individual and partnership levels. These findings provide support for comprehensive sex education that includes information about anal sex; findings from this study can inform public health campaigns targeting youth at risk for STIs. PMID:25583375

  17. Surgical Strategies for Acutely Ruptured Arteriovenous Malformations.

    PubMed

    Martinez, Jaime L; Macdonald, R Loch

    2015-11-01

    Brain arteriovenous malformations (AVMs) are focal neurovascular lesions consisting of abnormal fistulous connections between the arterial and venous systems with no interposed capillaries. This arrangement creates a high-flow circulatory shunt with hemorrhagic risk and hemodynamic abnormalities. While most AVMs are asymptomatic, they may cause severe neurological complications and death. Each AVM carries an annual rupture risk of 2-4%. Intracranial hemorrhage due to AVM rupture is the most common initial manifestation (up to 70% of presentations), and it carries significant morbidity and mortality. This complication is particularly important in the young and otherwise healthy population, in whom AVMs cause up to one-third of all hemorrhagic strokes. A previous rupture is the single most important independent predictor of future hemorrhage. Current treatment modalities for AVM are microsurgery, endovascular embolization, and radiosurgery. In acutely ruptured AVMs, early microsurgical excision is usually avoided. The standard is to wait at least 4 weeks to allow for patient recovery, hematoma liquefaction, and inflammatory reactions to subside. Exceptions to this rule are small, superficial, low-grade AVMs with elucidated angioarchitecture, for which early simultaneous hematoma evacuation and AVM excision is feasible. Emergent hematoma evacuation with delayed AVM excision (unless, as mentioned, the AVM is low grade) is recommended in patients with a decreased level of consciousness due to intracranial hemorrhage, posterior fossa or temporal lobe hematoma of >30 ml, or hemispheric hematoma of >60 ml. The applicability of endovascular techniques for acutely ruptured AVMs is not clear, but feasible options, until a definitive treatment is determined, include occluding intranidal and distal flow-related aneurysms and 'sealing' any rupture site or focal angioarchitectural weakness when one can be clearly identified and safely accessed. Radiosurgery is not performed in acutely ruptured AVMs because its therapeutic effects occur in a delayed fashion. PMID:26587641

  18. Prevalence of and Risk Factors for Anal Human Papillomavirus Infection Among Young Healthy Women in Costa Rica

    PubMed Central

    Castro, Felipe A.; Quint, Wim; Gonzalez, Paula; Katki, Hormuzd A.; Herrero, Rolando; van Doorn, Leen-Jan; Schiffman, Mark; Struijk, Linda; Rodriguez, Ana Cecilia; DelVecchio, Corey; Lowy, Douglas R.; Porras, Carolina; Jimenez, Silvia; Schiller, John; Solomon, Diane; Wacholder, Sholom; Hildesheim, Allan; Kreimer, Aime R.

    2012-01-01

    Background.?Anal cancer is caused by human papillomavirus (HPV), yet little is known about anal HPV infection among healthy young women. Methods.?A total of 2017 sexually active women in the control arm of an HPV-16/18 vaccine trial had a single anal specimen collected by a clinician at the 4-year study visit. Samples were tested for HPV by SPF10 PCR/DEIA/LiPA25, version 1. Results.?A total of 4% of women had HPV-16, 22% had oncogenic HPV, and 31% had any HPV detected in an anal specimen. The prevalence of anal HPV was higher among women who reported anal intercourse, compared with those who did not (43.4% vs 28.4%; P<.001). Among women who reported anal intercourse, cervical HPV (adjusted odds ratio [aOR], 5.3 [95% confidence interval {CI}, 3.48.2]), number of sex partners (aOR, 2.2 [95% CI, 1.14.6] for ?4 partners), and number of anal intercourse partners (aOR, 1.9 [95% CI, 1.13.3] for ?2 partners) were independent risk factors for anal HPV detection. Among women who reported no anal intercourse, cervical HPV (aOR, 4.7 [95% CI, 3.75.9]), number of sex partners (aOR, 2.4 [95% CI, 1.73.4] for ?4 partners), and report of anal fissures (aOR, 2.3 [95% CI, 1.14.8]) were associated with an increased odds of anal HPV detection. Conclusion.?Anal HPV is common among young women, even those who report no anal sex, and was associated with cervical HPV infection. Anal fissures in women who report never having had anal intercourse may facilitate HPV exposure. Clinical Trials Registration.?NCT00128661. PMID:22850119

  19. [Ileo-anal pouch for inflammatory intestinal disease].

    PubMed

    Derikx, Lauranne A A P; Heikens, Joost T; van Laarhoven, Cornelis J H M; Hoentjen, Frank

    2013-01-01

    The surgical treatment of choice for ulcerative colitis is colectomy followed by ileostomy or the construction of an ileo-anal pouch, which results in an improvement in quality of life. The pouch can be constructed in one operation after a total colectomy or in two steps: first, constructing an ileostomy after a subtotal colectomy and second, constructing the pouch after a proctectomy. The most common pouch-related diseases include surgical complications such as abscesses, fistulas and leaks, and inflammatory complications like pouchitis, cuffitis and Crohn's disease of the pouch. The most important diagnostic tool to differentiate between the often difficult to distinguish pouch-related diseases is a pouchoscopy. There are no evidence-based treatment strategies for pouch-related diseases due to the lack of large randomized placebo-controlled trials. Pouch-related diseases can lead to pouch failure which may require surgical reintervention with revision or excision of the pouch. PMID:24063669

  20. [Minor anal pathology. Suggestions for ambulatory and hospital treatment].

    PubMed

    Mori, G; Tajana, A; Boccasanta, P; Micheletto, G; Zani, B; Pisani, F

    1983-07-14

    A series of cases of anorectal pathology treated at the out-patient level or after hospitalisation in the course of the last five years is reviewed. Deference is made to subjects with haemorrhoids operated according to Milligan-Morgan or Parks in accordance with varying indications, or treated cryosurgically as out-patients, patients with upper or lower transsphincteric perianal fistula treated by means of the lay-open technique or elastic tourniquet under general or local anaesthesia, patients with acute anal fissures treated by means of internal lateral sphincterotomy under local anaesthesia, and those with inveterate forms subjected to Arnous posterior leiomyotomy. From a critical assessment of the hospital and out-patient activities carried out suggestions and indications are drawn with regard to cases that must be treated in hospital and those for which outpatient management is correct. PMID:6866308

  1. Planar spin-transfer device with dynamical polarizer and analizer

    NASA Astrophysics Data System (ADS)

    Bazaliy, Yaroslaw; Kravchenko, Anton

    2011-03-01

    The behavior of the planar spin-transfer devices with monodomain magnetic layers can be described by the macrospin Landau-Lifshitz-Gilbert (LLG) equation with spin-transfer terms. The LLG description of a device with two layers is simplified after applying the overdamped, large easy-plane anisotropy approximation. A decrease of the magnetic layer thickness asymmetry creates a transition from the conventional polarizer-analizer (``fixed layer -- free layer'') operation regime to the regime of the nearly identical magnets. Here electric current leads to a ``Slonczewski windmill'' dynamic state, rather than producing the magnetic switching. The ``windmill'' precession state of a device with two free layers was investigated by numerical solution of the LLG equation.

  2. Computed tomography of epithelial neoplasms of the anal canal

    SciTech Connect

    Cohan, R.H.; Silverman, P.M.; Thompson, W.M.; Halvorsen, R.A.; Baker, M.E.

    1985-09-01

    Twenty-five patients with squamous-cell or cloacogenic carcinomas of the rectum were evaluated by computed tomography (CT). CT provided excellent definition of tumor extent, including local spread, lymph node involvement and distant metastases. In one of seven pretherapy studies, CT findings significantly altered patient management. Tumor recurrence was correctly identified in 14 or 19 patients having post-therapy scans, although CT-guided biopsy was required to confirm the presence of malignancy in three cases. Extensive soft-tissue stranding in the ischiorectal fossa and/or perirectal fat associated with a large focal mass occurred in all patients with local tumor recurrence. Stranding was also seen in all patients treated with radiation. CT is an excellent method for preliminary evaluation and follow-up of patients with anal epithelial neoplasms, facilitating rapid and effective management.

  3. Pericardial rupture from blunt chest trauma

    PubMed Central

    Borrie, J.; Lichter, I.

    1974-01-01

    Borrie, J. and Lichter, I. (1974).Thorax, 29, 329-337. Pericardial rupture from blunt chest trauma. Pericardial rupture may occur in two distinct anatomical sites, namely the diaphragmatic pericardium and the pleuropericardium. They may be combined. The problems in each type are different. In ruptured diaphragmatic pericardium the rent may involve the pericardial cavity alone, or may extend into one or both adjoining pleural cavities. Upward herniation of abdominal viscera can occur, with or without strangulation. The presence of a pericardial rent may be suggested by diagnostic pneumoperitoneum, and chest films showing displaced abdominal viscera; its extent may be fully revealed only by thoracotomy. If the rent involves only the diaphragmatic pericardium without lateral spread into a pleural cavity, the presence of a rent may be revealed only by exploratory thoracotomy with pericardiotomy. In ruptured pleuropericardium the rent is usually vertical and may occur on either side, more usually on the left. It may be recognized on chest films in its early stages by the presence of intrapericardial air arising from associated lung trauma. There is serious risk of heart dislocation with or without strangulation. The defect must be surgically repaired and, because of pericardial retraction, it may require a fabric patch. Teflon fabric has proved to be a long-term satisfactory pericardial substitute. Two cases of each type of pericardial rupture are described and illustrate these points. Images PMID:4853582

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

    PubMed

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

    2014-08-01

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

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

    PubMed Central

    Kurtz, Steven P.; Surratt, Hilary L.; Inciardi, James A.

    2010-01-01

    Anal sexual intercourse represents the highest transmission risk for infection with the human immunodeficiency virus (HIV), 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 who practice anal sex, especially those who may be at risk for HIV such as substance users. The present study examined the demographic, sexual behaviors, substance use, and psychosocial correlates of recent anal intercourse among a heterosexual young adult sample of nightclub goers who also use substances. Data were drawn from an on-going natural history study of participants (n=597) in Miami's club scene who use club drugs, use prescription medications for non-medical reasons, and were regular attendees of nightclubs. Participants who reported anal sex (n=118) were more likely to be male, of moderate income, Latino, trade sex, have unprotected sex, and report victimization. Event-based and qualitative studies are needed to better understand the context in which anal sex occurs. Interventions that target heterosexual populations should include discussion about the risks of anal sex. PMID:20217224

  6. Anal cancer in Chinese: human papillomavirus infection and altered expression of p53

    PubMed Central

    Lai, Mao-De; Luo, Min-Jie; Yao, Jian-Er; Chen, Pei-Hui

    1998-01-01

    AIM: To detect the presence of HPV DNA and study the alteration of p53 expression in anal cancers in Chinese. METHODS: HPV DNA was amplified by PCR. The amplified HPV DNA was classified by DBH. HPV antigen and p53 expression were respectively detected by immunohistochemistry. RESULTS: HPV DNA was amplified only in one case of squamous cell carcinoma of the 72 Chinese anal cancers and further classified as HPV type 16. Others were all HPV negative. HPV antigen and p53 expression were also detected in this case. Positive stainings with anti-p53 antibody were seen in 61.2% anal cancers. There were no statistically significant differences between anal squamous cell carcinomas and adenocarcinomas and between anal adenocarcinomas and rectal adenocarcinomas. p53 protein expression was observed in the basal cells of squamous epithelium of condyloma acuminatum and morphologically normal squamous epithelium in 2 cases invaded by anal adenocarcinoma. CONCLUSION: HPV infection was not associated with these cases of anal cancer. p53 alteration was a common event. Positive p53 immunostaining can not be regarded as a marker for differentiating benign from malignant lesions. PMID:11819303

  7. Acoustic levels of heavy truck tire ruptures.

    PubMed

    Wood, Matthew; Woodruff, William

    2013-05-01

    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

  8. On the rupture of DNA molecule

    NASA Astrophysics Data System (ADS)

    Mishra, R. K.; Modi, T.; Giri, D.; Kumar, S.

    2015-05-01

    Using Langevin dynamics simulations, we study effects of the shear force on the rupture of a double stranded DNA molecule. The model studied here contains two single diblock copolymers interacting with each other. The elastic constants of individual segments of diblock copolymer are considered to be different. We showed that the magnitude of the rupture force depends on whether the force is applied at 3' - 3' - ends or 5' - 5' - ends. Distributions of extension in hydrogen bonds and covalent bonds along the chain show the striking differences. Motivated by recent experiments, we have also calculated the variation of rupture force for different chain lengths. Results obtained from simulations have been validated with the analytical calculation based on the ladder model of DNA.

