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Sample records for anal sphincter rupture

  1. Risk factors of recurrent anal sphincter ruptures

    DEFF Research Database (Denmark)

    Jangö, Hanna; Langhoff-Roos, J; Rosthøj, Steen;

    2012-01-01

    Please cite this paper as: Jangö H, Langhoff-Roos J, Rosthøj S, Sakse A. Risk factors of recurrent anal sphincter ruptures: a population-based cohort study. BJOG 2012;00:000-000 DOI: 10.1111/j.1471-0528.2012.03486.x. Objective  To determine the incidence and risk factors of recurrent anal sphincter...... rupture (ASR). Design  Population-based retrospective cohort study. Setting  Data were taken from the National Medical Birth Registry, Denmark. Population  Patients with a first and a second vaginal delivery in the time period 1997-2010. Methods  Univariate analysis and multivariate logistic regression...... were used to determine risk factors of recurrent ASR. Main outcome measures  The incidence of recurrent ASR and odds ratios for possible risk factors of recurrent ASR: age, body mass index, grade of ASR, birthweight, head circumference, gestational age, presentation, induction of labour, oxytocin...

  2. Anal incontinence in women with recurrent obstetric anal sphincter rupture

    DEFF Research Database (Denmark)

    Bøgeskov, Reneé; Nickelsen, Carsten Nahne Amtoft; Secher, Niels Jørgen

    2015-01-01

    UNLABELLED: Abstract Objectives: To determine the risk of recurrent anal sphincter rupture (ASR), and compare the risk of anal incontinence (AI) after recurrent ASR, with that seen in women with previous ASR who deliver by caesarean section or vaginally without sustaining a recurrent ASR. METHODS...

  3. The Danish anal sphincter rupture questionnaire: Validity and reliability

    DEFF Research Database (Denmark)

    Due, Ulla; Ottesen, Marianne

    2008-01-01

    Objective. To revise, validate and test for reliability an anal sphincter rupture questionnaire in relation to construct, content and face validity. Setting and background. Since 1996 women with anal sphincter rupture (ASR) at one of the public university hospitals in Copenhagen, Denmark have been...... among health care personnel, followed by an expert panel discussion. Ten women were interviewed about their understanding and attitude toward answering the questionnaire and it was pre-tested on 52 women with ASR. The questionnaire was revised five times during the validation process. The final version...... all main questions but one. Two questions needed further explanation. Seven women made minor errors. Conclusion. The validated Danish questionnaire has a good construct, content and face validity. It is a well accepted, reliable, simple and clinically relevant screening tool. It reveals physical...

  4. Defects on endoanal ultrasound and anal incontinence after primary repair of fourth-degree anal sphincter rupture: a study of the anal sphincter complex and puborectal muscle

    DEFF Research Database (Denmark)

    Sakse, A; Secher, N J; Ottesen, M; Starck, M

    2009-01-01

    OBJECTIVES: To perform three-dimensional endoanal ultrasound (EAUS) after primary repair of fourth-degree anal sphincter rupture (ASR) and correlate the sonographic defects with anal incontinence (AI); to measure the axial and sagittal thickness and angle of the puborectal muscle (PRM) as well as...... the length of the anal canal, and then correlate these measures with AI; and to assess the interobserver measurement agreement between an inexperienced and an experienced sonologist. METHODS: EAUS was offered to 84 consecutive women, who were asked to answer a validated questionnaire after fourth......-degree ASR. AI was graded according to the Wexner score and EAUS defects were graded according to the Starck score. RESULTS: Sixty-one women (73%) answered the questionnaire. The median (range) follow-up time was 5.1 (1.3-8.7) years. Thirty-three (54%) of these women underwent EAUS and were included in the...

  5. The Artificial Anal Sphincter

    OpenAIRE

    Christiansen, John

    2000-01-01

    The artificial anal sphincter as treatment for end stage anal incontinence was first described in 1987. Published series concern a total of 42 patients, with a success rate of approximately 80%. Infection has been the most serious complication, but a number of technical complications related to the device have also occurred and required revisional procedures in 40% to 60% of the patients. The artificial anal sphincter may be used for the same indications as dynamic graciloplasty except in pat...

  6. Early discharge after external anal sphincter repair

    DEFF Research Database (Denmark)

    Rosenberg, J; Kehlet, H

    1999-01-01

    PURPOSE: The aim of this study was to describe an accelerated-stay program for repair of the external anal sphincter. METHODS: Twenty consecutive patients undergoing overlapping repair of the external anal sphincter were included in the study. Effect parameters were length of hospitalization and....... CONCLUSION: We have described a safe accelerated-stay program (24 to 48 hours) for overlapping repair of external anal sphincter....

  7. Internal anal sphincter: an anatomic study.

    Science.gov (United States)

    Uz, A; Elhan, A; Ersoy, M; Tekdemir, I

    2004-01-01

    The anatomy of the internal anal sphincter and surrounding structures was investigated in 24 cadavers using a surgical microscope (6-25 x magnification). An understanding of the anatomy of the internal anal sphincter is helpful in avoiding complications during surgical procedures in the anorectal region. The external anal sphincter was composed of three ellipsoid rings of skeletal muscle (subcutaneous, superficial, and deep) that encircle the anal canal; in contrast, we found that the internal anal sphincter was composed of flat rings of smooth muscle bundles stacked one on top of the other, like the slats of a Venetian blind. In each anal canal, the average number of ring-like slats observed was 26.33 +/- 2.93 (range = 20-30) and each was covered by its own fascia. The smooth muscle fibers and fascia coalesced at three equidistant points around the anal canal to form three columns that extended distally into the lumen and differed in form from the other anal columns. When viewed from an anterior position, the columns were located anteriorly at the observer's right (5 o'clock position), posteriorly at the right (1 o'clock position), and laterally at the left (9 o'clock position). This heretofore unreported anatomy of the internal anal sphincter may play an important role in closing off the lumen of the anal canal and maintaining bowel continence. PMID:14695582

  8. Incontinence after primary repair of obstetric anal sphincter tears is related to relative length of reconstructed external sphincter

    DEFF Research Database (Denmark)

    Norderval, S; Røssaak, K.; Markskog, A; Vonen, B

    2012-01-01

    To determine if anatomic primary repair with end-to-end reconstruction of the external anal sphincter (EAS) in its full length combined with separate repair of coexisting internal anal sphincter (IAS) tear, when present, results in less incontinence and better anal sphincter integrity compared wi...

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

    Directory of Open Access Journals (Sweden)

    Jundt K

    2010-06-01

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

  10. High resolution MR imaging of the anal sphincter using an intravaginal surface coil

    International Nuclear Information System (INIS)

    MR imaging was performed using a 1.0 T unit. In 10 females (6 nullipara, one primipara without and three primipara with postpartum faecal incontinence) a surface coil, originally designed for endorectal use, was placed into the vagina. Transverse oblique T1-weighted spin echo and double echo turbo spin echo sequences with T2- and proton density-weighting were acquired parallel to the puborectal, rectococcygeal and anorectal planes. Three readers analysed the images in consensus. The anatomic structures of the external and internal sphincter as well as the mucosa were differentiated in all cases with a good contrast. The best results were yielded by the proton density weighting. In one case of faecal incontinence a sphincter defect after repair of a complete rupture of the anal sphincter was shown. In another case irregularities in the structure of the external sphincter and perineum were visualised. (orig./MG)

  11. Modifiable risk factors of obstetric anal sphincter injury in primiparous women

    DEFF Research Database (Denmark)

    Jango, Hanna; Langhoff-Roos, Jens; Rosthøj, Susanne;

    2014-01-01

    To determine modifiable risk factors and incidence of obstetric anal sphincter injury (OASIS) in primiparous women.......To determine modifiable risk factors and incidence of obstetric anal sphincter injury (OASIS) in primiparous women....

  12. Endosonographic and manometric assessment of the anal sphincters after ileal pouch-anal anastomosis

    International Nuclear Information System (INIS)

    Background. The aim of this study was to compare endosonography and manometry of the anal sphincters in patients after ileal pouch-anal anastomosis (IPAA). Patients and methods. Ten patients aged between 23 and 50 years with IPAA performed for ulcerative colitis were examined with anal endosonography (AES) and manometry. Results. AES visualised abnormal image of the internal anal sphincter (IAS) in 9 patients (90%). Defects of the external anal sphincter (EAS) and puborectalis muscle (PR) were shown in 4 patients (40%). In 5 patients (50%) correlation between endosonographic and manometric assessment for the all analysed muscles: IAS, EAS and PR was found. In 4 cases (40%) both methods correlated with the evaluation of the EAS only and in 1 patient (10%) no correlation was found. Correlation between both methods for the IAS was found in half of the patients (50%) while in the evaluation of the EAS and PR dynamic activity, it was found in 9 cases (90%). Conclusions. Anal endosonography and manometry allow us to assess the morphology as well as the function of the anal sphincters in patients with IPAA. The methods mentioned above show high correlation in the assessment of the EAS function (9 cases; 90%) whereas in the case of IAS, manometry frequently (5 patients; 50%) does not confirm endosonografically detected defects. (author)

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

    Science.gov (United States)

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

    2007-08-01

    The purpose of this study was to measure the internal and external anal sphincters using translabial ultrasound (TLU) at the proximal, mid, and distal levels of the anal sphincter complex. The human review committee approval was obtained and all women gave written informed consent. Sixty women presenting for gynecologic ultrasound for symptoms other than pelvic organ prolapse or urinary or anal incontinence underwent TLU. Thirty-six (60%) were asymptomatic and intact, 13 symptomatic and intact, and 11 disrupted. Anterior-posterior diameters of the internal anal sphincter at all levels and the external anal sphincter at the distal level were measured in four quadrants. Mean sphincter measurements are given for symptomatic and asymptomatic intact women and are comparable to previously reported endoanal MRI and ultrasound measurements. PMID:17221149

  14. Sphincter preservation in anal cancer: A brief review

    Directory of Open Access Journals (Sweden)

    Divya Khosla

    2013-01-01

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

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

    OpenAIRE

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

    2012-01-01

    Objective To compare the incidence of obstetric anal sphincter injuries (OASIS) in two time periods, before and after implementing a training programme for improved perineal support aimed at reducing the incidence of obstetric anal sphincter injuries. The secondary aim was to study incidence of obstetric anal sphincter injuries in subgroups defined by risk factors for OASIS. Design Population-based cohort study. Setting University hospital setting in Oslo, Norway. Participants Two...

  16. Effects of serotonin on the internal anal sphincter: in vivo manometric study in rats.

    OpenAIRE

    Goldberg, M; Hanani, M.; Nissan, S

    1986-01-01

    The effects of serotonin (5-hydroxytryptamine, 5-HT) on the internal anal sphincter were studied in anaesthesized rats. Serotonin induced a dose dependent relaxation of the internal anal sphincter. Methysergide blocked this relaxation, but did not affect the rectoanal reflex. Methysergide did not antagonise the actions of cholinergic and adrenergic agonists on the internal anal sphincter. Other 5-HT antagonists such as cyproheptadine, ketanserin, chlorpromazine, amitriptyline and ergotamine f...

  17. Mode of delivery after obstetric anal sphincter injury and the risk of long-term anal incontinence

    DEFF Research Database (Denmark)

    Jangö, Hanna; Langhoff-Roos, Jens; Rosthøj, Susanne; Sakse, Abelone

    2016-01-01

    BACKGROUND: Primiparous women have an increased risk of obstetric anal sphincter injury; because most of these patients deliver again, there are major concerns about mode of delivery: the risk of recurrent obstetric anal sphincter injury and the risk of long-term symptoms of anal incontinence....... Although an elective cesarean delivery protects against recurrent obstetric anal sphincter injury, it is uncertain how the second delivery affects the risk of long-term anal incontinence. OBJECTIVE: The purpose of this study was to evaluate whether the mode of delivery for a second pregnancy, after a...... documented obstetric anal sphincter injury at the time of first delivery, had a significant impact on the prevalence of anal and fecal incontinence in the long term. STUDY DESIGN: We performed a population-based questionnaire cohort study that evaluated anal and fecal incontinence, fecal urgency, and...

  18. Endosonographic appearance of the anal sphincters in patients following colostomy

    International Nuclear Information System (INIS)

    Background. The aim of the study was to visualize, by anal ultrasound (AUS), the suspected defects of the anal sphincters in the patients after colostomy and to analyze possible factors that could have led to such defects. Patients and methods. AUS, using a 7.0 MHz endorectal probe, was performed in a group of 25 patients with colostomy. The internal anal sphincter (IAS), external anal sphincter (EAS) and puborectalis muscle (PR) were visualized and the defects within them were qualified and quantified. For statistical analysis, the analysis of variance (ANOVA) was used. Results. The IAS was thin in all but three patients (22 patients; 88 %) with the mean thickness of 1.62 mm. A circular reduction of the thickness along the entire length of the IAS was seen in 20 patients (90.9 %). The echogenicity of the IAS was increased in 15 patients (60 %), and in 10 of them (66.6%), this defect embraced the whole length and circumference of the IAS. The margins of the IAS were not well-defined in 10 patients (40%). A significant correlation was found between the length of the patient's life with the stoma and the IAS echogenicity defect (p-value = 0.0001). No significant correlation was found between the dynamic examination, the IAS thickness and the IAS borders definition. Conclusion. The reduced thickness, increased echogenicity and borders definition defect of the IAS are seen in the patients after colostomy. The only significant correlation was confirmed between the length of the patient's life with the stoma and the IAS echogenicity defect. (author)

  19. A novel artificial anal sphincter system based on transcutaneous energy transmission

    Institute of Scientific and Technical Information of China (English)

    Zan Peng; Yan Guozheng; Liu Hua

    2008-01-01

    For controlling anal incontinence, a new artificial anal sphincter system (AASS) with sensor feedback based on transcutaneous energy transmission is developed. The device mainly comprises an artificial anal sphincter (AAS), a wireless power supply subsystem, and a communication subsystem. The artificial anal sphincter comprises a front cuff and a sensor cuff placed around the rectum, a reservoir sited in abdominal cavity and a micropump controlling inflation and deflation of the front cuff. There are two pressure sensors in the artificial anal sphincter. One can measure the pressure in the front cuff to clamp the rectum, the other in the sensor cuff can measure the pressure of the rectum. Wireless power supply subsystem includes a resonance transmit coil to transmit an alternating magnetic field and a secondary coil to receive the power. Wireless communication subsystem can transmit the pressure information of the artificial anal sphincter to the monitor, or send the control commands to the artificial anal sphincter. A prototype is designed and the basic function of the artificial anal sphincter system has been tested through experiments. The results demonstrate that the artificial anal sphincter system can control anal incontinence effectively.

  20. Role of intracellular calcium in contraction of internal anal sphincter

    Institute of Scientific and Technical Information of China (English)

    1999-01-01

    @@ INTRODUCTION Internal anal sphincter (IAS) is a continuation of the smooth circular muscle layer thickened at the rectum, innervated by vegetative nerve. IAS is a special smooth muscle, which is different from colonic smooth muscle in physiology and pharmaology[1]. It was found that contraction of gastric smooth muscle depends on the influx of extracellular calcium and release of intracellular calcium[2]. In present study, we observed and compared the effects of extra- and intracellular calcium on the contraction of IAS and colonic smooth muscle.

  1. DO CHANGES IN ANAL SPHINCTER ANATOMY CORRELATE WITH ANAL FUNCTION IN WOMEN WITH A HISTORY OF VAGINAL DELIVERY?

    Directory of Open Access Journals (Sweden)

    Sthela Maria MURAD-REGADAS

    2014-09-01

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

  2. Long-term outcome of internal sphincter myectomy in patients with internal anal sphincter achalasia.

    LENUS (Irish Health Repository)

    Doodnath, Reshma

    2012-02-01

    BACKGROUND: Internal anal sphincter achalasia (IASA) is a condition with presentation similar to Hirschsprung\\'s disease (HD), but with the presence of ganglion cells on rectal suction biopsy (RSB). The diagnosis is made on anorectal manometry (ARM) by the absence of the rectosphincteric reflex on rectal balloon inflation. Internal sphincter myectomy (ISM) is the treatment of choice for patients with IASA. Recently, botulinum toxin has been used to treat IASA patients. The purpose of this study was to assess the long-term bowel function in patients with IASA following ISM. METHODS: The medical records of 24 patients with IASA managed by ISM during 1993-2005 were examined. There were 18 boys and 6 girls, aged 2-12 years. All patients presented with intractable constipation with or without soiling. The diagnosis was made by the demonstration of the absence of the rectosphincteric reflex on ARM. HD was excluded by the presence of ganglion cells and normal acetylcholinesterase activity in RSB. Patients were followed 4-14 years later. RESULTS: Fifteen (62.5%) patients at the time of follow-up had regular bowel motions without the use of laxatives. Six (25%) patients had regular bowel motions, but remained on small doses of laxatives. Two (8.3%) patients who suffered from constipation and soiling required twice weekly enemas to remain clean. One (4.2%) patient required resection of dilated rectosigmoid colon 3 years after myectomy, remains on laxatives, but has normal bowel control. No patients had faecal incontinence following ISM. CONCLUSION: This long-term follow-up study shows that the vast majority of IASA patients have normal bowel control following ISM.

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

    Directory of Open Access Journals (Sweden)

    Marie Blomberg

    2014-01-01

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

  4. High-resolution magnetic resonance imaging of the anal sphincter using a dedicated endoanal receiver coil

    Energy Technology Data Exchange (ETDEWEB)

    DeSouza, N.M.; Williams, A.D.; Gilderdale, D.J. [Dept. of Radiology, Imperial College School of Medicine, London (United Kingdom)

    1999-04-01

    The use of a surface coil in MR imaging improves signal-to-noise ratio of adjacent tissues of interest. We therefore devised an endoanal receiver coil for imaging the anal sphincter. The probe is solid and re-usable: it comprises a saddle geometry receiver with integral tuning, matching and decoupling. It is placed in the anal canal and immobilised externally. Both in vitro and in vivo normal anatomy is identified. The mucosa is high signal intensity, the submucosa low signal intensity, the internal sphincter uniformly high signal intensity and the external sphincter low signal intensity on T1- and T2-weighted images. In females, the transverse perineal muscle bridges the inferior part of the external sphincter anteriorly. In perianal sepsis, collections and the site of the endoanal opening are identified. In early-onset fecal incontinence following obstetric trauma/surgery, focal sphincter defects are demonstrated; in late-onset fecal incontinence external sphincter atrophy is seen. In fecally incontinent patients with scleroderma, forward deviation of the anterior sphincter musculature with descent of rectal air and feces into the anal canal is noted. The extent of sphincter invasion is assessed in low rectal tumours. In children with congenital anorectal anomalies, abnormalities of the muscle components are defined using smaller-diameter coils. Such information is invaluable in the assessment and surgical planning of patients with a variety of anorectal pathologies. (orig.) With 15 figs., 26 refs.

  5. The diagnostic accuracy of endovaginal and transperineal ultrasound for detecting anal sphincter defects: The PREDICT study

    International Nuclear Information System (INIS)

    Aim: To determine the accuracy and predictive value of transperineal (TPU) and endovaginal ultrasound (EVU) in the detection of anal sphincter defects in women with obstetric anal sphincter injuries and/or postpartum symptoms of faecal incontinence. Materials and methods: One hundred and sixty-five women were recruited, four women were excluded as they were seen years after their last delivery. TPU and EVU, followed by endonanal ultrasound (EAU), were performed using the B and K Viking 2400 scanner. Sensitivity and specificity, as well as predictive values with 95% confidence intervals, for detecting anal sphincter defects were calculated for EVU and TPU, using EAU as the reference standard. Results: On EAU a defect was found in 42 (26%) women: 39 (93%) had an external (EAS) and 23 (55%) an internal anal sphincter (IAS) defect. Analysable images of one level of the EAS combined with an analysable IAS were available in 140 (87%) women for EVU and in 131 (81%) for TPU. The sensitivity and specificity for the detection of any defect was 48% (30-67%) and 85% (77-91%) for EVU and 64% (44-81%) and 85% (77-91%) for TPU, respectively. Conclusion: Although EAU using a rotating endoprobe is the validated reference standard in the identification of anal sphincter defects, it is not universally available. However while TPU and/or EVU with conventional ultrasound probes can be useful in identifying normality, for clinical purposes they are not sensitive enough to identify an underlying sphincter defect.

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

    International Nuclear Information System (INIS)

    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

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

    Institute of Scientific and Technical Information of China (English)

    Peng ZAN; Guo-zheng YAN; Hua LIU

    2008-01-01

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

  8. Restoration of anal sphincter function after myoblast cell therapy in incontinent rats.

    Science.gov (United States)

    Bisson, Aurélie; Fréret, Manuel; Drouot, Laurent; Jean, Laetitia; Le Corre, Stéphanie; Gourcerol, Guillaume; Doucet, Christelle; Michot, Francis; Boyer, Olivier; Lamacz, Marek

    2015-01-01

    Fecal incontinence (FI) remains a socially isolating condition with profound impact on quality of life for which autologous myoblast cell therapy represents an attractive treatment option. We developed an animal model of FI and investigated the possibility of improving sphincter function by intrasphincteric injection of syngeneic myoblasts. Several types of anal cryoinjuries were evaluated on anesthetized Fischer rats receiving analgesics. The minimal lesion yielding sustainable anal sphincter deficiency was a 90° cryoinjury of the sphincter, repeated after a 24-h interval. Anal sphincter pressure was evaluated longitudinally by anorectal manometry under local electrostimulation. Myoblasts were prepared using a protocol mimicking a clinical-grade process and further transduced with a GFP-encoding lentiviral vector before intrasphincteric injection. Experimental groups were uninjured controls, cryoinjured + PBS, and cryoinjured + myoblasts (different doses or injection site). Myoblast injection was well tolerated. Transferred myoblasts expressing GFP integrated into the sphincter and differentiated in situ into dystrophin-positive mature myofibers. Posttreatment sphincter pressures increased over time. At day 60, pressures in the treated group were significantly higher than those of PBS-injected controls and not significantly different from those of normal rats. Longitudinal follow-up showed stability of the therapeutic effect on sphincter function over a period of 6 months. Intrasphincteric myoblast injections at the lesion borders were equally as effective as intralesion administration, but an injection opposite to the lesion was not. These results provide proof of principle for myoblast cell therapy to treat FI in a rat model. This strategy is currently being evaluated in humans in a randomized double-blind placebo-controlled clinical trial. PMID:24143883

  9. Influence of preoperative (hyperthermic) radiochemotherapy on manometric anal sphincter function in locally advanced rectal cancer

    International Nuclear Information System (INIS)

    Background and purpose: preoperative radiochemotherapy (RCT) followed by curative surgery is a well-accepted therapeutic option in the treatment of advanced rectal cancer. Usually, the anal sphincter is located in the irradiation area of a preoperative RCT regime. The aim of this study is to evaluate the influence of preoperative RCT on anal sphincter function. Patients and methods: between 1994 and 2000, 102 patients with rectal cancer stage uT3/uT4 were analyzed. All patients underwent radiotherapy with 45 Gy (5 x 1.8 Gy) including two cycles of 5-fluorouracil (5-FU)/leucovorin (folinic acid) chemotherapy. 46 patients were treated additionally with up to five sessions of locoregional hyperthermia. The sphincter function was analyzed by perfusion manometry before preoperative therapy and 4 weeks after pretreatment had been finished. For statistics, the Wilcoxon signed rank test and mann-whitney U-test were used (SPSS 9.0 for Windows trademark). Results: the mean value of all 102 patients showed a significant reduction of the mean maximum resting pressure from 97 to 89 mmHg (p = 0.02). For the mean maximal squeeze pressure no significant difference could be shown (178 vs. 176 mmHg). For patients with distal (≤ 7.5 cm from anal verge) tumors the difference was highly significant (92 vs. 79 mmHg). Locoregional hyperthermia had no additional influence on sphincter function. Conclusion: preoperative RCT impairs sphincter function especially in patients with distal tumors. In addition, RCT could have a negative influence on the continence of patients who received sphincter-preserving surgery. (orig.)

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

    OpenAIRE

    Chen, Ji-Hong; Sallam, Hanaa S.; Lin, Lin; Jiande D. Z. Chen

    2010-01-01

    Distention of the proximal colon may have inhibitory or excitatory effects on the rectum and vice versa. The reflexes between the proximal colon and the rectum have not been well studied due to difficulties in accessing the proximal colon. The aim of this study was to investigate the reflex responses and their mechanisms between the proximal colon and the rectum in consideration of distention-related changes in tone and compliance of these regions as well as anal sphincter relaxation in a can...

  11. Novel artificial anal sphincter system based on transcutaneous energy transmission system tested in vivo.

    Science.gov (United States)

    Wang, Yongbing; Liu, Hua; Xu, Qianqian; Yan, Guozheng

    2013-12-01

    This paper proposes a novel artificial anal sphincter system (AASS) for severe fecal incontinence. The AASS is composed of an artificial anal sphincter (AAS), an external transcutaneous energy transmission system (TETS), and an external control device. The AAS is composed of a cuff, a micropump, a reservoir, and a remote control device. It is designed to be implanted into the body of the patient. The function of the AAS is to open and close the patient's natural anus. Patients suffering from loss of their natural sphincter lose rectal sensation and are thus unable to perceive imminent fecal incontinence. In order to restore rectal sensation, a pressure sensor in the AAS cuff is designed to detect pressure in the colon. The pressure reflects the present quantity of colon contents, allowing patients to control the AAS to open or close the anus according to the pressure. The TETS is designed to provide electrical energy to the implanted AAS without wire connections. The external control device is designed to receive the pressure information from the AAS and send the patient's command to the implanted device. This paper provides a thorough discussion of the design of the novel AASS and describes the performance of the AASS when tested in vivo on two Beagle dogs who were chosen to be the subjects for receiving the implant. The experimental results verified that the performance of the AASS met the functional requirements it was designed for; however, the trial also revealed some challenges to be further studied. PMID:24362899

  12. The Danish anal sphincter rupture questionnaire: Validity and reliability

    DEFF Research Database (Denmark)

    Due, Ulla; Ottesen, Marianne

    2008-01-01

    was test-retested among 20 women with ASR. Results. The questionnaire revealed typical problems after ASR. The length, use of language, and the way the questionnaire was constructed, was deemed appropriate. The reliability test showed good to very good correlation (Kappa values from 0.733 to 0.923) in...... problems including sexual problems, impact on quality of life and need for treatment among women 6-8 months after ASR....

  13. High resolution MR imaging of the anal sphincter using an intravaginal surface coil; Hochaufloesende Magnetresonanztomographie des Analsphinkters mit einer intravaginalen Oberflaechenspule

    Energy Technology Data Exchange (ETDEWEB)

    Mueller-Schimpfle, M. [Radiologische Klinik, Abt. fuer Radiologische Diagnostik, Tuebingen Univ. (Germany); Franz, H. [Frauenklinik, Tuebingen Univ. (Germany); Lobinger, B. [Radiologische Klinik, Abt. fuer Radiologische Diagnostik, Tuebingen Univ. (Germany); Claussen, C.D. [Radiologische Klinik, Abt. fuer Radiologische Diagnostik, Tuebingen Univ. (Germany)

    1995-06-01

    MR imaging was performed using a 1.0 T unit. In 10 females (6 nullipara, one primipara without and three primipara with postpartum faecal incontinence) a surface coil, originally designed for endorectal use, was placed into the vagina. Transverse oblique T{sub 1}-weighted spin echo and double echo turbo spin echo sequences with T{sub 2}- and proton density-weighting were acquired parallel to the puborectal, rectococcygeal and anorectal planes. Three readers analysed the images in consensus. The anatomic structures of the external and internal sphincter as well as the mucosa were differentiated in all cases with a good contrast. The best results were yielded by the proton density weighting. In one case of faecal incontinence a sphincter defect after repair of a complete rupture of the anal sphincter was shown. In another case irregularities in the structure of the external sphincter and perineum were visualised. (orig./MG) [Deutsch] Die Magnetresonanztomographie (MRT) wurde an einem 1,0-Tesla-Geraet durchgefuehrt. Bei 10 Frauen (6 Nulliparae, eine Primipara ohne und drei Primiparae mit postpartaler Stuhlinkontinenz) wurde eine Oberflaechenspule, die urspruenglich zur endorektalen Anwendung konzipiert war, intravaginal eingefuehrt. Es wurden T{sub 1}-gewichtete Spin-Echo-Sequenzen sowie Doppel-Echo-Turbo-Spin-Echo-Sequenzen mit T{sub 2}- und Protonendichtegewichtung parallel zur puborektalen, rektokokzygealen und anorektalen Ebene akquiriert. Drei Auswerter analysierten die Aufnahmen im Konsensmodus. Die anatomischen Strukturen des Musculus sphincter ani externus und internus sowie die Mukosa konnten in allen Faellen gut differenziert werden. Das beste Ergebnis wurde mit der Protonendichte-Gewichtung erzielt. In einem Fall von Stuhlinkontinenz zeigte sich ein kombinierter Defekt des M. sphincter ani internus und externus nach Naht eines Dammrisses III. Grades. In einem weiteren Fall waren Irregularitaeten im Perineum und externen Sphinkteranteil darzustellen. (orig./MG)

  14. Relation between electromyography and anal manometry of the external anal sphincter.

    OpenAIRE

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

    1991-01-01

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

  15. The Relationship of 3D Translabial Ultrasound Anal Sphincter Complex Measurements to Postpartum Anal and Fecal Incontinence

    Science.gov (United States)

    MERIWETHER, Kate V.; HALL, Rebecca J.; LEEMAN, Lawrence M.; MIGLIACCIO, Laura; QUALLS, Clifford; ROGERS, Rebecca G.

    2015-01-01

    Objective We aimed to determine whether ASC measurements on translabial ultrasound (TL-US) were related to anal incontinence (AI) or fecal incontinence (FI) symptoms six months postpartum. Methods A prospective cohort of primiparous women underwent TL-US six months after a vaginal birth (VB) or Cesarean delivery (CD). Muscle thickness was measured at 3, 6, 9, and 12 o’clock positions of the external sphincter (EAS), the same four quadrants of the internal sphincter (IAS) at proximal, mid, and distal levels, and at the bilateral pubovisceralis muscle (PVM). Measurements were correlated to AI and FI on the Wexner Fecal Incontinence Scale, with sub-analyses by mode of delivery. The odds ratio (OR) of symptoms was calculated for every one millimeter increase in muscle thickness (E1MIT). Results 423 women (299 VB, 124 CD) had TL-US six months postpartum. Decreased AI risk was associated with thicker measurements at the 6 o’clock (OR 0.74 E1MIT) and 9 o’clock proximal IAS (OR 0.71 E1MIT) in the entire cohort. For CD women, thicker measurements of the 9 o’clock proximal IAS were associated with decreased risk of AI (OR 0.56 E1MIT) and thicker distal 6 o’clock IAS measurements were related to a decreased risk of FI (OR 0.37 E1MIT). For VB women, no sphincter measurements were significantly related to symptoms, but thicker PVM measurements were associated with increased risk of AI (right side OR 1.32 E1MIT; left side OR 1.21 E1MIT). Conclusions ASC anatomy is associated with AI and FI in certain locations; these locations varybased on the patient’s mode of delivery. PMID:26085463

  16. Obstetric anal sphincter injury, risk factors and method of delivery - an 8-year analysis across two tertiary referral centers.

    LENUS (Irish Health Repository)

    Hehir, Mark P

    2013-10-01

    Obstetric anal sphincter injury (OASIS) represents a major cause of maternal morbidity and is a risk factor for the development of fecal incontinence. We set out to analyze the incidence of OASIS and its association with mode of delivery in two large obstetric hospitals across an 8-year study period.

  17. 2D and 3D endoanal and translabial ultrasound measurement variation in normal postpartum measurements of the anal sphincter complex

    Science.gov (United States)

    MERIWETHER, Kate V.; HALL, Rebecca J.; LEEMAN, Lawrence M.; MIGLIACCIO, Laura; QUALLS, Clifford; ROGERS, Rebecca G.

    2015-01-01

    Introduction Women may experience anal sphincter anatomy changes after vaginal or Cesarean delivery. Therefore, accurate and acceptable imaging options to evaluate the anal sphincter complex (ASC) are needed. ASC measurements may differ between translabial (TL-US) and endoanal ultrasound (EA-US) imaging and between 2D and 3D ultrasound. The objective of this analysis was to describe measurement variation between these modalities. Methods Primiparous women underwent 2D and 3D TL-US imaging of the ASC six months after a vaginal birth (VB) or Cesarean delivery (CD). A subset of women also underwent EA-US measurements. Measurements included the internal anal sphincter (IAS) thickness at proximal, mid, and distal levels and the external anal sphincter (EAS) at 3, 6, 9, and 12 o’clock positions as well as bilateral thickness of the pubovisceralis muscle (PVM). Results 433 women presented for US: 423 had TL-US and 64 had both TL-US and EA-US of the ASC. All IAS measurements were significantly thicker on TL-US than EA-US (all p0.20). On both TL-US and EA-US, there were multiple sites where significant asymmetry existed in left versus right measurements. Conclusion The ultrasound modality used to image the ASC introduces small but significant changes in measurements, and the direction of the bias depends on the muscle and location being imaged. PMID:25344221

  18. The molecular basis of the genesis of basal tone in internal anal sphincter.

    Science.gov (United States)

    Zhang, Cheng-Hai; Wang, Pei; Liu, Dong-Hai; Chen, Cai-Ping; Zhao, Wei; Chen, Xin; Chen, Chen; He, Wei-Qi; Qiao, Yan-Ning; Tao, Tao; Sun, Jie; Peng, Ya-Jing; Lu, Ping; Zheng, Kaizhi; Craige, Siobhan M; Lifshitz, Lawrence M; Keaney, John F; Fogarty, Kevin E; ZhuGe, Ronghua; Zhu, Min-Sheng

    2016-01-01

    Smooth muscle sphincters exhibit basal tone and control passage of contents through organs such as the gastrointestinal tract; loss of this tone leads to disorders such as faecal incontinence. However, the molecular mechanisms underlying this tone remain unknown. Here, we show that deletion of myosin light-chain kinases (MLCK) in the smooth muscle cells from internal anal sphincter (IAS-SMCs) abolishes basal tone, impairing defecation. Pharmacological regulation of ryanodine receptors (RyRs), L-type voltage-dependent Ca(2+) channels (VDCCs) or TMEM16A Ca(2+)-activated Cl(-) channels significantly changes global cytosolic Ca(2+) concentration ([Ca(2+)]i) and the tone. TMEM16A deletion in IAS-SMCs abolishes the effects of modulators for TMEM16A or VDCCs on a RyR-mediated rise in global [Ca(2+)]i and impairs the tone and defecation. Hence, MLCK activation in IAS-SMCs caused by a global rise in [Ca(2+)]i via a RyR-TMEM16A-VDCC signalling module sets the basal tone. Targeting this module may lead to new treatments for diseases like faecal incontinence. PMID:27101932

  19. Artificial Anal Sphincter with Sensor Feedback Powered by Transcutaneous Energy Transmission

    Institute of Scientific and Technical Information of China (English)

    LIU Hua; YAN Guo-zheng; ZAN Peng; ZHAO Yu-juan; LUO Nian-ting

    2008-01-01

    This artificial anal sphincter (AAS) is used to help patients who are in severe incontinence. It consists of two parts. The first part is taken outside with patients. The second is implanted in the bodies to provide independent evacuation for patients. It is powered through transcutaneous energy transmission by the first part. There are two sensors in the second part. One sensor measures the pressure in the cuff-clamp around the recta. The other measures the pressure of the recta. As soon as the pressure measured by the later reaches the threshold, a signal is sent out to patients through wireless communication to alarm patients preparing defecation. Patients can give a start signal to begin defecating after they are ready. And they can also give a signal to stop defecating like a healthy person. With the aids of the novel medical device, patients can defecate as a healthy person. The first generation of this AAS is presented.

  20. A comparison of the effectiveness of predictors of caudal block in children-swoosh test, anal sphincter tone, and heart rate response

    Directory of Open Access Journals (Sweden)

    Nandini M Dave

    2012-01-01

    Conclusion: The anal sphincter tone test was the best predictor of successful caudal block. We recommend the use of these additional simple predictors of accurate needle placement to increase the success rate of caudal block especially in teaching hospitals.

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

    Science.gov (United States)

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

    2015-07-01

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

  2. Shape and volume of internal anal sphincter showed by three-dimensional anorectal ultrasonography

    International Nuclear Information System (INIS)

    Purpose: The aim of this work is to characterize the shape and the volume of the internal anal sphincter (IAS) in normal subjects by three-dimensional anorectal ultrasonography. Methods: Thirty-nine normal volunteer males (mean age 58.5 ± 18.7) and 25 females (mean age 59.4 ± 14.1) were submitted to anorectal ultrasonography. The tissue is defined by a semiautomatic procedure. Measurements of thickness, length and volume were assessed automatically. The software provides an average number of 57,600 thickness measurements, 360 length measurements for each zone (90 for each quadrant) and seven volume measurements (one for each anatomical area).The mean values of magnitudes were calculated for the entire volume in each quadrant and zone. Age and gender-related variations were analyzed. Results: In assessments of the whole tissue, only thickness was gender-related, with greater thickness for females (male thickness: 1.81 ± 0.47 mm, female thickness 2.16 ± 0.57 mm, P-value 3 vs 2169 ± 871 mm3, P-value < 0.01 for the volume). In the medial zone, only thickness was gender-related, with greater thickness in females (male thickness: 2.04 ± 0.60 mm, female thickness:2.44 ± 0.74 mm, P-value < 0.02).The only variation observed in the proximal zone concerned length, larger in males (respectively: 11.27 ± 2.84 mm vs 9.55 ± 2.43 mm, P-value < 0.02). The male population was significantly positively correlated with ageing for volume in the whole tissue (ρ = 0.32, P-value < 0.05), and for both thickness and volume in the medial zone (ρ = 0.33, P-value < 0.05 for thickness; ρ = 0.39, P-value < 0.02 for the volume). Conclusion: This new method is useful to understand both functional anal disorders and local damage which may affect only part of the muscle tissue.

  3. Cellular regulation of basal tone in internal anal sphincter smooth muscle by RhoA/ROCK.

    Science.gov (United States)

    Patel, Chirag A; Rattan, Satish

    2007-06-01

    Sustained contractions of smooth muscle cells (SMC) maintain basal tone in the internal anal sphincter (IAS). To examine the molecular bases for the myogenic tone in the IAS, the present studies focused on the role of RhoA/ROCK in the SMC isolated from the IAS vs. the adjoining phasic tissues of the rectal smooth muscle (RSM) and anococcygeus smooth muscle (ASM) of rat. We also compared cellular distribution of RhoA/ROCK, levels of RhoA-GTP, RhoA-Rho guanine nucleotide dissociation inhibitor (GDI) complex formation, levels of p(Thr696)-MYPT1, and SMC relaxation caused by RhoA inhibition. Levels of RhoA/ROCK were higher at the cell membrane in the IAS SMC compared with those from the RSM and ASM. C3 exoenzyme (RhoA inhibitor) and Y 27632 (ROCK inhibitor) caused a concentration-dependent relaxation of the IAS SMC. In addition, active ROCK-II (primary isoform of ROCK in SMC) caused further shortening in the IAS SMC. C3 exoenzyme increased RhoA-RhoGDI binding and reduced the levels of RhoA-GTP and p(Thr696)-MYPT1. ROCK inhibitor attenuated PKC-induced contractions in IAS SMC. Conversely, a PKC inhibitor (Gö 6850, which causes partial relaxation of the SMC) had no significant effect on ROCK-II-induced contractions. Further experiments showed the highest levels of RhoA, active form of RhoA (RhoA-GTP), ROCK-II, 20-kDa myosin regulatory light chain (MLC(20)), phospho-MYPT1, and phospho-MLC(20) in the IAS vs. RSM and ASM SMC. However, the trend was the reverse with the levels of inactive RhoA (GDP-RhoA-RhoGDI complex) and MYPT1. We conclude that RhoA/ROCK play a critical role in maintenance of spontaneous tone in the IAS SMC via inhibition of myosin light chain phosphatase. PMID:17379756

  4. Comparison of surface and saddle endoanal coil to evaluate anal sphincter in infants and young childern: experimental study using phantom and cats

    International Nuclear Information System (INIS)

    We designed an inside-out-type endoanal surface and saddle coil to evaluate the anal sphincter of young children who have difficulty in controlling defecation after the correction of anorectal malformation, and compared two coils using an imaging phantom and cats. Using two coils, T1-and T2- weighted axial and coronal images of the phantom and of the anorectal region of cats were obtained, and the results were compared in terms of changes in signal intensity and SNR according to the distance from the coil's surface. We also compared the capability of the coils to delineate the internal and external anal sphincter of cat anorectum, both of which are important in the control of defection. The saddle coil was slightly superior to the surface coil in terms of SNR, but inferior in terms of the signal intensity of the region of interest of the cat's anorectum. Moreover, artifacts of low signal intensity appeared in an azimuthal direction on axial images acquired using the saddle coil and prohibited delineation of the whole of the anal sphincter. In terms of image quality, the surface coil was therefore superior to the saddle coil. Our findings suggest that among inside-out-type endoanal coils, the surface coil may be superior to the saddle coil in MR imaging to evaluate the anal sphincter of young children

  5. Management and operative strategy for Currarino syndrome associated with thickening of the internal anal sphincter, megarectum and presacral tumor: A case report and literature reviews

    Directory of Open Access Journals (Sweden)

    Yukihiro Tatekawa

    2016-04-01

    Full Text Available Currarino syndrome is characterized by anorectal malformation, a presacral tumor and sacral malformation. A funnel-shaped anal stenosis causes chronic constipation resulting in the development of megarectum and requires surgical intervention. We present a three-year-old girl with Currarino syndrome consisting of a presacral tumor, anal stenosis and megarectum associated with the thickening of the internal anal sphincter. After transverse loop colostomy, excision of the presacral tumor was performed via a posterior sagittal approach and posterior anoplasty with sphincterotomy was done for the anal stenosis. After discharge, anastomotic stenosis in the anal ring remained and anal dilatation, along with closure of colostomy, was performed with an extended skin graft method. Five months postoperatively, there had not been any recurrence of her tumor and she felt the desire to defecate and smoothly defecated with a laxative.

  6. Tissue-Engineered External Anal Sphincter Using Autologous Myogenic Satellite Cells and Extracellular Matrix: Functional and Histological Studies.

    Science.gov (United States)

    Kajbafzadeh, Abdol-Mohammad; Kajbafzadeh, Majid; Sabetkish, Shabnam; Sabetkish, Nastaran; Tavangar, Seyyed Mohammad

    2016-05-01

    The aim of the present study was to demonstrate the regaining histological characteristics of bioengineered external anal sphincters (EAS) in rabbit fecal incontinence model. The EAS of 16 rabbits were resected and decellularized. The decellularized scaffolds were transplanted to the terminal rectum following a period of 6 months of fecal incontinency (5 days after sterilization). The rabbits were divided into two groups: in group 1 (n = 8), myogenic satellite cells were injected into the transplanted sphincters. In group 2 (n = 8), the transplanted scaffolds remained in situ without cellular injection. The histological evaluation was performed with desmin, myosin, smooth muscle actin, CD31, and CD34 at 3-month intervals. The rabbits were followed for 2 years. Electromyography (EMG) with needle and electrical stimulation, pudendal and muscle electrical stimulation were also performed after 2 years of transplantation. At the time of biopsy, no evidence of inflammation or rejection was observed and the transplanted EAS appeared histologically and anatomically normal. The immunohistochemistry staining validated that the histological features of EAS was more satisfactory in group 1 in short-term follow-up. However, no statistically significant difference was detected between two groups in long-term follow-ups (p value > 0.05). In both groups, grafted EAS contracted in response to electrical signals delivered to the muscle and the pudendal nerve. However, more signals were detected in group 1 in EMG evaluation. In conclusion, bioengineered EAS with myogenic satellite cells can gain more satisfactory histological outcomes in short-term follow-ups with better muscle electrical stimulation outcomes. PMID:26424474

  7. A comparison of the effectiveness of predictors of caudal block in children—swoosh test, anal sphincter tone, and heart rate response

    OpenAIRE

    Nandini M Dave; Madhu Garasia

    2012-01-01

    Objective: To study the effectiveness of three predictors of successful caudal block in children, viz. swoosh test, heart rate response to injection, and laxity of anal sphincter tone. Aim: To improve the success rates of caudal block in children by identifying the best predictor. Background: Caudal blocks in children are placed after induction of anesthesia. Although simple to learn and perform, the success rate of the blocks may be variable especially in teaching hospitals where tra...

