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Sample records for anal sphincter rupture

  1. Disturbed anal sphincter function following vaginal delivery.

    PubMed Central

    Wynne, J M; Myles, J L; Jones, I; Sapsford, R; Young, R E; Hattam, A; Cantamessa, S E

    1996-01-01

    BACKGROUND: Recently interest in idiopathic (neurogenic) faecal incontinence has swung from denervation of the external anal sphincter to the internal sphincter. AIMS: To evaluate the effects of vaginal delivery on the internal sphincter. SUBJECTS: 1372 mothers were studied antenatally and 1202 were accepted into the study. METHODS: Sphincter pressures were measured antenatally, in the early postnatal period, and six to 10 weeks later in selected patients. RESULTS: 755 of 1202 subjects assessed antenatally were primiparous women and 447 multiparous women. Some 320 previous spontaneous vaginal deliveries (SVD) (mean 59 mm Hg) and 67 previous forceps deliveries (mean 58 mm Hg) had lower resting pressures than 755 primiparous women (mean 66 mm Hg) (p < 0.01). A total of 493 subjects were reassessed postnatally. There were 372 SVDs, 47 vacuum extractions, 20 forceps, and 54 caesarean deliveries. All vaginal deliveries but not caesarean sections dropped their resting anal pressures from antenatal values (p < 0.001). Some 227 first SVDs had a much greater fall than 145 subsequent SVDs. In 162 subjects who had undergone their first vaginal delivery and who were followed up there was some recovery but the resting pressures were still lowered at six to 10 weeks post partum. CONCLUSIONS: The first vaginal delivery causes a permanent lowering of resting anal pressures. The possible reasons for this are discussed. PMID:8881822

  2. 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

  3. 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.

  4. Obstetrics anal sphincter injury and repair technique: a review.

    PubMed

    Temtanakitpaisan, Teerayut; Bunyacejchevin, Suvit; Koyama, Masayasu

    2015-03-01

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

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

    PubMed Central

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

    2013-01-01

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

  6. Surgical implantation of a bioengineered internal anal sphincter?

    PubMed Central

    Hashish, Mohamed; Raghavan, Shreya; Somara, Sita; Gilmont, Robert R.; Miyasaka, Eiichi; Bitar, Khalil N.; Teitelbaum, Daniel H.

    2010-01-01

    Purpose Fecal incontinence is a common disorder that can have devastating social and psychologic consequences. However, there are no long-term ideal solutions for such patients. Although loss of continence is multifactorial, the integrity of the internal anal sphincter (IAS) has particular significance. We previously described the development of 3-dimensional bioengineered constructs using isolated smooth muscle tissue from donor C57BL/6 IAS. We hypothesized that the bioengineered ring constructs would retain cellular viability and promote neovascularization upon implantation into a recipient mouse. Methods Internal anal sphincter ring constructs were surgically implanted into the subcutaneous tissue of syngeneic C57BL/6 mice and treated with either fibroblastic growth factor 2 (0.26 µg daily) or saline controls using a microosmotic pump. Internal anal sphincter constructs were harvested after 25 days (range, 23–26 days) and assessed morphologically and for tissue viability. Result Gross morphology showed that there was no rejection. Rings showed muscle attachment to the back of the mouse with no sign of inflammation. Fibroblastic growth factor 2 infusion resulted in a significantly improved histologic score and muscle viability compared with the control group. Conclusions Three-dimensional bioengineered IAS rings can be successfully implanted into the subcutaneous tissue of recipient mice. The addition of fibroblastic growth factor 2 led to improved muscle viability, vascularity, and survival. This approach may become a feasible option for patients with fecal incontinence. PMID:20105579

  7. 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.

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

    PubMed Central

    Simó González, Marta; Porta Roda, Oriol; Perelló Capó, 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

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

    SciTech Connect

    Gavioli, Margherita Losi, Lorena; Luppi, Gabriele; Iacchetta, Francesco; Zironi, Sandra; Bertolini, Federica; Falchi, Anna Maria; Bertoni, Filippo; Natalini, Gianni

    2007-10-01

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

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

    PubMed Central

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

    2014-01-01

    We propose pretreatment using microneedles to increase perianal skin permeability for locally targeted delivery of phenylephrine (PE), a drug that increases resting anal sphincter pressure to treat fecal incontinence. Microneedle patches were fabricated by micromolding poly-lactic-acid. Pre-treatment of human cadaver skin with microneedles increased PE delivery across the skin by up to 10-fold in vitro. In vivo delivery was assessed in rats receiving treatment with or without use of microneedles and with or without PE. Resting anal sphincter pressure was then measured over time using water-perfused anorectal manometry. For rats pretreated with microneedles, topical application of 30% PE gel rapidly increased the mean resting anal sphincter pressure from 7 ± 2 cm H2O to a peak value of 43 ± 17 cm H2O after 1 h, which was significantly greater than rats receiving PE gel without microneedle pretreatment. Additional safety studies showed that topically applied green fluorescent protein–expressing E. coli penetrated skin pierced with 23- and 26-gauge hypodermic needles, but E. coli was not detected in skin pretreated with microneedles, which suggests that microneedle-treated skin may not be especially susceptible to infection. In conclusion, this study demonstrates local transdermal delivery of PE to the anal sphincter muscle using microneedles, which may provide a novel treatment for fecal incontinence. PMID:21586307

  11. 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

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

    PubMed Central

    Jones, Oliver M

    2007-01-01

    INTRODUCTION The internal anal sphincter (IAS) is an important structure that is responsible for the majority of resting tone of the sphincter complex. It has a central role in continence and damage to the muscle has serious implications. Injury is most frequently from obstetric trauma though iatrogenic injury from proctological surgery is also common. This review expands on how developments in understanding of the pharmacology of IAS might identify drug treatments as alternatives for proctological conditions such as anal fissure, avoiding the risk of sphincter injury. It also examines the role of pharmacology in treatment of those patients with established incontinence. RESULTS Much of the basic physiology and pharmacology of the IAS has been established through in vitro analysis, particularly in the superfusion organ bath. Further analysis has been undertaken using animal models such the pig. Clinical trials have established the efficacy of a number of agents for reducing IAS tone including glyceryl trinitrate and botulinum toxin. These drugs are probably safer, but less effective, than surgery for sphincter spasm, as is seen in anal fissure, though surgery alone or in combination with drug treatment may be appropriate for some patients. In vitro analysis and small-scale clinical trials suggest that phenylephrine and methoxamine may have a role in treating patients with incontinence primarily attributable to inadequate IAS function. CONCLUSIONS The pharmacology of IAS has been extensively studied in the laboratory, both in vitro and in animal models. In a short time, this laboratory work has been applied to clinical problems after testing in clinical trials. It is likely, however, that the best drugs and the optimal targets for manipulation have not yet been identified. PMID:18201470

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

    Köckerling, 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

  15. 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.

  16. 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 3 years after primary repair of obstetric anal sphincter injuries (OASIS). Methods Between July 2002 and December 2007 women who attended the perineal clinic at Croydon University Hospital, UK, 9 weeks following primary repair of OASIS were asked to complete the Manchester Health Questionnaire and a questionnaire to obtain a St Mark incontinence score. All women had endoanal scans at this visit. In June 2008 all women were asked to complete the questionnaires again. Results Of 344 patients who responded to the questionnaires and were included in the analysis, long-term symptoms of fecal urgency, flatus incontinence, and fecal incontinence occurred in 62 (18.0%), 52 (15.1%), and 36 (10.5%), respectively. Overall, there was a significant improvement in fecal urgency (P < 0.001) and flatus incontinence (P < 0.001) from 9 weeks to 3 years. Of 31 women with fecal incontinence symptoms at early follow-up, 28 were asymptomatic at 3 years. However, 33 women developed de novo symptoms. The only predictors of fecal incontinence at 3 years were fecal urgency at 9 weeks (OR 4.65; 95% CI, 1.38–15.70) and a higher St Mark score (OR 1.40; 95% CI, 1.09–1.80). Conclusion Following primary repair of OASIS, the majority of symptoms and QoL significantly improve, unless there is a persistent anal sphincter defect. This highlights the importance of adequate repair. PMID:25097141

  17. 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

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

    PubMed Central

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

    1998-01-01

    OBJECTIVE: To investigate the effects of two different dosage regimens of botulinum toxin to induce healing in patients with idiopathic anal fissure. SUMMARY BACKGROUND DATA: Chronic anal fissure is maintained by contraction of the internal anal sphincter. Sphincterotomy, which is successful in 85% to 95% of patients, permanently weakens the sphincter and therefore might be associated with anal deformity and incontinence. METHODS: Fifty-seven consecutive outpatients were evaluated. Type A botulinum toxin was injected into the internal anal sphincter. RESULTS: Patients were divided into two treatment groups based on the number of botulinum toxin units injected. Patients in the first group were treated with 15 units and retreated with 20 units. Patients in the second group were treated with 20 units and retreated with 25 units. Two months after treatment, 10 patients in the first group and 23 patients in the second group had a healing scar. Symptomatic improvement was observed in 13 patients in the first group and in 24 patients in the second group. Statistical analysis showed that resting anal pressure varied from baseline values as a function of treatment; in contrast, the treatment had no effect on maximum voluntary pressure. Long-term healing was achieved in 13 patients in the first group and in all patients in the second group who underwent a complete treatment. CONCLUSIONS: Botulinum toxin is safe and effective in the treatment of anal fissure. It is less expensive and easier to perform than surgical treatment. No adverse effects resulted from injections of the toxin. The higher dosage is effective in producing long-term healing without complications. PMID:9833804

  19. 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

  20. 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

  1. Restoration of anal sphincter tone by graciloplasty: a report of five cases.

    PubMed

    Khainga, S O; Tenge, R K; Kituyi, P W

    2011-01-01

    Stool incontinence can be as a result of congenital or acquired anal sphincter problems. It is a devastating state for a patient not to be able to control stools resulting into continued feacal soiling. It reduces an individual to a dejected and depressed person who becomes a social misfit. Hence any procedure that can alleviate this state is normally highly appreciated. Various techniques have been quoted in literature and use of gracilis muscle to form a neosphincter is one of them. Dynamic graciloplasty, is a technique whereby electrodes have been implanted into gracilis muscle and is connected to an implantable pulse generator which provides progressive levels of stimulation to convert the fast twitch, fatigue prone muscle fibres to a slow twitch, fatigue resistant firbres over eight week training period (1,2,3). This has shown improved efficacy over the static graciloplasty (3). In this case report, five patients with stool incontinence from different aetiologies are presented, all having been managed by static graciloplasty and intense physiotherapy with good outcomes reported. PMID:24968601

  2. Electromyography of the external anal sphincter muscle during urodynamic testing in children with meningomyelocele.

    PubMed

    Lissens, M; Van de Walle, J P; Vereecken, R; Bruyninckx, F; Rosselle, N

    1990-01-01

    In this study the correlation between the electromyographic examination of the external sphincter muscle and the urodynamic findings in patients with meningomyelocele was evaluated. Urodynamic testing, consisting of cystometry with bladder, urethral and abdominal pressure monitoring was performed with simultaneous electromyography of the external and sphincter muscle in 61 children, 29 boys and 32 girls, divided in groups according to age and to the level of lesion. Normal urodynamic studies were always correlated with normal external sphincter electromyography. In all patients with a high lesion and in 79% of all others detrusor hyperactivity was correlated with pathological sphincter electromyography. The clinical neurological level of the lesion was not correlated with the function of the detrusor-sphincter mechanism. In 29% of the patients examined with needle electromyography detrusor-sphincter dyssynergia was found, which is less than in most other published studies. And although dyssynergia is a risk factor for renal deterioration, the authors conclude that its effect on the ureter is less important than in subjects with normal perineal musculature, since 80% of the examined patients with meningomyelocele showed pathological sphincter electromyography. These findings thus show a significant correlation between electromyography of the external sphincter muscle and the urodynamic findings in meningomyelocele patients, and clearly demonstrate the importance of urodynamic testing with simultaneous external sphincter electromyography, in order to improve both diagnostic accuracy and reliability of follow-up and treatment. PMID:2097857

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

    PubMed Central

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

    2012-01-01

    Objectives To investigate the association between the geometrical properties of episiotomy and obstetric anal sphincter injuries (OASIS) because episiotomies angled at 40–60° are associated with fewer OASIS than episiotomies with more acute angles. Design Case–control study. Setting University Hospital of North Norway, Tromsø and Nordland Hospital, Bodø, Norway. Sample Seventy-four women who had one vaginal birth and episiotomy. Cases (n = 37) have sustained OASIS at birth, while controls (n = 37) had not. The groups were matched for instrumental delivery. Methods Two groups of women with history of only one vaginal birth were compared. Episiotomy scar was identified and photographed and relevant measures were taken. Data were analysed using conditional logistic analysis. Main outcome measures Mean episiotomy angle, length, depth, incision point. Results The risk of sustaining OASIS decreased by 70% (odds ratio [OR] 0.30; 95% CI 0.14–0.66) for each 5.5-mm increase in episiotomy depth, decreased by 56% (OR 0.44; 95% CI 0.23–0.86) for each 4.5-mm increase in the distance from the midline to the incision point of the episiotomy, and decreased by 75% (OR 0.25; 95% CI 0.10–0.61) for each 5.5-mm increase in episiotomy length. Lastly, there was no difference in mean angle between groups but there was a “U-shaped” association between angle and OASIS (OR 2.09; 95% CI 1.02–4.28) with an increased risk (OR 9.00; 95% CI 1.1–71.0) of OASIS when the angle was either smaller than 15°or >60°. Conclusion The present study showed that scarred episiotomies with depth > 16 mm, length > 17 mm, incision point > 9 mm lateral of midpoint and angle range 30–60° are significantly associated with less risk of OASIS. Shrinkage of tissue must be considered. PMID:22390647

  4. 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

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

    PubMed Central

    Poulsen, Mette Østergaard; Madsen, Mia Lund; Skriver-Møller, 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

  6. 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

  7. 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 5 year period (2004–2008) was obtained from the electronic maternity record system of one institution in the UK. All risk factors were analysed using logistic regression analysis. Odds ratios for independent variables were then used to construct a risk scoring algorithm. This algorithm was then tested on subsequent vaginal deliveries from the same institution to predict the incidence of OASIs. Results Data on 16,920 births were analysed. OASIs occurred in 616 (3.6%) of all vaginal deliveries between 2004 and 2008. Significant (p < 0.05) variables that increased the risk of OASIs on multivariate analysis were: African-Caribbean descent, water immersion in labour, water birth, ventouse delivery, forceps delivery. The following variables remained independently significant in decreasing the risk of OASIs: South Asian descent, vaginal multiparity, current smoker, home delivery. The subsequent odds ratios were then used to construct a risk-scoring algorithm that was tested on a separate cohort of patients, showing a sensitivity of 52.7% and specificity of 71.1%. Conclusions We have confirmed known risk factors previously associated with OASIs, namely parity, birth weight and use of instrumentation during delivery. We have also identified several previously unknown factors, namely smoking status, ethnicity and water immersion. This paper identifies a risk scoring system that fulfils the criteria of a reasonable predictor of the risk of OASIs. This supersedes current practice where no screening is implemented other than examination at the time of delivery by a single examiner. Further prospective studies are required to assess the clinical impact of this scoring system on the identification and prevention of third degree tears. PMID:25056485

  8. Delivery through perineal body and severed external anal sphincter with an intact vaginal orifice during a precipitous labor: a case report

    PubMed Central

    Ismail, Khadijah Irfah; McDonnell, Brendan; O'Coigligh, Seosamh

    2015-01-01

    Key Clinical Message We present the case of a patient who delivered her baby through the perineal body with an intact vaginal introitus. Damage to the perineal body through its connection to the external anal sphincter can involve the rectovaginal septum with increased morbidity and thought to be linked to rectocele development. PMID:25984315

  9. Anal fissure - series (image)

    MedlinePLUS

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

  10. 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

  11. Anal Fissure

    PubMed Central

    Zaghiyan, Karen N.; Fleshner, Phillip

    2011-01-01

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

  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. 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 ?M), but were almost completely abolished by the adrenergic neuron blocker guanethidine (10 ?M). Contractile responses were also reduced (by 45% at 5 Hz, P < 0.01) following desensitisation of purinergic receptors with ?,?-methylene-ATP (10 ?M). In the presence of guanethidine, atropine, and ?,?-methylene-ATP, the remaining relaxatory responses to EFS were examined. These responses were not altered by the cyclooxygenase inhibitor, indomethacin (5 ?M), 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 N?-nitro-L-arginine (L-NNA; 100 ?M), an inhibitor of nitric oxide synthesis (40–50% reduction), zinc protoprophyrin IX (10 ?M), an inhibitor of carbon monoxide synthesis (20–40% reduction), and also propargylglycine (30 ?M) and aminooxyacetic acid (30 ?M), 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

  14. Characteristic behavior of the respiratory muscles, esophagus, and external anal and urethral sphincters during straining, retching, and vomiting in the decerebrate dog.

    PubMed

    Koga, T; Fukuda, H

    1990-01-01

    To ascertain differences in the brainstem pattern generators for straining and retching, discharges of 230 respiratory single motor units from the intercostal nerves and discharges of the nerves to accessory respiratory muscles, the esophagus, and external anal and urethral sphincters were observed during straining, retching, and vomiting (fictive expulsion) in decerebrate and paralyzed dogs. Straining and retching were identified with coactivation of the phrenic nerve and the nerve to the rectus abdominis, which was elicited by distension of the rectum and stomach, respectively. Synchronous discharges with each retch and straining were always exhibited by the phrenic nerve, the nerves innervating the abdominal part of the rectus abdominis and the external anal and urethral sphincters. In contrast, different behaviours were constantly observed in four nerves. 1) The nerves to the serratus dorsalis cranialis was inhibited during straining, but activated synchronously with each retch and vomiting. 2) Vagal pharyngeal branches innervating the upper esophagus and branches of the recurrent nerve innervating the lower part of the cervical esophagus fired synchronously with straining. The esophageal nerves, on the other hand, did not fire with each retch, but did fire strongly between retches. 3) The nerve to the sacrocaudalis dorsalis lateralis discharged concomitantly with straining but did not with retches. Straining and retching behaviors exhibited by the nerves innervating other thoracic accessory inspiratory muscles (the intercartilagineus, rectus thoracis, scalenus) varied from dog to dog. The nerves innervating the thoracic parts of the rectus abdominis and obliquus externus abdominis always discharged synchronously with straining, and discharged with retches in the majority of dogs, but did not in a minority of dogs. The expiratory units from the internal intercostal nerves showed intense discharges synchronously with coactivation in straining (96%), retching (65%), and vomiting (100%). In contrast, none of the inspiratory units from the external intercostal nerves exhibited such intense discharges with straining and retching. These results suggest that the functional difference in straining and retching mainly depends on the differences in the behavior of the serratus dorsalis cranialis and esophagus. The forms of this dependence were discussed. PMID:1965598

  15. 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] =34–39) and 38 mm in the operative vaginal delivery group (SD=8, 95% CI=35–40). Post-suturing episiotomy angles were 53° (SD=6.5, 95% CI=50.7–55.8) in spontaneous vaginal deliveries and 52° (SD=9.6, 95% CI=49–54) 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

  16. [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

  17. Sphincter lesions observed on ultrasound after transanal endoscopic surgery

    PubMed Central

    Mora López, 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

  18. 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

  19. 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

  20. Inflatable artificial sphincter

    MedlinePLUS

    ... anesthesia, you will be asleep and will not feel pain. With spinal anesthesia, you will be awake but numb from the waist down. You will not feel pain. An artificial sphincter has three parts: A cuff, ...

  1. 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.

  2. [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

  3. 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 ...

  4. [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

  5. 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

  6. 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

  7. Prosthetic urinary sphincter

    NASA Technical Reports Server (NTRS)

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

    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.

  8. Paradoxical sphincter contraction is rarely indicative of anismus

    PubMed Central

    Voderholzer, W; Neuhaus, D; Klauser, A; Tzavella, K; Muller-Lissner, S; Schindlbeck, N

    1997-01-01

    Background—Anismus is thought to be a cause of chronic constipation by producing outlet obstruction. The underlying mechanism is paradoxical contraction of the anal sphincter or puborectalis muscle. However, paradoxical sphincter contraction (PSC) also occurs in healthy controls, so anismus may be diagnosed too often because it may be based on a non-specific finding related to untoward conditions during the anorectal examination. ?Aims—To investigate the pathophysiological importance of PSC found at anorectal manometry in constipated patients and in patients with stool incontinence. ?Methods—Digital rectal examination and anorectal manometry were performed in 102 chronically constipated patients, 102 patients with stool incontinence, and in 18 controls without anorectal disease. In 120 of the 222 subjects defaecography was also performed. Paradoxical sphincter contraction was defined as a sustained increase in sphincter pressure during straining. Anismus was assumed when PSC was present on anorectal manometry and digital rectal examination and the anorectal angle did not widen on defaecography. ?Results—Manometric PSC occurred about twice as often in constipated patients as in incontinent patients (41.2% versus 25.5%, p<0.017) and its prevalence was similar in incontinent patients and controls (25.5% versus 22.2%). Oroanal or rectosigmoid transit times in constipated patients with and without PSC did not differ significantly (total 64.6 (8.9) hours versus 54.2 (8.1) hours; rectosigmoid 14.9 (2.4) hours versus 13.8 (2.5) hours). ?Conclusions—Paradoxical sphincter contraction is a common finding in healthy controls as well as in patients with chronic constipation and stool incontinence. Hence, PSC is primarily a laboratory artefact and true anismus is rare. ?? Keywords: anismus; paradoxical sphincter contraction; constipation; stool incontinence; anorectal manometry PMID:9301508

  9. [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

  10. Progress in the understanding and treatment of chronic anal fissure

    PubMed Central

    McCallion, K; Gardiner, K

    2001-01-01

    BACKGROUND—Chronic anal fissure is a common and painful condition associated with internal anal sphincter hypertonia. Reduction of this hypertonia improves the local blood supply, encouraging fissure healing. Surgical sphincterotomy is very successful at healing these fissures but requires an operation with associated morbidity. Temporary reduction in sphincter tone can be achieved on an outpatient basis by applying a topical nitric oxide donor (for example, glyceryl trinitrate) or injecting botulinum toxin into the anal sphincter.?METHODS—A Medline database was used to perform a literature search for articles relating to the non-surgical treatment of chronic anal fissure.?RESULTS—Review of the literature shows botulinum toxin injection to be more effective at healing chronic anal fissures than topical glyceryl trinitrate. Topical isosorbide dinitrate has not been directly compared with either of these two agents but has a healing rate approaching that of botulinum toxin injection. The main side effect of botulinum toxin injection is temporary faecal incontinence in approximately 2% of cases, whereas topical nitrates cause headaches in 20%-100% of cases. No long term side effects were identified with any of the medical treatments.?CONCLUSION—Chemical sphincterotomy is an effective treatment for chronic anal fissure and has the advantages over surgical treatment of avoiding long term complications (notably incontinence) and not requiring hospitalisation.???Keywords: chronic anal fissure; sphincterotomy; glyceryl trinitrate; botulinum toxin PMID:11723312

  11. 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 ...

  12. [Possibilities in the preservation and restoration of anal continence].

    PubMed

    Lestár, B; Asztalos, I; László, S; Polányi, C; Hornok, L; Ritter, L; Rózsa, I

    2001-06-01

    The preservation of anal continence and the improvement of the patients' quality of life in general are primary objectives of colorectal surgery. Earlier the loss of the entire rectum, colon required a definitive stoma. This review describes surgical procedures designed to preserve anal continence. This paper also describes operative techniques designed to improve impaired sphincter function. Total extirpation of the mesorectum reduces local recurrence of rectal tumours. At the same time, this operation requires formation of the anastomosis low, at the level of the levator muscle. Low colorectal or coloanal anastomoses are associated with higher incidence of suture leakage and poor functional outcome. The distance between anastomosis and anal verge was less than 7 cm in 249 sphincter-sparing rectal resections performed during the examined 6-year period in our institute. Different techniques to perform anastomoses were applied, the prevalence of suture leakage and the functional results are analysed. Restorative proctocolectomy has dramatically improved the treatment of familial polyposis and ulcerative colitis with rectal involvement. Although proctocolectomy is necessary to cure the disease, acceptable faecal continence can be achieved by creating ileoanal anastomosis with ileal reservoir. We discuss our results after 43 operations. Weakness of the sphincter apparatus is the most common cause of continence problems. Occasionally, the sphincter is no longer suitable for reconstruction because of extensive damage or denervation. In such cases, the levator muscles or--if neither these are of acceptable quality--the gluteus maximus muscle can be used to repair the external sphincter. Anterior levator plasty involves tightening the levator plate by suturing its arches together between the rectum and the vagina. This procedure enhances the resistance of the sphincter barrier primarily by increasing functional sphincter length. The functional outcome of this procedure was acceptable in two-thirds of the 52 operations. Post anal repair was performed only in 3 patients. This method comprises reinforcing the levator plate through an access between the external and the internal sphincters. When the levator plate is unsuitable, bilateral gluteus plasty can be performed to increase the strength of sphincter muscles. As the gluteus is a striated muscle it can improve only the of the external sphincter function. Therefore this procedure can restore acceptable continence to hard stool only. This is demonstrated by our clinical experience obtained in 10 patients. PMID:11432169

  13. Anal Cancer

    MedlinePLUS

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

  14. [Anal endosonography: the study technic and the correlations between the normal and echographic anatomy].

    PubMed

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

    1996-03-01

    The authors report on 16 healthy volunteers examined with anal endosonography. The US examinations were performed with a dedicated Bruel and Kjaer 1846 unit equipped with a 7-MHz probe (type 1850) with 360 degrees circular mechanic movement. A rigid plastic cone filled of degassed water is mounted on the probe to ensure the symmetrical representation of the anal canal. A condom with gel on both the internal and the external surfaces is put on the cone. The peculiar anatomy of the single layers which form the anal canal determines their different US patterns. Endosonography was performed on three levels, i.e., deep, intermediate and superficial planes. In the deep plane (at the anorectal junction) anal endosonography demonstrates: epithelial-subepithelial complex (intermediate echogenicity); internal sphincter muscle (low echogenicity), made of smooth muscular fibers; longitudinal muscle (intermediate echogenicity), made of smooth and striated muscular fibers; puborectal muscle (high echogenicity), made of striated muscular fibers, and perineal body, which has a longitudinal shape in men and a transverse shape in women. In the intermediate plane anal endosonography demonstrates: epithelial-subepithelial complex, internal sphincter muscle, longitudinal muscle, and external sphincter muscle (high echogenicity), made of striated muscular fibers. In the superficial plane (distal anal canal extremity), anal endosonography demonstrates: epithelial-subepithelial complex and external sphincter muscle. Internal sphincter muscle thickness was measured and the results follow: while the average thickness was 2.1 mm, we had 1.8 mm in 12 patients under 44 and 2.6 mm in 4 patients over 44 years old. This finding is in agreement with literature data. External sphincter muscle thickness did not vary significantly in the two groups. PMID:8628939

  15. Anal Cancer

    MedlinePLUS

    ... Cancer.Net Editorial Board , which is composed of medical, surgical, radiation, gynecologic, and pediatric oncologists, oncology nurses, physician assistants, social workers, and patient advocates. Cancer.Net Guide Anal Cancer ...

  16. 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 ...

  17. Factors affecting sphincter-preserving resection treatment for patients with low rectal cancer

    PubMed Central

    SUN, ZHENQIANG; YU, XIANBO; WANG, HAIJIANG; MA, MING; ZHAO, ZELIANG; WANG, QISAN

    2015-01-01

    The aim of the present study was to identify the factors associated with the use of sphincter-preserving resection (SPR) surgery for the treatment of low rectal cancer. A total of 330 patients with histopathologically confirmed low rectal cancer were divided into two groups, namely the abdominoperineal resection (APR) and sphincter-preserving (SP) groups. For SPR factor analysis, the ?2 test was performed as the univariate analysis, while a logistic regression test was conducted as the multivariate analysis. Of the 330 patients, 192 cases (58.18%) received SPR surgery and 138 cases (41.82%) underwent an APR. Univariate analysis results revealed that the sphincter-preserving factor was significantly associated with age, gender, ethnicity, body mass index (BMI), total infiltrated circumference, distance of the tumor from the anal verge (DTAV), depth of invasion and tumor grade (P<0.05). However, there were no statistically significant associations with family medical history, diabetes history, venous tumor embolism, growth type, tumor length, lymphatic metastasis and level of preoperative carcinoembryonic antigen (P>0.05). Multivariate analysis indicated that the sphincter-preserving factor was strongly associated with DTAV and the depth of invasion, with significant statistical difference (P<0.05). Therefore, selecting SPR surgery for patients with low rectal cancer is dependent on age, gender, ethnicity, BMI, the total infiltrated circumference, DTAV, depth of invasion and tumor grade. In addition, DTAV and the depth of invasion are independent risk factors for the selection of SPR surgery.

  18. 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 3–5. In group II the rate of excellent and good scores was 81% (13/16). All patients have an appropriate size anus and regular bowel actions. There has been no rectal prolapse, or anal stricture. EAS activity and perineal proprioception were preserved postoperatively. Follow up computed tomogram showed central placement the pull through bowel in between the muscle complex. Conclusion The technique of SSARP allows safe and anatomical reconstruction in a significant proportion of patients with ARM's without the need to divide the levator plate and muscle complex. It preserves all the components contributing to superior faecal continence, and avoids the potential complications associated with the open posterior sagittal approach. PMID:17892560

  19. 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.

  20. 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

  1. Anal pressures in hemorrhoids and anal fissure.

    PubMed

    Arabi, Y; Alexander-Williams, J; Keighley, M R

    1977-11-01

    Maximal anal pressures have been measured after proctoscopy in 145 patients with hemorrhoids, 48 patients with anal fissure, and 78 asymptomatic control subjects. Anal pressures in patients with hemorrhoids (106 +/- 40 cm H2O) and anal fissure (130 +/- 43 cm H2O) were very significantly higher than those of controls (88 +/- 34 cm H2O) (P less than 0.001). Because patients with anal fissure have high anal pressures, these patients should benefit from manual dilatation of the anus or lateral subcutaneous sphincterotomy; however, only young male patients with hemorrhoids have anal pressures that are significantly higher than age- and sex-matched controls. Digital assessment and the two finger test are unreliable indicators of high anal pressure. These results indicate that measurement of anal pressure is useful in assessing the suitability of manual dilatation or sphincterotomy in the treatment of hemorrhoids. PMID:920890

  2. Stages of Anal Cancer

    MedlinePLUS

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

  3. Excitatory and inhibitory enteric innervation of horse lower esophageal sphincter.

    PubMed

    Chiocchetti, R; Giancola, F; Mazzoni, M; Sorteni, C; Romagnoli, N; Pietra, M

    2015-06-01

    The lower esophageal sphincter (LES) is a specialized, thickened muscle region with a high resting tone mediated by myogenic and neurogenic mechanisms. During swallowing or belching, the LES undergoes strong inhibitory innervation. In the horse, the LES seems to be organized as a "one-way" structure, enabling only the oral-anal progression of food. We characterized the esophageal and gastric pericardial inhibitory and excitatory intramural neurons immunoreactive (IR) for the enzymes neuronal nitric oxide synthase (nNOS) and choline acetyltransferase. Large percentages of myenteric plexus (MP) and submucosal (SMP) plexus nNOS-IR neurons were observed in the esophagus (72 ± 9 and 69 ± 8 %, respectively) and stomach (57 ± 17 and 45 ± 3 %, respectively). In the esophagus, cholinergic MP and SMP neurons were 29 ± 14 and 65 ± 24 vs. 36 ± 8 and 38 ± 20 % in the stomach, respectively. The high percentage of nitrergic inhibitory motor neurons observed in the caudal esophagus reinforces the role of the enteric nervous system in the horse LES relaxation. These findings might allow an evaluation of whether selective groups of enteric neurons are involved in horse neurological disorders such as megaesophagus, equine dysautonomia, and white lethal foal syndrome. PMID:25578519

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

  5. 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

  6. 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

  7. 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

  8. Amoebic anal fistula: new insight into an old disease.

    PubMed

    Agrawal, Vivek; Garg, Pankaj Kumar; Jain, Bhupendra Kumar; Mishra, Kiran; Mohanty, Debajyoti

    2014-04-01

    A 67-year-old gentleman underwent fistulectomy for low trans-sphincteric anal fistula along with curettage for an associated abscess extending proximally for half a centimeter into the intersphincteric plane. The roof of the cavity became clearly visible after satisfactory culmination of the surgical procedure. Histopathological examination of the fistulous tract and the curetted granulation tissue revealed presence of multiple trophozoites of Entamoeba histolytica exhibiting erythrophagocytosis in the background of mixed inflammatory infiltrate. This case report provides the outlook that yields the novel insight into the possible role of Entamoeba histolytica in the pathogenesis and persistence of the fistulous tract. PMID:25053686

  9. Adynamic and dynamic muscle transposition techniques for anal incontinence

    PubMed Central

    Bariši?, Goran; Krivokapi?, Zoran

    2014-01-01

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

  10. 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

  11. Treatment Option Overview (Anal Cancer)

    MedlinePLUS

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

  12. 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

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

    PubMed

    Bernard, D; Tassé, 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

  14. Designing micro- and nanostructures for artificial urinary sphincters

    NASA Astrophysics Data System (ADS)

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

  15. Opening mechanisms of the human upper esophageal sphincter IAN J. COOK, WYLIE J. DODDS, ROBERTO 0. DANTAS, BENSON MASSEY,

    E-print Network

    Brasseur, James G.

    relaxation, anterior laryngeal traction, and intrabolus pressure, 2) volume-dependent adaptive changes in UES centers. pharyngoesophageal sphincter; laryngeal motion; hyoid motion THE UPPER ESOPHAGEAL SPHINCTER (UES

  16. Can Anal Cancer Be Prevented?

    MedlinePLUS

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

  17. Inhibitory effect of coffee on lower esophageal sphincter pressure.

    PubMed

    Thomas, F B; Steinbaugh, J T; Fromkes, J J; Mekhjian, H S; Caldwell, J H

    1980-12-01

    We examined the effect of 150 ml of caffeinated instant coffee at two pHs, 4.5 and 7.0, on lower esophageal sphincter pressure in 20 normal volunteers and 16 patients with reflux esophagitis. When ingested alone coffee at pH 4.5 and 7.0 caused a decrease in basal sphincter pressure in normal volunteers from 19.4 +/- 1.5 to 13.7 +/- 1.0 mmHg (P ¿ 0.01) and from 18.7 +/- 1.5 to 16.0 +/- 0.8 mmHg (P < 0.05) respectively. When coffee at pH 4.5 was drunk with a mixed nutrient test meal, the resting sphincter pressure in normal subjects fell after 30-60 min with the nadir, 11.2 +/- 1.0 mmHg, being recorded at 60 min (P < 0.01). Coffee at pH 7.0 with the test meal resulted in a fall in pressure to 14.3 +/- 1.5 mmHg (P < 0.02) at 60 min. In patients with reflux esophagitis, coffee at pH 4.5 lowered lower esophageal sphincter pressure from 9.1 +/- 1.0 to 5.5 +/- 0.6 mmHg (P < 0.005); coffee at pH 7.0 decreased lower esophageal sphincter pressure from 8.5 +/- 1.1 to 6.9 +/- 0.7 mmHg (P < 0.05). In these patients, mean basal pressure, 9.2 +/- 0.8 mmHg, decreased to 5.2 +/- 0.7 mmHg (P < 0.001) 45 min after drinking coffee at pH 4.5 with the test meal. Coffee at the neutral pH caused a fall in pressure from 8.8 +/- 1.1 to 6.5 +/- 0.7 mmHg at 60 min after the test meal. Thus, coffee at either pH 4.5 or 7.0 caused a decrease in fasting and postcibal lower esophageal sphincter pressure in normal volunteers and patients with reflux esophagitis. The magnitude and the duration of the effect were greater after coffee at the lower pH. These data support the clinical belief that coffee may cause or aggravate heartburn by decreasing lower esophageal sphincter pressure. PMID:7002705

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

    PubMed Central

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

    2012-01-01

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

  19. Functional coupling between motor and sensory nerves through contraction of sphincters in the pudendal area of the female cat.