  9. Right ventricular hydatid cyst ruptured to pericardium.

    PubMed

    Sabzi, Feridoun; Vaziri, Siavoosh; Faraji, Reza

    2015-01-01

    Cardiac hydatidosis is rare presentation of body hydatidosis. Incidence of cardiac involvements range from 5% to 5% of patients with hydatid disease. Most common site of hydatid cyst in heart is interventricular septum and left ventricular free wall. Right ventricular free wall involvement by cyst that ruptured to pericardial cavity is very rare presentation of hydatid cyst. Cardiac involvement may have serious consequences such as rupture to blood steam or pericardial cavity. Both the disease and its surgical treatment carry a high complication rate, including rupture leading to cardiac tamponade, anaphylaxis and also death. In the present report, a 43-year-old man with constrictive pericarditis secondary to a pericardial hydatid cyst is described. PMID:26139761

  10. Postmyomectomic Uterine Rupture Despite Cesarean Section.

    PubMed

    Kacperczyk, Joanna; Bartnik, Paweł; Romejko-Wolniewicz, Ewa; Dobrowolska-Redo, Agnieszka

    2016-03-01

    Uterine fibroids (leiomyomas) are benign smooth muscle tumors of the uterus. Fibroids can develop anywhere within the muscular wall. Leiomyomas may be associated with infertility. Laparoscopic myomectomy is often used to remove symptomatic intramural or subserosal fibroids. Advantages of the procedure include short recovery time and minimal perioperative morbidity. At the same time, the multilayer suture technique is more complicated during laparoscopy. A rare but serious complication of laparoscopic myomectomies is uterine rupture. A brief review of the literature and a clinical example of a 33-year-old woman with history of infertility, laparoscopic myomectomies and uterine rupture followed by peripartum hemorrhage is presented. The treatment of leiomyomas is a challenge not only because of possible recurrence but also due to long-term consequences following successful myomectomy. Management of patients with uterine scars should include careful planning of the route of delivery, as the risk of rupture may be increased. PMID:26976991

  11. Component external leakage and rupture frequency estimates

    SciTech Connect

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

    1991-11-01

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

  12. Partial rupture of the distal biceps tendon.

    PubMed

    Drr, H R; Stbler, A; Pfahler, M; Matzko, M; Refior, H J

    2000-05-01

    Partial rupture of the distal biceps tendon is a relatively rare event, and various degrees of partial tendon tears have been reported. In the current study four patients with partial atraumatic distal biceps tendon tears (mean age, 59 years; range, 40-82 years) are reported. In all four patients, a common clinical pattern emerged. Pain at the insertion of the distal biceps tendon in the radius unrelated to any traumatic event was the main symptom. In all patients the diagnosis was based on magnetic resonance imaging or computed tomography imaging. In three of four patients the partial rupture of the tendon caused a significant bursalike lesion. The typical appearance was a partially ruptured biceps tendon, with contrast enhancement signaling the degree of degeneration, tenosynovitis, and soft tissue swelling extending along the tendon semicircular to the proximal radius. In three patients, conservative treatment was successful. Only one patient needed surgery, with reinsertion of the tendon resulting in total functional recovery. PMID:10818980

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

    PubMed Central

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

    2015-01-01

    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

  14. Prognostic factors of spontaneously ruptured hepatocellular carcinoma

    PubMed Central

    Han, Xiang-Jun; Su, Hong-Ying; Shao, Hai-Bo; Xu, Ke

    2015-01-01

    AIM: To evaluate the prognostic factors in patients with spontaneously ruptured hepatocellular carcinoma (HCC). METHODS: Seventy-nine patients experiencing spontaneous rupture of HCC between April 2004 and August 2014 were enrolled in this study. The clinical features, treatment modalities and outcomes were reviewed. The statistical methods used in this work included univariate analysis, Kaplan-Meier survival analysis with log-rank tests, and multivariate analysis using a Cox regression hazard model. RESULTS: Of the 79 patients with HCC rupture, 17 (21.5%) underwent surgery, 32 (40.5%) underwent transarterial embolization (TAE), and 30 (38%) received conservative treatment. The median survival time was 125 d, and the mortality rate at 30 d was 27.8%. Multivariate analysis revealed that lesion length (HR = 1.46, P < 0.001), lesion number (HR = 1.37, P = 0.042), treatment before tumor rupture (HR = 4.36, P = 0.019), alanine transaminase levels (HR = 1.0, P = 0.011), bicarbonate levels (HR = 1.18, P < 0.001), age (HR = 0.96, P = 0.026), anti-tumor therapy during the follow-up period (HR = 0.21, P = 0.008), and albumin levels (HR = 0.89, P = 0.010) were independent prognostic factors of survival after HCC rupture. The Barcelona-Clinic Liver Cancer (BCLC) stage was also an important prognostic factor; the median survival times for BCLC stages A, B and C were 251, 175 and 40 d, respectively (P < 0.001). CONCLUSION: Anti-tumor therapy during the follow-up period, without a history of anti-tumor therapy prior to HCC rupture, small tumor length and number, and early BCLC stage are the most crucial predictors associated with satisfactory overall survival. Other factors play only a small role in overall survival. PMID:26139994

  15. Anal Cancers among HIV-Infected Persons: HAART Is Not Slowing Rising Incidence

    PubMed Central

    Crum-Cianflone, Nancy F.; Hullsiek, Katherine Huppler; Marconi, Vincent C.; Ganesan, Anuradha; Weintrob, Amy; Barthel, R. Vincent; Agan, Brian K.

    2010-01-01

    Objective To evaluate the incidence rates of anal cancer over the HIV epidemic and assess the impact of HAART use on anal cancer events. Methods We evaluated the incidence of and factors associated with anal cancer using longitudinal data from the prospective U.S. Natural History Study (1985-2008). Poisson regression and Cox proportional hazard models were utilized. Results Among 4,506 HIV-infected males with 37,806 person-years (PY) of follow-up, anal cancer rates (per 100,000 PY) increased 5-fold, from 11 in the pre-HAART to 55 in the HAART era, p=0.02. Rates continued to increase, reaching 128 in 2006-2008. Persons with HIV infection for >15 years had a 12-fold higher rate than those with <5 years (348 vs. 28, p<0.01). At cancer diagnosis (n=19), median age was 42 years, median CD4 count was 432 cells/mm3, 74% had a CD4 nadir <200 cells/mm3, 42% had a prior AIDS event, and 74% had received HAART. From separate models, prior AIDS event (HR 3.88, p=0.01) and lower CD4 nadir (HR 0.85 per 50 cell, p=0.03) were associated with anal cancer, with a trend for a history of gonorrhea (HR 2.43, p=0.07). Duration of HAART use was not associated with a reduced risk of anal cancer (HR 0.94, p=0.42). Conclusions Incidence rates of anal cancer have progressively increased during the HIV epidemic. Persons with a longer duration of HIV infection have a substantially higher rate of anal cancer. Since HIV-infected persons are experiencing longer life expectancies and HAART does not appear protective of anal cancer, studies on preventive strategies are needed. PMID:19926961

  16. Linguine sign in musculoskeletal imaging: calf silicone implant rupture.

    PubMed

    Duryea, Dennis; Petscavage-Thomas, Jonelle; Frauenhoffer, Elizabeth E; Walker, Eric A

    2015-08-01

    Imaging findings of breast silicone implant rupture are well described in the literature. On MRI, the linguine sign indicates intracapsular rupture, while the presence of silicone particles outside the fibrous capsule indicates extracapsular rupture. The linguine sign is described as the thin, wavy hypodense wall of the implant within the hyperintense silicone on T2-weighted images indicative of rupture of the implant within the naturally formed fibrous capsule. Hyperintense T2 signal outside of the fibrous capsule is indicative of an extracapsular rupture with silicone granuloma formation. We present a rare case of a patient with a silicone calf implant rupture and discuss the MRI findings associated with this condition. PMID:25577259

  17. Gastric rupture after bag-mask-ventilation

    PubMed Central

    Bednarz, Stephan; Filipovic, Miodrag; Schoch, Otto; Mauermann, Eckhard

    2015-01-01

    A 42 year old woman underwent bronchoscopy with procedural propofol sedation. During the procedure, the patient suffered respiratory arrest, and bag-mask ventilation was initiated. During forced mask ventilation, abdominal distention occurred. Even after correct placement of an endotracheal and a nasogastric tube, high inspiratory pressures persisted. The abdominal CT scan revealed a high amount of intraperitoneal free air. An emergent laparotomy confirmed a stomach rupture. Immediately after opening of the peritoneal cavity, peak ventilatory pressures decreased. In this case forceful bag-mask ventilation led to air insufflation into the stomach, increasing gastric pressure, and consecutive stomach rupture. PMID:26744639

  18. COMPARISON OF CLADDING CREEP RUPTURE MODELS

    SciTech Connect

    P. Macheret

    2000-06-12

    The objective of this calculation is to compare several creep rupture correlations for use in calculating creep strain accrued by the Zircaloy cladding of spent nuclear fuel when it has been emplaced in the repository. These correlations are used to calculate creep strain values that are then compared to a large set of experimentally measured creep strain data, taken from four different research articles, making it possible to determine the best fitting correlation. The scope of the calculation extends to six different creep rupture correlations.

  19. Modeling rupture segmentations on the Cascadia megathrust

    NASA Astrophysics Data System (ADS)

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

    2012-12-01

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

  20. Thoracic Outlet Syndrome Following Breast Implant Rupture

    PubMed Central

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

    2015-01-01

    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

  1. Tendon ruptures: mallet, flexor digitorum profundus.

    PubMed

    Yeh, Peter C; Shin, Steven S

    2012-08-01

    Mallet injuries are the most common closed tendon injury in the athlete. Flexor digitorum profundus ruptures are rare in baseball, but are common injuries in contact sports. The diagnosis for each condition is based on clinical examination, although radiographs should be evaluated for a possible bony component. Treatment for mallet injury depends on the athlete's goals of competition and understanding of the consequences of any treatment chosen. Gripping, throwing, and catching would be restricted or impossible with the injured finger immobilized. Treatment of FDP ruptures is almost always surgical and requires reattachment of the torn tendon to the distal phalanx. PMID:22883898

  2. Rupture energy of a pendular liquid bridge

    NASA Astrophysics Data System (ADS)

    Pitois, O.; Moucheront, P.; Chateau, X.

    2001-09-01

    We propose a simple expression for the rupture energy of a pendular liquid bridge between two spheres, taking into account capillary and viscous (lubrication) forces. In the case of capillary forces only, the results are in accordance with curve fitting expressions proposed by Simons et al. [2] and Willett et al. [5]. We performed accurate measurements of the force exerted by liquid bridges between two spheres. Experimental results are found to be close to theoretical values. A reasonable agreement is also found in the presence of viscous forces. Finally, for small bridge volumes, the rupture criterion given by Lian et al. [10] is modified, taking into account additional viscous effects.

  3. Spontaneous Achilles tendon rupture in alkaptonuria.

    PubMed

    Alajoulin, Omar A; Alsbou, Mohammed S; Ja'afreh, Somayya O; Kalbouneh, Heba M

    2015-12-01

    Alkaptonuria (AKU) is a rare inborn metabolic disease characterized by accumulation of homogentisic acid (HGA). Excretion of HGA in urine causes darkening of urine and its deposition in connective tissues causes dark pigmentation (ochronosis), early degeneration of articular cartilage, weakening of the tendons, and subsequent rupture. In this case report, we present a rare case of a patient presented with unilateral spontaneous rupture of Achilles tendon due to AKU. The patient developed most of the orthopedic manifestations of the disease earlier than typical presentations. Alkaptonuria patients should avoid strenuous exercises and foot straining especially in patients developing early orthopedic manifestations. PMID:26620992

  4. Spontaneous Achilles tendon rupture in alkaptonuria

    PubMed Central

    Alajoulin, Omar A.; Alsbou, Mohammed S.; Jaafreh, Somayya O.; Kalbouneh, Heba M.

    2015-01-01

    Alkaptonuria (AKU) is a rare inborn metabolic disease characterized by accumulation of homogentisic acid (HGA). Excretion of HGA in urine causes darkening of urine and its deposition in connective tissues causes dark pigmentation (ochronosis), early degeneration of articular cartilage, weakening of the tendons, and subsequent rupture. In this case report, we present a rare case of a patient presented with unilateral spontaneous rupture of Achilles tendon due to AKU. The patient developed most of the orthopedic manifestations of the disease earlier than typical presentations. Alkaptonuria patients should avoid strenuous exercises and foot straining especially in patients developing early orthopedic manifestations. PMID:26620992

  5. Pectoralis major tendon rupture. Surgical procedures review.

    PubMed Central

    Merolla, Giovanni; Paladini, Paolo; Campi, Fabrizio; Porcellini, Giuseppe

    2012-01-01

    Summary Pectoralis major (PM) muscle is the powerful dynamic stabiliser of the shoulder that acts as a flexor, adductor and internal rotator. The rupture of the PM tendon is a relatively rare injury that was firstly described in a French boy by Patissier in 1822 and later, in 1861, by Letenneur who reported another similiar case. To date, over 200 cases have been published. In this article we describe the clinical anatomy and the mechanism of injuries of PM and we review the surgical procedures for acute and chronic ruptures. PMID:23738281

  6. The occurrence in and actions of amino acids on isolated supra oral sphincter preparations of the sea anemone Actinia equina

    PubMed Central

    Carlyle, R. F.

    1974-01-01

    1. L-glutamic acid reversibly inhibits the contractions of isolated circular muscle preparations from different body regions of the sea anemone Actinia equina to electrical stimulation. 2. L-glutamic acid does not cause inhibition of contraction by conversion to ammonia or ?-amino-butyric acid, but appears to act on a glutamate receptor. 3. It is postulated that in Actinia equina there is a receptor for glutamic acid whose structural requirements for activation are met by comparatively few analogues of glutamic acid. Of thirty-four analogues tested, only seven were active, most were less active, and only homocysteic acid had a greater activity than L-glutamic acid. 4. Glutamic acid does not depress conduction of contraction in circular muscle preparations. 5. The inhibition produced by L-glutamic acid does not appear to be conducted from one part of a preparation to another. 6. Glutamic acid occurs in high concentrations in supra oral sphincter preparations of Actinia equina. 7. Glutamic acid is released into sea water from sphincter preparations at rest and the amount released is increased by electrical stimulation of the preparation. However, many other amino acids are released at rest and following electrical stimulation, so that it is difficult to suggest that glutamic acid may be involved as a neurotransmitter in the sea anemone. PMID:4150801

  7. Evaluation of multiple-point measurement of sphincter of Oddi motility in the Australian brush-tailed possum.

    PubMed

    Craig, A G; Omari, T I; Saccone, G T; Toouli, J; Dent, J

    2000-10-01

    Manometric assembly diameter is a major limitation on the number of perfused manometric recording points for recordings from the sphincter of Oddi (SO). We evaluated novel polyimide manometric assemblies whereby four recording channels were incorporated in an overall assembly diameter of 0.8 mm. Over the very low range of perfusion rates tested (0.005-0.04 ml/min), the assemblies had pressure offsets attributable to water perfusion from 2 to 23 mmHg and pressure rise rates from 20 to 163 mmHg/s. In six anesthetized Australian brush-tailed possums, manometric recordings from the SO showed a significant reduction in the recorded peak amplitude of pressure waves with perfusion rates below 0.02 ml/min. The pressure profile of the sphincter was found to be asymmetric, and phasic wave propagation patterns were complex (antegrade 35.6%, "mixed" 64.4%). In conclusion, accurate multipoint SO manometry in the possum can be performed with micromanometric assemblies at very low perfusion rates to give a more complete understanding of SO mechanics. These methods are also potentially applicable to perfusion manometry in other small laboratory animals such as mice. PMID:11005772

  8. Upper and Lower Esophageal Sphincter Kinetics are Modified During Maturation: Effect of Pharyngeal Stimulus in Premature Infants

    PubMed Central

    Jadcherla, Sudarshan R.; Shubert, Theresa R.; Gulati, Ish K.; Jensen, Preceousa S.; Wei, Lai; Shaker, Reza

    2014-01-01

    Background We hypothesized that changes in proximal and distal esophageal sphincter kinetics evoked upon pharyngeal provocation undergo longitudinal maturation. Methods Pharyngeal stimulation-induced reflexes were characterized using novel pharyngoesophageal motility methods in 19 healthy premature neonates, studied at 34.7 0.8 wks (time-1), and 39.3 1.1 wks postmenstrual age (time-2). Graded volumes of air (290 infusions) and sterile water (172 infusions) were infused to define sensory-motor characteristics of upstream (pharyngeal reflexive swallow, PRS) and downstream (pharyngo-lower esophageal sphincter relaxation reflex, PLESRR) esophageal reflexes. Data displayed as mean SE. Results Threshold volumes were similar with air and water for PRS and PLESRR at time-1 and time-2. Multiple PRS responses were noted with water stimulus, and were different between the media (time-1 vs. air, P< 0.0001; time-2 vs. air, P =0.0003). Dose response relationships for water were significant (P<0.01 for PRS and PLESRR time-1 and time-2), but not with air. Conclusions Significantly, the recruitment frequency of PRS and PLESRR increases with maturation, liquid is a superior medium for evoking such swallowing reflexes, and stimulus-response relationships for these reflexes are evident. These changes in aerodigestive protective reflexive activity may indicate differences in modulation of excitatory and inhibitory pathways during longitudinal postnatal maturation. PMID:25279989

  9. Earthquake Stress Drop in Rupture Patches and Rupture Barriers on Gofar Transform Fault, East Pacific Rise

    NASA Astrophysics Data System (ADS)

    Moyer, P. A.; Boettcher, M. S.; McGuire, J. J.; Collins, J. A.