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

    OpenAIRE

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

    2013-01-01

    Objective To re-evaluate previously published findings from an uncontrolled before–after evaluation of an intervention programme to reduce the incidence of anal sphincter tears. A key component of the programme was the use of a hands-on technique where the birth attendant presses the neonate's head during the final stage of delivery while simultaneously supporting the woman's perineum with the other hand. Design Interrupted time-series analysis using segmented regression modelling. Setting Ob...

  9. Galectin-1-induced skeletal muscle cell differentiation of mesenchymal stem cells seeded on an acellular dermal matrix improves injured anal sphincter.

    Science.gov (United States)

    Ding, Zhao; Liu, Xiangui; Ren, Xianghai; Zhang, Qiulei; Zhang, Tingtao; Qian, Qun; Liu, Weicheng; Jiang, Congqing

    2016-05-01

    According to recent studies, mesenchymal stromal cells (MSCs) transplanted via local or tail vein injection can improve healing after anal sphincter injury (ASI) in animal models. However, the transplanted MSCs do not generate skeletal muscle that completely resembles the natural anal sphincter structure. In the present study, we investigated whether bone marrow (BM)-derived MSCs could be induced by Galectin-1 (Gal-1) to differentiate into skeletal muscle and whether the recellularization of an acellular dermal matrix (ADM) with skeletal muscle-differentiated MSCs represents a promising approach to restore ASI in a rat model. BM-MSCs subjected to adenovirus-mediated transfection with Gal-1-GFP (Ad-GFP-Gal-1) displayed increased Gal-1 and desmin expression and differentiated into skeletal muscle cells. MSCs transfected with Ad-GFP-Gal-1 (MSC-Gal-1) were seeded onto an ADM (ADM-MSC-Gal-1) via co-culture, and fusion was observed using a confocal laser scanning microscope. ADM-MSC-Gal-1, ADM-MSC, ADM-MSC-Ad, ADM, or a saline control was applied to a rat ASI model, and injury healing was evaluated via histological examination 6 weeks following treatment. ADM-MSC-Gal-1 treatment promoted significant healing after ASI and improved external anal sphincter contraction curves compared with the other treatments and also led to substantial skeletal muscle regeneration and neovascularization. Our results indicate that repair using ADMs and differentiated MSCs may improve muscle regeneration and restore ASI. PMID:27355329

  10. A comparison of the effectiveness of predictors of caudal block in children—swoosh test, anal sphincter tone, and heart rate response

    Science.gov (United States)

    Dave, Nandini M; Garasia, Madhu

    2012-01-01

    Objective: To study the effectiveness of three predictors of successful caudal block in children, viz. swoosh test, heart rate response to injection, and laxity of anal sphincter tone. Aim: To improve the success rates of caudal block in children by identifying the best predictor. Background: Caudal blocks in children are placed after induction of anesthesia. Although simple to learn and perform, the success rate of the blocks may be variable especially in teaching hospitals where trainee anesthetists perform these blocks. Materials and Methods: 223 patients, aged 2–12 years, undergoing lower abdominal and urologic surgery were studied. 0.25% Bupivacaine was administered after induction of general anesthesia according to the Armitage regimen. Results: The sensitivity and specificity were highest with the sphincter tone test (sensitivity 95.22%, specificity 92.86%), followed by the heart rate response (sensitivity 92.82%, specificity 78.57%) and the swoosh test (sensitivity 66.51%, specificity 35.71%). The anal sphincter tone test had the highest positive predictive value (99.5%) and positive likelihood ratio (13.33). The heart rate response had a positive predictive value of 98.48% and a positive likelihood ratio of 4.33. The swoosh test, in our study, had a positive predictive value of 93.92% and a positive likelihood ratio of 1.035. Conclusion: The anal sphincter tone test was the best predictor of successful caudal block. We recommend the use of these additional simple predictors of accurate needle placement to increase the success rate of caudal block especially in teaching hospitals. PMID:22345939

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

    Science.gov (United States)

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

    2009-08-01

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

  12. Long-term effects of neoadjuvant chemoradiotherapy followed by sphincter-preserving resection on anal sphincter function in relation to quality of life among locally advanced rectal cancer patients: a cross-sectional analysis

    International Nuclear Information System (INIS)

    There is growing recognition for the consequences of rectal cancer treatment to maintain an adequate functional sphincter in the long-term rather than preserving the anal sphincter itself. This study aims to evaluate long-term effects of neoadjuvant chemoradiotherapy (nCRT) followed by sphincter-preserving resection on anal sphincter function in relation to quality of life (QoL) among locally advanced rectal cancer patients. Twenty-nine patients treated with nCRT followed by low anterior resection surgery were included in this study. Data on patient demographics, tumor location and symptoms of urgency and fecal soiling were recorded and evaluated with respect to Wexner Fecal Incontinence Scoring Scale, European Organization for Research and Cancer (EORTC) cancer-specific (EORTC QLQ-C30) and colorectal cancer-specific (EORTC QLQ-CR38) questionnaires and anorectal manometrical findings. Correlation of manometrical findings with Wexner Scale, EORTC QLQ-CR38 scores and EORTC QLQ-C30 scores was also evaluated. Median follow-up was 45.6 months (ranged 7.5–98 months. Higher scores for incontinence for gas (p = 0.001), liquid (p = 0.048) and solid (p = 0.019) stool, need to wear pad (p = 0.001) and alteration in life style (p = 0.004) in Wexner scale, while lower scores for future perspective (p = 0.010) and higher scores for defecation problems (p = 0.001) in EORTC QLQ-CR38 were noted in patients with than without urgency. Manometrical findings of resting pressure (mmHg) was positively correlated with body image (r = 0.435, p = 0.030) and sexual functioning (r = 0.479, p = 0.011) items of functional scale, while rectal sensory threshold (RST) volume (mL) was positively correlated with defecation problems (r = 0.424, p = 0.031) items of symptom scale in EORTC QLQ-CR38 and negatively correlated with social function domain (r = −0.479, p = 0.024) in EORTC QLQ-C30. RST volume was also positively correlated with Wexner scores including incontinence for liquid stool (r = 0

  13. Incidence and Risk Factors of Obstetric Anal Sphincter Injuries after Various Modes of Vaginal Deliveries in Chinese Women

    Institute of Scientific and Technical Information of China (English)

    Tung Chi Wai; Cheon Willy Cecilia; Tong Wai Mei Anny; Leung Hau Yee

    2015-01-01

    Background:Obstetric anal sphincter injuries (OASIS) can cause an adverse impact on women's physical and mental health.There was lack of published data in Chinese population particularly on studying the risk of OASIS for nonrotational outlet forceps.This study was to determine the incidence and risk factors of OASIS.Methods:This is a retrospective cohort study carried out in a tertiary referral hospital in Hong Kong.The control group was selected randomly.Univariate and multivariate logistic regression analysis was performed to evaluate the influence of potential risk factors on OASIS.This study reviewed the obstetric records of OASIS women and random control from January 2011 to June 2014.Univariate and multivariate logistic regression analysis was performed to evaluate the influence of potential risk factors on OASIS.Results:Of 15,446 women delivered,49 had OASIS.The percentage of OASIS increased from 0.3% (2011) to 0.38% (2014).There was an increasing trend of OASIS in attempted spontaneous vaginal delivery without episiotomy (P < 0.01),but it did not increase the OASIS risk (P =0.46).Univariate analysis of 49 cases and 438 control subjects showed that forceps delivery (odds ratio [OR] =8.73,P < 0.01),prolong second stage of labor (OR =1.43,P < 0.01) increased the risk for OASIS.In multivariate regression models,only forceps delivery (OR =6.28,P < 0.01) proved to be independent risk factor.Conclusions:The incidence of OASIS in Chinese women was increased after 2012,but still lower than the reported figures in the literature.Outlet forceps delivery could be a possible associated risk factor.

  14. Comparison of the main body of the external anal sphincter muscle cross-sectional area between women with and without prolapse

    OpenAIRE

    Hsu, Yvonne; HUEBNER, Markus; Chen, Luyun; Fenner, Dee E.; DeLANCEY, John O.L.

    2007-01-01

    The aim of the study was to compare the main body of the external anal sphincter (EAS) cross-sectional area (CSA) of women with and without pelvic organ prolapse. Pelvic magnetic resonance imaging (MRI) scans of 40 women were selected for analysis. Of these women, 20 had pelvic organ prolapse and 20 had normal support. Of the women with normal support, 10 had known major levator ani (LA) muscle defects and 10 had normal LA muscles. The same was true for the women with pelvic prolapse: half ha...

  15. A comparative study of various electrodes in electromyography of the striated urethral and anal sphincter in children

    DEFF Research Database (Denmark)

    Nielsen, K K; Kristensen, E S; Qvist, N; Jensen, K M; Dalsgård, J; Krarup, T; Pedersen, D

    1985-01-01

    The series comprised 41 children aged 6 to 14 years consecutively referred with recurrent urinary tract infection and/or enuresis. Carbon dioxide cystometry was carried out in the supine and the erect position and combined with simultaneous electromyography (EMG). The external urethral sphincter...

  16. Anal acoustic reflectometry

    DEFF Research Database (Denmark)

    Mitchell, Peter J; Klarskov, Niels; Telford, Karen J; Hosker, Gordon L; Lose, Gunnar; Kiff, Edward S

    2011-01-01

    Anal acoustic reflectometry is a new technique of assessing anal sphincter function. Five new variables reflecting anal canal function are measured: the opening and closing pressure, the opening and closing elastance, and hysteresis.......Anal acoustic reflectometry is a new technique of assessing anal sphincter function. Five new variables reflecting anal canal function are measured: the opening and closing pressure, the opening and closing elastance, and hysteresis....

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

    International Nuclear Information System (INIS)

    Purpose: To assess the outcome of a multi-institutional, national cooperative group study attempting functional preservation of the anorectum for patients with limited, distal rectal cancer. Methods and Materials: Between September 21, 1989 and November 1, 1992, a Phase II trial of sphincter-sparing therapy was conducted for patients with clinically mobile rectal cancers located below the pelvic peritoneal reflection. Protocol treatment was designed for patients who were, in the judgement of their attending surgeon, unsuitable for anal sphincter conservation in the context of anterior resection, and would have required abdominoperineal resection (APR) as conventional surgical therapy. Primary cancers were estimated to be 4 cm or less in largest clinical diameter, and occupied 40% or less of the rectal circumference. Chest radiography and computerized axial tomography (CT) of the abdomen and pelvis excluded patients with overt lymphatic or hematogenous metastases. Protocol surgery was intended to remove the primary cancer by en-bloc, transmural excision of an ellipse of rectal wall by transanal, transcoccygeal, or trans-sacral technique, while conserving the anal sphincter. Based on tumor size, T classification, grade, and adequacy of surgical margins, patients were allocated to one of three treatment assignments: observation, or adjuvant treatment with 5-fluorouracil (5-FU) and one of two different dose levels of local-regional radiation. After completion of protocol therapy, patients were observed with follow-up that included periodic general physical and rectal examination, determinations of CEA, abdominopelvic CT, chest radiography, and surveillance endoscopy. Sixty-five eligible and analyzable patients were registered. Results: With minimum follow-up of 5 years and median follow-up of 6.1 years, 11 patients have failed: 3 patients recurred local-regionally only, 3 patients had distant failure alone, and 5 patients manifested local-regional and distant failure

  18. Tobacco smoking and long-lasting symptoms from the bowel and the anal-sphincter region after radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Background and purpose: Tobacco smoking can cause vascular injury, tissue hypoxia and fibrosis as can ionizing radiation. However, we do not know if tobacco smoking increases the risk of long-term side effects after radiotherapy for prostate cancer. Methods: We identified 985 men treated with radiotherapy for prostate cancer between 1993 and 2006. In 2008, long-lasting symptoms appearing after radiotherapy for prostate cancer were assessed through a study-specific questionnaire as were smoking habits and demographic factors of all these men. In the questionnaire the prostate-cancer survivors were asked to report symptom occurrence the previous six months. Results: We obtained information on tobacco smoking from 836 of the 985 prostate-cancer survivors with a median time to follow-up of six years (range 2–14 years). The prevalence ratio of defecation urgency among current smokers compared to never smokers was 1.6 (95% CI 1.2–2.2). Corresponding prevalence ratio for diarrhea was 2.8 (95% CI 1.2–6.5), the sensation of bowel not completely emptied after defecation 2.1 (95% CI 1.3–3.3) and for sudden emptying of all stools into clothing without forewarning 4.7 (95% CI 2.3–9.7). Conclusion: Tobacco smoking among prostate-cancer survivors treated with radiotherapy increases the risk of certain long-lasting symptoms from the bowel and anal-sphincter region.

  19. Influence of Location of Stoma on the Recovery of Anal Function in the Low Rectal Cancer Patients Treated with Anal Sphincter Preservation%吻合口位置对低位直肠癌患者保肛术后肛门功能恢复的影响

    Institute of Scientific and Technical Information of China (English)

    邓海权

    2014-01-01

    目的:探讨吻合口位置对低位直肠癌患者保肛术后肛门功能恢复的影响。方法选择120例低位直肠癌保肛手术患者为研究对象。根据吻合口位置距肛缘的距离将患者分为3组:A组距离≤3.0 cm,B组距离>3.0~5.0 cm,C组距离>5.0 cm。选择60例非直肠癌患者为对照组,比较各组患者术后肛门功能的改变。结果肛管缩榨压、平均静息压及最大静息压,术后3个月A组、B组及C组均显著低于术前(P<0.05);但术后6个月比术后3个月显著提高(P<0.05);术后1年B组及C组各项指标接近术前(P>0.05),但A组平均静息压及最大静息压仍显著低于术前(P<0.05)。术后3个月、6个月及1年A组、B组及C组Wexner评分逐渐降低(P<0.05),且组间差异有统计学意义(P<0.05)。A组、B组及C组吻合口瘘发生率依次降低(P<0.05)。结论低位直肠癌患者保肛术吻合口位置与患者术后肛门功能恢复关系密切,肛缘距离吻合口位置超过5 cm者术后肛门功能恢复最为理想。%Objective To explore the influence of location of stoma on the recovery of anal function in the low rectal cancer patients treated with anal sphincter preservation .Methods 120 low rectal cancer patients who received anal sphincter preservation were selected as the research subjects .The patients were divided into 3 groups according to location of stoma ,the dis-tance from stoma location to anal edge:group A:the distance ≤3.0 cm,group B:3.0cm5.0 cm.60 patients without rectal cancer was the control group .The changes of postoperative anal function were compared a-mong the groups .Results The maximal squeezing pressure of anus , resting anal pressures and the maximal anal pressure 3 months after operation in group A ,B and C all dropped significantly (P0.05),but the resting anal pressures and the maximal anal pressure in group A were much lower than before

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

    Science.gov (United States)

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

    1991-02-01

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

  1. Rupture

    CERN Multimedia

    Association du personnel

    2006-01-01

    Our Director-General is indifferent to the tradition of concertation foreseen in our statutes and is "culturally" unable to associate the Staff Association with problem-solving in staff matters. He drags his heels as long as possible before entering into negotiations, presents "often misleading" solutions at the last minute which he only accepts to change once a power struggle has been established. Faced with this rupture and despite its commitment to concertation between gentlemen. The results of the poll in which the staff is invited to participate this week. We therefore need your support to state our claims to the Governing Bodies. The Staff Association proposes a new medium of communication and thus hopes to show that it is ready for future negotiations. The pages devoted to the Staff Association are presented in a more informative, reactive and factual manner and in line with the evolution of the social situation at CERN. We want to establish strong and continuous ties between the members of CERN and ou...

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

    OpenAIRE

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

    2005-01-01

    Background: External anal sphincter (EAS) electromyography (EMG) abnormalities can distinguish multiple system atrophy (MSA) from Parkinson's disease in the first five years after disease onset. However, the prevalence of the abnormalities in the early stages of MSA is unknown.

  3. Quantificação da função esfincteriana pela medida da capacidade de sustentação da pressão de contração voluntária do canal anal Sphincteric function quantification by measuring the capacity to sustain the squeeze pressure of the anal canal

    Directory of Open Access Journals (Sweden)

    Luiz Henrique Cury Saad

    2002-10-01

    (78% para incontinência fecal. Embora a pressão máxima de contração voluntária não indique falso-positivos, apresenta 72% de falso-negativos. A probabilidade deste fato acontecer com a medida de capacidade de sustentação da pressão de contração voluntária é, praticamente, 20% menor, valor estatisticamente significativo. CONCLUSÃO: O indicativo de função esfincteriana é melhor analisado pela capacidade de sustentação. A capacidade de sustentação traduz com mais exatidão, a capacidade funcional do canal anal em relação à continência voluntária, sendo isoladamente, melhor que a pressão máxima de contração voluntária.BACKGROUND: It has been demonstrated that the maximum squeeze pressure and the mean resting pressure do not reflect the true clinical situation of patients having fecal incontinence, as well as the functional status of the anal canal. Furthermore, a wrong diagnosis could be obtained and therefore misleading to a not effective treatment. AIM: Under the hypothesis that squeezing and sustaining the anal canal contraction is more important than the maximum squeeze pressure, the capacity to sustain the squeeze pressure of the anal canal was analyzed aiming to quantify the sphincteric function. METHODS: Seventy-two patients having fecal incontinence in different degrees (56 female and 15 normal individuals (9 female were submitted to anorectal manometry to measure the mean resting pressure, the maximum voluntary squeeze pressure and the capacity to sustain the squeeze pressure. RESULTS: Normal individuals had normal values of mean resting pressure and maximum squeeze pressure, and adequate capacity to sustain the squeeze pressure of the canal anal. Incontinent patients had mean resting pressure and maximum squeeze pressure with normal or below normal pressoric values and similar profile of capacity to sustain which was moderate in the initial phase and worse in the intermediate and final phases, with decreasing of the capacity to

  4. Modern management of anal fistula.

    Science.gov (United States)

    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

  5. Study of Operated Patients of Lateral Internal Anal Sphincterotomy for Chronic Anal Fissure

    OpenAIRE

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

    2013-01-01

    Introduction: Anal fissure causes significant morbidity in the population. It is proposed that elevated sphincter pressures may cause ischaemia of the anal lining and this may be responsible for the pain of anal fissures and their failure to heal. When pharmacologic therapy fails or fissures recur frequently, lateral internal sphincterotomy is the surgical treatment of choice.

  6. An Unusual Perineal Swelling: A Cyst Between the Sphincters

    Directory of Open Access Journals (Sweden)

    ES Lake

    2010-11-01

    Full Text Available Epidermal cysts are very common lesions. Here we present the unusual case of an epidermal cyst occurring between the anal sphincters, presenting as a lump in the perineum. This was successfully excised with careful dissection of the intersphincteric plane. To our knowledge this is the only case of its kind reported in the literature.

  7. Anal incontinence: diagnosis by endoanal US or endovaginal MRI

    International Nuclear Information System (INIS)

    Preoperative evaluation was made of the diagnostic value of endoanal ultrasound (EAUS) and endovaginal magnetic resonance imaging (EVMRI) in diagnosing anal sphincter defects as the cause of anal incontinence. Nineteen female individuals with anal incontinence were examined clinically with EAUS and with EVMRI at 1.5 T using a prostatic coil. The findings were evaluated independently and compared with findings at surgery. In diagnosing external anal sphincter defects, EAUS and EVMRI showed almost similar agreement with surgical findings, 12 (63%) out of 19 vs 11 (58%), respectively. Internal anal sphincter defects were equally detected by EAUS and EVMRI as compared with surgical diagnosis. There was considerable variation between radiologists in diagnosing defects by EVMRI. EAUS and EVMRI are equal in diagnosing anal sphincter defects. (orig.)

  8. Electrophysiological observations on the human pudendo-anal reflex.

    OpenAIRE

    Varma, J S; Smith, A N; McInnes, A

    1986-01-01

    A reproducible electrophysiological technique is described to determine the latency of reflex contraction of the external anal sphincter in response to stimulation of the dorsal genital nerve: the pudendo-anal reflex. This was studied in 38 asymptomatic control subjects and 20 women with neurogenic faecal incontinence, supplemented by determination of the mean motor unit potential duration (MUPD) of the external anal sphincter and anorectal manometry. The reflex latency in the control group w...

  9. Inflatable artificial sphincter - series (image)

    Science.gov (United States)

    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 ...

  10. Relation between rectal sensation and anal function in normal subjects and patients with faecal incontinence.

    OpenAIRE

    Sun, W M; Read, N W; Miner, P B

    1990-01-01

    The relation between sensory perception of rapid balloon distension of the rectum and the motor responses of the rectum and external and internal anal sphincters in 27 normal subjects and 16 patients with faecal incontinence who had impaired rectal sensation but normal sphincter pressures was studied. In both patients and normal subjects, the onset and duration of rectal sensation correlated closely with the external anal sphincter electrical activity (r = 0.8, p less than 0.0001) and with re...

  11. Anal endosonographic findings in women after vaginal delivery

    Energy Technology Data Exchange (ETDEWEB)

    Kolodziejczak, Malgorzata [Department of Proctology, Hospital at Solec, Warsaw (Poland); Sudol-Szopinska, Iwona, E-mail: iwsud@ciop.pl [Department of Proctology, Hospital at Solec, Warsaw (Poland); Department of Diagnostic Imaging, Second Faculty of Warsaw Medical University, Warsaw (Poland); Stefanski, Robert [Department of Proctology, Hospital at Solec, Warsaw (Poland); Department of Diagnostic Imaging, Second Faculty of Warsaw Medical University, Warsaw (Poland); Panorska, Anna K. [Department of Mathematics and Statistics, University of Nevada, Reno (United States); Gardyszewska, Agnieszka [Second Clinic of Obstetrics and Gynecology, Warsaw (Poland); Krasnodebski, Ireneusz [Department of General and Gastroenterological Surgery and Nutrition, Medical University, Warsaw (Poland)

    2011-04-15

    Objective: To estimate a frequency of obstetric anal sphincters defects in women after vaginal delivery. Methods: The study included 102 women, aged from 16 to 40 years (mean age 28.6 years). 28 women had perineal lacerations of 3rd and 4th degree. 22 women had instrumental delivery. Anal endosonography was performed on all participants using BK Medical scanner Pro focus with a 3D endoprobe during the first week after delivery. Starck's classification was used to score sphincters defects. Results: The endosonographic images were abnormal in 8 out of 102 women (7.8%). Follow-up examinations after 6 weeks confirmed defects in 6 out of 102 women (5.8%). Five women had external anal sphincter torn, and 1 woman had both sphincters, internal and external, defected. Discordance between endosonographic diagnosis of defect and clinical assessment of sphincters continuity was demonstrated in 6 (5.9%) out of 8 initially found, including 2 (1.9%) false endosonographic results and 4 (3.9%) false clinical diagnosis (occult sphincter defects). The endosonography sensitivity and accuracy in sphincter defect diagnostic amounted to 100% and 98%, respectively. Conclusions: (1) Anal sphincters' tears in symptomatic women are not as frequent as it was believed. (2) The defect diagnosis in the first week after delivery should be verified by a follow-up endosonography in 6 weeks, after regression of the edema and hematoma.

  12. Anal endosonographic findings in women after vaginal delivery

    International Nuclear Information System (INIS)

    Objective: To estimate a frequency of obstetric anal sphincters defects in women after vaginal delivery. Methods: The study included 102 women, aged from 16 to 40 years (mean age 28.6 years). 28 women had perineal lacerations of 3rd and 4th degree. 22 women had instrumental delivery. Anal endosonography was performed on all participants using BK Medical scanner Pro focus with a 3D endoprobe during the first week after delivery. Starck's classification was used to score sphincters defects. Results: The endosonographic images were abnormal in 8 out of 102 women (7.8%). Follow-up examinations after 6 weeks confirmed defects in 6 out of 102 women (5.8%). Five women had external anal sphincter torn, and 1 woman had both sphincters, internal and external, defected. Discordance between endosonographic diagnosis of defect and clinical assessment of sphincters continuity was demonstrated in 6 (5.9%) out of 8 initially found, including 2 (1.9%) false endosonographic results and 4 (3.9%) false clinical diagnosis (occult sphincter defects). The endosonography sensitivity and accuracy in sphincter defect diagnostic amounted to 100% and 98%, respectively. Conclusions: (1) Anal sphincters' tears in symptomatic women are not as frequent as it was believed. (2) The defect diagnosis in the first week after delivery should be verified by a follow-up endosonography in 6 weeks, after regression of the edema and hematoma.

  13. [The anal incontinence-- study on 20 operated cases].

    Science.gov (United States)

    Iusuf, T; Sârbu, V; Grasa, C; Cristache, C; Botea, F

    2001-01-01

    The authors present 20 cases operated for anal incontinence. Two techniques were performed: direct repair (18 cases) and Musset-Cottrell procedure (2 cases). The results were excellent in 12 cases, good in 5 cases and satisfactory in 3 cases. The method of choice seems to be the direct repair of the anal sphincter after a proper local and general preparation. PMID:12731180

  14. Cause-Specific Colostomy Rates After Radiotherapy for Anal Cancer: A Danish Multicentre Cohort Study

    DEFF Research Database (Denmark)

    Sunesen, Kåre G; Nørgaard, Mette; Lundby, Lilli;

    2011-01-01

    In anal cancer, colostomy-free survival is a measure of anal sphincter preservation after treatment with radiotherapy or chemoradiotherapy. Failure to control anal cancer and complications of treatment are alternative indications for colostomy. However, no data exist on cause-specific colostomy...

  15. Hypertrophied anal papillae and fibrous anal polyps, should they be removed during anal fissure surgery?

    Institute of Scientific and Technical Information of China (English)

    Pravin J. Gupta

    2004-01-01

    AIM: Hypertrophied anal papillae and fibrous anal polyps are not given due importance in the proctology practice.They are mostly ignored being considered as normal structures. The present study was aimed to demonstrate that hypertrophied anal papillae and fibrous anal polyps could cause symptoms to the patients and that they should be removed in treatment of patients with chronic fissure in anus.METHODS: Two groups of patients were studied. A hundred patients were studied in group A in which the associated fibrous polyp or papillae were removed by radio frequency surgical device after a lateral subcutaneous sphincterotomy for relieving the sphincter spasm. Another group of a hundred patients who also had papillae or fibrous polyps, were treated by lateral sphincterotomy alone. They were followed up for one year.RESULTS: Eighty-nine percent patients from group A expressed their satisfaction with the treatment in comparison to only 64% from group B who underwent sphincterotomy alone with the papillae or anal polyps left untreated. Group A patients showed a marked reduction with regard to pain and irritation during defecation (P= 0.0011),pricking or foreign body sensation in the anus (P = 0.0006)and pruritus or wetness around the anal verge (P = 0.0008).CONCLUSION: Hypertrophied anal papillae and fibrous anal polyps should be removed during treatment of chronic anal fissure. This would add to effectiveness and completeness of the procedure.

  16. Conservative management of anal leiomyosarcoma

    International Nuclear Information System (INIS)

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

  17. Smooth muscle enfoldment internal sphincter construction after intersphincteric resection for rectal cancer.

    Directory of Open Access Journals (Sweden)

    Heiying Jin

    Full Text Available To assess smooth muscle enfoldment and internal sphincter construction (SMESC for improvement of continence after intersphincteric resection (ISR for rectal cancer.Twenty-four Bama miniature pigs were randomly divided into a conventional ISR group and experimental SMESC group, with 12 pigs in each group. The proximal sigmoid colon was anastomosed directly to the anus in the ISR group. In the SMESC group, internal sphincter construction was performed. At 12 weeks before and after surgery, rectal resting pressure and anal canal length were assessed. Three-dimensional ultrasound was used to determine the thickness of the internal sphincter. After the animals were sacrificed, the rectum and anus were resected and pathological examinations were performed to evaluate the differences in sphincter thickness and muscle fibers.All 24 animals in the SMESC group and the ISR group survived the surgery. Twelve weeks post-surgery, the rectal resting pressure, length of the anal high-pressure zone and the postoperative internal sphincter thickness for the ISR group were significantly lower than for the SMESC group. There was a thickened area (about 2 cm above the anastomotic stoma among animals from the SMESC group; in addition, the smooth muscles were significantly enlarged and enfolded when compared to the ISR group.This animal model study shows that the SMESC procedure achieved acceptable reconstruction of the internal anal neo-sphincter (IAN/S, without increasing surgical risk. However, the findings in this experimental animal model must be confirmed by clinical trials to determine the safety and efficacy of this procedure in clinical practice.

  18. Anal Warts

    Science.gov (United States)

    ... or mass in the anal area. WHAT CAUSES ANAL WARTS? They are caused by the human papilloma virus (HPV), which is transmitted from person to person by direct contact. HPV is considered a sexually transmitted disease (STD). You do not have to have anal intercourse to develop anal warts. DO ANAL WARTS ...

  19. Muscular urinary sphincter : electrically stimulated myoplasty for functional sphincter reconstruction

    NARCIS (Netherlands)

    Palacio, M M; Van Aalst, V C; Perez Abadia, G A; Stremel, R W; Werker, P M; Ren, X; Petty, G D; Heilman, S J; Van Savage, J G; Garcia Fernandez, A; Kon, M; Tobin, G R; Barker, J H

    1998-01-01

    PURPOSE: To reconstruct an electrically stimulated muscular urinary sphincter (MUS) using a tailored gracilis muscle free flap with intact nerve. MATERIALS AND METHODS: Unilateral surgically tailored gracilis muscle free flaps were transferred into the pelvis in eight dogs, leaving the obturator ner

  20. Anal cancer

    Science.gov (United States)

    Cancer - anus; Squamous cell carcinoma - anal; HPV - anal cancer ... is unclear. However, there is a link between anal cancer and the human papillomavirus or HPV infection. HPV is a sexually transmitted virus that ...

  1. Defining sphincter of oddi dysfunction

    DEFF Research Database (Denmark)

    Funch-Jensen, P

    1996-01-01

    Sphincter of Oddi (SO) dysmotility may give rise to pain. The golden standard for the demonstration of SO dysfunction is endoscopic manometry. A number of abnormalities are observed in patients with postcholecystectomy pain and in patients with idiopathic recurrent pancreatitis. Criteria for defi...

  2. ANAL FISSURE REVISITED : A SYSTEMATIC REVIEW

    Directory of Open Access Journals (Sweden)

    Manju

    2015-07-01

    Full Text Available 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. There are many options to treat chronic fissures in ano. Some of them are non - surgical while the others are su rgical. The efficacy claimed by each of the prevalent method is very high but the inconsistencies and contraindications are equally strong. To date, lateral sphincterotomy has been favoured by most of the proctologists, because it is the least extensive su rgical procedure and is offering a long lasting relief in sphincter spasm. Various management technique are reviewed in this article along with Advancement flap for anterior fissure and a new method combining the age - old technique of Lord's manual dilatati on followed by radio surgery is also highlighted along with their complications. The addition of radio surgery is found useful for refreshing the edges of the fissure and to tackle pathologies namely sentinel pile, small internal piles or hypertrophied ana l papillae often found associated with chronic fissures. Revisiting the trends of treatment of chronic anal fissures, the most preferred options are the manual dilatation with radio surgery and the subcutaneous lateral anal sphincterotomy. Both methods are easy to perform, have negligible complications and no special setup is needed, except the radio surgical unit, in case of the first procedure.

  3. The upper esophageal sphincter during normal deglutition

    International Nuclear Information System (INIS)

    The upper esophageal sphincter was studied during deglutition in 7 healthy subjects using simultaneous cineradiography and manometry. The pressure measuring device consisted of 3 sensors distally placed, and separated by 10 mm. They recorded pressure obliquely to the right at an angle of 15 to 45 degrees anteriorly. During the swalloing sequence a pressure sensor initially placed in the high pressure zone of the sphincter easily slid out of position due to asynchronous movements of the sphincter and the pressure measuring device. These movements can result in erroneous interpretation of pressure recordings. Continuous radiologic monitoring during the entire swallowing sequence thus seems to be mandatory. Immediately before the bolus entered the upper esophageal sphincter, the sphincter relaxed and low or even negative pressures were registered. When the bolus had passed onwards the sphincter contracted gradually, to resume its pre-swallow pressure. (orig.)

  4. AMS 742 sphincter: UCLA experience.

    Science.gov (United States)

    Bruskewitz, R; Raz, S; Smith, R B; Kaufman, J J

    1980-12-01

    Between December 1977 and November 1978 artificial sphincters were implanted in 2 female and 19 male patients for the treatment of urinary incontinence. Etiologies for incontinence varied, including post-prostatectomy incontinence, myelodysplasia and female incontinence after unsuccessful bladder neck suspension. Over-all, 38 per cent of the patients were excellent or improved postoperatively, while 24 per cent experienced continuing unabated urinary incontinence and 24 per cent experienced urethral erosion at the site of cuff placement. The device was removed in 14 per cent of the patients when it became infected. PMID:7441829

  5. Carcinoma of the anal canal

    Directory of Open Access Journals (Sweden)

    David T. Marshall

    2011-12-01

    Full Text Available There are around 5,000 new cases of anal canal cancer each year in the United States. It is of particular risk in HIV-positive populations. Many cases are related to persistent infection with human papillomavirus (HPV. The treatment of anal cancer has progressed from abdominoperineal resection mandating permanent colostomy in the 1940s through the 1970s to modern chemoradiation with sphincter preservation in around 80% of patients, even with locally advanced disease. The evolution of the treatment paradigm of this disease is a model for the treatment of malignant disease with organ preservation. Multiple randomized trials have been conducted to guide this evolution. Technological developments in the delivery of radiotherapy and anti-cancer pharmaceuticals harbor hope for further improvements in outcomes with possible reductions in toxicity and increases in tumor control. Perhaps most inspiring is the recent development of HPV vaccines that

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

    Science.gov (United States)

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

    2014-01-01

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

  7. Sphincter preservation in distal CT2N0 rectal cancer after preoperative chemoradiotherapy

    International Nuclear Information System (INIS)

    Preoperative chemoradiotherapy is usually not indicated for cT2N0 rectal cancer. Abdominoperineal resection is the standard treatment for distal rectal tumors. The aim of the study was to evaluate the actual sphincter-preservation rate in patients with distal cT2N0 rectal cancer given neoadjuvant chemoradiotherapy. Data were retrospectively collected for all patients who were diagnosed with distal cT2N0 rectal cancer at a tertiary medical center in 2000–2008 and received chemoradiotherapy followed by surgery (5–7 weeks later). Thirty-three patients (22 male) of median age 65 years (range, 32–88) were identified. Tumor distance from the anal verge ranged from 0 to 5 cm. R0 resection with sphincter preservation was accomplished in 22 patients (66%), with a 22% pathological complete response rate. Median follow-up time was 62 months (range 7–120). There were no local failures. Crude disease-free and overall survival were 82% and 86%, respectively. Factors associated with sphincter preservation were tumor location (OR = 0.58, p = 0.02, 95% CI = 0.37-0.91) and pathological downstaging (OR = 7.8, p = 0.02, 95% CI = 1.35-45.85). Chemoradiotherapy was well tolerated. High rates of sphincter preservation can be achieved after preoperative chemoradiotherapy for distal cT2N0 rectal cancer, with tolerable toxicity, without compromising oncological outcome

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

    Directory of Open Access Journals (Sweden)

    Paudel Bishnu

    2007-09-01

    Full Text Available Abstract 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

  9. Radiation therapy of recurrent anal squamous cell carcinoma in-situ: a case report

    Directory of Open Access Journals (Sweden)

    Noone Robert

    2010-02-01

    Full Text Available Abstract Introduction High-grade anal intraepithelial neoplasia, also referred to as anal squamous carcinoma in-situ, or Bowen's disease of the anus, make up less than 1% of all digestive system cancers in the United States. The treatment of choice is surgical resection with anal mapping. However, this disease often recurs or persists, requiring additional surgery for these patients. This can compromise the anal sphincter leading to leakage. In this case report, we discuss the efficacy of radiation therapy as a modality to treat post-excisional recurrent Bowen's disease, which may prevent sphincter compromise, leading to improved quality of life. Case presentation An 84-year-old Caucasian woman presented with post-excisional persistent/recurrent squamous cell carcinoma in-situ. The initial lesion measured 3 cm in diameter on the right lateral side of the anal margin. A standard surgery consisting of wide local excision with anal mapping was performed. The margins were clear and our patient was followed up. Our patient recurred with a 1.2 × 0.8 cm lesion on the left anal verge extending to the anal canal. A biopsy along with mapping was done, and 2 of the 17 mapping specimens were positive for carcinoma in-situ, one in the anal canal. Due to the location of the positive anal mapping, and in order to prevent sphincter compromise on re-excision, our patient was offered definitive radiation therapy. Two years after radiation therapy, our patient showed no signs of recurrent disease and had good sphincter control. Conclusion Although the main treatment modality for treating persistent/recurrent Bowen's disease is surgery, an alternative approach using external beam radiation for CIS may be enough to provide a cure for some patients with recurrent disease.

  10. Sphincter saving and abdomino-perineal resections following neoadjuvant chemoradiation in locally advanced low rectal cancer

    International Nuclear Information System (INIS)

    Background: The improvement in surgical techniques alongside neoadjuvant chemo radiation enabled more patients with low rectal cancer to have sphincter preservation. Study aim: To compare the oncologic and functional outcome in patients with locally advanced low rectal cancer treated by neoadjuvant chemo radiation followed by sphincter saving resection (SSR) against those who underwent abdomino-perineal resection (APR). Patients and methods: A total of 111 patients with low rectal cancer were included in the study. Sixty-one consented patients who prospectively underwent SSR, from Jan 2008 to Jan 2013, and a retrospective group, formed of 50 patients, selected from cases seen at NCI, with comparable demographic, clinical and pathologic criteria, who underwent APR from Jan 2003 to Jan 2008. All lesions were <5 cm from anal verge. All 111 patients received preoperative chemo radiation and total mesorectal excision. Results: All tumors were located at a median of 3.6 cm (range 2.5-4.5 cm) for the SSR group, and 3.5 cm (range 2.5-4.6 cm) for the APR group, from the anal verge. The median follow-up was 34 months (range 1-60 months) for both groups. The difference in disease recurrence and OS between the APR and SSR groups were both statistically insignificant. Conclusion: In low rectal cancer, the sphincter preservation appears to have nearly the same oncologic outcome compared to APR, this might be attributed to the small sample size and short follow up period. However, patients with sphincter preservation have certainly demonstrated an indisputable better functional outcome, in terms of stoma avoidance and adequate continence.

  11. Bioengineering functional human sphincteric and non-sphincteric gastrointestinal smooth muscle constructs.

    Science.gov (United States)

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

    2016-04-15

    Digestion and motility of luminal content through the gastrointestinal (GI) tract are achieved by cooperation between distinct cell types. Much of the 3 dimensional (3D) in vitro modeling used to study the GI physiology and disease focus solely on epithelial cells and not smooth muscle cells (SMCs). SMCs of the gut function either to propel and mix luminal contents (phasic; non-sphincteric) or to act as barriers to prevent the movement of luminal materials (tonic; sphincteric). Motility disorders including pyloric stenosis and chronic intestinal pseudoobstruction (CIPO) affect sphincteric and non-sphincteric SMCs, respectively. Bioengineering offers a useful tool to develop functional GI tissue mimics that possess similar characteristics to native tissue. The objective of this study was to bioengineer 3D human pyloric sphincter and small intestinal (SI) constructs in vitro that recapitulate the contractile phenotypes of sphincteric and non-sphincteric human GI SMCs. Bioengineered 3D human pylorus and circular SI SMC constructs were developed and displayed a contractile phenotype. Constructs composed of human pylorus SMCs displayed tonic SMC characteristics, including generation of basal tone, at higher levels than SI SMC constructs which is similar to what is seen in native tissue. Both constructs contracted in response to potassium chloride (KCl) and acetylcholine (ACh) and relaxed in response to vasoactive intestinal peptide (VIP). These studies provide the first bioengineered human pylorus constructs that maintain a sphincteric phenotype. These bioengineered constructs provide appropriate models to study motility disorders of the gut or replacement tissues for various GI organs. PMID:26314281

  12. Sphincter preservation with preoperative radiation therapy and coloanal anastomosis

    International Nuclear Information System (INIS)

    Purpose: To determine if preoperative radiation therapy allows sphincter preservation in the treatment of rectal cancer. Methods and Materials: Thirty patients with the diagnosis of invasive, resectable, primary adenocarcinoma of the rectum limited to the pelvis were enrolled on a Phase I/II trial of preoperative radiation therapy plus low anterior resection/coloanal anastomosis. By preoperative assessment, all patients had invasive tumors (2: T2, 28: T3) involving the distal half of the rectum and required an abdominoperineal resection. The median tumor size was 4 cm (range: 1.5-6 cm) and the median distance from the anal verge was 4 cm (range: 3-7 cm). The whole pelvis received 46.8 Gy followed by a 3.60 Gy boost to the primary tumor bed. The median follow-up was 43 months (range: 6-82 months). Results: Of the 29 patients who underwent resection, 3 (10%) had a complete pathologic response and 24 (83%) were able to successfully undergo a low anterior resection/coloanal anastomosis. The incidence of local failure was crude: 17% and 4-year actuarial: 23%. The 4-year actuarial survival was 75%. One patient developed a partial disruption of the anastomosis and two developed rectal stenosis. Analysis of sphincter function using a previously published scale was performed at the time of last follow-up in 22 of the 24 patients who underwent a low anterior resection/coloanal anastomosis. Function was good or excellent in 77%. The median number of bowel movements/day was two (range: 1-6). Conclusions: This technique may be an alternative to an abdominoperineal resection in selected patients. Continued follow-up is needed to determine if this approach ultimately has similar local control and survival rates as an abdominoperineal resection

  13. Anal fissure

    Science.gov (United States)

    ... pain interferes with normal bowel movements Petroleum jelly Zinc oxide, 1% hydrocortisone cream, Preparation H, and other ... anal muscle Prescription creams such as nitrates or calcium channel blockers, applied over the fissure to help ...

  14. The epidemiology of anal incontinence and symptom severity scoring

    OpenAIRE

    Nevler, Avinoam

    2014-01-01

    For many patients, anal incontinence (AI) is a devastating condition that can lead to social isolation and loss of independence, contributing to a substantial economic health burden, not only for the individual but also for the allocation of healthcare resources. Its prevalence is underestimated because of poor patient reporting, with many unrecorded but symptomatic cases residing in nursing homes. Endosonography has improved our understanding of the incidence of post-obstetric sphincter tear...

  15. Study of Operated Patients of Lateral Internal Anal Sphincterotomy for Chronic Anal Fissure

    Science.gov (United States)

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

    2013-01-01

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

  16. Squamous cell carcinoma of the anal canal.

    LENUS (Irish Health Repository)

    Martin, F T

    2012-01-31

    Squamous cell carcinoma ofthe anal canal represents 1.5% of all malignancies affectingthe gastrointestinal tract. Over the past 20 years dramatic changes have been seen in both the epidemiological distribution of the disease and in the therapeutic modalities utilised to manage it. CLINICAL MANAGEMENT: Historically abdominoperineal resection had been the treatment of choice with local resection reserved for early stage disease. Work by Nigro et al. has revolutionised how we currently manage carcinoma of the anal canal, demonstrating combined modality chemoradiotherapy as an appropriate alternative to surgical resection with the benefit of preserving sphincter function. Surgery is then reserved for recurrent disease with salvage abdominoperineal resection. This article reviews current literature and highlights the changing therapeutic modalities with selected clinical cases

  17. Histo-topographic study of the longitudinal anal muscle.

    Science.gov (United States)

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

    2008-07-01

    The longitudinal anal muscle (LAM) has been described as a vertical layer of muscular tissue interposed between the circular layers of the internal (IAS) and external (EAS) anal sphincters. There is, however, no general agreement in the literature on its composition and attachments. The aim of this study was to investigate the histological structure, attachments, and topography of the LAM in order to evaluate its role in continence and defecation, thus enhancing knowledge of the surgical anatomy of this region. After in situ formalin fixation, the pelvic viscera were removed from eight male and eight female cadavers (age range: 52-72 years). Serial macrosections of the bladder base, lower rectum and anal canal, cervix and pelvic floor complex, cut in the transverse (six specimens) and coronal (six specimens) planes, underwent histological and immunohistochemical studies. Four specimens were studied using the E12 sheet plastination technique. The LAM was identified in 10/12 specimens (83%). Transverse and coronal sections made clear that it is a longitudinal layer of muscular tissue, marking the boundary between the internal and external anal sphincters. From the anorectal junction it extends along the anal canal, receives fibers from the innermost part of the puborectalis and the puboanalis muscles, and terminates with seven to nine fibro-elastic septa, which traverse the subcutaneous part of the external anal sphincter, reaching the perianal dermis. In the transverse plane, the mean thickness of the LAM was 1.68 +/- 0.27 mm. Immunohistochemical staining showed that the LAM consists of predominantly outer striated muscle fibers and smaller numbers of inner smooth muscle fibers, respectively coming from the levator ani muscle and from the longitudinal muscular layer of the rectum. The oblique fibers suggest that the LAM may represent the intermediate longitudinal course of small bridging muscle bundles going reciprocally from the striated EAS to the smooth IAS and

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

    OpenAIRE

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

    2014-01-01

    A non-healing peri-anal abscess can be difficult to manage and is often attributed to chronic disease. This case documents a male in his seventh decade who presented with multiple peri-anal collections. The abscess cavity had caused necrosis of the internal sphincter muscles resulting in faecal incontinence. Biopsies were conclusive for diffuse large B-cell lymphoma. A de-functioning colostomy was performed and the patient was initiated on CHOP-R chemotherapy. Anal lymphoma masquerading as a ...