    PubMed

    Lagunes-Córdoba, Roberto; Hernández, Pablo Rogelio; Raya, José Guadalupe; Muñoz-Martínez, E J

    2010-01-01

    The question of whether skin receptors might help in the perception of muscle contraction and body movement has not been settled. The present study gives direct evidence of skin receptor firing in close coincidence with the contraction of the vaginal and anal sphincters. The distal stump of the sectioned motor pudendal nerve was stimulated. Single shocks induced a wavelike increase in the lumen pressure of the distal vagina and the anal canal, as well as constriction of the vaginal introitus and the anus. The constriction pulls on and moves the surrounding skin, which was initially detected visually. In the present experiments, a thin strain gauge that pressed on the skin surface detected its displacement. Single shocks to the motor nerve induced a wave of skin movement with maximal amplitude at 5 mm from the anus and propagated with decrement beyond 35 mm. The peripheral terminals of the sensory pudendal nerve and the posterior femoral nerve supply the skin that moves. Sensory axons from both nerves fired in response to both tactile stimulation and the skin movement produced by the constriction of the orifices (motor-sensory coupling). In cats with all nerves intact, a single shock to the sensory nerves induced reflex waves of skin movement and lumen pressure (sensory-motor coupling). Both couplings provide evidence for a feedforward action that might help to maintain the female posture during mating and to the perception of muscle contraction. PMID:19846621

  20. 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

  1. Treatment Options by Stage (Anal Cancer)

    MedlinePLUS

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

  2. 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, ...

  3. 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.

  4. 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.

  5. Surgical management of anal cancer.

    PubMed

    Gilshtein, H; Khoury, W

    2015-04-01

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

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

    PubMed Central

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

    2004-01-01

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

  7. 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 Goligher’s 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

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

  9. Supersonic Rupture of Rubber

    E-print Network

    M Marder

    2005-04-24

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

  10. General Information about Anal Cancer

    MedlinePLUS

    ... Anal cancer is a disease in which malignant (cancer) cells form in the tissues of the anus. The ... diagnosed, tests are done to find out if cancer cells have spread within the anus or to other ...

  11. 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.

  12. 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

  13. Ruptured intracranial dermoid cyst

    PubMed Central

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

    2012-01-01

    Rupture of an intracranial dermoid cyst is a rare event with considerable associated morbidity and potential mortality. We present a case of intracranial rupture of a dermoid cystic tumor with consequent dissemination of subarachnoid fat droplets resulting in acute aseptic chemical meningitis. Radiographic findings, operative treatment, and pathologic features are described. PMID:22275778

  14. What Are the Risk Factors for Anal Cancer?

    MedlinePLUS

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

  15. 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

  16. 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

  17. 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 8 × 8 cm, 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

  18. 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

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

    E-print Network

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

    2014-01-01

    307 308 Authorship contributions 309 CA, AA and AP conceived of and designed the study. CA collected and analyzed the data. 310 CA, AA and AP interpreted the data and wrote the manuscript. 311 14 312 313 314 315 316 References 317 1... and 368 Gynaecologists. March 2007. 369 20. National Collaborating Centre for Women's and Children's Health. Intrapartum 370 Care: care of healthy women and their babies during childbirth. RCOG Press; 2007, 371 updated 2008. 372 21. Poen AC, Felt...

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

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

  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. 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

  3. 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

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

    PubMed Central

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

    2007-01-01

    Quantifications of gastro-oesophageal anatomy in cadavers have led some to identify the lower oesophageal sphincter (LOS) with the anatomical gastric sling-clasp fibres at the oesophago-cardiac junction (OCJ). However, in vivo studies have led others to argue for two overlapping components proximally displaced from the OCJ: an extrinsic crural sphincter of skeletal muscle and an intrinsic physiological sphincter of circular smooth-muscle fibres within the abdominal oesophagus. Our aims were to separate and quantify in vivo the skeletal and smooth muscle sphincteric components pharmacologically and clarify the description of the LOS. In two protocols an endoluminal ultrasound-manometry assembly was drawn through the human gastro-oesophageal segment to correlate sphincteric pressure with the anatomic crus. In protocol I, fifteen normal subjects maintained the costal diaphragm at inferior/superior positions by full inspiration/expiration (FI/FE) during pull-throughs. These were repeated after administering atropine to suppress the cholinergic smooth-muscle sphincter. The cholinergic component was reconstructed by subtracting the atropine-resistant pressures from the full pressures, referenced to the anatomic crus. To evaluate the extent to which the cholinergic contribution approximated the full smooth-muscle sphincter, in protocol II seven patients undergoing general anaesthesia for non-oesophageal pathology were administered cisatracurium to paralyse the crus. The smooth-muscle sphincter pressures were measured after lung inflation to approximate FI. The cholinergic smooth-muscle pressure profile in protocol I (FI) matched closely the post-cisatracurium smooth-muscle pressure profile in protocol II, and the atropine-resistant pressure profiles correlated spatially with the crural sling during diaphragmatic displacement. Thus, the atropine-resistant and cholinergic pressure contributions in protocol I approximated the skeletal and smooth muscle sphincteric components. The smooth-muscle pressures had well-defined upper and lower peaks. The upper peak overlapped and displaced rigidly with the crural sling, while the distal peak separated from the crus/upper-peak by 1.1 cm between FI and FE. These results suggest the existence of separate upper and lower intrinsic smooth-muscle components. The ‘upper LOS’ overlaps and displaces with the crural sling consistent with a physiological LOS. The distal smooth-muscle pressure peak defines a ‘lower LOS’ that likely reflects the gastric sling/clasp muscle fibres at the OCJ. The distinct physiology of these three components may underlie aspects of normal sphincteric function, and complexity of sphincter dysfunction. PMID:17289789

  5. 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

  6. 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

  7. Arachnoid cyst spontaneous rupture.

    PubMed

    Marques, Inês Brás; Vieira Barbosa, José

    2014-01-01

    Arachnoid cysts are benign congenital cerebrospinal fluid collections, usually asymptomatic and diagnosed incidentally in children or adolescents. They may become symptomatic after enlargement or complications, frequently presenting with symptoms of intracranial hypertension. We report an unusual case of progressive refractory headache in an adult patient due to an arachnoid cyst spontaneous rupture. Although clinical improvement occurred with conservative treatment, the subdural hygroma progressively enlarged and surgical treatment was ultimately needed. Spontaneous rupture is a very rare complication of arachnoid cysts. Accumulation of cerebrospinal fluid accumulation in the subdural space causes sustained intracranial hypertension that may be life-threatening and frequently requires surgical treatment. Patients with arachnoid cysts must be informed on their small vulnerability to cyst rupture and be aware that a sudden and severe headache, especially if starting after minor trauma or a Valsalva manoeuvre, always requires medical evaluation. PMID:24581205

  8. 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

  9. 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

  10. 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 0–7), or race (14% Caucasian, 80% African American). PFS parameters were not significantly different within medication groups. No significant pre-post changes in CNE values were noted; however, trends in amplitudes were in a direction consistent with the expected physiologic effect of the medications. With CPT testing, a trend toward increased urethral sensation at the 5 Hz stimulation level, was observed following treatment with pseudoephedrine (0.15 to 0.09 mA at 5Hz; P=0.03). Conclusion In women without LUTS, pseudoephedrine improved urethral sensation, but not urethral neuromuscular function on CNE or pressure flow studies. Imipramine, cyclobenzaprine, tamsulosin, solifenacin, and placebo did not change urethral sensation or neuromuscular function. PMID:25185603

  11. 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.

  12. 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 51±12 years) underwent closure of a high trans-sphincteric (n=28) or supra-sphincteric (n=12) fistula with Gore BioA Fistula Plug® in three surgical departments. The surgical procedures had been performed by five colorectal surgeons. Four patients had Crohn’s disease. Preoperatively 33 patients were completely continent; seven patients complained of minor continence disorders. Treatment of the patients was performed on a intent-to-treat basis and evaluation of the results was retrospective using pooled data from each center. Results: Postoperatively one patient developed an abscess, which had to be managed surgically. In two patients the plug had fallen out within the first two weeks postoperatively. Six months after surgery the fistula has been healed in 20 patients (50.0%). Three additional fistulas healed after 7, 9 rsp. 12 months. The overall healing-rate was 57.5% (23/40). The healing rate differs considerably between the surgeons from 0 to 75% and depends on the number of previous interventions. In patients having only drainage of the abscess success occurred in 63.6% (14/22) whereas in patients after one or more flap fistula reconstruction the healing rate decreased slightly to 50% (9/18). No patient complained about any impairment of his preoperative continence status. Conclusion: By occlusion of high anal fistulas with a plug technique definitive healing could be achieved in nearly every second patients. Previous surgery seems to have a negative impact on success rate. We have not observed any negative impact on anal continence. From that point of view anal fistula plugs might be discussed as a treatment option for high anal fistulas, but further studies are needed to gain conclusive evidence. PMID:22984363

  13. [Pathogenesis and morphology of anal fistulas].

    PubMed

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

  14. Intramuscular triceps rupture.

    PubMed

    O'Driscoll, S W

    1992-04-01

    A 25-year-old man who had a complete intramuscular rupture of the long head of the triceps was treated nonoperatively and followed up prospectively for 10 years. The injury occurred after 4 days of white-water kayaking without any direct blow. Strengthening was performed by doing push-ups. Nine years of isokinetic testing revealed that isometric strength was normal, but endurance testing was reduced by 5% to 10%. Ruptures of the muscle belly can occur due to direct trauma or by forced elbow flexion during triceps contraction. From this and the few case reports available it appears that nonoperative treatment is effective and recommended for patients who do not require significant endurance strength in elbow extension. Whether or not the results can be improved by surgical repair is uncertain. PMID:1562935

  15. 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

  16. Motor function of the opossum sphincter of Oddi.

    PubMed Central

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

    1983-01-01

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

  17. 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 2011–2012 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 53–67%; the highest level of agreement was noted for the assessment of branching. PMID:26676232

  18. Can Anal Cancer Be Found Early?

    MedlinePLUS

    ... helpful. Anal cancer is not common in the United States, so screening the general public for anal cancer ... Help Site Map Privacy Accessibility Terms of ... The American Cancer Society is a qualified 501(c)(3) tax-exempt organization. Cancer.org is provided courtesy of ...

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

    PubMed Central

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

    1999-01-01

    BACKGROUND—Topical application of glyceryl trinitrate (GTN) ointment heals chronic anal fissures, providing an alternative to the traditional first line treatment of surgical sphincterotomy. ?AIMS—To determine the most effective dose of topical GTN for treatment of chronic anal fissures and to assess long term results. ?METHODS—Seventy consecutive patients with chronic anal fissure, were randomly allocated to eight weeks treatment with placebo, 0.2% GTN three times daily, or GTN starting at 0.2% with weekly 0.1% increments to a maximum of 0.6%, in a double blind study. ?RESULTS—After eight weeks fissure had healed in 67% of patients treated with GTN compared with 32% with placebo (p=0.008). No significant difference was seen between the two active treatments. Headaches were reported by 72% of patients on GTN compared with 27% on placebo (p<0.001). Maximum anal sphincter pressure reduced significantly from baseline by GTN treatment (p=0.02), but not placebo (p=0.8). Mean pain scores were lower after treatment with GTN compared with placebo (NS). Of fissures healed with placebo 43% recurred, compared with 33% of those healed with 0.2% GTN and 25% healed with escalating dose GTN (p=0.7). ?CONCLUSIONS—GTN is a good first line treatment for two thirds of patients with anal fissure. An escalating dose of GTN does not result in earlier healing. Significant recurrence of symptomatic fissures and a high incidence of headaches are limitations of the treatment. ?? Keywords: glyceryl trinitrate; anal fissures PMID:10205213

  20. [Achilles tendon rupture].

    PubMed

    Thermann, H; Hüfner, 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

  1. 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…

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

    E-print Network

    Kounaves, Samuel P.

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

  3. 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.

  4. 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

  5. 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

  6. Spontaneous Iliac Vein Rupture

    PubMed Central

    Kim, Dae Hwan; Park, Hyung Sub; Lee, Taeseung

    2015-01-01

    Spontaneous iliac vein rupture (SIVR) is a rare entity, which usually occurs without a precipitating factor, but can be a life-threatening emergency often requiring an emergency operation. This is a case report of SIVR in a 62-year-old female who presented to the emergency room with left leg swelling. Workup with contrast-enhanced computed tomography revealed a left leg deep vein thrombosis with May-Thurner syndrome and a hematoma in the pelvic cavity without definite evidence of arterial bleeding. She was managed conservatively without surgical intervention, and also underwent inferior vena cava filter insertion and subsequent anticoagulation therapy for pulmonary thromboembolism. This case shows that SIVR can be successfully managed with close monitoring and conservative management, and anticoagulation may be safely applied despite the patient presenting with venous bleeding. PMID:26217647

  7. Anal Disorders - Multiple Languages: MedlinePlus

    MedlinePLUS

    ... List of All Topics All Anal Disorders - Multiple Languages To use the sharing features on this page, please enable JavaScript. Arabic (???????) French (français) Hindi (??????) Japanese (???) Korean (???) Russian (???????) Somali (af Soomaali) Spanish (español) ...

  8. [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

  9. 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

  10. Alternative salvage technique for removing large sharp foreign body near upper esophageal sphincter.

    PubMed

    Hyun, Jong Jin; Chun, Hoon Jai; Keum, Bora; Seo, Yeon Seok; Kim, Yong Sik; Jeen, Yoon Tae; Lee, Hong Sik; Um, Soon Ho; Kim, Chang Duck; Ryu, Ho Sang

    2012-02-01

    Removing sharp foreign bodies located in the esophagus can be dangerous and challenging. Proper apparatus and appropriate technique should be employed to avoid life-threatening complications such as perforation and mediastinitis. A 59-year-old man came to the emergency department with foreign body sensation in the upper esophagus which proved to be a large sharp fish bone impacted near upper esophageal sphincter. With the ordinary upper endoscope, the foreign body could not be retrieved even with the assistance of a cap. Foreign body removal was attempted again using a colonoscope with cap fitted at the end. Larger caliber of the scope rendered more stable support within the lumen enabling better maneuver of the scope tip to secure wider working space, and application of the cap permitted better visual field. Herein, we report the first case of successful removal of a large sharp fish bone impacted near the upper esophageal sphincter using cap assisted colonoscope. PMID:22318080

  11. Steam generator tube rupture study

    E-print Network

    Free, Scott Thomas

    1986-01-01

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

  12. Blood vessel rupture by cavitation.

    PubMed

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

    2010-08-01

    Cavitation is thought to be one mechanism for vessel rupture during shock wave lithotripsy treatment. However, just how cavitation induces vessel rupture remains unknown. In this work, a high-speed photomicrography system was set up to directly observe the dynamics of bubbles inside blood vessels in ex vivo rat mesenteries. Vascular rupture correlating to observed bubble dynamics were examined by imaging bubble extravasation and dye leakage. The high-speed images show that bubble expansion can cause vessel distention, and bubble collapse can lead to vessel invagination. Liquid jets were also observed to form. Our results suggest that all three mechanisms, vessel distention, invagination and liquid jets, can contribute to vessel rupture. PMID:20680255

  13. Blood vessel rupture by cavitation

    PubMed Central

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

    2011-01-01

    Cavitation is thought to be one mechanism for vessel rupture during shock wave lithotripsy treatment. However, just how cavitation induces vessel rupture remains unknown. In this work, a high-speed photomicrography system was set up to directly observe the dynamics of bubbles inside blood vessels in ex vivo rat mesenteries. Vascular rupture correlating to observed bubble dynamics were examined by imaging bubble extravasation and dye leakage. The high-speed images show that bubble expansion can cause vessel distention, and bubble collapse can lead to vessel invagination. Liquid jets were also observed to form. Our results suggest that all three mechanisms, vessel distention, invagination and liquid jets, can contribute to vessel rupture. PMID:20680255

  14. 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.

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

    PubMed

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

    2015-04-01

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

  16. 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 ...

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

    E-print Network

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

    2012-09-08

    -genital mucosae (cervix, vagina, vulva, anus and penis) are oncogenic viruses causing ~ 5.2% of total human cancers [1]. Like cervical cancer, squamous cell carcinoma of the anus (anal SCC) is thought to be preceded by a spectrum of intra- epithelial changes, anal... , not sexual preference; increases in incidence were shown before the advent of the HIV epidemic [3]. The majority of studies of prevalence of anal HPV infection and AIN have been in the MSM cohort, especially HIV-positive MSM, as this is the highest risk group...

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

    E-print Network

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

  19. Special Issue 3 2011 J Anal Bioanal Techniques

    E-print Network

    Lamond, Angus I.

    Special Issue 3 · 2011 J Anal Bioanal Techniques ISSN:2155-9872 JABT, an open access journal Open AccessResearch Article Analytical & Bioanalytical Techniques Have et al. J Anal Bioanal Techniques 2011 Novelties and Future Directions. J Anal Bioanal Techniques S3:001. doi:10.4172/2155-9872. S3-001 Copyright

  20. 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,…

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

    E-print Network

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

  2. 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

  3. 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

  4. Spontaneous rupture of a neobladder.

    PubMed

    Martínez Jabaloyas, J M; Vera Donoso, C D; Morera Martínez, J F; Ruiz Cerdá, J L; Beamud Gómez, A; Jiménez Cruz, J F

    1994-01-01

    The spontaneous rupture of neobladder is an extremely rare entity of which there only exists one formerly reported case in the world literature. It is far more common after enterocystoplasty for augmentation (19 reported cases). We describe here the spontaneous rupture of a neobladder 8 months after performing cystectomy and bladder replacement by an enterocystoplasty in order to treat a bladder carcinoma. In this case the patient showed symptoms and signs of acute peritonitis. The diagnosis was carried out using a cystogram and the treatment consisted of a laparotomy with closure of the perforation and drainage of the peritoneal cavity. PMID:8200411

  5. 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

  6. 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…

  7. Analysis of anal secretions from phlaeothripine thrips.

    PubMed

    Suzuki, Takahisa; Haga, Kazuo; Tsutsumi, Tadaaki; Matsuyama, Shigeru

    2004-02-01

    The anal secretions of 16 phlaeothripine thrips species (Thysanoptera: Phlaeothripidae) were studied, including a reinvestigation of three species previously reported. A total of 37 components were detected, including hydrocarbons, acetates, terpenes, carboxylic acids, a quinone, an aromatic compound, and a pyranone compound. The secretions of all species were composed of some of these components, with Xylaplothrips inquilinus possessing as many as 11 components. Of these components, (Z)-9-octadecene, (Z)-9-nonadecene, nonadecadiene, octanoic acid, decanoic acid, geranial, neral, alpha-pinene, beta-pinene, caryophyllene, 2-hydroxy-6-methylbenzaldehyde, and two unidentified monoterpenes [UK-I (M+136) and UK-II (M+168)] were detected for the first time. The chemicals were species-specific; four Liothrips species and three Holothrips species could be distinguished from each other and their congeners by the GC profiles of the ether extracts of their anal secretions. The anal secretions of gall-inducing thrips commonly contained terpenes. of which citral (a mixture of geranial and neral) and beta-acaridial repelled ants or had antifungal activity. The findings suggest that these terpenes play a defensive role and prevent galls from fungal infestation. 3-Butanoyl-4-hydroxy-6-methyl-2H-pyran-2-one, found from three Holothrips spp., caused paralysis in ants. Chemical analysis of anal secretion components is a useful method for the classification of tubuliferan species that are difficult to distinguish on the basis of morphological characters. PMID:15112732

  8. 46 CFR 64.61 - Rupture disc.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  9. 46 CFR 64.61 - Rupture disc.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  10. 46 CFR 64.61 - Rupture disc.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  11. 46 CFR 64.61 - Rupture disc.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  12. 46 CFR 64.61 - Rupture disc.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  13. 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

  14. Spontaneous rupture of vaginal enterocele.

    PubMed

    Svendsen, J H; Galatius, H; Hansen, P K

    1985-01-01

    Spontaneous rupture of an enterocele is a rare complication. Only 24 cases including the present case have been reported in the literature. The patients were elderly and had had at least one vaginal operation. The patients were remarkably unaffected symptomatically on admission. PMID:4015021

  15. 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

  16. 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

  17. 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

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

    PubMed Central

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

    2003-01-01

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

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

    PubMed

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

    1979-01-01

    A prospective randomized trial has compared manual dilatation of the anus (MDA)during general anesthesia with lateral subcutaneous spincterotomy (LSS) during local anesthesia for the management of anal fissure in 156 patients. The two groups were similar with respect to age, sex and symptoms. There was no difference in the duration of time off work or early complications of treatment but, four months after operation, 93 per cent claimed to have been improved by MDA compared with 78 per cent after LSS (P less than 0.05). Recurrent fissure was recorded in 13 patients after LSS (29 per cent) compared with four (10 per cent) after MDA (P less than 0.02). There was a significant reduction in anal pressure at four months (P less than 0.02) after MDA, (123 +/- 31 to 97 +/-33) and LSS (127 +/- 36 to 104 +/- 32), but the anal pressure remained unchanged by operation in all patients where pressures were measured with recurrent fissure. These data indicate that MDA gives better results than LSS for treatment of anal fissure and that successful treatment is associated with a reduction in anal pressure. PMID:467194

  20. 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

  1. Achilles tendon rupture in badminton.

    PubMed Central

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

  2. 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], 1.28–10.40 and OR, 4.24; 95% CI, 1.16–15.51, respectively). History of smoking (OR, 2.71 95% CI, 1.43–5.14), duration, recency, and dose of smoking increased the risk of anal precancer among carcinogenic HPV-positive men but had no association with HPV infection. Conclusions.?We found distinct risk factors for anal HPV infection and anal precancer. Risk factors for HPV infection and anal precancer are similar to established risk factors for cervical cancer progression. PMID:23908478

  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. The deterministic nature of earthquake rupture.

    PubMed

    Olson, Erik L; Allen, Richard M

    2005-11-10

    Understanding the earthquake rupture process is central to our understanding of fault systems and earthquake hazards. Multiple hypotheses concerning the nature of fault rupture have been proposed but no unifying theory has emerged. The conceptual hypothesis most commonly cited is the cascade model for fault rupture. In the cascade model, slip initiates on a small fault patch and continues to rupture further across a fault plane as long as the conditions are favourable. Two fundamental implications of this domino-like theory are that small earthquakes begin in the same manner as large earthquakes and that the rupture process is not deterministic--that is, the size of the earthquake cannot be determined until the cessation of rupture. Here we show that the frequency content of radiated seismic energy within the first few seconds of rupture scales with the final magnitude of the event. We infer that the magnitude of an earthquake can therefore be estimated before the rupture is complete. This finding implies that the rupture process is to some degree deterministic and has implications for the physics of the rupture process. PMID:16281033

  5. 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

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

    PubMed Central

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

    1997-01-01

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

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

    PubMed Central

    Devesa, José Manuel; Vicente, Rosana

    2014-01-01

    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

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

    PubMed

    Athanasiadis, S; Köhler, 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

  9. Laparoscopic implantation of an artificial urinary sphincter around the prostatic urethra

    PubMed Central

    Ch?osta, Piotr; Aboumarzouk, Omar; Bondad, Jasper; Szopi?ski, Tomasz; Korzelik, Ignacy; Borówka, Andrzej

    2015-01-01

    Objective To report the first laparoscopic periprostatic implantation of an artificial urinary sphincter (AUS) after a transurethral resection of the prostate. Background The implantation of an AUS is a standard procedure for severe urinary incontinence. In men it is usually implanted through a perineal approach, with the cuff placed around the bulbous urethra, bladder neck, or even around the prostate. Method We report a laparoscopic periprostatic implantation of an AUS after a transurethral resection of a prostate in a 72-year-old-man with incontinence. Results The operative duration was 180 min and the blood loss was 150 mL. There were no complications. After activating the AUS the patient was totally continent. Conclusion The laparoscopic periprostatic implantation of an AUS is a safe, effective and considerably less invasive procedure. PMID:26413345

  10. 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

  11. 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, ?5 chain-containing laminins are recommended for further improvements of myogenic differentiation protocols of MSCs into smooth muscle cells. PMID:26406476

  12. 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

  13. 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

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

    E-print Network

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

  15. 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

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

    PubMed Central

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

    2014-01-01

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

  17. 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.

  18. Rupture to the Trench: Dynamic Rupture Simulations of the 11 March 2011 Tohoku Earthquake

    E-print Network

    Dunham, Eric M.

    Rupture to the Trench: Dynamic Rupture Simulations of the 11 March 2011 Tohoku Earthquake on seismic surveys of the Japan Trench. The fault obeys rate-and-state friction with standard logarithmic of the fault driving the rupture through the velocity- strengthening region to the trench. We validate

  19. Sphincter of Oddi hypomotility and its relationship with duodenal-biliary reflux, plasma motilin and serum gastrin

    PubMed Central

    Zhang, Zhen-Hai; Wu, Shuo-Dong; Wang, Bing; Su, Yang; Jin, Jun-Zhe; Kong, Jing; Wang, Hao-Lin

    2008-01-01

    AIM: To detect whether patients with a T tube after cholecystectomy and choledochotomy have duodenal-biliary reflux by measuring the radioactivity of Tc99m-labeled diethylene triamine penta-acetic acid (DTPA) in the bile and whether the patients with duodenal-biliary reflux have sphincter of Oddi hypomotility, by measuring the level of plasma and serum gastrin of the patients. Finally to if there is close relationship among sphincter of Oddi hypomotility, duodenal-biliary reflux and gastrointestinal peptides. METHODS: Forty-five patients with a T tube after cholecystectomy and choledochotomy were divided into reflux group and control group. The level of plasma and serum gastrin of the patients and of 12 healthy volunteers were measured by radioimmunoassay. Thirty-four were selected randomly to undergo choledochoscope manometry. Sphincter of Oddi basal pressure (SOBP), amplitude (SOCA), frequency of contractions (SOF), duration of contractions (SOD), duodenal pressure (DP) and common bile duct pressure (CBDP) were scored and analyzed. RESULTS: Sixteen (35.6%) patients were detected to have duodenal-biliary reflux. SOBP, SOCA and CBDP in the reflux group were much lower than the control group (t = 5.254, 3.438 and 3.527, P < 0.001). SOD of the reflux group was shorter than the control group (t = 2.049, P < 0.05). The level of serum gastrin and plasma motilin of the reflux group was much lower than the control group (t = -2.230 and -2.235, P < 0.05). There was positive correlation between the level of plasma motilin and SOBP and between the level of serum gastrin and SOBP and CBDP. CONCLUSION: About 35.9% of the patients with a T tube after cholecystectomy and choledochotomy have duodenal-biliary reflux. Most of them have sphincter of Oddi hypomotility and the decreased level of plasma motilin and serum gastrin. The disorder of gastrointestinal hormone secretion may result in sphincter of Oddi dysfunction. There is a close relationship between sphincter of Oddi hypomotility and duodenal-biliary reflux. PMID:18609694

  20. Traumatic rectal hematoma following anal rape.

    PubMed

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

    1986-07-01

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

  1. 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

  2. Delayed spontaneous rupture of an ileocolonic neobladder.

    PubMed

    Thompson, S T; Kursh, E D

    1992-12-01

    A case of delayed spontaneous rupture of an ileocolonic neobladder and subsequent peritonitis 4 years after the initial operation is reported. Many of the features of this case are similar to those noted in recent reports of spontaneous rupture of an augmented bladder and it is postulated that the etiology is the same. PMID:1433631

  3. Myocardial infarction complicated by ventricular septal rupture.

    PubMed

    Sahjian, Michael; Ventriglia, Rich; Bolton, Lauri

    2012-01-01

    Transporting patients with an ST segment elevation myocardial infarction (STEMI) is a fairly common practice for most critical care transport teams. When a STEMI is complicated by ventricular septal rupture, the care can become more challenging, especially if the rupture is not yet diagnosed. This article describes such a transport and reviews the pathophysiology of the process along with treatment options. PMID:22225564

  4. FRP rupture strains in FRP wrapped columns 

    E-print Network

    Li, Shiqing

    2012-06-25

    and bending of the FRP ring at the gap due to change of curvature caused by the relative moment of the two half disks, as the FRP (as a brittle material) ruptures once the maximum strain at one of these locations reaches the FRP rupture strain. A list...

  5. 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

  6. 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

  7. [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

  8. 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, Rüdiger; Vaegler, Martin; Grözinger, Gerd; Claussen, Claus D; Kramer, Ulrich; Schmehl, Jörg

    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 µg/mL) and ferumoxide (200 µg/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

  9. Effect of cholesterol liposomes on calcium mobilization in muscle cells from the rabbit sphincter of Oddi

    PubMed Central

    Wang, Xin-Jiang; Wei, Jing-Guo; Wang, Chun-Mei; Wang, Yao-Cheng; Wu, Qiu-Zhen; Xu, Jia-Kuan; Yang, Xiang-Xin

    2002-01-01

    AIM: To analyze the influence of cholesterol liposome on the Ca2+ mobilization of cultured muscle cells in rabbit sphincter of Oddi’s. METHODS: New Zealand rabbit was sacrificed and the sphincter of Oddi (SO) segement was obtained aseptically. The SO segment was cut into pieces and cultured in DMEM solution. Then the smooth muscle cells were subcultured, and the 4th-7th passage cells were used for further investigation. The intracellular Ca2+ increase was measured under confocal microscope after the addition of 20 mmol·L-1 KCl, 10-7 mol·L-1 acetylcholine and 10-7 mol·L-1 cholecystokinin, and different antagonists were added to analyze the Ca2+ mobilization pathway. After the cells were incubated with 1 g·L-1 cholesterol liposome (CL)(molar ratio was-2:1), the intracellular Ca2+ increase was measured again to determine the effect of CL on cellular Ca2+ mobilization. RESULTS: The resting cellular calcium concentration of cultured SO cell was 108 nmol·L-1 ± 21 nmol·L-1. The intracellular Ca2+ increases induced by 20 mmol·L-1 KCl, 10-7 mol·L-1 ACh and 10-7 mol·L-1 CCK were 183% ± 56%, 161% ± 52% and 130% ± 43%, respectively. When the extracellular Ca2+ was eliminated by 2 mmol·L-1 EGTA and 5 ?mol·L-1 verapamil, the intracellular Ca2+ increases induced by KCl, ACh and CCK were 20% ± 14%, 82% ± 21% and 104% ± 23%, respectively. After the preincubation with heparin, the Ca2+ increases were 62% ± 23% and 23% ± 19% induced by ACh and CCK, as for preincubation with procaine they were 72% ± 28% and 85% ± 37% induced by ACh and CCK, respectively. Pretreatment with CL for 18 h, the resting cellular Ca2+ concentration elevated to 152 nmol·L-1 ± 26 nmol·L-1, however, the cellular Ca2+ increase percentages in response to these agonists were 67% ± 32%, 56% ± 33% and 34% ± 15%. CONCLUSION: KCl elicite the SO cellular Ca2+ increase depends on influx of extracellular Ca2+, ACh evoked the SO celllular Ca2+ increase is through the mobilization of intracellular Ca2+ pool and influx of extracellular Ca2+ as well, CCK excites the SO cells mainly through mobilization of intracellular IP3-sensitive Ca2+ store. After the incorporation with cholesterol liposome, KCl,ACh and CCK induced cellular Ca2+ increase percentages decreased. PMID:11833091

  10. Dual Implantation of Artificial Urinary Sphincter and Inflatable Penile Prostheses for Concurrent Male Urinary Incontinence and Erectile Dysfunction

    PubMed Central

    Al-Shaiji, Tariq F.

    2011-01-01

    Erectile dysfunction and urinary incontinence secondary to sphincter dysfunction are common conditions affecting many men worldwide with a negative effect on quality of life. They are encountered in a number of etiologies most commonly following radical prostatectomy in which they coexist in the same patient. Implantations of an artificial urinary sphincter and inflatable penile prosthesis have proven to be effective in the treatment of both conditions should conservative and minimally invasive measures fail. The recent literature has shown that dual implantation of these devices is feasible and safe with a durable clinical outcome. Once indicated, this can be done in a synchronous or nonsynchronous manner; however, the emerging of the single transverse scrotal incision as well as advancement in the prostheses has made synchronous dual implantation more favourable and appealing option. It provides time and cost savings with an evidence of high patient satisfaction. Synchronous dual implantation should be offered initially when indicated. This paper discusses the surgical techniques of artificial urinary sphincter and inflatable penile prosthesis dual implantation in the management of concurrent moderate-to-severe urinary incontinence and medically refractive erectile dysfunction, in addition to highlighting the existing literature pertaining to this approach. PMID:22162678

  11. 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

  12. 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

  13. Differential effects of urethane and isoflurane on external urethral sphincter electromyography and cystometry in rats

    PubMed Central

    Chang, Hui-Yi; Havton, Leif A.