    2014-12-01

    The largest earthquakes on mid-ocean ridge transform faults (RTFs) exhibit the most systematic behaviors known in seismology. On the fast slipping Gofar transform fault on the East Pacific Rise (EPR), Mw ~6.0 earthquakes occur every ~5 years and repeatedly rupture the same asperities (fault patches), suggesting that the intervening fault segments (rupture barriers) stop the propagation of the largest earthquakes. In 2008, an ocean bottom seismometer (OBS) deployment captured the end of a seismic cycle on Gofar transform fault [McGuire et al., 2012]. We determine stress drop for earthquakes recorded during this experiment to investigate how the source properties of moderate sized earthquakes (3.0 < Mw < 5.5) differ between the rupture patch and rupture barrier fault segments. The OBS experiment on Gofar transform fault recorded an extensive foreshock sequence localized within a 10 km rupture barrier, the Mw 6.0 mainshock and its aftershocks that occurred in a ~10 km rupture patch, and an earthquake swarm that was located in a second rupture barrier adjacent to the ridge-transform intersection. Using waveforms recorded with a sample rate of 50 Hz on the OBS accelerometers, we calculate stress drop using the Madariaga [1976] circular crack model, with the corner frequency derived from an empirical Green's function (EGF) method, and seismic moment obtained by fitting an omega-squared source model to the low frequency amplitude of individual event spectra. Results for ~300 earthquakes in the foreshock, aftershock, and swarm zones have a range of stress drops from 0.2 to 50 MPa. Values for the best constrained 10% of earthquakes show a weighted average stress drop in the aftershock zone that is more than twice the weighted average stress drop in the foreshock zone (3.5 MPa and 1.1 MPa, respectively). These variations in earthquake stress drop reflect systematic differences in along strike fault zone properties between rupture patches and rupture barriers on Gofar transform fault.

  10. [Papillary Muscle Rupture after Repair of Ischemic Left Ventricular Free Wall Rupture; Report of a Case].

    PubMed

    Kurumisawa, Soki; Kaminishi, Yuichirou; Akutsu, Hirohiko; Takazawa, Ippei; Aizawa, Kei; Misawa, Yoshio

    2015-11-01

    A 67-year-old man experienced acute inferior myocardial infarction. Echocardiography and computed tomography showed massive pericardial effusion. He underwent emergency operation for ischemic ventricular free wall rupture. During the operation, an oozing type rupture was found on the inferior wall and the bleeding was completely controlled by applying fibrin glue sheets. On the 5th day after the operation, ventricular tachycardia appeared with hemodynamic deterioration. Echocardiography showed a ruptured posteromedial papillary muscle with massive mitral regurgitation. Intra-aortic balloon pumping was introduced and emergency repair operation was performed. The mitral valve was replaced with a bioprosthetic valve. The postoperative course was uneventful. PMID:26555919

  11. D-Zero Cryostat Supplemental Rupture Disc

    SciTech Connect

    Mulholland, G.T.; /Fermilab

    1987-08-03

    The common relief and rupture disc vent line requires a double disc assembly with vented interspace for accurate disc burst pressures. The first disc must take pump and purge vacuum loading, but be set to operate at 110% of the MAWP, 18.3 psig (ASME code). The available solution is 18.3 psig with a burst tolerance of +/- psig. The interspace should be locally vented by a flow limiting vent valve to decouple the vent line backpressure from the vessel rupture disc. The second disc must take the worst case vent line backpressure, the steady state value found in D-Zero engineering note 3740.000-EN-63 with all three cryostats simultaneously venting at the fire condition into the 4-inch x 6-inch and 6-inch x 8-inch sections. This value is less than 2 psid. The maximum rupture value for the second disc must be less than the minimum rupture value for the first disc less 2 psid i.e. < 16.3.

  12. Surgical Management of Spontaneous Ruptured Hepatocellular Adenoma

    PubMed Central

    Ribeiro Junior, Marcelo Augusto Fontenelle; Chaib, Eleazar; Saad, William Abro; DAlbuquerque, Luiz Augusto Carneiro; Cecconello, Ivan

    2009-01-01

    AIMS Spontaneous ruptured hepatocellular adenoma (SRHA) is a rare life-threatening condition that may require surgical treatment to control hemorrhaging and also stabilize the patient. We report a series of emergency surgeries performed at our institution for this condition. METHODS We reviewed medical records and radiology files of 28 patients (from 1989 to 2006) with a proven diagnosis of hepatocellular adenoma (HA). Three (10.7%) of 28 patients had spontaneous ruptured hepatocellular adenoma, two of which were associated with intrahepatic hemorrhage while one had intraperitoneal bleeding. Two patients were female and one was male. Both female patients had a background history of oral contraceptive use. Sudden abdominal pain associated with hemodynamic instability occurred in all patients who suffered from spontaneous ruptured hepatocellular adenoma. The mean age was 41.6 years old. The preoperative assessment included liver function tests, ultrasonography and computed tomography. RESULTS The surgical approaches were as follows: right hemihepatectomy for controlling intraperitoneal bleeding, and right extended hepatectomy and non-anatomic resection of the liver for intrahepatic hemorrhage. There were no deaths, and the postoperative complications were bile leakage and wound infection (re-operation), as well as intraperitoneal abscess (re-operation) and pleural effusion. CONCLUSION Spontaneous ruptured hepatocellular adenoma may be treated by surgery for controlling hemorrhages and stabilizing the patient, and the decision to operate depends upon both the patients condition and the expertise of the surgical team. PMID:19690662

  13. 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...

  14. Surgical resection of ruptured fibrolamellar hepatocellular carcinoma.

    PubMed

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

    2013-01-01

    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

  15. Surgical Resection of Ruptured Fibrolamellar Hepatocellular Carcinoma

    PubMed Central

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

    2013-01-01

    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

  16. Spontaneous splenic rupture resulted from infectious mononucleosis

    PubMed Central

    Won, Andy C.M.; Ethell, Anthony

    2011-01-01

    INTRODUCTION Infectious mononucleosis is common among young adults and teenagers. However, spontaneous rupture of spleen secondary to IM is rare and it is the most frequent cause of death in infectious mononucleosis. PRESENTATION OF CASE A previously healthy 16-year-old girl presented with a one-week history of sore throat, non-productive cough, fever, malaise and a positive Monospot test. Prior to transfer to the hospital, she had two syncopal episodes and a complaint of abdominal pain at home. Clinical examination revealed that she was febrile and mildly tachycardic with an evidence of localised peritonism on her left upper quadrant. Urgent abdominal ultrasound and computed tomography scan showed subcapsular haematoma with a significant amount of complex fluid within the abdominal cavity, especially the left flank. Emergency laparotomy was performed and a moderate amount of haemoperitoneum was evacuated. The spleen was found grossly enlarged with a haematoma identified on the ruptured capsule. Splenectomy was performed and peritoneal cavity was washed out meticulously prior to the closure of the abdominal wall. DISCUSSION Despite the fact that infectious mononucleosis is a self-limiting disease, it may cause serious and lethal complications. The best treatment of splenic rupture secondary to infectious mononucleosis has been controversial but it is mainly based on the haemodynamical status of the patient and the experience of the treating surgeon. CONCLUSION Spontaneous rupture of spleen secondary to IM can be lethal in those patients with high possibility of deterioration with conservative management, thus timely surgical intervention is required. PMID:22288057

  17. Bond-rupture immunosensors--a review.

    PubMed

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

    2008-07-15

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

  18. [Splenic rupture--a skateboard accident].

    PubMed

    Kruse, P

    1990-03-01

    A 13-year-old boy presented with persisting abdominal pain after a skateboard accident. Primary clinical and laboratory findings disclosed no signs of intra abdominal bleeding. Ultrasound scanning indicated rupture of the spleen which was confirmed by acute exploratory laparotomy. PMID:2321288

  19. Laparoscopic splenectomy for atraumatic splenic rupture.

    PubMed

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

    2011-01-01

    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

  20. Primary gastric rupture in 47 horses (19952011)

    PubMed Central

    Winfield, Laramie S.; Dechant, Julie E.

    2015-01-01

    The purpose of this retrospective case-control study was to identify factors associated with primary gastric rupture and to investigate if there were differences between etiologies of primary gastric rupture. Compared to the general colic population, Quarter horses were under-represented and Friesians and draft breeds were over-represented in 47 cases of primary gastric ruptures. Horses with primary gastric rupture typically presented with severe clinical and clinicopathological derangements. There were 24 idiopathic gastric ruptures, 20 gastric impaction associated ruptures, and 3 perforating gastric ulcers. Thoroughbred horses were over-represented in the idiopathic gastric rupture group compared to other breeds and etiologies. This study suggests the presence of important breed predispositions for development of gastric rupture. Further study is necessary to identify if these predispositions are associated with management factors or breed-specific disorders. PMID:26345205

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

    NASA Astrophysics Data System (ADS)

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

    2014-12-01

    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.

  2. Five-year cumulative incidence of invasive anal cancer among HIV-infected patients according to baseline anal cytology results: an inception cohort analysis

    PubMed Central

    Cachay, E.; Agmas, W.; Mathews, C.

    2015-01-01

    Objectives The aim of the study was to estimate the cumulative incidence of, and rates of progression to, invasive anal cancer (IAC) according to baseline anal cytology screening category in an unselected HIV clinical care cohort in the antiretroviral era. Methods A retrospective cohort analysis of HIV-infected patients under care at the University of California at San Diego Owen Clinic was carried out. Patients were eligible for this analysis if they had at least two anal cytohistological results available for longitudinal analysis. Kaplan-Meier analysis was used to estimate the cumulative incidence of IAC over time according to baseline cytology category [less than high-grade intraepithelial lesion (HSIL) versus HSIL]. Cox regression analysis was used to adjust for the following covariates: antiretroviral use, level of HIV viraemia, smoking status and infrared photocoagulation (IRC) ablation therapy. Results Between 2000 and 2012, we followed 2804 HIV-infected patients for a median of 4 years under a clinic protocol requiring baseline anal cytology screening. Incident IAC was diagnosed in 23 patients. Patients with a baseline HSIL anal cytology had an estimated 5-year probability of progression to IAC of 1.7% and an estimated annual progression risk of 1 in 263. None of the examined covariates was significantly associated with IAC incidence when examined in separate unadjusted Cox models. Conclusions HIV-infected patients with a baseline HSIL anal cytology had a 5-year cumulative incidence of IAC of 1.65%, with an upper 95% confidence bound of 4.5%. This population-based study provides quantitative risk estimates that may be used for counselling patients regarding management options for abnormal cytology results. PMID:25197003

  3. A wide field-of-view scanning endoscope for whole anal canal imaging

    PubMed Central

    Han, Chao; Huangfu, Jiangtao; Lai, Lily L.; Yang, Changhuei

    2015-01-01

    We report a novel wide field-of-view (FOV) scanning endoscope, the AnCam, which is based on contact image sensor (CIS) technology used in commercialized business card scanners. The AnCam can capture the whole image of the anal canal within 10 seconds with a resolution of 89 μm, a maximum FOV of 100 mm × 120 mm, and a depth-of-field (DOF) of 0.65 mm at 5.9 line pairs per mm (lp/mm). We demonstrate the performance of the AnCam by imaging the entire anal canal of pigs and tracking the dynamics of acetowhite testing. We believe the AnCam can potentially be a simple and convenient solution for screening of the anal canal for dysplasia and for surveillance in patients following treatment for anal cancer. PMID:25780750

  4. Human papillomavirus-related squamous cell carcinoma of the anal canal with papillary features

    PubMed Central

    Leon, Marino E; Shamekh, Rania; Coppola, Domenico

    2015-01-01

    Human papillomavirus (HPV) related squamous cell carcinoma (SCC) involving the anal canal is a well-known carcinoma associated with high-risk types of HPV. HPV-related SCC with papillary morphology (papillary SCC) has been described in the oropharynx. We describe, for the first time, a case of anal HPV-related squamous carcinoma with papillary morphology. The tumor arose from the anal mucosa. The biopsies revealed a superficially invasive SCC with prominent papillary features and associated in situ carcinoma. The tumor cells were positive for p16 and were also positive for high-risk types of HPV using chromogenic in situ hybridization. The findings are consistent with a HPV-related SCC of the anal canal with papillary features. This tumor shows histologic features similar to a papillary HPV-related SCC of the oropharynx. Additional studies are needed to characterize these lesions. PMID:25717259

  5. Anal Papilloma: An Exceptional Presentation of Fibrocystic Disease in Anogenital Mammary-Like Glands

    PubMed Central

    Subashchandrabose, Priya; Esakkai, Muthuvel; Venugopal, Palani; Kannaiyan, Ilavarasan; Srinivasan, Chitra; Reddy, Punuru Tejashwini; Ebenezer, Evelyn Elizabeth

    2015-01-01

    Previously ectopic breast tissue was thought to be derived from the caudal remnants of the primitive embryonic milk ridges; anogenital mammary-like glands are presently considered as normal constituents of the anogenital region. We report a case of young female, who presented with an anal papilloma. Histopathological examination revealed extensive fibrocystic changes in anogenital mammary-like glands. To date, a lot of benign changes and a wide range of benign and malignant neoplasms have been reported in these glands. However, extensive fibrocystic change of these glands in anal region is very rare. In addition, fibrocystic disease of anal mammary glands, masquerading clinically as an anal papilloma, has not been reported in literature. Hence, it is essential for clinicians and the pathologists to be aware of such a rare presentation. The features of fibrocystic disease in perianal region are also discussed. PMID:26495147

  6. [Anal hygiene in perianal skin diseases--compatibility of water moist and dry toilet paper].