  19. Sphincter Preservation After Short-term Preoperative Radiotherapy for Low Rectal Cancer - Presentation of Own Data and a Literature Review

    International Nuclear Information System (INIS)

    This report is based on a series of 108 patients with clinically staged T2 (9), T3 (94) and T4 (5) rectal cancer treated with preoperative irradiation with 25 Gy, 5 Gy per fraction given for one week. In 77% of patients, the tumour was located within 7 cm of the anal verge and in 15% the anal canal was involved. Surgery was usually undertaken during the week after irradiation. For low tumours, total mesorectal excision was performed, and for middle and upper cancers, the whole circumference of the mesorectum was excised at least 2 cm below the lower pole of a tumour. Tumour was resected in 103 patients, and sphincter-preserving surgery was performed in 73% of them. In the subgroup where the tumour was located higher than 4 cm from the anal verge, sphincter-preserving surgery was performed in 95%. The follow-up period ranged from 10 to 49 months, with a median of 25 months. Local recurrences were observed in 4% of patients. Anorectal dysfunction caused impairment of social life in 40% of patients and 18% admitted that their quality of life was seriously affected - however, none of them stated that they would have preferred a colostomy. These preliminary data suggest that following high dose per fraction short-term preoperative radiotherapy a high rate of sphincter-preserving surgery can be reached, with acceptable anorectal function and an acceptable rate of local failure and late complications. The results of our own data and literature review indicate the need for a randomized clinical trial comparing high dose per fraction preoperative radiotherapy with immediate surgery with conventional preoperative radiochemotherapy with delayed surgery

  20. Behavior Therapy in Children with Sphincter Incontinence

    Directory of Open Access Journals (Sweden)

    M Ghofrani

    2002-09-01

    Full Text Available Urinary and rectal sphincter incontinence is a frequently encountered symptom in mentally retarded children and those with learning disabilities. In addition to the fact incontinence is a very disagreeable problem, on the wide it is of more importance in Islamic societies, as to be “Clean” during religious practices is mandatory. Regarding the fact that 25-50% of mentally retarded children are unable to control urine and feces elimination, families and institutions in charge of these children face much inconvenience. This article discusses the teaching programs and methods of behavioral therapy of the affected patients.

  1. Anal squamous carcinoma: a new AIDS-defining cancer? Case report and literature review

    Directory of Open Access Journals (Sweden)

    Marcelo Corti

    2012-12-01

    Full Text Available Squamous anal cell carcinoma is a rare malignancy that represents the 1.5% to 2% of all the lower digestive tract cancers. However, an increased incidence of invasive anal carcinoma is observed in HIV-seropositive population since the widespread of highly active antiretroviral therapy. Human papillomavirus is strongly associated with the pathogenesis of anal cancer. Anal intercourse and a high number of sexual partners appear to be risk factors to develop anal cancer in both sexes. Anal pain, bleeding and a palpable lesion in the anal canal are the most common clinical features. Endo-anal ultrasound is the best diagnosis method to evaluate the tumor size, the tumor extension and the infiltration of the sphincter muscle complex. Chemoradiotherapy plus antiretroviral therapy are the recommended treatments for all stages of localized squamous cell carcinoma of the anal canal in HIV-seropositive patients because of its high rate of cure. Here we present an HIV patient who developed a carcinoma of the anal canal after a long time of HIV infection under highly active antiretroviral therapy with a good virological and immunological response.

  2. The Effect of Topical Nifedipine in Treatment of Chronic Anal Fissure

    Directory of Open Access Journals (Sweden)

    Farzaneh Golfam

    2010-10-01

    Full Text Available Chronic anal fissure is the most common cause of anal pain associated with internal anal sphincter hypertonia. Reduction of hypertonocity is a special treatment for fissure healing. For this purpose chronic anal fissures were conventionally treated by anal dilatation or by lateral sphincterotomy. However, both of these methods may cause a degree of incontinence in some patients. The uptake of medical therapies that create a reversible chemical sphincterotomy has recently become widespread. The aim of this prospective clinical trial study was to assess the effectiveness of nifedipine in healing anal fissure, a calcium channel blocker that reduces sphincter pressure. A single-blind randomized comparative trial was setup to compare traditional treatment with stool softeners and 2% lidocaine cream against 0.5% nifedipine cream for 4 weeks. 110 patients were included in this study, 60 patients in the nifedipine group and 50 patients in the control group and the therapeutic outcome and side effects were recorded. Healing had occurred in 70% of patients in the nifedipine group and in 12% of patients in the control group after 4 weeks treatment (P

  3. Sphincter preservation with pre-operative radiation therapy (RT) and coloanal anastomosis: long term follow-up

    International Nuclear Information System (INIS)

    PURPOSE: To determine the long term follow-up of sphincter preservation with pre-operative RT and coloanal anastomosis for rectal cancer. MATERIALS AND METHODS: A total of 36 pts (M:25, F:11) with invasive, clinically resectable, primary adenocarcinoma of the rectum were enrolled from 1/87 through 4/96 on a prospective Phase I/II trial. All patients were examined in the office by their operating surgeon prior to the start of RT and were judged clinically to require an abdominoperineal resection (APR) due to the proximity (but not invasion of) the tumor to the anal sphincter. By transrectal ultrasound, clinical T stage was T2:5, and T3:31. The median age was 55 years (range: 33-76 years), and the median distance from the anal verge was 4 cm (range: 3-7 cm). The median tumor size was 3.8 cm (range: 1.5-7 cm). Pts received 4680 cGy (180 cGy/day) to the whole pelvis followed by a boost to 5040 cGy followed by surgery 4-5 weeks later. Although no chemotherapy was delivered concurrently with RT, patients with pathologically positive pelvic nodes (13) or metastatic disease (6) received post-operative 5-FU based chemotherapy. All underwent fecal diversion which was closed 2-4 months post-op. Sphincter function was performed using a telephone survey according to the MSKCC sphincter function scale (Excellent: 1-2 bowel movements/day, no soilage, Good: 3-4 bowel movements/day, and/or mild soilage, fair: Episodic > 4 bowel movements/day, and/or moderate soilage, and Poor: incontinence). Actuarial calculations were performed using the Kaplan-Meier method. The median follow-up was 56 months (range: 4-121 months). RESULTS: Of the 35 patients who underwent surgery (1 pt with unresectable liver mets did not undergo surgery) (27(35)) (77%) were able to undergo a coloanal anastomosis and the pathological complete response rate was 14%. Post-operative complications included 1 (3%) partial anastamotic disruption, 2 (6%) rectal stenosis, and 1 (3%) pelvic abscess. For the total group of

  4. Efficacy of low-dose epidural anaesthesia in surgery of the anal canal--a randomised controlled trial.

    Science.gov (United States)

    Kausalya, R; Jacob, R

    1994-04-01

    The aim of the study was to compare in terms of patient comfort, surgical requirements and anaesthetic safety, the difference between epidural and general anaesthesia in patients undergoing surgery of the anal canal. The study was undertaken on 50 adult patients undergoing anal surgery. By random allocation 25 were given a general anaesthetic while 25 were given a low-dose epidural using 0.375% bupivacaine. Advantages and disadvantages of both methods were noted in the study. It was concluded that low-dose epidural is a more effective means of providing analgesia, while maintaining adequate sphincter tone for surgery on the anal canal, than general anaesthesia. PMID:8210019

  5. Optimization of the artificial urinary sphincter: modelling and experimental validation

    International Nuclear Information System (INIS)

    The artificial urinary sphincter should be long enough to prevent strangulation effects of the urethral tissue and short enough to avoid the improper dissection of the surrounding tissue. To optimize the sphincter length, the empirical three-parameter urethra compression model is proposed based on the mechanical properties of the urethra: wall pressure, tissue response rim force and sphincter periphery length. In vitro studies using explanted animal or human urethras and different artificial sphincters demonstrate its applicability. The pressure of the sphincter to close the urethra is shown to be a linear function of the bladder pressure. The force to close the urethra depends on the sphincter length linearly. Human urethras display the same dependences as the urethras of pig, dog, sheep and calf. Quantitatively, however, sow urethras resemble best the human ones. For the human urethras, the mean wall pressure corresponds to (-12.6 ± 0.9) cmH2O and (-8.7 ± 1.1) cmH2O, the rim length to (3.0 ± 0.3) mm and (5.1 ± 0.3) mm and the rim force to (60 ± 20) mN and (100 ± 20) mN for urethra opening and closing, respectively. Assuming an intravesical pressure of 40 cmH2O, and an external pressure on the urethra of 60 cmH2O, the model leads to the optimized sphincter length of (17.3 ± 3.8) mm

  6. Low rectal cancer: Sphincter preserving techniques-selectionof patients, techniques and outcomes

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Low rectal cancer is traditionally treated by abdominoperinealresection. In recent years, several newtechniques for the treatment of very low rectal cancerpatients aiming to preserve the gastrointestinal continuityand to improve both the oncological as well asthe functional outcomes, have been emerged. Literaturesuggest that when the intersphincteric resection isapplied in T1-3 tumors located within 30-35 mm fromthe anal verge, is technically feasible, safe, with equaloncological outcomes compared to conventional surgeryand acceptable quality of life. The Anterior PerinealPlanE for Ultra-low Anterior Resection technique,is not disrupting the sphincters, but carries a highcomplication rate, while the reports on the oncologicaland functional outcomes are limited. TransanalEndoscopic MicroSurgery (TEM) and TransAnal MinimallyInvasive Surgery (TAMIS) should represent thetreatment of choice for T1 rectal tumors, with specificcriteria according to the NCCN guidelines and favorablepathologic features. Alternatively to the standardconventional surgery, neoadjuvant chemo-radiotherapyfollowed by TEM or TAMIS seems promising for tumorsof a local stage T1sm2-3 or T2. Transanal TotalMesorectal Excision should be performed only whena board approved protocol is available by colorectalsurgeons with extensiveexperience in minimally invasiveand transanal endoscopic surgery.

  7. Familial disseminated plaque type porokeratosis with multiple horns and squamous cell carcinoma involving anal skin

    Directory of Open Access Journals (Sweden)

    Sarma Nilendu

    2009-01-01

    Full Text Available Porokeratosis is a disorder of keratinization showing a well-defined lesion with a hyperkeratotic ridge on the border that contains the coronoid lamella. We report familial (autosomal dominant with reduced penetrance disseminated plaque type (Mibelli′s type porokeratosis in a father and son. In the father, there were multiple horns and a large squamous cell carcinoma in a large lesion over the perianal region that reached up to the squamo-columnar junction of the anal mucosa and even invaded the anal sphincteric muscles. Disseminated lesions of the Mibelli′s type, development of horns, and malignancy in this unusual location have not been previously reported.

  8. Preoperative chemoradiotherapy and colonic J-pouch anal anastomosis for lower rectal cancer

    International Nuclear Information System (INIS)

    We performed colonic J-pouch anal anastomosis in 61 patients with rectal cancer located <4 cm from the anal verge. Surgical and oncological results were evaluated in multimodality therapy for advanced rectal cancer. According to Wexner's score, 7% of patients were fully continent, 71% had acceptable function with minor continence problems, and 22% were incontinent. No patients required intermittent self-catheterization during follow-up. After a median follow-up of 49 months, there was only 1 case of local recurrence after surgery. Our surgical approach irrespective of internal sphincter resection produces satisfactory functional and oncological results in multimodality therapy using preoperative chemoradiotherapy for lower rectal cancer. (author)

  9. Therapeutic effect and postoperative anal function after preoperative chemoradiotherapy for rectal cancer

    International Nuclear Information System (INIS)

    Preoperative chemoradiotherapy for rectal cancer has been shown to improve surgical outcome; however, it might result in an impaired postoperative anal function, which is a major drawback of this neoadjuvant therapy. Our clinical experience in this study shows that after preoperative chemoradiotherapy, chance of sphincter preserving surgery increased and local recurrence decreased, both of which contribute to preservation of anal function. Postoperative fecal continence following chemoradiotherapy significantly improved after 1 year of surgery, and did not differ significantly from that after surgery alone. However, defecation frequency after chemoradiotherapy was higher, and no apparent improvement with time was observed. (author)

  10. Congenital anorectal atresia: MR imaging of late post-operative appearances in adult patients with anal incontinence

    Energy Technology Data Exchange (ETDEWEB)

    Gartner, Louise; Peiris, Chand; Marshall, Michele [St. Mark' s Hospital, Department of Intestinal Imaging, London (United Kingdom); Taylor, Stuart A.; Halligan, Steve [University College London, Centre for Medical Imaging, London (United Kingdom)

    2013-12-15

    To describe the MR imaging findings in adults presenting with anal incontinence following pull-through perineoplasty for anorectal atresia. 15 adults (12 male, 3 female; age 22-52 years) with anal incontinence following a prior perineal pull-through procedure as an infant for anorectal atresia were identified retrospectively. MR imaging was performed using either an endoanal coil or body coil. MR images were reviewed by three observers who noted whether pelvic floor and sphincter muscles were present and, if so, whether they were thinned or not. Data were tabulated and raw frequencies determined. Images were unavailable for one patient, leaving 14 for analysis. Anal stenosis prevented endoanal coil placement in 5. The pull-through was anatomically correct in 12 (86 %) patients but was misdirected in 2. Thinned muscle was seen in 11 (79 %) patients. External sphincter thinning was commonest (present in 10 patients), with levator plate thinning least common (present in 4 patients). Only one patient had thinning of all muscle groups. MR imaging may be used to determine the extent and quality of residual pelvic floor and anal sphincter muscle in adults who have functional disability following pull-through perineoplasty for anorectal agenesis. (orig.)

  11. Congenital anorectal atresia: MR imaging of late post-operative appearances in adult patients with anal incontinence

    International Nuclear Information System (INIS)

    To describe the MR imaging findings in adults presenting with anal incontinence following pull-through perineoplasty for anorectal atresia. 15 adults (12 male, 3 female; age 22-52 years) with anal incontinence following a prior perineal pull-through procedure as an infant for anorectal atresia were identified retrospectively. MR imaging was performed using either an endoanal coil or body coil. MR images were reviewed by three observers who noted whether pelvic floor and sphincter muscles were present and, if so, whether they were thinned or not. Data were tabulated and raw frequencies determined. Images were unavailable for one patient, leaving 14 for analysis. Anal stenosis prevented endoanal coil placement in 5. The pull-through was anatomically correct in 12 (86 %) patients but was misdirected in 2. Thinned muscle was seen in 11 (79 %) patients. External sphincter thinning was commonest (present in 10 patients), with levator plate thinning least common (present in 4 patients). Only one patient had thinning of all muscle groups. MR imaging may be used to determine the extent and quality of residual pelvic floor and anal sphincter muscle in adults who have functional disability following pull-through perineoplasty for anorectal agenesis. (orig.)

  12. Conservative management of anal and rectal cancer

    International Nuclear Information System (INIS)

    The role of irradiation in the management of anal and rectal cancer has changed during the past ten years. In small epidermoid carcinomas of the anal canal (T1 T2) irradiation is in most departments considered the primary treatment, giving a 5-year survival rate of between 60 and 80% with good sphincter preservation. Even in larger tumors, irradiation can still offer some chance of cure without colostomy. Surgery remains the basic treatment of rectal cancer but irradiation is used in association with surgery in many cases. Radiotherapy is of value in the conservative management of cancer of the rectum in three situations: In small polypoid cancers contact X-ray therapy can give local control in about 90%. In cancers of the middle rectum, preoperative external irradiation may increase the chances of restorative surgery and reduce the risk of local relapse. In inoperable patients, external radiotherapy and/or intracavitary irradiation may cure some patients with infiltrating tumors (T2 T3) without colostomy. (orig.)

  13. Rectal atresia and anal stenosis: the difference in the operative technique for these two distinct congenital anorectal malformations.

    Science.gov (United States)

    Lane, V A; Wood, R J; Reck, C; Skerritt, C; Levitt, M A

    2016-04-01

    Rectal atresia and anal stenosis are rare forms of anorectal malformations. The aim of the definitive surgical repair in such cases is to preserve the anal canal, the dentate line, and the sphincter complex. We present a case of rectal atresia and anal stenosis to demonstrate the differences in the operative repair. The techniques described leave the anterior wall of the very distal anal canal untouched in both rectal stenosis and anal atresia; however, the dissection of the rectum differs. The atretic rectum in rectal atresia is mobilized and sutured to the anal canal circumferentially. In anal stenosis, the posterior rectum is mobilized in the form of rectal advancement, and the posterior 180° is anastomosed directly to the skin (as in a standard PSARP) with preservation of the anal canal as the anterior 180° of the final anoplasty. These patients have an excellent prognosis for bowel control and fecal continence, and therefore, complete mobilization and resection of the anal canal must be avoided. PMID:26902368

  14. Treatment Option Overview (Anal Cancer)

    Science.gov (United States)

    ... Cancer Treatment Anal Cancer Prevention Research Anal Cancer Treatment (PDQ®)–Patient Version General Information About Anal Cancer ... factors affect the prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) depends on ...

  15. Place of surgery in combined treatment. Arguments in favor of sparing the anal sphincter

    International Nuclear Information System (INIS)

    The author explains the advantages of a preoperative radiotherapy in the treatment of rectum cancer before surgery, presents possible surgeries and also gives the recurrence risks and expected survival rates

  16. External urethral sphincter pressure measurement: an accurate method for the diagnosis of detrusor external sphincter dyssynergia?

    Directory of Open Access Journals (Sweden)

    Carlos H Suzuki Bellucci

    Full Text Available BACKGROUND: Combined pelvic floor electromyography (EMG and videocystourethrography (VCUG during urodynamic investigation are the most acceptable and widely agreed methods for diagnosing detrusor external sphincter dyssynergia (DESD. Theoretically, external urethral sphincter pressure (EUSP measurement would provide enough information for the diagnosis of DESD and could simplify the urodynamic investigation replacing combined pelvic floor EMG and VCUG. Thus, we evaluated the diagnostic accuracy of EUSP measurement for DESD. PATIENTS #ENTITYSTARTX00026; METHODS: A consecutive series of 72 patients (36 women, 36 men with neurogenic lower urinary tract dysfunction able to void spontaneously was prospectively evaluated at a single university spinal cord injury center. Diagnosis of DESD using EUSP measurement (index test versus combined pelvic floor EMG and VCUG (reference standard was assessed according to the recommendations of the Standards for Reporting of Diagnostic Accuracy Initiative. RESULTS: Using EUSP measurement (index test and combined pelvic floor EMG and VCUR (reference standard, DESD was diagnosed in 10 (14% and in 41 (57% patients, respectively. More than half of the patients presented discordant diagnosis between the index test and the reference standard. Among 41 patients with DESD diagnosed by combined pelvic floor EMG and VCUR, EUSP measurement identified only 6 patients. EUSP measurement had a sensitivity of 15% (95% CI 5%-25%, specificity of 87% (95% CI 76%-98%, positive predictive value of 60% (95% CI 30%-90%, and negative predictive value of 56% (95% CI 44%-68% for the diagnosis of DESD. CONCLUSIONS: For diagnosis of DESD, EUSP measurement is inaccurate and cannot replace combined pelvic floor EMG and VCUR.

  17. Sphincter preservation in patients with low rectal cancer treated with radiation therapy with or without local excision or fulguration

    International Nuclear Information System (INIS)

    Twenty-six patients with small cancers limited to the lower two-thirds of the rectum were treated with conservative surgery and radiation therapy (XRT). In patients treated with local excision or fulguration followed by XRT, there was a 6% local failure rate (one in 17); in 16 of 17 patients receiving radiation doses above 4500 cGy, the local control was complete for follow-up periods of 6 months to 7 years. In nine patients treated with XRT for residual tumor, local failure occurred in five (56%). Serious late complications occurred only if total doses were greater than 6300 cGy. Local excision combined with XRT proved to be a safe alternative to radical surgery in selected patients and resulted in excellent local control while allowing preservation of anal sphincter function

  18. Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: the M. D. Anderson Cancer Center experience

    International Nuclear Information System (INIS)

    Purpose: To evaluate the rates of tumor downstaging after preoperative chemoradiation for locally advanced rectal cancer. Materials and Methods: Preoperative chemoradiotherapy (CTX/XRT) that delivered 45 Gy in 25 fractions over 5 weeks with continuous infusion 5-fluorouracil (300 mg/m2/day) was given to 117 patients. The pretreatment stage distribution, as determined by endorectal ultrasound (u), included uT2N0 in 2%, uT3N0 in 47%, uT3N1 in 49%, and uT4N0 in 2% of cases; endorectal ultrasound was not performed in 13% of cases (15 patients). Approximately 6 weeks after completion of CTX/XRT, surgery was performed. Results: The pathological tumor stages were Tis-2N0 in 26%, T2N1 in 5%, T3N0 in 21%, T3N1 in 15%, T4N0 in 5%, and T4N1 in 1%; a complete response (CR) to preoperative CTX/XRT was pathologically confirmed in 32 (27%) of patients. Tumor downstaging occurred in 72 (62%) cases. Only 3% of cases had pathologic evidence of progressive disease. Pretreatment tumor size (1 T-stage level was accomplished in 45% of those downstaged. Overall, a sphincter-saving (SP) procedure was possible in 59% of patients and an abdominoperineal resection (APR) was required in 41% of cases. Factors predictive of SP included downstaging (p 40 years (p 6 cm from the anal verge, SP was performed in 14 of the 15 (93%) patients with a CR and 32 of 33 (97%) of patients with residual disease (p < 0.00004). Conclusions: Significant tumor downstaging results from preoperative chemoradiation allowing sphincter sparing surgery in over 40% of patients whose tumors were located < 6 cm from the anal verge and who otherwise would have required colostomy

  19. Anal acoustic reflectometry predicts the outcome of percutaneous nerve evaluation for faecal incontinence

    DEFF Research Database (Denmark)

    Hornung, B R; Carlson, G L; Mitchell, P J; Klarskov, N; Lose, G; Telford, K J; Kiff, E S

    2014-01-01

    BACKGROUND: Sacral nerve stimulation (SNS) is effective for some patients with faecal incontinence. Before insertion of a costly implant, percutaneous nerve evaluation (PNE) is undertaken to identify patients likely to report success from SNS. The aim of this study was to determine whether...... variables of anal sphincter function measured by anal acoustic reflectometry (AAR) could predict the outcome of PNE for faecal incontinence. METHODS: Women with faecal incontinence undergoing PNE were recruited. AAR, followed by anal manometry, was performed on the day of surgery, immediately before PNE....... The outcome of PNE was determined by bowel diary results and incontinence severity score. Patients with a successful PNE outcome were compared with those with an unsuccessful outcome; logistic regression analysis was used to identify any independent predictors of success. RESULTS: Fifty-two patients...

  20. Anal condyloma acuminatum.

    Science.gov (United States)

    McCutcheon, Tonna

    2009-01-01

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

  1. The Effect of Topical Nifedipine in Treatment of Chronic Anal Fissure

    Directory of Open Access Journals (Sweden)

    Farzaneh Golfam

    2010-09-01

    Full Text Available "nChronic anal fissure is the most common cause of anal pain associated with internal anal sphincter hypertonia. Reduction of hypertonocity is a special treatment for fissure healing. For this purpose chronic anal fissures were conventionally treated by anal dilatation or by lateral sphincterotomy. However, both of these methods may cause a degree of incontinence in some patients. The uptake of medical therapies that create a reversible chemical sphincterotomy has recently become widespread. The aim of this prospective clinical trial study was to assess the effectiveness of nifedipine in healing anal fissure, a calcium channel blocker that reduces sphincter pressure. A single-blind randomized comparative trial was setup to compare traditional treatment with stool softeners and 2% lidocaine cream against 0.5% nifedipine cream for 4 weeks. 110 patients were included in this study, 60 patients in the nifedipine group and 50 patients in the control group and the therapeutic outcome and side effects were recorded. Healing had occurred in 70% of patients in the nifedipine group and in 12% of patients in the control group after 4 weeks treatment (P < 0.005. Recurrence of symptoms occurred in four of healed patients in the nifedipine group and three patients in the control group in two months. The final result of nifedipine application after 12 months follow up was recurrence in 11 patients (26.19%. Mild headache occurred in four patients (6.6% of the nifedipine group. Patients in the nifedipine group showed significant healing and relief from pain compared with patients in the control group. Recurrence rate with nifedipine use in spite of control of predisposing factors such as constipation was significant. Another finding was low complication rate with this treatment.

  2. Rerouting of high / recurrent anal fistula without seton

    International Nuclear Information System (INIS)

    Objective: To evaluate a new treatment option in cases of high or complex anal fistulas where either the internal opening could not be outlined or there is recurrence after surgery. Study Design: Quasi Experimental study. Place and Duration of study: This study was carried out in Pakistan Naval Ship Hafeez from Jun 2008 to Aug 2011. Patients and Methods: Thirty seven patients were selected for a rerouting procedure in PNS Hafeez. The selection criteria included patients with a high or a complex fistula who had previous surgery but had recurrence of their condition. Complex fistulas, tuberculous fistulas, fistulas with two or more external openings and patients with a recurrent fistula who subsequently were found to have a low fistula were excluded from the study.The lower part of the tract was dissected, rerouted and brought out through the anal canal. The excess tract was excised and the cut end was sutured with the anal canal mucosa, thus converting an external fistula into an internal one, where the secretions from it can be retained by the external anal sphincter, thus preventing constant soiling. Results: Average age was 37 years. Thirty (81%) patients were males. Follow up period was 6 months. Tuberculosis and malignancies were ruled out. The over all success rate was 86.5%. Conclusion: Rerouting of high or recurrent anal fistulas, though not the ideal procedure, can be a useful option in cases where either the internal opening cannot be found or there has been a failure of conventional procedures. It does not eradicate the problem, but prevents constant uncontrolled discharge, which is the main concern of the patient. (author)

  3. HIV-associated anal cancer

    OpenAIRE

    Newsom-Davis, Thomas; Bower, Mark

    2010-01-01

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

  4. Premature rupture of membranes

    Science.gov (United States)

    ... When the water breaks early, it is called premature rupture of membranes (PROM). Most women will go ... th week of pregnancy, it is called preterm premature rupture of membranes (PPROM). The earlier your water ...

  5. What Is Anal Cancer?

    Science.gov (United States)

    ... anal tumors Polyps: Polyps are small, bumpy, or mushroom-like growths that develop in the mucosa or ... affects skin of the perianal area, vulva, or breast. This condition should not be confused with Paget’s ...

  6. Radiotherapy of the anal canal cancer

    International Nuclear Information System (INIS)

    From 1976 to 1987, 58 patients presenting an anal canal epidermoid carcinoma underwent radiation therapy alone as primary treatment. There were 48 females and ten males with a mean age of 65 years ± 15.5. Tumors were staged according to the 1979 UICC-TNM classification. There were six T1 (10%), 15 T2 (26%), 28 T3 (48%) and nine T4 (16%). Inguinal lymph nodes were involved in 17 cases (29%). No chemotherapy was given. Forty one patients without node involvement were irradiated according to the Papillon Technique. Twenty seven of these patients were boosted with brachytherapy and eight through a perineal portal with a cobalt unit or an electron beam so that the mean cumulative dose to the tumor 55 Gy. Six patients had radical surgery after a poor response to initial radiation therapy. Patients with inguinal involvement were treated by a three or four fields technique with a high energy photons beam (X 25 MV). The given dose to the tumor was between 60-65 Gy in 6.5 weeks. Surgery was performed in two patients with poor regression of the tumor after initial radiotherapy. Mean follow up was 7 years. Forty nine patients (84.4%) were locally controlled. Four failures were salvaged by surgery. Twenty four patients died from cancer and the overall actuarial 3 years and 5 years survival rate were 67% and 50% respectively. Severe side effect of radiation therapy occurred in 5% of cases. Anal sphincter function was preserved in 69% of the patients. This study confirms that radiation therapy gives results comparable with those of surgery allowing the patients to avoid anorectal resection. (author). 22 refs

  7. Anal cancer; Cancer du canal anal

    Energy Technology Data Exchange (ETDEWEB)

    Fesneau, M.; Champeaux-Orange, E. [Service de radiotherapie, Centre regional universitaire de cancerologie Henry-S.-Kaplan CHU de Tours, Hopital Bretonneau, 37 - Tours (France); Champeaux-Orange, E. [Service d' oncologie-radiotherapie, Centre hospitalier regional d' Orleans, 45 - Orleans (France); Hennequin, C. [Service de cancerologie-radiotherapie, hopital Saint-Louis, 75 - Paris (France)

    2010-07-01

    Anal canal epidermoid carcinomas represent 1.2% of digestive cancers and 6% of ano-rectal cancers. For localized diseases, the treatment is based on radiotherapy with or without chemotherapy (5-FU and cisplatin or mitomycin), according to tumour and nodal extension. The recommended treatment dose is 45 Gy in the anal canal, the mesorectum, para-rectal lymph nodes, and inguinal lymph nodes. An additional dose of 15 to 20 Gy is delivered in the initial tumour for good responders. Salvage surgery is necessary in case of poor response. The organs at risk to be considered are bladder, femur heads, small intestine and vulva. The objective of this work is to summarize the epidemiological and radio-anatomic and prognostic characteristics of this tumour. The conformal radiotherapy technique is illustrated by a case report. (authors)

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

    Science.gov (United States)

    Mayer, Erik N.; Lenherr, Sara

    2016-01-01

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

  9. Velopharyngeal sphincter pathophysiologic aspects in the in cleft palat

    Directory of Open Access Journals (Sweden)

    Collares, Marcus Vinicius Martins

    2008-09-01

    Full Text Available Introduction: Cleft lip and palate are common congenital abnormalities with typical functional disorders on speech, deglutition and middle ear function. Objective: This article reviews functional labiopalatine disorders through a pathophysiological view. Method: We performed a literature search on line, as well as books and periodicals related to velopharyngeal sphincter. Our sources were LILACS, MEDLINE and SciELO databases, and we applied to the research Keywords of interest on the velopharyngeal pathophysiology, for articles published between 1965 and 2007. Conclusion: Velopharyngeal sphincter plays a central role in speech, swallowing and middle ear physiology in patients with labiopalatine cleft. At the end of our bibliographic review, pursuant to the velopharyngeal physiology in individuals with this disorder in the functional speech, deglutition and otologic function, we observed that although there is a great number of published data discussing this issue, further studies are necessary to completely understand the pathophysiology, due to the fact they have been exploited superficially.

  10. The Artificial Urinary Sphincter in the Management of Incontinence.

    Science.gov (United States)

    Suarez, Oscar A; McCammon, Kurt A

    2016-06-01

    Despite the emergence of different devices in the treatment of postprostatectomy urinary incontinence, the AMS 800 (American Medical Systems, Minnetonka, MN) remains the gold standard for the treatment of stress urinary incontinence in men. We reviewed the current literature regarding the indications, surgical principles, outcomes, and complications of artificial urinary sphincter placement for stress urinary incontinence after prostatectomy. Despite all the available information, heterogeneous data, different success definitions, and the lack of high-quality prospective studies with long-term follow-up, it is difficult to compare outcomes between studies. In spite of these, the perineal implantation of a single cuff artificial urinary sphincter has withstood the test of time. PMID:26845050

  11. Anal Warts and Anal Intradermal Neoplasia

    OpenAIRE

    Echenique, Ignacio; Phillips, Benjamin R.

    2011-01-01

    For the last five millennia we have been dealing with the annoyance of verrucas. Anogenital human papillomavirus (HPV) infection is the most common sexually transmitted disease in the United States and is increasing in incidence. As in other gastrointestinal conditions, HPV infection can lead to a stepwise transition from normal cells to dysplastic cells and then to invasive anal cancer. Knowledge of the natural history of HPV infection, risk factors, diagnostic tools, and therapeutic methods...

  12. Velopharyngeal sphincter pathophysiologic aspects in the in cleft palat

    OpenAIRE

    Collares, Marcus Vinicius Martins; Costa, Sady Selaimen da; Paniagua, Lauren Medeiros; Dornelles, Sílvia; Silva, Daniela Preto da

    2008-01-01

    Introduction: Cleft lip and palate are common congenital abnormalities with typical functional disorders on speech, deglutition and middle ear function. Objective: This article reviews functional labiopalatine disorders through a pathophysiological view. Method: We performed a literature search on line, as well as books and periodicals related to velopharyngeal sphincter. Our sources were LILACS, MEDLINE and SciELO databases, and we applied to the research Keywords of interest on the velophar...

  13. Rupture of materials

    International Nuclear Information System (INIS)

    The aim of this work is to give a concrete knowledge of the rupture mechanisms of materials. The following points are most particularly detailed: 1)the means used for examining the ruptures 2)the phenomena generating defects in the structures and the mechanical concepts allowing to quantify the local solicitations they induce (mechanics of rupture) 3)the physical mechanisms which lead to the rupture of a material: theoretical rupture, ductile rupture, cleavage, tearing, fatigue and environment effects: stress corrosion, fatigue by corrosion, hydrogen embrittlement, creep...The materials considered are mainly metals and metallic alloys as well as ceramics, glasses or polymers. Some advices to follow in presence of defects and the methods of calculation of materials lifetime are given too. This book is particularly intended to students or engineers already familiarized with materials science and which would deepen the specific phenomena leading to ruptures. (O.M.)

  14. Local generation and action of angiotensin II in dog iris sphincter muscle.

    Science.gov (United States)

    Okamura, T; Wang, Y; Toda, N

    1992-10-01

    Existence of the renin-angiotensin system was pharmacologically investigated in the dog isolated iris sphincter muscle. The sphincter muscle contracted in response to tetradecapeptide, a synthetic renin substrate, angiotensin (ANG) I and ANG II dose-dependently. The contractions induced by these peptides were suppressed by treatment with saralasin, indomethacin and aspirin. Contractile responses to tetradecapeptide and ANG I were also reduced by KRI-1314, a renin inhibitor, and captopril, respectively. ANG II stimulated the release of prostaglandin (PG) F2 alpha from the sphincter muscle. Angiotensin-converting enzyme activity was measurable in the sphincter muscle. Miosis was observed by intracameral injection of ANG I and ANG II into the anterior chamber. These results strongly suggest that angiotensin generating enzymes function in the sphincter muscle and ANG II produced by these enzymes contracts the sphincter muscle via the formation of PG (s), possibly PG F2 alpha. PMID:1336465

  15. Combined surgical/radiological therapy of carcinomas of the anal canal and the peri-anal skin

    International Nuclear Information System (INIS)

    The object of this study was to present a therapeutic conception for the anal carcinoma, based on our own experiences with 26 patients, the communications of literature, and the pathologic and anatomic conditions. It is shown by our own results as well as by literature that a limited surgery restricted itself to removing the tumor site and the concerned lymph nodes together with an appropriate adjuvant radiotherapy brings about the same results as radical surgery alone but is more favorable from the point of view of functionality. For every degree according to TNM stages, a therapy plan is presented taking into consideration the tumor localisation, the fact if lymph nodes are concerned or not, and the possibility of preserving the sphincter. (orig.)

  16. Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer

    DEFF Research Database (Denmark)

    Emmertsen, Katrine; Laurberg, Solveig; Jess, Per

    2013-01-01

    Bowel dysfunction after sphincter-preserving surgery for rectal cancer is a common complication, with the potential to affect quality of life (QoL) strongly. The aim of this study was to examine the extent of bowel dysfunction and impact on health-related QoL after curative sphincter-preserving r......Bowel dysfunction after sphincter-preserving surgery for rectal cancer is a common complication, with the potential to affect quality of life (QoL) strongly. The aim of this study was to examine the extent of bowel dysfunction and impact on health-related QoL after curative sphincter......-preserving resection for rectal cancer....

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

    Institute of Scientific and Technical Information of China (English)

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

    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.

  18. [Anal intraepithelial neoplasia].

    Science.gov (United States)

    de Parades, Vincent; Fathallah, Nadia; Barret, Maximilien; Zeitoun, Jean-David; Lemarchand, Nicolas; Molinié, Vincent; Weiss, Laurence

    2013-01-01

    Anal intraepithelial lesions are caused by chronic infection with oncogenic types of human papillomavirus. Their incidence and prevalence are increasing, especially among patients with HIV infection. Their natural history is not well known, but high-grade intraepithelial lesions seem to have an important risk to progress to squamous cell carcinoma. Their treatment can be achieved by many ways (surgery, coagulation, imiquimod, etc.) but there is a high rate of recurrent lesions. Pretherapeutic evaluation should benefit from high-resolution anoscopy. Periodic physical examination and anal cytology may probably be interesting for screening the disease among patients with risk factors. Vaccine against oncogenic types of papillomavirus may prevent the development of anal intraepithelial neoplasia. PMID:23122632

  19. Anal screening cytology

    Directory of Open Access Journals (Sweden)

    Leiman Gladwyn

    2005-02-01

    Full Text Available Abstract This issue of CytoJournal contains an article on screening for anal intraepithelial neoplasia in high-risk male patients. This accompanying Editorial focuses on current understanding of this relatively new disease entity, with insights as to the potential role of screening cytopathology in the epidemiology, pathophysiology and clinical management of this HIV and HPV related anal lesion, which predominates in male patients living long-term with AIDS. Mention is made of techniques of obtaining samples, methods of preparation, and morphologic classification. Issues of anoscopic confirmation, as well as topical and surgical management are emphasized. The similarity of initial experiences in anal screening to problems encountered early in cervical cancer screening programs several decades ago, are highlighted.

  20. Reflexo pudendo-anal em mulheres normais Pudendo-anal reflex in normal women

    Directory of Open Access Journals (Sweden)

    Geraldo de Aguiar Cavalcanti

    2004-09-01

    Full Text Available São descritas observações do registro do reflexo pudendo-anal em mulheres sem queixas de incontinência urinária. Foram estudadas 31 voluntárias adultas, com estimulação elétrica bilateral e independente do clitóris e registros de superfície em ambos os lados do músculo esfíncter externo do ânus (EEA. As respostas foram obtidas com pulsos duplos de 0,2 ms de duração e intervalos de 5 ms, aplicados a uma freqüência menor que 0,5 Hz. Foram medidas as latências iniciais das respostas. Não foram evidenciadas diferenças entre as respostas obtidas de cada lado do EEA e nem entre os lados, com relação aos estímulos. Uma das voluntárias não apresentou respostas após estimulação de um dos lados. Não foram observadas diferenças relacionadas a paridade total e nem com a presença de partos vaginais. A idade e o índice de massa corpórea não se correlacionaram com as respostas. Em 12% das respostas, a medida das latências foi dificultada pela baixa relação sinal-ruído.The pudendo-anal reflex was studied in a sample of 31 normal women. Responses were obtained after bilateral independent stimulation of the clitoris, with surface recordings from both sides of the external anal sphincter. Reponses were elicited with double-pulses of 0,2 ms duration with a interstimulus interval of 5 ms, frequency of stimulation was lower than 0,5 Hz. A minimal of four responses were recorded after supramaximal stimulation. In one volunteer no response was recorded after unilateral stimulation. Latencies of the responses from the right and left sides of the anal sfincter after right and left stimulation were 36.35±6.37, 36.28±6.23, 35.88±4.68, 36.44±4.45ms, respectively. No relation was detected between latencies and age, body mass index and parity (considering either total parity or vaginal delivery only. In 12% of the recordings uncertainty was introduced in the latency measurements related to a poor signal-noise ratio.

  1. Hepatic rupture in preeclampsia

    International Nuclear Information System (INIS)

    The diagnosis of hepatic rupture in patients with pregnancy-induced hypertension (preeclampsia and eclampsia) is rarely made preoperatively. Diagnostic imaging can be utilized in some patients to confirm the preoperative diagnosis. Since hematoma formation precedes hepatic rupture, then, when diagnostic modalities such as sonography and computed tomography identify patients with hematomas, these patients are at risk of rupture, and should be hospitalized until the hematomas resolve

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

    International Nuclear Information System (INIS)

    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.

  3. [Prevention of intraoperative incidental injuries during sphincter-preserving surgery for rectal cancer and management of postoperative complication].

    Science.gov (United States)

    Han, Fanghai; Li, Hongming

    2016-06-25

    Prevention of intraoperative incidental injuries during radical operation for rectal cancer and management of postoperative complication are associated with successful operation and prognosis of patients. This paper discusses how to prevent such intraoperative incidental injuries and how to manage postoperative complication. (1) Accurate clinical evaluation should be performed before operation and reasonable treatment decision should be made, including determination of the distance from transection to lower margin of the tumor, T and M staging evaluated by MRI, fascia invasion of mesorectum, metastasis of lateral lymph nodes, metastatic station of mesentery lymph node, association between levator ani muscle and anal sphincter, course and length of sigmoid observed by Barium enema, length assessment of pull-through bowel. Meanwhile individual factors of patients and tumors must be realized accurately. (2) Injury of pelvic visceral fascia should be avoided during operation. Negative low and circumference cutting edge must be ensured. Blood supply and adequate length of pull-down bowel must be also ensured. Urinary system injury, pelvic bleeding and intestinal damage should be avoided. Team cooperation and anesthesia procedure should be emphasized. Capacity of handling accident events should be cultivated for the team. (3) intraoperative incidental injuries during operation by instruments should be avoided, such as poor clarity of camera due to spray and smog, ineffective instruments resulted from repeated usage. (4) As to the prevention and management of postoperative complication of rectal cancer operation, prophylactic stoma should be regularly performed for rectal cancer patients undergoing anterior resection, while drainage tube placement does not decrease the morbidities of anastomosis and other complications. After sphincter-preserving surgery for rectal cancer, attentions must be paid to the occurrence of anastomotic bleeding, pelvic bleeding, anastomotic

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

    International Nuclear Information System (INIS)

    External beam radiation therapy alone or in combination with curietherapy is the recommended treatment for anal canal carcinoma in some countries. In others, surgery is the sole accepted treatment. The results for 64 patients treated by external radiotherapy alone show excellent survival for stage T1T2 tumors but results are poor for large tumors (stage T4). Complications follow radiotherapy more frequently in those with stage T3 and T4 tumors. The analysis of local recurrences, complications and survival shows that radiation therapy may be sufficient treatment for stage T1 and T2 and for some stage T3 tumors. The importance of anal sphincter involvement and the poor quality of life for patients who are cured but develop complications, shows the need for combined treatment with surgery and perhaps with chemotherapy. For small tumors the results obtained by external radiotherapy alone are comparable with those obtained by external radiotherapy and curietherapy in terms of survival and complications. (Auth.)

  5. Treatment of anal cancer in the Troendelag region of Norway 1970 to 1989

    International Nuclear Information System (INIS)

    The authors have retrospectively examined the medical records and prospectively studied the survival of 43 patients treated for anal cancer in the Troendelag region of Norway during the period 1970 to 1989. During this period, different strategies were used, ranging from primary surgery to combined chemo-radiotherapy and sphincter saving therapy. 20 patients were treated with surgery alone, 9 patients first with surgery and postoperatively with irradiation because the surgery was non-radical, and 14 patients with combined chemo- and radiotherapy. The five year cancer ani-specific survival in the whole group is 69%. The predicted five year survival in the chemo-radiotherapy group was 90% versus 61% in the group treated with surgery. Primary chemotherapy combined with radiotherapy should be the preferred treatment for carcinoma of the anal canal. 13 refs., 3 figs., 4 tabs

  6. Experimental induction of isolated lower esophageal sphincter relaxation in anesthetized opossums.

    OpenAIRE

    Paterson, W.G.; Rattan, S; Goyal, R K

    1986-01-01

    Isolated lower esophageal sphincter (LES) relaxation, defined as a transient sphincteric relaxation unaccompanied by esophageal peristalsis, has been shown to precede most episodes of gastroesophageal reflux in humans. We studied the genesis of isolated LES relaxation in anesthetized opossums by observing the response of four components of the deglutition reflex (mylohyoid electrical activity, pharyngeal contraction, esophageal peristalsis, and LES relaxation) to pharyngeal tactile stimulatio...