    2008-01-01

    Urethane is a common and often preferred anesthetic agent for urodynamic recordings in rats, but its use is often restricted to terminal procedures because of a prolonged duration of action and potentially toxic effects. When urodynamic recordings are part of survival procedures in rodent experimental models, inhalation anesthetics, such as isoflurane, are frequently used and generally well tolerated. In this study, we compared the effects of urethane and isoflurane on lower urinary tract function. For this purpose, adult female rats were anesthetized by subcutaneous administration of urethane (n = 6) or by inhalation of isoflurane (n = 5). Micturition reflexes were assessed by concurrent cystometrogram and external urethral sphincter (EUS) electromyography (EMG) recordings to determine bladder contractile properties, EUS activation patterns, and the coordination between bladder contractions and EUS activation. Compared with urethane, isoflurane reduced frequency of bursts, firing frequency, and amplitude of EUS EMG activity during voiding as well as the EUS EMG amplitude during the bladder filling phase. Isoflurane also prolonged the bladder intercontractile intervals. Other several key functional aspects of the bladder contractile properties as well as the coordination between bladder contractions were not different between the two experimental groups. We conclude that micturition reflexes were differentially affected by isoflurane and urethane. Specifically, isoflurane exhibited a significant suppression of the EUS EMG activity and prolonged the bladder intercontractile intervals compared with urethane. We suggest that these anesthetic properties be taken into consideration during the experimental design and interpretation of urodynamic recordings in rodent models. PMID:18753298

  14. 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

  15. 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

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

    PubMed Central

    Cottrell, D F; Iggo, A

    1984-01-01

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

  17. 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

  18. The effects of paraoesophageal structures and vagotomy on the canine lower oesophageal sphincter function.

    PubMed

    Laitinen, S

    1977-01-01

    The effects of paraoesophageal structures and vagotomy on lower oesophageal sphincter (LOS) function were studied in the dog using modern oesophageal manometric technique. The isolation of the gastro-oesophageal junction from surrounding structures by a stiff-walled Silastic-tube led to a slight decrease in LOS pressure, but the difference was not statistically significant. LOS response to abdominal compression also decreased slightly, but the difference was without statistical significance. Bilateral transabdominal, transthoracic and cervical vagotomy did not produce any marked changes in resting LOS pressure, whereas a statistically significant decrease in LOS response to abdominal compression occurred after each type of vagotomy. The results suggest that the mechanism intrinsic to the gastro-oesophageal junction, the LOS, is mainly responsible for the maintenance of gastro-oesophageal competence, and the effect of extrinsic paraoesophageal structures is of minor importance. The vagus nerves apparently have no major role in the maintenance of resting LOS pressure. LOS response to increased intra-abdominal pressure seems to represent a genuine increase in LOS tone, to which extrinsic mechanical factors add only a small contribution. This response seems to be mediated by a vagal reflex arc, the afferent part of which has its origin below the diaphragm. PMID:603223

  19. Sphincter of Oddi dysfunction Type III: New studies suggest new approaches are needed.

    PubMed

    Wilcox, C Mel

    2015-05-21

    Sphincter of Oddi dysfunction (SOD) has been classified into three types based upon the presence or absence of objective findings including liver test abnormalities and bile duct dilatation. Type III is the most controversial and is classified as biliary type pain in the absence of any these objective findings. Many prior studies have shown that the clinical response to endoscopic therapy is higher based upon the presence of these objective criteria. However, there has been variable correlation of the manometry findings to outcome after endoscopic therapy. Nevertheless, manometry and sphincterotomy has been recommended for Type III patients given the overall response rate of 33%, although the reported response rates are highly variable. However, all of the prior data was non-blinded and non-randomized with variable follow-up. The evaluating predictors in SOD study - a prospective randomized blinded sham controlled one year outcome study showed no correlation between manometric findings and outcome after sphincterotomy. Furthermore, patients receiving sham therapy had a statistically significantly better outcome than those undergoing biliary or dual sphincterotomy. This study calls into question the whole concept of SOD Type III and, based upon prior physiologic studies, one can suggest that SOD Type III likely represents a right upper quadrant functional abdominal pain syndrome and should be treated as such. PMID:26019439

  20. 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 ?-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

  1. 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 ?-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

  2. PHARYNGEAL SWALLOWING: DEFINING PHARYNGEAL AND UPPER ESOPHAGEAL SPHINCTER RELATIONSHIPS IN HUMAN NEONATES

    PubMed Central

    Jadcherla, Sudarshan Rao; Gupta, Alankar; Stoner, Erin; Fernandez, Soledad; Shaker, Reza

    2008-01-01

    Objective To test the hypothesis that the sensory-motor characteristics of the reflexes evoked upon stimulation with air and water infusions differ, we studied the effect of pharyngeal stimulation on the pharyngeal-upper esophageal sphincter (UES) interactions in healthy neonates Study design Pharyngo-UES-esophageal manometry was recorded in 10 neonates at 39 ± 4 wk postmenstrual age. Pharyngeal infusions (n=155) of air (0.1–2.0 ml) and sterile water (0.1–0.5 ml) were given. Two types of reflexes were recognized: Pharyngeal reflexive swallowing (PRS) and pharyngo-UES-contractile reflex (PUCR). Frequency occurrence, distribution of reflexes, threshold volume, response time, and stimulus-response relationship were evaluated. Results The reflex response rate for air was 30% and was 76% for water (P<0.001). The frequency occurrence of PRS was greater than PUCR with air and water (P<0.05), although the stimulation thresholds and response latency were similar. Graded volumes of water but not air resulted in an increased frequency of PRS (P<0.01). Conclusions PRS is the most frequent response, and characteristics of the reflexes are distinct between air vs. water stimuli. These methods have implications for the evaluation of swallowing in infants. PMID:18035137

  3. 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

  4. 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 (20×10-6s). The observed results show that interface rupture propagation may accelerate (or even decelerate) and the dynamic rupture behavior is very sensitive to the geometry of the interface between the two films: (1) When the subsonic rupture front reaches the first rectangular corner, it accelerates around the corner and then advances supersonically along the interface; and (2) when the supersonic interface rupture front approaches the second corner (obtuse with respect to the rupture front in fluid), it bifurcates for a short period (400 ?s): the first branch unexpectedly expands rather straight into the bulk and the second one propagates along the interface at a lower speed; At a later stage, again unexpectedly, the first branched crack decelerates significantly in the bulk and the two cracks eventually merge into a single crack. The overall behavior is - in some sense - similar to that of the oblique shock and Prandtl- Meyer expansion waves in fluid mechanics, and it might give new insights not only into the question of high rupture speeds of natural earthquakes but also into the generation mechanism of tsunamis. u.ac.jp/~uenishi/

  5. 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 code’s results with the results of other dynamic rupture codes running the same earthquake simulation benchmark. To perform such a comparison consistently, it is necessary to have quantitative metrics. In this paper, we present a new method for quantitatively comparing the results of dynamic earthquake rupture computer simulation codes.

  6. 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…

  7. [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

  8. 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

  9. 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.

  10. [ 44] G.R. Long, S.E. Bialkowski, Anal. Chem. 56 (1984) [ 45] S.E. Bialkowski, G.R. Long, Anal. Chem. 59 (1987) 873.

    E-print Network

    Michel, Robert G.

    1984-01-01

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

  11. 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

  12. 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

  13. En bloc pelvic lymphadenectomy and sphincter preservation in the surgical management of rectal cancer.

    PubMed Central

    Enker, W E; Pilipshen, S J; Heilweil, M L; Stearns, M W; Janov, A J; Hertz, R E; Sternberg, S S

    1986-01-01

    From 1968-1976, 412 patients were operated on for rectal cancers. One hundred fifty-six underwent abdominoperineal resection (APR) and 256 underwent low anterior resection (LAR). One hundred ninety-two underwent en bloc pelvic lymphadenectomy in conjunction with their resection, while 220 patients underwent more conservative or conventional resection. Thirty-day hospital mortality was 1.7%. The cancer-related 5-year survival was 58.8% for all patients. The proportion of patients surviving 5 years after LAR (62.8%) was significantly better than those surviving after APR (52.4%), p = 0.008. Statistically significantly superior survival was observed after extended dissection when compared to conventional resections in Dukes' A, B, and C patients as a whole (63.8 and 54.3%) and in Dukes' C patients in particular. Superiority of en bloc pelvic lymphadenectomy versus conventional resection was observed in all cases of Dukes' Stage C, Astler-Coller Stage C1, Level II (adjacent) lymph nodes, and Level I (proximal) lymph nodes and was most effective in combination with sphincter-preserving operations. Patient groups were compared for bias and/or case selection, using both contingency tables and Cox-based multiple covariant linear regression analysis, and none was found. In the face of current adjuvant therapy, which is of questionable benefit and which carries its own treatment morbidity, en bloc pelvic lymphadenectomy is advocated as an adjunct to the curative operations for rectal cancer. To improve the overall benefit, patients can be selected for pelvic lymphadenectomy as an adjuvant to resection when preoperative examination suggests that the rectal cancer penetrates the bowel wall. Accurate preoperative staging may help to define a more restricted group of patients warranting (pelvic lymphadenectomy) (PLND). A control randomized trial of the effectiveness of PLND is appropriate to further test its value. PMID:3963898

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

    PubMed

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

    2010-09-01

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

  15. 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

  16. 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)?=?0.916–0.992] was associated with a lower likelihood of unprotected anal intercourse, while being not married (OR?=?2.301, 95% CI?=?1.151–4.601), and high perceived HIV risk (OR?=?1.776, 95% CI?=?1.376–2.290) were associated with a higher likelihood of unprotected anal intercourse. Conclusion: Although the results might not be generalizable to all Iranian IDUs, this study findings may still be helpful for design and implementation of public health programs in Iran to prevent sexual transmission of HIV through IDUs. PMID:24350203

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

    E-print Network

    Kounaves, Samuel P.

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

  18. 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

  19. 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

  20. JC Virus T-Antigen Expression in Anal Carcinoma

    PubMed Central

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

    2010-01-01

    Background & Aims Anal carcinoma is thought driven by HPV infection through interrupting function of cell regulatory proteins such as p53 and pRb. JCV expresses a T-antigen (T-Ag) that causes malignant transformation through development of aneuploidy and interaction with some of the same regulatory proteins as HPV. JCV T-Ag is present in brain, gastric and colon malignancies, but has not been evaluated in anal cancers. We examined a cohort of anal cancers for JCV T-Ag and correlated this with clinicopathologic data. Methods Archived anal carcinomas were analyzed for JCV T-Ag expression. DNA from tumor and normal tissue was sequenced for JCV with viral copies determined by qPCR and Southern blotting. HPV and MSI status was correlated with JCV T-Ag expression. Results Of 21 cases of anal cancer (mean age 49 years, 38% female), 12 (57%) were in HIV-positive individuals. All 21 cancers expressed JCV T-Ag, including 9 HPV-negative specimens. More JCV copies were present in cancer vs. surrounding normal tissue (mean 32.54 copies/?g DNA vs. 2.98 copies/?g DNA, P=0.0267). There was no correlation between disease stage and viral copies, nor between viral copies and HIV-positive or -negative status (28.7 vs. 36.34 copies/?g DNA, respectively, P=0.7804). In subset analysis, we found no association between JCV T-Ag expression and HPV or MSI status. Conclusions Anal carcinomas uniformly express JCV T-Ag and contain more viral copies compared to surrounding normal tissue. JCV and its T-Ag oncogenic protein, presumably through interruption of cell regulatory proteins, may play a role in anal cancer pathogenesis. PMID:24048785

  1. 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

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

    E-print Network

    Averbuch, Amir

    2012-01-01

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

  3. 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

  4. 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

  5. Scaling in rupture of polymer chains

    E-print Network

    S. Fugmann; I. M. Sokolov

    2008-07-18

    We consider the rupture dynamics of a homopolymer chain pulled at one end at a constant loading rate r. Compared to single bond breaking, the existence of the chain introduces two new aspects into rupture dynamics: the non-Markovian aspect in the barrier crossing and the slow-down of the force propagation to the breakable bond. The relative impact of both these processes is investigated, and the second one was found to be the most important at moderate loading rates. The most probable rupture force is found to decrease with the number of bonds as f_{max} const-(ln(N/r))^(2/3) and finally to approach a saturation value independent on N. All our analytical findings are confirmed by extensive numerical simulations.

  6. 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.

  7. On the rupture of DNA molecule

    E-print Network

    R. K. Mishra; T. Modi; D. Giri; S. Kumar

    2015-07-01

    Using Langevin Dynamic 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 the 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.

  8. 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

  9. Shock wave theory for rupture of rubber

    E-print Network

    M. Marder

    2004-07-09

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

  10. 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.

  11. 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

  12. 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

  13. 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.

  14. 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

  15. 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.

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

    E-print Network

    Starck, Jean-Luc

    2009-01-01

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

  17. Appl. Comput. Harmon. Anal. 27 (2009) 157179 Contents lists available at ScienceDirect

    E-print Network

    Nemirovski, Arkadi

    2009-01-01

    Appl. Comput. Harmon. Anal. 27 (2009) 157­179 Contents lists available at ScienceDirect Applied reserved. doi:10.1016/j.acha.2009.02.001 #12;158 A. Juditsky, A. Nemirovski / Appl. Comput. Harmon. Anal

  18. SIAM J. MATRIX ANAL. APPL. Vol. 13, No. 1, pp. 386-401, January 1992

    E-print Network

    Manne, Fredrik

    SIAM J. MATRIX ANAL. APPL. Vol. 13, No. 1, pp. 386-401, January 1992 () 1992 Society for Industrial to the second edition of this excellent text and reference book. Their notation and anal- ysis of the "level-3

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

    E-print Network

    Eldar, Yonina

    2011-01-01

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

  20. 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

  1. [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

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

    PubMed

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

    2014-03-01

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

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

  4. Primary gastric rupture in 47 horses (1995-2011).

    PubMed

    Winfield, Laramie S; Dechant, Julie E

    2015-09-01

    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

  5. 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.

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

    E-print Network

    Blumstein, Daniel T.

    Do marmots display a `dear enemy phenomenon' in response to anal gland secretions? H. B. Cross1 , D, Crested Butte, CO, USA Keywords anal gland secretion; dear enemy phenomenon; kinship; Marmota flaviventris. We hypothesized that dominant females discriminated between the anal gland secretion (AGS) from

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

    E-print Network

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

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

    E-print Network

    Xarles, Xavier

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

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

    E-print Network

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

  10. A wide field-of-view scanning endoscope for whole anal canal imaging

    E-print Network

    Yang, Changhuei

    A wide field-of-view scanning endoscope for whole anal canal imaging Chao Han,1,4,5 JiangtaoCam can capture the whole image of the anal canal within 10 seconds with a resolution of 89 m, a maximum demonstrate the performance of the AnCam by imaging the entire anal canal of pigs and tracking the dynamics

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

    E-print Network

    Xarles, Xavier

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

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

    E-print Network

    Weekes, Suzanne L.

    2009-01-01

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

  13. [The formation of the transplant for its descending to perineum with the sphincter-salvaging surgery in patients with disseminated sigmoid colon blood supply].

    PubMed

    Bondar', G V; Basheev, V Kh; Zolotukhin, S E; Popadinets, A A; Donets, V L; Borota, A V; Efimochkin, O E; Psaras, G G; Iaroshenko, M V

    2000-01-01

    The methods of the transplant formation in the loose type of the sigmoyd colon blood supply and insufficiency of the over vessel, applied in patients during sphincter-preserving operation performance for cancer recti, was proposed. Satisfactory immediate and late follow up result was noted. PMID:10859912

  14. Traumatic bladder rupture in a paratrooper.

    PubMed

    Ford, David; Palma, James; Robinson, John

    2009-06-01

    A paratrooper presents after a parachuting accident with the inability to urinate. Initial emergency bedside ultrasound, followed by confirmatory abdominal CT, is carried out and demonstrates an intraperitoneal bladder rupture. The patient is taken to the operating room and a 3-layer closure with omental buttressing is carried out. PMID:19585785

  15. 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...

  16. 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.

  17. Spontaneous rupture of liver during pregnancy.

    PubMed

    Mäntymaa, M L; Ekblad, U

    1994-01-01

    Spontaneous rupture of the hepatic capsule and subsequent massive intra-abdominal bleeding is a rare but life-threatening complication of pregnancy, which is often associated with pregnancy-induced hypertension. High maternal and fetal mortality rates have been reported. We describe a case with massive intra-abdominal bleeding. The diagnosis and treatment of this condition are discussed. PMID:8092784

  18. The physics of strain localization in dynamic earthquake rupture simulations

    E-print Network

    Daub,Eric G.

    The physics of strain localization in dynamic earthquake rupture simulations Eric G. Daub) and Jean M. Carlson (UCSB) #12;Goal: improve our understanding of the basic physics of earthquake rupture of Earthquakes Seismologists do not have a complete description of the physics governing earthquake rupture. Why

  19. 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

  20. 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

  1. 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.

  2. Sphincter of Oddi Dysfunction and the Formation of Adult Choledochal Cyst Following Cholecystectomy: A Retrospective Cohort Study.

    PubMed

    Xia, Hong-Tian; Wang, Jing; Yang, Tao; Liang, Bin; Zeng, Jian-Ping; Dong, Jia-Hong

    2015-11-01

    To determine the causes underlying the formation of adult choledochal cyst.Anomalous pancreaticobiliary junction is the most widely accepted theory regarding the etiology of choledochal cyst. However, choledochal cysts have been found in patients in the absence of this anomaly. Because the number of adult patients with choledochal cyst is increasing, it is important to address this controversy.Bile amylase levels in the cysts of 27 patients (8 males and 19 females) who had undergone cholecystectomy were retrospectively evaluated.The average age of the 27 patients was 45.8?±?10.1 years and the majority (85.2%) were diagnosed with Todani type I cysts. None of the patients had dilatation of the common bile duct prior to surgery. There were 6 (22.2%) patients with anomalous pancreaticobiliary junction. However, amylase levels did not significantly differ between patients with and without this anomaly (P?=?0.251). According to bile amylase levels, pancreatobiliary reflux was present in 21 (77.8%) patients. The mean amylase level significantly differed in patients with pancreatobiliary reflux (23,462?±?11,510?IU/L) and those without (235?±?103?IU/L) (P?sphincter of Oddi dysfunction, we proposed that the formation of adult choledochal cyst is mainly due to sphincter of Oddi dysfunction. PMID:26632721

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

    PubMed Central

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

    2004-01-01

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

  4. 766 Anal. Chem. $909, citive current at the ensemble (ic,,) is given by i , , = vC~A,,

    E-print Network

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

  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 2–60). 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. 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 55–125 km, depending on source depth, for site amplification and source–receiver 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.

  8. Fecal Incontinence

    MedlinePLUS

    ... anal sphincter pressure, rectal sensation and rectal storage capacity. The anal sphincter is a muscle that contracts ... stool is there. This is the rectal storage capacity. A person also must be alert enough to ...

  9. 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.

  10. 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

  11. 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

  12. [Esthetic surgery and psychological rupture states].

    PubMed

    Julliard, F A

    1991-01-01

    Although the psychological profile of patients requesting cosmetic surgery is often similar, the consequences of surgery can be dramatic in certain cases and result in a true state of rupture. The various forms, depression or aggression, and the conditions of onset are analysed. The four essential predisposing factors are: lack of information, result-satisfaction dichotomy, patient-surgeon divorce, and the responsibility of colleagues who, as a result of their inconsiderable comments, destabilize an already fragile psychological state. PMID:1721785

  13. 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

  14. Mechanism of rupture of single adsorbed vesicles

    NASA Astrophysics Data System (ADS)

    Zhdanov, Vladimir P.

    2015-11-01

    Rupture of single adsorbed lipid vesicles is believed to occur via pore formation in the membrane. The latter process is related to the support-induced membrane strain. It includes membrane bending primarily near the rim of the vesicle-substrate contact area and tension distributed over the whole membrane. Herein, the relative role of these two factors is scrutinized from the perspectives of general theory and available experiments. The former factor is concluded to dominate.

  15. Isolated rupture of the teres major tendon.

    PubMed

    Lester, Jonathan D; Boselli, Karen J; Kim, Paul D; Ahmad, Christopher S

    2010-11-01

    Acute isolated rupture of the teres major is an uncommon injury. This article presents the first report of midterm subjective and objective functional results following nonoperative management of an isolated teres major rupture. A 30-year-old right hand dominant man presented after a waterskiing traction injury to his left upper extremity. On physical examination, the patient had swelling and retraction of the teres major at the lower scapular border, which was accentuated with resisted adduction of the extremity. His teres major attachment at the humerus was not palpable. Magnetic resonance imaging revealed an isolated teres major tendon rupture. The patient was treated non-operatively with a rehabilitation protocol emphasizing rotator cuff, periscapular, and latissimus muscle strengthening. By 3 months postinjury, the patient had returned to all of his usual sporting activities, despite a persistent muscle retraction deformity over the teres major. At 3-year follow-up, the patient had no subjective complaints in the injured extremity and excellent functional outcome scores. A mean 37 kg loss of internal rotation strength (as measured by dynamometer) in the affected extremity with the arm abducted to 90° existed, although this difference was not subjectively appreciable. Although previously published reports have presented various options for the management of teres major injuries, the present case demonstrates that nonoperative treatment can produce excellent midterm subjective results in spite of objective internal rotation weakness. PMID:21053871

  16. 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.

  17. 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.

  18. 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.

  19. Association between patella spurs and quadriceps tendon ruptures

    PubMed Central

    Ellanti, Prasad; Moriarity, Andrew; Wainberg, Nikita; Fhoghlu, Cliodhna Ni; McCarthy, Tom

    2015-01-01

    Summary Background quadriceps tendon (QT) ruptures are significant injuries that are relatively uncommon. The diagnosis of QT ruptures is frequently missed or delayed. An association between the presence of a patella spur and QT ruptures has been suggested in the literature. Patients and methods the Hospital Inpatient Enquiry system was used to gather data on all patients who sustained a QT rupture over a six year period from 2008 to 2014. A retrospective review of the medical notes as well as radiographs was undertaken. We reviewed 200 knee radiographs of patients without QT ruptures to establish the incidence of patella spurs in our normal population. Statistical analysis was performed using SPSS version 11.5 for Windows®. Results the records of 20 consecutive patients with 21 QT ruptures were reviewed. The mean age was 60.9 yrs (range 44.9–82.1 yrs) and the majority were male (n=17; 85%). There was one bilateral QT ruptures. Patella spurs were noted in 13 cases (62%) which were significantly higher than in patients without QT rupture 19% (P?0.05). Conclusion we noted a significantly higher incidence of patella spurs in patients with QT ruptures compared to those without. The presence of a QT rupture should be ruled out in patients with a knee injury and a patella spur on the knee radiographs. PMID:26261786

  20. Addressing Anal Health in the HIV Primary Care Setting: A Disappointing Reality

    PubMed Central

    Cardenas, Gabriel A.; Dickinson, Gordon; Metsch, Lisa R.

    2010-01-01

    Abstract The increased risk of anal cancer among individuals living with HIV suggests that anal health (e.g., anal symptoms, anal practices, examination of the anus) should be an issue of priority for HIV care providers to discuss with their HIV-infected patients. We investigated the prevalence of HIV-infected individuals discussing anal health with their HIV primary care provider and factors associated with this discussion. We surveyed 518 adult patients from 5 HIV primary care clinics in Miami, Florida, from May 2004 to May 2005. Overall, only 22% of women, 32% of heterosexual men, and 54% of men who have sex with men (MSM) reported discussing anal health with their HIV providers in the prior 12 months. In a multivariable logistic regression, when adjusting for other factors, heterosexual men and MSM were 2.31 and 5.56 times, respectively, more likely to discuss anal health with their HIV providers compared to their women counterparts. Other factors associated with anal health discussion were the patients' better perception of engagement with HIV providers and having had a sexually transmitted disease exam in the past 12 months. Reporting of unprotected sex with HIV-negative or unknown HIV status was inversely related to discussion of anal health with primary care providers (odds ratio [OR]?=?0.53). Efforts are greatly needed to increase the focus on anal health in the HIV primary care setting for both men and women. PMID:20731611

  1. Increased HIV-1 activity in anal high-grade squamous intraepithelial lesions compared with unaffected anal mucosa in men who have sex with men.

    PubMed

    Pollakis, Georgios; Richel, Olivier; Vis, Joost D; Prins, Jan M; Paxton, William A; de Vries, Henry J C

    2014-06-01

    We studied 3 patients with focal intra-anal tissue high-grade squamous intraepithelial lesions (HSILs). All had increased human immunodeficiency virus type 1 (HIV-1) RNA and DNA in lesions compared with that in healthy mucosa. HIV-1 RNA and HIV-1 episomal DNA were indicative of ongoing viral replication, more so in anal HSILs. PMID:24604897

  2. 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.

  3. Rupture process of the Wenchuan earthquake (Mw 7.9) from surface ruptures and fault striations characteristics

    NASA Astrophysics Data System (ADS)

    Pan, Jiawei; Li, Haibing; Si, Jialiang; Pei, Junling; Fu, Xiaofang; Chevalier, Marie-Luce; Liu, Dongliang

    2014-04-01

    On 12 May 2008, the Wenchuan earthquake (Mw 7.9) produced complicated thrust-type co-seismic surface rupture zones, which encompass the dextral-slip thrust of the Yingxiu-Beichuan fault, the approximately pure thrust of the Guanxian-Anxian fault, and the sinistral-slip thrust of the Xiaoyudong rupture zone located between the former two. In order to understand the faulting mechanism, we discuss the rupture process by examining the segmentation and kinematics of the surface rupture zones, together with the co-seismic fault striations at various sites. Based on the two along-strike main displacement peaks (6-6.5 m and 11-12 m) and on the different geometric and kinematic patterns for the southern and northern segments of the surface rupture zones, we find that the Wenchuan earthquake might have consisted of two rupture stages, which is in agreement with seismic wave inversion results. By comparing the kinematics of fault striations occurring in the Bajiaomiao and Beichuan areas, it suggests that during the first stage, thrusting along both the Yingxiu-Beichuan fault and Guanxian-Anxian fault produced the ~ 80-100 km-long Yingxiu-Qingping surface rupture segment and the ~ 80 km-long Guanxian-Anxian surface rupture zone, respectively. Then, faulting was triggered along the Yingxiu-Beichuan fault by the first rupture process, yielding the second rupture stage, which was characterized by dextral strike-slip (or dextral oblique thrusting). Due to the overlap between the two rupture stages, the southern segment (Yingxiu-Qingping) of the Yingxiu-Beichuan rupture zone comprises two different processes while the northern segment (Gaochuan-Beichuan-Shikan) only suggests one rupture phase.

  4. Managing faecal incontinence or leakage: the Peristeen Anal Plug.

    PubMed

    Doherty, Willie

    Incontinence can be a devastating problem to many individuals. It is embarrassing and limiting socially, and prevents those with the problem from going about their day-to-day activities. People adopt coping strategies to manage the problem and those with urinary incontinence often look for containment products such as disposable pads or nappy-style products. These products have been developed using different absorbent materials and are accessible to sufferers in local supermarkets. Absorbency of the products has improved so that once wetted, they hold urine more easily. However, the same cannot be said for faecal incontinence management products and there are few that can be called upon to manage this devastating condition. The Peristeen Anal Plug, developed originally as the Conveen Anal Plug, stands alone in the search for a device to manage faecal incontinence or leakage. PMID:15580080

  5. Rectal Perforation Caused by Anal Stricture After Hemorrhoid Treatment

    PubMed Central

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

    2013-01-01

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

  6. 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

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  8. Characterization of functional biliary pain and dyspeptic symptoms in patients with sphincter of Oddi dysfunction: Effect of papillotomy

    PubMed Central

    Madácsy, László; Fejes, Roland; Kurucsai, Gábor; Joó, Ildikó; Székely, András; Bertalan, Viktória; Szepes, Attila; Lonovics, János

    2006-01-01

    AIM: To characterize functional biliary pain and other gastrointestinal (GI) symptoms in postcholecystectomy syndrome (PCS) patients with and without sphincter of Oddi dysfunction (SOD) proved by endoscopic sphincter of Oddi manometry (ESOM), and to assess the post-endoscopic sphincterotomy (EST) outcome. METHODS: We prospectively investigated 85 cholecystectomized patients referred for ERCP because of PCS and suspected SOD. On admission, all patients completed our questionnaire. Physical examination, laboratory tests, abdominal ultrasound, quantitative hepatobiliary scintigraphy (QHBS), and ERCP were performed in all patients. Based on clinical and ERCP findings 15 patients had unexpected bile duct stone disease and 15 patients had SOD biliary typeI. ESOM demonstrated an elevated basal pressure in 25 patients with SOD biliary-type III. In the remaining 30 cholecystectomized patients without SOD, the liver function tests, ERCP, QHBS and ESOM were all normal. As a control group, 30 ‘asymptomatic’ cholecystectomized volunteers (attended to our hospital for general cardiovascular screening) completed our questionnaire, which is consisted of 50 separate questions on GI symptoms and abdominal pain characteristics. Severity of the abdominal pain (frequency and intensity) was assessed with a visual analogue scale (VAS). In 40 of 80 patients having definite SOD (i.e. patients with SOD biliary typeIand those with elevated SO basal pressure on ESOM), an EST was performed just after ERCP. In these patients repeated questionnaires were filled at each follow-up visit (at 3 and 6 mo) and a second look QHBS was performed 3 mo after the EST to assess the functional response to EST. RESULTS: The analysis of characteristics of the abdominal pain demonstrated that patients with common bile duct stone and definite SOD had a significantly higher score of symptomatic agreement with previously determined biliary-like pain features than patient groups of PCS without SOD and controls. In contrary, no significant differences were found when the pain severity scores were compared in different groups of PCS patients. In patients with definite SOD, EST induced a significant acceleration of the transpapillary bile flow; and based on the comparison of VASs obtained from the pre- and post-EST questionnaires, the severity scores of abdominal pain were significantly improved, however, only 15 of 35 (43%) patients became completely pain free. Post-EST severity of abdominal pain by VASs was significantly higher in patients with predominant dyspepsia at initial presentation as compared to those without dyspeptic symptoms. CONCLUSION: Persistent GI symptoms and general patient dissatisfaction is a rather common finding after EST in patients with SOD, and correlated with the presence of predominant dyspeptic symptoms at the initial presentation, but does not depend on the technical and functional success of EST. PMID:17106935

  9. Posterior polar cataracts: a predisposition to intraoperative posterior capsular rupture.

    PubMed

    Osher, R H; Yu, B C; Koch, D D

    1990-03-01

    We performed phacoemulsification or planned extracapsular cataract extraction on posterior polar cataracts in 31 eyes of 22 patients and experienced eight cases of posterior capsular rupture (26%). Capsular rupture occurred during removal of the posterior polar opacity or during cleaning of the posterior capsule after the opacity had been removed. We believe that excessive adherence of the opacity to the posterior capsule and unusual thinness of the capsule predisposed these eyes to posterior capsular rupture. PMID:2329471

  10. Rupture of multiple parallel molecular bonds under dynamic loading.

    PubMed

    Seifert, U

    2000-03-20

    Biological adhesion often involves several pairs of specific receptor-ligand molecules. Using rate equations, we study theoretically the rupture of such multiple parallel bonds under dynamic loading assisted by thermal activation. For a simple generic type of cooperativity, both the rupture time and force exhibit several different scaling regimes. The dependence of the rupture force on the number of bonds is predicted to be either linear, like a square root, or logarithmic. PMID:11017316

  11. A Rare Case of Adductor Longus Muscle Rupture

    PubMed Central

    van de Kimmenade, R. J. L. L.; van Bergen, C. J. A.; van Deurzen, P. J. E.; Verhagen, R. A. W.

    2015-01-01

    An adductor longus muscle rupture is a rare injury. This case report describes a 32-year-old patient with an adductor longus rupture. The trauma mechanism was a hyperabduction movement during a soccer game. Nonoperative treatment was initiated. After a follow-up of 4 years, the patient was without pain but a small swelling was still visible. This report describes the anatomy, pathophysiology, and evidence-based treatment of adductor longus rupture. PMID:25918663

  12. [Otogenic brain abscess with rupture into the lateral ventricle].

    PubMed

    Bliouras, K; Skevas, A; Vrettos, X

    1989-07-01

    We present a case of otogenic abscess of the brain that ruptured into the ipsilateral cerebral ventricle. All the diagnostic, surgical and postoperative procedures which led not only to saving this patient but also his complete recovery are described. Because there is a great difference between rupture of a cerebral abscess into a ventricle and rupture of the ventricle into an abscess, particularly with reference to the prognosis, the pathology of the two different complications is reviewed, based on the literature. PMID:2668239

  13. 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

  14. 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.

  15. [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

  16. Isolated ruptures of the supraspinatus muscle.

    PubMed

    Holibka, Radomír; Ditmar, Rudolf; Holibková, Alzbeta; Laichman, Stanislav; R?zicková, Katherine

    2003-12-01

    We rarely encounter isolated ruptures of the supraspinatus muscle. At the Clinic of Orthopedics at the Faculty Hospital in Olomouc, we encountered only 21 cases out of 385 arthroscopic operation cases from October 1998 to October 2003. The patients were examined by USG, 5 patients were examined arthrographically and 3 patients underwent MRI examination. Of these 21 patients, only 3 were operated for acute post-injury haemarthrosis of the shoulder joint. During arthroscopic operation, an isolated rupture of the supraspinatus muscle was discovered in all these patients. The remaining 40 patients were only treated at our clinic for problems associated with impingement syndrome after an interval of 3-11 months and were indicated for operational therapy for the rupture of the supraspinatus muscle, verified sonographically and by MRI. Surgically we performed end to end sutures in 12 patients, in 9 cases we performed refixation using 1-2 titanium MITEK anchors. We supplemented the work by a detailed anatomical study of the supraspinatus muscle on 27 cadaverous anatomical preparations. It was noted that the supraspinatus muscle may be divided into three parts, with a superficial and deep layer of muscle fascicles. An aponeurotic insertion tendon runs through the center, to which part of the superficial muscle fascicles are attached. The muscle fascicles, including the central attachment tendon, run across the superior margin of the shoulder joint and by broad tendon are attached to the superior surface of the greater tubercle of the humerus. Together with the long head of the biceps muscle, they act as a significant shoulder stabiliser. The authors believe that due to the course of the muscle fascicles, this muscle acts as a significant shoulder stabiliser and a powerful abductor and elevator in the shoulder joint. The inferior portion of the muscle fascicles acts as an external rotator of the shoulder. PMID:15037909

  17. Mechanisms of plaque formation and rupture.

    PubMed

    Bentzon, Jacob Fog; Otsuka, Fumiyuki; Virmani, Renu; Falk, Erling

    2014-06-01

    Atherosclerosis causes clinical disease through luminal narrowing or by precipitating thrombi that obstruct blood flow to the heart (coronary heart disease), brain (ischemic stroke), or lower extremities (peripheral vascular disease). The most common of these manifestations is coronary heart disease, including stable angina pectoris and the acute coronary syndromes. Atherosclerosis is a lipoprotein-driven disease that leads to plaque formation at specific sites of the arterial tree through intimal inflammation, necrosis, fibrosis, and calcification. After decades of indolent progression, such plaques may suddenly cause life-threatening coronary thrombosis presenting as an acute coronary syndrome. Most often, the culprit morphology is plaque rupture with exposure of highly thrombogenic, red cell-rich necrotic core material. The permissive structural requirement for this to occur is an extremely thin fibrous cap, and thus, ruptures occur mainly among lesions defined as thin-cap fibroatheromas. Also common are thrombi forming on lesions without rupture (plaque erosion), most often on pathological intimal thickening or fibroatheromas. However, the mechanisms involved in plaque erosion remain largely unknown, although coronary spasm is suspected. The calcified nodule has been suggested as a rare cause of coronary thrombosis in highly calcified and tortious arteries in older individuals. To characterize the severity and prognosis of plaques, several terms are used. Plaque burden denotes the extent of disease, whereas plaque activity is an ambiguous term, which may refer to one of several processes that characterize progression. Plaque vulnerability describes the short-term risk of precipitating symptomatic thrombosis. In this review, we discuss mechanisms of atherosclerotic plaque initiation and progression; how plaques suddenly precipitate life-threatening thrombi; and the concepts of plaque burden, activity, and vulnerability. PMID:24902970

  18. Intracranial Aneurysms: Wall Motion Analysis for Prediction of Rupture.

    PubMed

    Vanrossomme, A E; Eker, O F; Thiran, J-P; Courbebaisse, G P; Zouaoui Boudjeltia, K

    2015-10-01

    Intracranial aneurysms are a common pathologic condition with a potential severe complication: rupture. Effective treatment options exist, neurosurgical clipping and endovascular techniques, but guidelines for treatment are unclear and focus mainly on patient age, aneurysm size, and localization. New criteria to define the risk of rupture are needed to refine these guidelines. One potential candidate is aneurysm wall motion, known to be associated with rupture but difficult to detect and quantify. We review what is known about the association between aneurysm wall motion and rupture, which structural changes may explain wall motion patterns, and available imaging techniques able to analyze wall motion. PMID:25929878

  19. Rupture velocity inferred from near-field shear strain analysis

    NASA Astrophysics Data System (ADS)

    Causse, M.; Cornou, C.; Bécasse, J.