    PubMed

    Brhl, W; Schmauz, R

    1998-02-01

    The most common morphological changes in 485 of our ambulatory patients were found on external examination of the anal region (46%). These changes included erosions, fissur and eczema. Regarding the symptoms the predominant complaints were itching and burning in 42.1%. Anal hygiene after defaecation was most commonly done with dry toilet-paper (55%). A change in anal hygiene after defaecation relieves symptoms: By changing from water to moist toilet paper in 9%, from dry toilet paper to moist toilet paper in 30%, from moist toilet paper to water in 32%, an from dry toilet paper to water in 60%. These results confirm known facts regarding the influences of conserving agents an printing materials in dry (often recycled) and moist toilet papers on the skin. These side-effects to be even more pronounced in the compromised skin and suggest that anal hygiene should be done with water only. PMID:9531728

  7. Treating High-grade Lesions to Prevent Anal Cancer in HIV-infected People

    Cancer.gov

    This study, called the ANCHOR trial, will investigate whether screening and prevention methods similar to those used to prevent cervical cancer can help prevent anal cancer in HIV-infected men and women.

  8. [The surgical anatomy of the rectal and anal blood vessels].

    PubMed

    Vogel, P; Klosterhalfen, B

    1988-01-01

    The authors examined 40 rectum specimens by angiography, preparation and staining methods to show the exact arterial vessel supply of the rectum and tried to find out whether a reason could be found for the relatively high rate of suture leaks after low resection of the rectum or not. The insertion of the levator muscle is a sort of vessel divide: caudal to the levator muscle the inferior rectal artery is the main supplying vessel, cranially the superior rectal artery. Here a vessel deficient-area always remains in the dorso-caudal sector of the rectal ampulla which cannot be compensated by another rectum-supplying vessel. The middle rectal artery supplies the rectum accessorily. The results are able to explain why the suture leaks are constantly observed in the dorso-caudal ampulla after profound anterior resection of the rectum. Furthermore the results account for the good healing tendency of coloanal anastomoses: the inferior rectal artery amply supplies the anal canal; there is not the same vessel-deficient area as found cranial to the levator muscle. PMID:3268710

  9. Spontaneous rupture of multifocal hepatocellular carcinoma: case report

    PubMed Central

    zen, zkan; Tosun, Alptekin; Akgl, i?dem

    2015-01-01

    Hemoperitoneum due to nontraumatic liver rupture is rare. The most common cause of nontraumatic rupture of the liver is hepatocellular carcinoma (HCC). The other causes of nontraumatic liver ruptures are peliosis hepatis, polyarteritis nodosa, systemic lupus erythematosus, preeclampsia, metastatic carcinoma, and other primary liver tumors. In this report, we present the computed tomography findings of spontaneous liver rupture in a 52-year-old male patient due to multifocal HCC, with the diagnosis proven by surgical specimen. PMID:26316825

  10. Rupture of wetting films caused by nanobubbles.

    PubMed

    Stckelhuber, Klaus Werner; Radoev, Boryan; Wenger, Andreas; Schulzet, Hans Joachim

    2004-01-01

    It is now widely accepted that nanometer sized bubbles, attached at a hydrophobic silica surface, can cause rupture of aqueous wetting films due to the so-called nucleation mechanism. But the knowledge of the existence of such nanobubbles does not give an answer to how the subprocesses of this rupture mechanism operate. The aim of this paper is to describe the steps of the rupture process in detail: (1) During drainage of the wetting film, the apex of the largest nanobubble comes to a distance from the wetting film surface, where surface forces are acting. (2) An aqueous "foam film" in nanoscale size is formed between the bubble and the wetting film surface; in this foam film different Derjaguin-Landau-Verwey-Overbeek (DLVO) forces are acting than in the surrounding wetting film. In the investigated system, hydrophobized silica/water/air, all DLVO forces in the wetting film are repulsive, whereas in the foam film the van der Waals force becomes attractive. (3) The surface forces over and around the apex of the nanobubble lead to a deformation of the film surfaces, which causes an additional capillary pressure in the foam film. An analysis of the pressure balance in the system shows that this additional capillary pressure can destabilize the foam film and leads to rupture of the foam film. (4) If the newly formed hole in the wetting film has a sufficient diameter, the whole wetting film is destabilized and the solid becomes dewetted. Experimental data of rupture thickness and lifetime of wetting films of pure electrolyte and surfactant solutions show that the stabilization of the foam film by surfactants has a crucial effect on the stability of the wetting film. PMID:15745015

  11. [Pay attention to the functional protection during operation for benign anal diseases].

    PubMed

    Ding, Shuqing

    2014-12-01

    Benign anorectal diseases are common. Hemorrhoids, anal fissure and anal fistula are the top three of colorectal surgery for benign anrorectal clinical practice. Postoperative fecal incontinence or stool seepage has not yet got enough attention by specialists. This article elaborates on the clinical status, evaluation process, functional protection and treatment strategies etc. Following the continence protection principle requires specialists to focus on not only the disease itself but the patient-centered quality of life. PMID:25529944

  12. Correlates of anal sex roles among Malay and Chinese MSM in Kuala Lumpur, Malaysia.

    PubMed

    Dangerfield, Derek T; Gravitt, Patti; Rompalo, Anne M; Tai, Raymond; Lim, Sin How

    2016-03-01

    Identifying roles for anal sex is an important issue for populations of MSM. We describe the prevalence of identifying as being 'top', 'bottom', 'versatile', or 'don't know/not applicable' among Malay and Chinese MSM in Kuala Lumpur, Malaysia, and behavioural outcomes according to these labels for sexual role identity. Data analysis was conducted on a survey administered during weekly outreach throughout Kuala Lumpur in 2012. Pearson's Chi square tests were used to compare demographic and behavioural characteristics of MSM who reported roles for anal sex. Binary logistic regression was used to explore the odds of behavioural outcomes among MSM who identified as 'bottom', 'versatile,' and 'don't know' compared to MSM who reported that 'top' was their sexual role. Labels for anal sex roles were significantly associated with condom use for last anal sex. Among MSM who used labels for anal sex roles, MSM who identified as 'bottom' had highest level of not using condoms for last anal sex (24.1%, p = .045). In binary logistic regression model, identifying as 'top' was significantly associated with reporting using a condom during last anal sex and reported consistent condom use for anal sex in the past six months (p = .039 and .017, respectively). With regard to sexual role identity, some MSM may be a part of a special subgroup of at-risk men to be targeted. Future research should evaluate the origins, meanings, and perceptions of these labels, and the developmental process of how these MSM identify with any of these categories. Research should also uncover condom use decision making with regard to these labels for sexual positioning. PMID:25887064

  13. Clinical Inquiry: Does qHPV vaccine prevent anal intraepithelial neoplasia and condylomata in men?

    PubMed

    Shum, Johnny; Kelsberg, Gary; Safranek, Sarah

    2015-09-01

    Yes. Quadrivalent human papillomavirus (qHPV) vaccine reduces rates of anal intraepithelial neoplasia (AIN) by 50% to 54%, and persistent anal infection by 59%, associated with the 4 types of HPV in the vaccine (6, 11, 16, and 18) in young men who have sex with men (MSM); it also reduces external genital lesions by 66%, and persistent HPV infection associated with the same 4 HPV types by 48 to 59% in all young men, heterosexual men, and MSM. PMID:26546954

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

    USGS Publications Warehouse

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

    1985-01-01

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

  15. Radionuclide diagnosis of splenic rupture in infectious mononucleosis

    SciTech Connect

    Vezina, W.C.; Nicholson, R.L.; Cohen, P.; Chamberlain, M.J.

    1984-06-01

    Spontaneous splenic rupture is a rare but serious complication of infectious mononucleosis. Although radionuclide spleen imaging is a well accepted method for diagnosis of traumatic rupture, interpretation can be difficult in the setting of mononucleosis, as tears may be ill-defined and diagnosis hampered by inhomogeneous splenic uptake. Four proven cases of spontaneous rupture are presented, three of which illustrate these diagnostic problems.

  16. Ruptured rectal duplication with urogenital abnormality: Unusual presentation

    PubMed Central

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

    2015-01-01

    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

  17. Ruptured rectal duplication with urogenital abnormality: Unusual presentation.

    PubMed

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

    2015-01-01

    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

  18. Addressing Risk and Reluctance at the Nexus of HIV and Anal Cancer Screening

    PubMed Central

    Ka‘opua, Lana Sue I.; Cassel, Kevin; Shiramizu, Bruce; Stotzer, Rebecca L.; Robles, Andrew; Kapua, Cathy; Orton, Malulani; Milne, Cris; Sesepasara, Maddalynn

    2015-01-01

    Anal cancer disproportionately burdens persons living with human immunodeficiency virus (PLHIV) regardless of natal sex, sexual orientation, gender expression, and ethnic identity. Culturally competent communications are recommended to address health disparities, with sociocultural relevance ensured through constituent dialogic processes. Results are presented from six provider focus groups conducted to inform the promotion/education component of a Hawai‘i-based project on anal cancer screening tools. Krueger’s focus group methodology guided discussion queries. Verbatim transcripts of digitally recorded discussions were analyzed using grounded theory and PEN-3 procedures. Adherence to an audit trail ensured analytic rigor. Grounded theory analysis detected the overall theme of risk and reluctance to anal cancer screening, characterized by anal cancer not being “on the radar” of PLHIV, conflicting attributions of the anus and anal sex, fear of sex-shaming/-blaming, and other interrelated conceptual categories. PEN-3 analysis revealed strategies for destigmatizing anal cancer, through “real talk” (proactive, candid, nonjudgmental discussion) nested in a framework of sexual health and overall well-being, with additional tailoring for relevance to Native Hawaiians/Pacific Islanders, transgender persons, and other marginalized groups. Application of strategies for health practice are specific to the Hawai‘i context, yet may offer considerations for developing strengths-based, culturally relevant screening promotion/education with diverse PLHIV in other locales. PMID:26630979

  19. An Electronic Daily Diary Study of Anal Intercourse in Drug-Using Women.

    PubMed

    Reynolds, Grace L; Fisher, Dennis G; Laurenceau, Jean-Philippe; Fortenberry, J Dennis

    2015-12-01

    Women (N = 138) with histories of illicit drug use were recruited into an electronic diary study that used Android smartphones for data collection. The diary was to be completed each day for 12 weeks using an "app" created in HTML5 and accessed over the Internet via smartphone. Data collection included information on sexual behaviors with up to 10 partners per day and contextual factors surrounding sexual behavior such as drug use before/after, type of sexual behavior (oral, vaginal, anal), and other activities such as using condoms for vaginal and anal intercourse and use of sexual lubricants. The sample was predominantly African American (58 %); 20 % Latina, 20 % White and 2 % reported as Other. Most women reported either less than a high school education (33 %) or having a high school diploma (33 %). The mean age was 39 years (SD = 11.78). Anal intercourse occurred on days when women also reported using illicit drugs, specifically methamphetamine and cocaine. Anal intercourse was not an isolated sexual activity, but took place on days when vaginal intercourse and giving and receiving oral sex also occurred along with illicit drug use. Anal intercourse also occurred on days when women reported they wanted sex. HIV prevention interventions must address the risks of anal intercourse for women, taking into account concurrent drug use and sexual pleasure that may reduce individual harm-reduction behaviors. PMID:25835461

  20. VIDEO-ASSISTED ANAL FISTULA TREATMENT: TECHNICAL CONSIDERATIONS AND PRELIMINARY RESULTS OF THE FIRST BRAZILIAN EXPERIENCE

    PubMed Central

    MENDES, Carlos Ramon Silveira; FERREIRA, Luciano Santana de Miranda; SAPUCAIA, Ricardo Aguiar; LIMA, Meyline Andrade; ARAUJO, Sergio Eduardo Alonso

    2014-01-01

    Backgroung Anorectal fistula represents an epithelized communication path of infectious origin between the rectum or anal canal and the perianal region. The association of endoscopic surgery with the minimally invasive approach led to the development of the video-assisted anal fistula treatment. Aim To describe the technique and initial experience with the technique video-assisted for anal fistula treatment. Technique A Karl Storz video equipment was used. Main steps included the visualization of the fistula tract using the fistuloscope, the correct localization of the internal fistula opening under direct vision, endoscopic treatment of the fistula and closure of the internal opening which can be accomplished through firing a stapler, cutaneous-mucosal flap, or direct closure using suture. Results The mean distance between the anal verge and the external anal orifice was 5.5 cm. Mean operative time was 31.75 min. In all cases, the internal fistula opening could be identified after complete fistuloscopy. In all cases, internal fistula opening was closed using full-thickness suture. There were no intraoperative or postoperative complications. After a 5-month follow-up, recurrence was observed in one (12.5%) patient. Conclusion Video-assisted anal fistula treatment is feasible, reproducible, and safe. It enables direct visualization of the fistula tract, internal opening and secondary paths. PMID:24676305

  1. An Electronic Daily Diary Study of Anal Intercourse in Drug-Using Women

    PubMed Central

    Fisher, Dennis G.; Laurenceau, Jean-Philippe; Fortenberry, J. Dennis

    2015-01-01

    Women (N = 138) with histories of illicit drug use were recruited into an electronic diary study that used Android smartphones for data collection. The diary was to be completed each day for 12 weeks using an “app” created in HTML5 and accessed over the Internet via smartphone. Data collection included information on sexual behaviors with up to 10 partners per day and contextual factors surrounding sexual behavior such as drug use before/after, type of sexual behavior (oral, vaginal, anal), and other activities such as using condoms for vaginal and anal intercourse and use of sexual lubricants. The sample was predominantly African American (58 %); 20 % Latina, 20 % White and 2 % reported as Other. Most women reported either less than a high school education (33 %) or having a high school diploma (33 %). The mean age was 39 years (SD = 11.78). Anal intercourse occurred on days when women also reported using illicit drugs, specifically methamphetamine and cocaine. Anal intercourse was not an isolated sexual activity, but took place on days when vaginal intercourse and giving and receiving oral sex also occurred along with illicit drug use. Anal intercourse also occurred on days when women reported they wanted sex. HIV prevention interventions must address the risks of anal intercourse for women, taking into account concurrent drug use and sexual pleasure that may reduce individual harm-reduction behaviors. PMID:25835461

  2. Expression profile of epidermal differentiation complex genes in normal and anal cancer cells.

    PubMed

    Zucchini, C; Biolchi, A; Strippoli, P; Solmi, R; Rosati, G; Del Governatore, M; Milano, E; Ugolini, G; Salfi, N; Farina, A; Caira, A; Zanotti, S; Carinci, P; Valvassori, L