  7. Video manometry of the sphincter of Oddi: a new aid for interpreting manometric tracings and excluding manometric artefacts

    DEFF Research Database (Denmark)

    Madácsy, L; Middelfart, H V; Matzen, Peter;

    2000-01-01

    and were referred with a suspicion of sphincter of Oddi dysfunction were investigated. Sphincter of Oddi pressure and endoscopic images (20 frames/s) were recorded simultaneously on a Synectics PC Polygraf computer system with a time-correlated basis, and then compared. RESULTS: On ESOM, 69 sphincter...

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

    Science.gov (United States)

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

    2013-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2013-01-01

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

  10. The Effect of Biofeedback Therapy on Anorectal Function After the Reversal of Temporary Stoma When Administered During the Temporary Stoma Period in Rectal Cancer Patients With Sphincter-Saving Surgery

    Science.gov (United States)

    Kye, Bong-Hyeon; Kim, Hyung-Jin; Kim, Gun; Yoo, Ri Na; Cho, Hyeon-Min

    2016-01-01

    Abstract We evaluated the effect of biofeedback therapy (BFT) on anorectal function after stoma closure when administered during the interval of temporary stoma after sphincter-preserving surgery for rectal cancer. Impaired anorectal function is common after lower anterior resections, though no specific treatment options are currently available to prevent this adverse outcome. Fifty-six patients who underwent neoadjuvant chemoradiation therapy after sphincter-preserving surgery with temporary stoma were randomized into 2 groups: group 1 (received BFT during the temporary stoma period) and group 2 (did not receive BFT). To evaluate anorectal function, anorectal manometry was performed in all patients and subjective symptoms were evaluated using the Cleveland Clinic Incontinence Score. The present study is a report at 6 months after rectal resection. Forty-seven patients, including 21 in group 1 and 26 in group 2, were evaluated by anorectal manometry. Twelve patients (57.1%) in group 1 and 13 patients (50%) in group 2 were scored above 9 points of Cleveland Clinic Incontinence Score, which is the reference value for fecal incontinence (P = 0.770). With time, there was a significant difference (P = 0.002) in the change of mean resting pressure according to time sequence between the BFT and control groups. BFT during the temporary stoma interval had no effect on preventing anorectal dysfunction after temporary stoma reversal at 6 months after rectal resection. However, BFT might be helpful for maintaining resting anal sphincter tone (NCT01661829). PMID:27149496

  11. The Effect of Biofeedback Therapy on Anorectal Function After the Reversal of Temporary Stoma When Administered During the Temporary Stoma Period in Rectal Cancer Patients With Sphincter-Saving Surgery: The Interim Report of a Prospective Randomized Controlled Trial.

    Science.gov (United States)

    Kye, Bong-Hyeon; Kim, Hyung-Jin; Kim, Gun; Yoo, Ri Na; Cho, Hyeon-Min

    2016-05-01

    We evaluated the effect of biofeedback therapy (BFT) on anorectal function after stoma closure when administered during the interval of temporary stoma after sphincter-preserving surgery for rectal cancer.Impaired anorectal function is common after lower anterior resections, though no specific treatment options are currently available to prevent this adverse outcome.Fifty-six patients who underwent neoadjuvant chemoradiation therapy after sphincter-preserving surgery with temporary stoma were randomized into 2 groups: group 1 (received BFT during the temporary stoma period) and group 2 (did not receive BFT). To evaluate anorectal function, anorectal manometry was performed in all patients and subjective symptoms were evaluated using the Cleveland Clinic Incontinence Score. The present study is a report at 6 months after rectal resection.Forty-seven patients, including 21 in group 1 and 26 in group 2, were evaluated by anorectal manometry. Twelve patients (57.1%) in group 1 and 13 patients (50%) in group 2 were scored above 9 points of Cleveland Clinic Incontinence Score, which is the reference value for fecal incontinence (P = 0.770). With time, there was a significant difference (P = 0.002) in the change of mean resting pressure according to time sequence between the BFT and control groups.BFT during the temporary stoma interval had no effect on preventing anorectal dysfunction after temporary stoma reversal at 6 months after rectal resection. However, BFT might be helpful for maintaining resting anal sphincter tone (NCT01661829). PMID:27149496

  12. Do We Know What Causes Anal Cancer?

    Science.gov (United States)

    ... of anal cancer, but the exact cause of anal cancer is not known. HPV infection Most anal cancers seem to be linked ... cell carcinoma and is also found in some anal warts. Another subtype, HPV-18, is found less often. Most anal warts ...

  13. Radiotherapy of anal carcinomas

    International Nuclear Information System (INIS)

    Report is given on radiotherapy of anal carcinomas. Own experiences and a review of the recent literature are presented. Prior to surgery radiotherapy with high energy electrons in combination with chemotherapy is in the foreground. Especially in cloacogenous carcinoma no residual tumor was found after preliminary irradiation. Our recommended conception of post-operative radiotherapy of the regional lymphatic draining vessels is outlined. (orig./MG)

  14. Treatment Options by Stage (Anal Cancer)

    Science.gov (United States)

    ... Cancer Treatment Anal Cancer Prevention Research Anal Cancer Treatment (PDQ®)–Patient Version General Information About Anal Cancer ... factors affect the prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) depends on ...

  15. Induction chemotherapy and radiotherapy in loco-regionally advanced epidermoid carcinoma of the anal canal

    International Nuclear Information System (INIS)

    OBJECTIVE: To evaluate the treatment results of induction chemotherapy (IC) with carboplatin + 5-FU in combination with curatively intended external beam radiotherapy (RT). MATERIALS AND METHODS: Thirty-two patients diagnosed during the period 1989 - 1994 with loco-regionally advanced cancer of the anal (PHI Tmax≥4 cm or T4 or N+) were treated with IC consisting of one to three courses of carboplatin (300 - 375 mg/m2 i.v.) and 5-fluorouracil [5,000 mg/(m2x120 h) i.v.] followed by RT ± surgery. Treatment results have been analyzed and retrospectively compared to those for 17 patients fulfilling the same disease criteria but treated according to the Swedish National Care Program for Anal Carcinoma during the period 1985 - 1991. Differences in proportions were tested with Fisher's exact test. Kaplan-Meier life table analysis and the Wilcoxon-Peto test statistic were used in the univariate analyses of longitudinal follow-up data. Cox regression analysis was used for the multivariate analyses. RESULTS: The IC regimen is well tolerated. The most common side effects are oral mucositis, gastro-intestinal symptoms with diarrhoea, haematological toxicity, and general fatigue. The treatment results appear promising. A greater proportion of the patients in the IC + RT group were tumor free at conclusion of the primary therapy ((30(32)) vs (10(17)); P = .02). Statistically significant differences in favor of the induction therapy regimen were also found in the Kaplan-Meier analyses for preservation of sphincter (65% vs 46% at 5 years; P = .02), for probability of survival with a preserved sphincter (52 % vs 33 % at 5 years, P = .02), and freedom from recurrence (76 % vs 35 % at 5 years; P = .003). No difference was found with respect to overall survival (66 % vs 59 % at 5 years, P = .8) and tumor specific survival (80 % vs 63 % at 5 years, P = .3). The multivariate Cox regression analyses yielded a significant result in favor of the new regimen with respect to risk for

  16. Treatment of Gastrointestinal Sphincters Spasms with Botulinum Toxin A

    Directory of Open Access Journals (Sweden)

    Giuseppe Brisinda

    2015-05-01

    Full Text Available 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.

  17. Effect of gastro-oesophageal reflux on upper oesophageal sphincter motility in children.

    OpenAIRE

    Willing, J; Davidson, G P; Dent, J; Cook, I

    1993-01-01

    Motor events of the upper oesophageal sphincter associated with gastro-oesophageal reflux were evaluated in 53 symptomatic children (median age 13 months) who were studied recumbent and unsedated. Children were divided into four groups according to symptoms, and then into two groups according to the presence or absence of neurological deficit. No grouping had basal upper oesophageal sphincter pressure that differed significantly from any other. Oesophageal distention due to gastro-oesophageal...

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

    OpenAIRE

    Stoffel, John T.

    2016-01-01

    Detrusor sphincter dyssynergia (DSD) is the urodynamic description of bladder outlet obstruction from detrusor muscle contraction with concomitant involuntary urethral sphincter activation. DSD is associated with neurologic conditions such as spinal cord injury, multiple sclerosis, and spina bifida and some of these neurogenic bladder patients with DSD may be at risk for autonomic dysreflexia, recurrent urinary tract infections, or upper tract compromise if the condition is not followed and t...

  19. Inter-Rater Agreement of Anal Cytology

    OpenAIRE

    Darragh, Teresa M.; Tokugawa, Diane; Castle, Philip E.; Follansbee, Stephen; Borgonovo, Sylvia; LaMere, Brandon J.; Schwartz, Lauren; Gage, Julia C.; Fetterman, Barbara; Lorey, Thomas; Wentzensen, Nicolas

    2012-01-01

    Most anal cancers are caused by persistent infections with carcinogenic human papillomaviruses (HPV). Similar to cervical carcinogenesis, the progression from HPV infection to anal cancer goes through precancerous lesions that can be treated to prevent invasion. In analogy to cervical cytology, anal cytology has been proposed as a screening tool for anal cancer precursors in high-risk populations. We analyzed the inter-observer reproducibility of anal cytology in a population of 363 HIV-infec...

  20. 46 CFR 64.61 - Rupture disc.

    Science.gov (United States)

    2010-10-01

    ... 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, the rupture disc must— (a) Rupture at a pressure...

  1. Variation of the anal resting pressure induced by postexpiratory apnea effort in patients with constipation

    Directory of Open Access Journals (Sweden)

    Thaís Helena Benetti

    2011-03-01

    Full Text Available CONTEXT: Intestinal constipation - a common symptom among the general population - is more frequent in women. It may be secondary to an improper diet or organic or functional disturbances, such as dyskinesia of the pelvic floor. This is basically characterized by the absence of relaxation or paradoxical contraction of the pelvic floor and anal sphincter during evacuation. OBJECTIVE: To analyze, by manometric data, the anal pressure variation at rest, during evacuation effort by using the Valsalva maneuver and forced post-expiratory apnea in subjects with secondary constipation. METHODS: Twenty-one patients (19 females - 90.4% with a mean age of 47.5 years old (23-72 were studied. The diagnosis was performed using anorectal manometry, with a catheter containing eight channels disposed at the axial axis, measuring the proximal (1 and distal (2 portions of the anal orifice. The elevation of the pressure values in relation to the resting with the evacuation effort was present in all patients. The Agachan score was used for clinical evaluation of constipation. The variables studied were: mean anal pressure of the anal orifice for 20 seconds at rest, the effort of evacuation using Valsalva maneuver and the effort of evacuation during apnea after forced expiration, as well as the area under the curve of the manometric tracing at moments Valsalva and apnea. RESULTS: The analysis of the mean values of the anal pressure variation at rest evidenced difference between proximal and distal channels (P = 0.007, independent of the moment and tendency to differ during moments Valsalva and apnea (P = 0.06. The mean of values of the area under the manometric tracing curve showed differences between moments Valsalva and apnea (P = 0.0008, either at the proximal portion or at the distal portion of the anal orifice. CONCLUSION: The effort of evacuation associated with postexpiratory apnea, when compared with the effort associated with the Valsalva maneuver, provides

  2. Induction chemotherapy and radiotherapy in loco-regionally advanced epidermoid carcinoma of the anal canal

    International Nuclear Information System (INIS)

    Purpose: To evaluate the efficacy of induction chemotherapy in combination with radiotherapy for treatment of loco-regionally advanced epidermoid anal carcinoma. Methods and Materials: Thirty-one patients diagnosed during the period 1989-1994 with loco-regionally advanced cancer of the anal canal (PHITmax ≥ 4 cm or T4 or N+) were treated with induction chemotherapy consisting of one to three courses of carboplatin (300-375 mg/m2 i.v.) and 5-fluorouracil [5,000 mg/(m2 x 120 h) i.v.] followed by external beam irradiation ± surgery. Results: The toxicity of the chemotherapy was low. Twenty-nine patients were tumor free after the primary therapy. Kaplan-Meier analyses were made for overall survival, tumor-specific survival, freedom from recurrence, preservation of sphincter, and event-free survival. For these end points the 5-year data were 67, 85, 80, 69, and 51%, respectively. Conclusion: The results are promising but a well-designed randomized trial is needed to further elucidate the role of induction chemotherapy in the treatment of loco-regionally advanced anal carcinoma

  3. Anal channel neoplasm: a neoplasm radio chemo curable

    International Nuclear Information System (INIS)

    Presently work is made an exhaustive revision of the anatomy of the region, the history of the treatments and of the current treatments of channel cancer anal. It makes emphasis in the importance of the conservative treatment with radiochemotherapy (RQT). The present is a prospective study,longitudinal and descriptive. Material and method: between January of 1989 and December of 1994 20 patients attended with cancer of anal channel with an illness metastasis. An average age it was of 62.4 years.The sex, 16 men and 4 women. The performance status 0,1 or 2 of the scale of the ECOQ. In the pathological anatomy: 15 patient epidermic neoplasm, 5 patient basal neoplasm. State I: 2 patients, II: 12 patients, III: 6 patients, IV: 0 patients.Treatment: the radiotherapy one carries out with cobalt 60 and it irradiates the primary tumour and the ganglion structures region, pelvic and inguinal. It surrendered to Gy/dia from Monday to Friday up to 50 Gy. The chemotherapy one carries out with mitomicine C 10 mg/ previous day to the radiotherapy and 5-UGH 1 intravenous g/my in infusion the days from 1 to 4 and from 29 to 32 after the radiotherapy.Results: to) control locorregional patient RC-16 (80%) ,RP 2 patients (10%) , without answer or with progression lesional a patient (5%) .b) State vital: living 15 patients, died 5 patients(continuation 12 to 60 months) .e)Tolerance: there were not deaths for the gastrointestinal treatment and haematological with toxicity moderate.To conclude:1) The radiochemotherapy is the treatment of elect.2)A feasible treatment of being carried out in our environment.3)Required of a good relationship predictable interdisciplinary.4)Toxicity and tolerable.5)Results of conservation of the sphincter in 80%(AU)

  4. Is routine endoanal ultrasound useful in anal fistulas? ¿Es útil la ecografía endoanal de rutina en las fístulas perianales?

    Directory of Open Access Journals (Sweden)

    I. Pascual Migueláñez

    2005-05-01

    Full Text Available Objective: to evaluate the effectiveness of endoanal ultrasound with hydrogen peroxide enhancement in the assessment of anal fistula (tract and internal opening, and to value the utility of this examination for anal or perianal suppuration when performed by a colorectal surgeon trained in this technique. Patients: endoanal ultrasound was performed in 103 patients with anal or perianal suppuration. Twenty patients were excluded: 9 had the external opening closed, and 11 had cryptoglandular abscesses. All ultrasound scans were performed by the same explorer using a B&K Diagnostic Ultrasound System with a 7 MHz endoprobe. The examination was based on the identification of the three anal planes, then hydrogen peroxide was infused and the procedure was repeated. Results: out of 83 patients included, 11 had a perianal sinus and 72 an anal fistula. In all fistulas the main tract was found: 24 were inter-sphinteric (33.33%, 33 trans-sphincteric (45.83%, 3 supra-sphincteric (4.17%, and 12 extra-sphincteric (16.67%. An internal opening was identified in 69 (95.83%. Conclusions: endoanal ultrasound with hydrogen peroxide enhancement is an effective examination to visualize fistulous tracts and internal openings. We think it is highly useful for anal or perianal suppuration to identify abscesses, to recognize a perianal sinus, to check the sphincteric condition, and to plan subsequent surgery.Objetivo: evaluar la efectividad de la ecografía endoanal contrastada con inyección de agua oxigenada para establecer la topografía fistulosa (trayecto y localización del orificio interno y valorar la conveniencia de esta exploración en la supuración anal o perianal cuando es realizada por un cirujano general dedicado a coloproctología y entrenado en esta técnica. Pacientes: se hizo ecografía endoanal a 103 pacientes con supuración anal o perianal. Se excluyeron 20 pacientes del estudio: 9 tenían el orificio externo de la fístula cerrado y 11 presentaban

  5. Double rupture disc experience

    International Nuclear Information System (INIS)

    Result of these observations, comparisons and evaluations can be summarized in the following list of concerns regarding the use of double rupture discs coupled to the liquid space of a steam generator that is subjected to a large leak sodium water reaction event. Single rupture disc show delayed collapse characteristics in LLTR Series I and double disc assemblies are presumed to be more complex with additional delay before opening to give pressure relief. Delayed failure increases pressures in the IHTS and must be adequately covered by design requirements. With CRBR design, the first disc may fail only partially reducing the loading on the second disc with the result that relief performance may not meet requirements

  6. Blunt traumatic pericardial rupture.

    OpenAIRE

    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.

  7. Rupture of Renal Transplant

    OpenAIRE

    Shona Baker; Maria Popescu; Jacob A Akoh

    2015-01-01

    Background. Rupture of renal allograft is a rare and serious complication of transplantation that is usually attributed to acute rejection, acute tubular necrosis, or renal vein thrombosis. Case Presentation. LD, a 26-year-old male with established renal failure, underwent deceased donor transplantation using kidney from a 50-year-old donor with acute kidney injury (Cr 430 mmol/L). LD had a stormy posttransplant recovery and required exploration immediately for significant bleeding. On day th...

  8. Gender influences sphincter of Oddi response to cholecystokinin in the prairie dog.

    Science.gov (United States)

    Tierney, S; Qian, Z; Yung, B; Lipsett, P A; Pitt, H A; Sostre, S; Lillemoe, K D

    1995-10-01

    Although gallstones and disorders of biliary tract motility are both more common in women than men, sphincter of Oddi motility has not previously been compared between the sexes. In this study, cholescintigraphy (under ketamine and diazepam anesthesia) was used to determine gallbladder emptying rate and ejection fraction in response to cholecystokinin (CCK) in eight male and six female prairie dogs fed a nonlithogenic diet. Ten days later, under alpha-chloralose anesthesia, sphincter of Oddi phasic wave activity was monitored for 10-min intervals before (control), during 20 min of CCK infusion, and for 20 min after infusion. Gallbladder emptying rate and ejection fraction and baseline sphincter of Oddi frequency, amplitude, and motility index (= frequency x amplitude) did not differ significantly between the sexes. Sphincter of Oddi phasic wave frequency was increased during CCK infusion in both males and females, but the change in amplitude was significantly greater in females, than males. We conclude that the increased incidence of biliary tract disease in women may be due to altered sphincter of Oddi hormonal response. PMID:7485498

  9. Gallbladder ejection fraction. Nondiagnostic for sphincter of Oddi dysfunction in patients with intact gallbladders.

    Science.gov (United States)

    Kalloo, A N; Sostre, S; Meyerrose, G E; Pasricha, P J; Szabo, Z

    1994-08-01

    Thirty consecutive patients with intact gallbladders and biliary pain were evaluated to determine whether gallbladder ejection fraction could identify sphincter of Oddi dysfunction. The mean gallbladder ejection fraction was 45% in patients with abdominal pain and 72% in normal controls. Gallbladder ejection fractions were then correlated with endoscopically measured sphincter of Oddi pressures in patients with abdominal pain. The mean gallbladder ejection fraction was 41% in 7 patients with elevated sphincter pressures and 46% in 23 patients with normal pressures (P = NS). Thirty-six percent of patients with elevated pressures and 33% of patients with normal pressures had abnormal gallbladder ejection fractions. Gallbladder ejection fraction had a sensitivity of 33%, a specificity of 63%, and a positive predictive value of 25% for detection of elevated pressures. Regression analysis revealed a poor correlation between sphincter pressure and gallbladder ejection fraction (r2 = 0.02). These findings suggest that gallbladder ejection fraction cannot be used to diagnose sphincter of Oddi dysfunction in patients before they undergo cholecystectomy. PMID:7955753

  10. Blunt cardiac rupture.

    Science.gov (United States)

    Martin, T D; Flynn, T C; Rowlands, B J; Ward, R E; Fischer, R P

    1984-04-01

    Blunt injury to the heart ranges from contusion to disruption. This report comprises 14 patients seen during a 6-year period with cardiac rupture secondary to blunt trauma. Eight patients were injured in automobile accidents, two patients were injured in auto-pedestrian accidents, two were kicked in the chest by ungulates, and two sustained falls. Cardiac tamponade was suspected in ten patients. Five patients presented with prehospital cardiac arrest or arrested shortly after arrival. All underwent emergency department thoracotomy without survival. Two patients expired in the operating room during attempted cardiac repair; both had significant extracardiac injury. Seven patients survived, three had right atrial injuries, three had right ventricular injuries, and one had a left atrial injury. Cardiopulmonary bypass was not required for repair of the surviving patients. There were no significant complications from the cardiac repair. The history of significant force dispersed over a relatively small area of the precordium as in a kicking injury from an animal or steering wheel impact should alert the physician to possible cardiac rupture. Cardiac rupture should be considered in patients who present with signs of cardiac tamponade or persistent thoracic bleeding after blunt trauma. PMID:6708151

  11. Rectal prolapse and anal incontinence treated with a modified Roscoe Graham operation

    DEFF Research Database (Denmark)

    Klaaborg, K E; Qvist, N; Kronborg, O

    1985-01-01

    The results of abdominal mobilization of the rectum and repair of the pelvic floor behind the anorectal junction are reported in 23 patients with rectal prolapse, being accompanied by some form of anal incontinence in 12. Within 20 months, on the average, three patients had recurrent prolapse. Two...... thirds of the patients with incontinence for solid and/or fluid feces were cured for prolapse as well as incontinence. Seven became constipated, while 14 were fully satisfied. Seven of eight patients with a highly reduced tone of the external sphincter before surgery had a marked improvement after...... surgery. The results do not differ greatly from those after the suspension operation or repair of the pelvic floor in front of the rectum, despite being more physiologic, but suggest that simultaneous suspension and abdominal repair of the pelvic floor may avoid the need for a secondary postanal repair...

  12. Electrocautery Superior to Topical Treatments for Precancerous Anal Lesions

    Science.gov (United States)

    ... and data sets for researchers Research by Cancer Type Find research about a specific cancer type Progress Annual Report ... Laws Careers Visitor Information Search Search Home Cancer Types Anal Cancer Research Anal Cancer Patient Anal Cancer Treatment Anal Cancer ...

  13. What's New in Anal Cancer Research and Treatment?

    Science.gov (United States)

    ... resources for anal cancer What’s new in anal cancer research and treatment? Important research into anal cancer is ... Your Doctor After Treatment What`s New in Anal Cancer Research? Other Resources and References Cancer Information Cancer Basics ...

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

    Directory of Open Access Journals (Sweden)

    Covarelli Piero

    2009-11-01

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

  15. Phasic or terminal detrusor overactivity in women: age, urodynamic findings and sphincter behavior relationships

    Directory of Open Access Journals (Sweden)

    Françoise A. Valentini

    2011-12-01

    Full Text Available OBJECTIVES: To search for relationships between phasic (P and terminal (T DO with age, urodynamic findings and sphincter behavior during involuntary detrusor contraction in woman. MATERIALS AND METHODS: Urodynamic studies (triple lumen catheter 7F, seated position of 164 successive women referred for LUTS with diagnosis of DO were reviewed. Patients were stratified in 4 sub-groups: pre- (18-44y, peri- (45-54 y, post-menopause (55-74 y and oldest old (≥ 75 y. The urethral sensor was positioned at the level of the maximum urethral closure pressure for sphincter behavior analysis. A variation of at least 5 cmH2O in pressure (detrusor or urethra was chosen to assert DO or sphincter response. Sphincter response was classified as relaxation (re before or during DO, or steady (st. RESULTS: Occurrence of P and TDO was similar: 77 P and 87 T. The PDO group was significantly younger (p = 0.0003. TDO was more frequent in patients with a history of neurological disease. The percentage of PDO remained almost constant in age groups, while that of TDO increased with age from 6.7% to 23.2% (p = 0.0013. Uninhibited contraction occurred at a smaller bladder volume in the P group: 149 ± 95 vs. 221 ± 113 mL (p < 0.0001. Steady sphincter predominated in the TDO subgroup: 45.9% vs. 32.1% and increased significantly in each DO sub-group of ³ 75y. CONCLUSION: Steady sphincter during both P and TDO, and occurrence of TDO appear as specific of aging. The last result could be related to structural changes in the detrusor muscle with aging.

  16. [Achilles tendon rupture].

    Science.gov (United States)

    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

  17. Blood vessel rupture by cavitation

    OpenAIRE

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

    2010-01-01

    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 ca...

  18. Comparison of botox and lateral internal sphincterotomy treatment outcomes in chronic anal fissures

    Directory of Open Access Journals (Sweden)

    Tolga Dinç

    2014-03-01

    Full Text Available Objective: Both botox and lateral internal sfinkterotomi are treatment technics used in chronic anal fissure; provide the relaxation of anal sphincter and as a result of this, healing occurs. Aim of this study is to compare efficacy of botox and LIS treatment in chronic anal fissure and discussing with the literature. Methods: 60 of 66 patients who has chronic anal fissure, that we reached, treated but not healed with medical therapy, appealed to the Dr. Sami Ulus Hospital included the study. Gender, age, fissure localization, complaints (pain, bleeding, itching, constipation, complaint length, recurrences after treatment, continence conditions and complications of patients were registered. Results: Sixty patients were enrolled the study. Of the 60 patients; 38(63.3% were male and 22 (27.7% were female. Mean age of all patients was 35.93 ± 11.45 (21 -60. Pain was the common complaint of the all patients. 10 (32.3% recurrence were detected in botox treatment group (Group-I, only 1 (3.4% recurrence was in LIS group (Group-II. There was no complication as an incontinence in group-I but 3 cases with incontinence (10.39% were obtained in group-II. In the evaluation of these 3 cases by Cleveland Clinic Continence Scoring System, 2 cases classified as gas incontinence and 1 case as moderate fecal incontinence. Conclusion: Although botulinum toxin injection seen as an alternative treatment method with low complication rates such as incontinence, high recurrence is an important shortcoming of this technic. LIS performed by experienced surgeons remained the most popular treatment modality with low complication rates and great deal of healing success.

  19. Delay in diagnosis of congenital anal stenosis

    OpenAIRE

    Weledji, Elroy P; Motaze Sinju

    2016-01-01

    Although a minor anorectal malformation the delay in diagnosis and treatment of anal stenosis may result in significant early or late complications. Early inspection of the perineum in the neonate to pick up and correct anorectal malformation improves long term outcome but this requires proper anal examination or it could be missed. We present and discuss a case of delayed diagnosis of congenital anal stenosis (a low anorectal anomaly) with an imminent colonic perforation. Severe anal stenosi...

  20. Sphincter of Oddi Manometry: Reproducibility of Measurements and Effect of Sphincterotomy in the EPISOD Study

    Science.gov (United States)

    Suarez, Alejandro L; Pauls, Qi; Durkalski-Mauldin, Valerie; Cotton, Peter B

    2016-01-01

    Background/Aims The reproducibility of sphincter of Oddi manometry (SOM) measurements and results of SOM after sphincterotomy has not been studied sufficiently. The aim of our study is to evaluate the reproducibility of SOM and completeness of sphincter ablation. Methods The recently published Evaluating Predictors and Interventions in sphincter of Oddi dysfunction (EPISOD) study included 214 subjects with post-cholecystectomy pain, and fit the criteria of sphincter of Oddi dysfunction type III. They were randomized into 3 arms, irrespective of manometric findings: sham (no sphincterotomy), biliary sphincterotomy, and dual (biliary and pancreatic). Thirty-eight subjects had both biliary and pancreatic manometries performed twice, at baseline and at repeat endoscopic retrograde cholangiopancreatography after 1–11 months. Sham arm was examined to assess the reproducibility of manometry, and the treatment arms to assess whether the sphincterotomies were complete (elevated pressures were normalized). Results Biliary and pancreatic measurements were reproduced in 7/14 (50%) untreated subjects. All 12 patients with initially elevated biliary pressures in biliary and dual sphincterotomy groups normalized after biliary sphincterotomy. However, 2 of 8 subjects with elevated pancreatic pressures in the dual sphincterotomy group remained abnormal after pancreatic sphincterotomy. Paradoxically, normal biliary pressures became abnormal in 1 of 15 subjects after biliary sphincterotomy, and normal pancreatic pressures became abnormal in 5 of 15 patients after biliary sphincterotomy, and in 1 of 9 after pancreatic sphincterotomy. Conclusions Our data suggest that SOM measurements are poorly reproducible, and question whether we could adequately perform pancreatic sphincterotomy. PMID:26951046

  1. Delay in diagnosis of congenital anal stenosis

    Directory of Open Access Journals (Sweden)

    Elroy P. Weledji

    2016-03-01

    Full Text Available Although a minor anorectal malformation the delay in diagnosis and treatment of anal stenosis may result in significant early or late complications. Early inspection of the perineum in the neonate to pick up and correct anorectal malformation improves long term outcome but this requires proper anal examination or it could be missed. We present and discuss a case of delayed diagnosis of congenital anal stenosis (a low anorectal anomaly with an imminent colonic perforation. Severe anal stenosis will always require examination under anesthesia with graded Hegar's dilatation followed by postoperative maintenance. The Hegar dilator is thus both diagnostic and therapeutic in congenital anal stenosis.

  2. Primer izpeljave analize besedila v kvalitativni raziskavi

    OpenAIRE

    Roblek, Vasja

    2013-01-01

    V članku na podlagi kvalitativne raziskave prikazujemo primer načina analize in razlage besedila. V prvem delu se osredotočimo na teoretično opredelitev analitičnega orodja ter značilnosti analize in interpretacije besedil znotraj kvalitativne raziskave. V nadaljevanju na podlagi izsledkov (polstrukturiranih intervjujev in osebnih zapisov, opazovanja delovanja dveh mrež) prikažemo možnost analize in interpretacije dobljenih podatkov z uporabo analitičnega orodja tematske mreže.

  3. Primer izpeljave analize besedila v kvalitativni raziskavi:

    OpenAIRE

    Roblek, Vasja

    2009-01-01

    V članku na podlagi kvalitativne raziskave prikazujemo primer načina analize in razlage besedila. V prvem delu se osredotočimo na teoretično opredelitev analitičnega orodja ter značilnosti analize in interpretacije besedil znotraj kvalitativne raziskave. V nadaljevanju na podlagi izsledkov (polstrukturiranih intervjujev in osebnih zapisov, opazovanja delovanja dveh mrež) prikažemo možnost analize in interpretacije dobljenih podatkov z uporabo analitičnega orodja tematske mreže.

  4. Untreated silicone breast implant rupture

    DEFF Research Database (Denmark)

    Hölmich, Lisbet R; Vejborg, Ilse M; Conrad, Carsten;

    2004-01-01

    Implant rupture is a well-known complication of breast implant surgery that can pass unnoticed by both patient and physician. To date, no prospective study has addressed the possible health implications of silicone breast implant rupture. The aim of the present study was to evaluate whether untre...

  5. Carcinoma of the anal canal

    International Nuclear Information System (INIS)

    There are many unresolved issues in the management of epidermoid anal canal cancer, although substantial progress has been made in gaining acceptance of techniques that preserve anal function. Resolution of the most basic questions would require formal comparisons of radical surgery, radiation therapy alone, and combined modality therapy. However, patients are unlikely to participate in studies in which one or more options would offer a chance to avoid a colostomy. Informal comparisons of published series suggest that modern radiation therapy and combined modality therapy give survival rates similar to those reported following radical surgery. Other questions being addressed include identification of optimal radiation techniques, detailed exploration of the mechanisms, efficacy, and toxicity of drug and radiation combinations, and identification of effective systemic chemotherapy. All studies are made difficult by the relative rarity of this tumor. Even without formal clinical trials, however, the series reported the use of either radiation therapy alone or combined modality therapy as the initial treatment for epidermoid anal canal carcinoma, thereby preserving anal function whenever possible and reserving radical surgery for the patient with residual carcinoma

  6. 'Frozen finger' in anal fissures.

    Science.gov (United States)

    Chintamani; Tandon, Megha; Khandelwal, Rohan

    2009-10-01

    Acute anal fissures are usually managed by various invasive and non-invasive modalities ranging from simple lifestyle changes to chemical and surgical sphincterotomies. Frozen finger, prepared using a water-filled ordinary rubber glove, was successfully used in one hundred patients, thus providing a cost-effective and simple solution to the problem. PMID:19671780

  7. Blunt traumatic diaphragmatic rupture

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Nogueira

    2011-09-01

    Full Text Available Traumatic injury of the diaphragm ranges from 0.6 to 1.2% and rise up to 5%among patients who were victims of blunt trauma and underwent laparotomy.Clinical suspicion associated with radiological assessment contributes to earlydiagnosis. Isolated diaphragmatic injury has a good prognosis. Generallyworse outcomes are associated with other trauma injuries. Bilateral andright diaphragmatic lesions have worse prognosis. Multi detector computed tomography (MDCT scan of the chest and abdomen provides better diagnosticaccuracy using the possibility of image multiplanar reconstruction. Surgicalrepair via laparotomy and/ or thoracotomy in the acute phase of the injury hasa better outcome and avoids chronic complications of diaphragmatic hernia.The authors present the case of a young male patient, victim of blunt abdominaltrauma due to motor vehicle accident with rupture of the diaphragm, spleenand kidney injuries. The diagnosis was made by computed tomography of thethorax and abdomen and was confirmed during laparotomy.

  8. Spontaneous Rupture of Pyometra

    Directory of Open Access Journals (Sweden)

    Fatemeh Mallah

    2013-01-01

    Full Text Available Spontaneous perforation is a very rare complication of pyometra. The clinical findings of perforated pyometra are similar to perforation of the gastrointestinal tract and other causes of acute abdomen. In most cases, a correct and definite diagnosis can be made only by laparotomy. We report two cases of diffuse peritonitis caused by spontaneous perforated pyometra. The first case is a 78-year-old woman with abdominal pain for which laparotomy was performed because of suspected incarcerated hernia. The second case is a 61-year-old woman with abdominal pain for which laparotomy was performed because of symptoms of peritonitis. At laparotomy of both cases, 1 liter of pus with the source of uterine was found in the abdominal cavity. The ruptured uterine is also detected. More investigations revealed no malignancy as the reason of the pyometra.

  9. Splenic rupture following colonoscopy

    Institute of Scientific and Technical Information of China (English)

    Juan Francisco Guerra; Ignacio San Francisco; Fernando Pimentel; Luis Ibanez

    2008-01-01

    Colonoscopy is a safe and routinely performed diagnostic and therapeutic procedure for different colorectal diseases. Although the most common complications are bleeding and perforation, extracolonic or visceral injuries have also been described. Splenic rupture is a rare complication following colonoscopy, with few cases reported. We report a 60-year-old female who presented to surgical consultation 8 h after a diagnostic colonoscopy. Clinical, laboratory and imaging findings were suggestive for a massive hemoperitoneum. At surgery, an almost complete splenic disruption was evident, and an urgent splenectomy was performed. After an uneventful postoperative period, she was discharged home. Splenic injury following colonoscopy is considered infrequent. Direct trauma and excessive traction of the splenocolic ligament can explain the occurrence of this complication. Many times the diagnosis is delayed because the symptoms are due to colonic insufflation, so the most frequent treatment is an urgent splenectomy. A high index of suspicion needs an early diagnosis and adequate therapy.

  10. Short-lived Supershear Rupture

    Science.gov (United States)

    Fukuyama, E.; Xu, S.; Yamashita, F.; Mizoguchi, K.; Takizawa, S.; Kawakata, H.

    2015-12-01

    Fukuyama and Olsen (2002) computed the supershear rupture initiation, propagation and termination process due to a passage of high stress drop area (called asperity) using a boundary integral equation method. They found that supershear rupture continued to propagate after the passage through high stress drop area but it died after a certain propagation distance, which depends on the elastic energy released at the high stress drop area. Here, we could reproduce a similar phenomenon in the laboratory. We conducted large-scale biaxial friction experiments using a pair of meter-scaled metagabbro rock specimens (VP=6.9km/s, VS=3.6km/s) at the National Research institute for Earth Science and Disaster Prevention (NIED). We observed several stick slip rupture events that initiated close to an asperity and immediately became supershear ruptures. But after propagating certain distance they died out and co-existing subshear ruptures became prominent. If we look into details, during the supershear rupture, we could see a sequence of rupture acceleration, its short rest and re-acceleration. This feature reminds us of a sequential breakage of small high stress patches as predicted by Fukuyama and Madariaga (2000). These observations might be interpreted under a concept of energy balance where the energy transmission from strain energy released by the asperity to fracture energy consumed at the crack tip was not instantaneously balanced in space. This could be related to the fact that earthquake rupture velocity is rather smooth reported from the finite fault analysis of large earthquakes with seismic waveforms. References Fukuyama, E. and R. Madariaga (2000) Dynamic propagation and interaction of a rupture front on a planar fault, PAGEOPH, 257, 1959-1979. Fukuyama, E. and K.B. Olsen (2002) A condition for super-shear rupture propagation in a heterogeneous stress field, PAGEOPH, 159, 2047-2056.

  11. Orthognathic Consequences of Sphincter Pharyngoplasty in Cleft Patients: A 2-Institutional Study

    Science.gov (United States)

    Yoshikane, Frances; Lai, Li Han; Hui, Brian K.; Martins, Deborah B.; Farias-Eisner, Gina; Mandelbaum, Rachel S.; Hoang, Han; Bradley, James P.; Wilson, Libby

    2016-01-01

    Background: Understanding long-term sequelae of cleft treatment is paramount in the refinement of treatment algorithms to accomplish optimized immediate and long-term outcomes. In this study, we reviewed sphincter pharyngoplasties as a method of velopharyngeal insufficiency (VPI) treatment in relationship to orthognathic surgery. Methods: Cleft lip/palate and cleft palate patients, 15 years of age and older, were reviewed for demographics, VPI surgery, revisions, and subsequent orthognathic surgery at 2 institutions. Chi-square test, Student’s t test, and logistic regression analyses were performed. Results: In 214 patients reviewed (mean age, 19.5 years), 61.7% were male, 18.2% had isolated cleft palate, 61.2% had unilateral cleft lip and palate, and 20.6% had bilateral cleft lip and palate. A total of 33.6% were diagnosed with VPI and received a sphincter pharyngoplasty (mean age, 11.9 years). When subsequent orthognathic surgery was examined, sphincter pharyngoplasty was not associated with maxillary advancement (P = 0.59) but did correlate with an increase in mandibular surgery from 2.8% to 11.1% (P = 0.02). The indications for mandibular surgery in the pharyngoplasty population were related to congenital micrognathia. When cephalometric analyses were evaluated, sphincter pharyngoplasty resulted in a decreased sella-to-nasion-to-B point angle (mean, 79.0–76.3 degrees, P = 0.02) and a higher incidence of normal to class II maxillomandibular relationships as defined by A point-to-nasion-to-B point angles >0.5 (P = 0.02). Conclusions: Sphincter pharyngoplasty decreases anterior mandibular growth and the discrepancy between maxillomandibular skeletal relationships because of the frequent predisposition of cleft patients to maxillary hypoplasia. In patients with congenital mandibular micrognathia, a small increase in mandibular surgeries may occur. PMID:27200238

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

    Institute of Scientific and Technical Information of China (English)

    Grace H Elta

    2008-01-01

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

  13. Can preoperative radiotherapy of rectal cancer convert a radical abdomino-perineal resection into a sphincter preserving surgery?

    International Nuclear Information System (INIS)

    Randomized trials published in the literature do not demonstrate definitively that preoperative radiotherapy increases the chance of sphincter preservation in rectal cancer. A long interval (four to six weeks) between radiotherapy and surgery may increase in selected cases of low rectal cancer the chance of sphincter preservation. Such an improvement must not lead to an increased rate of local recurrence and must preserve a good functional sphincter. Ongoing trials of dose escalation and concurrent radio-chemotherapy will provide interesting data regarding this complex question. (author)

  14. Neural control of the sphincter of Oddi. A physiological role of 5-hydroxytryptamine in the regulation of basal sphincter of Oddi motor activity in the cat.

    OpenAIRE

    Behar, J; Biancani, P

    1983-01-01

    The effect of 5-hydroxytryptamine (5-HT) on the sphincter of Oddi (SO) was studied in the cat. The SO had two motor responses to 5-HT: the most common was an initial contraction followed by a more prolonged relaxation, and the other was an exclusive relaxation. Tetrodotoxin did not impair the magnitude of the net contraction induced by 5-HT, but it completely blocked the relaxation. Methysergide partially inhibited the SO contraction in response to submaximal doses of 5-HT (5-20 micrograms/kg...

  15. Analýza mysli

    Czech Academy of Sciences Publication Activity Database

    Nosek, Jiří

    Praha : Filosofia, 2005 - (Sousedík, P.), s. 337-351 ISBN 80-7007-212-1. [Aktuální problémy logické a filosofické analýzy /8./. Pec pod Sněžkou (CZ), 19.09.2004-22.09.2004] Institutional research plan: CEZ:AV0Z90090514 Keywords : Analysis * Mind * Plato Subject RIV: AA - Philosophy ; Religion

  16. Elements of an anal dysplasia screening program.

    Science.gov (United States)

    Jay, Naomi

    2011-01-01

    The incidence of anal cancer in HIV-infected men who have sex with men (MSM) is highly elevated compared to the general population, as is the incidence of its precursor lesion, high-grade anal intraepithelial neoplasia (HGAIN). MSM in general and other immunocompromised populations are also at higher risk. Treatment of HGAIN may prevent development of cancer, similar to the decrease in cervical cancers that has occurred since the advent of cervical cancer screening programs in women. Cervical cancer screening tools have been adapted and validated for screening, diagnosis, and treatment of anal HGAIN. Anal cancer screening programs have now been available for more than a decade, although they are not yet standards of care. Incorporating screening procedures into practice depends on the available resources in a particular community. This article discusses the procedures for anal cancer screening including cytology, digital anal rectal examinations, high-resolution anoscopy, and biopsy. PMID:22035526

  17. The ruptured PIP breast implant

    International Nuclear Information System (INIS)

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2000-01-01

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

  19. Premature closure of the upper esophageal sphincter as a cause of severe deglutition disorder in infancy

    DEFF Research Database (Denmark)

    Nielsen, Rasmus; Husby, Steffen; Kruse-Andersen, Søren

    2005-01-01

    Deglutition disorders in infancy are often associated with birth asphyxia or structural abnormalities in the hypopharynx, the trachea, or the esophagus. Manometry can be crucial for clarifying the dynamics of the swallowing disorder in the infant with deglutition problems and without signs of these...... causes. An 8-week-old infant was referred because of suspicion of cricopharyngeal achalasia causing persistent swallowing problems and failure to thrive. Manometry results showed normal resting tone and relaxation but premature closure of the upper esophageal sphincter. The infant was treated with...... balloon dilatation of the upper esophageal sphincter and expectance. A maturation process of the swallowing sequence was noted over time and documented by repeated manometric procedures....

  20. Movement of the upper esophageal sphincter and a manometric device during deglutition

    International Nuclear Information System (INIS)

    A cineradiographic examination of 9 healthy subjects showed asynchronous movement of a manometric device in relation to movement of the upper esophageal sphincter (UES) during deglutition. A single sensor placed within the UES high pressure zone at rest registered pressures existing outside this zone during the major part of deglutition. The manometric device must therefore comprise at least three sensors placed at different levels and about 10 mm apart if consistent pressure recording within this zone is to be achieved. In order to evaluate the pressure profile within the sphincter adequately, cineradiographic determination of the orientation of the measuring device is necessary. This was made possible by insertion of two mutually perpendicular radiopaque indicators into the catheter. (orig.)

  1. Human Papillomavirus, Condylomata Acuminata, and Anal Neoplasia

    OpenAIRE

    Chang, George J.; Welton, Mark L.

    2004-01-01

    Genital human papillomavirus (HPV) infection is an increasingly common sexually transmitted disease. This virus causes condylomata acuminata and is associated with anal neoplasia. Management options are discussed.