    2014-12-01

    We propose a new technique to determine the rupture velocity of large strike slip earthquakes. By means of simple numerical ground motion simulations, we show that when the rupture penetrates a shallow layer of sediment or fractured rock, shock waves propagate along the surface fault trace in the forward rupture direction. Such shock waves, which are insensitive to the complexity of slip over the fault plane, propagate at a phase velocity equal to the rupture speed. We show that those shock waves can be easily isolated in the frequency domain, and that phase velocity can then be simply obtained from shear strain.

  20. Stress rupture resistance. [of Co and Ni superalloys

    NASA Technical Reports Server (NTRS)

    Freche, J. C.

    1976-01-01

    Principles underlying the design of metallic systems for stress rupture resistance are outlined by considering the specific case studies of cobalt- and nickel-base superalloys. Ways in which superalloys can be designed for high stress rupture resistance are discussed. In describing the alloying procedures, the strengthening mechanisms involved and methods of avoiding phases detrimental to stress rupture resistance are identified. New processing techniques such as controlled solidification, prealloyed powder processing, and autoclave heat treatments are described as further means of achieving increased stress rupture resistance in superalloy and other systems.

  1. Surgical Treatment of Distal Biceps Ruptures.

    PubMed

    Stoll, Laura E; Huang, Jerry I

    2016-01-01

    Distal biceps ruptures occur from eccentric loading of a flexed elbow. Patients treated nonoperatively have substantial loss of strength in elbow flexion and forearm supination. Surgical approaches include 1-incision and 2-incision techniques. Advances in surgical technology have facilitated the popularity of single-incision techniques through a small anterior incision. Recently, there is increased focus on the detailed anatomy of the distal biceps insertion and the importance of anatomic repair in restoring forearm supination strength. Excellent outcomes are expected with early repair of the distal biceps, with restoration of strength and endurance to near-normal levels with minimal to no loss of motion. PMID:26614933

  2. Complex earthquake rupture and local tsunamis

    USGS Publications Warehouse

    Geist, E.L.

    2002-01-01

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

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

    E-print Network

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

  4. Ap endice A Estudio Anal tico de las Teor as Lineales

    E-print Network

    Moro, Esteban

    Ap#19;endice A Estudio Anal#19;#16;tico de las Teor#19;#16;as Lineales Las teor#19;#16;as lineales anal#19;#16;ticas como las aproximaciones variacionales y el grupo de renormalizaci#19;on. De forma d=2+x=2 #11; #17;(r 0 ; t 0 ); (A.3) 203 #12; 204 Estudio Anal#19; #16;tico de las Teor#19; #16;as

  5. Anatomical Tracer Injections into the Lower Urinary Tract May Compromise Cystometry and External Urethral Sphincter Electromyography in Female Rats

    PubMed Central

    Chang, Hui-Yi; Havton, Leif A.

    2010-01-01

    Physiological and anatomical investigations are commonly combined in experimental models. When studying the lower urinary tract (LUT), it is often of interest to perform both urodynamic studies and retrogradely labeled neurons innervating the peripheral target organs. However, it is not known whether the use of anatomical tracers for the labeling of e.g. spinal cord neurons may interfere with the interpretation of the physiological studies on micturition reflexes. We performed cystometry and external urethral sphincter (EUS) electromyography (EMG) under urethane anesthesia in adult female rats at 5-7 days after injection of a 5% fluorogold (FG) solution or vehicle into the major pelvic ganglia (MPG) or the EUS. FG and vehicle injections into the MPG and EUS resulted in decreased voiding efficiency. MPG injections increased the duration of both bladder contractions and the inter-contractile intervals. EUS injections decreased EUS EMG bursting activity during voiding as well as increased both the duration of bladder contractions and the maximum intravesical pressure. In addition, the bladder weight and size were increased after either MPG or EUS injections in both the FG and vehicle groups. We conclude that the injection of anatomical tracers into the MPG and EUS may compromise the interpretation of subsequent urodynamic studies and suggest investigators to consider experimental designs, which allow for physiological assessments to precede the administration of anatomical tracers into the LUT. PMID:20004710

  6. The repetition of large-earthquake ruptures.

    PubMed Central

    Sieh, K

    1996-01-01

    This survey of well-documented repeated fault rupture confirms that some faults have exhibited a "characteristic" behavior during repeated large earthquakes--that is, the magnitude, distribution, and style of slip on the fault has repeated during two or more consecutive events. In two cases faults exhibit slip functions that vary little from earthquake to earthquake. In one other well-documented case, however, fault lengths contrast markedly for two consecutive ruptures, but the amount of offset at individual sites was similar. Adjacent individual patches, 10 km or more in length, failed singly during one event and in tandem during the other. More complex cases of repetition may also represent the failure of several distinct patches. The faults of the 1992 Landers earthquake provide an instructive example of such complexity. Together, these examples suggest that large earthquakes commonly result from the failure of one or more patches, each characterized by a slip function that is roughly invariant through consecutive earthquake cycles. The persistence of these slip-patches through two or more large earthquakes indicates that some quasi-invariant physical property controls the pattern and magnitude of slip. These data seem incompatible with theoretical models that produce slip distributions that are highly variable in consecutive large events. Images Fig. 3 Fig. 7 Fig. 9 PMID:11607662

  7. Ruptured aneurysms of the sinus of Valsalva.

    PubMed

    Mayer, E D; Ruffmann, K; Saggau, W; Butzmann, B; Bernhardt-Mayer, K; Schatton, N; Schmitz, W

    1986-07-01

    From 1964 to 1984, 10 male and 5 female patients with ruptured aneurysms of the sinus of Valsalva (ASVs) underwent surgical correction. These procedures constituted 0.23% of the 6,350 surgical procedures that used cardiopulmonary bypass during this period. Five patients had an inflammatory condition (bacterial endocarditis, 4; syphilis, 1), and 1 had an ASV relapse 5 years after her first operation. Coexistent lesions included aortic valve regurgitation in 5 patients, ventricular septal defect in 3 (1 of whom had mitral insufficiency), patent foramen ovale in 2, and atrial septal defect in 1. Ninety-three percent were symptomatic (sudden onset of symptoms, 5 patients; gradual onset, 9 patients), commonly with shortness of breath, fatigability, chest pain, and tachycardia. The following connections occurred: noncoronary sinus to right atrium (RA) (5 patients); right coronary sinus (RCS) to RA (5 patients); and RCS to right ventricle (5 patients). There were no early or late postoperative deaths. One patient underwent reoperation after an ASV relapse. The mean follow-up period (+/- standard deviation) was 7.9 years (range, 10 months to 20.1 years). Eighty percent of the patients were found to be in New York Heart Association class I, and 20% were in class II. Apart from ASV relapse, late complications are determined by prosthetic valve dysfunction or evidence of valve disease. Early surgical intervention is justified in patients with ruptured ASV. PMID:3729620

  8. TMI-2 lower head creep rupture analysis

    SciTech Connect

    Thinnes, G.L.

    1988-08-01

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

  9. False vs True rupture of membranes.

    PubMed

    Cohain, J S

    2015-05-01

    New medical nomenclature: False rupture of membranes or False ROM and Double rupture of membranes or Double ROM are being introduced into the English language. A single caregiver found about 1% of term births and 10% of term PROM involved False ROM, in which the chorion breaks while the amnion remains intact. Diagnostically, if meconium or vernix is observed, then both the chorionic and amniotic sacs have broken. In the absence of detection of vernix or meconium, an immediate accurate diagnostic test for False ROM is lacking and differentiating between True ROM from False ROM is possible only after leaking stops, which takes hours to days. The obvious benefit of differentiating between 'True' and 'False' ROM, is that in the case of False ROM, the amnion is intact and ascending infections are likely not at increased risk, although research is lacking as to whether False ROM is associated with an increased rate of ascending infection. Three cases of False ROM are presented and avenues for future research are enumerated. PMID:25279443

  10. Dynamic path selection along branched faults: Experiments involving sub-Rayleigh and supershear ruptures

    E-print Network

    Rosakis, Ares J.

    ruptures Carl-Ernst Rousseau1 and Ares J. Rosakis2 Received 27 October 2008; revised 12 March 2009 of rupture propagation along a branch by the Mach cone, when the initial rupture is supershear driven

  11. The Utility of Bedside Ultrasound in the Detection of a Ruptured Globe in a Porcine Model

    E-print Network

    Chandra, Amit; Mastrovitch, Todd; Ladner, Heidi; Ting, Vincent; Radeos, Michael S; Samudre, Sandeep

    2009-01-01

    identify abnormal eyes with a sensitivity of 79% (95% CI 73%eye,” rupture Identification of a or vitrectomy (CI) ruptured globe (CI) 1st Year Resident Sensitivityeye as a vitrectomy or a CVL as a rupture. The sensitivity

  12. Human Fetal Membranes: Their Preterm Premature Rupture1 [Create Reference

    E-print Network

    Bryant-Greenwood, Gillian D.

    Human Fetal Membranes: Their Preterm Premature Rupture1 [Create­1579. Human Fetal Membranes: Their Preterm Premature Rupture1 Gillian D. Bryant-Greenwood, a, 2 and Lynnae K. Millar a aPacific Biomedical Research Center, University of Hawaii, Honolulu, Hawaii 96822 Manuscript

  13. Isolated rupture of teres major in a goalkeeper.

    PubMed

    Maciel, Rafael Almeida; Zogaib, Rodrigo Kallas; Pochini, Alberto De Castro; Ejnisman, Benno

    2015-01-01

    A complete rupture of the teres major is an extremely rare injury and rarely described in the literature. We report the first case of an isolated rupture of the teres major in a professional football goalkeeper. The diagnosis requires a high degree of suspicion and complementation by image examinations. Conservative treatment has a high success rate with early return to sport. PMID:26701915

  14. Non-bleeding Spontaneous Rupture of Hepatocellular Carcinoma.

    PubMed

    Islam, Mahibul; Deka, Pranjal; Kapur, Raj; Ansari, Md Abu Masud

    2013-07-01

    Rupture of hepatocellular carcinoma (HCC) is not uncommon and most ruptured HCC present with hemoperitoneum and hemorrhagic shock. Management of ruptured HCC is different than non-ruptured one. Short- and long-term mortality increases following rupture of HCC with increasing chances of tumor dissemination. We describe a case with non-bleeding spontaneous rupture of HCC. A 62-year-old male patient was admitted to our institute hospital with mild to moderate pain in the right upper part of the abdomen. He lost appetite and weight. Ultrasonography of the abdomen was performed and it suggested HCC and ascites. Triple phase computer tomography revealed HCC in segments 6 and 7 of liver with typical radiological characteristics. Portal vein was thrombosed. No extravasation of dye was seen. Ruptured of tumor through liver capsule was seen with necrosis and hemorrhage in the center of the tumor. Non-bleeding ruptured HCC has not been reported in the literature to the best of our knowledge. We herein describe this rare case. PMID:24497757

  15. Non-bleeding Spontaneous Rupture of Hepatocellular Carcinoma

    PubMed Central

    Islam, Mahibul; Deka, Pranjal; Kapur, Raj; Ansari, Md. Abu Masud

    2013-01-01

    Rupture of hepatocellular carcinoma (HCC) is not uncommon and most ruptured HCC present with hemoperitoneum and hemorrhagic shock. Management of ruptured HCC is different than non-ruptured one. Short- and long-term mortality increases following rupture of HCC with increasing chances of tumor dissemination. We describe a case with non-bleeding spontaneous rupture of HCC. A 62-year-old male patient was admitted to our institute hospital with mild to moderate pain in the right upper part of the abdomen. He lost appetite and weight. Ultrasonography of the abdomen was performed and it suggested HCC and ascites. Triple phase computer tomography revealed HCC in segments 6 and 7 of liver with typical radiological characteristics. Portal vein was thrombosed. No extravasation of dye was seen. Ruptured of tumor through liver capsule was seen with necrosis and hemorrhage in the center of the tumor. Non-bleeding ruptured HCC has not been reported in the literature to the best of our knowledge. We herein describe this rare case. PMID:24497757

  16. Spleen rupture in course of chronic pancreatitis. A case report.

    PubMed

    Luck, O D; Juhl-Jensen, V

    1990-01-01

    Non-traumatic spleen rupture is exceedingly rare. We report case, in which an occlusion of the pancreatic duct induced a fistula from the pancreatic tail to the spleen coursing enzymatic digestion resulting in subcapsular bleeding and rupture of the spleen. The pathogenesis is discussed. PMID:2131568

  17. Ultrasound Diagnosis of Bilateral Quadriceps Tendon Rupture After Statin Use

    PubMed Central

    Nesselroade, Ryan D.; Nickels, Leslie Connor

    2010-01-01

    Simultaneous bilateral quadriceps tendon rupture is a rare injury. We report the case of bilateral quadriceps tendon rupture sustained with minimal force while refereeing a football game. The injury was suspected to be associated with statin use as the patient had no other identifiable risk factors. The diagnosis was confirmed using bedside ultrasound. PMID:21079697

  18. 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

  19. A Three Year Clinicopathological Study of Cases of Rupture Uterus

    PubMed Central

    Rathod, Setu; Swain, Sujata

    2015-01-01

    Introduction Rupture uterus is a life threatening obstetric complication with serious maternal and fetal side-effects. We report a 3 year (2010-2013) retrospective clinical study of pregnancy with rupture uterus cases attending a tertiary care hospital. Aim The aim of the study was to evaluate the incidence of rupture uterus, incidence as per age, parity, clinical presentations, risk factors, complications and management. Materials and Methods Retrospective data of 74 cases of rupture uterus in SCB Medical college, Cuttack was collected from case records of 26,547 deliveries during a 3 year span (2010-2013). Parameters like cause of rupture, type, site of rupture and outcome were recorded. The collected data was analysed by SPSS software v19. Results Out of 26,547 deliveries during the three year period, there were 74 cases of rupture uterus with an incidence of rupture 1 in 359 (0.28%). The mean age of rupture uterus was 27.4 years. 95.8% were multigravida and majority were referred cases from low socioeconomic status. Only 40.5% had the required minimum of four antenatal visits as recommended by WHO (World Health Organisation). A total of 48.6% of cases with rupture uterus had history of previous Caesarean section. Prolonged labour was present in 75.6% of the cases. Only 12.2% of the cases had history of oxytocin use whereas 9.5% had undergone an operative vaginal delivery. Obstructed labour was the cause in 24.3% of cases, 85.1% had complete rupture. Majority had a rupture in the anterior wall (69%) and 81.1% had rupture in lower segment of uterus. Only 17.6% had broad ligament haematoma, 10.8% colporrhexis and 6.8% had associated bladder injury. Repair was possible in only 39.2% of cases, whereas majority landed up in hysterectomy. Internal iliac ligation was done in 2.7% of cases. Perinatal mortality was 90.5% whereas maternal death was seen in 13.5% cases. One patient developed VVF (vesicovaginal fistula). Duration of hospital stay was upto 14 days in 81.1% cases. Conclusion Education and proper care especially of high risk patients like previous caesarean by competent personnal, proper use of oxytocin and early referral may help to reduce the incidence of “rupture uterus”. PMID:26673858

  20. Relaxing Segmentation: Does It Improve Characterization of Fault Rupture Behavior?

    NASA Astrophysics Data System (ADS)

    Schwartz, D. P.

    2014-12-01

    Most faults have not ruptured once historically, let alone repeatedly. Estimating future rupture length of an earthquake source has been a challenge since the 1970s when concepts of full and half fault lengths were employed. In the 1980s paleoseismic event timing and observations of slip, coupled with geometric and other physical fault changes, led to concepts of fault segmentation and it's modeling for hazard. The Uniform California Earthquake Rupture Forecast 3 (UCERF 3, Field et al., 2014) relaxed segmentation, guided by rules in which a separation distance of ?5km and orientation to Coulomb stress changes at fault junctions are prime factors for allowing fault-to-fault jumps. A set of ~350 fault sections produced ~250K ruptures ranging in length from 15 km-1200 km. An inversion provided the rates of these, which range from 102-108 years. Many of the long ruptures have exceedingly low individual rates within the UCERF 3 geologic model but are sufficient in number to release cumulative moment that brings the long-term (Myr) and historical (since 1850) MFDs for the California region into close agreement. Does UCERF 3 have too many multi-fault ruptures? Since 1850 there have been ~260 surface ruptures worldwide in shallow continental crust. 77% are 0-49km; 6% exceed 150km, and the longest is 1906 San Francisco (435-470 km). In California since 1857 there have been 31 surface ruptures. 77% are shorter than 49 km. The longest are 1906, 1857 Fort Tejon (297km), and 1872 Owens Valley (108 km). Most long historical strike-slip ruptures are continuous and geomorphically well-defined traces with limited geometric changes. In contrast, UCERF3 modeling of the south Hayward, as an example, allows it to participate in ruptures that extend to the south ends of the San Andreas or San Jacinto faults (900 km). These include branching (Hayward-Calaveras, San Andreas-San Jacinto) and jumps (Calaveras-San Andreas) on creeping sections of these faults. 5km is the connectivity threshold in UCERF 3 but only 40% of historical ruptures have negotiated this distance. There are other controls of rupture propagation: frictional properties, rupture dynamics, creep, and, as shown by the 2002 Denali-Totschunda rupture, the timing of the prior event and level of stress accumulation on adjacent fault sections. Time will be the tester.

  1. Material contrast does not predict earthquake rupture propagation direction

    USGS Publications Warehouse

    Harris, R.A.; Day, S.M.

    2005-01-01

    Earthquakes often occur on faults that juxtapose different rocks. The result is rupture behavior that differs from that of an earthquake occurring on a fault in a homogeneous material. Previous 2D numerical simulations have studied simple cases of earthquake rupture propagation where there is a material contrast across a fault and have come to two different conclusions: 1) earthquake rupture propagation direction can be predicted from the material contrast, and 2) earthquake rupture propagation direction cannot be predicted from the material contrast. In this paper we provide observational evidence from 70 years of earthquakes at Parkfield, CA, and new 3D numerical simulations. Both the observations and the numerical simulations demonstrate that earthquake rupture propagation direction is unlikely to be predictable on the basis of a material contrast. Copyright 2005 by the American Geophysical Union.

  2. Spontaneous diaphragmatic rupture related to local invasion by retroperitoneal liposarcoma.

    PubMed

    Pehar, M; Vukoja, I; Rozi?, D; Miškovi?, J

    2012-01-01

    We report a case of the female patient who was admitted to the hospital because of syncope experienced while climbing stairs. Diagnostic workup raised the suspicion of a right diaphragmatic rupture that was eventually confirmed by surgery (right-sided thoracotomy). Surgery also revealed tissue protruding through the rupture site from within the retroperitoneum that was proven subsequently to be a dedifferentiated liposarcoma. Second surgery was performed to completely remove the liposarcoma tissue and repair a coincident old right lumbar region hernia. The patient recovered fully. Spontaneous rupture of the diaphragm is rare and this is especially true for the right hemidiaphragm. We report the first case of diaphragmatic rupture caused by local infiltration by a retroperitoneal liposarcoma. This and similar reports emphasise that in cases with high clinical suspicion of diaphragmatic rupture, diagnosis should be pursued even in the absence of a preceding traumatic event. PMID:22524913

  3. SIAM J. NUMER. ANAL. c 2015 Society for Industrial and Applied Mathematics Vol. 53, No. 1, pp. 82104

    E-print Network

    Hero, Alfred O.

    SIAM J. NUMER. ANAL. c 2015 Society for Industrial and Applied Mathematics Vol. 53, No. 1, pp. 82. In a previous work [SIAM J. Math. Anal., 46 (2014), pp. 603­638], we showed that nondominated sorting has

  4. 54 BULLETIN OF TEE UNITED STATES FISH COMMISSION. scarcely longest, 16 in head. Anal comparatively long and high, its

    E-print Network

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

  5. 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.

  6. Macroscopic Source Properties from Dynamic Rupture Styles in Plastic Media

    NASA Astrophysics Data System (ADS)

    Gabriel, A.; Ampuero, J. P.; Dalguer, L. A.; Mai, P. M.

    2011-12-01

    High stress concentrations at earthquake rupture fronts may generate an inelastic off-fault response at the rupture tip, leading to increased energy absorption in the damage zone. Furthermore, the induced asymmetric plastic strain field in in-plane rupture modes may produce bimaterial interfaces that can increase radiation efficiency and reduce frictional dissipation. Off-fault inelasticity thus plays an important role for realistic predictions of near-fault ground motion. Guided by our previous studies in the 2D elastic case, we perform rupture dynamics simulations including rate-and-state friction and off-fault plasticity to investigate the effects on the rupture properties. We quantitatively analyze macroscopic source properties for different rupture styles, ranging from cracks to pulses and subshear to supershear ruptures, and their transitional mechanisms. The energy dissipation due to off-fault inelasticity modifies the conditions to obtain each rupture style and alters macroscopic source properties. We examine apparent fracture energy, rupture and healing front speed, peak slip and peak slip velocity, dynamic stress drop and size of the process and plastic zones, slip and plastic seismic moment, and their connection to ground motion. This presentation focuses on the effects of rupture style and off-fault plasticity on the resulting ground motion patterns, especially on characteristic slip velocity function signatures and resulting seismic moments. We aim at developing scaling rules for equivalent elastic models, as function of background stress and frictional parameters, that may lead to improved "pseudo-dynamic" source parameterizations for ground-motion calculation. Moreover, our simulations provide quantitative relations between off-fault energy dissipation and macroscopic source properties. These relations might provide a self-consistent theoretical framework for the study of the earthquake energy balance based on observable earthquake source parameters.

  7. Generation of microcracks by dynamic shear rupture and its effects on rupture growth and elastic wave radiation

    E-print Network

    Yamashita, Teruo

    Generation of microcracks by dynamic shear rupture and its effects on rupture growth and elastic propagating earthquake faults generate a large number of tensile microcracks in their vicinity, which waves will also be affected by the generation of microcracks. We numerically study how such tensile

  8. 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

  9. [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

  10. Multifractal scaling of thermally activated rupture processes.

    PubMed

    Sornette, D; Ouillon, G

    2005-01-28

    We propose a "multifractal stress activation" model combining thermally activated rupture and long memory stress relaxation, which predicts that seismic decay rates after mainshocks follow the Omori law approximately 1/t(p) with exponents p linearly increasing with the magnitude M(L) of the mainshock. We carefully test this prediction on earthquake sequences in the Southern California earthquake catalog: we find power law relaxations of seismic sequences triggered by mainshocks with exponents p increasing with the mainshock magnitude by approximately 0.1-0.15 for each magnitude unit increase, from p(M(L) = 3) approximately 0.6 to p(M(L) = 7) approximately 1.1, in good agreement with the prediction of the multifractal model. PMID:15698332

  11. Iodamoeba butschlii in an anal pap test confirmed by iodine stain.

    PubMed

    Schuetz, Audrey N; Pritt, Bobbi S; Schreiner, Andrew M

    2014-09-01

    We report the finding of Iodamoeba butschlii amebic cysts on a liquid-based anal Pap smear from an HIV-positive male. Iodine staining of the smear confirmed the diagnosis. It is important to distinguish I. butschlii from pathogenic ameobae and other organisms seen on anal Pap smears. PMID:24167099

  12. J. Math. Anal. Appl. 273 (2002) 2444 www.academicpress.com

    E-print Network

    Fridman, Emilia

    2002-01-01

    J. Math. Anal. Appl. 273 (2002) 24­44 www.academicpress.com Stability of linear descriptor systems. PII: S0022-247X(02)00202-0 #12;E. Fridman / J. Math. Anal. Appl. 273 (2002) 24­44 25 has been pointed

  13. Appl. Comput. Harmon. Anal. 26 (2009) 6476 www.elsevier.com/locate/acha

    E-print Network

    Nehorai, Arye

    2009-01-01

    Appl. Comput. Harmon. Anal. 26 (2009) 64­76 www.elsevier.com/locate/acha Robust dimension reduction. doi:10.1016/j.acha.2008.03.001 #12;G. Kutyniok et al. / Appl. Comput. Harmon. Anal. 26 (2009) 64­76 65

  14. Anal Intercourse and Sexual Risk Factors among College Women, 1993-2000

    ERIC Educational Resources Information Center

    Flannery, Diana; Ellingson, Lyndall; Votaw, Karen S.; Schaefer, Elizabeth Ann

    2003-01-01

    Objective: To determine trends and sexual risk behaviors associated with anal intercourse among college women over an 8-year period. Methods: A sexual activity questionnaire was used to collect data from 813 students enrolled in a women's health course. Results: Thirty-two percent of the women had engaged in anal intercourse, and this measure was…

  15. J. Math. Anal. Appl. 313 (2006) 251261 www.elsevier.com/locate/jmaa

    E-print Network

    Ge, Shuzhi Sam

    2006-01-01

    J. Math. Anal. Appl. 313 (2006) 251­261 www.elsevier.com/locate/jmaa A global Implicit Function.08.072 #12;252 W. Zhang, S.S. Ge / J. Math. Anal. Appl. 313 (2006) 251­261 Lemma 1 (Implicit Function Theorem

  16. J. Math. Anal. Appl. 361 (2010) 420430 Contents lists available at ScienceDirect

    E-print Network

    Pasciak, Joseph

    2010-01-01

    J. Math. Anal. Appl. 361 (2010) 420­430 Contents lists available at ScienceDirect Journal on the unbounded domain, which preserves the solution inside the layer while decaying rapidly outside [2;S. Kim, J.E. Pasciak / J. Math. Anal. Appl. 361 (2010) 420­430 421 We consider the exterior

  17. J. Math. Anal. Appl. 370 (2010) 168186 Contents lists available at ScienceDirect

    E-print Network

    Pasciak, Joseph

    2010-01-01

    J. Math. Anal. Appl. 370 (2010) 168­186 Contents lists available at ScienceDirect Journal, a properly constructed PML preserves the solution inside while exponentially damping the solutions within, J.E. Pasciak / J. Math. Anal. Appl. 370 (2010) 168­186 169 lim r r1/2 u r - iku = 0. (1.1) Here k

  18. J. Math. Anal. Appl. 314 (2006) 710723 www.elsevier.com/locate/jmaa

    E-print Network

    Tysk, Johan

    2006-01-01

    J. Math. Anal. Appl. 314 (2006) 710­723 www.elsevier.com/locate/jmaa The American put is log in the most fundamental case of the underlying asset being modeled by geometric Brown- ian motion / J. Math. Anal. Appl. 314 (2006) 710­723 711 formulation and the free boundary problem for a put

  19. 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.…

  20. 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, Aimée 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}, 3.4–8.2]), number of sex partners (aOR, 2.2 [95% CI, 1.1–4.6] for ?4 partners), and number of anal intercourse partners (aOR, 1.9 [95% CI, 1.1–3.3] 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, 3.7–5.9]), number of sex partners (aOR, 2.4 [95% CI, 1.7–3.4] for ?4 partners), and report of anal fissures (aOR, 2.3 [95% CI, 1.1–4.8]) 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

  1. Effectiveness of Rehabilitative Balloon Swallowing Treatment on Upper Esophageal Sphincter Relaxation and Pharyngeal Motility for Neurogenic Dysphagia

    PubMed Central

    Kim, Yong Kyun; Choi, Sung Sik; Choi, Jung Hwa

    2015-01-01

    Objective To investigate the relationship between dysphagia severity and opening of the upper esophageal sphincter (UES), and to assess the effect of balloon size on functional improvement after rehabilitative balloon swallowing treatment in patients with severe dysphagia with cricopharyngeus muscle dysfunction (CPD). Methods We reviewed videofluoroscopic swallowing studies (VFSS) conducted in the Department of Physical Medicine and Rehabilitation, Myongji Hospital from January through December in 2012. All subjects diagnosed with CPD by VFSS further swallowed a 16-Fr Foley catheter filled with barium sulfate suspension for three to five minutes. We measured the maximum diameter of the balloon that a patient could swallow into the esophagus and subsequently conducted a second VFSS. Then, we applied a statistical technique to correlate the balloon diameter with functional improvement after the balloon treatment. Results Among 283 inpatients who received VFSS, 21 subjects were diagnosed with CPD. It was observed that the degree of UES opening evaluated by swallowing a catheter balloon had inverse linear correlations with pharyngeal transit time and post-swallow pharyngeal remnant. Videofluoroscopy guided iterative balloon swallowing treatment for three to five minutes, significantly improved the swallowing ability in terms of pharyngeal transit time and pharyngeal remnant (p<0.005 and p<0.001, respectively). Correlation was seen between balloon size and reduction in pharyngeal remnants after balloon treatment (Pearson correlation coefficient R=-0.729, p<0.001), whereas there was no definite relationship between balloon size and improvement in pharyngeal transit time (R=-0.078, p=0.738). Conclusion The maximum size of the balloon that a patient with CPD can swallow possibly indicates the maximum UES opening. The iterative balloon swallowing treatment is safe without the risk of aspiration, and it can be an effective technique to improve both pharyngeal motility and UES relaxation. PMID:26361588

  2. Is sphincter electromyography a helpful investigation in the diagnosis of multiple system atrophy? A retrospective study with pathological diagnosis.

    PubMed

    Paviour, Dominic C; Williams, David; Fowler, Clare J; Quinn, Niall P; Lees, Andrew J

    2005-11-01

    Sphincter electromyography (spEMG) is often used as an ancillary test when multiple system atrophy (MSA) is suspected. Our aim was to determine the clinical features associated with spEMG being performed, the influence of the result on the final clinical diagnosis, and its utility as a clinical investigation. A retrospective audit of all cases in the Queen Square Brain Bank between 1989 and 2002 was performed. The clinical features and diagnostic accuracy were compared between patients in whom spEMG was performed and those in whom it was not. From 845 sets of complete clinical records, we identified 37 (4.4%) cases that had been investigated with spEMG. Thirty of these cases had a pathological diagnosis of MSA. Of these 30, 24 had abnormal spEMGs, 5 had a borderline result, and only 1 had a normal spEMG. Sixty-six cases had pathologically proven MSA but no spEMG. Those investigated with spEMG were younger at disease onset (P < 0.001), more frequently male (P = 0.03), and more likely to have had other investigations performed. They had a greater incidence of pyramidal tract signs at final clinical diagnosis, and the final clinical diagnostic accuracy was higher (P = 0.04). Due to the retrospective nature of the study, balanced populations for calculation of sensitivity and specificity were not available. In this selected series of pathologically confirmed cases, investigation with spEMG was one of several factors associated with improved clinical diagnostic accuracy. A normal spEMG is unlikely in pathologically proven MSA, at least in cases with a mean symptom duration of more than 5 years when the test is performed. PMID:16007638

  3. Creep and rupture of an ODS alloy with high stress rupture ductility. [Oxide Dispersion Strengthened

    NASA Technical Reports Server (NTRS)

    Mcalarney, M. E.; Arsons, R. M.; Howson, T. E.; Tien, J. K.; Baranow, S.

    1982-01-01

    The creep and stress rupture properties of an oxide (Y2O3) dispersion strengthened nickel-base alloy, which also is strengthened by gamma-prime precipitates, was studied at 760 and 1093 C. At both temperatures, the alloy YDNiCrAl exhibits unusually high stress rupture ductility as measured by both elongation and reduction in area. Failure was transgranular, and different modes of failure were observed including crystallographic fracture at intermediate temperatures and tearing or necking almost to a chisel point at higher temperatures. While the rupture ductility was high, the creep strength of the alloy was low relative to conventional gamma prime strengthened superalloys in the intermediate temperature range and to ODS alloys in the higher temperature range. These findings are discussed with respect to the alloy composition; the strengthening oxide phases, which are inhomogeneously dispersed; the grain morphology, which is coarse and elongated and exhibits many included grains; and the second phase inclusion particles occurring at grain boundaries and in the matrix. The creep properties, in particular the high stress dependencies and high creep activation energies measured, are discussed with respect to the resisting stress model of creep in particle strengthened alloys.

  4. Arterial distensibility in patients with ruptured and unruptured intracranial aneurysms: Is it a predisposing factor for rupture risk?