    2001-12-01

    Anal cancer originates from a peculiar histological region and provides a useful model for investigating alterations in proliferation and/or differentiation of neoplastic keratinocytes. Epidermal differentiation complex (EDC) genes, which form one of the major gene clusters in the human genome, are involved in the terminal differentiation of epithelial cells and in many instances have been implicated in epithelial tumours. We constructed a DNA macroarray capable of characterising the expression profiles of the entire EDC gene complex in normal mucosa and anal cancer biopsies of seven unrelated patients. Brain tissue and cultured keratinocytes were used as controls. All anal cancer samples showed expression profiles in which none of the EDC genes was silent, as evaluated by phosphor-imager analysis. Variance analysis showed significantly lower expression of SPRR2 with respect to SPRR1 or SPRR3, and significantly higher expression of S100A8 than of other S100A subfamily members. At hierarchical clustering analysis, the four basaloid anal cancer cases conglomerated in the top five positions. The macroarray method used by us provides the first demonstration of the expression profile of the EDC gene family in anal cancer, and is capable of producing significant information on the subgrouping of epithelial tumours such as anal cancer. PMID:11713581

  3. Addressing Risk and Reluctance at the Nexus of HIV and Anal Cancer Screening.

    PubMed

    Ka'opua, Lana Sue I; Cassel, Kevin; Shiramizu, Bruce; Stotzer, Rebecca L; Robles, Andrew; Kapua, Cathy; Orton, Malulani; Milne, Cris; Sesepasara, Maddalynn

    2016-01-01

    Anal cancer disproportionately burdens persons living with human immunodeficiency virus (PLHIV) regardless of natal sex, sexual orientation, gender expression, and ethnic identity. Culturally competent communications are recommended to address health disparities, with sociocultural relevance ensured through constituent dialogic processes. Results are presented from six provider focus groups conducted to inform the promotion/education component of a Hawai'i-based project on anal cancer screening tools. Krueger's focus group methodology guided discussion queries. Verbatim transcripts of digitally recorded discussions were analyzed using grounded theory and PEN-3 procedures. Adherence to an audit trail ensured analytic rigor. Grounded theory analysis detected the overall theme of risk and reluctance to anal cancer screening, characterized by anal cancer not being "on the radar" of PLHIV, conflicting attributions of the anus and anal sex, fear of sex-shaming/-blaming, and other interrelated conceptual categories. PEN-3 analysis revealed strategies for destigmatizing anal cancer, through "real talk" (proactive, candid, nonjudgmental discussion) nested in a framework of sexual health and overall well-being, with additional tailoring for relevance to Native Hawaiians/Pacific Islanders, transgender persons, and other marginalized groups. Application of strategies for health practice are specific to the Hawai'i context, yet may offer considerations for developing strengths-based, culturally relevant screening promotion/education with diverse PLHIV in other locales. PMID:26630979

  4. The Influence of Antral Ulcers on Intramural Gastric Nerve Projections Supplying the Pyloric Sphincter in the Pig (Sus scrofa domestica)Neuronal Tracing Studies

    PubMed Central

    Zalecki, Michal

    2015-01-01

    Background Gastric ulcerations in the region of antrum pylori represent a serious medical problem in humans and animals. Such localization of ulcers can influence the intrinsic descending nerve supply to the pyloric sphincter. The pyloric function is precisely regulated by intrinsic and extrinsic nerves. Impaired neural regulation could result in pyloric sphincter dysfunction and gastric emptying malfunction. The aim of the study was to determine the effect of gastric antral ulcerations on the density and distribution of intramural gastric descending neurons supplying the pyloric sphincter in pigs. Methodology/Principal Findings The experiment was performed on 2 groups of pigs: healthy gilts (n=6) and gilts with experimentally induced peptic ulcers in the region of antrum pylori (n=6). Gastric neurons supplying pyloric sphincter were labeled using the retrograde neuronal tracing technique (20?l of Fast Blue tracer injected into the pyloric sphincter muscle). After a week survival period the animals were sacrificed and the stomachs were collected. Then, the stomach wall was cross-cut into 0.5cm thick sections taken in specified intervals (section I - 1.5cm; section II - 3.5cm; section III - 5.5cm; section IV 7.5cm) starting from the sphincter. Consecutive microscopic slices prepared from each section were analyzed under fluorescent microscope to count traced neurons. Obtained data were statistically analyzed. The total number of FB-positive perikarya observed within all studied sections significantly decreased from 903.3 130.7 in control to 243.8 67.3 in experimental animals. In healthy pigs 76.1 6.7% of labeled neurons were observed within the section I, 23.53 6.5% in section II and only occasional cells in section III. In experimental animals, as many as 93.8 2.1% of labeled cells were observed within the section I and only 6.2 2.2% in section II, while section III was devoid of such neurons. There were no traced perikarya in section IV observed in both groups of pigs. Conclusions/Significance Obtained results revealed for the first time significant impact of antral ulcerations on intramural descending nerve pathways supplying the pyloric sphincter in pigs, animals of increasing value in biomedical research and great economic importance. PMID:25962176

  5. Megathrust Properties and Large Earthquake Rupture Processes

    NASA Astrophysics Data System (ADS)

    Lay, T.; Ye, L.; Kanamori, H.

    2014-12-01

    Constraining physical controls on seismic rupture of plate boundary megathrust faults is challenging due to observational limitations, but seismic, geodetic, tsunami, electromagnetic, geologic and hydrologic studies are steadily accumulating data that hold potential of advancing our understanding of subduction fault zones. Very shallow (< 15 km deep) megathrust earthquakes are rare, but intermittently occur as large tsunami earthquakes such as the 2010 Mentawai Mw 7.8 event. This rupture occurred up-dip of prior large interplate ruptures in the Sumatra subduction zone in 2007, and rupture extended all the way to the trench, but with patchy large-slip regions that can only be confidently resolved using tsunami observations. The seismic wave radiation from tsunami earthquakes is now established to be distinct from that of ruptures deeper on the megathrust, but the controlling factors are not well-resolved. Smaller events at shallow depths tend to have diverse rupture processes, but some are also anomalously depleted in short-period radiation, suggesting that the shallow environment has variable scale-lengths of frictional heterogeneity. At the other end of the megathrust, large events deeper than about 35 km tend to have modest enhancement of short-period seismic wave radiation, with somewhat lower slope to their short-period source spectra than typical of shallower events. The controlling process are also not well-resolved for this behavior. These depth-variations of megathrust earthquake source spectra are one class of observations that may relate to pressure- and temperature-dependent evolution of the megathrust from the trench to decoupling depths near 45-50 km. Other attributes of seismic sources, such as static stress drop and moment-scaled radiated energy have large variability, but do not show systematic variations with depth on the megathrust, so some attributes of earthquake processes are not strongly influenced by evolving conditions of the plate boundary. We explore these issues based on a recent seismological study of all large interplate earthquakes from 1990-2014 combined with detailed investigations of several recent large and great earthquakes for which we have unprecedented geophysical data sets.

  6. Isolated Total Rupture of Extraocular Muscles

    PubMed Central

    Chen, Jingchang; Kang, Ying; Deng, Daming; Shen, Tao; Yan, Jianhua

    2015-01-01

    Abstract Total rupture of extraocular muscles is an infrequent clinical finding. Here we conducted this retrospective study to evaluate their causes of injury, clinical features, imaging, surgical management, and final outcomes in cases of isolated extraocular muscle rupture at a tertiary center in China. Thirty-six patients were identified (24 men and 12 women). Mean age was 34 years (range 260). The right eye was involved in 21 patients and the left 1 in 15. A sharp object or metal hook was the cause of this lesion in 16 patients, sinus surgery in 14 patients, traffic accident in 3 patients, orbital surgery in 2 patients, and conjunctive tumor surgery in 1 patient. The most commonly involved muscles were medial (18 patients) and inferior rectus muscles (13 patients). The function of the ruptured muscles revealed a scale of ?3 to ?4 defect of ocular motility and the amount of deviation in primary position varied from 10 to 140 PD (prism diopter). Computerized tomography (CT) confirmed the presence of ruptured muscles. An end-to-end muscle anastomosis was performed and 3 to 5?mm of muscle was resected in 23 patients. When the posterior border of the injured muscle could not be identified (13 patients), a partial tendon transposition was performed, together with recession of the antagonist in most patients, whereas a recession of the antagonist muscle plus a resection of the involved muscle with or without nasal periosteal fixation was performed in the remaining patients. After an average of 16.42 months of follow-up an excellent result was achieved in 23 patients and results of 13 patients were considered as a failure. In most patients, the posterior border of the ruptured muscle can be identified and an early surgery can be performed to restore function. Alternatively, a partial tendon transposition should be performed. When muscular rupture is suspected, an early orbital CT is required to confirm this possibility, which can then verify the necessity for an early surgical intervention. PMID:26426604

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

    PubMed Central

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

    2011-01-01

    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

  8. Update in procedural therapy for GERD--magnetic sphincter augmentation, endoscopic transoral incisionless fundoplication vs laparoscopic Nissen fundoplication.

    PubMed

    Min, Michael X; Ganz, Robert A

    2014-02-01

    Gastroesophageal reflux disease (GERD) is a common and progressive condition manifested by heartburn or regurgitation. Though Nissen fundoplication has been and remains the gold standard for procedural therapy for GERD, two newer interventions have gained popularity: magnetic sphincter augmentation (MSA), which entails the placement of a self expanding magnetic ring around the gastroesophageal (GE) junction, and transoral incisionless fundoplication (TIF), an endoscopic approach that creates a neogastroesophageal valve near the fundus. Collective data gathered from four studies published within the past year suggest that the three modalities share comparable effectiveness in pH monitoring and patient satisfaction, TIF may have a lower proton pump inhibitor cessation rate, and Nissen fundoplication required longer recovery time and had a more serious adverse effects profile. Large, prospective, randomized controlled studies are needed to reliably compare the three procedures. PMID:24522889

  9. Local recurrence after sphincter-saving resection for rectal and rectosigmoid carcinoma: Value of various diagnostic methods

    SciTech Connect

    Grabbe, E.; Winkler, R.

    1985-05-01

    The authors reviewed 51 cases of local recurrence after sphincter-saving resection for rectal and rectosigmoid carcinoma to assess the sensitivity of current diagnostic procedures. A combination of followup serum CEA levels and rectoscopy was found to be most efficient during the first two years after surgery in terms of the time frequency, and location of the recurrence as well as the cost-benefit ratio. On the other hand, almost all recurrent lesions developed extraluminally, infiltrating the suture line secondarily; moreover, one fourth extended outside the bowel wall. Thus in addition to endoscopy, CT is useful as a means of defining the entire mass at the anastomosis as well as detecting pericolic recurrence and is essential if repeat resection is contemplated.

  10. Stress urinary incontinence animal models as a tool to study cell-based regenerative therapies targeting the urethral sphincter.

    PubMed

    Herrera-Imbroda, Bernardo; Lara, María F; Izeta, Ander; Sievert, Karl-Dietrich; Hart, Melanie L

    2015-03-01

    Urinary incontinence (UI) is a major health problem causing a significant social and economic impact affecting more than 200million people (women and men) worldwide. Over the past few years researchers have been investigating cell therapy as a promising approach for the treatment of stress urinary incontinence (SUI) since such an approach may improve the function of a weakened sphincter. Currently, a diverse collection of SUI animal models is available. We describe the features of the different models of SUI/urethral dysfunction and the pros and cons of these animal models in regard to cell therapy applications. We also discuss different cell therapy approaches and cell types tested in preclinical animal models. Finally, we propose new research approaches and perspectives to ensure the use of cellular therapy becomes a real treatment option for SUI. PMID:25453264

  11. Sphincteroplasty of the Sphincter of Oddi in the Treatment of Benign Distal Obstructions of the Bile Duct

    PubMed Central

    1989-01-01

    Seventy patients in whom sphincteroplasty was performed by an original technique are presented. In 65 cases the indication was stenosis of the sphincter of oddi, associated or not with cholelithiasis or hepatic hydatid disease. There were relative indications in another 5 patients. Sphincteroplasty was achieved with the aid of an original probe, and average length of the incision of the ampullary area was 28 mm. In the immediate postoperative period there was one case of acute postoperative pancreatitis, one duodenal fistula and an upper digestive haemorrhage; also a residual stone was detected. All these complications have responded favourably to conservative treatment. There was a single death in an old patient with bronchopneumonia. The late results were very good or good with the exception of two cases: one which presented with cholangitis episodes maintained by duodenal stasis, and one female patient, who after one year from sphincteroplasty had to be reoperated on for an hepatic abscess. PMID:2487060

  12. Therapeutic management of anal eczema: an evidence-based review

    PubMed Central

    Havlickova, B; Weyandt, G H

    2014-01-01

    Aim To conduct a systematic review of treatments for anal eczema (AE). Methods We conducted a Medline search for clinical trial data for the treatment of perianal diseases including AE, including papers not published in the English language. We assessed the study reports using the system recommended by the Oxford Centre for Evidence-based Medicine. No meta-analysis was attempted. Results The evidence base for topical treatments used to treat AE is very poor: there are very few studies and many of those that exist are of poor quality. The best evidence was found for medications that are yet to be licensed for AE. Among products with existing licences for the treatment of eczema, our assessment found some evidence to support the continued use of mild-to-moderate corticosteroids first line in most patients. Discussion Features of the perianal region, and the fact that it is almost always occluded, mean that not all medications recommended in the general treatment guidelines for eczema are appropriate for AE. However, there are no specific treatment guidelines for these patients. This may in part be because of the lack of high-quality evidence-based medicine in this therapy area. Many frequently prescribed medications were developed and licensed many years ago, in an era when clinical trial design was not expected to be as rigorous as it is today. Conclusion This review highlights the need to conduct more high-quality clinical trials in patients with AE in order that specific guidelines for the management of this difficult proctological condition can be prepared. PMID:24898365

  13. IMRT treatment of anal cancer with a scrotal shield

    SciTech Connect

    Hood, Rodney C.; Wu, Q. Jackie; McMahon, Ryan; Czito, Brian; Willett, Christopher

    2012-01-01

    The risk of sterility in males undergoing radiotherapy in the pelvic region indicates the use of a shielding device, which offers protection to the testes for patients wishing to maintain fertility. The use of such devices in the realm of intensity-modulated radiotherapy (IMRT) in the pelvic region can pose many obstacles during simulation, treatment planning, and delivery of radiotherapy. This work focuses on the development and execution of an IMRT plan for the treatment of anal cancer using a scrotal shielding device on a clinical patient. An IMRT plan was developed using Eclipse treatment planning system (Varian Medical Systems, Palo Alto, CA), using a wide array of gantry angles as well as fixed jaw and fluence editing techniques. When possible, the entire target volume was encompassed by the treatment field. When the beam was incident on the scrotal shield, the jaw was fixed to avoid the device and the collimator rotation optimized to irradiate as much of the target as possible. This technique maximizes genital sparing and allows minimal irradiation of the gonads. When this fixed-jaw technique was found to compromise adequate coverage of the target, manual fluence editing techniques were used to avoid the shielding device. Special procedures for simulation, imaging, and treatment verification were also developed. In vivo dosimetry was used to verify and ensure acceptable dose to the gonads. The combination of these techniques resulted in a highly conformal plan that spares organs and risk and avoids the genitals as well as entrance of primary radiation onto the shielding device.