  2. KRAS and BRAF mutations in anal carcinoma

    DEFF Research Database (Denmark)

    Serup-Hansen, Eva; Linnemann, Dorte; Høgdall, Estrid;

    2015-01-01

    The EGF receptor (EGFR) is expressed in most cases of anal carcinomas. Anecdotal benefit from EGFR-targeted therapy has been reported in anal cancer and a negative correlation with Kirsten Ras (KRAS) mutation status has been proposed. The purpose of this retrospective study was to investigate the...... frequency and the prognostic value of KRAS and BRAF mutations in a large cohort of patients with anal cancer. One hundred and ninety-three patients with T1-4N0-3M0-1 anal carcinoma were included in the study. Patients were treated with curative (92%) or palliative intent (8%) between January 2000 and...

  3. Botulinum toxin for upper oesophageal sphincter dysfunction in neurological swallowing disorders.

    OpenAIRE

    Walshe, Margaret; Coughlan, Tara; MCMAHON, BARRY; REGAN, JULIE

    2014-01-01

    PUBLISHED Art. No.: CD009968. DOI: 10.1002/14651858.CD009968.pub2 Adequate upper oesophageal sphincter (UOS) opening is critical to safe and efficient swallowing due to the close proximity of the UOS to the airway entrance. Many people with neurological conditions, progressive and non-progressive, present with UOS dysfunction. The consequences for the person include difficulty swallowing food with subsequent choking and aspiration (passage of material into the trachea beyond the level o...

  4. Pubovaginal sling in the treatment of stress urinary incontinence for urethral hypermobility and intrinsic sphincteric deficiency

    Directory of Open Access Journals (Sweden)

    Agnaldo L. Silva-Filho

    2003-12-01

    Full Text Available PURPOSE: This study was undertaken to evaluate the use of pubovaginal sling for the treatment of female stress urinary incontinence in patients with intrinsic sphincteric deficiency and patients with urethral hypermobility. MATERIALS AND METHODS: Sixty-two patients aging 22 to 73 years-old (mean = 49.6 with a median parity of 4.1 (range 0 - 14 who underwent pubovaginal autologous fascial sling procedures for stress urinary incontinence from August/1999 to August/2002 were prospectively analyzed. Objective pre and postoperative urodynamic evaluation was performed in all cases. The patients were divided into 2 groups: thirty-nine patients (62.9% with urethral hypermobility (Valsalva leak point pressure equal or superior to 60 cm of H2O and twenty-three patients (37.1% with intrinsic sphincteric insufficiency (Valsalva leak point pressure below 60 cm of H2O. RESULTS: The average follow-up period was 24.8 months, ranging from 3 to 38 months. Three patients (4.8% had detrusor overactivity before the operation, and 36 patients (58.1% had voiding dysfunction before surgery. The postoperative objective cure rate was 88.7% for stress urinary incontinence. The study also showed that 32.2% of the patients had voiding dysfunction and 11.3% had detrusor overactivity. The mean hospital stay was 3.1 days (range 2 - 4. No difference in the above parameters was noticed between patients with intrinsic sphincteric deficiency and those with urethral hypermobility. CONCLUSION: Construction of a pubovaginal sling is an effective technique for the relief of severe stress urinary incontinence, for both patients with urethral hipermobility and with intrinsic sphincteric deficiency, having a cure rate of 88.7%. The high frequency of postoperative voiding urgency was not related to the detrusor overactivity as evaluated by urodynamic studies.

  5. Detrusor-External Sphincter Dyssynergia: Review of Minimally Invasive and Endoscopic Management.

    Science.gov (United States)

    Barbalat, Yanina; Rutman, Matthew

    2016-04-01

    Detrusor-external sphincter dyssynergia (DSD) is a debilitating problem in patients with spinal cord injury. DSD carries a high risk of complications, and even life expectancy can be affected. Management of this condition includes the use of antimuscarinic agents in combination with intermittent catheterization, indwelling urethral catheterization, suprapubic catheterization, and a variety of surgical options, depending on patient and physician preference. This paper will review the current literature and data on minimally invasive and endoscopic management of DSD. PMID:26826587

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

    OpenAIRE

    Elta, Grace H.

    2008-01-01

    Although there are numerous causes of acute pancreatitis, an etiology cannot always be found. Two potential etiologies, microlithiasis and sphincter of Oddi dysfunction, are discussed in this review. Gallbladder microlithiasis, missed on transcutaneous ultrasound, is reported as the cause of idiopathic acute pancreatitis in a wide frequency range of 6%-80%. The best diagnostic technique for gallbladder microlithiasis is endoscopic ultrasound although biliary crystal analysis and empiric chole...

  7. Bowel symptom experiences and management following sphincter saving surgery for rectal cancer: A qualitative perspective

    OpenAIRE

    Landers, Margaret; McCarthy, Geraldine; Savage, Eileen

    2012-01-01

    The aim of this research was to explore participants’ qualitative perspectives on bowel symptom experiences and management strategies following sphincter saving surgery for rectal cancer. Methods and sample The data presented in this paper were gleaned from a semi-structured question that formed part of a larger multi-site quantitative correlational study. From a sample of 143 participants, a total of 77 (62.6%) males and 46 (37.3%) females provided qualitative comments. Participants were age...

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

    LENUS (Irish Health Repository)

    Mulsow, Jürgen

    2011-02-21

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

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

    LENUS (Irish Health Repository)

    Mulsow, Jurgen

    2012-02-01

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

  10. Comparative Relaxant Effects of Ataciguat and Zaprinast on Sheep Sphincter of Oddi

    Science.gov (United States)

    Çakmak, Erol; Yönem, Özlem; Saraç, Bülent; Parlak, Mesut; Çelik, Cumali; Ataseven, Hilmi; Bağcivan, İhsan

    2016-01-01

    Background: Relaxing the sphincter of Oddi (SO) is an important process during endoscopic retrograde cholangiopancreatography (ERCP) procedures. This issue suggests that the easier the sphincterotomy and cannulation, the more post-ERCP complications decrease. Aims: To compare the relaxant effects of ataciguat (a novel soluble guanylyl cyclase activator) and zaprinast (an inhibitor of phosphodiesterase 5) on sheep SO in vitro, thus testing whether they can be used during ERCP. Study Design: Animal experimentation. Methods: Sheep SO rings were placed in tissue baths and their isometric tension to ataciguat and zaprinast were tested. We also tested their isometric tension against ataciguat in the presence of 1H-(1,2,4) oxadiazole (4,3-a) quinoxalin-1-one (ODQ) which is a soluble guanylyl cyclase inhibitor. Results: Ataciguat and zaprinast both triggered concentration addicted relaxation on sheep SO rings (p=0.0018, p=0.0025 respectively) but the relaxation of the ataciguat was significantly greater than that of zaprinast at all concentrations (p=0.0024). It was observed that decreased relaxation responses were initiated by ataciguat in the presence of ODQ (p=0.0012). Conclusion: Ataciguat and zaprinast both have relaxing effects on sphincter of Oddi, although that of zaprinast is lower. We believe that ataciguat and zaprinast can be used in ERCP procedures in order to relax the sphincter of Oddi and thus can be used locally in order to decrease complications.

  11. Impact of castration with or without alpha-tocopherol supplementation on the urethral sphincter of rats

    Directory of Open Access Journals (Sweden)

    Mirian Kracochansky

    2012-04-01

    Full Text Available OBJECTIVE: To analyze the impact of low levels of testosterone induced by orchiectomy and the effect of alpha-tocopherol supplementation on oxidative stress in the urethral sphincter. MATERIALS AND METHODS: Forty male Wistar rats weighing 250-300g were divided into four groups with 10 each: Sham group; Orchiectomy group: bilateral orchiectomy; Orchiectomy-pre-Tocopherol group: bilateral orchiectomy preceded by alpha-tocopherol supplementation for four weeks; Orchiectomy-full-Tocopherol group: bilateral orchiectomy with alpha-tocopherol supplementation for four weeks preceding the procedure and for eight weeks afterwards. At the protocol end, animals were euthanized and had the sphincter analyzed stereologically focusing on collagen and muscle fibers percentage. Oxidative stress levels were determined using 8-epi-PGF2. RESULTS: The 8-epi-PGF2 levels were statistically higher (p < 0.0003 in the Orchiectomy group compared to others groups while Sham and Orchiectomy-full-Tocopherol groups presented statistically similar values (p = 0.52. Collagen volumetric densities were significantly lower in Sham and Orchiectomy-full-Tocopherol groups (p < 0.022. Sham group presented statistically greater muscle fiber percent. CONCLUSION: Castration caused oxidative stress in the urethral sphincter complex, with increased collagen deposition. Alpha-tocopherol had a protective effect and its supplementation for twelve weeks provided the greatest protection.

  12. Nocturnal faecal soiling and anal masturbation.

    OpenAIRE

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

    1990-01-01

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

  13. Anal intraepithelial neoplasia: review and recommendations for screening and management.

    Science.gov (United States)

    Smyczek, Petra; Singh, Ameeta E; Romanowski, Barbara

    2013-11-01

    Anal cancer is a rare malignancy of the distal gastrointestinal tract, often associated with human papillomavirus, the most common sexually transmitted infection worldwide. Currently available screening methods for anal intraepithelial neoplasia, a precursor for anal cancer, combine anal Papanicolaou cytology and high resolution anoscopy with biopsy of suspicious lesions. Significant barriers to establishing anal cancer screening programmes include the small number of healthcare professionals performing high resolution anoscopy and the lack of data showing that anal cancer screening can reduce morbidity and mortality related to anal carcinoma. Despite several controversies surrounding anal cancer screening, the rising incidence of this disease in some groups supports routine screening programmes in high-risk populations, especially in HIV-positive men who have sex with men. This review outlines the epidemiology of anal intraepithelial neoplasia and anal cancer and summarizes issues related to the introduction of anal cancer screening programmes. PMID:23970583

  14. Self-Rupturing Hermetic Valve

    Science.gov (United States)

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

    2011-01-01

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

  15. Partial ACL rupture: an MR diagnosis?

    International Nuclear Information System (INIS)

    We sought to clarify the ability of magnetic resonance imaging (MR) to show partial anterior cruciate ligament (ACL) ruptures and to allow distinction of partial from complete ACL ruptures. Eighty-eight patients were studied by arthroscopy and MR (36 with normal ACLs, 21 with partial ACL ruptures, and 31 with complete ACL ruptures). MR studies were interpreted by an experienced, blinded reader. MR examinations were also independently scored with respect to four primary and seven secondary signs, and these data were analyzed using discriminant analysis. The sensitivity of MR is lower for partial than for complete ACL ruptures. Most detected partial ACL ruptures resemble complete ruptures on MR. Secondary signs do not significantly improve detection of partial ACL ruptures, but they do help to distinguish partial from complete ACL ruptures. Displacement of the posterior horn of the lateral meniscus and popliteus muscle injury are indicative of complete ACL rupture. The majority of partial ACL ruptures are shown by MR, but MR is less sensitive for partial than for complete ACL rupture. The distinction of partial from complete ACL rupture on MR examination, while problematic, is slightly improved by assessment of secondary signs. (orig.)

  16. Partial ACL rupture: an MR diagnosis?

    Energy Technology Data Exchange (ETDEWEB)

    Yao, L. [Dept. of Radiological Sciences, UCLA Center for the Health Sciences, Los Angeles, CA (United States); Gentili, A. [Dept. of Radiology, UCLA-Wadsworth Medical Center, Los Angeles, CA (United States); Petrus, L. [Dept. of Radiology, UCLA-Olive View Medical Center, Sylmar, CA (United States); Lee, J.K. [Dept. of Radiology, Samaritan Hospital, Troy, NY (United States)

    1995-05-01

    We sought to clarify the ability of magnetic resonance imaging (MR) to show partial anterior cruciate ligament (ACL) ruptures and to allow distinction of partial from complete ACL ruptures. Eighty-eight patients were studied by arthroscopy and MR (36 with normal ACLs, 21 with partial ACL ruptures, and 31 with complete ACL ruptures). MR studies were interpreted by an experienced, blinded reader. MR examinations were also independently scored with respect to four primary and seven secondary signs, and these data were analyzed using discriminant analysis. The sensitivity of MR is lower for partial than for complete ACL ruptures. Most detected partial ACL ruptures resemble complete ruptures on MR. Secondary signs do not significantly improve detection of partial ACL ruptures, but they do help to distinguish partial from complete ACL ruptures. Displacement of the posterior horn of the lateral meniscus and popliteus muscle injury are indicative of complete ACL rupture. The majority of partial ACL ruptures are shown by MR, but MR is less sensitive for partial than for complete ACL rupture. The distinction of partial from complete ACL rupture on MR examination, while problematic, is slightly improved by assessment of secondary signs. (orig.)

  17. The relapses of cancerous growths of anal canal

    International Nuclear Information System (INIS)

    In this chapter of book authors give information about general comprehensions of the relapses of anal canal cancerous growths, the classification of the relapses of anal canal cancerous growths, frequency of the relapses of anal canal cancerous growths, the diagnostics of the relapses of anal canal cancerous growths and prophylaxis and treatment of relapses

  18. Spontaneous Splenic Rupture in Melanoma

    Directory of Open Access Journals (Sweden)

    Hadi Mirfazaelian

    2014-01-01

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

  19. Sonographic Findings of Ruptured Endometrioma

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Sung Il; Ko, Su Yeon; Kim, Young Jun; Park, Hee Seun; Jeon, Hae Jeong [Konkuk University School of Medicine, Seoul (Korea, Republic of); Jeong, Kyung Ah [School of Medicine, Ewha Womans University, Seoul (Korea, Republic of)

    2010-03-15

    To evaluate the characteristic sonographic findings of ruptured endometrioma in comparison with unruptured endometrioma. Fifty nine cases of pathologically proven endometrioma were categorized as the ruptured endometrioma group and the unruptured endometrioma group on the basis of the operation records. The sonographic findings such as locularity, the internal echotexture, the size and the wall thickness of the cyst and the presence of a fluid-fluid level, fibrin strands, a retracting clot and fluid in the pelvic cavity were retrospectively evaluated using logistic regression analysis. On univariate analysis, the sonographic finding of a thin wall (odds ratio, 4.1: 95% confidence interval: 1.2-13.8) and a fluid-fluid level (odds ratio, 9.0: 95% confidence interval: 2.4-33.6) were significantly different between the ruptured endometrioma group and the unruptured endometrioma group. Logistic regression analysis showed that a thin wall (odds ratio, 7.5: 95% confidence interval: 1.6-34.4) and a fluid-fluid level (odds ratio, 14.7: 95% confidence interval: 3.1-70.2) were both independent variables significantly associated with unruptured endometrioma. The characteristic sonographic findings of ruptured endometrioma are a thin cystic wall and a fluid-fluid level in the cyst, as compared with those of unruptured endometrioma

  20. Prophylactic HPV vaccination and anal cancer.

    Science.gov (United States)

    Stier, Elizabeth A; Chigurupati, Nagasudha L; Fung, Leslie

    2016-06-01

    The incidence of anal cancer is increasing. High risk populations include HIV-positive men who have sex with men (MSM), HIV-negative MSM, HIV-positive women and heterosexual men and women with a history of cervical cancer. HPV has been detected in over 90% of anal cancers. HPV16 is the most common genotype detected in about 70% of anal cancers. The quadrivalent HPV (qHPV) vaccine has been demonstrated to prevent vaccine associated persistent anal HPV infections as well as anal intraepithelial neoplasia grades 2-3 (AIN2+) in young MSM not previously infected. A retrospective analysis also suggests that qHPV vaccination of older MSM treated for AIN2+ may significantly decrease the risk of recurrence of the AIN2+. The HPV types detected in anal cancer are included in the 9-valent vaccine. Thus, the 9-valent HPV vaccine, when administered to boys and girls prior to the onset of sexual activity, should effectively prevent anal cancer. PMID:26933898

  1. Mechanics of Multifault Earthquake Ruptures

    Science.gov (United States)

    Fletcher, J. M.; Oskin, M. E.; Teran, O.

    2015-12-01

    The 2010 El Mayor-Cucapah earthquake of magnitude Mw 7.2 produced the most complex rupture ever documented on the Pacific-North American plate margin, and the network of high- and low-angle faults activated in the event record systematic changes in kinematics with fault orientation. Individual faults have a broad and continuous spectrum of slip sense ranging from endmember dextral strike slip to normal slip, and even faults with thrust sense of dip slip were commonly observed in the aftershock sequence. Patterns of coseismic slip are consistent with three-dimensional constrictional strain and show that integrated transtensional shearing can be accommodated in a single earthquake. Stress inversions of coseismic surface rupture and aftershock focal mechanisms define two coaxial, but permuted stress states. The maximum (σ1) and intermediate (σ2) principal stresses are close in magnitude, but flip orientations due to topography- and density-controlled gradients in lithostatic load along the length of the rupture. Although most large earthquakes throughout the world activate slip on multiple faults, the mechanical conditions of their genesis remain poorly understood. Our work attempts to answer several key questions. 1) Why do complex fault systems exist? They must do something that simple, optimally-oriented fault systems cannot because the two types of faults are commonly located in close proximity. 2) How are faults with diverse orientations and slip senses prepared throughout the interseismic period to fail spontaneously together in a single earthquake? 3) Can a single stress state produce multi-fault failure? 4) Are variations in pore pressure, friction and cohesion required to produce simultaneous rupture? 5) How is the fabric of surface rupture affected by variations in orientation, kinematics, total geologic slip and fault zone architecture?

  2. A Mouse Model for Human Anal Cancer

    OpenAIRE

    Stelzer, Marie K.; Pitot, Henry C.; Liem, Amy; Schweizer, Johannes; Mahoney, Charles; Lambert, Paul F.

    2010-01-01

    Human anal cancers are associated with high-risk human papillomaviruses (HPVs) that cause other anogenital cancers and head and neck cancers. As with other cancers, HPV16 is the most common high-risk HPV in anal cancers. We describe the generation and characterization of a mouse model for human anal cancer. This model makes use of K14E6 and K14E7 transgenic mice in which the HPV16 E6 and E7 genes are directed in their expression to stratified squamous epithelia. HPV16 E6 and E7 possess oncoge...

  3. VERJETNOSTNE VARNOSTNE ANALIZE JEDRSKE ELEKTRARNE V ZAUSTAVITVI

    OpenAIRE

    Antončič, Mitja

    2016-01-01

    Pričujoča magistrska naloga obravnava verjetnostne varnostne analize jedrske elektrarne v zaustavitvenih stanjih. Verjetnostne varnostne analize so namenjene ocenjevanju in izboljšanju varnosti kompleksnih sistemov, tudi jedrskih elektrarn. Skozi analizo izvemo možne neželene dogodke, do katerih lahko pride v sistemu, verjetnost nastopa teh dogodkov, način njihovega razvoja in končne posledice. Na podlagi analize lahko določimo pomembnost posameznih komponent, kar je koristna informacija pri ...

  4. Magnetic resonance imaging in acute tendon ruptures

    Energy Technology Data Exchange (ETDEWEB)

    Daffner, R.H.; Lupetin, A.R.; Dash, N.; Riemer, B.L.

    1986-11-01

    The diagnosis of acute tendon ruptures of the extensor mechanism of the knee or the Achilles tendon of the ankle may usually be made by clinical means. Massive soft tissue swelling accompanying these injuries often obscures the findings, however. Magnetic resonance imaging (MRI) can rapidly demonstrate these tendon ruptures. Examples of the use of MRI for quadriceps tendon, and Achilles tendon rupture are presented.

  5. Effect of somatostatin on the sphincter of Oddi in patients with acute non-biliary pancreatitis

    OpenAIRE

    Lai, K.; Lo, G.; Cheng, J; Fu, M; Wang, E; Chan, H.; Wang, Y.; P. Hsu; Lin, C.

    2001-01-01

    BACKGROUND—Somatostatin has been used to prevent pancreatitis after endoscopic retrograde cholangiopancreatography but its effect on acute non-biliary pancreatitis is still unclear.
AIM—The purpose of this study was to evaluate the function of the sphincter of Oddi (SO) and the effect of somatostatin on patients with non-biliary pancreatitis.
METHODS—Twenty patients (18 males, two females) with acute pancreatitis (alcoholic 18, idiopathic two) received SO manometry within one week after admis...

  6. Chemoradiation therapy for anal cancer

    International Nuclear Information System (INIS)

    Chemoradiation therapy for anal cancer was carried out in 58 patients using low-dose, continuous infusion of 5-fluorouracil (5-FU) with or without continuous infusion of cisplatin (cDDP) and external beam irradiation (chemoXRT). Thirty-nine patients received 5-FU chemoXRT resulting in a local control rate of 50% in those receiving a total dose of 60 Gy. The actuarial local control rate at 2 years was 77% after chemoXRT alone; overall local control was 67% at 5 years. In 18 patients receiving 5-FU plus cisplatin with radiation doses of 54-55 Gy, actuarial local control was 85% at 2 years. Fifteen patients failed chemoXRT, 13 of whom had abdominoperineal resection for salvage; the overall local control rate was 93% (54/58). The actuarial survival at 5 years was 81% for the 5-FU chemoXRT group and 94% at 2 years for the 5-FU plus cisplatin chemoXRT group; median follow-up was 54 and 20 months, respectively. Diarrhea and nausea were the most frequent early reactions and were ameliorated by limiting the duration of chemotherapy to 5 days/week and by using XRT techniques to exclude the small bowel from the radiation portal. Serious late radiation complications have not been observed and may be related to XRT fraction and the use of protracted chemotherapy infusion. The absence of late morbidity coupled with the high local control rate by the use of this chemoXRT program is an area to investigate for improving the therapeutic ratio for the treatment of anal cancers. (author)

  7. Treatment of anal canal carcinoma with concomitant radiotherapy and chemotherapy. Preliminary results from Hospital do Cancer A.C. Camargo, Sao Paulo State, Brazil; Tratamento do carcinoma do canal anal com radioterapia e quimioterapia concomitantes. Resultados preliminares do Hospital do Cancer A.C. Camargo

    Energy Technology Data Exchange (ETDEWEB)

    Lima Junior, Carlos Genesio Bezerra; Ferrigno, Robson; Salvajoli, Joao Victor [Hospital do Cancer A.C. Camargo, Sao Paulo, SP (Brazil). Dept. de Radioterapia]. E-mail: rferrigno@uol.com.br; David Filho, Waldec Jose [Hospital do Cancer A.C. Camargo, Sao Paulo, SP (Brazil). Dept. de Oncologia Clinica; Rossi, Benedito Mauro; Lopes, Ademar [Hospital do Cancer A.C. Camargo, Sao Paulo, SP (Brazil). Dept. de Cirurgia Pelvica

    2001-02-01

    Background: To report our results of anal canal carcinoma treatment with concomitant radiotherapy and chemotherapy. Method: From January 1992 to May 1998, 24 patients with anatomo-pathologic diagnosis of anal canal carcinoma were treated. Age ranged from 35 years old to 74 years old median of 59 years old. Female and male ratio was 3:1. The number of patients per stage was: I - 1, II - 13, III - 9 and IV - 1. Radiotherapy was delivered with doses of 45 Gy at the whole pelvis with 4 MeV Linear Accelerator followed by boost to the anal canal until 55 Gy through direct field at Cobalt unit. Chemotherapy consisted of 5-FU (1000 mg/m{sup 2}) and Mitomycin C (10 mg/m{sup 2}) during the first and last five days of radiotherapy. Results: The mean follow-up period was 34 months. Complete response was observed in 23 (95,8%) patients. Fourteen (58,3%) patients are alive with no cancer, 3 (12%) are alive with cancer, 5 (20,8%) died with cancer and 1 (4,2%) died with no evidence of cancer. Local recurrences occurred in 5 (20,8%) and distant metastasis in 4 (16,6%). All patients with local recurrence were salvaged with abdominal perineal resection. Sphincter function was preserved in 18 (75%) patients. Acute and chronic complications were observed in 19 (79,2%) and in 9 (37,5%) patients, respectively. Conclusions: The treatment was effective in terms of local control and sphincter preservation, but a with high incidence of acute and late complications. Lower dose of radiation at the whole pelvis should be a reasonable approach to improve acute and late side effects. A larger number of patients and a longer follow-up will give more information about this treatment approach. (author)

  8. Anal intercourse: a risk factor for anal papillomavirus infection in women?

    OpenAIRE

    Law, C L; Thompson, C. H.; Rose, B R; Cossart, Y E

    1991-01-01

    OBJECTIVE--To determine whether anal intercourse is a risk factor for anal HPV infection in women. DESIGN--Results derived from clinical examination, anal cytology and HPV DNA hybridisation were correlated with data obtained from a questionnaire administered to the patients at the time of their clinical examination. SETTING--A sexually transmitted diseases (STD) clinic in Sydney, Australia. SUBJECTS--31 women attending the clinic for HPV related problems. METHODS AND RESULTS--A thorough histo...

  9. Effects of remifentanil on the sphincter of Oddi in a 3-year-old child: a case report.

    Science.gov (United States)

    Sato, Makoto; Kikuchi, Chika; Sasakawa, Tomoki; Kunisawa, Takayuki

    2016-08-01

    Opioids cause spasm of the sphincter of Oddi. Remifentanil is metabolized enzymatically throughout the body. Its context-sensitive half-time is 3 to 4minutes. The effect of remifentanil on the sphincter of Oddi is unknown, especially in children. We recently encountered a patient in whom the administration of remifentanil caused spasm of the sphincter of Oddi, which resolved rapidly after discontinuation of remifentanil. A 3-year-old girl weighing 11.3kg was scheduled to undergo common bile duct excision with ductoplasty. Her diagnosis was congenital biliary dilatation. In the operating room, after achieving the initial induction through sevoflurane (5%) and intravenous rocuronium (10mg), she was intubated and administered a continuous paravertebral block by levobupivacaine (25mg/10mL +2.5mg/h). General anesthesia was maintained with sevoflurane (2%), remifentanil (0.5 μg kg(-1) min(-1)), and oxygen (fractional inspired oxygen tension, 0.33). The first intraoperative cholangiogram obtained via the cystic duct tube showed obstruction at the terminal end of the common bile duct. We injected scopolamine butylbromide (5mg, intravenous) to relax the sphincter of Oddi. However, the next cholangiogram obtained 3minutes later still showed an obstruction. We speculated that the obstruction may have been caused by remifentanil-induced spasm of the sphincter of Oddi. Therefore, we stopped administering remifentanil; 2minutes later, we achieved satisfactory passage of the contrast material to the duodenum. The predicted plasma concentrations of remifentanil at the time of stopping its administration and at the time of disobliteration were 6.38and 2.55ng/mL, respectively. The patient's postoperative course was uneventful. In patients who have spasms of the sphincter of Oddi during the administration of remifentanil, the resultant obstruction can be treated effectively by reducing the infusion rate of remifentanil. PMID:27290986

  10. Spontaneous Rupture of Bladder in Puerperium without Uterine Rupture

    Directory of Open Access Journals (Sweden)

    Subrat Panda

    2012-11-01

    Full Text Available Objective: we report a case of intraperitoneal urinary bladder rupture I week following normal delivery ina primigravida, who presented with huge urinary ascites, anuria and renal failure. Abdominalparacentesis and exploratory laparotomy was done and a diagnosis of intraperitoneal bladder rupturewas made. The rent was repaired in layers. This may be preventable if adequate precaution in the formof evacuating the bladder before the patient goes into second stage of labor is undertaken.

  11. Radiochemotherapy of locally advanced anal canal carcinoma: Prospective assessment of early impact on the quality of life (randomized trial ACCORD 03)

    International Nuclear Information System (INIS)

    Background and purpose: The aim of this study was to prospectively assess the quality of life (QOL) of patients treated by concomitant chemo radiation for locally advanced anal canal carcinoma. Materials and methods: We report on a subgroup of 119 patients enrolled in a 306-patient therapeutic intensification prospective trial (ACCORD 03). This trial evaluated the impact on colostomy-free survival of induction chemotherapy and/or high dose radiotherapy (factorial design 2 * 2 treatment arms). QOL was assessed both before and 2 months after treatment using the EORTC QLQ-C30 questionnaire as well as a questionnaire relating to anal sphincter conservative treatment (AS-CT). Results: Compared to pre-treatment scores, patients reported significant improvement in their emotional function (+8.4 points p = 0.002), global health status (+5.9 points p = 0.0007), as well as a decrease in insomnia (-13.8 points p < 0.0001), constipation (-12.0 points p < 0.0001), appetite loss (-10.3 points p < 0.0001) and pain (-9.6 points p = 0.0002). The AS-CT degree of satisfaction with intestinal functions score was increased (+11.2 points p < 0.0001). Conclusion: This is the first prospective study comparing QOL of patients with advanced anal canal carcinoma, before and 2 months after conservative treatment. Two months after treatment, QOL was improved. Induction chemotherapy and/or high dose radiotherapy did not provide a negative impact on QOL

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

    Science.gov (United States)

    Leung, Felix W

    2011-10-01

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

  13. Ultrassom anorretal tri-dimensional pode selecionar pacientes com tumor no reto após neoadjuvância para cirurgia de preservação esfincteriana? Can three-dimensional anorectal ultrasound select patients with rectal tumor for sphincter-saving resection after post-chemoradiotherapy

    Directory of Open Access Journals (Sweden)

    Sthela Maria Murad-Regadas

    2009-09-01

    Full Text Available OBJETIVO: Avaliar a resposta pós-quimioradioterapia-QT no tratamento do tumor no reto utilizando ultrassom anorretal tridimensional(US-3-D visando definir a estratégia cirúrgica adequada. MÉTODO: Avaliou-se prospectivamente 32 pacientes com adenocarcinoma no reto médio e inferior. Realizou-se US-3-D para estadiamento e avaliação quanto à invasão no canal anal ou distância(cm entre tumor e esfíncter anal interno-EAI: GrupoI-invasão no canal anal; GrupoII-distância menor-ou-igual 2cm, GrupoIII-distância maior 2. Foram encaminhados neoadjuvância e realizado US-3D após 50-55 dias. A escolha da estratégia cirúrgica baseou-se na resposta pós-QT e achados do US-3-D/pós-QT e comparado com histopatológico. RESULTADOS: O US-3-D/pós-QT coincidiu com histopatológico em 31/32, eficácia de 97%. Evidenciou-se 26/27 casos com lesão residual, sensibilidade de 96%, sendo 19(59% resposta parcial e 07 (22% sem resposta. Em 5/5 o US-3-D/pós-QT demonstrou resposta completa, especificidade e valor preditivo positivo 100%. Valor preditivo negativo 83% pois um(3% caso inconclusivo. Realizou-se cirurgia de preservação esfincteriana em 16 pacientes (05 com resposta completa, 10 com resposta parcial e um inconclusivo com margem maior que 2cm. Confirmados ao histopatológico com margem livre. O índice Kappa na avaliação de linfonodos demonstrou concordância substancial(87,5%. Conclui-se que o US-3D pode ser útil na escolha de pacientes que irão beneficiar-se com a cirurgia de preservação esfincteriana.PROPOSAL: Evaluate the post-chemoradiotherapy response for treatment of rectal tumor using three-dimensional anorectal ultrasound-3D-US to determine the best surgical approach METHODS: 32 patients with lower and middle rectal cancer were prospectively staged using 3D-US to identify anal canal invasion and the distance(cm between tumor and the internal anal sphincter-IAS, Group l:with anal canal invasion; Group II-with distance =2cm; Group

  14. Radiochemotherapy in the conservative treatment of anal canal carcinoma: Retrospective analysis of results and radiation dose effectiveness

    International Nuclear Information System (INIS)

    Purpose: This retrospective analysis reports the results on patients with anal canal carcinoma treated by combined radiotherapy and chemotherapy. Methods and materials: Between March 1993 and December 2001, 43 patients with anal canal carcinoma were treated with radiochemotherapy at the Hospital do Ca-hat ncer A.C. Camargo. Stage distribution was as follows: I, 3 (7%); II, 23 (53.5%); IIIA, 8 (18.6%); and IIIB, 9 (21%). The median age was 56 years (range, 36-77 years) with most patients being women (4:1). External radiotherapy (RT) was delivered at the whole pelvis followed by a boost at the primary tumor. The median dose of RT at the whole pelvis and at the primary tumor was 45 Gy and 55 Gy, respectively. Chemotherapy was carried out during the first and last 4 days of RT with continuous infusion of 5-fluorouracil (1000 mg/m2) and bolus mitomycin C (10 mg/m2). Median overall treatment time was 51 days (range, 30-129 days). Thirty-four patients (79%) did not receive elective RT at the inguinal region. Patient's age, tumor stage, overall treatment time, and RT dose at primary tumor were variables analyzed for survival and local control. Results: Median follow-up time was 42 months (range, 4-116 months). Overall survival and colostomy-free survival at 5 years was 68% and 52%, respectively. Overall survival according to clinical stage was as follows: I, 100%; II, 82%; IIIA, 73%; and IIIB, 18% (p = 0.0049). Complete response was observed in 40 patients (93%). Local recurrence occurred in 9 (21%) patients, and of these, 6 were rescued by surgery. Local control with a preserved sphincter was observed in 34 patients (79%). According to the RT dose, local control was higher among patients who received more than 50 Gy at primary tumor (86.5% vs. 34%, p = 0.012). Inguinal failure was observed in 5 patients (15%) who did not receive inguinal elective RT. Distant metastasis was observed in 11 patients (25.6%). Temporary interruption of the treatment as a result of acute

  15. Anal Disorders - Multiple Languages: MedlinePlus

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Anal Disorders URL of this page: https://medlineplus.gov/languages/analdisorders.html Other topics A-Z A B ...

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

    International Nuclear Information System (INIS)

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

  17. Squamous cell carcinoma of anal canal

    International Nuclear Information System (INIS)

    Squamous cell carcinoma of the anal canal is rather rare and amounts to 3.5% of all rectal neoplasms. Though it has a clear-cut clinical picture, 29.5% of patients admitted for specialized treatment suffer from stage 4 due to inadequate diagnosis. Surgery is the most effective method of management of squamous cell carcinoma of the anal canal. Radiation therapy may be an adjuvant procedure to surgery

  18. Anal intraepitelial neoplasia: a narrative review

    OpenAIRE

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

    2016-01-01

    Anal intraepitelial neoplasia (AIN) constitutes a major health problem in certain risk groups, such as patients with immunosuppression of varied origin, males who have sexual relations with other males, and females with a previous history of vaginal or cervical abnormalities in cytology. Its relationship with the human papillomavirus (HPV) infection has been well documented; however, many of the factors involved in the progression and regression of the viral infection to dysplasia and anal ca...

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

    Science.gov (United States)

    Stoffel, John T

    2016-02-01

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

  20. Spontaneous hepatic rupture in pregnancy.

    Science.gov (United States)

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

    1977-12-01

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

  1. Oesophageal rupture masquerading as STEMI.

    Science.gov (United States)

    Skaug, Brian; Taylor, Kenneth R; Chandrasekaran, Somya

    2016-01-01

    A 67-year-old man presented to the emergency department, with acute onset of chest pain. Based on ECG changes suggestive of ST elevation myocardial infarction (STEMI), he was taken emergently to the cardiac catheterisation laboratory for coronary angiography. There he was found to have only non-obstructive coronary disease. Subsequent physical examination and review of his chest radiograph revealed subcutaneous emphysema, and CT scan revealed a distal oesophageal rupture and pneumomediastinum. After stabilisation in the intensive care unit (ICU), he was taken to the operating room for thoracotomy, chest tube placement and stenting of his oesophagus. He survived the incident and, after several weeks of ICU stay, recovered to a large extent. His case highlights the importance of considering oesophageal rupture in the differential diagnosis for acute onset of chest pain. PMID:27068730

  2. Coerced anal sex against spouses in Turkey

    Directory of Open Access Journals (Sweden)

    Ramazan Karanfil

    2014-12-01

    Full Text Available Objective: The aim of this study was to investigate medicolegal aspects of sexual assaults involving anal penetration against females by their partners. Methods: This study includes 34 females claimed to be exposed to anal sexual assaults and referred to the Department of Forensic Medicine, Kahramanmaraş Sütçü İmam University between January 2007 and June 2012. Data were obtained from physical examination records and a face to face applied questionnaire composed of questions about socio-demographic features. Results: Sexual assaults involving anal penetration were committed against females in all 34 cases included in the study. The mean age of the victims was 23.2±5.2 years. Twenty-four women (70.6% had a history of physical violence, but 10 (29.4% did not. Out of all, only four women were presented to hospital because of assault. The rest were noticed to be transferred with conditions other than assaults but they were found out to be exposed to anal assaults on examinations. Most of the cases were young, female and a housewife and were exposed to anal assault. Conclusion: Anal sexual assault against females by their partners is a serious problem in our region. Therefore, screening studies on women should be conducted to determine the frequency of the condition and to provide solutions for the problem. J Clin Exp Invest 2014; 5 (4: 529-533

  3. Rupture of the meniscofibular ligament

    OpenAIRE

    Poyanli Oguz; Esenkaya Irfan; Ozkan Korhan; Unay Koray; Akan Kaya

    2010-01-01

    Abstract The meniscofibular ligament is an anatomically defined ligament of the knee in humans. However, there are no data regarding the prognosis following injury to this ligament. Our case was a 42-year-old man who presented at our clinic with pain of the lateral side of his left knee. MRI of his left knee revealed the rupture of the meniscofibular ligament. The mechanism of injury was consistent with anatomical and mechanical studies of the meniscofibular ligament. The patient was treated ...

  4. Bubble rupture in bubble electrospinning

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    Chen Rouxi

    2015-01-01

    Full Text Available As the distinctive properties and different applications of nanofibers, the demand of nanofibers increased sharply in recently years. Bubble electrospinning is one of the most effective and industrialized methods for nanofiber production. To optimize the set-up of bubble electrospinning and improve its mass production, the dynamic properties of un-charged and charged bubbles are studied experimentally, the growth and rupture process of a bubble are also discussed in this paper.

  5. Preoperative chemoradiation for extraperitoneal T3 rectal cancer: Acute toxicity, tumor response, and sphincter preservation

    International Nuclear Information System (INIS)

    Purpose: To evaluate whether or not an intermediate dose of preoperative external radiation therapy intensified by systemic chemotherapy could improve the tumor response, sphincter preservation, and tumor control. Methods and Materials: Between March 1990 and December 1995, 83 consecutive patients with resectable extraperitoneal adenocarcinoma of the rectum were treated with preoperative chemoradiation: bolus i.v. mitomycin C (MMC), 10 mg/m2, Day 1 plus 24-h continuous infusion i.v. 5-fluorouracil (5FU) 1000 mg/m2, Days 1-4, and concurrent external beam radiotherapy (37.8 Gy). All but 2 patients had T3 disease. Surgery was performed 4-6 weeks after the end of chemoradiation. Results: Total Grade 3-4 acute toxicity during chemoradiation was observed in 11 (13%) patients: hematological Grade 3 toxicity was recorded in 8 (10%) patients, and Grade 4 toxicity was recorded in 2 (2%) patients. Grade 3 diarrhea was seen in 2 (2%) patients. No patient had major skin or urological acute toxicity. Two patients had no surgery: 1 died before surgery from septic complications after Grade 4 hematological toxicity; 1 refused surgery and is still alive after 6 years. There was no postoperative mortality and the overall perioperative morbidity rate was 25%. The analysis of tumor response involved 81 patients. Overall, 9% of 81 patients had a complete pathologic response. Comparing the stage at the diagnostic workup with the pathologic stage, tumor downstaging was observed in 46 (57%) patients. We had 7 (9%) pT0, 5 (6%) pT1, 33 (41%) pT2, and 36 (44%) pT3. Nodal status downstaging was detected in 46 patients (57%). No evidence of nodal involvement was observed in 59 patients (73%). The incidence of tumor response was affected significantly by the number of quarters of rectal circumference involved (p = 0.03) and, marginally, by the length of the tumor (p = 0.09). The distance between the lower pole of the tumor and the anorectal ring had no influence. Of the patients, 63 (78%) had a

  6. Molecular dynamics of interface rupture

    Science.gov (United States)

    Koplik, Joel; Banavar, Jayanth R.

    1993-01-01

    Several situations have been studied in which a fluid-vapor or fluid-fluid interface ruptures, using molecular dynamics simulations of 3000 to 20,000 Lennard-Jones molecules in three dimensions. The cases studied are the Rayleigh instability of a liquid thread, the burst of a liquid drop immersed in a second liquid undergoing shear, and the rupture of a liquid sheet in an extensional flow. The late stages of the rupture process involve the gradual withdrawal of molecules from a thinning neck, or the appearance and growth of holes in a sheet. In all cases, it is found that despite the small size of the systems studied, tens of angstroms, the dynamics is in at least qualitative accord with the behavior expected from continuum calculations, and in some cases the agreement is to within tens of percent. Remarkably, this agreement occurs even though the Eulerian velocity and stress fields are essentially unmeasurable - dominated by thermal noise. The limitations and prospects for such molecular simulation techniques are assessed.

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

    Science.gov (United States)

    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

  8. Chemotherapy and low-dose radiotherapy in the treatment of HIV-infected patients with carcinoma of the anal canal

    International Nuclear Information System (INIS)

    Purpose: To determine the efficacy and tolerance of a standardized protocol of chemotherapy and low-dose radiotherapy in the treatment of anal cancer in human immunodeficiency virus (HIV)-infected patients. Methods and Materials: Between 1987 and 1995, eight HIV-positive patients with squamous cell carcinoma of the anal canal, four of whom had acquired immunodeficiency syndrome (AIDS), received therapy at the Kaiser Permanente Medical Center. All patients were treated using a combined modality approach consisting of lowdose radiotherapy (30 Gy in 15 fractions delivered 5 days/week), and chemotherapy [1000 mg/m2 of 5-fluorouracil (5-FU) delivered on days 1-4 and 29-32 as a continuous infusion over 96 h, and 10 mg/m2 of mitomycin C delivered as a bolus injection on day 1]. Patients have been followed from 4 to 81 months (mean 41, median 38). Results: All eight patients completed the therapy with minor variations to the protocol, and all have attained a clinical complete response. Four patients are alive and free of disease, and four died as a result of complications of AIDS, but remained free of anal carcinoma. There were no mortalities from the protocol and the morbidity was acceptable. Only one patient each was noted to have Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer Grade 4 hematologic and gastrointestinal acute toxicity, and no Grade 4 skin toxicity was noted. Conclusion: This combined therapy is effective for HIV-infected patients and appears to be tolerable with acceptable toxicities. It is best applied to patients who are HIV positive, or who have AIDS without concurrent major opportunistic infections. This approach is reasonable and affords patients a reasonably good chance at sphincter preservation by avoiding abdominoperineal resection. The optimal therapy for HIV-positive patients with advanced AIDS remains less well defined

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

    OpenAIRE

    Kim, Yong Kyun; Choi, Sung Sik; Choi, Jung Hwa; Yoon, Jeong-Gyu

    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 Decemb...

  10. Upper esophageal sphincter pressure in patients with Chagas' disease and primary achalasia

    Directory of Open Access Journals (Sweden)

    Dantas R.O.