    PubMed Central

    Dusak, Abdurrahim; Kamasak, Kaan; Goya, Cemil; Adin, Mehmet E.; Elbey, Mehmet A.; Bilici, Aslan

    2013-01-01

    Background A risk factor assessment that reliably predicts whether patients are predisposed to intracranial aneurysm (IA) rupture has yet to be formulated. As such, the clinical management of unruptured IA remains unclear. Our aim was to determine whether impaired arterial distensibility and hypertrophic remodeling might be indicators of risk for IA rupture. Material/Methods The study population (n=49) was selected from consecutive admissions for either unruptured IA (n=23) or ruptured IA (n=26) from January to December 2010. Hemodynamic measures were taken from every patient, including systolic and diastolic blood pressure using a sphygmomanometer. Unruptured IA and ruptured IA characteristics, including aneurysmal shape, size, angle, aspect ratio, and bottleneck factor, were measured and calculated from transverse brain CT angiography images. With ultrasound, the right common carotid artery intima-media thickness was measured, as well as the lumen diameter during systole and diastole. Arterial wall strain, distensibility, stiffness index, and elastic modulus were calculated and compared between patients with unruptured IAs and ruptured IAs. A p-value less than 0.05 was considered statistically significant. Results General demographic data did not differ between patients with unruptured IAs and ruptured IAs. Greater mean intima-media thickness (p=0.013), mean stiffness index (p=0.044), and mean elastic modulus (p=0.026) were observed for patients with ruptured IAs. Moreover, mean strain (p=0.013) and mean distensibility (p=0.024) were decreased in patients with ruptured IAs. Conclusions Patients with ruptured IAs demonstrated decreased arterial distensibility and increased intima-media thickness at the level of the carotid arteries. By measuring these parameters via ultrasound, it may be possible to predict whether patients with existing IAs might rupture and hemorrhage into the subarachnoid space. PMID:23974299

  5. 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

  6. 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

  7. 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

  8. Anal. Chem. 1991, 63, 2193-2196 2193 background due to the secondary ions generated in the de-

    E-print Network

    Anal. Chem. 1991, 63, 2193-2196 2193 background due to the secondary ions generated in the de-362 and ref-. .erences therein. Klimcak, 0.;Wessei, J. E. Anal. Chem. 1080, 52, 1233. Rhodes, 0.; Opsal, R. B.; Meek, J. T.; Reiiiy, J. P. Anal. Chem. 1083, 55. 280..., ~ . . Dobson, R. L. M.; D'Siiva, A. P.; Weeks

  9. Anal. Chem. 1993,65,2389-2393 2388 Hydrodynamic Model of Matrix-Assisted Laser Desorption Mass

    E-print Network

    Vertes, Akos

    Anal. Chem. 1993,65,2389-2393 2388 Hydrodynamic Model of Matrix-Assisted Laser Desorption Mass, HungarianAcademyofSciences,H-1525Budapeat,P.O.Box17,Hungary. (1)Karas, M.; Hillenkamp, F. Anal. Chem. 1988.; Cotter, R. J. Anal. Chem. 1990,62, 793. (8)Nuwaysir, L. M.; Wilkins, Ch. L. Proc. 38th ASMS Conf. Mass

  10. Anal. Ch" 1992, 64, 2775-2782 Acousto-Optic Tunable Filter as a Polychromator and Its

    E-print Network

    Reid, Scott A.

    Anal. Ch" 1992, 64, 2775-2782 Acousto-Optic Tunable Filter as a Polychromator and Its Application. M.; Callis, J. B.; Davidson, E. R.; Gauyeman, M.; (2)Warner, I.M.;Patonay, G.;Thomas,M. P. Anal.;Callii,J. B.;Christian,G. D.;Davidson, E. R. Anal. (7) Roesi, T. M.; Warner, I. M. Appl. Spectrosc. 1984

  11. 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

  12. Shigella subverts the host recycling compartment to rupture its vacuole.

    PubMed

    Mellouk, Nora; Weiner, Allon; Aulner, Nathalie; Schmitt, Christine; Elbaum, Michael; Shorte, Spencer L; Danckaert, Anne; Enninga, Jost

    2014-10-01

    Shigella enters epithlial cells via internalization into a vacuole. Subsequent vacuolar membrane rupture allows bacterial escape into the cytosol for replication and cell-to-cell spread. Bacterial effectors such as IpgD, a PI(4,5)P2 phosphatase that generates PI(5)P and alters host actin, facilitate this internalization. Here, we identify host proteins involved in Shigella uptake and vacuolar membrane rupture by high-content siRNA screening and subsequently focus on Rab11, a constituent of the recycling compartment. Rab11-positive vesicles are recruited to the invasion site before vacuolar rupture, and Rab11 knockdown dramatically decreases vacuolar membrane rupture. Additionally, Rab11 recruitment is absent and vacuolar rupture is delayed in the ipgD mutant that does not dephosphorylate PI(4,5)P? into PI(5)P. Ultrastructural analyses of Rab11-positive vesicles further reveal that ipgD mutant-containing vacuoles become confined in actin structures that likely contribute to delayed vacular rupture. These findings provide insight into the underlying molecular mechanism of vacuole progression and rupture during Shigella invasion. PMID:25299335

  13. How does damage affect rupture propagation across a fault stepover?

    NASA Astrophysics Data System (ADS)

    Cooke, M. L.; Savage, H. M.

    2011-12-01

    We investigate the potential for fault damage to influence earthquake rupture at fault step-overs using a mechanical numerical model that explicitly includes the generation of cracks around faults. We compare the off-fault fracture patterns and slip profiles generated along faults with a variety of frictional slip-weakening distances and step-over geometry. Models with greater damage facilitate the transfer of slip to the second fault. Increasing separation and decreasing the overlap distance reduces the transfer of slip across the step over. This is consistent with observations of rupture stopping at step-over separation greater than 4 km (Wesnousky, 2006). In cases of slip transfer, rupture is often passed to the second fault before the damage zone cracks of the first fault reach the second fault. This implies that stresses from the damage fracture tips are transmitted elastically to the second fault to trigger the onset of slip along the second fault. Consequently, the growth of damage facilitates transfer of rupture from one fault to another across the step-over. In addition, the rupture propagates along the damage-producing fault faster than along the rougher fault that does not produce damage. While this result seems counter to our understanding that damage slows rupture propagation, which is documented in our models with pre-existing damage, these model results are suggesting an additional process. The slip along the newly created damage may unclamp portions of the fault ahead of the rupture and promote faster rupture. We simulate the M7.1 Hector Mine Earthquake and compare the generated fracture patterns to maps of surface damage. Because along with the detailed damage pattern, we also know the stress drop during the earthquake, we may begin to constrain parameters like the slip-weakening distance along portions of the faults that ruptured in the Hector Mine earthquake.

  14. Blunt traumatic cardiac rupture. A 5-year experience.

    PubMed Central

    Brathwaite, C E; Rodriguez, A; Turney, S Z; Dunham, C M; Cowley, R

    1990-01-01

    Blunt traumatic cardiac rupture is associated with a high rate of mortality. A review of the computerized trauma registry (1983 to 1988) identified 32 patients with this injury (ages 19 to 65 years; mean age, 39.5 years; 21 men and 11 women). Twenty-one patients (65.6%) were injured in vehicular crashes, 3 (9.4%) in pedestrian accidents, 3 (9.4%) in motorcycle accidents; 3 (9.4%) sustained crush injury; 1 (3.1%) was injured by a fall; and 1 (3.1%) was kicked in the chest by a horse. Anatomic injuries included right atrial rupture (13[40.6%]), left atrial rupture (8 [25%]), right ventricular rupture (10[31.3%]), left ventricular rupture (4[12.5%]), and rupture of two cardiac chambers (3 [9.4%]). Diagnosis was made by thoracotomy in all 20 patients presenting in cardiac arrest. In the remaining 12 patients, the diagnosis was established in seven by emergency left anterolateral thoracotomy and in five by subxyphoid pericardial window. Seven of these 12 patients (58.3%) had clinical cardiac tamponade and significant upper torso cyanosis. The mean Injury Severity Score (ISS), Trauma Score (TS), and Glasgow Coma Scale (GCS) score were 33.8, 13.2, and 14.3, respectively, among survivors and 51.5, 8.3, and 7.0 for nonsurvivors. The overall mortality rate was 81.3% (26 of 32 patients), the only survivors being those presenting with vital signs (6 of 12 patients [50%]). All patients with rupture of two cardiac chambers or with ventricular rupture died. The mortality rate from myocardial rupture is very high. Rapid prehospital transportation, a high index of suspicion, and prompt surgical intervention contribute to survival in these patients. PMID:2256761

  15. The study between the dynamics and the X-ray anatomy and regularizing effect of gallbladder on bile duct sphincter of the dog

    PubMed Central

    Wei, Jing-Guo; Wang, Yao-Cheng; Liang, Guo-Min; Wang, Wei; Chen, Bao-Ying; Xu, Jia-Kuan; Song, Li-Jun

    2003-01-01

    AIM: To study the relationship between the radiological anatomy and the dynamics on bile duct sphincter in bile draining and regulatory effect of gallbladder. METHODS: Sixteen healthy dogs weighing 18 kg to 25 kg were divided randomly into control group and experimental group (cholecystectomy group). Cineradiography, manometry with perfusion, to effect of endogenous cholecystokinin and change of ultrastructure were employed. RESULTS: According to finding of the choledochography and manometry, in control group the intraluminal basal pressure of cephalic cyclic smooth muscle of choledochal sphincter cCS was 9.0 ± 2.0 mmHg and that of middle oblique smooth muscle of choledochal sphincter (mOS) was 16.8 ± 0.5 mmHg, the intraluminal basal pressure of cCS segment was obviously lower than that of mOS (P < 0.01) in the interval period of bile draining, but significant difference of intraluminal basal pressure of the mOS segment was not found between the interval period of bile draining (16.8 ± 0.5 mmHg) and the bile flowing period (15.9 ± 0.9 mmHg) (P > 0.05). The motility of cCS was mainly characterized by rhythmically concentric contraction, just as motility of cCS bile juice was pumped into the mOS segment in control group. And motility of mOS segment showed mainly diastolic and systolic activity of autonomically longitudinal peristalsis. There was spasmodic state in cCS and mOS segment and reaction to endogenous cholecystokinin was debased after cholecystectomy. The change of ultrastructure of cCS portion showed mainly that the myofilaments of cell line in derangement and mitochondria is swelling. CONCLUSION: During fasting, the cCS portion has a function as similar cardiac "pump" and it is main primary power source in bile draining, and mOS segment serves mainly as secondary power in bile draining. The existence of the intact gallbladder is one of the important factors in guaranteeing the functional coordination between the cCS and mOS of bile duct sphincter. There is dysfunction in the cCS and mOS with cholecystectomy. PMID:12717848

  16. Frictional melting during the rupture of the 1994 bolivian earthquake

    PubMed

    Kanamori; Anderson; Heaton

    1998-02-01

    The source parameters of the 1994 Bolivian earthquake (magnitude Mw = 8.3) suggest that the maximum seismic efficiency eta was 0.036 and the minimum frictional stress was 550 bars. Thus, the source process was dissipative, which is consistent with the observed slow rupture speed, only 20% of the local S-wave velocity. The amount of nonradiated energy produced during the Bolivian rupture was comparable to, or larger than, the thermal energy of the 1980 Mount St. Helens eruption and was sufficient to have melted a layer as thick as 31 centimeters. Once rupture was initiated, melting could occur, which reduces friction and promotes fault slip. PMID:9452378

  17. Rupture Synchronicity in Complex Fault Systems

    NASA Astrophysics Data System (ADS)

    Milner, K. R.; Jordan, T. H.

    2013-12-01

    While most investigators would agree that the timing of large earthquakes within a fault system depends on stress-mediated interactions among its elements, much of the debate relevant to time-dependent forecasting has been centered on single-fault concepts, such as characteristic earthquake behavior. We propose to broaden this discussion by quantifying the multi-fault concept of rupture synchronicity. We consider a finite set of small, fault-spanning volumes {Vk} within a fault system of arbitrary (fractal) complexity. We let Ck be the catalog of length tmax comprising Nk discrete times {ti(k)} that mark when the kth volume participates in a rupture of magnitude > M. The main object of our analysis is the complete set of event time differences {?ij(kk') = ti(k) - tj(k')}, which we take to be a random process with an expected density function ?kk'(t). When k = k', we call this function the auto-catalog density function (ACDF); when k ? k', we call it the cross-catalog density function (CCDF). The roles of the ACDF and CCDF in synchronicity theory are similar to those of autocorrelation and cross-correlation functions in time-series analysis. For a renewal process, the ACDF can be written in terms of convolutions of the interevent-time distribution, and many of its properties (e.g., large-t asymptote) can be derived analytically. The interesting information in the CCDF, like that in the ACDF, is concentrated near t = 0. If two catalogs are completely asynchronous, the CCDF collapses to an asymptote given by the harmonic mean of the ACDF asymptotes. Synchronicity can therefore be characterized by the variability of the CCDF about this asymptote. The brevity of instrumental catalogs makes the identification of synchronicity at large M difficult, but we will illustrate potentially interesting behaviors through the analysis of a million-year California catalog generated by the earthquake simulator, RSQSim (Deiterich & Richards-Dinger, 2010), which we sampled at a dozen fault-spanning volumes. At the magnitude threshold M = 7, the ACDF can be well fit by renewal models with fairly small aperiodicity parameters (? < 0.2) for all fault volumes but one (on the San Jacinto fault). At interseismic (Reid) time scales, we observe pairs of fault segments that are tightly locked, such as the Cholame and Carrizo sections of the San Andreas Fault (SAF), where the CCDF and two ACDFs are nearly equal; segments out of phase (Carrizo-SAF/Coachella-SAF and Coachella-SAF/San Jacinto), where the CCDF variation is an odd function of time; and segments where events are in phase with integer ratios of recurrence times (2:1 synchronicity of Coachella-SAF/Mojave-SAF and Carrizo-SAF/Mojave-SAF). At near-seismic (Omori) time scales, we observe various modes of clustering, triggering, and shadowing in RSQSim catalogs; e.g., events on Mojave-SAF trigger Garlock events, and events on Coachella-SAF shut down events on San Jacinto. Therefore, despite its geometrical complexity and multiplicity of time scales, the RSQSim model of the San Andreas fault system exhibits a variety of synchronous behaviors that increase the predictability of large ruptures within the system. A key question for earthquake forecasting is whether the real San Andreas system is equally, or much less, synchronous.

  18. Co-existence of a rare dyspnea with pericardial diaphragmatic rupture and pericardial rupture: a case report

    PubMed Central

    Karg?, Ahmet Bülent; Zeybek, Arife

    2015-01-01

    Pericardial-diaphragmatic rupture is a rare condition which occurs after blunt trauma and involves the herniation of abdominal organs into the pericardium. A 77-year-old female patient presenting with complaints of palpitation and difficulty in breathing was admitted to the emergency room. Left lateral thoracotomy revealed the herniation of abdominal organs into the thorax. A pericardial-diaphragmatic rupture and a pericardial rupture were found to co-exist. The diaphragm and the pericardium were repaired primarily. The case is presented here because herniation of abdominal organs into the pleural cavity through the pericardium is a rare condition. PMID:26336505

  19. Appendix T--Defining the Inversion Rupture Set Using Plausibility Filters

    E-print Network

    Shaw, Bruce E.

    the Uniform California Earthquake Rupture Forecast, version 3 (UCERF3), California Reference Fault Parameter Earthquake Rupture Forecast, Version 3 (UCERF3) 2 Table T1. Summary of Uniform California Earthquake Rupture.S. Geological Survey. 3 University of Nevada, Reno. 4 Columbia University. #12;Appendix T of Uniform California

  20. 2082 ANALYTICAL CHEMISTRY, VOL. 51, NO. 13, NOVEMBER 1979 (18) Burdo, T. G.; Seitz, W. R. Anal. Chem. 1975, 47, 1639.

    E-print Network

    2082 ANALYTICAL CHEMISTRY, VOL. 51, NO. 13, NOVEMBER 1979 (18) Burdo, T. G.; Seitz, W. R. Anal.D.Thesis, Wayne State University,Detroit, Mich., 1974. (24) Nau, v.; Nieman, T. A. Anal. Chem. 1979, 51, 424. (25) Stieg, S.; Nieman, T. A. Anal. Chem. submitted for publication. (26) Veazey, R.; Nieman, T. A. Anal

  1. 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

  2. Emergency endovascular repair of ruptured visceral artery aneurysms

    E-print Network

    Sadat, Umar; Noor, Nadim; Tang, Tjun Y; Varty, Kevin

    2007-07-02

    Abstract Background Visceral artery aneurysms although rare, have very high mortality if they rupture. Case presentation An interesting case of a bleeding inferior pancreaticduodenal artery aneurysm is reported in a young patient who presented...

  3. Neglected bilateral rupture of the patellar tendon: A case report.

    PubMed

    Cherrad, Taoufik; Louaste, Jamal; Kasmaoui, El Houcine; Bousbaä, Hicham; Rachid, Khaled

    2015-12-01

    Simultaneous bilateral rupture of the patellar tendon (PT) is extremely rare and is generally associated to some chronic diseases. When the rupture becomes chronic, it is more difficult to repair that as it remained untreated. The diagnosis, which is clinical, is often delayed, guided by standard radiography and confirmed by ultrasound or MRI. The management of a bilateral neglected, chronic patellar tendon rupture must address some serious difficulties: the proximally retracted patella, the reconstruction of the patellar tendon, finally, the temporary protection of this repair. We report a case of neglected bilateral rupture of the patellar tendon in a chronic hemodialysis patient, treated with a plastic surgery of the ipsilateral quadriceps tendon. PMID:26566349

  4. Rate dependent rupture of solid-supported phospholipid bilayers.

    E-print Network

    Ng, Sarah S

    2006-01-01

    An experimental study on solid-supported phospholipid bilayers was performed in order to investigate rate-dependent behavior of force and probability of bilayer rupture. 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphocholine ...

  5. Aneurysmal Rupture of a Mesodiverticular Band to a Meckel's Diverticulum

    PubMed Central

    Sommerhalder, Christian; Fretwell, Kenneth R.; Salzler, Gregory G.; Creasy, John M.; Robitsek, R. Jonathan; Schubl, Sebastian D.

    2015-01-01

    Aneurysmal rupture of a mesodiverticular band has not previously been reported in the clinical literature. We are reporting a case of hemoperitoneum in a 51-year-old male after an aneurysmal rupture of a mesodiverticular band. This case demonstrates that in rare instances, a rupture of the mesodiverticular band leading to Meckel's diverticulum can lead to significant hemoperitoneum. This is usually caused by a traumatic injury but in our case was apparently caused by an aneurysm of the mesodiverticular artery. Patients with known Meckel's diverticula should be aware of the possibility of rupture, as should clinicians treating those with a history of this usually benign congenital abnormality. Rapid surgical intervention is necessary to repair the source of bleeding, as massive blood loss was encountered in this case. PMID:25688323

  6. Controls on earthquake rupture and triggering mechanisms in subduction zones

    E-print Network

    Llenos, Andrea Lesley

    2010-01-01

    Large earthquake rupture and triggering mechanisms that drive seismicity in subduction zones are investigated in this thesis using a combination of earthquake observations, statistical and physical modeling. A comparison ...

  7. Experimental investigation of creep rupture of reactor vessel lower head

    SciTech Connect

    Chu, Tze Yao; Pilch, M.M.; Bentz, J.H.

    1997-12-01

    This paper summarizes experiments on creep rupture of reactor pressure vessel (RPV) lower heads under the thermal and pressure loads of a core meltdown accident. Lower head failure (LHF) is of importance to accident assessment and accident management.

  8. Soft, Brown Rupture: Clinical Signs and Symptoms Associated with Ruptured PIP Breast Implants

    PubMed Central

    Duncan, Robert T.; Feig, Christine; Reintals, Michelle; Hill, Sarah

    2014-01-01

    Background: Preoperative signs and symptoms of patients with Poly Implant Prothese (PIP) implants could be predictive of device failure. Based on clinical observation and intraoperative findings 4 hypotheses were raised: (1) Preoperative clinical signs including acquired asymmetry, breast enlargement, fullness of the lower pole, decreased mound projection, and change in breast consistency could be indicative of implant rupture. (2) Device failure correlates with a low preoperative Baker grade of capsule. (3) Brown-stained implants are more prone to implant failure. (4) The brown gel could be indicative of iodine ingression through a substandard elastomer shell. Methods: Preoperative clinical signs were compared with intraoperative findings for 27 patients undergoing PIP implant explantation. Results: Acquired asymmetry (P = 0.0003), breast enlargement (P = 0.0002), fuller lower pole (P < 0.0001), and loss of lateral projection (P < 0.0001) were all significantly predictive of device failure. Capsule Baker grade was lower preoperatively for ruptured implants. The lack of palpable and visible preoperative capsular contracture could be secondary to the elastic nature of the capsular tissue found. Brown implants failed significantly more often than white implants. Analysis of brown gel revealed the presence of iodine, suggesting povidone iodine ingression at implantation. Conclusions: Preoperative signs can be predictive of PIP implant failure. Brown-stained implants are more prone to rupture. The presence of iodine in the gel suggests unacceptable permeability of the shell early in the implant’s life span. A noninvasive screening test to detect brown implants in situ could help identify implants at risk of failure in those who elect to keep their implants. PMID:25506532

  9. Rapid Estimates of Rupture Extent for Large Earthquakes Using Aftershocks

    NASA Astrophysics Data System (ADS)

    Polet, J.; Thio, H. K.; Kremer, M.

    2009-12-01

    The spatial distribution of aftershocks is closely linked to the rupture extent of the mainshock that preceded them and a rapid analysis of aftershock patterns therefore has potential for use in near real-time estimates of earthquake impact. The correlation between aftershocks and slip distribution has frequently been used to estimate the fault dimensions of large historic earthquakes for which no, or insufficient, waveform data is available. With the advent of earthquake inversions that use seismic waveforms and geodetic data to constrain the slip distribution, the study of aftershocks has recently been largely focused on enhancing our understanding of the underlying mechanisms in a broader earthquake mechanics/dynamics framework. However, in a near real-time earthquake monitoring environment, in which aftershocks of large earthquakes are routinely detected and located, these data may also be effective in determining a fast estimate of the mainshock rupture area, which would aid in the rapid assessment of the impact of the earthquake. We have analyzed a considerable number of large recent earthquakes and their aftershock sequences and have developed an effective algorithm that determines the rupture extent of a mainshock from its aftershock distribution, in a fully automatic manner. The algorithm automatically removes outliers by spatial binning, and subsequently determines the best fitting “strike” of the rupture and its length by projecting the aftershock epicenters onto a set of lines that cross the mainshock epicenter with incremental azimuths. For strike-slip or large dip-slip events, for which the surface projection of the rupture is recti-linear, the calculated strike correlates well with the strike of the fault and the corresponding length, determined from the distribution of aftershocks projected onto the line, agrees well with the rupture length. In the case of a smaller dip-slip rupture with an aspect ratio closer to 1, the procedure gives a measure of the rupture extent and dimensions, but not necessarily the strike. We found that using standard earthquake catalogs, such as the National Earthquake Information Center catalog, we can constrain the rupture extent, rupture direction, and in many cases the type of faulting, of the mainshock with the aftershocks that occur within the first hour after the mainshock. However, this data may not be currently available in near real-time. Since our results show that these early aftershock locations may be used to estimate first order rupture parameters for large global earthquakes, the near real-time availability of these data would be useful for fast earthquake damage assessment.

  10. Determination of closure disk rupture parameters

    SciTech Connect

    Merten, C.W.; Robinson, M.A. ); Evans, N.A. )

    1990-01-01

    The necessity of decoupling strain rate from burn rate effects for tests designed to characterize closure disks is discussed. A method for simulating the high rates of pressure increase to which closure disks are subjected and which does not employ pyrotechnic material as a means of pressurization is presented. It consists of slowly pressurizing both sides of a closure disk to a high pressure and then rapidly releasing the pressure from one side of the disk. Means of rapidly releasing gas from the downstream side of the closure disk and measuring the pressure differential across the closure disk are discussed in detail. Rates of pressure decrease as high as 335,000,000 psi/sec downstream from the closure disk have been attained. Baseline disks slotted by wire EDM failed at an average pressure differential of 10,150 psi. Disks slotted by chemical etching exhibited a higher burst pressure differential and greater variability. Glass-ceramic closure disks had the lowest average burst pressure and highest variability. An increase in the diameter of a closure disk was found to lower the pressure differential required to rupture the disk. Burst pressure was found to increase linearly with the thickness of the web in the slot. 5 refs., 6 figs., 5 tabs.

  11. [Spontaneous hepatic rupture during an uncomplicated twin pregnancy].

    PubMed

    Fat, B Chung; Terzibachian, J J; Grisey, A; Houzé, J P; Faller, J P; Leung, F; de Lapparent, T; Maillet, R; Riethmuller, D

    2011-01-01

    Liver subcapsular haematoma and its consequence, spontaneous hepatic rupture, are very rare complications of pregnancy. They are mainly associated with pre-eclampsia. The diagnosis is difficult and the maternal and fetal mortality rates are high. We report the case of a spontaneous hepatic rupture on a normal liver during an uncomplicated twin pregnancy with a favorable outcome for both the mother and the newborns. PMID:21183383

  12. Myotomy of Distal Esophagus Influences Proximal Esophageal Contraction and Upper Esophageal Sphincter Relaxation in Patients with Achalasia After Peroral Endoscopic Myotomy

    PubMed Central

    Ren, Yutang; Tang, Xiaowei; Chen, Fengping; Deng, Zhiliang; Wu, Jianuan; Nei, Soma; Jiang, Bo; Gong, Wei

    2016-01-01

    Background/Aims The motility change after peroral endoscopic myotomy (POEM) in achalasia is currently focused on lower esophageal sphincter (LES). This study aims to investigate the correlation of motility response between distal and proximal esophagus after POEM. Methods A total of 32 achalasia patients who received POEM and high-resolution manometry (HRM) were included for analysis. Eckardt score was used to assess symptom improvement. HRM was applied for studying motility. Main parameters analyzed were (1) LES: resting pressure (restP), 4-second integrated relaxation pressure; (2) esophageal body (EB): contractile integral of distal segment with myotomy (CI-DM) and proximal segment without myotomy (CI-PNM); and (3) upper esophageal sphincter (UES): relaxation pressure (UES-RP). Results There were 6 type I, 17 type II, and 9 type III achalasia patients included for analysis. (1) Eckardt score, LES tone, CI-DM, CI-PNM and UES-RP were reduced remarkably after POEM (P < 0.001). (2) no significant correlation was noted between LES tone and contractile intergral of EB. (3) a positive linear correlation of CI-DM and CI-PNM changes was detected (P < 0.001). (4) the change of UES-RP was positively correlated with the change of contractile integral of EB (P < 0.001). Conclusions Myotomy of the distal esophagus would attenuate proximal EB contraction and assist UES relaxation in achalasia patients after POEM. PMID:26459454

  13. Incidence and outcome of rupture of the Achilles tendon.

    PubMed

    Cretnik, Andrej; Frank, Aleksander

    2004-01-01

    We determined the incidence of complete rupture of the Achilles tendon in the Maribor region (273,609 inhabitants) between 1991 and 1996. During this period, 116 ruptures were treated at Maribor Teaching Hospital. The average incidence was 7 ruptures per 100,000 inhabitants, with a peak incidence of almost 9 per 100,000. Most injuries (65%) occurred during sports activities, with soccer as the major cause of rupture. The average age of patients was 37 years with a male-to-female ratio of 18:1. All patients underwent open surgical repair of the ruptured Achilles tendon, with a minimum follow-up of two years. 19.8% of cases developed complications and in 10.4% of these the complications were major. 1.9% of patients sustained a re-rupture. The mean AOFAS score was 96 points. The patients were subjectively very satisfied with their treatment in 88% of cases. Good functional results with a return to the usual pre-injury activities were achieved in 96% of patients. PMID:15506308

  14. The temporal distribution of seismic radiation during deep earthquake rupture

    USGS Publications Warehouse

    Houston, H.; Vidale, J.E.

    1994-01-01

    The time history of energy release during earthquakes illuminates the process of failure, which remains enigmatic for events deeper than about 100 kilometers. Stacks of teleseismic records from regional arrays for 122 intermediate (depths of 100 to 350 kilometers) and deep (depths of 350 to 700 kilometers) earthquakes show that the temporal pattern of short-period seismic radiation has a systematic variation with depth. On average, for intermediate depth events more radiation is released toward the beginning of the rupture than near the end, whereas for deep events radiation is released symmetrically over the duration of the event, with an abrupt beginning and end of rupture. These findings suggest a variation in the style of rupture related to decreasing fault heterogeneity with depth.The time history of energy release during earthquakes illuminates the process of failure, which remains enigmatic for events deeper than about 100 kilometers. Stacks of teleseismic records from regional arrays for 122 intermediate (depths of 100 to 350 kilometers) and deep (depths of 350 to 700 kilometers) earthquakes show that the temporal pattern of short-period seismic radiation has a systematic variation with depth. On average, for intermediate depth events more radiation is released toward the beginning of the rupture than near the end, whereas for deep events radiation is released symmetrically over the duration of the event, with an abrupt beginning and end of rupture. These findings suggest a variation in the style of rupture related to decreasing fault heterogeneity with depth.

  15. Rupture of a Biomembrane under Dynamic Surface Tension

    E-print Network

    D. J. Bicout; E. I. Kats

    2011-12-19

    How long a fluid membrane vesicle stressed with a steady ramp of micropipette last before rupture? Or conversely, how high the surface tension should be to rupture a membrane? To answer these challenging questions we have developed a theoretical framework that allows description and reproduction of Dynamic Tension Spectroscopy (DTS) observations. The kinetics of the membrane rupture under ramps of surface tension is described as a combination of initial pore formation followed by Brownian process of the pore radius crossing the time-dependent energy barrier. We present the formalism and derive (formal) analytical expression of the survival probability describing the fate of the membrane under DTS conditions. Using numerical simulations for the membrane prepared in an initial state with a given distribution of times for pore nucleation, we have studied the membrane lifetime (or inverse of rupture rate) and distribution of membrane surface tension at rupture as a function of membrane characteristics like pore nucleation rate, the energy barrier to failure and tension loading rate. It is found that simulations reproduce main features of the experimental data, particularly, the pore nucleation and pore size diffusion controlled limits of membrane rupture dynamics. This approach can also be applied to processes of permeation and pore opening in membranes (electroporation, membrane disruption by antimicrobial peptides, vesicle fusion).

  16. Volume Fraction Dependence of Droplet Rupturing in Concentrated Nanoemulsions

    NASA Astrophysics Data System (ADS)

    Meleson, K.

    2005-03-01

    We investigate droplet rupturing by extreme shear in concentrated silicone oil-in-water nanoemulsions stabilized by sodium dodecyl sulfate (SDS) surfactant. According to Taylor's prediction for dilute emulsions, the ruptured droplet radius, a, varies inversely with the viscosity of the continuous phase. If one assumes that the emulsion's effective viscosity controls the average radius of the ruptured droplets, then emulsions that have larger droplet volume fractions, ?s would be ruptured by the same shear flow to smaller radii. In stark contrast to this, we find that the average droplet radius actually rises with as ? approaches the quiescent maximally random jammed value of 0.64. This is evidence that both droplet rupturing and coalescence occur when concentrated emulsions are subjected to extreme shear. We have also observed phase inversion to an oil-continuous emulsion for ? > 0.64. This supports the idea that coalescence occurs as the driving shear breaks thin films between the concentrated oil droplets at high ?. In addition, we find that the ruptured droplet size is relatively insensitive to large changes in the oil viscosity inside the droplets.

  17. 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.

  18. Sphincter of Oddi Dysfunction

    MedlinePLUS

    ... recurrent attacks of unexplained inflammation of the pancreas (pancreatitis). About half of these patients will have findings ... of Oddi manometry) can cause an attack of pancreatitis in 5–10% of cases. While most of ...

  19. Vortex dynamics in ruptured and unruptured intracranial aneurysms

    NASA Astrophysics Data System (ADS)

    Trylesinski, Gabriel

    Intracranial aneurysms (IAs) are a potentially devastating pathological dilation of brain arteries that affect 1.5-5 % of the population. Causing around 500 000 deaths per year worldwide, their detection and treatment to prevent rupture is critical. Multiple recent studies have tried to find a hemodynamics predictor of aneurysm rupture, but concluded with distinct opposite trends using Wall Shear Stress (WSS) based parameters in different clinical datasets. Nevertheless, several research groups tend to converge for now on the fact that the flow patterns and flow dynamics of the ruptured aneurysms are complex and unstable. Following this idea, we investigated the vortex properties of both unruptured and ruptured cerebral aneurysms. A brief comparison of two Eulerian vortex visualization methods (Q-criterion and lambda 2 method) showed that these approaches gave similar results in our complex aneurysm geometries. We were then able to apply either one of them to a large dataset of 74 patient specific cases of intracranial aneurysms. Those real cases were obtained by 3D angiography, numerical reconstruction of the geometry, and then pulsatile CFD simulation before post-processing with the mentioned vortex visualization tools. First we tested the two Eulerian methods on a few cases to verify their implementation we made as well as compare them with each other. After that, the Q-criterion was selected as method of choice for its more obvious physical meaning (it shows the balance between two characteristics of the flow, its swirling and deformation). Using iso-surfaces of Q, we started by categorizing the patient-specific aneurysms based on the gross topology of the aneurysmal vortices. This approach being unfruitful, we found a new vortex-based characteristic property of ruptured aneurysms to stratify the rupture risk of IAs that we called the Wall-Kissing Vortices, or WKV. We observed that most ruptured aneurysms had a large amount of WKV, which appears to agree with the current hypothesized biological triggers of pathological remodeling of the artery walls. Having a good natural ratio of statuses in our IA cohort (55 unruptured vs. 19 ruptured), we were able to test the statistical significance of our predictor to fortify our findings. We also performed a distribution analysis of our cohort with respect to the number of WKV to strengthen the encouraging statistical analysis result; both analyses provided a clear good separation of the status of the aneurysms based on our predictor. Lastly, we constructed a receiver operating characteristic (ROC) curve to analyze the power different thresholds of WKV had in splitting the data in a binary way (unruptured/ruptured). The number of WKV was efficaciously able to stratify the rupture status, identifying 84.21 % of the ruptured aneurysms (with 25.45 % of false positives, i.e. unruptured IAs tagged as ruptured) when using a threshold value of 2. Our novel work undertaken to study the vortex structures in IAs brought to light interesting characteristics of the flow in the aneurysmal sac. We found that there are several distinct categories in which the aneurysm vortex topologies can be put in without relationship to the aneurysm rupture status. This first finding was in contradiction with available already-published results. Nonetheless, ruptured IAs had a statistically significant larger amount of WKV as opposed to unruptured aneurysms. This new predictor we propose to the community could very well clear a new path among the currently controversial WSS-based parameters. Although it needs to be improved to be more resilient, the first results obtained by the WKV-based parameter are promising when applied to a large dataset of 74 IAs patient-specific transient CFD simulations.

  20. Creep-rupture behavior of candidate Stirling engine iron supperalloys in high-pressure hydrogen. Volume 2: Hydrogen creep-rupture behavior

    NASA Technical Reports Server (NTRS)

    Bhattacharyya, S.; Peterman, W.; Hales, C.

    1984-01-01

    The creep rupture behavior of nine iron base and one cobalt base candidate Stirling engine alloys is evaluated. Rupture life, minimum creep rate, and time to 1% strain data are analyzed. The 3500 h rupture life stress and stress to obtain 1% strain in 3500 h are also estimated.

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

    E-print Network

    Wesfreid, José Eduardo

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

  2. 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 ?m, 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

  3. 476 Anal. Chem. 1883, 65, 476-481 Determination of Carbohydrates by Capillary Zone

    E-print Network

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

  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. 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.