  14. Genetics of canine anal furunculosis in the German shepherd dog.

    PubMed

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

    2014-05-01

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

  15. Correlates of unprotected anal intercourse: the influence of anal sex position among men who have sex with men in Beijing, china.

    PubMed

    Zhang, Heng; Lu, Hongyan; Pan, Stephen W; Xia, Dongyan; Zhao, Yuejuan; Xiao, Yan; He, Xiong; Yue, Hai; Sun, Zheya; Xu, Yunan; Ruan, Yuhua; Shao, Yiming

    2015-02-01

    Understanding barriers to consistent condom use among men who have sex with men (MSM) requires consideration of the context in which risk behaviors occur. Anal sex position is one such context. This pooled cross-sectional study used survey data from 1,230 MSM and their 2,618 reported male sexual partnerships. Overall, nearly half of the participants engaged in unprotected anal intercourse (UAI) with at least one of upto three partners in the past 6months. "Insertive" men engaged in less UAI (39%) than "receptive" (53%) or "versatile" (51%) men. Regardless of sexual position, UAI was associated with cohabiting with a male or female partner and perceiving great or moderate risk of HIV from male contact at the individual level, and steady (vs. casual) partnership at the dyad level. However, early MSM anal sex debut, high number of male partners, alcohol use, receiving and buying condoms, HIV testing, and MSM sex-seeking venues were found to be only statistically significantly correlated with UAI among some but not all sexual positions, implying that interventions to increase condom use should take into account how anal sex position may influence willingness and ability to engage in safer sex. Dyad level data appear to provide additional insight into the influence of sexual positions, and should be used to complement individual data for future intervention designs. PMID:25548064

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

    SciTech Connect

    Hatzidakis, Adam A.; Tsetis, Dimitris; Chrysou, Evangelia; Sanidas, Elias; Petrakis, John; Gourtsoyiannis, Nicholas C.

    2001-07-15

    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.

  17. Response of the Upper Esophageal Sphincter to Esophageal Distension is Affected by Posture, Velocity, Volume, and Composition of the Infusate

    PubMed Central

    Babaei, Arash; Dua, Kulwinder; Naini, Sohrab Rahimi; Lee, Justin; Katib, Omar; Yan, Ke; Hoffmann, Raymond; Shaker, Reza

    2012-01-01

    Background & Aims Studies of the pressure response of the upper esophageal sphincter (UES) to simulated or spontaneous gastroesophageal reflux have shown conflicting results. These discrepancies could result from uncontrolled influence of variables such as posture, volume, and velocity of distension. We characterized in humans the effects of these variables on UES pressure response to esophageal distension. Methods We studied 12 healthy volunteers (average 27±5 years old, 6 male) using concurrent esophageal infusion and high-resolution manometry to determine UES, lower esophageal sphincter, and intraesophageal pressure values. Reflux events were simulated by distal esophageal injections of room-temperature air and water (5, 10, 20, and 50 ml) in individuals in 3 positions (upright, supine and semi-supine). Frequencies of various UES responses were compared using χ2 analysis. Multinomial logistical regression analysis was used to identify factors that determine the UES response. Results UES contraction and relaxation were the overriding responses to esophageal water and air distension, respectively, in a volume-dependent fashion (P<.001). Water-induced UES contraction and air-induced UES relaxation were the predominant responses among individuals in supine and upright positions, respectively (P<.001). The prevalence of their respective predominant response significantly decreased in the opposite position. Proximal esophageal dp/dt significantly and independently differentiated the UES response to infusion with water or air. Conclusions The UES response to esophageal distension is affected by combined effects of posture (spatial orientation of the esophagus), physical properties, and volume of refluxate, as well as the magnitude and rate of increase in intraesophageal pressure. The UES response to esophageal distension can be predicted using a model that incorporates these factors. PMID:22248662

  18. A review on delayed presentation of diaphragmatic rupture

    PubMed Central

    Rashid, Farhan; Chakrabarty, Mallicka M; Singh, Rajeev; Iftikhar, Syed Y

    2009-01-01

    Diaphragmatic rupture is a life-threatening condition. Diaphragmatic injuries are quite uncommon and often result from either blunt or penetrating trauma. Diaphragmatic ruptures are usually associated with abdominal trauma however, it can occur in isolation. Acute traumatic rupture of the diaphragm may go unnoticed and there is often a delay between the injury and the diagnosis. A comprehensive literature search was performed using the terms "delayed presentation of post traumatic diaphragmatic rupture" and "delayed diaphragmatic rupture". The diagnostic and management challenges encountered are discussed, together with strategies for dealing with them. We have focussed on mechanism of injury, duration, presentation and site of injury, visceral herniation, investigations and different approaches for repair. We intend to stress on the importance of delay in presentation of diaphragmatic rupture and to provide a review on the available investigations and treatment methods. The enclosed case report also emphasizes on the delayed presentation, diagnostic challenges and the advantages of laparoscopic repair of delayed diaphragmatic rupture. PMID:19698091

  19. An unusual presentation of recurrent uterine rupture during pregnancy

    PubMed Central

    Tan, Shu Qi; Thia, Edwin Wee Hong; Tee, Chee Seng John; Yeo, George Seow Heong

    2015-01-01

    We describe a case of recurrent uterine rupture at the site of a previous rupture. Our patient had a history of right interstitial pregnancy with spontaneous uterine fundal rupture at 18 weeks of pregnancy. During her subsequent pregnancy, she was monitored closely by a senior consultant obstetrician. The patient presented at 34 weeks with right hypochondriac pain. She was clinically stable and fetal monitoring showed no signs of fetal distress. Ultrasonography revealed protrusion of the intact amniotic membranes in the abdominal cavity at the uterine fundus. Uterine rupture is a rare but hazardous obstetric complication. High levels of caution should be exercised in patients with a history of prior uterine rupture, as they may present with atypical symptoms. Ultrasonography could provide valuable information in such cases where there is an elevated risk of uterine rupture at the previous rupture site. PMID:26106245

  20. Spontaneous rupture of renal angiomyolipoma during pregnancy.

    PubMed

    dos Santos, Mariana Mouraz Lopes; Proena, Sara Marques Soares; Reis, Maria Ins Nunes Pereira de Almeida; Viana, Rui Miguel Almeida Lopes; Martins, Lusa Maria Bernardo; Colao, Joo Manuel dos Reis; Nunes, Filomena Maria Pinheiro

    2014-08-01

    Renal angiomyolipoma is a benign tumor, composed of adipocytes, smooth muscle cells and blood vessels. The association with pregnancy is rare and related with an increased risk of complications, including rupture with massive retroperitoneal hemorrhage. The follow-up is controversial because of the lack of known cases, but the priorities are: timely diagnosis in urgent cases and a conservative treatment when possible. The mode of delivery is not consensual and should be individualized to each case. We report a case of a pregnant woman with 18 weeks of gestation admitted in the emergency room with an acute right low back pain with no other symptoms. The diagnosis of rupture of renal angiomyolipoma was established by ultrasound and, due to hemodynamically stability, conservative treatment with imaging and clinical monitoring was chosen. At 35 weeks of gestation, it was performed elective cesarean section without complications for both mother and fetus. PMID:25184352

  1. Creep rupture behavior of Stirling engine materials

    NASA Technical Reports Server (NTRS)

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

    1985-01-01

    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.

  2. Spontaneous intramural rupture of the oesophagus.

    PubMed Central

    Steadman, C; Kerlin, P; Crimmins, F; Bell, J; Robinson, D; Dorrington, L; McIntyre, A

    1990-01-01

    The clinical, endoscopic, and radiological features of seven patients with an uncommon oesophageal injury characterised by long lacerations of the oesophageal mucosa with haematoma formation but without perforation are reported. The injuries were not related to forceful vomiting or any other definable cause but were similar to those previously described as intramural oesophageal rupture. Upper gastrointestinal endoscopy undertaken to identify the cause of haematemesis in six patients proved safe and useful. When dysphagia and odynophagia occurred early in the clinical course to alert the clinician to possible oesophageal injury, radiological contrast studies were used to exclude perforation. One patient in this study had oesophageal cavernocapillary haemangiomatosis which may have caused intramural oesophageal bleeding and submucosal dissection but in the remainder the aetiology of intramural oesophageal rupture remains uncertain. Conservative management was successful in all patients. Images Figure 1 Figure 2 Figure 3 Figure 4 PMID:2387502

  3. Premature rupture of the membranes: neonatal consequences.

    PubMed

    Merenstein, G B; Weisman, L E

    1996-10-01

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

  4. Liquid salt environment stress-rupture testing

    DOEpatents

    Ren, Weiju; Holcomb, David E.; Muralidharan, Govindarajan; Wilson, Dane F.

    2016-03-22

    Disclosed herein are systems, devices and methods for stress-rupture testing selected materials within a high-temperature liquid salt environment. Exemplary testing systems include a load train for holding a test specimen within a heated inert gas vessel. A thermal break included in the load train can thermally insulate a load cell positioned along the load train within the inert gas vessel. The test specimen can include a cylindrical gage portion having an internal void filled with a molten salt during stress-rupture testing. The gage portion can have an inner surface area to volume ratio of greater than 20 to maximize the corrosive effect of the molten salt on the specimen material during testing. Also disclosed are methods of making a salt ingot for placement within the test specimen.

  5. Computational model of retinal photocoagulation and rupture

    NASA Astrophysics Data System (ADS)

    Sramek, Christopher; Paulus, Yannis M.; Nomoto, Hiroyuki; Huie, Phil; Palanker, Daniel

    2009-02-01

    In patterned scanning laser photocoagulation, shorter duration (< 20 ms) pulses help reduce thermal damage beyond the photoreceptor layer, decrease treatment time and minimize pain. However, safe therapeutic window (defined as the ratio of rupture threshold power to that of light coagulation) decreases for shorter exposures. To quantify the extent of thermal damage in the retina, and maximize the therapeutic window, we developed a computational model of retinal photocoagulation and rupture. Model parameters were adjusted to match measured thresholds of vaporization, coagulation, and retinal pigment epithelial (RPE) damage. Computed lesion width agreed with histological measurements in a wide range of pulse durations and power. Application of ring-shaped beam profile was predicted to double the therapeutic window width for exposures in the range of 1 - 10 ms.

  6. An unusual diagnosis of splenic rupture.

    PubMed

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

    2014-01-01

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

  7. Unsuspected paperboard-endophthalmitis in ruptured eye.

    PubMed

    Wolter, J R; Pavilack, M A

    1990-05-01

    The eye of a 3-year-old boy was directly exposed to the explosion of an M-80 firecracker which he had been holding in his hand. The cornea and lens were ruptured. Although not evident on an initial CT scan, pathologic examination revealed a paperboard foreign body lodged in the vitreous. This paperboard, rather than the burnt powder, was likely the central focus of the subacute endophthalmitis that developed. PMID:2381660

  8. Megakaryocyte rupture for acute platelet needs

    PubMed Central

    Stritt, Simon

    2015-01-01

    Circulating platelets were thought to arise solely from the protrusion and fragmentation of megakaryocyte cytoplasm. Now, Nishimura et al. (2015. J. Cell Biol. http://dx.doi.org/10.1083/jcb.201410052) show that platelet release from megakaryocytes can be induced by interleukin-1? (IL-1?) via a new rupture mechanism, which yields higher platelet numbers, occurs independently of the key regulator of megakaryopoiesis thrombopoietin, and may occur during situations of acute platelet need. PMID:25963815

  9. Megakaryocyte rupture for acute platelet needs.

    PubMed

    Nieswandt, Bernhard; Stritt, Simon

    2015-05-11

    Circulating platelets were thought to arise solely from the protrusion and fragmentation of megakaryocyte cytoplasm. Now, Nishimura et al. (2015. J. Cell Biol. http://dx.doi.org/10.1083/jcb.201410052) show that platelet release from megakaryocytes can be induced by interleukin-1? (IL-1?) via a new rupture mechanism, which yields higher platelet numbers, occurs independently of the key regulator of megakaryopoiesis thrombopoietin, and may occur during situations of acute platelet need. PMID:25963815

  10. Wrapped Wire Detects Rupture Of Pressure Vessel

    NASA Technical Reports Server (NTRS)

    Hunt, James B.

    1990-01-01

    Simple, inexpensive technique helps protect against damage caused by continuing operation of equipment after rupture or burnout of pressure vessel. Wire wrapped over area on outside of vessel where breakthrough most likely. If wall breaks or burns, so does wire. Current passing through wire ceases, triggering cutoff mechanism stopping flow in vessel to prevent further damage. Applied in other situations in which pipes or vessels fail due to overpressure, overheating, or corrosion.