    2000-01-01

    Full Text Available The most important component of the upper esophageal sphincter (UES is the cricopharyngeal muscle. During the measurement of sphincter pressure the catheter passed through the sphincter affects the pressure value. In Chagas' disease and primary achalasia there is an esophageal myenteric plexus denervation which may affect UES pressure. We measured the UES pressure of 115 patients with Chagas' disease, 28 patients with primary achalasia and 40 healthy volunteers. We used a round manometric catheter with continuous perfusion and the rapid pull-through method, performed in triplicate during apnea. Pressures were measured in four directions, and the direction with the highest pressure (anterior/posterior and the average of the four directions were measured. The highest UES pressure in Chagas' disease patients without abnormalities upon radiologic esophageal examination (N = 63 was higher than in normal volunteers (142.8 ± 47.4 mmHg vs 113.0 ± 46.0 mmHg, mean ± SD, P<0.05. There was no difference in UES pressure between patients with primary achalasia and patients with Chagas' disease and similar esophageal involvement and normal volunteers (P>0.05. There was no difference between patients with or without esophageal dilation. In the group of subjects less than 50 years of age the UES pressure of primary achalasia (N = 21 was lower than that of Chagas' disease patients with normal radiologic esophageal examination (N = 41, measured at the site with the highest pressure (109.3 ± 31.5 mmHg vs 149.6 ± 45.3 mmHg, P<0.01 and as the average of the four directions (64.2 ± 17.1 mmHg vs 83.5 ± 28.6 mmHg, P<0.05. We conclude that there is no difference in UES pressure between patients with Chagas' disease, primary achalasia and normal volunteers, except for patients with minor involvement by Chagas' disease, for whom the UES pressure at the site with the highest pressure was higher than the pressure of normal volunteers and patients with primary

  11. Anal cancer: current and future treatment strategies

    Directory of Open Access Journals (Sweden)

    Chin JY

    2013-01-01

    Full Text Available Joanna Y Chin, Theodore S Hong, Jennifer Y WoDepartment of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USAAbstract: Anal cancer is a relatively rare malignancy, accounting for approximately 2% of gastrointestinal cancers. Concurrent chemoradiation with 5-fluorouracil/mitomycin remains the standard of care for the treatment of anal cancer. There is currently no proven role for platinum-based induction or adjuvant chemotherapy in anal cancer, even in cases of bulky disease. Multiple trials have shown that radiosensitization with concurrent chemotherapy is beneficial over radiation alone, and in particular, efforts to remove or substitute mitomycin from the chemoradiation regimen have been unsuccessful. Because local-regional control remains a challenge in the management of anal cancer, future studies will need to focus on radiation dose-escalation and/or addition of further chemotherapy or targeted agents. Patient selection, eg, with PET-CT or with biomarkers including HPV status, may be necessary to define patients who need more aggressive local treatment, ie, for patients with bulky disease, or to de-escalate treatment in others, ie, patients with early-stage, localized cancer.Keywords: anal cancer, chemoradiation, IMRT

  12. FRP rupture strains in FRP wrapped columns

    OpenAIRE

    Li, Shiqing

    2012-01-01

    Applying lateral confinement to concrete columns using fibre-reinforced polymer (FRP) composites is a very promising technique. FRP rupture is the typical failure mode of FRP wrapped columns under axial compression. numerous experiments have shown that the FRP rupture strain in an FRP wrapped circular column is significantly lower than the FRP ultimate rupture strain determined from flat coupon test of FRP. Despite a large number of studies on the application of FRP confined columns, the mech...

  13. Misdiagnosed Chest Pain: Spontaneous Esophageal Rupture

    OpenAIRE

    Inci, Sinan; Gundogdu, Fuat; Gungor, Hasan; Arslan, Sakir; Turkyilmaz, Atila; Eroglu, Atila

    2013-01-01

    Chest pain is one of themost common complaints expressed by patients presenting to the emergency department, and any initial evaluation should always consider life-threatening causes. Esophageal rupture is a serious condition with a highmortality rate. If diagnosed, successful therapy depends on the size of the rupture and the time elapsed between rupture and diagnosis.We report on a 41-year-old woman who presented to the emergency department complaining of left-sided chest pain for two hours.

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

    Institute of Scientific and Technical Information of China (English)

    Anupender Singh Sidhu; George Triadafilopoulos

    2008-01-01

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

  15. Radiographic and manometric correlation in achalasia with apparent lower esophageal sphincter relaxation

    International Nuclear Information System (INIS)

    The authors compared the clinical, radiographic, and manometric findings in ten patients with atypical achalasia showing complete but short-duration lower esophageal sphincter (LES) relaxation with findings in 39 patients with classic achalasia. Patients with atypical achalasia were younger, had dysphagia and weight loss of shorter duration, and had less esophageal dilation than patients with classic achalesia. LES pressure and esophagogastric junction caliber, however, were similar in the two groups. The majority of patients in both groups responded well to pneumatic dilation. They conclude that achalasia with apparent LES relaxation may represent an early form of this motor disorder and that the radiographic findings remain characteristic except for less dilation of the esophagus

  16. Spontaneous rupture of the malarial spleen

    Directory of Open Access Journals (Sweden)

    Tauro Leo

    2007-01-01

    Full Text Available Spontaneous rupture of the spleen is a well-described occurrence in many diseases, being most commonly found in malaria. Exact incidence of this complication is not clear. In this article, we discuss pathology, diagnostic approach and therapeutic options in a patient with malarial splenic rupture. Ruptures of malarial spleens do heal and attempts at splenic lavage/conservative approach should be the aim in their management. Splenectomy should be reserved for those patients with severe rupture or those with continued or recurrent bleeding.

  17. Gastric and diaphragmatic rupture in early pregnancy.

    Science.gov (United States)

    Morcillo-López, Inmaculada; Hidalgo-Mora, Juan José; Baamonde, Andrés; Díaz-García, César

    2010-11-01

    Simultaneous gastric and diaphragmatic rupture is an exceptional situation during pregnancy and it implies a high-risk of maternal and fetal mortality. They are usually associated with previous diaphragmatic abnormalities such as diaphragmatic hernia or diaphragmatic eventration. Both gastric and diaphragmatic rupture can be triggered by situations involving high intra-abdominal pressure. We present the case of a 35-year-old pregnant woman presenting an unspecific clinical picture of intense chest pain and hypoventilation at 15 weeks of pregnancy. She was diagnosed with diaphragmatic rupture complicated by a gastric rupture. PMID:20716556

  18. Rupture dynamics in model polymer systems.

    Science.gov (United States)

    Borah, Rupam; Debnath, Pallavi

    2016-05-11

    In this paper we explore the rupture dynamics of a model polymer system to capture the microscopic mechanism during relative motion of surfaces at the single polymer level. Our model is similar to the model for friction introduced by Filippov, Klafter, and Urbakh [Filippov et al., Phys. Rev. Lett., 2004, 92, 135503]; but with an important generalization to a flexible transducer (modelled as a bead spring polymer) which is attached to a fixed rigid planar substrate by interconnecting bonds (modelled as harmonic springs), and pulled by a constant force FT. Bonds are allowed to rupture stochastically. The model is simulated, and the results for a certain set of parameters exhibit a sequential rupture mechanism resulting in rupture fronts. A mean field formalism is developed to study these rupture fronts and the possible propagating solutions for the coupled bead and bond dynamics, where the coupling excludes an exact analytical treatment. Numerical solutions to mean field equations are obtained by standard numerical techniques, and they agree well with the simulation results which show sequential rupture. Within a travelling wave formalism based on the Tanh method, we show that the velocity of the rupture front can be obtained in closed form. The derived expression for the rupture front velocity gives good agreement with the stochastic and mean field results, when the rupture is sequential, while propagating solutions for bead and bond dynamics are shown to agree under certain conditions. PMID:27087684

  19. Development of a rabbit's urethral sphincter deficiency animal model for anatomical-functional evaluation

    Directory of Open Access Journals (Sweden)

    M. Skaff

    2012-02-01

    Full Text Available OBJECTIVE: The aim of the study was to develop a new durable animal model (using rabbits for anatomical-functional evaluation of urethral sphincter deficiency. MATERIALS AND METHODS: A total of 40 New Zealand male rabbits, weighting 2.500 kg to 3.100 kg, were evaluated to develop an incontinent animal model. Thirty-two animals underwent urethrolysis and 8 animals received sham operation. Before and at 2, 4, 8 and 12 weeks after urethrolysis or sham operation, it was performed cystometry and leak point pressure (LPP evaluation with different bladder distension volumes (10, 20, 30 mL. In each time point, 10 animals (8 from the study group and 2 from the sham group were sacrificed to harvest the bladder and urethra. The samples were evaluated by H&E and Masson's Trichrome to determine urethral morphology and collagen/smooth muscle density. RESULTS: Twelve weeks after urethrolysis, it was observed a significant decrease in LPP regardless the bladder volume (from 33.7 ± 6.6 to 12.8 ± 2.2 cmH2O. The histological analysis evidenced a decrease of 22% in smooth muscle density with a proportional increase in the collagen, vessels and elastin density (p < 0.01. CONCLUSIONS: Transabdominal urethrolysis develops urethral sphincter insufficiency in rabbits, with significant decrease in LPP associated with decrease of smooth muscle fibers and increase of collagen density. This animal model can be used to test autologous cell therapy for stress urinary incontinence treatment.

  20. Increased rate change over time of a sphincter-saving procedure for lower rectal cancer

    Institute of Scientific and Technical Information of China (English)

    WU Xiao-jian; WANG Jian-ping; WANG Lei; HE Xiao-sheng; ZOU Yi-feng; LIAN Lei; ZHANG Long-juan; LAN Ping

    2008-01-01

    Background Total mesorectal excision(TME)has increased the rate of sphincter-preservation(SP)for more patients with low-lying rectal cancer.Here,we analyze the change of sphincter preserving rates in lower rectal cancer and their related factors.Methods We reviewed retrospectively the medical records of 316 patients with lower rectal cancers,1 to 5 cm from the anorectal line,who had surgical resections from August 1994 to November 2005.The 12-year span was divided into 2 periods:period Ⅰ(August 1994-December 1998)and period Ⅱ(January 1999-November 2005),based on the date (January 1999)when standard total mesorectal excision(TME)was introduced.The patients were divided jnto two groups based on the operation:abdominoperineal resection(APR)or SP surgery.SP rates,leakage and other clinicopathological characteristics were compared between the two time periods and between the two different groups.Results The SP rate increased significantly over the 12 years,from 44.9% in period Ⅰ to 76.2% in period Ⅱ(P=0.000).The factors significantly influencing SP included the distance of the tumor from the anorectal line,gender,time period,circumference of intramural spread and histological differentiation (P<0.05).Significant differences were detected between the two time periods in gender,blood transfusion volume and Dukes'stage(P<0.05).The leakage rate was 2.7% in period Ⅰ and 1.3% in period Ⅱ (P>0.05).Conclusions Over the 12-year period of the study the SP rate in rectal cancers 1-5 cm from the anorectal line has increased significantly while the blood transfusion volume has decreased due to the introduction of TME.However,TME had no effect on operating time and leakage rates.

  1. PRIMENA SWOT ANALIZE NA SISTEM INTEGRALNOG TRANSPORTA VOJSKE SRBIJE

    OpenAIRE

    Dragan Pamučar

    2008-01-01

    U radu je prikazana primena SWOT analize na sistem integralnog transporta Vojske Srbije. Kao rezultat analize predstavljeni su ciljevi daljeg usavršavanja integralnog transporta, kao i mogući problemi generisani strateškim upravljanjem.

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

    Directory of Open Access Journals (Sweden)

    Stanley Margaret A

    2012-09-01

    Full Text Available Abstract Background Human papillomavirus (HPV is well known as the major etiological agent for ano-genital cancer. In contrast to cervical cancer, anal cancer is uncommon, but is increasing steadily in the community over the last few decades. However, it has undergone an exponential rise in the men who have sex with men (MSM and HIV + groups. HIV + MSM in particular, have anal cancer incidences about three times that of the highest worldwide reported cervical cancer incidences. Discussion There has therefore traditionally been a lack of data from studies focused on heterosexual men and non-HIV + women. There is also less evidence reporting on the putative precursor lesion to anal cancer (AIN – anal intraepithelial neoplasia, when compared to cervical cancer and CIN (cervical intraepithelial neoplasia. This review summarises the available biological and epidemiological evidence for HPV in the anal site and the pathogenesis of AIN and anal cancer amongst traditionally non-high risk groups. Summary There is strong evidence to conclude that high-grade AIN is a precursor to anal cancer, and some data on the progression of AIN to invasive cancer.

  3. Synchronous squamous and glandular neoplasia of the anal canal.

    OpenAIRE

    Yeong, M. L.; Wood, K. P.; Scott, B; Yun, K.

    1992-01-01

    A 48 year old man presented with invasive adenocarcinoma in the wall of a non-healing anal fistula. The subsequent abdomino-perineal resection specimen showed residual invasive carcinoma coexisting with in situ carcinoma of anal glands as well as in situ squamous carcinoma of the anal canal. The epithelium of the anal canal had koilocytotic features. DNA hybridisation studies by the dot blot technique showed weak positivity for human papillomavirus (HPV) subtypes 16, 18. This case illustrates...

  4. The Anal Pap Smear: Cytomorphology of squamous intraepithelial lesions

    OpenAIRE

    Arain Shehla; Walts Ann; Thomas Premi; Bose Shikha

    2005-01-01

    Abstract Background Anal smears are increasingly being used as a screening test for anal squamous intraepithelial lesions (ASILs). This study was undertaken to assess the usefulness and limitations of anal smears in screening for ASILs. Methods The cytomorphological features of 200 consecutive anal smears collected in liquid medium from 198 patients were studied and findings were correlated with results of surgical biopsies and/or repeat smears that became available for 71 patients within six...

  5. Predicting creep rupture from early strain data

    International Nuclear Information System (INIS)

    To extend creep life modelling from classical rupture modelling, a robust and effective parametric strain model has been developed. The model can reproduce with good accuracy all parts of the creep curve, economically utilising the available rupture models. The resulting combined model can also be used to predict rupture from the available strain data, and to further improve the rupture models. The methodology can utilise unfailed specimen data for life assessment at lower stress levels than what is possible from rupture data alone. Master curves for creep strain and rupture have been produced for oxygen-free phosphorus-doped (OFP) copper with a maximum testing time of 51,000 h. Values of time to specific strain at given stress (40-165 MPa) and temperature (125-350 deg. C) were fitted to the models in the strain range of 0.1-38%. With typical inhomogeneous multi-batch creep data, the combined strain and rupture modelling involves the steps of investigation of the data quality, extraction of elastic and creep strain response, rupture modelling, data set balancing and creep strain modelling. Finally, the master curves for strain and rupture are tested and validated for overall fitting efficiency. With the Wilshire equation as the basis for the rupture model, the strain model applies classical parametric principles with an Arrhenius type of thermal activation and a power law type of stress dependence for the strain rate. The strain model also assumes that the processes of primary and secondary creep can be reasonably correlated. The rupture model represents a clear improvement over previous models in the range of the test data. The creep strain information from interrupted and running tests were assessed together with the rupture data investigating the possibility of rupture model improvement towards lower stress levels by inverse utilisation of the combined rupture based strain model. The developed creep strain model together with the improved rupture model is

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

    Science.gov (United States)

    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,…

  7. Is Anal Smear Necessary in Turkish Women with Vulvar Condyloma Who Are At A Low Risk of Developing Anal Cancer ?

    OpenAIRE

    KESER, Buket; ERSOY, Gülçin ŞAHİN; KURT, Sefa; KEBAPÇILAR, Ayşe Gül

    2015-01-01

    Background: There is still no Turkey-based study dealing with the anal smear results in Turkish women. Thus a study was designed to investigate the probability of anal autoinfection with vulvar HPV and to determine whether anal screening for the presence of anal cancer is beneficial in turkish women with pre-existing vulvar condyloma. Materials and Methods: Between 2011 and 2012 one hundred and sixty patients with a history of vulvar condyloma accuminata treated with electrocautery were se...

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

    Institute of Scientific and Technical Information of China (English)

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

    2008-01-01

    AIM: To detect whether patients with a T tube after cholecystectomy and choledochotomy have duodenalbiliary 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

  9. Migraine before rupture of intracranial aneurysms

    DEFF Research Database (Denmark)

    Lebedeva, Elena R; Gurary, Natalia M; Sakovich, Vladimir P;

    2013-01-01

    Rupture of a saccular intracranial aneurysm (SIA) causes thunderclap headache but it remains unclear whether headache in general and migraine in particular are more prevalent in patients with unruptured SIA.......Rupture of a saccular intracranial aneurysm (SIA) causes thunderclap headache but it remains unclear whether headache in general and migraine in particular are more prevalent in patients with unruptured SIA....

  10. Urinary bladder rupture during voiding cystourethrography

    Directory of Open Access Journals (Sweden)

    Kyong Ok Lee

    2012-05-01

    Full Text Available Voiding cystourethrography (VCUG is a commonly performed diagnostic procedure for the evaluation of vesicoureteral reflux with urinary tract infection or congenital renal diseases in children. The procedure is relatively simple and cost-effective, and complications are very rare. The iatrogenic complication of VCUG range from discomfort, urinary tract infection to bacteremia, as well as bladder rupture. Bladder rupture is a rare complication of VCUG, and only a few cases were reported. Bladder rupture among healthy children during VCUG is an especially uncommon event. Bladder rupture associated with VCUG is usually more common in chronically unused bladders like chronic renal failure. Presented is a case of bladder rupture that occurred during a VCUG in a healthy 9-monthold infant, due to instilled action of dye by high pressure. This injury completely healed after 7 days of operation, and it was confirmed with a postoperative cystography. The patient’s bladder volume, underlying disease, velocity of the contrast media instilled, catheter size, and styles of instillation are important factors to prevent bladder rupture during VCUG. Management of bladder rupture should be individualized, but the majority of infants are treated with the operation. In conclusion, bladder rupture is a rare complication, however, delicate attention is needed in order to prevent more dire situations.

  11. Tracheal rupture post-emergency intubation

    OpenAIRE

    Andrea Billè; Luca Errico; Francesco Ardissone; Luciano Cardinale

    2009-01-01

    Tracheal rupture is an uncommon and potentially lifethreatening complication of endotracheal intubation. We present a case of intrathoracic tracheal rupture in a female patient who required emergent endotracheal intubation for acute respiratory distress related to chronic obstructive pulmonary disease exacerbation. Possible contributing factors to tracheal injury included overinflation of the tube cuff, chronic obstructive pulmonary disease, and chronic steroid use. The patient underwent surg...

  12. Simultaneous and spontaneous bilateral quadriceps tendons rupture.

    Science.gov (United States)

    Celik, Evrim Coşkun; Ozbaydar, Mehmet; Ofluoglu, Demet; Demircay, Emre

    2012-07-01

    Simultaneous and spontaneous bilateral quadriceps tendon rupture is an uncommon injury that is usually seen in association with multiple medical conditions and some medications. We report a case of simultaneous and spontaneous bilateral quadriceps tendon rupture that may be related to the long-term use of a statin. PMID:22561379

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

    OpenAIRE

    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.

  14. Simultaneous bilateral patellar tendon rupture without

    Directory of Open Access Journals (Sweden)

    LU Hua-ding

    2012-04-01

    Full Text Available 【Abstract】There is a dearth of case reports de-scribing simultaneous bilateral patellar tendon ruptures in the medical literature. These ruptures are often associated with systemic disorders such as lupus erythematosus or chronic steroid use. The author describes a case of a 24-year-old man who sustained traumatic bilateral patellar ten-don ruptures without any history of systemic disease or steroidal medication. We repaired and reattached the rup-tured tendons to the patella and augmented our procedure with allogeneic tendon followed by wire loop reinforcement. One year after operation, the patient regained a satisfactory range of motion of both knees with good quadriceps strength and no extensor lag. The recurrent microtrauma from a history of intense sports activity and a high body mass index may have played an important role in this trauma event. Key words: Patella; Patellar ligament; Rupture; Ten-don injuries; Knee

  15. HIV– positive anal cancer: an update for the clinician

    OpenAIRE

    Savita V. Dandapani; Eaton, Michael; Thomas, Charles R.; Pagnini, Paul G

    2010-01-01

    Anal cancer used to be a rare cancer traditionally associated with elderly women. There are approximately 5260 cases per year in the U.S. (1). The onslaught of the Human Immunodeficiency Virus (HIV) virus has led to a change in anal cancer demographics. Anal cancer is on the rise in the U.S and the number of anal cases documented has quadrupled in the past 20 yrs correlating with the rise of the HIV epidemic. The incidence of anal cancer is 40 to 80 fold higher in the HIV positive (HIV+) popu...

  16. Second-Generation Recombinant Hemoglobin Molecules Do Not Stimulate Sphincter of Oddi, Gallbladder, or Duodenal Motility in the Australian Brush-Tailed Possum

    OpenAIRE

    2004-01-01

    BACKGROUND: Several studies have investigated the effects of hemoglobin-based oxygen carriers on gastrointestinal motility. Diaspirin cross-linked hemoglobin reduces sphincter of Oddi trans-sphincteric flow and increases duodenal motility in the Australian brush-tailed possum, effects attributed to nitric oxide (NO) scavenging. Recently, second-generation recombinant hemoglobin molecules with reduced NO scavenging ability have been developed.AIM: To determine the effects of two second-generat...

  17. Magnetic resonance imaging of anal cancer

    International Nuclear Information System (INIS)

    AIM: The purpose of this study was to evaluate the magnetic resonance imaging (MRI) appearances of primary and recurrent anal carcinoma, and to demonstrate the commonest patterns of local and distant disease spread. METHODS: A retrospective review was performed of 27 cases of biopsy-proven anal carcinoma, where MRI was used for primary staging (9 patients) or suspected recurrence (18 patients). Two oncological radiologists reviewed the MR images, following a standardized approach. The size, extent and signal characteristics of the anal tumour were documented. Metastatic disease spread to lymph nodes, viscera and bone was recorded. In all, 7 patients with recurrent disease underwent surgery and subsequent histological correlation was performed. RESULTS: Primary and recurrent tumours were of high signal intensity relative to skeletal muscle on T2-weighted images (T2WI), and of low to intermediate signal intensity on T1-weighted images (T1WI). Lymph node metastases were of similar signal intensity to the anal cancer. Recurrent tumours were more locally advanced than primary tumours and extended into adjacent organs and the pelvic skeleton. Recurrent lymph node disease involved perirectal, presacral and internal iliac nodes more commonly than did primary lymph node disease. CONCLUSION: MRI can be useful in the primary staging of bulky tumours or of those with a long craniocaudal extent. MR has a role in the preoperative evaluation and surgical planning of cases of recurrent disease following radiotherapy

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

    Science.gov (United States)

    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

  19. Effect of lesogaberan, a novel GABAB-receptor agonist, on transient lower esophageal sphincter relaxations in male subjects

    OpenAIRE

    Guy E. Boeckxstaens; Rydholm, Hans; Lei, Aaltje; Adler, John; Ruth, Magnus

    2010-01-01

    Abstract Background: Transient lower esophageal sphincter relaxations (TLESRs) are a major mechanism behind gastroesophageal reflux disease (GERD). Aim: To assess the effect of lesogaberan (AZD3355) ? a novel peripherally active GABAB receptor agonist ? on TLESRs. Methods: Twenty-four healthy men were enrolled in this single-blind, placebo-controlled, randomized, single-centre, three-period crossover phase 1 study. Subjects were randomized to receive single oral doses of leso...

  20. Epidermoid carcinomas of the anal canal treated with definitive radiation therapy in a series of 305 patients; Carcinomes epidermoides du canal anal traites par irradiation a visee curative: a propos de 305 patients

    Energy Technology Data Exchange (ETDEWEB)

    Deniaud-Alexandre, E.; Touboul, E.; Huang, R.; Qu, S.H.; Pene, F.; Schlienger, M. [Hopital Tenon, Service d' Oncologie-Radiotherapie, 75 - Paris (France); Tiret, E.; Parc, R. [Hopital Saint-Antoine, Service de Chirurgie Digestive, 75 - Paris (France); Sezeur, A. [Hopital des Diaconesses, Service de Chirurgie Generale, 75 - Paris (France); Houry, S. [Hopital Tenon AP-HP, Service de Chirurgie Digestive, 75 - Paris (France); Gallot, D. [Groupe Hospitalier Bichat-Claude-Bernard, Service de Chirurgie Generale et Digestive B, 75 - Paris (France)

    2003-08-01

    -free survival was 74%. After multivariate analysis, 3 independent predicting factors significantly influenced the disease-free survival: gap duration between 2 courses of RT (>38 days vs {<=}38 days, P=0.0025), pretreatment anal function scoring (0 vs 1 vs 2 vs 3 vs 4, P =4.4 10{sup -6}), and cCR after the end of RT (no complete response vs complete response, P =2.5 10{sup -14}). Conclusion. - We confirm excellent results with RT in T1 and T2 lesions. However, chemoradiotherapy should be preferred to improves survival free. of colostomy with a good anal sphincter function for tumors more than or equal to 2 cm in length and locally advanced tumors. (author)

  1. O papel do óxido nítrico na pressão anal esfincteriana de ratos submetidos à colite experimental The role of nitric oxide in sphincteric anal pressure of rats with experimental colitis

    OpenAIRE

    Henrique Sarubbi Fillmann; Nélson Kretzmann Filho; Suzana Llesuy; Lúcio Sarubbi Fillmann; Norma Possa Marroni

    2006-01-01

    O óxido nítrico (NO) é um radical livre sintetizado endogenamente por várias células do nosso organismo. Apresenta um amplo espectro de ações fisiológicas, sendo as mais importantes o seu mecanismo de ação parácrino no relaxamento da musculatura lisa, sua atividade neurotransmissora em vários sistemas e seu envolvimento no processo inflamatório. O NO é sintetizado em diferentes tecidos através da conversão da L-arginina em L-citrulina pela ação da enzima óxido nítrico sintase (NOS). OBJETIVOS...

  2. Bilateral spontaneous rupture of 'hale' kidneys

    International Nuclear Information System (INIS)

    A rare case of spontaneous bilateral rupture of the kidneys, occurring consecutively over a one-year period in a young male patient with 'hale' kidneys until then, is described. The patient's past history and thorough examination performed do not justify to assign the case under the heading of some of the etiological factors as the underlying cause of spontaneous kidney rupture. The literature survey on spontaneous bilateral non-tumor ruptures of kidneys shows that over a 20-year period, only 3 cases of bilateral spontaneous ruptures have been reported. It is pointed out that panarteritis nodosa followed by hemorrhagic fever with renal syndrome is the commonest underlying cause of such ruptures. Clinically spontaneous ruptures become manifest with emergency condition presenting severe renal colic, impaired to serious general condition, often with acute abdomen and hemodynamic breakdown, and no past history evidence of renal disease or injury. In the initial phase diagnosing is not always easy; it is usually made on the ground of physical examination and the full range of imaging studies used in urological practice and during operative treatment. Emphasis is laid on the fact that the imaging methods are not invariably sufficient to identify the exact etiological factor giving rise to such a severe condition, but nevertheless these methods have an essential practical bearing on diagnosing a rupture. (authors)

  3. Forebygging av obstetriske sfinkterskader - holdninger og teknikker blant gynekologer og jordmødre

    OpenAIRE

    Skaara, Silje Vassbotn

    2014-01-01

    Abstract Background: Obstetric anal sphincter rupture (OASR) is a severe complication in vaginal delivery, and is shown to be the strongest predicator of later anal incontinence. The rate of OASR in Norway increased from the 1960s until 2000. This trend evoked a national focus on how to decrease the rate of OASR, and especially how to perform perineum support during labour as a technique to prevent OASR. Objective: To review the documentation of today s clinical use of perineum support and ep...

  4. Eccentric pressurized tube for measuring creep rupture

    International Nuclear Information System (INIS)

    Creep rupture is a long term failure mode in structural materials that occurs at high temperatures and moderate stress levels. The deterioration of the material preceding rupture, termed creep damage, manifests itself in the formation of small cavities on grain boundaries. To measure creep damage, sometimes uniaxial tests are performed, sometimes density measurements are made, and sometimes the grain boundary cavities are measured by microscopy techniques. The purpose of the present research is to explore a new method of measuring creep rupture, which involves measuring the curvature of eccentric pressurized tubes. Theoretical investigations as well as the design, construction, and operation of an experimental apparatus are included in this research

  5. RUPTURED RUDIMENTARY HORN PREGNANCY OF UNICORNUATE UTERUS

    Directory of Open Access Journals (Sweden)

    Vijay Kumar

    2015-06-01

    Full Text Available Unicornuate uterus can sometimes be associated with rudimentary horn. Pregnancy in a rudimentary horn is rare and usually ends up in rupture. Diagnosis is difficult and can be missed in routine ultrasound scan and is usually detected after rupture. We report a case of G1P1 with rudimentary horn pregnancy which raised suspicion on ultr asound and was later diagnosed by MR imaging. Patient refused termination and presented next day with shock. Laparotomy revealed ruptured right rudimentary horn pregnancy.

  6. Treatment of an Aortic Traumatic Double Rupture

    Directory of Open Access Journals (Sweden)

    Attinà Domenico

    2015-03-01

    Full Text Available Traumatic thoracic aortic rupture is a life-threatening condition; aortic isthmus is the most common site of rupture, but in rare cases traumatic injury can localize elsewhere, such as at aortic arch or at the level of the diaphragm. In the past few years, endovascular treatment of traumatic aortic injury became a safe procedure, with lower mortality and complication, if compared with open surgery. We report a case of a 40-year-old-man admitted to emergency department after a violent car crash in which an aortic traumatic double rupture was successfully treated with two endovascular stent-grafts coverage.

  7. Patellar tendon: From tendinopathy to rupture

    Directory of Open Access Journals (Sweden)

    Federica Rosso

    2015-10-01

    Full Text Available Patellar tendinopathy is very common in patients complaining of anterior knee pain. Its aetiology is still unclear, but neovascularisation seems to play a role. Different treatments have been proposed overtime, from rehabilitation to platelet-rich-plasma injections, but there is no agreement on the best treatment protocol. The final stage of patellar tendinopathy is patellar tendon rupture. In these cases surgical treatment is often required. The aim of this literature review is to focus on the aetiology, diagnosis, and treatment of both patellar tendinopathy and rupture. We report the conservative treatments proposed for patellar tendinopathy and the surgical techniques described for its rupture.

  8. Scaling in rupture of polymer chains

    OpenAIRE

    Fugmann, S.; I. M. Sokolov

    2008-01-01

    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...

  9. Ruptured rudimentary horn pregnancy at sixteen weeks.

    Science.gov (United States)

    Zeqiri, Fehmi; Paçarada, Myrvete; Kongjeli, Niltene; Zeqiri, Vlora; Kongjeli, Gyltene; Krasniqi, Burim

    2010-01-01

    Pregnancy in a non-communicating rudimentary horn is very difficult to diagnose before it ruptures, leading to life -threatening intraperitoneal hemorrhage. A 22-year-old second gravida patient presented at the Emergency Center of the University Clinical Center of Kosova with a 16-week history of amenorrhea and acute onset of severe abdominal pain. She was resuscitated and taken for an emergency laparotomy under general anesthesia. Intraoperatively, there was a massive hemoperitoneum with a ruptured right rudimentary horn Given their rarity, ruptured rudimentary horn pregnancies are of interest. PMID:24591927

  10. Misdiagnosed Chest Pain: Spontaneous Esophageal Rupture

    Science.gov (United States)

    Inci, Sinan; Gundogdu, Fuat; Gungor, Hasan; Arslan, Sakir; Turkyilmaz, Atila; Eroglu, Atila

    2013-01-01

    Chest pain is one of themost common complaints expressed by patients presenting to the emergency department, and any initial evaluation should always consider life-threatening causes. Esophageal rupture is a serious condition with a highmortality rate. If diagnosed, successful therapy depends on the size of the rupture and the time elapsed between rupture and diagnosis.We report on a 41-year-old woman who presented to the emergency department complaining of left-sided chest pain for two hours. PMID:27122690

  11. Urethropexy for the management of urethral sphincter mechanism incompetence in the bitch.

    Science.gov (United States)

    White, R N

    2001-10-01

    Urethropexy was performed on 100 bitches for the management of urethral sphincter mechanism incompetence (SMI). The dogs ranged in age from 12 months to nine years (mean 4.5 years). Diagnosis of the condition was based upon clinical, laboratory and contrast radiographic examinations, and clinical response to medical management. In all bitches, incontinence developed in the adult individual and in the majority (89 bitches) after spaying. Radiographic findings were unremarkable in 22 bitches, apart from the presence of an intrapelvic bladder neck. Follow-up periods ranged from 12 months to seven years (mean 2.9 years). Fifty-six bitches were completely cured by surgery, 27 became less incontinent and 17 either failed to respond (nine animals) or showed an initial improvement in urinary function, but then relapsed (eight animals). Nine of these 17 animals underwent a second urethropexy procedure, resulting in a cure in six and an improvement in three cases (follow-up 12 to 41 months, mean 22.2 months). A deterioration in the response rate was observed over time. Postoperative complications were seen in 21 bitches and included an increased frequency of micturition (14 bitches), dysuria (six bitches) and anuria (three bitches). PMID:11688522

  12. Expansion sphincter pharyngoplasty for the treatment of OSA: a systemic review and meta-analysis.

    Science.gov (United States)

    Pang, Kenny P; Pang, Edward B; Win, Ma Thin Mar; Pang, Kathleen A; Woodson, B Tucker

    2016-09-01

    This study seeks to determine the success rates of the expansion sphincter pharyngoplasty and its variants on the treatment of obstructive sleep apnea (OSA). Systematic review and meta-analysis. Two independent searches of MEDLINE, Google Scholar, Cochrane Library and Evidence Based Medicine Reviews to identify publications relevant to OSA and expansion pharyngoplasty. All relevant studies published before 31 March 2015 were included. Five studies were included in the systematic review and meta-analysis. The numbers of patients in each paper ranged from 10 to 85 (total = 155), and mean age ranged from 8 to 56 years. Substantial and consistent improvement in PSG outcomes were observed post-expansion pharyngoplasty patients, with or without multilevel surgery groups. The results showed that the expansion pharyngoplasty technique has significantly lower AHI than control group [Standardised mean difference -7.32, 95 %CI (-11.11, -3.52), p = 0.0002]; however, substantial heterogeneity between these studies were observed. The mean pre-operative AHI (in the five papers) improved from 40.0 ± 12.6 to 8.3 ± 5.2 post-operatively. The overall pro-rated pooled success rate for all the patients was 86.3 %. The expansion pharyngoplasty is effective in the management of patients with OSA. PMID:26541714

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    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 highresolution 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 thevolunteer 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 H2 O. The ISD incontinence was defined with MUCP pressure below 20 cm H2 O, and VLPP pressure less or equal to 60 cm H2 O. 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(Stata Corp 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

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

    Energy Technology Data Exchange (ETDEWEB)

    Salvadori, Priscila Silveira; Atzingen, Augusto Castelli von; D' Ippolito, Giuseppe [Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP (Brazil). Escola Paulista de Medicina; Bomfim, Lucas Novais [Universidade Tiradentes (UNIT), Maceio, AL, (Brazil)

    2015-09-15

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

  16. Traumatic Gallbladder Rupture Treated by Laparoscopic Cholecystectomy

    Science.gov (United States)

    Egawa, Noriyuki; Ueda, Junji; Hiraki, Masatsugu; Ide, Takao; Inoue, Satoshi; Sakamoto, Yuichiro; Noshiro, Hirokazu

    2016-01-01

    Abstract Gallbladder rupture due to blunt abdominal injury is rare. There are few reports of traumatic gallbladder injury, and it is commonly associated with other concomitant visceral injuries. Therefore, it is difficult to diagnose traumatic gallbladder rupture preoperatively when it is caused by blunt abdominal injury. We report a patient who underwent laparoscopic cholecystectomy after an exact preoperative diagnosis of traumatic gallbladder rupture. A 43-year-old man was admitted to our hospital due to blunt abdominal trauma. The day after admission, abdominal pain and ascites increased and a muscular defense sign appeared. Percutaneous drainage of the ascites was performed, and the aspirated fluid was bloody and almost pure bile. He was diagnosed with gallbladder rupture by the cholangiography using the endoscopic retrograde cholangiopancreatography technique. Laparoscopic cholecystectomy was performed safely, and he promptly recovered. If accumulated fluids contain bile, endoscopic cholangiography is useful not only to diagnose gallbladder injury but also to determine the therapeutic strategy. PMID:27462188

  17. Arthrographic diagnosis of ruptured calcaneofibular ligament. I

    International Nuclear Information System (INIS)

    A new projection, oblique axial, is recommended for the arthrography of the acute sprained ankle for the correct diagnosis of a ruptured calcaneofibular ligament. Its value is experimentally confirmed. (Auth.)

  18. Uterine rupture without previous caesarean delivery

    DEFF Research Database (Denmark)

    Thisted, Dorthe L A; Mortensen, Laust H; Krebs, Lone

    2015-01-01

    .3/100,000 deliveries. Multiparity (RR 8.99 (95% CI 1.86-43.29)), induction of labour (RR 3.26 (95% CI 1.24-8.57)), epidural analgesia (RR 10.78 (95% CI 4.25-27.39)), and augmentation by oxytocin (RR 9.50 (95% CI 3.15-28.63)) were associated with uterine rupture. Induction of labour was not significantly related to...... uterine rupture when adjusted for parity, epidural analgesia and augmentation by oxytocin. CONCLUSION: Although uterine rupture is rare, its association with epidural analgesia and augmentation of labour with oxytocin in multipara should be considered. Thus, vigilance should be exercised when labour is...... obstructed and there is need for epidural analgesia and/or augmentation by oxytocin in multiparous women. Due to the rare occurrence of uterine rupture caution should be exerted when interpreting the findings of this study....

  19. Analýza rizik projektu

    OpenAIRE

    Kunc, Aleš

    2014-01-01

    Diplomová práce je zaměřena na proces řízení projektových rizik ve společnosti ČKD Blansko Holding, a. s. Na základě analýzy průběhu realizace obchodního případu je doporučen vhodný rozsah metodiky managementu rizik. Návrh metodiky je zčásti názorně aplikován na vybraném projektu. Je provedena analýza rizik a nalezeny způsoby k jejich ošetření. Práce rovněž popisuje základní principy a pojmy z oblasti rizikového a projektové managementu.

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

    Science.gov (United States)

    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

  1. Splenic artery aneurysm rupture in pregnancy

    International Nuclear Information System (INIS)

    Rupture of a splenic artery aneurysm, commonly associated with pregnancy is a rare and catastrophic event. We report here a case of a patient in her second pregnancy who presented with a short history of left hypochondriac and epigastric pain, followed by collapse at 32 weeks gestation. Sudden fetal distress lead to emergency caesarean delivery when splenic artery aneurysm rupture was diagnosed. With timely involvement of multidisciplinary personnel both mother and baby survived and had an uneventful recovery. (author)

  2. Unscarred uterine rupture: a retrospective study

    Directory of Open Access Journals (Sweden)

    Preety Aggarwal

    2015-12-01

    Conclusions: Rupture uterus is a high risk category of patients. An unscarred uterus can undergo rupture even without risk factors. The patients with mismanaged labour, grand multiparas and obstructed prolonged labour must be managed by proper trained personnel and in tertiary care centre in order to avoid the morbidity or mortality. [Int J Reprod Contracept Obstet Gynecol 2015; 4(6.000: 1997-1999

  3. Management of Anal Squamous Intraepithelial Lesions

    OpenAIRE

    Pineda, Carlos E.; Welton, Mark L.

    2009-01-01

    Anal squamous intraepithelial lesions include both low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL) and are caused by chronic infection with the human papillomavirus (HPV). The disease is increasing in both incidence and prevalence, especially among patients with the following risk factors: homosexual men, acquired or iatrogenic immunosuppression, and presence of other HPV-related diseases. Although the natural history of the disease is ...

  4. Endovascular therapeutic strategies in ruptured intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Machi, Paolo, E-mail: paolo.machi@gmail.com [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Lobotesis, Kyriakos, E-mail: kyriakos@lobotesis.co.uk [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Vendrell, Jean Francoise, E-mail: jfvendrell@yahoo.fr [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Riquelme, Carlos, E-mail: riquelme.carlos@neuf.fr [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Eker, Omer, E-mail: eker_omer@yahoo.fr [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Costalat, Vincent, E-mail: vincentcost@hotmail.com [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Bonafe, Alain, E-mail: bonafeh@aol.com [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France)

    2013-10-01

    The aim of the present study was to evaluate endovascular techniques used currently which were not available at the time of ISAT inclusion period, such as balloon remodelling and flow-divertion, in order to assess whether these new technologies have improved the endovascular approach outcomes. We present a review of articles, published in major journals, with the aim to evaluate the efficacy and the safety of coiling with balloon remodelling for the treatment of ruptured aneurysms in comparison to coiling performed without such coadjutant techniques. Furthermore, we reviewed publications reporting on the treatment of ruptured aneurysms in the acute phase with the one of the most recent technologies available nowadays: the flow diverting stent. Looking at the recent literature the results regarding ruptured aneurysms treated with balloon assisted coiling (BAC) have shown an improvement in terms of anatomical results and morbi-mortality rates. Case series of ruptured middle cerebral artery (MCA) aneurysms treated by EVT report results similar to those obtained by surgical clipping. Several articles recently report encouraging results in treating ruptured dissecting and blister aneurysms with flow diverters. Questions regarding the best treatment available for ruptured aneurysms are yet to be answered. Hence there is a need for a subsequent trial aiming to answer these unresolved issues.

  5. Anal intraepitelial neoplasia: a narrative review

    Directory of Open Access Journals (Sweden)

    Garazi Elorza

    2016-01-01

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

  6. Development of a pulse height analizer

    International Nuclear Information System (INIS)

    The development of a Pulse Height Analizer is described. This equipment is essential to analize data coming from detectors producing information codified in pulse amplitudes. The system developed consist of a Signal Input Module connected to a Controller Module based on a 8085A microprocessor capable to memorize pulses up to 1 uS in 256 channels with a resolution better than 20 mV. A Communication Module with a serial interface is used for data transfer to a host computer using RS232c protocol. The Monitoring and Operation Module consist of a hexadecimal Keybord, a 6 digit 7-segment display and a XY analog output enabling real time visualization of data on a XY monitor. The hardware and the software designed for this low cost system were optimized to obtain a typical dead time of approximately 100 uS. As application, this device was used to adquire curves at the Small Angle X-ray Scattering Laboratory in this Department. The apparatus performance was tested by comparing its data with a Northern Pulse Height Analizer model NS633 output, with favorable results. (Author)

  7. Anal intraepitelial neoplasia: A narrative review.

    Science.gov (United States)

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

    2016-01-01

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

  8. Cáncer anal en la era del VIH: papel de la citología anal Anal cancer in the HIV era

    Directory of Open Access Journals (Sweden)

    Juan Carlos Cataño Correa

    2004-09-01

    Full Text Available El cáncer anal solía ser una neoplasia infrecuente que afectaba principalmente a mujeres y personas mayores de 65 años, pero recientemente su incidencia ha venido en aumento debido a la pandemia de VIH, fenómeno que tiende a empeorar porque la terapia antirretroviral altamente activa (HAART, por su sigla en inglés no solo alarga la vida de los pacientes, sino que al mismo tiempo hace posible una prolongada evolución de las lesiones precancerosas que conducen a cáncer anal; además, está plenamente demostrado que la HAART no evita la evolución de las lesiones intraepiteliales escamosas hacia cáncer anal. La citología anal ha demostrado ser una prueba de tamización poblacional útil y costoefectiva para el diagnóstico de las lesiones precancerosas producidas por Papilomavirus humano en el canal anal de hombres homosexuales y bisexuales, principalmente de aquellos positivos para VIH. Esta revisión tiene como objetivo llamar la atención sobre la creciente incidencia de cáncer anal en la población de pacientes VIH positivos, y sobre la utilidad del diagnóstico temprano utilizando la citología anal en este grupo de pacientes de riesgo. Anal cancer used to be an uncommon neoplasia that affected mainly women and people aged over 65 years, but recently its incidence has been growing, mostly due to the HIV pandemic, and it will become worse because highly active antiretroviral therapy (HAART at the same time that lengthens life expectancy in HIV positive subjects, will increase the possibility to develop anal cancer; it has already been demonstrated that HAART does not prevent the evolution of intraepithelial squamous lesions to anal cancer. Anal cytology has demonstrated to be an useful and cost-effective screening tool for detection of precancerous lesions associated with human Papillomavirus (HPV infection in the anal canal of homosexual and bisexual men, specially in those that are HIV positive. This article is an update of the

  9. Detection of Multiple Human Papillomavirus Genotypes in Anal Carcinoma

    OpenAIRE

    Ramamoorthy, Sonia; Liu, Yu-Tsueng; Luo, Linda; Miyai, Katsumi; Lu, Qing; John M. Carethers

    2010-01-01

    Abstract Infection with human papillomavirus (HPV) is a major risk factor for development of anal squamous cell carcinoma. Despite over 100 genotypes of the virus, HPV 16 and 18 are considered pathogenic as they are seen in the majority of cervical and anal cancers. We have employed a custom microarray to examine DNA for several HPV genotypes. We aimed to determine the accuracy of our microarray in anal cancer DNA for HPV genotypes compared to the DNA sequencing gold standard. Method...

  10. Detection of Multiple Human Papillomavirus Genotypes in Anal Carcinoma

    OpenAIRE

    Luo Linda; Liu Yu-Tsueng; Ramamoorthy Sonia; Miyai Katsumi; Lu Qing; Carethers John M

    2010-01-01

    Abstract Infection with human papillomavirus (HPV) is a major risk factor for development of anal squamous cell carcinoma. Despite over 100 genotypes of the virus, HPV 16 and 18 are considered pathogenic as they are seen in the majority of cervical and anal cancers. We have employed a custom microarray to examine DNA for several HPV genotypes. We aimed to determine the accuracy of our microarray in anal cancer DNA for HPV genotypes compared to the DNA sequencing gold standard. Methods We util...