  7. Composite Overwrap Pressure Vessels: Mechanics and Stress Rupture Lifing Philosophy

    NASA Technical Reports Server (NTRS)

    Thesken, John C.; Murthy, Pappu L. N.; Phoenix, Leigh

    2007-01-01

    The NASA Engineering and Safety Center (NESC) has been conducting an independent technical assessment to address safety concerns related to the known stress rupture failure mode of filament wound pressure vessels in use on Shuttle and the International Space Station. The Shuttle's Kevlar-49 fiber overwrapped tanks are of particular concern due to their long usage and the poorly understood stress rupture process in Kevlar-49 filaments. Existing long term data show that the rupture process is a function of stress, temperature and time. However due to the presence of load sharing liners and the complex manufacturing procedures, the state of actual fiber stress in flight hardware and test articles is not clearly known. Indeed non-conservative life predictions have been made where stress rupture data and lifing procedures have ignored the contribution of the liner in favor of applied pressure as the controlling load parameter. With the aid of analytical and finite element results, this paper examines the fundamental mechanical response of composite overwrapped pressure vessels including the influence of elastic-plastic liners and degraded/creeping overwrap properties. Graphical methods are presented describing the non-linear relationship of applied pressure to Kevlar-49 fiber stress/strain during manufacturing, operations and burst loadings. These are applied to experimental measurements made on a variety of vessel systems to demonstrate the correct calibration of fiber stress as a function of pressure. Applying this analysis to the actual qualification burst data for Shuttle flight hardware revealed that the nominal fiber stress at burst was in some cases 23% lower than what had previously been used to predict stress rupture life. These results motivate a detailed discussion of the appropriate stress rupture lifing philosophy for COPVs including the correct transference of stress rupture life data between dissimilar vessels and test articles.

  8. Composite Overwrap Pressure Vessels: Mechanics and Stress Rupture Lifting Philosophy

    NASA Technical Reports Server (NTRS)

    Thesken, John C.; Murthy, Pappu L. N.; Phoenix, S. L.

    2009-01-01

    The NASA Engineering and Safety Center (NESC) has been conducting an independent technical assessment to address safety concerns related to the known stress rupture failure mode of filament wound pressure vessels in use on Shuttle and the International Space Station. The Shuttle s Kevlar-49 (DuPont) fiber overwrapped tanks are of particular concern due to their long usage and the poorly understood stress rupture process in Kevlar-49 filaments. Existing long term data show that the rupture process is a function of stress, temperature and time. However due to the presence of load sharing liners and the complex manufacturing procedures, the state of actual fiber stress in flight hardware and test articles is not clearly known. Indeed nonconservative life predictions have been made where stress rupture data and lifing procedures have ignored the contribution of the liner in favor of applied pressure as the controlling load parameter. With the aid of analytical and finite element results, this paper examines the fundamental mechanical response of composite overwrapped pressure vessels including the influence of elastic plastic liners and degraded/creeping overwrap properties. Graphical methods are presented describing the non-linear relationship of applied pressure to Kevlar-49 fiber stress/strain during manufacturing, operations and burst loadings. These are applied to experimental measurements made on a variety of vessel systems to demonstrate the correct calibration of fiber stress as a function of pressure. Applying this analysis to the actual qualification burst data for Shuttle flight hardware revealed that the nominal fiber stress at burst was in some cases 23 percent lower than what had previously been used to predict stress rupture life. These results motivate a detailed discussion of the appropriate stress rupture lifing philosophy for COPVs including the correct transference of stress rupture life data between dissimilar vessels and test articles.

  9. Comparison of Hybribio GenoArray and Roche Human Papillomavirus (HPV) Linear Array for HPV Genotyping in Anal Swab Samples

    PubMed Central

    Silver, Michelle I.; Brown, Brandon J.; Leng, Chan Yoon; Blas, Magaly M.; Gravitt, Patti E.; Woo, Yin Ling

    2014-01-01

    Human papillomavirus (HPV) is causally associated with anal cancer, as HPV DNA is detected in up to 90% of anal intraepithelial neoplasias and anal cancers. With the gradual increase of anal cancer rates, there is a growing need to establish reliable and clinically relevant methods to detect anal cancer precursors. In resource-limited settings, HPV DNA detection is a potentially relevant tool for anal cancer screening. Here, we evaluated the performance of the Hybribio GenoArray (GA) for genotyping HPV in anal samples, against the reference standard Roche Linear Array (LA). Anal swab samples were obtained from sexually active men who have sex with men. Following DNA extraction, each sample was genotyped using GA and LA. The overall interassay agreement, type-specific, and single and multiple genotype agreements were evaluated by kappa statistics and McNemar's ?2 tests. Using GA and LA, 68% and 76% of samples were HPV DNA positive, respectively. There was substantial interassay agreements for the detection of all HPV genotypes (? = 0.70, 86% agreement). Although LA was able to detect more genotypes per sample, the interassay agreement was acceptable (? = 0.53, 63% agreement). GA had poorer specific detection of HPV genotypes 35, 42, and 51 (? < 0.60). In conclusion, GA and LA showed good interassay agreement for the detection of most HPV genotypes in anal samples. However, the detection of HPV DNA in up to 76% of anal samples warrants further evaluation of its clinical significance. PMID:25502520

  10. Anal complaints in Nigerians attending Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu.

    PubMed

    Tade, A O; Salami, B A; Musa, A A; Adeniji, A O

    2004-09-01

    The objective of this study was to determine prospectively the prevalence of anal complaints amongst Nigerians attending the General Out-patient Department (GOPD) of the hospital and review the records of those admitted to the surgical service with related complications. All the 272 patients attending the GOPD of OOUTH in November, 1999 were interviewed using a structured questionnaire. Information concerning age, sex, educational status, present or past history of at least one of the following symptoms viz recurrent bleeding per rectum, anal prolapse, anal/perianal pain, pruritus ani and anal discharge were obtained. Also obtained were reason(s) for current hospital attendance and any previous medical consultation. Those with at least one of the symptoms were classified as symptomatic. The symptomatic group had rectal examination including proctoscopy. The results showed that 82/272 (30.15% ) were symptomatic. Rectal examination on these 82 patients showed that 10(3.7% of 272) had haemorrhoids, 2(0.7% ) had rectal prolapse, 0.7% had peri-anal warts; 15(5.5% ) anal tags, 10(3.7% ) chronic anal fissure, 2 (0.7% ) perianal fistulae. In 29(10.4% ), the examination was normal and in 12 the rectum was too loaded with feaces to permit proctoscopy. However, only 5/272 (1.84% ) attended the clinic for the anal complaint, while 12(4.4% ) had previously consulted a physician for same. Fear of impotence following surgery in 24 males and belief in herbal remedies in 32 patients were the main reasons for not consulting a physician. During the year 1999, out of a total of 558 admissions into our surgical service, only 4(0.6% ) were for complications related to anal complaints. This study indicated the prevalence of anal complaints in the study population of Nigerians as 30.15% , haemorrhoids constitute 3.7% and anal fissure 3.7% , contrary to low rates reported for developing countries. While this result cannot be extended to represent prevalence amongst Nigerians, it may be a pointer to what is to be expected. PMID:15505655

  11. Increased 18F-FDG Uptake Is Predictive of Rupture in a Novel Rat Abdominal Aortic Aneurysm Rupture Model

    PubMed Central

    English, Sean J.; Piert, Morand R.; Diaz, Jose A.; Gordon, David; Ghosh, Abhijit; D'Alecy, Louis G.; Whitesall, Steven E.; Sharma, Ashish K.; DeRoo, Elise P.; Watt, Tessa; Su, Gang; Henke, Peter K.; Eliason, Jonathan L.; Ailawadi, Gorav; Upchurch, Gilbert R.

    2015-01-01

    Objective To determine whether 18F-fluorodeoxyglucose (18F-FDG) micro–positron emission tomography (micro-PET) can predict abdominal aortic aneurysm (AAA) rupture. Background An infrarenal AAA model is needed to study inflammatory mechanisms that drive rupture. 18F-FDG PET can detect vascular inflammation in animal models and patients. Methods After exposing Sprague-Dawley rats to intra-aortic porcine pancreatic elastase (PPE) (12 U/mL), AAA rupture was induced by daily, subcutaneous, ?-aminopropionitrile (BAPN, 300 mg/kg, N = 24) administration. Negative control AAA animals (N = 15) underwent daily saline subcutaneous injection after PPE exposure. BAPN-exposed animals that did not rupture served as positive controls [nonruptured AAA (NRAAA) 14d, N = 9]. Rupture was witnessed using radiotelemetry. Maximum standard uptakes for 18F-FDG micro-PET studies were determined. Aortic wall PAI-1, uPA, and tPA concentrations were determined by western blot analyses. Interleukin (IL)-1?, IL-6, IL-10, and MIP-2 were determined by Bio-Plex bead array. Neutrophil and macrophage populations per high-power field were quantified. Matrix metalloproteinase (MMP) activities were determined by zymography. Results When comparing ruptured AAA (RAAA) to NRAAA 14d animals, increased focal 18F-FDG uptakes were detected at subsequent sites of rupture (P = 0.03). PAI-1 expression was significantly less in RAAA tissue (P = 0.01), with comparable uPA and decreased tPA levels (P = 0.02). IL-1? (P = 0.04), IL-6 (P = 0.001), IL-10 (P = 0.04), and MIP-2 (P = 0.02)expression, neutrophil (P = 0.02) and macrophage presence (P = 0.002), and MMP9 (P < 0.0001) activity were increased in RAAA tissue. Conclusions With this AAA rupture model, increased prerupture 18F-FDG uptake on micro-PET imaging was associated with increased inflammation in the ruptured AAA wall. 18F-FDG PET imaging may be used to monitor inflammatory changes before AAA rupture. PMID:24651130

  12. 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.

  13. J. Math. Anal. Appl. 342 (2008) 14811484 www.elsevier.com/locate/jmaa

    E-print Network

    Magajna, Bojan

    2008-01-01

    J. Math. Anal. Appl. 342 (2008) 1481­1484 www.elsevier.com/locate/jmaa On weakly central C by EUCP(A). Clearly maps in EUCP(A) are contractive, preserve all ideals in A and the positive part A.01.037 #12;1482 B. Magajna / J. Math. Anal. Appl. 342 (2008) 1481­1484 A unital C-algebra A is called weakly

  14. J. Math. Anal. Appl. 328 (2007) 13091320 www.elsevier.com/locate/jmaa

    E-print Network

    Hiriart-urruty, Jean-Baptiste

    2007-01-01

    J. Math. Anal. Appl. 328 (2007) 1309­1320 www.elsevier.com/locate/jmaa Convex solutions.1016/j.jmaa.2006.06.035 #12;1310 J.-B. Hiriart-Urruty, J.-E. Martínez-Legaz / J. Math. Anal. Appl. 328), this involution f f preserves convexity: f is convex if and only if f is convex. So, for symmetry reasons

  15. J. Math. Anal. Appl. 341 (2008) 961974 www.elsevier.com/locate/jmaa

    E-print Network

    Mátrai, Tamás

    2008-01-01

    J. Math. Anal. Appl. 341 (2008) 961­974 www.elsevier.com/locate/jmaa On perturbations preserving on a generation theorem of A.M. Gomilko, D.-X. Feng and D.-H. Shi also preserves the immediate norm continuity:10.1016/j.jmaa.2007.10.048 #12;962 T. Mátrai / J. Math. Anal. Appl. 341 (2008) 961­974 regularity

  16. 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

  17. 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

  18. 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

  19. 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

  20. Earthquake Rupture Complexity Evidence from Field Observations (Invited)

    NASA Astrophysics Data System (ADS)

    Hudnut, K. W.; Fletcher, J. M.; Rockwell, T. K.; Gonzalez-Garcia, J. J.; Teran, O.; Akciz, S. O.

    2010-12-01

    Field observations provide strong evidence for four intriguing aspects of rupture process complexity for the 4 April 2010 El Mayor - Cucapah - Indiviso earthquake. First, the southern “fork” of the rupture exhibits two splays just to the northwest of the event epicenter, both with nearly pure right-lateral faulting. Teleseismic source modeling by others indicates normal slip on deep fault surface preceded the shallow strike-slip faulting, and our field observations from the fork area indicate that the earliest phase of strike-slip faulting did not involve a significant normal faulting component. Second, as rupture propagated to the northwest along the Pescadores fault, slip ended abruptly on this fault and transferred across a complex zone to the Borrego fault (although the Pescadores fault continues farther and would have seemed an easier route to follow). This stepover is called the Puerta Accommodation Zone (PAZ) which extends 11 km along-strike within an elevated portion of the Cucapah massif and accommodates a left step (transpressional) that measures less than 2 km across-strike. Though partly obscured by rockfalls in the steep terrain here, only discontinuous faulting of up to one meter reached the ground surface, yet imagery differencing by others indicates several meters of continuous subsurface slip throughout this section. This 11 km region of reduced and discontinuous slip is one of the longest surface rupture jumps ever observed, with lengthy and continuous surface faulting on either side. The SE end of the stepover coincides spatially with the Canon Rojo embayment where the M7.2 1892 surface rupture propagated onto a second fault forming an abrupt corner in its surface trace. Hence, the surface rupture and slip distribution pattern in 2010 appears to have been influenced by stress changes induced by the 1892 event. Thirdly, from the NW end of the transition section, the Borrego fault continues to the NNW with strong east-down slip obliquity. Along this same reach of fault, the Laguna Salada fault was re-activated with minor west side down slip. Along the Paso Inferior accommodation zone, splays trending NNW to N had strong east-down slip, with right-lateral oblique motion. It was along this portion of the rupture that an eyewitness observed the rupture propagating from N to S, instead of in the expected S to N direction. Back-rupture may have resulted from triggered slip having raced ahead of the slower main rupture front, or may indicate a place where contiguous deep rupture ran out in front of shallow slip, or may result from the involvement here of the detachment fault system. Finally, in the northwestern portion of the rupture, from Paso Superior to the northwest of Cerro Centinela, a pattern of NE - SW oriented “cross faults” and N-S faults broke at the surface, in a manner similar to rupture that occurred in the Elmore Ranch Fault Zone during the Superstition Hills earthquake sequence of 1987. Unlike the Elmore Ranch event, however, there was no known main shock sub-event or any large aftershock that can be readily associated with the extensive cross-faulting that is observed in this case.

  1. Near-Source Shaking and Dynamic Rupture in Plastic Media

    NASA Astrophysics Data System (ADS)

    Gabriel, A.; Mai, P. M.; Dalguer, L. A.; Ampuero, J. P.

    2012-12-01

    Recent well recorded earthquakes show a high degree of complexity at the source level that severely affects the resulting ground motion in near and far-field seismic data. In our study, we focus on investigating source-dominated near-field ground motion features from numerical dynamic rupture simulations in an elasto-visco-plastic bulk. Our aim is to contribute to a more direct connection from theoretical and computational results to field and seismological observations. Previous work showed that a diversity of rupture styles emerges from simulations on faults governed by velocity-and-state-dependent friction with rapid velocity-weakening at high slip rate. For instance, growing pulses lead to re-activation of slip due to gradual stress build-up near the hypocenter, as inferred in some source studies of the 2011 Tohoku-Oki earthquake. Moreover, off-fault energy dissipation implied physical limits on extreme ground motion by limiting peak slip rate and rupture velocity. We investigate characteristic features in near-field strong ground motion generated by dynamic in-plane rupture simulations. We present effects of plasticity on source process signatures, off-fault damage patterns and ground shaking. Independent of rupture style, asymmetric damage patterns across the fault are produced that contribute to the total seismic moment, and even dominantly at high angles between the fault and the maximum principal background stress. The off-fault plastic strain fields induced by transitions between rupture styles reveal characteristic signatures of the mechanical source processes during the transition. Comparing different rupture styles in elastic and elasto-visco-plastic media to identify signatures of off-fault plasticity, we find varying degrees of alteration of near-field radiation due to plastic energy dissipation. Subshear pulses suffer more peak particle velocity reduction due to plasticity than cracks. Supershear ruptures are affected even more. The occurrence of multiple rupture fronts affect seismic potency release rate, amplitude spectra, peak particle velocity distributions and near-field seismograms. Our simulations enable us to trace features of source processes in synthetic seismograms, for example exhibiting a re-activation of slip. Such physical models may provide starting points for future investigations of field properties of earthquake source mechanisms and natural fault conditions. In the long-term, our findings may be helpful for seismic hazard analysis and the improvement of seismic source models.

  2. Composite Overwrapped Pressure Vessels (COPV) Stress Rupture Test

    NASA Technical Reports Server (NTRS)

    Russell, Richard; Flynn, Howard; Forth, Scott; Greene, Nathanael; Kezian, Michael; Varanauski, Don; Yoder, Tommy; Woodworth, Warren

    2009-01-01

    One of the major concerns for the aging Space Shuttle fleet is the stress rupture life of composite overwrapped pressure vessels (COPVs). Stress rupture life of a COPV has been defined as the minimum time during which the composite maintains structural integrity considering the combined effects of stress levels and time. To assist in the evaluation of the aging COPVs in the Orbiter fleet an analytical reliability model was developed. The actual data used to construct this model was from testing of COPVs constructed of similar, but not exactly same materials and pressure cycles as used on Orbiter vessels. Since no actual Orbiter COPV stress rupture data exists the Space Shuttle Program decided to run a stress rupture test to compare to model predictions. Due to availability of spares, the testing was unfortunately limited to one 40" vessel. The stress rupture test was performed at maximum operating pressure at an elevated temperature to accelerate aging. The test was performed in two phases. The first phase, 130 F, a moderately accelerated test designed to achieve the midpoint of the model predicted point reliability. The more aggressive second phase, performed at 160 F was designed to determine if the test article will exceed the 95% confidence interval of the model. This paper will discuss the results of this test, it's implications and possible follow-on testing.

  3. Spontaneous Flexor Tendon Rupture Due to Atraumatic Chronic Carpal Instability

    PubMed Central

    Miranda, B. H.; Cerovac, S.

    2014-01-01

    Background?Spontaneous flexor tendon rupture is considered to be invariably associated with previous hand/wrist injury or systemic disease such as rheumatoid arthritis. Case Description?A 54-year-old man presented with a 4-month history of mild ulnar wrist pain and spontaneous left little finger flexion loss in the absence of distant/recent trauma and systemic arthropathy. Surgical exploration confirmed a zone IV left little finger flexor digitorum profundus (FDP5) attritional rupture (100%), ring finger flexor digitorum profundus (FDP4) attenuation (40%) and a disrupted lunotriquetral ligament and volar-ulnar wrist capsule. Volar subluxation of the narrowed carpal tunnel resulted in flexor tendon attrition against the hamate hook. A side-to-side tendon transfer was performed along with a lunotriquetral ligament repair and temporary Kirschner wire fixation. At 6 months the patient had full active, synchronous flexion of the ring and little fingers and reduced wrist pain. Literature Review?Traumatic flexor tendon ruptures have been reported following distal radius/hamate hook fractures, from carpal bone osteophytes, accessory carpal bones and intraosseous ganglia. Attritional ruptures caused by chronic, degenerative carpal pathology are less common. Clinical Relevance?This case highlights an unusual cause of flexor tendon rupture due to chronic carpal instability. PMID:25032080

  4. Spontaneous Atraumatic Extensor Pollicis Longus Rupture in the Nonrheumatoid Population

    PubMed Central

    Rada, Erin M.; Shridharani, Sachin M.; Lifchez, Scott D.

    2013-01-01

    Introduction: Extensor pollicis longus (EPL) tendon rupture is a well-described phenomenon in patients with rheumatoid arthritis. Mechanisms of EPL tendon rupture in the nonrheumatoid population have also been described and include traumatic rupture, repetitive motion strain, and steroid injection into the tendon. Methods: The operative records for patients undergoing extensor pollicis longus reconstruction by the senior author were reviewed. Patients with a history of trauma to the wrist or inflammatory arthropathy were excluded. Results: We identified 3 patients who presented with spontaneous EPL tendon rupture. These patients reported no risk factors (as listed earlier) or inciting event. All 3 patients had some exposure to local steroids but this exposure was not at the site of subsequent tendon rupture. All patients were operatively repaired and went on to full recovery of EPL function. Discussion: In patients with sudden loss of extension of the thumb interphalangeal joint, a thorough history of steroid exposure including local steroid exposure remote to the affected EPL tendon may be relevant. PMID:23460929

  5. Rupture of an evaporating liquid bridge between two grains

    NASA Astrophysics Data System (ADS)

    Mielniczuk, Boleslaw; El Youssoufi, Moulay; Sabatier, Laurent; Hueckel, Tomasz

    2014-10-01

    The study examines rupture of evaporating liquid bridges between two glass spheres. Evolution of the bridge profile has been recorded with the use of high-speed camera. Geometrical characteristics of the bridge were then used to calculate evolution of the variables during the process: Laplace pressure, capillary force, and surface tension force. For the purpose of reference, the bridge evolution is followed also during kinematic extension. During both processes the diameter of the neck decreases, with an acceleration of about 1-2 ms before the rupture. Two distinct rupture modes are observed, depending on the bridge aspect ratio. After the rupture, the mass of liquid splits, forming two separate oscillating drops attached to the spheres, and a suspended satellite droplet. Just before the rupture, an increasing repulsive Laplace pressure, and decreasing negative surface tension force develop. Capillary force follows the trend of the surface tension force, with an accelerating decline. Duration of the whole process and liquid mass stabilization is from 10 to 60 ms.

  6. Two cases of spontaneous liver rupture and literature review.

    PubMed

    Cozzi, P J; Morris, D L

    1996-01-01

    Spontaneous liver rupture is uncommon, difficult to diagnose and carries a universally high mortality. It has been well documented to occur as a complication of primary or secondary hepatic malignancy. Similarly, there are 28 cases of ruptured haemangiomata described in the world literature. It is also well described in severe pregnancy-induced hypertension and is said to carry a mortality of 18% for patients treated by packing and drainage of the haematoma and 75% for patients treated with liver resection. Two female patients aged 60 and 61 presented to our accident and emergency department. One had a history of hypertension only and the other a history of a bleeding diathesis from the lupus anticoagulant. Both presented with hypotension and abdominal pain and both were diagnosed by abdominal CT scan. One was treated with hepatic artery ligation and tamponade and the other with liver resection and correction of the coagulopathy. Neither had any evidence of a ruptured hemangioma or tumor at laparotomy or on histological examination, and both are alive and well. The conclusions to be drawn from this review and our own recent experience is that the treatment of choice for ruptured haemangiomata is liver resection and, for rupture during pregnancy, is tamponade with packs and evacuation of the haematoma. Hepatic arteriography and embolisation, if possible, is a useful adjunct. Correction of any coagulopathy is essential. We can only speculate that the aetiology in our patients was uncontrolled hypertension in one and coagulopathy in the other. PMID:8809590

  7. Radiographic Risk Factors for Contralateral Rupture in Dogs with Unilateral Cranial Cruciate Ligament Rupture

    PubMed Central

    Chuang, Connie; Ramaker, Megan A.; Kaur, Sirjaut; Csomos, Rebecca A.; Kroner, Kevin T.; Bleedorn, Jason A.; Schaefer, Susan L.; Muir, Peter

    2014-01-01

    Background Complete cranial cruciate ligament rupture (CR) is a common cause of pelvic limb lameness in dogs. Dogs with unilateral CR often develop contralateral CR over time. Although radiographic signs of contralateral stifle joint osteoarthritis (OA) influence risk of subsequent contralateral CR, this risk has not been studied in detail. Methodology/Principal Findings We conducted a retrospective longitudinal cohort study of client-owned dogs with unilateral CR to determine how severity of radiographic stifle synovial effusion and osteophytosis influence risk of contralateral CR over time. Detailed survival analysis was performed for a cohort of 85 dogs after case filtering of an initial sample population of 513 dogs. This population was stratified based on radiographic severity of synovial effusion (graded on a scale of 0, 1, and 2) and severity of osteophytosis (graded on a scale of 0, 1, 2, and 3) of both index and contralateral stifle joints using a reproducible scoring method. Severity of osteophytosis in the index and contralateral stifles was significantly correlated. Rupture of the contralateral cranial cruciate ligament was significantly influenced by radiographic OA in both the index and contralateral stifles at diagnosis. Odds ratio for development of contralateral CR in dogs with severe contralateral radiographic stifle effusion was 13.4 at one year after diagnosis and 11.4 at two years. Odds ratio for development of contralateral CR in dogs with severe contralateral osteophytosis was 9.9 at one year after diagnosis. These odds ratios were associated with decreased time to contralateral CR. Breed, age, body weight, gender, and tibial plateau angle did not significantly influence time to contralateral CR. Conclusion Subsequent contralateral CR is significantly influenced by severity of radiographic stifle effusion and osteophytosis in the contralateral stifle, suggesting that synovitis and arthritic joint degeneration are significant factors in the disease mechanism underlying the arthropathy. PMID:25254499

  8. Composite Overwrapped Pressure Vessel (COPV) Stress Rupture Testing

    NASA Technical Reports Server (NTRS)

    Greene, Nathanael J.; Saulsberry, Regor L.; Leifeste, Mark R.; Yoder, Tommy B.; Keddy, Chris P.; Forth, Scott C.; Russell, Rick W.

    2010-01-01

    This paper reports stress rupture testing of Kevlar(TradeMark) composite overwrapped pressure vessels (COPVs) at NASA White Sands Test Facility. This 6-year test program was part of the larger effort to predict and extend the lifetime of flight vessels. Tests were performed to characterize control parameters for stress rupture testing, and vessel life was predicted by statistical modeling. One highly instrumented 102-cm (40-in.) diameter Kevlar(TradeMark) COPV was tested to failure (burst) as a single-point model verification. Significant data were generated that will enhance development of improved NDE methods and predictive modeling techniques, and thus better address stress rupture and other composite durability concerns that affect pressure vessel safety, reliability and mission assurance.

  9. Silent Spontaneous Uterine Rupture at 36 Weeks of Gestation

    PubMed Central

    Woo, J. Y.; Tate, L.; Roth, S.; Eke, A. C.

    2015-01-01

    Introduction. Silent spontaneous rupture of the uterus before term, with extrusion of an intact amniotic sac and delivery of a healthy neonate, with no maternal or neonatal morbidity or mortality is very rare. Very few cases have been reported in literature. Case Presentation. We report a case of silent spontaneous uterine rupture, found during a scheduled repeat cesarean section at 36 weeks of gestation. Patient had history of two prior classical cesarean sections. She underwent cesarean section, with delivery of a healthy male infant. She had a good postoperative recovery and was discharged on postoperative day 3. Conclusion. Silent spontaneous rupture of the uterus before term with extrusion of an intact amniotic sac is rare. A high index of suspicion and good imaging during pregnancy are important in making this diagnosis. PMID:26357580

  10. Spontaneous rupture of a hepatic angiomyolipoma: Report of a case.

    PubMed

    Aoki, Hideki; Arata, Takashi; Morihiro, Toshiaki; Kanaya, Nobuhiko; Takeda, Sho; Sui, Kenta; Shigeyasu, Kunitoshi; Katsuda, Koh; Tanakaya, Kohji; Takeuchi, Hitoshi

    2014-10-01

    A 70-year-old female experienced sudden onset of back pain on the right side and was admitted to our hospital in December 2010. Abdominal computed tomography revealed an S7 hepatic mass measuring 7 cm in diameter accompanied by a subcapsular hematoma. Emergency angiography confirmed the diagnosis of a ruptured hepatic mass, and hemostasis was carried out by embolization of A8 and A7 of the liver. A right hepatic lobectomy was carried out 39 days following transarterial embolization. Although almost all aspects of the tumor were necrotic, residual tumor cells stained positive for HMB-45, and negative for ?-SMA, S-100, CD 34, c-kit, CAM 5.2, and hepatocytes. The MIB-1 index was 2 %. Pathological diagnosis was hepatic angiomyolipoma (HAML). The patient has shown no signs of recurrence at 42 months following surgery. Here, we report on this case of spontaneous HAML rupture and discuss therapeutic strategies for HAML and ruptured hepatic tumors. PMID:26184024

  11. Predictors and clinical outcomes for spontaneous rupture of hepatocellular carcinoma

    PubMed Central

    Zhu, Qian; Li, Jing; Yan, Jian-Jun; Huang, Liang; Wu, Meng-Chao; Yan, Yi-Qun

    2012-01-01

    AIM: To determine the risk factors for hepatocellular carcinoma (HCC) rupture, and report the management and long-term survival results of patients with spontaneous rupture of HCC. METHODS: Among 4209 patients with HCC who were diagnosed at Eastern Hepatobiliary Surgery Hospital from April 2002 to November 2006, 200 (4.8%) patients with ruptured HCC (case group) were studied retrospectively in term of their clinical characteristics and prognostic factors. The one-stage therapeutic approach to manage ruptured HCC consisted of initial management by conservative treatment, transarterial embolization (TACE) or hepatic resection. Results of various treatments in the case group were evaluated and compared with the control group (202 patients) without ruptured HCC during the same study period. Continuous data were expressed as mean ± SD or median (range) where appropriate and compared using the unpaired t test. Categorical variables were compared using the Chi-square test with Yates correction or the Fisher exact test where appropriate. The overall survival rate in each group was determined using the Kaplan-Meier method and a log-rank test. RESULTS: Compared with the control group, more patients in the case group had underlying diseases of hypertension (7.5% vs 3.0%, P =0.041) and liver cirrhosis (87.5% vs 56.4%, P < 0.001), tumor size >5 cm (83.0% vs 57.4%, P < 0.001), tumor protrusion from the liver surface (66.0% vs 44.6%, P < 0.001), vascular thrombus (30.5% vs 8.9%, P < 0.001) and extrahepatic invasion (36.5% vs 12.4%, P < 0.001). On multivariate logistic regression analysis, underlying diseases of hypertension (P = 0.002) and liver cirrhosis (P < 0.001), tumor size > 5 cm (P < 0.001), vascular thrombus (P = 0.002) and extrahepatic invasion (P < 0.001) were predictive for spontaneous rupture of HCC. Among the 200 patients with spontaneous rupture of HCC, 105 patients underwent hepatic resection, 33 received TACE, and 62 were managed with conservative treatment. The median survival time (MST) of all patients with spontaneous rupture of HCC was 6 mo (range, 1-72 mo), and the overall survival at 1, 3 and 5 years were 32.5%, 10% and 4%, respectively. The MST was 12 mo (range, 1-72 mo) in the surgical group, 4 mo (range, 1-30 mo) in the TACE group and 1 mo (range, 1-19 mo) in the conservative group. Ninety-eight patients in the control group underwent hepatic resection, and the MST and median disease-free survival time were 46 mo (range, 6-93 mo) and 23 mo (range, 3-39 mo) respectively, which were much longer than that of patients with spontaneous rupture of HCC undergoing hepatic resection (P < 0.001). The 1-, 3-, and 5-year overall survival rates and the 1-, 3- and 5-year disease-free survival rates in patients with ruptured HCC undergoing hepatectomy were 57.1%, 19.0% and 7.6%, 27.6%, 14.3% and 3.8%, respectively, compared with those of 77.1%, 59.8% and 41.2%, 57.1%, 40.6% and 32.9% in 98 patients without ruptured HCC undergoing hepatectomy (P < 0.001). CONCLUSION: Prolonged survival can be achieved in selected patients undergoing one-stage hepatectomy, although the survival results were inferior to those of the patients without ruptured HCC. PMID:23326137

  12. Transcatheter Arterial Embolization for Spontaneous Rupture of the Omental Artery

    SciTech Connect

    Matsumoto, Tomohiro; Yamagami, Takuji; Morishita, Hiroyuki; Iida, Shigeharu; Tazoe, Jun; Asai, Shunsuke; Masui, Koji; Ikeda, Jun; Nagata, Akihiro; Sato, Osamu; Nishimura, Tsunehiko

    2011-02-15

    We encountered a rare case of spontaneous rupture of the omental artery. A 25-year-old man without any episode of abdominal trauma or bleeding disorders came to the emergency unit with left upper abdominal pain. Hematoma with extravasation of the greater omentum and a hemoperitoneum was confirmed on abdominal contrast-enhanced computed tomography. Bleeding from the omental artery was suspected based on these findings. Transcatheter arterial embolization was successfully performed after extravasation of the omental artery, which arises from the left gastroepiploic artery, was confirmed on arteriography. Partial ometectomy was performed 10 days after transcatheter arterial embolization, revealing that the hematoma measured 10 cm in diameter in the greater omentum. Pathological examination showed rupture of the branch of an omental artery without abnormal findings, such as an aneurysm or neoplasm. Thus, we diagnosed him with spontaneous rupture of the omental artery. The patient recovered and was discharged from the hospital 10 days after the surgery, with a favorable postoperative course.

  13. Acute airway compromise due to ruptured inferior thyroid artery aneurysm.

    PubMed

    Coskun, Zerrin Ozerg?n; Yava?i, Özcan; Durakoglugil, Tugba; Celebi Erdivanli, Ozlem; Ozgur, Abdulkadir; Terzi, Suat; Dursun, Engin

    2015-08-01

    A cervical hematoma secondary to the spontaneous rupture of an aneurysm is an uncommon but catastrophic life-threatening condition because it can potentially obstruct the airway. Inferior thyroid artery aneurysm and rupture is a very rare clinical entity and only a limited number of cases have been reported in the literature. In this article, we present the case of a female patient who suffered from a rapidly enlarging cervical mass followed by a rapid onset of dyspnea as a result of rupture of an inferior thyroid artery aneurysm. The diagnosis was confirmed by magnetic resonance angiography, and delayed surgery resulted in an uneventful outcome. We aim to draw the attention of emergency physicians to this rare condition. PMID:25770593

  14. Emergency Stenting of a Ruptured Infected Anastomotic Femoral Pseudoaneurysm

    SciTech Connect

    Klonaris, Chris Katsargyris, Athanasios; Matthaiou, Alexandros; Giannopoulos, Athanasios; Tsigris, Chris; Papadopouli, Katerina; Tsiodras, Sotiris; Bastounis, Elias

    2007-11-15

    A 74-year-old man presented with a ruptured infected anastomotic femoral pseudoaneurysm. Due to severe medical comorbidities he was considered unsuitable for conventional surgical management and underwent an emergency endovascular repair with a balloon-expandable covered stent. The pseudoaneurysm was excluded successfully and the patient had an uneventful postoperative recovery with long-term suppressive antimicrobials. He remained well for 10 months after the procedure with no signs of recurrent local or systemic infection and finally died from an acute myocardial infarction. To our knowledge, emergency endovascular treatment of a free ruptured bleeding femoral artery pseudoaneurysm has not been documented before in the English literature. This case illustrates that endovascular therapy may be a safe and efficient alternative in the emergent management of ruptured infected anastomotic femoral artery pseudoaneurysms when traditional open surgery is contraindicated.