  11. Endovascular Treatment of Ruptured Pericallosal Artery Aneurysms

    PubMed Central

    Ko, Jun Kyeung; Kim, Hwan Soo; Choi, Hyuk Jin; Lee, Tae Hong; Yun, Eun Young

    2015-01-01

    Objective Aneurysms arising from the pericallosal artery (PA) are uncommon and challenging to treat. The aim of this study was to report our experiences of the endovascular treatment of ruptured PA aneurysms. Methods From September 2003 to December 2013, 30 ruptured PA aneurysms in 30 patients were treated at our institution via an endovascular approach. Procedural data, clinical and angiographic results were retrospectively reviewed. Results Regarding immediate angiographic control, complete occlusion was achieved in 21 (70.0%) patients and near-complete occlusion in 9 (30.0%). Eight procedure-related complications occurred, including intraprocedural rupture and early rebleeding in three each, and thromboembolic event in two. At last follow-up, 18 patients were independent with a modified Rankin Scale (mRS) score of 0-2, and the other 12 were either dependent or had expired (mRS score, 3-6). Adjacent hematoma was found to be associated with an increased risk of poor clinical outcome. Seventeen of 23 surviving patients underwent follow-up conventional angiography (mean, 16.5 months). Results showed stable occlusion in 14 (82.4%), minor recanalization in two (11.8%), and major recanalization, which required recoiling, in one (5.9%). Conclusion Our experiences demonstrate that endovascular treatment for a ruptured PA aneurysms is both feasible and effective. However, periprocedural rebleedings were found to occur far more often (20.0%) than is generally suspected and to be associated with preoperative contrast retention. Analysis showed existing adjacent hematoma is predictive of a poor clinical outcome. PMID:26539261

  12. Ruptured carotid aneurysm revealing a Behcet's disease.

    PubMed

    Lyazidi, Youssef; Abissegue, Ghislain Y; Chtata, Hassan T; Taberkant, Mustafa

    2015-08-01

    We report the case of a 20-year-old male who was operated for a large ruptured aneurysm of the right common carotid artery, revealing a Behcet's disease. The aneurysm was excised and the right common carotid artery was repaired with a polytetrafluoroethylene prosthesis. None of the criteria of the International Study Group for Behcet's disease was present at the time of the diagnosis. PMID:26038305

  13. Rupture directivity of moderate earthquakes in northern California

    USGS Publications Warehouse

    Seekins, Linda C.; Boatwright, John

    2010-01-01

    We invert peak ground velocity and acceleration (PGV and PGA) to estimate rupture direction and rupture velocity for 47 moderate earthquakes (3.5?M?5.4) in northern California. We correct sets of PGAs and PGVs recorded at stations less than 55125 km, depending on source depth, for site amplification and sourcereceiver distance, then fit the residual peak motions to the unilateral directivity function of Ben-Menahem (1961). We independently invert PGA and PGV. The rupture direction can be determined using as few as seven peak motions if the station distribution is sufficient. The rupture velocity is unstable, however, if there are no takeoff angles within 30 of the rupture direction. Rupture velocities are generally subsonic (0.5?0.9?); for stability, we limit the rupture velocity at v=0.92?, the Rayleigh wave speed. For 73 of 94 inversions, the rupture direction clearly identifies one of the nodal planes as the fault plane. The 35 strike-slip earthquakes have rupture directions that range from nearly horizontal (6 events) to directly updip (5 events); the other 24 rupture partly along strike and partly updip. Two strike-slip earthquakes rupture updip in one inversion and downdip in the other. All but 1 of the 11 thrust earthquakes rupture predominantly updip. We compare the rupture directions for 10 M?4.0 earthquakes to the relative location of the mainshock and the first two weeks of aftershocks. Spatial distributions of 8 of 10 aftershock sequences agree well with the rupture directivity calculated for the mainshock.

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

    SciTech Connect

    Schwarz, Julie K.; Siegel, Barry A.; Dehdashti, Farrokh; Myerson, Robert J.; Fleshman, James W.; Grigsby, Perry W.

    2008-05-01

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

  15. Sexual abuse of English boys and girls: the importance of anal examination.

    PubMed

    Hobbs, C J; Wynne, J M

    1989-01-01

    Child sexual abuse is attracting increasing attention in the United Kingdom. In Leeds this is reflected in the work of two pediatricians who receive multiagency, direct referrals for children of all ages. Over two years 1,368 referrals were received for all kinds of abuse and neglect, including 608 for suspected sexual abuse (Hobbs & Wynne, 1987a), of which 337 (243 girls, 94 boys) were confirmed or probable cases. The abuses included genital touching, masturbation, oral, vaginal and anal penetration. Of these abuses, 30% (which were frequently multiple) involved and penetration by finger or penis; and 42% of 337 children exhibited one or more anal findings, rising to 60% of 115 children in the 0-5 years of age group. The diagnosis of abuse was made from results of multidisciplinary assessment including medical examination. Genital findings were present in 3% of boys and 50% of girls. Anal findings included erythema; swelling (tyre); laxity; shortening or eversion; reflex anal dilatation (dilatation); fissures; venous congestion; reversible and permanent skin changes; twitching; funnelling; hematoma and bruising; as well as signs of infection. The pattern of anal signs varied with the age of the child and chronicity of abuse, as judged from the history. Healing and resolution of anal physical findings on follow-up were observed from days to months after initial examination. The general absence of these findings in the group of children judged not to have been sexually abused supports a cause and effect hypothesis, but further research is required. Medical examination of every child where symptoms, signs, or situation raise the possibility of abuse or neglect must include anal inspection, but instrumental or digital examination is not recommended. PMID:2743180

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

    PubMed Central

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

    2014-01-01

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

  17. Transient gravity perturbations induced by earthquake rupture

    NASA Astrophysics Data System (ADS)

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

    2015-06-01

    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.

  18. Dynamics of retinal photocoagulation and rupture

    NASA Astrophysics Data System (ADS)

    Sramek, Christopher; Paulus, Yannis; Nomoto, Hiroyuki; Huie, Phil; Brown, Jefferson; Palanker, Daniel

    2009-05-01

    In laser retinal photocoagulation, short (<20 ms) pulses have been found to reduce thermal damage to the inner retina, decrease treatment time, and minimize pain. However, the safe therapeutic window (defined as the ratio of power for producing a rupture to that of mild coagulation) decreases with shorter exposures. To quantify the extent of retinal heating and maximize the therapeutic window, a computational model of millisecond retinal photocoagulation and rupture was developed. Optical attenuation of 532-nm laser light in ocular tissues was measured, including retinal pigment epithelial (RPE) pigmentation and cell-size variability. Threshold powers for vaporization and RPE damage were measured with pulse durations ranging from 1 to 200 ms. A finite element model of retinal heating inferred that vaporization (rupture) takes place at 180-190C. RPE damage was accurately described by the Arrhenius model with activation energy of 340 kJ/mol. Computed photocoagulation lesion width increased logarithmically with pulse duration, in agreement with histological findings. The model will allow for the optimization of beam parameters to increase the width of the therapeutic window for short exposures.

  19. Bladder rupture after intentional medication overdose.

    PubMed

    Huston, Butch; Mills, Kelly; Froloff, Victor; McGee, Michael

    2012-06-01

    We report the case of a 51-year-old woman who had a medical history of diabetes, depression with past suicide attempts, and suicidal ideation. She was found unresponsive in a motel with multiple bottles of medicines (melatonin, carisoprodol, ativan, and clonazepam) and an unopened bottle of wine. She was transported to the local hospital and treated for benzodiazepine toxicity and aspiration pneumonitis.The decedent gradually became more alert and was extubated 3 days after hospital admission. The decedent was reportedly getting up to use the restroom when she became tachypneic and diaphoretic and complained of generalized body pain. Her condition quickly declined, and she was pronounced deceased. A postmortem examination revealed an acute bladder rupture and soft tissue hemorrhage.A review of the literature reveals that isolated bladder rupture after minimal or no trauma in association with alcohol or drug ingestion is an infrequently reported, but recognized, injury. The diagnosis of bladder rupture should be considered in a patient with lower abdominal pain, even without a history of trauma. A history of voiding or bladder dysfunction should increase the suspicion for this injury. If suspected, a retrograde cystogram should be obtained promptly. Failure to consider and recognize this injury may lead to significant morbidity. PMID:21897194

  20. [Muscular rupture of the extensor pollicis longus].

    PubMed

    Towfigh, H

    1984-12-01

    Closed ruptures of the extensor pollicis longus tendon usually appear as a consequence of fractures of the wrist joint or the carpal bones or ensue from polyarthritic changes or result from a process of degeneration. Mechanical injury of the tendon is quite rare but can be observed after direct trauma or after operative treatment of a distal fracture of the radius. Closed traumatic ruptures of the extensor pollicis longus tendon in the absence of pathological changes are--in spite of the frequency of rotation injuries of the forearm--very rare. The patient in the case described is a 45-year-old locksmith whose forearm and hand had been caught in a lathe. This led to sudden, extreme rotation and pronation of the hand. Clinically distinct signs of a rupture of the extensor pollicis longus tendon could be seen. During operation a tear of the muscular portion of the long extensor tendon of the thumb was found. The function of extension was restored by transfer of the extensor indicis tendon. PMID:6392038

  1. Anal dilatation, lateral subcutaneous sphincterotomy and haemorrhoidectomy for the treatment of second and third degree haemorrhoids. A prospective randomized study.

    PubMed

    Hiltunen, K M; Matikainen, M

    1992-01-01

    Patients with second or third degree haemorrhoids were randomized for treatment by anal dilatation, lateral subcutaneous sphincterotomy or haemorrhoidectomy. The patients were studied by means of proctoscopy, anal manometry and symptom grading preoperatively, two months and one year after the procedure. After one year, more than half of the patients were symptomless in each treatment group. Both anal dilatation and sphincterotomy gave poor results in 25% of the patients, compared with 9% after haemorrhoidectomy. Young age was related to good results in anal dilatation or sphincterotomy, but not in haemorrhoidectomy. Results of anal dilatation and sphincterotomy in treating haemorrhoids are unpredictable, so they cannot be recommended as routine procedures. Maximal basal pressure was reduced after all three procedures, but neither the preoperative nor postoperative anal pressures were able to predict the result of the different treatment techniques. PMID:1478806

  2. Intersonic and Supersonic ruptures in a model of dynamic rupture in a layered medium

    NASA Astrophysics Data System (ADS)

    Ma, X.; Elbanna, A. E.

    2014-12-01

    The velocity structure in the lithosphere is quite complex and is rarely homogeneous. Wave reflection, transmission, and diffraction from the boundaries of the different layers and inclusions are expected to lead to a rich dynamic response and significantly affect rupture propagation on embedded faults. Here, we report our work on modeling dynamic rupture in an elastic domain with an embedded soft (stiff) layer as a first step towards modeling rupture propagation in realistic velocity structures. We use the Finite Element method (Pylith) to simulate rupture on a 2D in-plane fault embedded in an elastic full space. The simulated domain is 30 km wide and 100km long. Absorbing boundary conditions are used around the edges of the domain to simulate an infinite extension in all directions. The fault operates under linear slip-weakening friction law. We initiate the rupture by artificially overstressing a localized region near the left edge of the fault. We consider embedded soft/stiff layers with 20% to 60% reduction/increase of wave velocity respectively. The embedded layers are placed at different distances from the fault surface. We observed that the existence of a soft layer significantly shortens the transition length to supershear propagation through the Burridge-Andrews mechanism. The higher the material contrast, the shorter the transition length to supershear propagation becomes. We also observe that supershear rupture could be generated at pretress values that are lower than what is theoretically predicted for a homogeneous medium. We find that the distance from the lower boundary of the soft layer to the fault surface has a stronger influence on the supershear transition length as opposed to the thickness of the soft layer. In the existence of an embedded stiffer layer we found that rupture could propagate faster than the fault zone P-wave speed. In this case, the propagating rupture generate two Mach cones; one is associated with the shear wave, and the other is associated with the local P-wave speed. This is a signature of supersonic crack tips. We also noted a smooth transition into supershear, with the rupture speed increasing continuously through the so-called 'energetically forbidden zone' (between Rayleigh wave speed and shear wave speed) corresponding to the wave speeds of the background medium.

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

    SciTech Connect

    Ar Latin-Small-Letter-Dotless-I bas, Bilgin Kadri Dingil, Guerbuez; Koeroglu, Mert; Uenguel, Uemit; Zaral Latin-Small-Letter-Dotless-I , Aliye Ceylan

    2011-02-15

    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.

  4. Bougie dilators: simple, safe and cost-effective treatment for Crohns-related fibrotic anal strictures

    PubMed Central

    Kashkooli, Soleiman B.; Samanta, Sujon; Rouhani, Mehrdad; Akbarzadeh, Shoaleh; Saibil, Fred

    2015-01-01

    Summary Anal strictures with fibrotic induration have been shown to develop in up to 50% of all patients with Crohns disease (CD) with anal ulceration. We evaluate the technical feasibility, safety and long-term efficacy of bougie dilation for a subgroup of patients with symptomatic Crohns-related fibrotic anal strictures. Bougie dilation is simple to perform, relatively inexpensive and has a low risk of complications. PMID:26204140

  5. Rupture Velocities of Intermediate- and Deep-Focus Earthquakes

    NASA Astrophysics Data System (ADS)

    Warren, L. M.

    2014-12-01

    The rupture velocities of intermediate- and deep-focus earthquakes --- how they vary between subduction zones, how they vary with depth, and what their maximum values are --- may help constrain the mechanism(s) of the earthquakes. As part of a global study of intermediate- and deep-focus earthquakes, I have used rupture directivity to estimate the rupture vector (speed and orientation) for 422 earthquakes >70 km depth with MW ?5.7 since 1990. I estimate the rupture velocity relative to the local P-wave velocity (vr/?). Since the same method is used for all earthquakes, the results can be readily compared across study areas. The study areas --- Middle America, South America, Tonga-Kermadec, Izu-Bonin-Marianas, and Japan-Kurils-Kamchatka --- include some of the warmest and coldest subduction zones: subducting plate ages range from 9-150 Myr and descent rates range from 1-13 cm/yr. Across all subduction zones and depth ranges, for the 193 earthquakes with observable directivity and well-constrained rupture vectors, most earthquakes rupture on the more horizontal of the two possible nodal planes. However, the rupture vectors appear to be randomly-oriented relative to the slip vector, so the earthquakes span the continuum from Mode II (i.e., parallel slip and rupture vectors) to Mode III rupture (i.e., perpendicular slip and rupture vectors). For this earthquake population, the mean rupture velocity is 0.43 vr/? 0.14 vr/?. The mean earthquake rupture velocities are similar between all subduction zones. Since the local seismic wavespeed is faster in colder subduction zones, absolute rupture velocities are faster in colder subduction zones. Overall, the fastest rupture velocities exceed the local S-wave speed. The supershear ruptures are associated with earthquakes closer to Mode II than Mode III faulting. This is consistent with theoretical calculations, which limit the rupture velocity to the S-wave speed for Mode III rupture but the P-wave speed for Mode II rupture.

  6. Research Summaries for Normal Birth

    PubMed Central

    Romano, Amy M.