  11. Californium-252 brachytherapy for anal and ano-rectal carcinoma

    International Nuclear Information System (INIS)

    Surgery has historically been the standard treatment for anal, ano-rectal and rectal carcinoma but is prone to local or regional failure. Over the past 15 years there has been increasing interest in and success with radiation therapy and combined chemoradiotherapy for treatment of anal and ano-rectal cancers. Cf-252 brachytherapy combined with external beam teletherapy has been investigated for anal and ano-rectal lesions at the Univ. of Kentucky with encouraging results

  12. Current treatment options for management of anal intraepithelial neoplasia

    OpenAIRE

    Weis SE

    2013-01-01

    Stephen E Weis1,2 1Division of Dermatology, Department of Internal Medicine, University of North Texas Health Science Center at Fort Worth, 2Preventive Medicine Clinic, Tarrant County Public Health, Fort Worth, TX, USA Abstract: 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 intraepi...

  13. Environmental scan of anal cancer screening practices: worldwide survey results

    OpenAIRE

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

    2014-01-01

    Anal squamous cell carcinoma is rare in the general population but certain populations, such as persons with HIV, are at increased risk. High-risk populations can be screened for anal cancer using strategies similar to those used for cervical cancer. However, little is known about the use of such screening practices across jurisdictions. Data were collected using an online survey. Health care professionals currently providing anal cancer screening services were invited to complete the survey ...

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

    OpenAIRE

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

    2012-01-01

    Abstract Background Human papillomavirus (HPV) is well known as the major etiological agent for ano-genital cancer. In contrast to cervical cancer, anal cancer is uncommon, but is increasing steadily in the community over the last few decades. However, it has undergone an exponential rise in the men who have sex with men (MSM) and HIV + groups. HIV + MSM in particular, have anal cancer incidences about three times that of the highest worldwide reported cervical cancer incidences. Discussion T...

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

    OpenAIRE

    L Alemany; Saunier, M; Alvarado, I.; Quirós, B; Salmeron, J.; Shin, HR; Pirog, E; Guimerà, N; Hernández, GA; Felix, A.; Clavero, O; Lloveras, B; Kasamatsu, E; Goodman, MT; Hernandez, BY

    2014-01-01

    Knowledge about the human papillomaviruses (HPV) types in anal cancers in some world regions is scanty. Here we describe the HPV DNA prevalence and type distribution in a series of invasive anal cancers and anal intraepithelial neoplasias (AIN) grades 2/3 from 24 countries. We analyzed 43 AIN 2/3 cases and 496 anal cancers diagnosed from 1986 to 2011. After histopathological evaluation of formalin-fixed paraffin-embedded samples, HPV DNA detection and genotyping was performed using SPF-10/DEI...

  16. Environmental scan of anal cancer screening practices: worldwide survey results

    International Nuclear Information System (INIS)

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

  17. Environmental scan of anal cancer screening practices: worldwide survey results.

    Science.gov (United States)

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

    2014-08-01

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

  18. Analýza vybrané firmy

    OpenAIRE

    Křemečková, Tereza

    2013-01-01

    Tato bakalářská práce obsahuje celkovou analýzu firmy Pegas NONWOVENS. Práce se zabývá analýzami SWOT a SLEPTE, Porterovým pětifaktorovým modelem, Kralickovým Quick testem a vybranými ukazateli finanční analýzy. Na základě zpracování těchto analýz jsou navržena doporučení, která by mohla zlepšit situaci firmy.

  19. Risk of Anal Cancer in People Living with HIV: Addressing Anal Health in the HIV Primary Care Setting.

    Science.gov (United States)

    Walker, Crystal Martin; Likes, Wendy; Bernard, Marye; Kedia, Satish; Tolley, Elizabeth

    2016-01-01

    Anal health and anal cancer are rarely addressed in HIV primary care. We sought to understand factors that impeded or promoted addressing anal health in HIV primary care from providers' perspectives. In this exploratory study, HIV primary care providers from the Mid-South region of the United States participated in brief individual interviews. We analyzed transcribed data to identify barriers and facilitators to addressing anal health. Our study sample included five physicians and four nurse practitioners. The data revealed a number of barriers such as perception of patient embarrassment, provider embarrassment, external issues such as time constraints, demand of other priorities, lack of anal complaints, lack of resources, and gender discordance. Facilitators included awareness, advantageous circumstances, and the patient-provider relationship. Anal health education should be prioritized for HIV primary care providers. Preventive health visits should be considered to mitigate time constraints, demands for other priorities, and unequal gender opportunities. PMID:27080925

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

    Directory of Open Access Journals (Sweden)

    Seppo Taskinen

    2007-06-01

    Full Text Available OBJECTIVE: To assess the technical feasibility of mini-invasive sling procedure and present preliminary results in the treatment of urinary incontinence due to sphincteric insufficiency. MATERIALS AND METHODS: Thirteen patients (6 males, 7 females, 8 with myelomeningocele, 1 with tethered spinal cord, 3 with bladder exstrophy, 1 with epispadias underwent sling procedure with porcine dermis acellular collagen matrix (PelvilaceTM, Bard medical, UK. The median age was 15.5 (range 8.9-27.5 years. A suprapubic catheter was inserted for the measurement of leak point pressure during the operation. In females vaginal and in males perineal incision was used for sling insertion. The sling was introduced under cystoscopic control. The sling was not fixed with sutures. The outcomes were reviewed at 1, 6 and 12 month after the operation. RESULTS: The median leak point pressure increased from 21.5 (range 5-25 cm H2O to 85 (range 70-100 cm H2O. At 1 month 8 and at 6 months 3 out of 13 patients were dry. At 12 months, none out of 11 patients was completely dry. However, at 12 months some improvement in incontinence was detected in 9 out of 11 patients. Two patients had primary failures. One patient got sling erosion to urethra after a tightening attempt. In one patient detrusor overactivity increased after the sling procedure. CONCLUSIONS: PelvilaceTM sling is safe and easy to introduce in both males and females if pelvic floor anatomy is normal. Although immediate results were promising in neuropathic incontinence, the results seem to deteriorate to unacceptable low level already during the first year. In exstrophy patients the results are generally poor.

  1. Lower esophageal sphincter relaxation is impaired in older patients with dysphagia

    Institute of Scientific and Technical Information of China (English)

    Laura K Besanko; Carly M Burgstad; Reme Mountifield; Jane M Andrews; Richard Heddle; Helen Checklin; Robert JL Fraser

    2011-01-01

    AIM: To characterize the effects of age on the mechanisms underlying the common condition of esophageal dysphagia in older patients, using detailed manometric analysis. METHODS: A retrospective case-control audit was performed on 19 patients aged ≥ 80 years (mean age 85 ± 0.7 year) who underwent a manometric study for dysphagia (2004-2009). Data were compared with 19 younger dysphagic patients (32 ± 1.7 years). Detailed manometric analysis performed prospectively included basal lower esophageal sphincter pressure (BLESP), pre-swallow and nadir LESP, esophageal body pressures and peristaltic duration, during water swallows (5 mL) in right lateral (RL) and upright (UR) postures and with solids. Data are mean ± SE; a P -value < 0.05 was considered significant. RESULTS: Elderly dysphagic patients had higher BLESP than younger patients (23.4 ± 3.8 vs 14.9 ± 1.2 mmHg; P < 0.05). Pre-swallow LESP was elevated in the elderly in both postures (RL: 1 and 4 s P = 0.019 and P = 0.05; UR: P < 0.05 and P = 0.05) and solids (P < 0.01). In older patients, LES nadir pressure was higher with liquids (RL: 2.3 ± 0.6 mmHg vs 0.7 ± 0.6 mmHg, P < 0.05; UR: 3.5 ± 0.9 mmHg vs 1.6 ± 0.5 mmHg, P = 0.01) with shorter relaxation after solids (7.9 ± 1.5 s vs 9.7 ± 0.4 s, P = 0.05). No age-related differences were seen in esophageal body pressures or peristalsis duration. CONCLUSION: Basal LES pressure is elevated and swallow-induced relaxation impaired in elderly dysphagic patients. Its contribution to dysphagia and the effects of healthy ageing require further investigation.

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

    Institute of Scientific and Technical Information of China (English)

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

    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 motilityof 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

  3. The roentgenographic findings of achilles tendon rupture

    International Nuclear Information System (INIS)

    To evaluate the diagnostic value of a lateral view of the ankles in Achilles tendon rupture. We performed a retrospective analysis of the roentgenographic findings of 15 patients with surgically proven Achilles tendon rupture. Four groups of 15 patients(normal, ankle sprain, medial lateral malleolar fracture, and calcaneal fracture) were analysed as reference groups. Plain radiographs were reviewed with regard to Kager's triangle, Arner's sign, Toygar's angle, ill defined radiolucent shadow through the Achilles tendon, sharpness of the anterior margin of Achilles tendon, and meniscoid smooth margin of the posterior skin surface of the ankle. Kager's triangle was deformed and disappeared after rupture of the Achilles tendon in nine patients(60%) with operative verification of the rupture, six patients(40%) had a positive Arner's sign, while none had a diminished Toygars angle. In 13 patients(87%) with a ruptured Achilles tendon, the thickness of this was nonuniform compared with the reference group. The anterior margin of the Achilles tendon became serrated and indistinct in 14 patients(93%) in whom this was ruptured. An abnormal ill defined radiolucent shadow through the Achilles tendon was noted in nine patient(60%), and nonparallelism between the anterior margin of the Achilles tendon and posterior skin surface of the ankle was detected in 11 patients(73%). The posterior skin surface of the ankle had a nodular surface margin in 13 patients(87%). A deformed Kager's triangle and Achilles tendon, and an abnormal ill defined radiolucent shadow through the Achilles tendon in a lateral view of the ankles are important findings for the diagnesis of in diagnosing achilles tendon rupture

  4. The roentgenographic findings of achilles tendon rupture

    Energy Technology Data Exchange (ETDEWEB)

    Seouk, Kang Hyo; Keun, Rho Yong [Shilla General Hospital, Seoul (Korea, Republic of)

    1999-03-01

    To evaluate the diagnostic value of a lateral view of the ankles in Achilles tendon rupture. We performed a retrospective analysis of the roentgenographic findings of 15 patients with surgically proven Achilles tendon rupture. Four groups of 15 patients(normal, ankle sprain, medial lateral malleolar fracture, and calcaneal fracture) were analysed as reference groups. Plain radiographs were reviewed with regard to Kager's triangle, Arner's sign, Toygar's angle, ill defined radiolucent shadow through the Achilles tendon, sharpness of the anterior margin of Achilles tendon, and meniscoid smooth margin of the posterior skin surface of the ankle. Kager's triangle was deformed and disappeared after rupture of the Achilles tendon in nine patients(60%) with operative verification of the rupture, six patients(40%) had a positive Arner's sign, while none had a diminished Toygars angle. In 13 patients(87%) with a ruptured Achilles tendon, the thickness of this was nonuniform compared with the reference group. The anterior margin of the Achilles tendon became serrated and indistinct in 14 patients(93%) in whom this was ruptured. An abnormal ill defined radiolucent shadow through the Achilles tendon was noted in nine patient(60%), and nonparallelism between the anterior margin of the Achilles tendon and posterior skin surface of the ankle was detected in 11 patients(73%). The posterior skin surface of the ankle had a nodular surface margin in 13 patients(87%). A deformed Kager's triangle and Achilles tendon, and an abnormal ill defined radiolucent shadow through the Achilles tendon in a lateral view of the ankles are important findings for the diagnesis of in diagnosing achilles tendon rupture.

  5. Spontaneous rupture of the esophagus associated with intramural rupture caused by ingestion of weeding medicine (Lasso)

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jong Keon; Park, Heung Il; Kwun, Chung Sik [Chun Nam University College of Medicine, Kwangju (Korea, Republic of)

    1975-06-15

    This is a report of a case of spontaneous rupture of the esophagus associated with intramural rupture caused by ingestion of weeding medicine for the purpose of suicide in a 27 year old Korean male whose chief complaints were dyspnea, epigastric pain, swallowing disturbance, and hoarseness for 3 days prior to admission. A review of literature is submitted.

  6. Spontaneous rupture of the esophagus associated with intramural rupture caused by ingestion of weeding medicine (Lasso)

    International Nuclear Information System (INIS)

    This is a report of a case of spontaneous rupture of the esophagus associated with intramural rupture caused by ingestion of weeding medicine for the purpose of suicide in a 27 year old Korean male whose chief complaints were dyspnea, epigastric pain, swallowing disturbance, and hoarseness for 3 days prior to admission. A review of literature is submitted.

  7. Trends in incidence of anal cancer and high-grade anal intraepithelial neoplasia in Denmark, 1978-2008

    DEFF Research Database (Denmark)

    Nielsen, Ann; Plum, Christian Edinger Munk; Kjaer, Susanne K

    2012-01-01

    The aim of the study was to determine the incidences of anal cancer and high-grade anal intraepithelial neoplasia (AIN2/3) over time in Danish women and men. Describing the burden of anal cancer and AIN may be valuable in future evaluations of the human papillomavirus (HPV) vaccine. We included all......-HPV-associated histological types levelled out or even declined during the 30 years of observation. In women, the increase in HPV-associated cancers was more pronounced among those under 60 years of age. Our findings indicate that vaccines against HPV might play an important role in the prevention of anal cancer and its...

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

    OpenAIRE

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

    1998-01-01

    A central role in anal carcinogenesis of high-risk types of human papillomaviruses (hrHPV) was recently established, but the possible role of benign anal lesions has not been addressed in hrHPV-positive and -negative anal cancers. As part of a population-based case-control study in Denmark and Sweden, we interviewed 417 case patients (93 men and 324 women) diagnosed during the period 1991-94 with invasive or in situ anal cancer, 534 patients with adenocarcinoma of the rectum and 554 populatio...

  9. Dynamic rupture processes inferred from laboratory microearthquakes

    Science.gov (United States)

    Passelègue, François. X.; Schubnel, Alexandre; Nielsen, Stefan; Bhat, Harsha S.; Deldicque, Damien; Madariaga, Raúl

    2016-06-01

    We report macroscopic stick-slip events in saw-cut Westerly granite samples deformed under controlled upper crustal stress conditions in the laboratory. Experiments were conducted under triaxial loading (σ1>σ2=σ3) at confining pressures (σ3) ranging from 10 to 100 MPa. A high-frequency acoustic monitoring array recorded particle acceleration during macroscopic stick-slip events allowing us to estimate rupture speed. In addition, we record the stress drop dynamically and we show that the dynamic stress drop measured locally close to the fault plane is almost total in the breakdown zone (for normal stress >75 MPa), while the friction f recovers to values of f > 0.4 within only a few hundred microseconds. Enhanced dynamic weakening is observed to be linked to the melting of asperities which can be well explained by flash heating theory in agreement with our postmortem microstructural analysis. Relationships between initial state of stress, rupture velocities, stress drop, and energy budget suggest that at high normal stress (leading to supershear rupture velocities), the rupture processes are more dissipative. Our observations question the current dichotomy between the fracture energy and the frictional energy in terms of rupture processes. A power law scaling of the fracture energy with final slip is observed over 8 orders of magnitude in slip, from a few microns to tens of meters.

  10. Ultrasonogram of tubal pregnancy: Unruptured or ruptured?

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hee Jung; Kim, Jung Sik; Lee, Sung Moon; Kim, Hong; Woo, Seong Ku; Yeun, Seong Do; Lee, Doo Ryong [Keimyung University Schoool of Medicine, Seoul (Korea, Republic of)

    1993-12-15

    To evaluate the usefulness of ultrasonography in the differentiation of the unruptured ones, we performed prospective ultrasonographic study in 56 patients with tubal pregnancy and subsequently correlated with the surgical (45 cases) and laparoscopic (11 cases) findings. The criterion for unruptured tubal pregnancy was the visualization of extra uterine gestational sac or a mass that was separated from the ipsilateral ovary. All cases were confirmed surgically or laparoscopically within 48 hours after sonographic examination. Forty five (80%)cases were proved as unruptured, tubal pregnancy, while 11 (20%) as ruptured one. Extra uterine gestational sac was seen in 31/45 (69%) in unruptured group and 2/11 (18%) in ruptured group. A mass separated from the ipsilateral ovary was seen in 7 unruptured tubal pregnancies and 2 ruptured pregnancies. A mass that was not separated from the ipsilateral ovary was seen in 13 cases. Seven of these were ruptured pregnancies, while 6 were unrupture dones. Using our criteria, the unruptured tubal pregnancy was diagnosed with a sensitivity of 84%, a specificity of 64%, an accuracy of 80%, a positive predictive value of 90% and a negative predictive value of 50%. We conclude that ultrasonography is useful in the differentiation of the unruptured tubal pregnancy from the ruptured one

  11. Ultrasonogram of tubal pregnancy: Unruptured or ruptured?

    International Nuclear Information System (INIS)

    To evaluate the usefulness of ultrasonography in the differentiation of the unruptured ones, we performed prospective ultrasonographic study in 56 patients with tubal pregnancy and subsequently correlated with the surgical (45 cases) and laparoscopic (11 cases) findings. The criterion for unruptured tubal pregnancy was the visualization of extra uterine gestational sac or a mass that was separated from the ipsilateral ovary. All cases were confirmed surgically or laparoscopically within 48 hours after sonographic examination. Forty five (80%)cases were proved as unruptured, tubal pregnancy, while 11 (20%) as ruptured one. Extra uterine gestational sac was seen in 31/45 (69%) in unruptured group and 2/11 (18%) in ruptured group. A mass separated from the ipsilateral ovary was seen in 7 unruptured tubal pregnancies and 2 ruptured pregnancies. A mass that was not separated from the ipsilateral ovary was seen in 13 cases. Seven of these were ruptured pregnancies, while 6 were unrupture dones. Using our criteria, the unruptured tubal pregnancy was diagnosed with a sensitivity of 84%, a specificity of 64%, an accuracy of 80%, a positive predictive value of 90% and a negative predictive value of 50%. We conclude that ultrasonography is useful in the differentiation of the unruptured tubal pregnancy from the ruptured one

  12. Right ventricular hydatid cyst ruptured to pericardium

    Directory of Open Access Journals (Sweden)

    Feridoun Sabzi

    2015-01-01

    Full Text Available Cardiac hydatidosis is rare presentation of body hydatidosis. Incidence of cardiac involvements range from 5% to 5% of patients with hydatid disease. Most common site of hydatid cyst in heart is interventricular septum and left ventricular free wall. Right ventricular free wall involvement by cyst that ruptured to pericardial cavity is very rare presentation of hydatid cyst. Cardiac involvement may have serious consequences such as rupture to blood steam or pericardial cavity. Both the disease and its surgical treatment carry a high complication rate, including rupture leading to cardiac tamponade, anaphylaxis and also death. In the present report, a 43-year-old man with constrictive pericarditis secondary to a pericardial hydatid cyst is described.

  13. Pedicle screw rupture: A case study

    Directory of Open Access Journals (Sweden)

    Giorgio E.O. Giacaglia

    2015-10-01

    Full Text Available In this work we present a technical description related to the rupture of a titanium alloy pedicle screw and connecting bar implanted in dorsal vertebras of a patient. Only metallurgical facts are described, with no attempt to identify any imperfections in the clinical aspects related to the rupture. The results described here are based on extensive analysis of the broken materials in a material sciences specialized laboratory. Excluding an incorrect prosthesis implantation in the surgical procedure and a possible low bone density, an information not available to the research team, with high probability the rupture of metallic pieces used in the prosthetic implant, was produced by the low fatigue resistance resulting by an improper machining process and excessive bending of the connecting bar prior to implant.

  14. Pressure tube rupture in a closed tank

    International Nuclear Information System (INIS)

    A study has been prepared on the feasibility of conducting pressure tube/calandria tube rupture tests in a closed tank, simulating a scaled-down calandria vessel. The study includes: i) a review of previous work, ii) an analytical investigation of the scaling problem of the calandria vessel and relevant in-core structures, iii) selection of a method for initiating pressure tube/calandria tube rupture, iv) a set of specifications for the test assembly, v) general arrangement drawings, vi) a proposal for a test matrix, vii) a survey and evaluation of existing facilities which could provide the required high pressure, temperature and fluid inventory, and viii) a cost estimate for the detailed design and construction, instrumentation, data acquisition and reduction, testing and reporting. The study concludes that it is both technically and practically feasible to conduct pressure tube rupture tests in a closed tank

  15. Component external leakage and rupture frequency estimates

    International Nuclear Information System (INIS)

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

  16. Rupture of pectoralis major muscle: review article

    Directory of Open Access Journals (Sweden)

    Guity MR

    2010-05-01

    Full Text Available "nBackground: Rupture of pectoralis major muscle is a very rare and often athletic injury. These days in our country this injury occurs more frequently. This could be due to increase in professional participation of amateur people in different types of sport, like body building and weight-lifting (especially bench-pressing without adequate preparation, training and taking necessary precautions. In this article, we have tried to review several aspects of complex anatomy of pectoralis major muscle, epidemiology, mechanism, clinical presentations, imaging modalities, surgical indications and techniques of its rupture. Complex and especial anatomy of pectoralis major muscle, in its humeral insertion particularly, have a major role of its vulnerability to sudden and eccentric contraction as the main mechanism of rupture. Also, restoration of this complex anatomy seems to be important during surgical repair to have normal function of the muscle again.

  17. Comentarios sobre dibujo analítico

    OpenAIRE

    Mata Botella, Elena

    2004-01-01

    Cuaderno de apoyo a la docencia del DIBUJO DE ARQUITECTURA que pretende hacer reflexionar al alumno (de primero o segundo de carrera) sobre un tipo de dibujo que aquí se ha llamado “dibujo analítico”. Un dibujo que a través de operaciones gráficas y conceptuales como la esquematización y la selección de información, tiende a alejarse de la descripción del objeto arquitectónico para adentrarse en determinados aspectos o dimensiones que subyacen en el proyecto arquitectónico. Unas notas intr...

  18. Kromatografske metode analize polifenola u vinima

    OpenAIRE

    Rastija, V.; Medić-Šarić, M.

    2009-01-01

    Vino je bogat izvor različitih skupina polifenola koje uključuju fenolne kiseline, flavonoide i trihidroksistilben-resveratrol. U posljednje vrijeme zanimanje za te supstancije potaknuto je brojnim dokazima o njihovim pozitivnim učincima na zdravlje čovjeka. Do sada su primjenjivane različite metode analize polifenola u vinu uključujući kromatografske, spektrofotometrijske i elektrokemijske metode. U ovom članku opisane su ukratko metode priprave uzoraka i najnovija dostignuća u analizi polif...

  19. Multiscale Entropy Analysis of Surface Electromyographic Signals from the Urethral Sphincter as a Prognostic Indicator for Surgical Candidates with Primary Bladder Neck Obstruction

    Directory of Open Access Journals (Sweden)

    Hsien-Tsai Wu

    2015-12-01

    Full Text Available To explore information hidden in the electromyographic (EMG signals of the urethral sphincter that may be of prognostic significance for patients with primary bladder neck obstruction (PBNO, 41 patients with voiding difficulty were divided into four groups: 1 patients with primary bladder neck obstruction (PBNO with successful (Group 1, n = 14 and 2 unsuccessful (Group 2, n = 8 surgical outcomes, 3 patients with detrusor overactivity (Group 3, n = 7, and 4 patients with detrusor-external sphincter dyssynergia (Group 4, n = 12. All patients underwent baseline urodynamic studies (preoperative for Group 1 and Group 2 for comparison. The results demonstrated that, despite no significant difference in urodynamic parameters between Group 1 and Group 2, the large-scale multiscale entropy (MSE of preoperative EMG (i.e., MSELS(EMG of Group 1 was significantly higher than that of Group 2 without notable difference between Group 1 and Group 3 (i.e., patients with normal sphincter function. Moreover, the MSELS(EMG and small-scale MSE of preoperative EMG (i.e., MSESS(EMG of Group 2 were notably higher than those of Group 4 (i.e., patients with abnormal sphincter function, while both MSELS(EMG and MSESS(EMG of Group 3 were notably higher than those of Group 2. In conclusion, using MSE analysis for assessing preoperative urethral sphincter EMG signals successfully distinguished between PBNO patients with subsequent successful surgery from those with surgical failure possibly due to subtle functional impairment of the urethral sphincter that cannot be detected by routine urodynamic studies. The results, therefore, highlight the potential clinical significance of this analytical tool in guiding urologists regarding their choice of medical versus surgical treatment for this patient population.

  20. Linguine sign in musculoskeletal imaging: calf silicone implant rupture

    International Nuclear Information System (INIS)

    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. (orig.)

  1. Linguine sign in musculoskeletal imaging: calf silicone implant rupture

    Energy Technology Data Exchange (ETDEWEB)

    Duryea, Dennis; Petscavage-Thomas, Jonelle [Milton S. Hershey Medical Center, Department of Radiology, H066, 500 University Drive, P.O. Box 850, Hershey, PA (United States); Frauenhoffer, Elizabeth E. [Milton S. Hershey Medical Center, Department of Pathology, 500 University Drive, P.O. Box 850, Hershey, PA (United States); Walker, Eric A. [Milton S. Hershey Medical Center, Department of Radiology, H066, 500 University Drive, P.O. Box 850, Hershey, PA (United States); Uniformed Services University of the Health Sciences, Department of Radiology and Nuclear Medicine, Bethesda, MD, 20814 (United States)

    2015-08-15

    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. (orig.)

  2. Anal cancer and intraepithelial neoplasia screening: A review.

    Science.gov (United States)

    Leeds, Ira L; Fang, Sandy H

    2016-01-27

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

  3. Kirurgisk behandling af anale fistler ved Crohns sygdom

    DEFF Research Database (Denmark)

    Heyckendorff-Diebold, Tina; Maeda, Yasuko; Buntzen, Steen;

    2012-01-01

    The treatment of transsphincteric anal fistulas in Crohn's disease is a balance between the elimination of the sepsis and the functional outcome. Loose setons can be used as a preoperative drainage or chronic treatment. Fibrin glue and the anal fistula plug are methods with excellent functional o...

  4. Sotsiaalvõrgustike analüüs / Innar Liiv

    Index Scriptorium Estoniae

    Liiv, Innar, 1982-

    2005-01-01

    Sotsiaalvõrgustike analüüs (social network analys - SNA) on tehnikate, meetodite ning vahendite kogum, mis aitab avastada mustreid sotsiaalsetes struktuurides. Analüüsi kasutamisest energeetikaettevõtte Enron ja kohalike ettevõtete võrgustike näitel. Skeemid

  5. Thoracic Outlet Syndrome Following Breast Implant Rupture

    Directory of Open Access Journals (Sweden)

    Raakhi Mistry, MBChB

    2015-03-01

    Full Text Available 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.

  6. Ruptured rudimentary horn at 22 weeks

    Directory of Open Access Journals (Sweden)

    Hansa Dhar

    2012-01-01

    Full Text Available Rudimentary horn is a developmental anomaly of the uterus. Pregnancy in a non-communicating rudimentary horn is very difficult to diagnose before it ruptures. A case of undiagnosed rudimentary horn pregnancy at 22 weeks presented to Nizwa regional referral hospital in shock with features of acute abdomen. Chances of rupture in first or second trimester are increased with catastrophic haemorrhage leading to increased maternal and perinatal morbidity and mortality. Management of such cases is a challenge till today due to diagnostic dilemma. Expertise in ultrasonography and early resort to surgical management is life saving in such cases.

  7. Ruptured rudimentary horn at 22 weeks.

    Science.gov (United States)

    Dhar, Hansa

    2012-07-01

    Rudimentary horn is a developmental anomaly of the uterus. Pregnancy in a non-communicating rudimentary horn is very difficult to diagnose before it ruptures. A case of undiagnosed rudimentary horn pregnancy at 22 weeks presented to Nizwa regional referral hospital in shock with features of acute abdomen. Chances of rupture in first or second trimester are increased with catastrophic haemorrhage leading to increased maternal and perinatal morbidity and mortality. Management of such cases is a challenge till today due to diagnostic dilemma. Expertise in ultrasonography and early resort to surgical management is life saving in such cases. PMID:23293421

  8. [Gastric rupture after ingestion of liquid nitrogen].

    Science.gov (United States)

    Knudsen, Anders Riegels; Nielsen, Casper; Christensen, Peter

    2009-02-01

    A 28-year-old male was admitted to hospital with severe abdominal distension and subcutaneous emphysema after ingesting 15 ml liquid nitrogen to produce an impressive burp. A rupture of the stomach at the lesser curvature was sutured by laparotomy. Peroperative gastroscopy showed no signs of cold-induced lesions. Liquid nitrogen boils at -196 degrees C. When heated to body temperature, it instantly expands 700 times, in this case predictably leading to gastric rupture. Therefore, any oral intake of even small amounts of liquid nitrogen should be avoided. PMID:19210943

  9. COMPARISON OF CLADDING CREEP RUPTURE MODELS

    International Nuclear Information System (INIS)

    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

  10. Gravid med spontan ruptur af arteria uterina

    DEFF Research Database (Denmark)

    Jònsdòttir, Fjòla; Pinborg, Anja; Wilken-Jensen, Charlotte

    2014-01-01

    Pregnant women with acute abdominal pain are a clinical challenge. We present a rare but potential life-threatening condition of a pregnant woman with acute abdominal pain. The woman was in gestational week 37 with severe abdominal pain and was admitted to the labour ward. She became haemo......-dynamic instable 24 hours after vaginal delivery, and emergency laparotomi revealed a spontaneous rupture of the right uterine artery. Spontaneous rupture of the uterine artery is rare but should be considered as a possible cause of acute abdominal pain in pregnant women....

  11. A Rare Case of Simultaneous Acute Bilateral Quadriceps Tendon Rupture and Unilateral Achilles Tendon Rupture

    Directory of Open Access Journals (Sweden)

    Wei Yee Leong

    2013-07-01

    Full Text Available Introduction: There have been multiple reported cases of bilateral quadriceps tendon ruptures (QTR in the literature. These injuries frequently associated with delayed diagnosis, which results in delayed surgical treatment. In very unusual cases, bilateral QTRs can be associated with other simultaneous tendon ruptures. Case Report: We present a rare case of bilateral QTR with a simultaneous Achilles Tendon Rupture involving a 31 years old Caucasian man who is a semi-professional body builder taking anabolic steroids. To date bilateral QTR with additional TA rupture has only been reported once in the literature and to our knowledge this is the first reported case of bilateral QTR and simultaneous TA rupture in a young, fit and healthy individual. Conclusion: The diagnosis of bilateral QTR alone can sometimes be challenging and the possibility of even further tendon injuries should be carefully assessed. A delay in diagnosis could result in delay in treatment and potentially worse outcome for the patient. Keywords: Quadriceps tendon rupture; Achilles tendon rupture; Bilateral.

  12. Hypertensive lower esophageal sphincter (HLES: Prevalence,symptoms genesis and effect of pneumatic balloon dilatation

    Directory of Open Access Journals (Sweden)

    Gad El-Hak Nabil

    2006-01-01

    Full Text Available Background: Summary and background data: The Hypertensive lower esophageal sphincter (HLES is an unusual primary motor disorder of the esophagus. The significance of this motility disorder is still questionable. Objective: The objectives were: (a identification of the prevalence of HLES in these patients, (b identification of the common presenting symptoms of HLES, (c study of the correlation of the symptoms with LESP and (d study of the effectiveness of pneumatic balloon dilation in cases that fail to respond to medical treatment. Methods: A retrospective study that includes four thousand one hundred and seventy patients, who were subjected to esophageal manometry in the period from January 1994 to December 2003, among whom sixty-six patients with HLES (LESP> 40 mmHg were found. In addition to manometry, upper endoscopy was done to forty-nine patients, upper GI barium studies to thirtyeight patients and esophageal pH- metry to sixteen patients. Results: showed that most of our patients were females (45 females and 21 males, with a mean age of 36.6 ±±14 years. Patients with dysphagia (57.5% had the highest LESP (52.1 ±±21, mmHg while patients with chest pain (47% had the highest distal esophageal contraction amplitude (153.9 ±± 93.2 mmHg. Endoscopy showed varying degrees of esophagitis in 17 patients (34%. Barium studies showed corkscrew esophagus in seven patients (18.4% and dilated esophagus in nine patients (23.7%. LESP was highest in patients with dilated esophagus (57.5 ±± 33.4 mmHg. All our patients were subjected to medical treatment, of which twelve patients underwent pneumatic dilation with successfully reduced LESP and symptoms relief in 91% of patients. Conclusions: It was concluded that the prevalence of HLES is around 1.6, in which dysphagia and chest pain are the usual presenting symptom, and that pneumatic balloon dilatation is very effective when properly applied. It will probably occupy the same position it has in

  13. Anal canal carcinoma: Diagnosis - therapy - prognosis

    International Nuclear Information System (INIS)

    78 patients with anal canal carcinoma were treated between 1970 and 1988 at the University Hospital Erlangen. 48 patients (35 women, 13 men) were treated by surgery alone, 44/48 by abdominoperineal resection, 4/48 by local excision. Median age was 63 years, median follow-up 8.5 years. The overall local recurrence rate was 16.7%, the overall five-year-survival was 51%. 30 patients received a combined radio-chemotherapy. The small pelvis was treated with a.-p./p.-a. fields up to a total dose between 42 and 50 Gy. Two courses of chemotherapy consisting of 5-FU (800 to 1000 mg/m2 days 1 to 4 and 29 to 32) and Mitomycin C (10 mg/m2 days 1 and 29) were administered. Two months after completion of treatment 83% had a biopsy proven complete remission. After a median follow-up of 15 months 87% are alive with NED, 74% are continent. The combined regimen of radio-chemotherapy is considered as the treatment of the choice for anal canal carcinoma. Abdominoperineal resection is only performed in patients with non response or local recurrent disease. (orig.)

  14. Technická analýza

    OpenAIRE

    Skoupý, David

    2014-01-01

    Jedním ze způsobů, jak nakládat s finančními prostředky je investování. To za určitých modelů a predikcí sleduje vývoj trhu či daného instrumentu (akcie). Tato práce se zabývá vypracováním programu, jenž předem tvoří predikci vývoje pro daný instrument na určené období. Zpočátku uvádí nezbytná teoretická východiska. První část se tak zaměřuje na popis technické analýzy, která vychází z historie grafů a statistik. Dále na popis jejích indikátorů a také grafů, na kterých lze technickou analýzu ...

  15. Elektromagnetická analýza

    OpenAIRE

    Kolofík, Josef

    2012-01-01

    Tato práce se zabývá problematikou elektromagnetické analýzy a aplikací elektromagnetického postranního kanálu. První a druhá část práce popisují základy kryptografie, funkci kryptografického modulu a útoky vedené postranními kanály. Třetí část práce rozebírá možnosti elektromagnetické analýzy, konstrukci sondy, popis laboratorního pracoviště, elektromagnetickou emisi PIC16F84A, algoritmus AES a přípravu na laboratorní měření. Čtvrtá část práce popisuje konkrétní laboratorní měření a extrakci...

  16. Technická analýza

    OpenAIRE

    NĚMEC, Ondřej

    2014-01-01

    Předmětem diplomové práce je technická analýza – vytvoření investičních strategií. V teoretické části jsou popsána teoretická východiska vztahující se k technické analýze a indikátorům. V praktické části je zmapována současná situace v prostředí investování na forexu – porovnání brokerů, výběr platformy apod. Vlastní řešení potom obsahuje popis investičních strategií, které byly naprogramovány v jazyku Meta Quotes Language 4 a testovány a optimalizovány pomocí genetických algoritmů v prostřed...

  17. Ruptures in probability scale. Their manifestations in economics and forecasting

    OpenAIRE

    Harin, Alexander

    2010-01-01

    Proofs of theorems of existence of ruptures in finite numerical segments and in the probability scale are considered. The proofs are performed for the continuous case. Manifestations of these ruptures in economics and forecasting are touched upon.

  18. Rupture safety for nuclear reactor pressure vessels

    International Nuclear Information System (INIS)

    This safety device for pressure vessels with cooling water inlet and outlet supports is to catch flying parts in the case of a rupture and to convert their energy into forming work without rupturing itself. A steel cladding is used for this purpose which surrounds the lower part of the pressure vessel as protective container like a pot, right up to the coolant supports. In order to keep the possible acceleration paths of the rupture pieces as small as possible, the gap between the two vessels is limited to a small tolerance to compensate for the differences in thermal expansion. In order to take up the compensating pressure after rupture of the reactor pressure vessel, the cylindrical part of the protective vessel requires double wall thickness like the concave floor. The cylindrical part is thus cladded by a cylindrical protective ring of the same wall thickness or by a multilayer sheet cladding which can be easily fabricated, transported and assembled. The cylindrical and concave part of the inner protective vessel have uniform wall thickness. This hence ensures that the elastic form changing is uniformly distributed over the height of the protective vessel. (HP)

  19. Bilateral synchronous rupture of the quadriceps tendon.

    LENUS (Irish Health Repository)

    Ellanti, P

    2012-09-01

    Bilateral simultaneous rupture of the quadriceps tendon is a rare entity. They are often associated with degenerative changes of the tendons and predisposing conditions such as diabetes or excessive steroid use. They most commonly tend to occur in patients of 40 years of age or older.

  20. Rupture of the neck in nuclear fission

    International Nuclear Information System (INIS)

    We introduce a degree of freedom to describe the rupture of the neck in nuclear fission and calculate the point at which the neck ruptures as the nucleus descends dynamically from its fission saddle point. This is done by mentally slicing the system into two portions at its minimum neck radius and calculating the force required to separate the two portions while keeping their shapes fixed. This force is obtained by differentiating with respect to separation the sum of the Coulomb and nuclear interaction energies between the two portions. For nuclei throughout the Periodic Table we calculate this force along dynamical paths leading from the fission saddle point. The force is initially attractive but becomes repulsive when the neck reaches a critical size. For actinide nuclei the neck radius at which rupture occurs is about 2 fm. This increases the calculated translational kinetic energy of the fission fragments at infinity relative to that calculated for scission occurring at zero neck radius. With the effect of neck rupture taken into account, we calculate and compare with experimental results fission-fragment kinetic energies for two types of nuclear dissipation: ordinary two-body viscosity and one-body dissipation

  1. The diagnosis of breast implant rupture

    DEFF Research Database (Denmark)

    Hölmich, Lisbet R; Vejborg, Ilse; Conrad, Carsten; Sletting, Susanne; McLaughlin, Joseph K

    2005-01-01

    STUDY OBJECTIVE: The aim of this study was to evaluate the accuracy of Magnetic Resonance Imaging (MRI) as performed according to a strict study protocol in diagnosing rupture of silicone breast implants. MATERIAL AND METHODS: The study population consisted of 64 women with 118 implants, who had ...

  2. Ruptured ectopic pregnancy in rudimentary horn

    Directory of Open Access Journals (Sweden)

    Nivedita A. Goverdhan

    2016-04-01

    Full Text Available A unicornuate uterus with a rudimentary horn is a rare mullerian abnormality which may cause many gynaecological and obstetrical complications like infertility, endometriosis, hematometra, abortions, and preterm deliveries; and is usually associated with urinary tract anomalies. Pregnancy in a non-communicating rudimentary horn is very difficult to diagnose before it ruptures, leading to life -threatening intraperitoneal hemorrhage, which usually presents in the second or third trimester. A 23 year old G2P1L1 in lactational amenorrhea was admitted to the labour room with haemorrhagic shock. Provisionally diagnosed as ruptured ectopic pregnancy, patient was taken for laparotomy after resuscitation. Intraoperative findings were: haemoperitoneum of 3 liters, unicornuate uterus with a ruptured left rudimentary non-communicating horn containing products of conception, and macroscopically normal fallopian tubes and ovaries. The left adnexa were attached to the rudimentary horn. Excision of the rudimentary horn was done. The fetus, weighing about 250 grams, was recovered en-sac from the peritoneal cavity. There is a need for an increased awareness of rudimentary horn pregnancy especially in developing countries where the possibility of detection before pregnancy or before the rupture is unlikely, and precious time is lost in shifting these women to the referral hospital. [Int J Reprod Contracept Obstet Gynecol 2016; 5(4.000: 1247-1250

  3. Rupture process of the 2011 Lorca earthquake

    International Nuclear Information System (INIS)

    The focal mechanism of the Lorca 2011 earthquake has been estimated from the inversion of the seismic moment tensor at regional and P and SH waveforms at tele seismic distances. Results shown a reverse fault with planes oriented in E-W direction and shallow focus (4km). The rupture process may be explained using a extended fault (circular fracture of 2 km radius) and rupture velocity of 2.2 km/s. From this model we have generated velocity and acceleration synthetic records for a range of distances from 20 to 200 km. From joint inversion of these synthetic and observed data we have identify the WSWENE plane as the rupture plane, with the rupture propagating to the WSW. The 2011 Lorca earthquake is an evidence of the complexity of the region, where we have normal (Lorca, 1977), reverse (Mula, 1999 and Lorca 2011) and strike-slip (Bullas (2002, 2005) motions, while the regional stress pattern corresponds to horizontal N-S compression, with the exception of Lorca 1977 shock. (Author) 9 refs.

  4. Spontaneous rupture of hepatocellular carcinoma in children

    Directory of Open Access Journals (Sweden)

    Nejmeddine Affes

    2010-01-01

    Full Text Available Spontaneous rupture of hepatocellular carcinoma (HCC with intraperitoneal haemorrhage is a life-threatening complication with a high mortality rate. The mechanism of spontaneous rupture of HCC is unknown. It may be related to venous congestion, haemorrhage, central necrosis, or trauma. Patients with ruptured tumours confirmed on computerised tomography (CT scan underwent immediate cardiovascular resuscitation. Depending on the stage of the tumour as seen on the CT scan and the condition of the patient, stoppage of bleeding was accomplished by transcutaneous hepatic artery embolisation, selective hepatic artery ligation, or hepatic resection. Only clinically stable, small tumours were resected as an emergency procedure. We report the case of a 12-year-old child admitted with acute right upper quadrant abdominal pain and signs of hypovolaemia. Ultrasonography revealed free peritoneal fluid and left liver haematoma was suspected. CT scan showed a tumour on the left side of the liver and free peritoneal fluid. Emergency laparotomy revealed haemoperitoneum and a 5-cm diameter left liver tumour which was ulcerated and haemorrhagic. The tumour was completely resected. Histopathological examination confirmed a diagnosis of rupture of differentiated HCC.

  5. Double heart rupture after acute myocardial infarction: A case report

    OpenAIRE

    Ivanov Igor; Lovrenski Aleksandra; Dejanović Jadranka; Petrović Milovan; Jung Robert; Raffay Violetta

    2014-01-01

    Introduction. Double heart rupture is a rare complication of acute myocardial infarction with high mortality. Case report. We presented a 67-year-old female patient with symptoms and signs of myocardial infarction, diagnosed with echocardiography, rupture of the septum, the presence of a thrombus and a small pericardial effusion. Soon after admission the patient died. Autopsy revealed tamponade and double myocardial rupture, free wall rupture and ventricula...

  6. Computing broadband accelerograms using kinematic rupture modeling

    International Nuclear Information System (INIS)

    In order to make the broadband kinematic rupture modeling more realistic with respect to dynamic modeling, physical constraints are added to the rupture parameters. To improve the slip velocity function (SVF) modeling, an evolution of the k-2 source model is proposed, which consists to decompose the slip as a sum of sub-events by band of k. This model yields to SVF close to the solution proposed by Kostrov for a crack, while preserving the spectral characteristics of the radiated wave field, i.e. a w2 model with spectral amplitudes at high frequency scaled to the coefficient of directivity Cd. To better control the directivity effects, a composite source description is combined with a scaling law defining the extent of the nucleation area for each sub-event. The resulting model allows to reduce the apparent coefficient of directivity to a fraction of Cd, as well as to reproduce the standard deviation of the new empirical attenuation relationships proposed for Japan. To make source models more realistic, a variable rupture velocity in agreement with the physics of the rupture must be considered. The followed approach that is based on an analytical relation between the fracture energy, the slip and the rupture velocity, leads to higher values of the peak ground acceleration in the vicinity of the fault. Finally, to better account for the interaction of the wave field with the geological medium, a semi-empirical methodology is developed combining a composite source model with empirical Green functions, and is applied to the Yamaguchi, Mw 5.9 earthquake. The modeled synthetics reproduce satisfactorily well the observed main characteristics of ground motions. (author)

  7. The classification and staging of cancerous growths of the anal canal

    International Nuclear Information System (INIS)

    In this chapter authors give information about frequency of cancerous growths of the anal canal, general analysis of observations the classification and staging of cancerous growths of the anal canal, clinical-anatomy classification of cancerous growths of the anal canal and staging of cancerous growths of anal canal

  8. Radionuclide diagnosis of splenic rupture in infectious mononucleosis

    Energy Technology Data Exchange (ETDEWEB)

    Vezina, W.C.; Nicholson, R.L.; Cohen, P.; Chamberlain, M.J.