  15. Ruptured Mycotic Aortic Aneurysm after Bacille Calmette-Guerin Therapy.

    PubMed

    Floros, Nikolaos; Meletiadis, Konstantinos; Kusenack, Ulrich; Zirngibl, Hubert; Kamper, Lars; Haage, Patrick; Dreger, Nici Markus

    2015-10-01

    To report a case of a ruptured mycotic abdominal aortic aneurysm (MAA) after intravesical Bacille Calmette-Guerin (BCG) therapy because of bladder carcinoma. A 57-year-old male patient was admitted to our hospital for follow-up computed tomography 14 months after transurethral resection of a papillary carcinoma of the bladder and intravesical BCG therapy. The CT scan revealed a ruptured MAA aneurysm and the patient underwent an endovascular repair with an aorto-bi-iliac stent graft. A ruptured MAA is a rare but lethal complication after BCG instillation therapy. The standard therapy is the open reconstruction but according to the literature an endovascular therapy in combination with long-term antibiotics should be considered as a bridging or a definite solution. PMID:26119640

  16. Premature rupture of the membranes: a cause for neonatal osteomyelitis?

    PubMed

    Liao, Sui-Ling; Lai, Shen Hao; Lin, Tzo-Yen; Chou, Yi-Hong; Hsu, Jen-Fu

    2005-02-01

    Osteomyelitis is rare in the neonatal period. Many etiologic factors for causing neonatal osteomyelitis have been discussed in the literature; however, premature rupture of the membranes has never been emphasized. We report on a neonate with osteomyelitis of the right humerus infected with an uncommon pathogen, Klebsiella pneumonia. In the absence of any perinatal disease, premature rupture of the membranes was suggested to be the cause of the illness. The infant was initially regarded as having Erb palsy because of the absence of systemic symptoms and lack of perinatal high-risk factors. Antibiotic administration was delayed for 3 weeks. Luckily, nearly complete recovery was noted after 2 months of follow up. We emphasize the importance of considering osteomyelitis in a newborn infant with limb palsy, particularly in the presence of premature rupture of the membranes of the mother. We also discuss the results of the microbial examination and significance of magnetic resonance imaging in neonatal osteomyelitis. PMID:15731982

  17. Rupture of the Pitáycachi Fault in the 1887 Mw 7.5 Sonora, Mexico earthquake (southern Basin-and-Range Province): Rupture kinematics and epicenter inferred from rupture branching patterns

    NASA Astrophysics Data System (ADS)

    Suter, Max

    2015-01-01

    During the 3 May 1887 Mw 7.5 Sonora earthquake (surface rupture end-to-end length: 101.8 km), an array of three north-south striking Basin-and-Range Province faults (from north to south Pitáycachi, Teras, and Otates) slipped sequentially along the western margin of the Sierra Madre Occidental Plateau. This detailed field survey of the 1887 earthquake rupture zone along the Pitáycachi fault includes mapping the rupture scarp and measurements of surface deformation. The surface rupture has an endpoint-to-endpoint length of ?41.0 km, dips ~70°W, and is characterized by normal left-lateral extension. The maximum surface offset is 487 cm and the mean offset 260 cm. The rupture trace shows a complex pattern of second-order segmentation. However, this segmentation is not expressed in the 1887 along-rupture surface offset profile, which indicates that the secondary segments are linked at depth into a single coherent fault surface. The Pitáycachi surface rupture shows a well-developed bipolar branching pattern suggesting that the rupture originated in its central part, where the polarity of the rupture bifurcations changes. Most likely the rupture first propagated bilaterally along the Pitáycachi fault. The southern rupture front likely jumped across a step over to the Teras fault and from there across a major relay zone to the Otates fault. Branching probably resulted from the lateral propagation of the rupture after breaching the seismogenic part of the crust, given that the much shorter ruptures of the Otates and Teras segments did not develop branches.

  18. Bougie dilators: simple, safe and cost-effective treatment for Crohn’s-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 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

  19. Anal. Chem. 1994,66, 3696-3701 On-Line Time-of-Flight Mass Spectrometric Analysis of

    E-print Network

    Anal. Chem. 1994,66, 3696-3701 On-Line Time-of-Flight Mass Spectrometric Analysis of Peptides: Departmentofchemistry,Universityof Californiaat Berkeley, Berkeley, CA 94720. (1) Kuhr, W. G.; Monnig, C. A. Anal. Chem. 1992,64, 389R407R. (2) Olivares,J.A,;Nguyen, N. T.;Yonker,C. R.;Smith, R. D. Anal. Chem.1987, (3) Smith

  20. 1056 Anal. Chem. 1987, 59. 1056-1059 be done selectively, and any ions that are not completely

    E-print Network

    1056 Anal. Chem. 1987, 59. 1056-1059 be done selectively, and any ions that are not completely, B. S. Anal. Chem. 1979, 51, 547-551. Fedor, D. M.; Cody, R. B.;Burinsky,D. J.; Freiser, B. S.; Cooks, C. E. Anal. Chim. Acta 1988, 178, 43-66. Ghaderi, S.; Kulkarni,P. S.; Ledford,E. B.,Jr.; Wilkins, C

  1. Anal. Chem. 1994,66, 2694-2700 Real-Time Measurement of Electroosmotic Flow in Capiliary

    E-print Network

    Anal. Chem. 1994,66, 2694-2700 Real-Time Measurement of Electroosmotic Flow in Capiliary Zone,61. (2) Lee, T. T.; Yeung, E. S.Anal. Chem. 1991,63, 2842. ( 3 ) Bcckcrs,J. L.; Everacrts,F. M. (5) Towns, J. K.; Rcgnicr, F. E. Anal. Chem. 1992. 64, 2473. (6) Burgi, D. S.;Chitn, R.-L. And. Chem

  2. Adv. X-Ray. Chem. Anal., Japan 39, pp.1-8 (2008) 2-8-1 112-8681

    E-print Network

    Jun, Kawai

    2008-01-01

    Adv. X-Ray. Chem. Anal., Japan 39, pp.1-8 (2008) 2-8-1 112-8681 PRESTO-JST 5 102-0075Copyright Origin of Plasmon Peaks Shoichi TAKAYAMA and Jun KAWAI #12;#12;39 161 Adv. X-Ray. Chem. Anal., Japan 39 analysis method in XPS, taken from M. Jo, Surf. Interface Anal., 35, 729 (2003) with permission. XPS Al 2s

  3. Incidence of and risk factors for type-specific anal human papillomavirus infection among HIV-positive MSM

    PubMed Central

    Hernandez, Alexandra L.; Efird, Jimmy T.; Holly, Elizabeth A.; Berry, J. Michael; Jay, Naomi; Palefsky, Joel M.

    2015-01-01

    Objective HIV-positive MSM are at increased risk of anal human papillomavirus (HPV) infection compared with men in the general population, and little is known about the natural history of anal HPV infection in this population. The objective of this study was to determine the incidence of and risk factors for anal type-specific HPV infection. Design Prospective cohort study. Methods HIV-positive MSM were evaluated for anal HPV DNA, lifestyle factors, and sexual risk behaviors every 6 months for at least 2 years. Results The overall incidence rate of detectable type-specific anal HPV infection was 21.3 per 100 person-years [95% confidence interval (CI) 17.7–25.4] and was 13.3/100 person-years (10.5–16.6) for oncogenic HPV types. The most common incident infections were HPV 18 (3.7/100 person-years) and HPV 16 (3.5/100 person-years). An increased number of recent partners with whom the participant was the receptive partner [odds ratio (OR) 2.9 (1.6–5.1) 8+ partners vs. 0–1], an increased number of new partners in which the participant was the receptive partner [OR 1.03 (1.01–1.1) per partner], an increased number of new oral–anal contact partners in which the participant was the receptive partner [OR 1.1 (1.03–1.1) per partner], and the frequency of receptive anal intercourse [OR 1.1 (1.03–1.1) per act] all significantly increased the odds of incident HPV infection (P ? 0.05). Conclusion HIV-positive MSM have a high incidence of oncogenic anal HPV infection. Recent receptive anal sexual behaviors, including receptive anal intercourse and receptive oral–anal contact, are the most important risk factors for incident anal HPV infection. PMID:24959962

  4. Rapid aneurysm growth and rupture in systemic lupus erythematosus

    PubMed Central

    Graffeo, Christopher S.; Tanweer, Omar; Nieves, Cesar Fors; Belmont, H. Michael; Izmirly, Peter M.; Becske, Tibor; Huang, Paul P.

    2015-01-01

    Background: Subarachnoid hemorrhage (SAH) due to intracranial aneurysm rupture is a major neurosurgical emergency associated with significant morbidity and mortality. Rapid aneurysm growth is associated with rupture. Systemic lupus erythematosus (SLE) is a multi-system autoimmune disorder whose complications can include cerebral vasculitis and vasculopathy. Intracranial aneurysms are not known to occur more frequently in SLE patients than the general population; however, aneurysm growth rates have not been studied in SLE. Case Description: We present a 43-year-old female with SLE on prednisone, hydroxychloroquine, and azathioprine with moderate disease activity who presented with severe, acute-onset headache and was found to have Hunt and Hess grade II SAH due to rupture of an 8 mm saccular anterior communicating artery (ACoA) aneurysm. The patient developed severe vasospasm, re-ruptured, and was taken for angiography and embolization, which was challenging due to a high degree of vasospasm and arterial stenosis. Review of imaging from less than 2 years prior demonstrated a normal ACoA complex without evidence of an aneurysm. Conclusion: We review the literature and discuss the risk factors and pathophysiology of rapid aneurysm growth and rupture, as well as the pathologic vascular changes associated with SLE. Although SLE patients do not develop intracranial aneurysm at an increased rate, these changes may predispose them to higher incidence of growth and rupture. This possibility-coupled with increased morbidity and mortality of SAH in SLE-suggests that SAH should be considered in SLE patients presenting with headache, and advocates for more aggressive treatment of SLE patients with unruptured aneurysms. PMID:25657862

  5. PIP breast implants: rupture rate and correlation with breast cancer

    PubMed Central

    MOSCHETTA, M.; TELEGRAFO, M.; CORNACCHIA, I.; VINCENTI, L.; RANIERI, V.; CIRILLI, A.; RELLA, L.; IANORA, A.A. STABILE; ANGELELLI, G.

    2014-01-01

    Aim To evaluate the incidence of Poly Implant Prosthése (PIP) rupture as assessed by magnetic resonance imaging (MRI), the prevalence of the detected signs and the potential correlation with breast carcinoma. Patients and methods 67 patients with silicone breast implants and clinical indications for breast MRI were evaluated for a total of 125 implants: 40 (32%) PIP in 21 patients and 85 non-PIP in 46 patients (68%), the latest considered as control group. A 1.5-T MR imaging device was used in order to assess implant integrity with dedicated sequences and in 6 cases a dynamic study was performed for characterizing breast lesions. Two radiologists with more than 5 years’ experience in the field of MRI evaluated in consensus all MR images searching for the presence of clear signs of intra or extra-capsular implant rupture. Results 20/40 (50%) PIP implants presented signs of intra-capsular rupture: linguine sign in 20 cases (100%), tear-drop sign in 6 (30%). In 12/20 cases (60%), MRI signs of extra-capsular rupture were detected. In the control group, an intra-capsular rupture was diagnosed in 12/85 cases (14%) associated with extra-capsular one in 5/12 cases (42%). Among the six cases with suspected breast lesions, in 2/21 patients with PIP implants (10%) a breast carcinoma was diagnosed (mucinous carcinoma, n=1; invasive ductal carcinoma, n=1). In 4/46 patients (9%) with non-PIP implants, an invasive ductal carcinoma was diagnosed. Conclusion The rupture rate of PIP breast implants is significantly higher than non-PIP (50% vs 14%). MRI represents the most accurate imaging tool for evaluating breast prostheses and the linguine sign is the most common MRI sign to be searched. The incidence of breast carcinoma does not significantly differ between the PIP and non-PIP implants and a direct correlation with breast cancer can not been demonstrated. PMID:25644728

  6. Frequency-Dependent Rupture Processes for the 2011 Tohoku Earthquake

    NASA Astrophysics Data System (ADS)

    Miyake, H.

    2012-12-01

    The 2011 Tohoku earthquake is characterized by frequency-dependent rupture process [e.g., Ide et al., 2011; Wang and Mori, 2011; Yao et al., 2011]. For understanding rupture dynamics of this earthquake, it is extremely important to investigate wave-based source inversions for various frequency bands. The above frequency-dependent characteristics have been derived from teleseismic analyses. This study challenges to infer frequency-dependent rupture processes from strong motion waveforms of K-NET and KiK-net stations. The observations suggested three or more S-wave phases, and ground velocities at several near-source stations showed different arrivals of their long- and short-period components. We performed complex source spectral inversions with frequency-dependent phase weighting developed by Miyake et al. [2002]. The technique idealizes both the coherent and stochastic summation of waveforms using empirical Green's functions. Due to the limitation of signal-to-noise ratio of the empirical Green's functions, the analyzed frequency bands were set within 0.05-10 Hz. We assumed a fault plane with 480 km in length by 180 km in width with a single time window for rupture following Koketsu et al. [2011] and Asano and Iwata [2012]. The inversion revealed source ruptures expanding from the hypocenter, and generated sharp slip-velocity intensities at the down-dip edge. In addition to test the effects of empirical/hybrid Green's functions and with/without rupture front constraints on the inverted solutions, we will discuss distributions of slip-velocity intensity and a progression of wave generation with increasing frequency.

  7. Magnetic Sphincter Augmentation for Gastroesophageal Reflux at 5 Years: Final Results of a Pilot Study Show Long-Term Acid Reduction and Symptom Improvement

    PubMed Central

    Saino, Greta; Bonavina, Luigi; Lipham, John C.; Dunn, Daniel

    2015-01-01

    Abstract Background: As previously reported, the magnetic sphincter augmentation device (MSAD) preserves gastric anatomy and results in less severe side effects than traditional antireflux surgery. The final 5-year results of a pilot study are reported here. Patients and Methods: A prospective, multicenter study evaluated safety and efficacy of the MSAD for 5 years. Prior to MSAD placement, patients had abnormal esophageal acid and symptoms poorly controlled by proton pump inhibitors (PPIs). Patients served as their own control, which allowed comparison between baseline and postoperative measurements to determine individual treatment effect. At 5 years, gastroesophageal reflux disease (GERD)-Health Related Quality of Life (HRQL) questionnaire score, esophageal pH, PPI use, and complications were evaluated. Results: Between February 2007 and October 2008, 44 patients (26 males) had an MSAD implanted by laparoscopy, and 33 patients were followed up at 5 years. Mean total percentage of time with pH <4 was 11.9% at baseline and 4.6% at 5 years (P?sphincter augmentation for GERD. PMID:26437027

  8. Pyloric Sphincter Dysfunction in nNOS?/? and W/Wv Mutant Mice: Animal Models of Gastroparesis and Duodeno-gastric Reflux

    PubMed Central

    Sivarao, Digavalli V.; Mashimo, Hiroshi; Goyal, Raj K.

    2009-01-01

    Background and & Aims Nitrergic nerves and interstitial cells of Cajal (ICC) have been implicated in the regulation of pyloric motility. The purpose of these studies was to define their roles in pyloric function in vivo. Methods Pyloric sphincter manometry was performed in wild type (WT) controls, neuronal nitric oxide synthase deficient (nNOS?/?) and ICC deficient W/Wv mice, and the effect of deafferented cervical vagal stimulation was examined. Results Mice showed a distinct ~ 0.6 mm wide zone of high pressure at the antro-duodenal junction, representing the pyloric sphincter. In WT, the pylorus exhibited tonic active pressure of 12.4±1.6 mm Hg with superimposed phasic contractions. The motility indices, minute motility index (MMI) and the total myogenic activity (TMA) were reduced by vagal stimulation and the reduction was antagonized by nitric oxide synthase inhibitor, L-NAME. In nNOS?/? mice, pyloric basal tone, MMI and TMA were not significantly different from the controls, but vagal stimulation paradoxically increased pyloric motility. In contrast, the W/Wv mice had significantly reduced resting pyloric pressure that was suppressed by vagal stimulation in an L-NAME-sensitive manner. The stomachs of fasted nNOS?/? mice showed solid food residue and bezoar formation, while W/Wv mice showed bile reflux. Conclusion (1) In nNOS?/? mice, loss of nitrergic pyloric inhibition leads to gastric stasis and bezoars; (2) In contrast, basal pyloric hypotension with normal nitrergic inhibition predisposes W/Wv mice to duodeno-gastric bile reflux. PMID:18640116

  9. Dynamic ruptures in recent models of earthquake faults

    NASA Astrophysics Data System (ADS)

    Ben-Zion, Yehuda

    2001-09-01

    We discuss several problems of dynamic rupture relevant to mechanics of earthquake faults, material sciences, and physics of spatially extended dissipative systems. The problems include dynamic rupture along an interface separating different elastic solids, dynamic rupture on a planar surface governed by strongly velocity-weakening friction, and elastodynamic calculations of long deformation history on a smooth fault in an elastic continuum. These separate problems share a number of methodological and conceptual issues that form recurring themes in the paper. An important methodological issue for computational schemes is dependency of numerical results on the used grid size. This arises inevitably in computer simulations when the assumed constitutive laws do not include a length scale (e.g., of shear or extensional displacement) over which material properties evolve. Such simulations do not have a stable underlying solution, to which they may converge with sufficient grid refinement. However, they may provide rough approximations—lacking at present a rigorous foundation—to the behavior of systems containing elements of discreteness (associated with abrupt fluctuations) at scales relevant to observations of interest. Related important conceptual issues are connections between, or when appropriate separation of, small scale phenomena (e.g., nucleation of rupture, processes at rupture front) and large scale features of the response (e.g., overall space-time dimensions of rupture, statistics of many events). Additional recurring conceptual topics are crack vs. pulse modes of dynamic rupture, the stress under which earthquake faults slip, and the origin of spatio-temporal complexities of earthquakes. These seemingly different issues probably have one or more common origins. Dynamic rupture on an interface between different solids, strongly velocity-weakening friction on a homogeneous fault, and strong fault zone heterogeneities can all produce narrow self-healing slip pulses with low dynamic stress (and low associated frictional heat) during the active part of slip. Strong fault heterogeneities probably play the dominant role in producing the observed earthquake complexities. Improved understanding of the discussed problems will require establishing connections between discrete and continuum descriptions of mechanical failure processes, generalization of current models to realistic three-dimensional dynamic models, and high-resolution laboratory and in-situ observations over broad scales of space and time. These challenging problems provide by their subject matter and involved great difficulties important targets for multi-disciplinary research by engineers, earth scientists, and physicists.

  10. BWH emergency radiology-surgical correlation: intraperitoneal urinary bladder rupture.

    PubMed

    Landman, Wendy; Khurana, Bharti; Briggs, Alexandra; Fairweather, Mark; Cooper, Zara; Riviello, Robert; Sodickson, Aaron D

    2015-12-01

    We describe the radiological and intraoperative correlation of two cases of intraperitoneal bladder rupture: a 23-year-old man involved in a high-speed motor vehicle collision and a 49-year-old man with hematuria and abdominal pain after a night of heavy alcohol ingestion. Both patients underwent urgent exploratory laparotomies and repair of their bladder injuries. The purpose of this article is to emphasize the importance of understanding the different etiologies of bladder rupture and recognizing the imaging findings on computed tomography (CT) and CT cystography to help guide the surgeons in the patient's management. PMID:25998022

  11. Intra-Aortic Balloon Pump Rupture and Entrapment

    PubMed Central

    Jahollari, Artan; Sarac, Atilla; Ozal, Ertugrul

    2014-01-01

    Intra-aortic balloon pump is used frequently to support a failing myocardium in cardiac patients. Due to the invasive nature of this device, usage is accompanied by consistent risk of complications. Balloon rupture, although it occurs rarely, may lead to entrapment if diagnosis delays. A 78-year male who underwent cardiac surgery experienced balloon rupture and entrapment in the right femoral artery during the postoperative follow-up. Surgical extraction under local anesthesia was performed and the patient had an uneventful course. Fast and gentle solution of the problem is necessary to prevent further morbidity or mortality related to a retained balloon catheter in these delicate patients. PMID:24707435

  12. Intra-aortic balloon pump rupture and entrapment.

    PubMed

    Jahollari, Artan; Sarac, Atilla; Ozal, Ertugrul

    2014-01-01

    Intra-aortic balloon pump is used frequently to support a failing myocardium in cardiac patients. Due to the invasive nature of this device, usage is accompanied by consistent risk of complications. Balloon rupture, although it occurs rarely, may lead to entrapment if diagnosis delays. A 78-year male who underwent cardiac surgery experienced balloon rupture and entrapment in the right femoral artery during the postoperative follow-up. Surgical extraction under local anesthesia was performed and the patient had an uneventful course. Fast and gentle solution of the problem is necessary to prevent further morbidity or mortality related to a retained balloon catheter in these delicate patients. PMID:24707435

  13. Spontaneous Liver Rupture After Treatment With Drug-Eluting Beads

    SciTech Connect

    Ritter, C. O.; Wartenberg, M.; Mottok, A.; Steger, U.; Goltz, J. P.; Hahn, D.; Kickuth, R.

    2012-02-15

    Spontaneous rupture of hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) is a rare and life-threatening complication. Pathophysiologic mechanisms are not yet fully known; it is suggested that rupture is preceded by reactive tissue edema and intratumerous bleeding, leading to a rapid expansion of tumour mass with risk of extrahepatic bleeding in the case of subcapsular localisation. This case report discusses a sudden, unexpected lethal complication in a 74 year-old male patient treated with TACE using DC Bead loaded with doxorubicin (DEBDOX) in a progressive multifocal HCC.

  14. Frontal lobe cerebral aneurysm rupture presenting as psychosis.

    PubMed Central

    Hall, D P; Young, S A

    1992-01-01

    A 23 year old male with acute onset of blunted affect, looseness of associations and auditory hallucinations presented to a tertiary care hospital 10 days after development of symptoms. Before transfer, the patient received a diagnosis of schizophreniform disorder and treatment with haloperidol was started which resulted in moderate improvement. Examination led to detection of a ruptured cerebral aneurysm in the left frontal lobe. Evacuation of the haematoma and repair of the aneurysm resulted in nearly complete resolution of symptoms. The rare incidence of acute aneurysm rupture, presenting in the case described, demonstrates the importance of a complete neurological examination in the evaluation of acute mental status changes. Images PMID:1479403

  15. Rapid Mapping of Surface Rupture from the South Napa Earthquake

    NASA Astrophysics Data System (ADS)

    Trexler, C. C.; Morelan, A. E., III; Oskin, M. E.

    2014-12-01

    Rapid documentation (<1 day) of co-seismic surface rupture location and slip is essential for scientific and emergency response. We demonstrate how social media (text messaging and Twitter) and the emerging 3D data collection technique known as Structure from Motion (SfM), used in conjunction with traditional field reconnaissance, enabled us to rapidly locate and document surface ruptures from the Mw 6.0 South Napa earthquake. On the morning of the event, our field team used information available on social media to identify locations with potential surface rupture. Preliminary observations of surface rupture (measurements and geo-tagged photographs) were texted to the office-based team member who created digital maps of the rupture trace and shared them online via Twitter in near-real time. We documented many ephemeral features (such as offset roads, curbs, and driveways) along the rupture trace within 12 hours of the event, before these features were destroyed by road and infrastructure repair. We were able to return to most sites again within several days, allowing us to document continuing slip and create time-series datasets of offset features. After the collection and re-collection of data at selected sites, we made detailed measurements remotely using 3D models constructed with SfM. The ability to quantitatively project features into the fault plane using these models allows for accurate measurements of small features often difficult to observe and quantify in the field. Traditionally, even preliminary maps of rupture extent and offset magnitudes are not available for several days after an event because office-based processing and compilation is required. Because we were able to compile our data in real time, we distributed our results while they were still valuable for ongoing scientific response. Our work helped other science teams efficiently target fieldwork and instrument deployment; for example, one geodetic survey team used our surface rupture map to adjust their field deployment plans in an effort to capture rapidly-decaying postseismic movement. With social media and rapid, inexpensive data collection methods like SfM in mind, scientific response to future events has the potential to be more efficient and coordinated than ever before.

  16. Left ventricular rupture postmitral valve replacement: surviving a catastrophe.

    PubMed

    Bisoyi, Samarjit; Mohanty, Jitendu; Mohapatra, Raghunath; Nayak, Debashish

    2015-01-01

    One of the dreaded mechanical complications of mitral valve replacement (MVR) is rupture of the left ventricle (LV). This report describes the early diagnosis and successful repair of rupture of posterior wall of LV in an elderly patient who underwent MVR. We have discussed the risk factors and perioperative issues implicated in such complication. The anesthesiologist as an intra-operative echocardiographer can aid in identifying the patient at risk. Though important surgical steps are necessary to prevent the complication; nonetheless, the anesthesiologist needs to take key measures in the perioperative period. PMID:25566717

  17. Shock-Wave Theory for Rupture of Rubber

    NASA Astrophysics Data System (ADS)

    Marder, M.

    2005-01-01

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

  18. Spleen rupture due to primary angiosarcoma: a case report.

    PubMed

    Koutelidakis, Ioannis M; Tsiaousis, Panagiotis Z; Papaziogas, Basilios Th; Patsas, Aristeides G; Atmatzidis, Stefanos K; Atmatzidis, Konstantinos S

    2007-01-01

    A case of a 79-year-old female with rupture of the spleen due to primary angiosarcoma is presented. Symptoms were non-specific. Diagnosis was based on histology postoperatively. Primary angiosarcoma of the spleen is a very rare and aggressive neoplasm with a high metastatic rate and almost uniformly fatal. Due to small number of reported cases, there are no guidelines concerning adjuvant or palliative treatment or any beneficial protocols of chemotherapy or radiotherapy up to date. Splenectomy prior to rupture seems to have a positive impact on long-term survival. PMID:19016352

  19. Spontaneous rupture of non-parasitic hepatic cyst.

    PubMed

    Poggi, G; Gatti, C; Delmonte, A; Teragni, C; Bernardo, G

    2006-01-01

    Intrahepatic cysts are generally classified as congenital, traumatic, infectious or neoplastic. Non-parasitic hepatic cysts (NPHCs) include simple cysts and adult polycystic liver disease in which the liver is diffusely occupied by cysts. NPHCs usually reach a large size before causing symptoms, unless a complication such as rupture, bleeding, infection, obstructive jaundice or neoplastic transformation occurs. We report the case of a 67-year-old man with spontaneous rupture of simple liver cyst. The clinical pictures and the unusual ultrasound features of this rare condition are discussed. PMID:16409436

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

    E-print Network

    Weidner, John W.

    , M. J.; Briggs, D.; Yoon, S. C.; Ratner; B. D. SIA, Surf. Inter- face Anal. 1087, IO,524. Hues. S. M.;Colton, R. J.; Mowery, R. L.; McGrath, K. J.; Wyatt, J. R. Appl. Surf. Sci. 1989, 35,507. Clark. M. B., Jr

  1. 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.

  2. Coupling a geodynamic seismic cycling model to rupture dynamic simulations

    NASA Astrophysics Data System (ADS)

    Gabriel, Alice; van Dinther, Ylona

    2014-05-01

    The relevance and results of dynamic rupture scenarios are implicitly linked to the geometry and pre-existing stress and strength state on a fault. The absolute stresses stored along faults during interseismic periods, are largely unquantifiable. They are, however, pivotal in defining coseismic rupture styles, near-field ground motion, and macroscopic source properties (Gabriel et al., 2012). Obtaining these in a physically consistent manner requires seismic cycling models, which directly couple long-term deformation processes (over 1000 year periods), the self-consistent development of faults, and the resulting dynamic ruptures. One promising approach to study seismic cycling enables both the generation of spontaneous fault geometries and the development of thermo-mechanically consistent fault stresses. This seismo-thermo-mechanical model has been developed using a methodology similar to that employed to study long-term lithospheric deformation (van Dinther et al., 2013a,b, using I2ELVIS of Gerya and Yuen, 2007). We will innovatively include the absolute stress and strength values along physically consistent evolving non-finite fault zones (regions of strain accumulation) from the geodynamic model into dynamic rupture simulations as an initial condition. The dynamic rupture simulations will be performed using SeisSol, an arbitrary high-order derivative Discontinuous Galerkin (ADER-DG) scheme (Pelties et al., 2012). The dynamic rupture models are able to incorporate the large degree of fault geometry complexity arising in naturally evolving geodynamic models. We focus on subduction zone settings with and without a splay fault. Due to the novelty of the coupling, we first focus on methodological challenges, e.g. the synchronization of both methods regarding the nucleation of events, the localization of fault planes, and the incorporation of similar frictional constitutive relations. We then study the importance of physically consistent fault stress, strength, and geometry input for dynamic rupture propagation in terms of rupture path and dynamics. On the other hand, it will provide the opportunity to compare slow earthquake akin events developing in quasi-static geodynamic model to fully dynamic ruptures in terms of coseismic displacements and stress changes. Gabriel, A.-A. (2012), J.-P. Ampuero, L. A. Dalguer, and P. M. Mai, The transition of dynamic rupture modes in elastic media, J. Geophys. Res., 117(B9), 01480227. Gerya, T., and D. Yuen (2007), Robust characteristics method for modelling multiphase visco-elasto-plastic thermo-mechanical problems, Phys. Earth Planet In., 163(1-4), 83-105. Pelties, C. (2012), J. De la Puente, J.-P. Ampuero, G. B. Brietzke, and M. Käser Three-Dimensional Dynamic Rupture, Simulation with a High-order Discontinuous Galerkin Method on Unstructured Tetrahedral Meshes, J. Geophys. Res., 117(B2), B02309. van Dinther, Y. (2013a), T.V. Gerya, L.A. Dalguer, F. Corbi, F. Funiciello, and P.M. Mai, The seismic cycle at subduction thrusts: 2. Dynamic implications of geodynamic simulations validated with laboratory models, J. Geophys. Res., 118(4), 1502-1525. van Dinther, Y. (2013b), T.V. Gerya, L.A. Dalguer, P.M. Mai, G. Morra, and D. Giardini, The seismic cycle at subduction thrusts: insights from seismo-thermo-mechanical models, J. Geophys. Res., 118, 6183-6202.

  3. Dynamic earthquake rupture simulations on nonplanar faults embedded in 3D geometrically complex, heterogeneous elastic solids

    E-print Network

    Dunham, Eric M.

    Dynamic earthquake rupture simulations on nonplanar faults embedded in 3D geometrically complex simulations of earthquake ruptures and the resulting strong ground motion form a crucial component idealization of natural earthquakes. The conditions relating discontinuities in particle velocities across

  4. Rupture termination at restraining bends: The last great earthquake on the Altyn Tagh Fault

    NASA Astrophysics Data System (ADS)

    Elliott, Austin J.; Oskin, Michael E.; Liu-Zeng, Jing; Shao, Yanxiu

    2015-04-01

    Strike-slip rupture propagation falters where changes in fault strike increase Coulomb failure stress. Numerical models of this phenomenon offer predictions of rupture extent based on bend geometry, but have not been verified with field data. To test model predictions of rupture barriers, we examine rupture extent along a section of the sinistral Altyn Tagh Fault punctuated by three major double bends. We measure 3-8 m offsets and map >95 km of continuous scarps that define the most recent surface rupture. We document the eastern terminus of this rupture within the Aksay bend, where an undeformed Pleistocene alluvial fan we mapped and dated overlaps the fault. We conclude, based on this geomorphologic evidence, that multiple Holocene ruptures have stopped in the Aksay bend. Our field data validate model predictions of rupture termination at a >18° restraining bend and support use of geometric parameters to define expected earthquake sizes in seismic hazard models.

  5. 14 CFR 25.1453 - Protection of oxygen equipment from rupture.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...2013-01-01 2013-01-01 false Protection of oxygen equipment from rupture. 25.1453 Section...Miscellaneous Equipment § 25.1453 Protection of oxygen equipment from rupture. Oxygen pressure tanks, and lines between tanks and...

  6. 14 CFR 25.1453 - Protection of oxygen equipment from rupture.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...2011-01-01 2011-01-01 false Protection of oxygen equipment from rupture. 25.1453 Section...Miscellaneous Equipment § 25.1453 Protection of oxygen equipment from rupture. Oxygen pressure tanks, and lines between tanks and...

  7. 14 CFR 23.1453 - Protection of oxygen equipment from rupture.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 2012-01-01 false Protection of oxygen equipment from rupture. 23.1453 ...Equipment § 23.1453 Protection of oxygen equipment from rupture. (a) Each element of the oxygen system must have sufficient...

  8. 14 CFR 23.1453 - Protection of oxygen equipment from rupture.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 2010-01-01 false Protection of oxygen equipment from rupture. 23.1453 ...Equipment § 23.1453 Protection of oxygen equipment from rupture. (a) Each element of the oxygen system must have sufficient...

  9. 14 CFR 23.1453 - Protection of oxygen equipment from rupture.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 2014-01-01 false Protection of oxygen equipment from rupture. 23.1453 ...Equipment § 23.1453 Protection of oxygen equipment from rupture. (a) Each element of the oxygen system must have sufficient...

  10. 14 CFR 25.1453 - Protection of oxygen equipment from rupture.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...2010-01-01 2010-01-01 false Protection of oxygen equipment from rupture. 25.1453 Section...Miscellaneous Equipment § 25.1453 Protection of oxygen equipment from rupture. Oxygen pressure tanks, and lines between tanks and...

  11. 14 CFR 23.1453 - Protection of oxygen equipment from rupture.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 2013-01-01 false Protection of oxygen equipment from rupture. 23.1453 ...Equipment § 23.1453 Protection of oxygen equipment from rupture. (a) Each element of the oxygen system must have sufficient...

  12. 14 CFR 25.1453 - Protection of oxygen equipment from rupture.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...2012-01-01 2012-01-01 false Protection of oxygen equipment from rupture. 25.1453 Section...Miscellaneous Equipment § 25.1453 Protection of oxygen equipment from rupture. Oxygen pressure tanks, and lines between tanks and...

  13. 14 CFR 23.1453 - Protection of oxygen equipment from rupture.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 2011-01-01 false Protection of oxygen equipment from rupture. 23.1453 ...Equipment § 23.1453 Protection of oxygen equipment from rupture. (a) Each element of the oxygen system must have sufficient...

  14. 14 CFR 25.1453 - Protection of oxygen equipment from rupture.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...2014-01-01 2014-01-01 false Protection of oxygen equipment from rupture. 25.1453 Section...Miscellaneous Equipment § 25.1453 Protection of oxygen equipment from rupture. Oxygen pressure tanks, and lines between tanks and...