    2007-01-01

    In this column, the author summarizes four research studies that further support the benefits of normal birth. The topics of the studies include the optimality of midwifery care for pregnant women at moderate risk; obstetric care practices associated with anal sphincter tears in vaginal births; the effect of acupuncture treatment on women with prelabor rupture of membranes at term; and women's ability to adapt to early labor. PMID:18311339

  7. High resolution anoscopy may be useful in achieving reductions in anal cancer local disease failure rates.

    PubMed

    Goon, P; Morrison, V; Fearnhead, N; Davies, J; Wilson, C; Jephcott, C; Sterling, J; Crawford, R

    2015-05-01

    Anal cancer is uncommon, with an incidence rate of 0.5-1.0 per 100,000 of the population but incidence rates have been steadily increasing over the last 3 decades. Biological and epidemiological evidence have been mounting and demonstrate that anal cancer has many similarities to cervical cancer, especially in regard to its aetiology. High-resolution anoscopy (HRA) of the anal region analogous to colposcopy of the cervix, is a technique that is not well-known in the medical and surgical fraternity. Evidence to support the use of HRA for detection and treatment in the surveillance of AIN exists and strongly suggests that it is beneficial, resulting in reduced rates of cancer progression. Pilot data from our study showed a local disease failure rate of 1.73 per 1000 patient-months compared with a published rate of 9.89 per 1000 patient-months. This demonstrates a 5.72-fold reduction in local disease failure rates of patients with T1-T3 tumours; the data therefore suggests that use of HRA for detection and treatment in surveillance of anal cancer patients will help prevent local regional relapse at the anal site. There is an urgent need for a large, randomised controlled clinical trial to definitively test this hypothesis. PMID:24373061

  8. Anal heterosex among young people and implications for health promotion: a qualitative study in the UK

    PubMed Central

    Marston, C; Lewis, R

    2014-01-01

    Objective To explore expectations, experiences and circumstances of anal sex among young people. Design Qualitative, longitudinal study using individual and group interviews. Participants 130 men and women aged 16–18 from diverse social backgrounds. Setting 3 contrasting sites in England (London, a northern industrial city, rural southwest). Results Anal heterosex often appeared to be painful, risky and coercive, particularly for women. Interviewees frequently cited pornography as the ‘explanation’ for anal sex, yet their accounts revealed a complex context with availability of pornography being only one element. Other key elements included competition between men; the claim that ‘people must like it if they do it’ (made alongside the seemingly contradictory expectation that it will be painful for women); and, crucially, normalisation of coercion and ‘accidental’ penetration. It seemed that men were expected to persuade or coerce reluctant partners. Conclusions Young people's narratives normalised coercive, painful and unsafe anal heterosex. This study suggests an urgent need for harm reduction efforts targeting anal sex to help encourage discussion about mutuality and consent, reduce risky and painful techniques and challenge views that normalise coercion. PMID:25122073

  9. The Energy Budget of Earthquake Rupture: a View From Spontaneous Rupture Modeling and Finite-Source Models

    NASA Astrophysics Data System (ADS)

    Mai, P.; Guatteri, M.

    2003-12-01

    It is a common and frustrating experience of many dynamic modelers to initiate spontaneous rupture calculations that subsequently abort before rupturing to the desired earthquake size [Nielsen and Olsen, 2000; Oglesby and Day, 2002]. Source parameters in such dynamic source models are strongly correlated, but stress drop is the main factor affecting the distribution of the other dynamic rupture parameters. Additionally, the position of the hypocenter exerts a strong influence on the dynamic properties of the earthquake, and certain hypocenter positions are not plausible as those would not lead to spontaneous rupture propagation. To further investigate this last statement, we analyze the energy budget during earthquake rupture using spontaneous dynamic rupture calculations and finite-source rupture models. In describing the energy budget during earthquake rupture, we follow Favreau and Archuleta [2003]. Each point on the fault contributes to the radiated seismic energy Ers = Eel - Efr - Erx, where Eel denotes the elasto-static energy and Efr the fracture energy. In this study we neglect for simplicity the relaxation work Erx spent during the stopping of the earthquake. A rupture can be characterized by locally negative seismic energy density values, but its integral over the fault plane must be positive. The fundamental condition for rupture growth is therefore that the integral of Ers on the rupture area remains always positive during rupture propagation. Based on a simple energy budget calculation, we focus on identifying those target slip/stress distribution in dynamic rupture modeling that for a given hypocenter location fail to rupture spontaneously. Additionally, we study the energy budget of finite-source rupture models by analyzing the integrated seismic energy for the inferred slip maps using also hypocenter positions other than the network location. These results indicate how rupture was promoted for the true hypocenter while randomized hypocenters may not have been able to sustain a large earthquake. Our approach helped us both to speed up the computation of successful spontaneous rupture models, as well as to construct dynamically consistent rupture models for strong motion prediction.

  10. Bacteriological comparison of low anal fistula operated by ordinary methods and laser methods

    NASA Astrophysics Data System (ADS)

    Yang, Yuanrong; Xiong, Yigai

    1996-09-01

    Since 1989, 42 cases with low anal fistula were operated with laser and ordinary methods respectively. During the operation, secreted or charred tissues were extracted from the surface of the wound for bacteria culture. Experimental group (laser method): no bacteria were found in 24 cases operated by laser method. Control group (ordinary method): bacterial were found in 16 out of 18 cases operated by ordinary methods. The results of two different group showed that they had statistical difference for P < 0.001. So, CO2 laser is proved to be a definitely practical tool in surgical use for its bacteria killing power. While the anal fistula were operated by the laser, the neurotic carboatomic tissue can block blood vessel and prevent infection from spreading. The high temperature produced by the carboatomic action have enough ability to kill directly the bacteria living in the anal fistula.

  11. [A Case of Anal Canal Carcinoma with Inguinal Lymph Node Metastasis Treated with Laparoscopic Abdominoperineal Resection].

    PubMed

    Tonooka, Toru; Takiguchi, Nobuhiro; Yamamoto, Hiroshi; Nabeya, Yoshihiro; Ikeda, Atsushi; Kainuma, Osamu; Soda, Hiroaki; Cho, Akihiro; Saito, Hiroshige; Arimitsu, Hidehito; Yanagibashi, Hiroo; Kobayashi, Ryosuke; Chibana, Tomofumi; Tokoro, Yukinari; Nagata, Matsuo

    2015-11-01

    We report a case ofanal canal cancer with inguinal lymph node metastasis treated with laparoscopic abdominoperineal resection combined with inguinal lymph node dissection. A 52-year-old woman was diagnosed with anal squamous carcinoma after excision of an anal canal tumor. Further examination revealed right inguinal lymph node metastasis. Chemoradiotherapy was administered but was discontinued because of serious adverse events. We therefore performed laparoscopic abdominoperineal resection combined with inguinal lymph node dissection. The pathological findings revealed residual squamous cell carcinoma at the lymphatic vessels in the rectal wall and lymph nodes, including the right inguinal region. Therapeutic effect ofGrade 1a was achieved in spite ofinterruption ofthe chemoradiotherapy. She was discharged 17 days after the operation, and no recurrence was observed for 11 months. Radical resection was performed for the anal canal squamous cell carcinoma with the metastasis to the right inguinal lymph node, even after interruption of the chemoradiotherapy. PMID:26805350

  12. Missed Iatrogenic Bladder Rupture Following Normal Vaginal Delivery

    PubMed Central

    Baheti, Vidyasagar H; Patwardhan, Sujata K

    2015-01-01

    Bladder rupture following caesarian section is well documented complications. Intraperitoneal bladder rupture following normal vaginal delivery is very rare. Hereby, we present a case report of intraperitoneal bladder rupture presented late following normal vaginal delivery. We report a case of spontaneous intraperitoneal urinary bladder rupture following uneventful outlet forceps delivery in a 22-year-old primi gravid woman with gestational diabetes mellitus and fetal macrosomia who presented with large urinary ascites, anuria and renal failure. Emergent exploratory laparotomy with repair of the intraperitoneal bladder rupture helped to prevent its potential complications. Postpartum patients who undergo episiotomy or perineal repair may land up in unnoticed urinary retention which may rarely terminate in spontaneous urinary bladder rupture. Awareness of its manifestations amongst emergency physician would help to initiate appropriate timely management. PMID:26557563

  13. Measuring thermal rupture force distributions from an ensemble of trajectories.

    PubMed

    Swan, J W; Shindel, M M; Furst, E M

    2012-11-01

    Rupture, bond breaking, or extraction from a deep and narrow potential well requires considerable force while producing minimal displacement. In thermally fluctuating systems, there is not a single force required to achieve rupture, but a spectrum, as thermal forces can both augment and inhibit the bond breaking. We demonstrate measurement and interpretation of the distribution of rupture forces between pairs of colloidal particles bonded via the van der Waals attraction. The otherwise irreversible bond is broken by pulling the particles apart with optical tweezers. We show that an ensemble of the particle trajectories before, during and after the rupture event may be used to produce a high fidelity description of the distribution of rupture forces. This analysis is equally suitable for describing rupture forces in molecular and biomolecular contexts with a number of measurement techniques. PMID:23215431

  14. Measuring Thermal Rupture Force Distributions from an Ensemble of Trajectories

    NASA Astrophysics Data System (ADS)

    Swan, J. W.; Shindel, M. M.; Furst, E. M.

    2012-11-01

    Rupture, bond breaking, or extraction from a deep and narrow potential well requires considerable force while producing minimal displacement. In thermally fluctuating systems, there is not a single force required to achieve rupture, but a spectrum, as thermal forces can both augment and inhibit the bond breaking. We demonstrate measurement and interpretation of the distribution of rupture forces between pairs of colloidal particles bonded via the van der Waals attraction. The otherwise irreversible bond is broken by pulling the particles apart with optical tweezers. We show that an ensemble of the particle trajectories before, during and after the rupture event may be used to produce a high fidelity description of the distribution of rupture forces. This analysis is equally suitable for describing rupture forces in molecular and biomolecular contexts with a number of measurement techniques.

  15. Capturing Continental Rupture Processes in Afar

    NASA Astrophysics Data System (ADS)

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

    2014-05-01

    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.

  16. [SURGICAL TREATMENT OF PATIENTS WITH URETERAL RUPTURES].

    PubMed

    Komjakov, B K; Guliev, B G

    2015-01-01

    The aim of the study was to analyze the causes of ureteral ruptures and the types surgical procedures used for their management. Over the period from 2006 to 2014, 7 patients with ureteral ruptures underwent surgical treatment in the Mechnikov N-WSMU clinic. All of them were males aged 50 to 71 years. In all cases, the ureter was injured during ureteroscopy and contact lithotripsy. In two patients the right ureter was cut off at the border of the upper and middle third, in four--at 3-4 cm below pyeloureteral segment, one patient diagnosed with a complete separation of the ureter from the kidney pelvis. Patients, who have suffered a detachment of the ureter in other hospitals, previously underwent surgical exploration of the retroperitoneal space, drainage of the kidney by pyelonephrostomy (5) and ureterocutaneostomy (1). In a case of a patient with an injury that occurred in our clinic, laparoscopic nephrectomy with autologous renal transplantation was carried out. Five patients with extended ureter defects underwent ileo-ureteroplasty. The patient with left ureterocutaneostomy underwent nephrovesical bypass. Patency of the upper urinary tract and kidney function were restored in all patients, all of them were relieved from external drains. The duration of the intestinal plastic averaged 160 minutes, laparoscopic nephrectomy with autologous transplantation--210 min and nephrovesical bypass--110 min. Blood transfusion was required only in autologous graft patient. The ureteral rupture is a serious complication of ureteral endourological procedures in upper urinary tract. It requires such complicated reconstructive operations as autologous transplantation of the kidney or intestinal ureteroplasty. PMID:26390553

  17. Dynamic stress changes during earthquake rupture

    USGS Publications Warehouse

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

    1998-01-01

    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.

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

    SciTech Connect

    Pepek, Joseph M.; Willett, Christopher G.; Wu, Q. Jackie; Yoo, Sua; Clough, Robert W.; Czito, Brian G.

    2010-12-01

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

  19. Ileal pouch anal anastomosis with modified double-stapled mucosectomy-the experience in China

    PubMed Central

    Zhang, Ya-Jie; Han, Yi; Lin, Mou-Bin; He, Yong-Gang; Zhang, Hao-Bo; Yin, Lu; Huang, Liang

    2013-01-01

    AIM: To investigate the feasibility and long-term functional outcome of ileal pouch-anal anastomosis with modified double-stapled mucosectomy. METHODS: From January 2002 to March 2011, fourty-five patients underwent ileal pouch anal anastomosis with modified double-stapled mucosectomy technique and the clinical data obtained for these patients were reviewed. RESULTS: Patients with ulcerative colitis (n = 29) and familial adenomatous polyposis (n = 16) underwent ileal pouch-anal anastomosis with modified double-stapled mucosectomy. Twenty-eight patients underwent one-stage restorative proctocolectomy, ileal pouch anal anastomosis, protective ileostomy and the ileostomy was closed 4-12 mo postoperatively. Two-stage procedures were performed in seventeen urgent patients, proctectomy and ileal pouch anal anastomosis were completed after previous colectomy with ileostomy. Morbidity within the first 30 d of surgery occurred in 10 (22.2%) patients, all of them could be treated conservatively. During the median follow-up of 65 mo, mild to moderate anastomotic narrowing was occurred in 4 patients, one patient developed persistent anastomotic stricture and need surgical intervention. Thirty-five percent of patients developed at least 1 episode of pouchitis. There was no incontinence in our patients, the median functional Oresland score was 6, 3 and 2 after 1 year, 2.5 years and 5 years respectively. Nearly half patients (44.4%) reported moderate functioning, 37.7% reported good functioning, whereas in 17.7% of patients poor functioning was observed after 1 year. Five years later, 79.2% of patients with good function, 16.7% with moderate function, only 4.2% of patients with poor function. CONCLUSION: The results of ileal pouch anal anastomosis with modified double-stapled mucosectomy technique are promising, with a low complication rate and good long-term functional results. PMID:23483639

  20. Diversity of human papillomavirus in the anal canal of men: the HIM Study.

    PubMed

    Sichero, L; Nyitray, A G; Nunes, E M; Nepal, B; Ferreira, S; Sobrinho, J S; Baggio, M L; Galan, L; Silva, R C; Lazcano-Ponce, E; Giuliano, A R; Villa, L L

    2015-05-01

    Human papillomavirus (HPV) infections are associated with the development of anogenital lesions in men. There are no reports describing the distribution of non-? HPV types in the anal canal of a sexually diverse group of men. The HPV Infection in Men (HIM) Study is a multicentre study on the natural history of HPV infection in Brazil, Mexico, and the USA. At baseline, 12% of anal canal PCR HPV-positive specimens were not typed by the Roche Linear Array, and were considered to be unclassified. Our goals were to characterize HPVs among these unclassified specimens at baseline, and to assess associations with participant socio-demographic and behavioural characteristics. Unclassified HPVs were typed by sequencing of amplified PGMY09/11 products or cloning of PGMY/GP + nested amplicons followed by sequencing. Further analysis was conducted with FAP primers. Of men with unclassified HPV in the anal canal, most (89.1%) were men who have sex with women. Readable sequences were produced for 62.8% of unclassified specimens, of which 75.2% were characterized HPV types. Eighteen, 26 and three different ?-HPV, ?-HPV and ?-HPV types were detected, respectively. ?-HPVs were more commonly detected among young men (18-30 years) than among older men (45-70 years), whereas ?-HPVs were more frequent among mid-adult men (31-44 years). ?-HPVs were more common among heterosexual men (85.0%) than among non-heterosexual men. All ?-HPVs detected among non-heterosexual men were ?2-HPV types. The high prevalence of ?-HPV in the anal canal of men who do not report receptive anal sex is suggestive of other forms of transmission that do not involve penile-anal intercourse. PMID:25698660