  15. Improved Data Set for the Frequency of Gaps and Steps in Ground Ruptures

    NASA Astrophysics Data System (ADS)

    Biasi, G. P.; Wesnousky, S. G.; Morelan, A. E., III

    2014-12-01

    Observations of actual ground ruptures from moderate and large earthquakes show a wide range of behaviors, including fault-to-fault jumps, branching topologies, and rupture traces with multi-kilometer gaps between them. Seismic hazard assessments have responded to these observations by including increasingly sophisticated scenarios of possible ruptures in their earthquake rate forecasts. The largest of these to date has been the Uniform California Earthquake Forecast 3 (UCERF3), which explicitly included ruptures with fault-to-fault jumps in its rupture rate estimates. High-level site-specific seismic source characterizations such as for the Diablo Canyon Power Plant have also begun including complicated rupture geometries. Systematic collection of observations from ground rupturing earthquakes provide one way to evaluate these seismic source models. We have expanded an initial collection by Wesnousky (2008) with events post-dating that collection and events for which new information is available. New events increase the strike-slip and normal event set by 50% and reverse events by 35%. New data allow us to revise previous estimates for strike-slip rupture of the probability that a step of 1 km or more in width will arrest rupture. Observationally, 65% of strike-slip ruptures include at least one step of 1 km or greater. The number of steps through which ruptures are observed to rupture through can be modeled by a geometric distribution in which steps are crossed about 59% of the time. Steps are slightly more effective at arresting rupture in normal and reverse faulting cases, being crossed 56% and 50%, respectively. New events were also systematically examined for gaps in the mapped rupture trace. We find gaps of 1 km or more in about half of the ruptures of the new event set. These empirical data will compliment new research into rupture propagation across gaps, exemplified by the 2010 El Mayor Cucapah earthquake, which included a gap measured variously at 7 or 15 km in length.

  16. A New Surgical Repair Technique for Ischemic Total Papillary Muscle Rupture.

    PubMed

    Lee, Sung Kwang; Heo, Woon; Min, Ho-Ki; Kang, Do Kyun; Jun, Hee Jae; Hwang, Youn-Ho

    2015-11-01

    Papillary muscle (PM) rupture is an emergency surgical condition that may occur after acute myocardial infarction. In patients with compete rupture of the PM, mitral valve replacement is preferred or recommended generally because of unstable vital signs or technical difficulties with successful repair, as compared with patients with partial PM rupture. This case report describes the successful repair of a complete anterolateral PM rupture by using the single PM formation technique with subsequent ring annuloplasty. PMID:26522535

  17. Stress Rupture Life Reliability Measures for Composite Overwrapped Pressure Vessels

    NASA Technical Reports Server (NTRS)

    Murthy, Pappu L. N.; Thesken, John C.; Phoenix, S. Leigh; Grimes-Ledesma, Lorie

    2007-01-01

    Composite Overwrapped Pressure Vessels (COPVs) are often used for storing pressurant gases onboard spacecraft. Kevlar (DuPont), glass, carbon and other more recent fibers have all been used as overwraps. Due to the fact that overwraps are subjected to sustained loads for an extended period during a mission, stress rupture failure is a major concern. It is therefore important to ascertain the reliability of these vessels by analysis, since the testing of each flight design cannot be completed on a practical time scale. The present paper examines specifically a Weibull statistics based stress rupture model and considers the various uncertainties associated with the model parameters. The paper also examines several reliability estimate measures that would be of use for the purpose of recertification and for qualifying flight worthiness of these vessels. Specifically, deterministic values for a point estimate, mean estimate and 90/95 percent confidence estimates of the reliability are all examined for a typical flight quality vessel under constant stress. The mean and the 90/95 percent confidence estimates are computed using Monte-Carlo simulation techniques by assuming distribution statistics of model parameters based also on simulation and on the available data, especially the sample sizes represented in the data. The data for the stress rupture model are obtained from the Lawrence Livermore National Laboratories (LLNL) stress rupture testing program, carried out for the past 35 years. Deterministic as well as probabilistic sensitivities are examined.

  18. Influence of plastic deformation on bimaterial fault rupture directivity

    E-print Network

    Dmowska, Renata

    Influence of plastic deformation on bimaterial fault rupture directivity Nora DeDontney,1 Elizabeth of the role of the stress state on the distribution of plastic deformation and the direction of preferred in determining the location of plastic deformation. For different orientations, plastic deformation can

  19. Double Passive Cavitation Detection of OptisonTM Shell Rupture

    E-print Network

    Illinois at Urbana-Champaign, University of

    of ultrasonic excitation parameters (driving frequency, pulse duration, and peak rarefactional pressure transducer functioning in the pulse-echo mode. Post-excitation signals were used to detect rupture thresholds. By allowing acquisition of the signals received by the insonifying transducer (pulse-echo during

  20. Mechanics of shear rupture applied to earthquake zones

    NASA Technical Reports Server (NTRS)

    Li, Victor C.

    1986-01-01

    The mechanics of shear slippage and rupture in rock masses are reviewed. The essential ideas in fracture mechanics are summarized emphasizing the interpretation and relation among the fracture parameters in shear cracks. The slip-weakening model is described. The general formulation of the problem of nonuniform slip distribution in a continuum is covered.

  1. The Rupture and Repair of Cooperation in Borderline

    E-print Network

    Zeki, Semir

    The Rupture and Repair of Cooperation in Borderline Personality Disorder Brooks King-Casas,1 individuals afflicted with borderline personality disorder (BPD) to play a multiround economic exchange game group of individuals diagnosed with borderline per- sonality disorder (BPD), a psychiatric disorder

  2. Rupture Loop Annex (RLA) ion exchange vault entry and characterization

    SciTech Connect

    Ham, J.E.

    1996-01-04

    This engineering report documents the entry and characterization of the Rupture Loop Annex Ion Exchange (RLAIX) Vault located near the 309 Building`s Plutonium Recycle Test Reactor (PRTR). Twelve ion exchange columns were found in the vault. Some of which contained transuranics, Cs 137, and Co 60. The characterization information is necessary for future vault cleanout and column disposal.

  3. Depth-varying rupture properties of subduction zone megathrust faults

    E-print Network

    Cerveny, Vlastislav

    ­45 km in subduction zones where relatively young oceanic lithosphere is being underthrust with shallowDepth-varying rupture properties of subduction zone megathrust faults Thorne Lay,1 Hiroo Kanamori,2] Subduction zone plate boundary megathrust faults accommodate relative plate motions with spatially varying

  4. Prediction of Cerebral Aneurysm Rupture using Hemodynamic, Morphologic and Clinical

    E-print Network

    Riera, Jesús Bisbal

    Prediction of Cerebral Aneurysm Rupture using Hemodynamic, Morphologic and Clinical Features¸cats (ICREA), Barcelona, Spain jesus.bisbal@upf.edu Abstract. Cerebral aneurysms pose a major clinical threat of the patient and characteristics of the aneurysm. The dataset used included 157 cases, with 294 features each

  5. "The Little Gray Book": Pedagogy, Discourse and Rupture in 1937

    ERIC Educational Resources Information Center

    Milewski, Patrice

    2008-01-01

    In 1937, the Ministry of Education in Ontario published a document entitled "Programme of Studies for Grades 1 to VI of Public and Separate Schools" that became known amongst teachers as the "little gray book". The curriculum and pedagogy in the document enunciated a rupture or mutation in pedagogical discourse that broke with previously existing…

  6. Complex rupture during the 12 January 2010 Haiti earthquake

    USGS Publications Warehouse

    Hayes, G.P.; Briggs, R.W.; Sladen, A.; Fielding, E.J.; Prentice, C.; Hudnut, K.; Mann, P.; Taylor, F.W.; Crone, A.J.; Gold, R.; Ito, T.; Simons, M.

    2010-01-01

    Initially, the devastating Mw 7.0, 12 January 2010 Haiti earthquake seemed to involve straightforward accommodation of oblique relative motion between the Caribbean and North American plates along the Enriquillog-Plantain Garden fault zone. Here, we combine seismological observations, geologic field data and space geodetic measurements to show that, instead, the rupture process may have involved slip on multiple faults. Primary surface deformation was driven by rupture on blind thrust faults with only minor, deep, lateral slip along or near the main Enriquillog-Plantain Garden fault zone; thus the event only partially relieved centuries of accumulated left-lateral strain on a small part of the plate-boundary system. Together with the predominance of shallow off-fault thrusting, the lack of surface deformation implies that remaining shallow shear strain will be released in future surface-rupturing earthquakes on the Enriquillog-Plantain Garden fault zone, as occurred in inferred Holocene and probable historic events. We suggest that the geological signature of this earthquakeg-broad warping and coastal deformation rather than surface rupture along the main fault zoneg-will not be easily recognized by standard palaeoseismic studies. We conclude that similarly complex earthquakes in tectonic environments that accommodate both translation and convergenceg-such as the San Andreas fault through the Transverse Ranges of Californiag-may be missing from the prehistoric earthquake record. ?? 2010 Macmillan Publishers Limited. All rights reserved.

  7. On the theory of the rupture of black films

    NASA Astrophysics Data System (ADS)

    Derjaguin, B. V.; Prokhorov, A. V.

    1994-04-01

    The present work covers the solution of a problem on the fluctuation rupture of black films [Derjaguin, B.V., and Gutop, Yu. V., Kolloid. zh.24, 431 (1962); Dokl. AN SSSR153, 859 (1963); “Research in Surface Forces,” Vol. 2, p. 36. Consultants Bureau, New York, 1966], which is interpreted as a two-dimensional analog of the homogeneous boiling of fluid. Such a two-dimensional mechanism of rupture must be realized first of all for secondary black and lipid films. Using the solution of the stationary Kramers-Zeldovich equation as the basis, we have derived a general expression for the probability of the isothermal rupture of a stretched film of the given area per unit time. The use of Gibbs Grand Ensemble [Derjaguin, B.V., Zh. eksp. teor. fis.65, 2261 (1973); J. Chem. Phys.61, 3665 (1974)] enabled us to calculate accurately the pre-exponential factor in that expression. Criteria of the applicability of the results obtained have been determined. A possibility is discussed for applying the abrupt dependence of the rupture probability of a film on its linear tension, to the accurate measurement of the latter.

  8. Axial creep-rupture time of boron-aluminum composites

    SciTech Connect

    Goda, Koichi; Hamada, Jun`ichi

    1995-11-01

    Axial creep tests of a 10vol% boron-aluminum hotpressed monolayer composite were carried out under several constant loads at 300 C in air. The composite behaved with slight primary creep, but did not show appreciable secondary creep. Several specimens encountered a momentary increase of strain during the creep test which separated the creep curve into two regions, because of the individual fiber breaks in the composite. And then, almost all the specimens suddenly fractured without tertiary creep. From the viewpoint of reliability engineering the statistical properties of the creep-rupture time were investigated. The average creep-rupture time decreased with an increase in the applied stress, and the relatively large coefficient of variation was estimated in every case, being around 1,000%. However, these scatters were estimated to be smaller than the scatter of creep-rupture time in the boron fiber itself. That means, the reliability of the fiber`s creep-rupture time is improved by compositing with matrix material.

  9. Diagnosis of splenic rupture in malignant lymphoma using radionuclides

    SciTech Connect

    Wallace, J.C.

    1985-01-01

    The case of a 59-year-old woman with malignant lymphoma who was investigated for fever and left upper quadrant abdominal pain is presented. A combined spleen/lung scan showed marked medial displacement of an enlarged spleen and a gallium scan showed increased splenic uptake consistent with lymphomatous infiltration. The diagnosis of prior splenic rupture with subphrenic hematoma was confirmed at laparotomy.

  10. Correlation of earthquake source parameters inferred from dynamic rupture simulations

    E-print Network

    Archuleta, Ralph

    authors. This database contains ruptures computed using different models of initial stress, peak stress of the physics of the earthquake process or at the very least, a reasonable approximation to the physics. Two the initial state of stress is given together with a friction law that describes how the shear stress evolves

  11. Preterm Delivery in the Setting of Left Calyceal Rupture

    PubMed Central

    Hanson, Brent; Tabbarah, Rami

    2015-01-01

    Spontaneous rupture of the renal collecting system is a rare but serious complication of pregnancy. We report a case of nontraumatic left renal calyceal rupture in a pregnancy which ultimately progressed to preterm delivery. A 29-year-old primigravida with a remote history of urolithiasis presented with left flank pain, suprapubic pain, and signs of preterm labor at 33 weeks of gestation. The patient was believed to have urolithiasis, although initial renal ultrasound failed to demonstrate definitive calculi. After a temporary improvement in flank pain with medication, the patient experienced acute worsening of her left flank pain. Urology was consulted and further imaging was obtained. Magnetic resonance imaging (MRI) was consistent with bilateral hydronephrosis and rupture of the left renal calyx. Given the patient's worsening pain in the setting of left calyceal rupture, the urology team planned for placement of a left ureteral stent. However, before the patient could receive her stent, she progressed to active labor and delivered a viable female infant vaginally. Following delivery, the patient's flank pain resolved rapidly and spontaneously, so no surgical intervention was performed. A summary of the literature and the details of this specific clinical situation are provided. PMID:26483981

  12. Complex rupture during the 12 January 2010 Haiti earthquake

    NASA Astrophysics Data System (ADS)

    Hayes, G. P.; Briggs, R. W.; Sladen, A.; Fielding, E. J.; Prentice, C.; Hudnut, K.; Mann, P.; Taylor, F. W.; Crone, A. J.; Gold, R.; Ito, T.; Simons, M.

    2010-11-01

    Initially, the devastating Mw 7.0, 12 January 2010 Haiti earthquake seemed to involve straightforward accommodation of oblique relative motion between the Caribbean and North American plates along the Enriquillo-Plantain Garden fault zone. Here, we combine seismological observations, geologic field data and space geodetic measurements to show that, instead, the rupture process may have involved slip on multiple faults. Primary surface deformation was driven by rupture on blind thrust faults with only minor, deep, lateral slip along or near the main Enriquillo-Plantain Garden fault zone; thus the event only partially relieved centuries of accumulated left-lateral strain on a small part of the plate-boundary system. Together with the predominance of shallow off-fault thrusting, the lack of surface deformation implies that remaining shallow shear strain will be released in future surface-rupturing earthquakes on the Enriquillo-Plantain Garden fault zone, as occurred in inferred Holocene and probable historic events. We suggest that the geological signature of this earthquake-broad warping and coastal deformation rather than surface rupture along the main fault zone-will not be easily recognized by standard palaeoseismic studies. We conclude that similarly complex earthquakes in tectonic environments that accommodate both translation and convergence-such as the San Andreas fault through the Transverse Ranges of California-may be missing from the prehistoric earthquake record.

  13. Rupture of a left internal mammary artery during cardiopulmonary resuscitation

    PubMed Central

    Metting, Austin; Curtis, Brydan; Mixon, Timothy

    2016-01-01

    We present a rare case of a left internal mammary artery rupture during cardiopulmonary resuscitation (CPR). This case demonstrates that intrinsic cardiac/vascular injuries can occur even with manual CPR, and each patient should be monitored closely, considering the very subtle signs that can clue the physicians into the diagnosis. PMID:26722182

  14. A rare knee extensor mechanism injury: Vastus intermedius tendon rupture

    PubMed Central

    Cetinkaya, Engin; Aydin, Canan Gonen; Akman, Yunus Emre; Gul, Murat; Arikan, Yavuz; Aycan, Osman Emre; Kabukcuoglu, Yavuz Selim

    2015-01-01

    Introduction Quadriceps tendon injuries are rare. There is a limited number of studies in the literature, reporting partial quadriceps tendon ruptures. We did not find any study reporting an isolated vastus intermedius tendon injury in the literature. Presentation of case A 22 years old professional rugby player with the complaints of pain in the right lower limb, decreased range of motion in right knee and a mass in the mid-anterior of the right thigh applied following an overloading on his hyperflexed knee during a rugby match. T2 sequence magnetic resonance images revealed discontinuity in the vastus intermedius tendon and intramuscular hematoma. The patient has been conservatively treated. Discussion Quadriceps tendon ruptures generally occur after the 4th decade in the presence of degenerative changes. Our case is a young professional rugby player. Isolated vastus intermedius tendon rupture is unusual. Conservative treatment is performed as the intermedius tendon is in the deepest layer of the quadriceps muscle. Conclusion We report the first case of isolated rupture of the vastus intermedius tendon in the literature and we claim that disorder may be succesfully treated with conservative treatment and adequate physiotheraphy. PMID:26298093

  15. Tsunami early warning using earthquake rupture duration Anthony Lomax1

    E-print Network

    Rawlinson, Nick

    Tsunami early warning using earthquake rupture duration Anthony Lomax1 and Alberto Michelini2] Effective tsunami early warning for coastlines near a tsunamigenic earthquake requires notification within 5, greater than about 50 s. Here we show that T0 gives more information on tsunami importance than moment

  16. Theory of time-dependent rupture in the Earth

    NASA Technical Reports Server (NTRS)

    Das, S.; Scholz, C. H.

    1980-01-01

    Fracture mechanics is used to develop a theory of earthquake mechanism which includes the phenomenon of subcritical crack growth. The following phenomena are predicted: slow earthquakes, multiple events, delayed multiple events (doublets), postseismic rupture growth and afterslip, foreshocks, and aftershocks. The theory predicts a nucleation stage prior to an earthquake, and suggests a physical mechanism by which one earthquake may 'trigger' another.

  17. Stretching and Rupture of Suspension Bridges, of the Fluid Variety

    NASA Astrophysics Data System (ADS)

    Connington, Kevin; Miskin, Mark; Lee, Taehun; Shattuck, Mark; Morris, Jeffrey; Jaeger, Heinrich

    2013-11-01

    A ``suspension bridge'' is similar to a liquid bridge but contains solid particles suspended in the liquid. In this work, experiments and numerical simulations are performed to examine the dynamics of the stretching of a suspension bridge, and the eventual rupture. The experiments are performed using a suspension density matched with the surrounding immiscible liquid to minimize gravitational effects; the simulations are performed using a multi-component lattice-Boltzmann(LB) method coupled with an established method for LB simulation of suspended solids. The focus is on particle rearrangements and rupture dynamics, as well as the force required to stretch the bridge, with comparisons made between the case of a suspension bridge and simple liquid bridge. It is found that even under dilute particle loading, the rupture dynamics are significantly altered by the influence of particles. Under concentrated conditions, the rearrangements of the particles are associated with significant distortion of the interface, and a simpler simulation tool which balances particle interactions with the capillary forces from the boundary appears to capture salient features of the dynamics. The ultimate rupture dynamics are compared to the pinch-off behavior in drop formation from suspensions.

  18. Percutaneous and Endovascular Embolization of Ruptured Hepatic Artery Aneurysm

    SciTech Connect

    Little, Andrew F.; Lee, Wai Kit

    2002-06-15

    A 72-year-old woman presented with an intraperitoneal hemorrhage from a ruptured intrahepatic arteryaneurysm, with an associated pseudoaneurysm developing a high-flow arteriovenous fistula. Persistent coagulopathy and a median arcuate ligament stenosis of the celiac axis further complicated endovascular management. Aneurysm thrombosis required percutaneous embolization with coils, a removable core guidewire and polyvinyl alcohol particles.

  19. Spontaneous rupture of the liver in severe preeclampsia. Case report.

    PubMed

    Ghosh, T S; Kwawukume, E Y

    1993-01-01

    Uncontrolled haemorrhage is the most common cause of death after spontaneous rupture of the liver in pregnancy. This severe complication of pregnancy-induced hypertension is associated with a high rate of both maternal and fetal mortality, and aggressive therapy should be instituted including treatment of haemorrhagic shock, control of hepatic bleeding, and delivery. PMID:8312216

  20. [Spontaneous liver rupture in pregnancy-induced hypertension].

    PubMed

    Perucca, E; Cazenave, H; Gutiérrez, I; Barrera, C; Fuenzalida, J P

    1991-01-01

    Spontaneous rupture of liver during pregnancy is associated with a very high maternal mortality. This lesion is an unusual complication of the preeclampsia-eclampsia syndrome. We report the case of a 34 years old woman who suffered this complication; responding satisfactorily after conservative surgical treatment. PMID:1845200

  1. Ultrasound evaluation of a spontaneous plantar fascia rupture.

    PubMed

    Louwers, Michael J; Sabb, Brian; Pangilinan, Percival H

    2010-11-01

    Plantar fascia rupture is an occasional complication in patients with chronic plantar fasciitis or in patients with plantar fasciitis treated with steroid injection. Very few cases of spontaneous plantar fascia rupture have been reported in the literature (Herrick and Herrick, Am J Sports Med 1983;11:95; Lun et al, Clin J Sports Med 1999;9:48-9; Rolf et al, J Foot Ankle Surg 1997;36:112-4; Saxena and Fullem, Am J Sports Med 2004;32:662-5). Spontaneous medial plantar fascia rupture in a 37-yr-old man with no preceding symptoms or steroid injections was confirmed with diagnostic ultrasound, which revealed severe fasciitis at the calcaneal insertion with partial tearing. After conservative treatment, the patient returned to full activities. We discuss the anatomy, risk factors, examination findings, and treatment for this condition, as well as the unique benefits that ultrasound offers over magnetic resonance imaging. It is important to consider plantar fascia rupture in patients with hindfoot pain and medioplantar ecchymosis, particularly if an injury occurred during acceleration maneuvers. Ultrasound in these cases can be used to diagnose a plantar fascia tear quickly, accurately, and cost-effectively. PMID:20962604

  2. Anthrax toxin-induced rupture of artificial lipid bilayer membranes

    NASA Astrophysics Data System (ADS)

    Nablo, Brian J.; Panchal, Rekha G.; Bavari, Sina; Nguyen, Tam L.; Gussio, Rick; Ribot, Wil; Friedlander, Art; Chabot, Donald; Reiner, Joseph E.; Robertson, Joseph W. F.; Balijepalli, Arvind; Halverson, Kelly M.; Kasianowicz, John J.

    2013-08-01

    We demonstrate experimentally that anthrax toxin complexes rupture artificial lipid bilayer membranes when isolated from the blood of infected animals. When the solution pH is temporally acidified to mimic that process in endosomes, recombinant anthrax toxin forms an irreversibly bound complex, which also destabilizes membranes. The results suggest an alternative mechanism for the translocation of anthrax toxin into the cytoplasm.

  3. 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

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

    PubMed Central

    Kassir, Radwan; Kaczmarek, David

    2014-01-01

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

  5. Anal Cancer Screening in an Urban HIV Clinic: Provider Perceptions and Practice.

    PubMed

    Sowah, Leonard Anang; Buchwald, Ulrike K; Riedel, David J; Gilliam, Bruce L; Khambaty, Mariam; Fantry, Lori; Spencer, Derek E; Weaver, Jeffery; Taylor, Gregory; Skoglund, Mary; Amoroso, Anthony; Redfield, Robert R

    2015-01-01

    In this article, we sought to understand the perceptions and practice of providers on anal cancer screening in HIV-infected patients. Providers in an academic outpatient HIV practice were surveyed. Data were analyzed to determine the acceptability and perceptions of providers on anal Papanicolaou tests. Survey response rate was 55.3% (60.7% among male and 47.4% among female providers). One-third of the providers had received screening requests from patients. Female providers had higher self-rated comfort with anal Papanicolaou tests, with a mean score of 7.1 (95% confidence interval [CI] 4.7-9.5) compared to 3.6 (95% CI 1.5-5.7) for male providers, P = .02. Sixty-seven percent of male providers and 37.5% of female providers would like to refer their patients for screening rather than perform the test themselves. Only 54.2% of our providers have ever performed anal cytology examination. Our survey revealed that not all providers were comfortable performing anal cancer screening for their patients. PMID:26307210

  6. Heterosexual anal intercourse and HIV infection risks in the context of alcohol serving venues, Cape Town, South Africa

    PubMed Central

    2011-01-01

    Background The most efficient sexual behavior for HIV transmission is unprotected receptive anal intercourse. However, it is unclear what role heterosexual unprotected anal sex is playing in the world's worst HIV epidemics of southern Africa. The objective is to examine the prevalence of heterosexual unprotected anal intercourse among men and women who drink at informal alcohol serving establishments (shebeens) in South Africa. Methods Cross-sectional surveys were collected from a convenience sample of 5037 patrons of 10 shebeens in a peri-urban township of Cape Town, South Africa. Analyses concentrated on establishing the rates of unprotected anal intercourse practiced by men and women as well as the factors associated with practicing anal intercourse. Results We found that 15% of men and 11% of women reported anal intercourse in the previous month, with 8% of men and 7% of women practicing any unprotected anal intercourse. Multiple logistic regression showed that younger age, having primary and casual sex partners, and meeting sex partners at shebeens were independently associated with engaging in anal intercourse. Mathematical modeling showed that individual risks are significantly impacted by anal intercourse but probably not to the degree needed to drive a generalized HIV epidemic. Conclusions Anal intercourse likely plays a significant role in HIV infections among a small minority of South Africans who patronize alcohol serving establishments. Heterosexual anal intercourse, the most risky sexual behavior for HIV transmission, should not be ignored in HIV prevention for South African heterosexuals. However, this relatively infrequent behavior should not become the focus of prevention efforts. PMID:21999574

  7. Assessment of Aortic Aneurysm Rupture Risk Rafael Izbicki, Ann B. Lee and Ender A. Finol

    E-print Network

    Assessment of Aortic Aneurysm Rupture Risk Rafael Izbicki, Ann B. Lee and Ender A. Finol Carnegie Mellon University May 2011 Abstract The rupture of an abdominal aortic aneurysm (AAA) is associated, it is important to find good predictors for immediate risk of rupture. Clinically, the size of the aneurysm

  8. Similarity solutions for van der Waals rupture of a thin film on a solid substrate

    E-print Network

    Gardel, Margaret

    . INTRODUCTION Van der Waals forces can cause a thin liquid film on a solid substrate to rupture and form a dry. Van-der-Waals-driven film rupture is an important step in the collapse of a foam and in dropletSimilarity solutions for van der Waals rupture of a thin film on a solid substrate Wendy W. Zhang

  9. Earthquake Early Warning and the Physics of Earthquake Rupture Gilead Wurman

    E-print Network

    Allen, Richard M.

    Earthquake Early Warning and the Physics of Earthquake Rupture By Gilead Wurman 2010 #12; #12; 1 Abstract Earthquake Early Warning and the Physics of Earthquake Rupture of whether earthquake ruptures are self-similar, cascading failures, or whether their size is somehow

  10. 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

  11. 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.

  12. Anicteric gallbladder rupture in dogs: 5 cases (2007-2013).

    PubMed

    Guess, Sarah C; Harkin, Kenneth R; Biller, David S

    2015-12-15

    Objective-To describe clinical, laboratory, and surgical findings in dogs with confirmed gallbladder rupture and in which serum total bilirubin concentration was within reference limits. Design-Retrospective case series. Animals-5 dogs. Procedures-Medical records were searched to identify dogs with gallbladder rupture that underwent treatment at the Kansas State University Veterinary Health Center from November 2007 through November 2013. Dogs were included if they had undergone abdominal ultrasonography, serum total bilirubin concentration was ? 0.4 mg/dL, and abdominal exploratory surgery confirmed the presence of gallbladder upture. Results-An exploratory celotomy was performed in all dogs because of ultrasonographic findings of mild to marked abdominal effusion and either an unidentifiable gallbladder (n = 1 dog) or a distended gallbladder with a suspected gallbladder mucocele (4 dogs). Serum total bilirubin concentration was within reference limits (median, 0.2 mg/dL; range, 0.1 to 0.4 mg/dL; reference range, 0.1 to 0.4 mg/dL) in all dogs before surgery. In 1 dog, bile acids concentrations in serum and in peritoneal fluid were compared and the results (48 ?mol/L and 1,070 ?mol/L, respectively) were supportive of the diagnosis of gallbladder rupture. Conclusions and Clinical Relevance-Results indicated that even when serum total bilirubin concentration is within reference limits, gallbladder rupture should be considered in dogs with acute signs of abdominal pain when a mucocele is suspected on abdominal imaging and free abdominal fluid is present. Results suggested that a comparison of serum to peritoneal fluid bile acids concentrations may provide additional support for a diagnosis of gallbladder rupture. PMID:26642136

  13. Dynamic Rupture Benchmarking of the ADER-DG Method

    NASA Astrophysics Data System (ADS)

    Pelties, C.; Gabriel, A.

    2012-12-01

    We will verify the arbitrary high-order derivative Discontinuous Galerkin (ADER-DG) method in various test cases of the 'SCEC/USGS Dynamic Earthquake Rupture Code Verification Exercise' benchmark suite (Harris et al. 2009). The ADER-DG scheme is able to solve the spontaneous rupture problem with high-order accuracy in space and time on three-dimensional unstructured tetrahedral meshes. Strong mesh coarsening or refinement at areas of interest can be applied to keep the computational costs feasible. Moreover, the method does not generate spurious high-frequency contributions in the slip rate spectra and therefore does not require any artificial damping as demonstrated in previous presentations and publications (Pelties et al. 2010 and 2012). We will show that the mentioned features hold also for more advanced setups as e.g. a branching fault system, heterogeneous background stresses and bimaterial faults. The advanced geometrical flexibility combined with an enhanced accuracy will make the ADER-DG method a useful tool to study earthquake dynamics on complex fault systems in realistic rheologies. References: Harris, R.A., M. Barall, R. Archuleta, B. Aagaard, J.-P. Ampuero, H. Bhat, V. Cruz-Atienza, L. Dalguer, P. Dawson, S. Day, B. Duan, E. Dunham, G. Ely, Y. Kaneko, Y. Kase, N. Lapusta, Y. Liu, S. Ma, D. Oglesby, K. Olsen, A. Pitarka, S. Song, and E. Templeton, The SCEC/USGS Dynamic Earthquake Rupture Code Verification Exercise, Seismological Research Letters, vol. 80, no. 1, pages 119-126, 2009 Pelties, C., J. de la Puente, and M. Kaeser, Dynamic Rupture Modeling in Three Dimensions on Unstructured Meshes Using a Discontinuous Galerkin Method, AGU 2010 Fall Meeting, abstract #S21C-2068 Pelties, C., J. de la Puente, J.-P. Ampuero, G. Brietzke, and M. Kaeser, Three-Dimensional Dynamic Rupture Simulation with a High-order Discontinuous Galerkin Method on Unstructured Tetrahedral Meshes, JGR. - Solid Earth, VOL. 117, B02309, 2012

  14. Dynamic Rupture Benchmarking of the ADER-DG Method

    NASA Astrophysics Data System (ADS)

    Gabriel, Alice; Pelties, Christian

    2013-04-01

    We will verify the arbitrary high-order derivative Discontinuous Galerkin (ADER-DG) method in various test cases of the 'SCEC/USGS Dynamic Earthquake Rupture Code Verification Exercise' benchmark suite (Harris et al. 2009). The ADER-DG scheme is able to solve the spontaneous rupture problem with high-order accuracy in space and time on three-dimensional unstructured tetrahedral meshes. Strong mesh coarsening or refinement at areas of interest can be applied to keep the computational costs feasible. Moreover, the method does not generate spurious high-frequency contributions in the slip rate spectra and therefore does not require any artificial damping as demonstrated in previous presentations and publications (Pelties et al. 2010 and 2012). We will show that the mentioned features hold also for more advanced setups as e.g. a branching fault system, heterogeneous background stresses and bimaterial faults. The advanced geometrical flexibility combined with an enhanced accuracy will make the ADER-DG method a useful tool to study earthquake dynamics on complex fault systems in realistic rheologies. References: Harris, R.A., M. Barall, R. Archuleta, B. Aagaard, J.-P. Ampuero, H. Bhat, V. Cruz-Atienza, L. Dalguer, P. Dawson, S. Day, B. Duan, E. Dunham, G. Ely, Y. Kaneko, Y. Kase, N. Lapusta, Y. Liu, S. Ma, D. Oglesby, K. Olsen, A. Pitarka, S. Song, and E. Templeton, The SCEC/USGS Dynamic Earthquake Rupture Code Verification Exercise, Seismological Research Letters, vol. 80, no. 1, pages 119-126, 2009 Pelties, C., J. de la Puente, and M. Kaeser, Dynamic Rupture Modeling in Three Dimensions on Unstructured Meshes Using a Discontinuous Galerkin Method, AGU 2010 Fall Meeting, abstract #S21C-2068 Pelties, C., J. de la Puente, J.-P. Ampuero, G. Brietzke, and M. Kaeser, Three-Dimensional Dynamic Rupture Simulation with a High-order Discontinuous Galerkin Method on Unstructured Tetrahedral Meshes, JGR. - Solid Earth, VOL. 117, B02309, 2012

  15. Chang, S.-K., Kozenlauskas, R., and Harrington, G. W. (1977). Determination of nitrite ion using differential pulse polarography. Anal. Chem. 49, 2272.

    E-print Network

    Liu, Jie

    1977-01-01

    ion using differential pulse polarography. Anal. Chem. 49, 2272. Gjerde, D. T., Fritz, J. S conductimetric detection. Anal. Chem. 47, 1801. Stratford, M. R. L. (1999). Measurement of nitrite and nitrate

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

    PubMed Central

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

    2013-01-01

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

  17. [Treatment of chronic anal fissures: diltiazem or isosorbide dinitrate as first choice?].

    PubMed

    Boeker, Eveline B; Kruijer, M J P Marjan; Verbeek, Paul C M

    2011-01-01

    Chronic anal fissures are a painful condition frequently seen in general practice, with an incidence of 2,5/1000 per year. According to the practice guidelines of the Dutch College of General Practitioners, isosorbide dinitrate 1% ointment (ISDN) is the treatment of first choice for chronic anal fissures. Systemic side-effects such as headache are reported in 27% of all cases. This side effect in combination with the frequent application of ISDN (4-6 times daily) leads to a low compliance for this therapy. A meta-analysis of the Cochrane Collaboration showed similar efficacy of diltiazem compared to ISDN. Diltiazem has several advantages: the application frequency is only twice daily, no systemic side-effects have been reported, the total costs of treatment are lower than the costs of ISDN and a standard preparation of diltiazem ointment is available. Therefore, diltiazem 2% ointment should be the first line treatment for chronic anal fissures. PMID:21262020

  18. Expression of PDGFR-? and Kit in canine anal sac apocrine gland adenocarcinoma using tissue immunohistochemistry.

    PubMed

    Brown, R J; Newman, S J; Durtschi, D C; Leblanc, A K

    2012-03-01

    Canine anal sac apocrine gland adenocarcinoma (ASAGAC) is an uncommon but highly invasive and metastatic malignancy. Toceranib phosphate (Palladia) is a receptor tyrosine kinase (RTK) inhibitor that targets several members of the split kinase RTK family. These membrane receptors are important for cell cycling, apoptosis and angiogenesis, all of which can contribute to carcinogenesis. The objective of this study was to evaluate archived, paraffin-embedded canine ASAGAC and normal canine anal sacs for immunohistochemical detection of Kit and platelet-derived growth factor receptor beta (PDGFR-?). Two of 77 neoplasms (2.6%) expressed Kit. Fifteen of the neoplasms (19.5%) were positive for PDGFR-? expression. None of the normal canine anal sac epithelium expressed Kit or PDGFR-?. Because of these results, further investigation should be considered to determine the role of RTKs in the clinical course and treatment of canine ASAGAC. PMID:22235855

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

    PubMed

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

    2014-02-01

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

  20. 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.