    1984-06-01

    Spontaneous splenic rupture is a rare but serious complication of infectious mononucleosis. Although radionuclide spleen imaging is a well accepted method for diagnosis of traumatic rupture, interpretation can be difficult in the setting of mononucleosis, as tears may be ill-defined and diagnosis hampered by inhomogeneous splenic uptake. Four proven cases of spontaneous rupture are presented, three of which illustrate these diagnostic problems.

  9. Radionuclide diagnosis of splenic rupture in infectious mononucleosis

    International Nuclear Information System (INIS)

    Spontaneous splenic rupture is a rare but serious complication of infectious mononucleosis. Although radionuclide spleen imaging is a well accepted method for diagnosis of traumatic rupture, interpretation can be difficult in the setting of mononucleosis, as tears may be ill-defined and diagnosis hampered by inhomogeneous splenic uptake. Four proven cases of spontaneous rupture are presented, three of which illustrate these diagnostic problems

  10. Bilateral spontaneous rupture of flexor digitorum profundus tendons.

    LENUS (Irish Health Repository)

    O'Sullivan, S T

    2012-02-03

    Spontaneous tendon rupture is an unusual condition usually associated with underlying disease processes such as rheumatoid arthritis, chronic renal failure or bony abnormalities of the hand. We report a case of spontaneous, non-concurrent bilateral rupture of flexor profundus tendons in an otherwise healthy individual. Treatment was successful and consisted of a two-stage reconstruction of the ruptured tendon.

  11. Spontaneous rupture of a congenital diaphragmatic eventration in an infant.

    Science.gov (United States)

    Saha, Soumitra; Bal, Harshjeet Singh; Sen, Sudipta

    2015-01-01

    Rupture of the diaphragm may be traumatic or spontaneous. A spontaneous rupture occurring in a congenital eventration of the diaphragm is extremely rare. Only one such case has been reported previously. We report a case of a 5-month-old male infant who presented with acute life-threatening respiratory distress secondary to spontaneous rupture of a congenital diaphragmatic eventration. PMID:25976306

  12. Analýza vybrané firmy

    OpenAIRE

    Žahourek, Martin

    2010-01-01

    V dnešní nelehké situaci musí organizace obzvlášť pečlivě sledovat svoje hospodaření a plánovat. Cílem této práce je zhodnotit aktuální situace společnosti Centropen a.s.. Použitými nástroji jsou finanční analýza, fundamentální analýza, SLEPTE analýza a Porterova analýza pěti sil. Výsledky těchto analýz jsou dále zpracovány ve SWOT analýza, ta je potom porovnána se SWOT analýzou k situaci z roku 2006. Today, in the hard situation, must organization very carefully observe its economy and pl...

  13. Open lateral internal anal sphincterotomy under local anesthesia as the gold standard in the treatment of chronic anal fissures: A prospective clinical and manometric study Esfinterotomía lateral interna abierta con anestesia local como gold standard en el tratamiento de la fisura anal crónica: Estudio prospectivo clínico y manométrico a largo plazo

    Directory of Open Access Journals (Sweden)

    A. Sánchez Romero

    2004-12-01

    Full Text Available Background: chronic anal fissure is one of the most frequent proctological disorders in Western populations. Open lateral internal sphincterotomy is one of the therapeutic options accepted as the treatment of choice for chronic anal fissure, since it reduces the hypertonia of the internal anal sphincter (the main etiopathogenic mechanism of fissures, decreases anal pain, and allows the fissure to heal. Material and methods: we carried out a prospective study of 120 patients operated on for chronic anal fissure with open sphincterotomy under local anesthesia at our Proctology Outpatient Unit from 1998 to 2001. No preoperative studies, bowel preparation, or antibiotic prophylaxis were carried out. All patients were followed up after 1 week, 2 months, 6 months, and 1 year, and underwent an anal manometry before and after surgery. Results: early complications: 3 hematoma-ecchymosis of the wound (2.5%, 3 self-limited hemorrhage events (2.5%. No hemorrhoidal thrombosis, fistulas, or perianal abscesses occurred. Fissures recurred in nine patients (7.5% within one year. The initial rate of incontinence of 7.5% at two months dropped down to 5% at six months. The mean resting pressure (MRP in incontinent patients was lower than in continent patients (55±7 mmHg versus 80.7 ± 21 mmHg. The difference in mean squeeze pressure (MSP between incontinent patients and continent patients was not statistically significant. Conclusions: open sphincterotomy under local anesthesia has a long-term rate of healing and a morbidity rate similar to other techniques. It may therefore be considered an effective treatment for chronic anal fissure.Introducción: la fisura anal crónica sigue siendo uno de los problemas proctológicos más frecuentes e incapacitantes en la población occidental actual. La esfinterotomía lateral interna abierta es una de las opciones terapéuticas descritas y aceptadas como tratamiento de elección de la fisura anal crónica, ya que reduce la

  14. Effect of delta(9)-tetrahydrocannabinol, a cannabinoid receptor agonist, on the triggering of transient lower oesophageal sphincter relaxations in dogs and humans

    NARCIS (Netherlands)

    H. Beaumont; J. Jensen; A. Carlsson; M. Ruth; A. Lehmann; G.E. Boeckxstaens

    2009-01-01

    Background and purpose: Transient lower oesophageal sphincter relaxations (TLESRs) are the main mechanism underlying gastro-oesophageal reflux and are a potential pharmacological treatment target. We evaluated the effect of the CB(1)/CB(2) receptor agonist Delta(9)-tetrahydrocannabinol (Delta(9)-THC

  15. Metachronous tubulovillous and tubular adenomas of the anal canal

    OpenAIRE

    NOZAWA, HIROAKI; ISHIHARA, SOICHIRO; Morikawa, Teppei; Tanaka, Junichiro; YASUDA, KOJI; Ohtani, Kensuke; Nishikawa, Takeshi; Tanaka, Toshiaki; Kiyomatsu, Tomomichi; Kawai, Kazushige; Hata, Keisuke; Kazama, Shinsuke; Yamaguchi, Hironori; Sunami, Eiji; Kitayama, Joji

    2015-01-01

    Anal canal adenoma is an extremely rare disease that has the potential to transform into a malignant tumor. We herein presented a rare case of metachronous multiple adenomas of the anal canal. A 48-year-old woman underwent total colonoscopy following a positive fecal blood test. A 9-mm villous polyp arising from the posterior wall of the anal canal was removed by snare polypectomy. Histologically, the tumor was tubulovillous adenoma with high-grade dysplasia and the cut end was negative for t...

  16. The Influence of Antral Ulcers on Intramural Gastric Nerve Projections Supplying the Pyloric Sphincter in the Pig (Sus scrofa domestica-Neuronal Tracing Studies.

    Directory of Open Access Journals (Sweden)

    Michal Zalecki

    Full Text Available Gastric ulcerations in the region of antrum pylori represent a serious medical problem in humans and animals. Such localization of ulcers can influence the intrinsic descending nerve supply to the pyloric sphincter. The pyloric function is precisely regulated by intrinsic and extrinsic nerves. Impaired neural regulation could result in pyloric sphincter dysfunction and gastric emptying malfunction. The aim of the study was to determine the effect of gastric antral ulcerations on the density and distribution of intramural gastric descending neurons supplying the pyloric sphincter in pigs.The experiment was performed on 2 groups of pigs: healthy gilts (n=6 and gilts with experimentally induced peptic ulcers in the region of antrum pylori (n=6. Gastric neurons supplying pyloric sphincter were labeled using the retrograde neuronal tracing technique (20μl of Fast Blue tracer injected into the pyloric sphincter muscle. After a week survival period the animals were sacrificed and the stomachs were collected. Then, the stomach wall was cross-cut into 0.5cm thick sections taken in specified intervals (section I - 1.5cm; section II - 3.5cm; section III - 5.5cm; section IV - 7.5cm starting from the sphincter. Consecutive microscopic slices prepared from each section were analyzed under fluorescent microscope to count traced neurons. Obtained data were statistically analyzed. The total number of FB-positive perikarya observed within all studied sections significantly decreased from 903.3 ± 130.7 in control to 243.8 ± 67.3 in experimental animals. In healthy pigs 76.1 ± 6.7% of labeled neurons were observed within the section I, 23.53 ± 6.5% in section II and only occasional cells in section III. In experimental animals, as many as 93.8 ± 2.1% of labeled cells were observed within the section I and only 6.2 ± 2.2% in section II, while section III was devoid of such neurons. There were no traced perikarya in section IV observed in both groups of pigs

  17. Technická analýza

    OpenAIRE

    Procházka, Jiří

    2012-01-01

    V této diplomové práci analyzuji společnost Apple a její konkurenty, které vyberu podle daných specifik. Na základě teoretických poznatků provedu technickou analýzu na jejich akciích. Stanovím doporučení pro investory a porovnám je s reálnými výsledky. V Miscrosoft Visual Basicu vytvořím program s technickými indikátory, které budu používat.

  18. Advances in the Management of Anal Cancer.

    Science.gov (United States)

    Julie, Diana R; Goodman, Karyn A

    2016-03-01

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

  19. Isolated Total Rupture of Extraocular Muscles.

    Science.gov (United States)

    Chen, Jingchang; Kang, Ying; Deng, Daming; Shen, Tao; Yan, Jianhua

    2015-09-01

    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

  20. A comparison between cytology and histology to detect anal intraepithelial neoplasia.

    OpenAIRE

    Ruiter, A.; Carter, P.; Katz, D. R.; Kocjan, G.; Whatrup, C; Northover, J; Mindel, A

    1994-01-01

    INTRODUCTION--Anal intraepithelial neoplasia (AIN), which may be a precursor of anal carcinoma, has been identified on histology following minor anal surgical procedures, in particular the removal of perianal condylomata, in increasing numbers of homosexual and bisexual men. Anal cytology has recently been proposed as a useful method of identifying AIN lesions. OBJECTIVE--To compare anal cytology with histology as a method of detecting AIN. METHODS--215 homosexual and bisexual men attending a...

  1. Anal HPV Infection in HIV-Positive Men Who Have Sex with Men from China

    OpenAIRE

    Gao, Lei; Zhou, Feng; Li, Xiangwei; Yang, Yu; Ruan, Yuhua; Jin, Qi

    2010-01-01

    Background Anal HPV infection, which contributes to the development of anal warts and anal cancer, is well known to be common among men who have sex with men (MSM), especially among those HIV positives. However, HIV and anal HPV co-infection among MSM has not been addressed in China. Methods A cross-sectional study was conducted in Beijing and Tianjin, China. Study participants were recruited using multiple methods with the collaboration of local volunteer organizations. Blood and anal swabs ...

  2.  Surgical excision of extensive anal condylomata is a safe operation without risk of anal stenosis

    Directory of Open Access Journals (Sweden)

    Konrad Wroński

    2012-03-01

    Full Text Available  Introduction:Anal condylomata acuminata was a well-known disease in ancient times but in recent years there has been a rapidly increasing number of people who suffer from this disease. The main cause of this disease is infection of human papilloma virus (HPV which occurs through sexual contact.Currently there are three different ways to treat anal condylomata. Small changes of anal condylomata can be treated with local therapeutic agents, but the best results of treatment of extensive changes are obtained by surgical techniques.Material/Methods:The study group consisted of 30 patients with diagnosed extensive anal condylomata who underwent surgery in Mikolaj Pirogow High Specialized Hospital in Lodz. The survey was conducted from 2007 to 2011. Patients had been directed to the surgical ward by general surgeons and practitioners, proctologists and urologists. The diagnosis was made after proctological assessment in the knee-chest position.Results:All patients underwent surgery and had complete macroscopic electroexcision of anal condylomata. In the research group there was no mortality. Postoperative complications occurred in 4 (13.3�20patients – postoperative bleeding. Strong pain was present in 14 (46.7�20patients but only in the postoperative period. During postoperative follow-up there was no observed infection in the anal region or recurrence of disease. In the operated group there were no observed cosmetic deformations of the anus and/or the anal canal, narrow anal canal or functional fecal incontinence symptoms.Conclusions:Surgical treatment of anal condylomata is an effective and safe method for the patient. In our research there were no serious postoperative complications or recurrence of the disease during the follow-up period.

  3. The value of anal cytology and human papillomavirus typing in the detection of anal intraepithelial neoplasia: a review of cases from an anoscopy clinic

    OpenAIRE

    Fox, P; Seet, J; Stebbing, J; Francis, N.; Barton, S.; Strauss, S; Allen-Mersh, T; Gazzard, B.; Bower, M

    2005-01-01

    Background: Previous studies have reached differing conclusions about the utility of anal cytology as a screening tool for anal intraepithelial neoplasia (AIN). There is a need also to establish whether HPV typing offers a useful adjunct to screening.

  4. Video manometry of the sphincter of Oddi: a new aid for interpreting manometric tracings and excluding manometric artefacts

    DEFF Research Database (Denmark)

    Madácsy, L; Middelfart, H V; Matzen, Peter;

    2000-01-01

    develop a new method sphincter of Oddi video manometry-based on simultaneous ESOM and real-time endoscopic image analysis, and to investigate the usefulness of video manometry for detecting manometric artefacts during ESOM. PATIENTS AND METHODS: Seven consecutive patients who had undergone cholecystectomy...... of Oddi phasic contractions were identified, with an average amplitude of 153.9+/-85.0 mm Hg and a duration of 7.9+/-1.2 seconds. Visual analysis of the real-time endoscopic images, replayed in cine loop by the computer, revealed 236 separate duodenal contractions, with an average frequency of 3.......5+/-2.4/min (range: 1-12/min). On the ESOM tracing, 78% of the duodenal contractions had a corresponding pressure wave with an average duration of 2.8+/-0.4 seconds and an amplitude of 71.9+/-16.7 mm Hg. Other artefacts on the ESOM tracings, such as catheter movements, pseudocontractions, hyperventilation, or...

  5. Liquid salt environment stress-rupture testing

    Science.gov (United States)

    Ren, Weiju; Holcomb, David E.; Muralidharan, Govindarajan; Wilson, Dane F.

    2016-03-22

    Disclosed herein are systems, devices and methods for stress-rupture testing selected materials within a high-temperature liquid salt environment. Exemplary testing systems include a load train for holding a test specimen within a heated inert gas vessel. A thermal break included in the load train can thermally insulate a load cell positioned along the load train within the inert gas vessel. The test specimen can include a cylindrical gage portion having an internal void filled with a molten salt during stress-rupture testing. The gage portion can have an inner surface area to volume ratio of greater than 20 to maximize the corrosive effect of the molten salt on the specimen material during testing. Also disclosed are methods of making a salt ingot for placement within the test specimen.

  6. Recurrent spontaneous scleral rupture in Marfan's syndrome.

    Science.gov (United States)

    Turaga, Kiranmaye; Senthil, Sirisha; Jalali, Subhadra

    2016-01-01

    The ocular manifestations of Marfan's syndrome (MS) range from ectopia lentis, microspherophakia, myopia, glaucoma and retinal detachment. Spontaneous scleral rupture is a rare complication and recurrent scleral perforation is extremely rare. We report a rare case of a 26-year-old male with MS who had sequential recurrent spontaneous scleral rupture which required surgical repair. He suffered from a similar problem 4 years later in both eyes in a different location, with overlying thin cystic blebs and hypotony maculopathy. Surgical repair with preserved scleral donor patch graft and conjunctival autograft in one eye, and conjunctival advancement in the other eye was performed. This helped stabilise the eyes, and resulted in complete visual recovery in both eyes. PMID:27199441

  7. RARE PRESENTATION OF RUPTURED RUDIMENTARY HORN PREGNANCY

    Directory of Open Access Journals (Sweden)

    Shergill Harbhajan K, Grover Suparna, Chhabra Ajay

    2015-10-01

    Full Text Available It is a rare occurrence for the rudimentary horn of uterus to harbour a pregnancy and the usual outcome is devastating leading to a spontaneous rupture in second trimester with the patient presenting in shock with massive intra-peritoneal haemorrhage and if appropriate management is not instituted in time it may lead to high rate of mortality. We report an unusual case of rupture rudimentary horn pregnancy who presented as a chronic ectopic with an adnexal mass and surprisingly with no sign of shock. Diagnosis is often difficult in such a situation which puts the treating gynaecologist in dilemma. High clinical suspicion supplemented with radiological findings helped clinch the diagnosis and laparotomy was performed followed by resection of the rudimentary horn to prevent future complications.

  8. Softwarová podpora analýzy rizik

    OpenAIRE

    Psota, Michal

    2013-01-01

    Tato práce se zabývá teoretickým popisem možností řízení rizik především v oblasti informačních technologií a popisuje metody sloužící k analýze rizik. Rozebrané metody jsou analýza stromu událostí, analýza stromu poruch, FMEA, HAZOP a Markovova analýza. Praktická část práce zahrnuje návrh a implementaci aplikace, která vizualizuje rozhodovací stromy a určuje pravděpodobnosti jednotlivých prvků.

  9. Analýza vybrané firmy

    OpenAIRE

    Soukupová, Šárka

    2013-01-01

    Bakalářská práce se zabývá analýzou malého podniku ESTA, spol. s r.o. Obsahuje teoretická východiska, která jsou následně implementována do skutečné reality podniku, a to prostřednictvím SLEPTE analýzy, Modelu 7S, Porterovy analýzy a SWOT analýzy. Závěrem je vyhodnocena situace a jsou navržena řešení, která zlepší současný stav podniku.

  10. Analýza vybrané firmy

    OpenAIRE

    Peloušková, Tereza

    2013-01-01

    Předmětem bakalářská práce je analýza společnosti MMB Consulting, s.r.o., která se zabývá realizací staveb v Jihomoravském kraji. Obsahem práce je vypracování SLEPTE analýzy, Porterova modelu pěti konkurenčních sil a SWOT analýzy. Na základě provedených analýz jsou nakonec navrženy způsoby zlepšení současné situace společnosti. Subject of this thesis is the analysis the MMB Consulting company, which is engaged in construction of buildings in the South Moravian region. The thesis includes S...

  11. What Are the Risk Factors for Anal Cancer?

    Science.gov (United States)

    ... have few or no known risk factors. Human papilloma virus (HPV) infection Most squamous cell anal cancers ... to be linked to infection by the human papilloma virus (HPV), the same virus that causes cervical ...

  12. Analýza vybrané firmy

    OpenAIRE

    Jandová, Jana

    2010-01-01

    Tato bakalářská práce utváří celkový obraz o vybrané firmě pomocí SWOT analýzy, SLEPTE analýzy, Porterovy analýzy konkurence a analyzuje její finanční situaci od roku 2006 do roku 2008 prostřednictvím soustav poměrových ukazatelů. Z výsledků všech analýz jsou navržena doporučení ke zlepšení stávající situace firmy. This bachelor’s thesis presents a picture of a selected firm by applying SWOT and SLEPTE analysis and Porter´s Five Forces analysis. Next follows an analysis of the financial st...

  13. Tubulovillous adenoma of anal canal: A case report

    Institute of Scientific and Technical Information of China (English)

    Bhupinder S Anand; Gordana Verstovsek; George Cole

    2006-01-01

    Tumors arising from the anal canal are usually of epithelial origin and are mostly squamous cell carcinoma or basal cell carcinoma. We present a case of benign anal adenomas arising from the anus, an extremely rare diagnosis. A 78-year-old white man presented with rectal bleeding of several months duration. Examination revealed a 4 cm friable mass attached to the anus by a stalk. At surgery, the mass was grasped with a Babcock forceps and was resected using electrocautery.Microscopic examination revealed a tubulovillus adenoma with no areas of high grade dysplasia or malignant transformation. The squamocolumnar junction was visible at the edges of the lesion confirming the anal origin of the tumor. We believe the tubulovillus adenoma arose from either an anal gland or its duct that opens into the anus. Although seen rarely, it is important to recognize and treat these tumors at an early stage because of their potential to transform into adenocarcinoma.

  14. Can preoperative radiotherapy of rectal cancer convert a radical abdomino-perineal resection into a sphincter preserving surgery?; La radiotherapie preoperatoire peut-elle convertir une amputation abdominoperineale en une chirurgie conservatrice dans les adenocarcinomes du rectum?

    Energy Technology Data Exchange (ETDEWEB)

    Gerard, J.P.; Favrel, V.; Chapet, O.; Freyer, G. [Centre Hospitalier Universitaire Lyon-Sud, 69 - Pierre-Benite (France)

    1999-11-01

    Randomized trials published in the literature do not demonstrate definitively that preoperative radiotherapy increases the chance of sphincter preservation in rectal cancer. A long interval (four to six weeks) between radiotherapy and surgery may increase in selected cases of low rectal cancer the chance of sphincter preservation. Such an improvement must not lead to an increased rate of local recurrence and must preserve a good functional sphincter. Ongoing trials of dose escalation and concurrent radio-chemotherapy will provide interesting data regarding this complex question. (author)

  15. Patellar tendon: From tendinopathy to rupture

    OpenAIRE

    Federica Rosso; Davide Edoardo Bonasia; Umberto Cottino; Federico Dettoni; Matteo Bruzzone; Roberto Rossi

    2015-01-01

    Patellar tendinopathy is very common in patients complaining of anterior knee pain. Its aetiology is still unclear, but neovascularisation seems to play a role. Different treatments have been proposed overtime, from rehabilitation to platelet-rich-plasma injections, but there is no agreement on the best treatment protocol. The final stage of patellar tendinopathy is patellar tendon rupture. In these cases surgical treatment is often required. The aim of this literature review is to focus on t...

  16. Renal Allograft Rupture: A Clinicopathologic Review

    OpenAIRE

    Ramos, M.; Martins, L.; L. Dias; HENRIQUES, A.C.; Soares, J.; Queirós, J.; Sarmento, A M

    2000-01-01

    Transplantation Proceedings Volume 32, Issue 8, December 2000, Pages 2597-2598 -------------------------------------------------------------------------------- doi:10.1016/S0041-1345(00)01801-7 | How to Cite or Link Using DOI Copyright © 2000 Elsevier Science Inc. All rights reserved. Cited By in Scopus (4) Permissions & Reprints Renal allograft rupture: a clinicopathologic review M Ramosa, , L Martinsa, L Diasa, A.C Henriquesa, J Soaresa, J Queirósa and A.M ...

  17. Wrapped Wire Detects Rupture Of Pressure Vessel

    Science.gov (United States)

    Hunt, James B.

    1990-01-01

    Simple, inexpensive technique helps protect against damage caused by continuing operation of equipment after rupture or burnout of pressure vessel. Wire wrapped over area on outside of vessel where breakthrough most likely. If wall breaks or burns, so does wire. Current passing through wire ceases, triggering cutoff mechanism stopping flow in vessel to prevent further damage. Applied in other situations in which pipes or vessels fail due to overpressure, overheating, or corrosion.

  18. Study of cartridge rupture detection installations

    International Nuclear Information System (INIS)

    Very numerous physical or technological parameters are involved in the preparation of projects for can rupture detection installations. These parameters are connected essentially with the design of the reactor, the detector used, the disposition of the pneumatic circuits, the type of fuel and the safety required. The present report analyses the main problems arising and their mutual compatibilities; it defines a certain number of ideas which had up till now been accepted implicitly in the design. (authors)

  19. Spontaneous Bile Duct Rupture in Pregnancy

    OpenAIRE

    Piotrowski, Joseph J.; Greg Van Stiegmann; R. Dale Liechty

    1990-01-01

    Spontaneous bile duct rupture occurred in a 23-year-old who required emergency Cesarean section for fetal distress. This condition has not been reported in association with pregnancy. Only forty cases of spontaneous bile duct perforation in adults have been previously reported. Seventy percent of these perforations were related to biliary calculi. Sites of perforation were evenly distributed between common hepatic duct and common bile duct. Recommended treatment includes cholecystectomy, comm...

  20. Studies on the regulation of transient lower esophageal sphincter relaxations (TLESRs) by acid in the esophagus and stomach.

    Science.gov (United States)

    Banovcin, P; Halicka, J; Halickova, M; Duricek, M; Hyrdel, R; Tatar, M; Kollarik, M

    2016-07-01

    Transient lower esophageal sphincter relaxation (TLESR) is the major mechanism of gastroesophageal reflux, but the regulation of TLESR by stimuli in the esophagus is incompletely understood. We have recently reported that acid infusion in the esophagus substantially (by 75%) increased the number of meal-induced TLESR in healthy subjects. We concluded that the TLESR reflex triggered by gastric distention with meal was enhanced by the stimulation of esophageal nerves by acid. However, the possibilities that the acid infused into the esophagus acts after passing though lower esophageal sphincter in stomach to enhance TLESR, or that the acid directly initiates TLESR from the esophagus were not addressed. Here, we evaluated the effect of acid infusion into the proximal stomach on meal-induced TLESR (study 1) and the ability of acid infusion into the esophagus to initiate TLESR without prior meal (study 2). We analyzed TLESRs by using high-resolution manometry in healthy subjects in paired randomized studies. In study 1, we found that acid infusion into the proximal stomach did not affect TLESRs induced by standard meal. The number of meal-induced TLESRs following the acid infusion into the proximal stomach was similar to the number of meal-induced TLESRs following the control infusion. In study 2, we found that acid infusion into the esophagus without prior meal did not initiate TLESRs. We conclude that the increase in the meal-induced TLESRs by acid in the esophagus demonstrated in our previous study is not attributable to the action of acid in the stomach or to direct initiation of TLESR from the esophagus by acid. Our studies are consistent with the concept that the stimuli in the esophagus can influence TLESRs. The enhancement of TLESR by acid in the esophagus may contribute to pathogenesis of gastroesophageal reflux in some patients. PMID:25873206

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

    International Nuclear Information System (INIS)

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

  2. The efficacy of balloon dilation in achalasia is the result of stretching of the lower esophageal sphincter, not muscular disruption.

    Science.gov (United States)

    Borhan-Manesh, F; Kaviani, M J; Taghavi, A R

    2016-04-01

    Pneumatic dilation (PD) of the lower esophageal sphincter (LES) in achalasia is a major palliative treatment. It is generally believed, although never substantiated, that therapeutic efficacy of ballooning in achalasia is the result of the disruption and tearing of the muscular layers of the LES. To clarify this issue, we investigated the frequency of muscular disruption at the LES, 24 hours after PD, by employing the endoscopic ultrasound (EUS), in a group of 43 consented patients with achalasia. Between July 2009 and March2012, 51 consecutive adult patients with tentative diagnosis of achalasia, some with recurrence of symptoms after an earlier treatment with balloon dilation, were evaluated and underwent PD, using Rigiflex balloon without major adverse effect. Out of the 51 evaluated, 43 eligible and consenting patients who underwent EUS, 24 hours after PD, using Olympus GF-UE 160 echoendoscope and an Aloka Prosound probe at 7.5 MHZ, are the subjects of this study. The EUS in 43 eligible patients revealed an intact LES in 36 (83.7%), small area of muscular disruption in 5 (11.6%) and small hematoma in 2 patients (4.6%). Our data convincingly demonstrate that the clinical effectiveness of balloon dilation in achalasia is not the result of muscular disruption, but of circumferential stretching of the LES. Our findings on the mechanism of action of PD in achalasia could result in modifying the current method of dilation for a safer procedure, by slowing the rate of inflation and allowing the sphincter to slowly stretch itself to the distending balloon. PMID:25765473

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

    Science.gov (United States)

    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 < 0.001). In patients with pancreatobiliary reflux, only 4 patients had anomalous pancreaticobiliary junction. That is, the majority of patients (17/21, 81%) having pancreatobiliary reflux did not have an anomalous junction of the pancreatic and biliary ducts.Since the only explanation for pancreatobiliary reflux in patients with a normal pancreaticobiliary junction is sphincter of Oddi dysfunction, we proposed that the formation of adult choledochal cyst is mainly due to sphincter of Oddi dysfunction. PMID:26632721

  4. [Traumatic rupture of the thoracic aorta].

    Science.gov (United States)

    Glock, Y; Roux, D; Soula, P; Cerene, A; Fournial, G

    1996-01-01

    This is a retrospective analysis of 50 postraumatic aortic rupture (1968-1996, 39 males, mean age: 34.5). Group A is composed of 35 patients with an acute aortic rupture and a prompt diagnosis. Group B includes 13 patients with a chronic rupture. All patients from group A had a severe politraumatism with abdominal, cranial, extremities or hip fractures. Mediastinal thickening with or without hemothorax indicated an angiography or a transesophageal echocardiography lately. In group A, 36 patients have been operated on urgently (12-24 hours); cardiopulmonary bypass was performed on 20 patients; an aorto-aortical bypass was done in 27 cases and a direct suture in the remaining 9. In group B, cardiopulmonary bypass was performed on 9 patients; a aorto-aortical bypass was done in 11 cases and a direct suture in 2. Overall hospital mortality was 16%; 19% in group A and 7.6% in group B. Ischemic paraplejia appeared in 5 patients (10%), all from group A. No false aneurysm developed after 4.5 years of follow-up (3-135 months) in the 38 survivors. The usefulness of transesophageal echocardiography, the importance of medular protection and the utility of several interventionist radiologic techniques are discussed. PMID:9053930

  5. Ruptured corpus luteal cyst: CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Hyuck Jae; Kim, Seung Hyup; Kim, Sun Ho; Kim, Hyo Cheol; Park, Chang Min; Lee, Hak Jong; Moon, Min Hoan; Jeong, Jun Yong [Seoul National University Hospital, Seoul (Korea, Republic of)

    2003-03-01

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

  6. Carotid artery rupture and cervicofacial actinomycosis.

    Science.gov (United States)

    Kummer, Anne; Lhermitte, Benoît; Ödman, Micaela; Grabherr, Silke; Mangin, Patrice; Palmiere, Cristian

    2012-11-01

    Cervicofacial actinomycosis is an uncommon, progressive infection caused by bacilli of the Actinomyces genus. Actinomyces are common commensal saprophytes in the oral cavity which may have medical importance as facultative pathogens. Subsequent to local injuries to the oral mucosa, they may penetrate the deep tissues and be responsible for suppurative or granulomatous infections. We herein report a case of a 65-year-old man who underwent surgery followed by chemotherapy and radiotherapy for a tonsillar carcinoma. An ulcerous lesion in the base of the tongue developed and spread to the carotid artery wall. The man died of a massive hemorrhage due to left carotid artery rupture. Postmortem computed tomography angiography performed prior to autopsy allowed the precise localization of the source of bleeding to be detected. Postmortem biochemical investigations confirmed the presence of inflammation associated with local bacterial infection. Histological investigations revealed the rupture of the left carotid artery surrounded by numerous colonies of Actinomyces. Acute and chronic inflammation with tissue necrosis as well as post-actinic, fibrotic changes were also found in the tissues surrounding the ruptured artery wall. PMID:22819527

  7. Single Event Gate Rupture in EMCCD technology

    Science.gov (United States)

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

    2012-12-01

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

  8. Ruptured ectopic pregnancy diagnosed with computed tomography

    International Nuclear Information System (INIS)

    The rupture of ectopic pregnancy (EP) still remains the primary and direct cause of death in the first trimester of pregnancy. Ultrasonography is known to be a modality of choice in EP diagnostics. We found a severe discrepancy between the frequency of ectopic pregnancies (EP) and the number of available computed tomography (CT) examinations. A 29-year-old woman was admitted to the emergency department with a history of abdominal pain, nausea, vomiting and collapse. Sonographic findings of a suspected EP were unclear. Moreover, not all features of intrauterine pregnancy were present. Due to the patient’s life-threatening condition, an emergency multi-slice CT with MPR and VRT reconstructions was performed, revealing symptoms of a ruptured EP. In the right adnexal area, a well-vascularized, solid-cystic abnormal mass lesion was found. Intraperitoneal hemorrhage was confirmed intraoperatively, and the right fallopian tube with a tubal EP was resected. In the surgery in situ, as well as in the pathological examination of the tumor mass, a human embryo of approximately 1.5 cm in length (beginning of the 8th week of gestation) was found. Although ultrasonography still remains the first-line imaging examination in EP diagnostics, sometimes the findings of suspected EPs are unclear and not sufficient. The rupture of EP, with serious bleeding and symptoms of shock, may require an emergent pelvic and abdominal CT inspection. A clear correlation was found between the macroscopic CT images and the intraoperatively sampled material

  9. Chemoradiotherapy with or without consolidation chemotherapy using cisplatin and 5-fluorouracil in anal squamous cell carcinoma: long-term results in 31 patients

    International Nuclear Information System (INIS)

    The objectives of this study were to evaluate long-term results of concurrent chemoradiotherapy (CRT) with 5-fluorouracil and cisplatin and the potential benefit of consolidation chemotherapy in patients with anal squamous cell carcinoma (ASCC). Between January 1995 and February 2006, 31 patients with ASCC were treated with CRT. Radiotherapy was administered at 45 Gy over 5 weeks, followed by a boost of 9 Gy to complete or partial responders. Chemotherapy consisted of 5-fluorouracil (750 or 1,000 mg/m2) daily on days 1 to 5 and days 29 to 33; and, cisplatin (75 or 100 mg/m2) on day 2 and day 30. Twelve patients had T3–4 disease, whereas 18 patients presented with lymphadenopathy. Twenty-one (67.7%) received consolidation chemotherapy with the same doses of 5-fluorouracil and cisplatin, repeated every 4 weeks for maximum 4 cycles. Nineteen patients (90.5%) completed all four courses of consolidation chemotherapy. After CRT, 28 patients showed complete responses, while 3 showed partial responses. After a median follow-up period of 72 months, the 5-year overall, disease-free, and colostomy-free survival rates were 84.7%, 82.9% and 96.6%, demonstrating that CRT with 5-fluorouracil and cisplatin yields a good outcome in terms of survival and sphincter preservation. No differences in 5-year OS and DFS rates between patients treated with CRT alone and CRT with consolidation chemotherapy was observed. our study shows that CRT with 5-FU and cisplatin, with or without consolidation chemotherapy, was well tolerated and proved highly encouraging in terms of long-term survival and the preservation of anal function in ASCC. Further trials with a larger patient population are warranted in order to evaluate the potential role of consolidation chemotherapy

  10. Innovations in chronic anal fissure treatment: A systematic review

    OpenAIRE

    2010-01-01

    A chronic anal fissure is a common perianal condition. This review aims to evaluate both existing and new therapies in the treatment of chronic fissures. Pharmacological therapies such as glyceryl trinitrate (GTN), Diltiazem ointment and Botulinum toxin provide a relatively non-invasive option, but with higher recurrence rates. Lateral sphincterotomy remains the gold standard for treatment. Anal dilatation has no role in treatment. New therapies include perineal support devices, Gonyautoxin i...

  11. Anal bölgede malign dev kondilom

    OpenAIRE

    Baydar, B; Yılmaz, Y.; Kamer, E; Alper, E.; Örmeci, B; Aslan, F; Tarcan, E; Ermete, M.

    2010-01-01

    Human Papilloma Virus (HPV) infection is one of the most common sexually transmitted disease. In this study, 50 years old male patient is presented with a growing mass in anal region for 6 years. Surgical exicision was performed with a giant anal condyloma diagnose and squamose cell carcinoma in few areas was reported in pathology specimen, radiotheraphy was performed in the postoperative period. There was no recurrence in six months period. As a result, surgery is an effective theraphy f...

  12. Anal cancer and intraepithelial neoplasia screening: A review

    OpenAIRE

    Leeds, Ira L.; Fang, Sandy H

    2016-01-01

    This review focuses on the early diagnosis of anal cancer and its precursor lesions through routine screening. A number of risk-stratification strategies as well as screening techniques have been suggested, and currently little consensus exists among national societies. Much of the current clinical rationale for the prevention of anal cancer derives from the similar tumor biology of cervical cancer and the successful use of routine screening to identify cervical cancer and its precursors earl...

  13. Detection of Multiple Human Papillomavirus Genotypes in Anal Carcinoma

    Directory of Open Access Journals (Sweden)

    Luo Linda

    2010-10-01

    Full Text Available Abstract Infection with human papillomavirus (HPV is a major risk factor for development of anal squamous cell carcinoma. Despite over 100 genotypes of the virus, HPV 16 and 18 are considered pathogenic as they are seen in the majority of cervical and anal cancers. We have employed a custom microarray to examine DNA for several HPV genotypes. We aimed to determine the accuracy of our microarray in anal cancer DNA for HPV genotypes compared to the DNA sequencing gold standard. Methods We utilized a sensitive microarray platform to classify 37 types of mucosal HPVs including 14 known high-risk and 23 low-risk types based on cervical cancer data. We utilized DNA from pathologically confirmed cases of anal squamous cell carcinoma. All samples underwent microarray HPV genotyping and PCR analysis. Results HPV was detected in 18/20 (90% anal cancers. HPV genotypes 16 and 18 were present in the majority of specimens, with HPV 16 being the most common. Eighty percent of anal cancers had at least two HPV types. Ten percent of cases (2/20 tested negative using our microarray; DNA sequencing confirmed the lack of presence of HPV DNA in these samples. Conclusions Microarray technology is an accurate way to screen for various genotypes of HPV in anal cancer, with 100% correlation with genomic DNA detection of HPV. The majority of anal cancers in our study associated with pathogenic HPV 16 and/or 18. Other HPV genotypes are present simultaneously with HPV 16 and 18, and might contribute to its pathogenesis.

  14. Premalignant Neoplasms and Squamous Cell Carcinoma of the Anal Margin

    OpenAIRE

    Sahai, Aalok; Kodner, Ira J.

    2006-01-01

    Premalignant and malignant lesions of the anal margin are rare. Understanding anal anatomy and performing a biopsy of any suspicious lesions are essential in avoiding a delay in diagnosis and appropriately treating these tumors. Wide local excision continues to remain the treatment of choice for many of these lesions. Combined multimodality treatment has come to play an important role in managing patient with more advanced or metastatic disease.

  15. High prevalence of high grade anal intraepithelial neoplasia in HIV-infected women screened for anal cancer.

    Science.gov (United States)

    Hou, June Y; Smotkin, David; Grossberg, Robert; Suhrland, Mark; Levine, Rebecca; Smith, Harriet O; Negassa, Abdissa; McAndrew, Thomas C; Einstein, Mark H

    2012-06-01

    There is no consensus on optimal screening for anal cancer (AC) in HIV+ women. Seven hundred fifteen unique asymptomatic women in a high-prevalence HIV+ community were screened for AC with anal cytology and triage to high-resolution anoscopy after routine screening was implemented in a large urban hospital system. Of these, 75 (10.5%) had an abnormal anal cytology and 29 (38.7%) of those with an abnormality had high-grade anal intraepithelial neoplasia (AIN). Women with poorly controlled HIV were significantly more likely to have high-grade AIN (P = 0.03). Given the high rate of AIN in screened HIV-infected women, routine AC screening in all HIV-infected women should be strongly considered. PMID:22466085

  16. Local control of human papillomavirus infection after anal condylomata acuminata eradication

    Directory of Open Access Journals (Sweden)

    Thiago da Silveira Manzione

    2014-04-01

    Full Text Available OBJECTIVE: To verify whether the eradication of anal condylomata acuminata was effective for local control of HPV infection using anal colposcopy and anal brush cytology.METHODS: We evaluated 147 patients treated for anal margin and/or anal canal condyloma, with 108 HIV-positive and 39 HIV-negative individuals. The average age for males was 40 years for HIV-positive and 27.5 for HIV-negative. In females, the mean age was 37.5 years for HIV-positive and 31.5 for HIV-negative.RESULTS: Twenty-four patients (16.3% had normal cytology and anal colposcopy, 16 (10.9% normal cytology and altered anal colposcopy, 52 (35.4% normal anal colposcopy and altered cytology, and 55 (37.4% had altered cytology and anal colposcopy.CONCLUSION: the eradication of clinical lesions failed to locally control HPV infection.

  17. Reflection of the State of Hunger in Impulse Activity of Nose Wing Muscles and Upper Esophageal Sphincter during Search behavior in Rabbits.

    Science.gov (United States)

    Kromin, A A; Dvoenko, E E; Zenina, O Yu

    2016-07-01

    Reflection of the state of hunger in impulse activity of nose wing muscles and upper esophageal sphincter muscles was studied in chronic experiments on rabbits subjected to 24-h food deprivation in the absence of locomotion and during search behavior. In the absence of apparent behavioral activity, including sniffing, alai nasi muscles of hungry rabbits constantly generated bursts of action potentials synchronous with breathing, while upper esophageal sphincter muscles exhibited regular aperiodic low-amplitude impulse activity of tonic type. Latent form of food motivation was reflected in the structure of temporal organization of impulse activity of alai nasi muscles in the form of bimodal distribution of interpulse intervals and in temporal structure of impulse activity of upper esophageal sphincter muscles in the form of monomodal distribution. The latent form of food motivation was manifested in the structure of temporal organization of periods of the action potentials burst-like rhythm, generated by alai nasi muscles, in the form of monomodal distribution, characterized by a high degree of dispersion of respiratory cycle periods. In the absence of physical activity hungry animals sporadically exhibited sniffing activity, manifested in the change from the burst-like impulse activity of alai nasi muscles to the single-burst activity type with bimodal distribution of interpulse intervals and monomodal distribution of the burst-like action potentials rhythm periods, the maximum of which was shifted towards lower values, which was the cause of increased respiratory rate. At the same time, the monomodal temporal structure of impulse activity of the upper esophageal sphincter muscles was not changed. With increasing food motivation in the process of search behavior temporal structure of periods of the burst-like action potentials rhythm, generated by alai nasi muscles, became similar to that observed during sniffing, not accompanied by animal's locomotion, which is

  18. Current treatment options for management of anal intraepithelial neoplasia.

    Science.gov (United States)

    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

  19. Missed Iatrogenic Bladder Rupture Following Normal Vaginal Delivery.

    Science.gov (United States)

    Baheti, Vidyasagar H; Wagaskar, Vinayak G; Patwardhan, Sujata K

    2015-10-01

    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

  20. Bilateral patellar tendon rupture associated with statin use.

    Science.gov (United States)

    Kearns, Marie C; Singh, Vinay K

    2016-01-01

    Patellar tendon rupture is an uncommon clinical presentation, which generally affects the under 40s who are active in sport. Bilateral rupture of both tendons is much rarer. It occurs most frequently in patients with predisposing factors such as corticosteroid use or systemic diseases. The authors present the case of a 56-year-old male on long-term statin therapy who sustained this injury following a fall on ice. He had no known risk factors for tendon rupture. Surgical treatment involved tendon repair using Krakow suture via bony tunnels in the patella. Statins have previously been associated with tendon ruptures at other sites but there have been no published cases of bilateral patellar tendon rupture linked to statin use. We review the literature regarding the association between statins and tendon rupture. PMID:27165749

  1. The Effect of Biofeedback Therapy on Anorectal Function After the Reversal of Temporary Stoma When Administered During the Temporary Stoma Period in Rectal Cancer Patients With Sphincter-Saving Surgery

    OpenAIRE

    Kye, Bong-Hyeon; Kim, Hyung-Jin; Kim, Gun; Yoo, Ri Na; Cho, Hyeon-Min

    2016-01-01

    Abstract We evaluated the effect of biofeedback therapy (BFT) on anorectal function after stoma closure when administered during the interval of temporary stoma after sphincter-preserving surgery for rectal cancer. Impaired anorectal function is common after lower anterior resections, though no specific treatment options are currently available to prevent this adverse outcome. Fifty-six patients who underwent neoadjuvant chemoradiation therapy after sphincter-preserving surgery with temporary...

  2. Kinetics of hole nucleation in biomembrane rupture

    Energy Technology Data Exchange (ETDEWEB)

    Evans, Evan [Biomedical Engineering, Boston University, Boston, MA 02215 (United States); Smith, Benjamin A, E-mail: evanse@bu.edu [Departments of Physics and Pathology, University of British Columbia, Vancouver, BC, V6T 2A6 (Canada)

    2011-09-15

    The core component of a biological membrane is a fluid-lipid bilayer held together by interfacial-hydrophobic and van der Waals interactions, which are balanced for the most part by acyl chain entropy confinement. If biomembranes are subjected to persistent tensions, an unstable (nanoscale) hole will emerge at some time to cause rupture. Because of the large energy required to create a hole, thermal activation appears to be requisite for initiating a hole and the activation energy is expected to depend significantly on mechanical tension. Although models exist for the kinetic process of hole nucleation in tense membranes, studies of membrane survival have failed to cover the ranges of tension and lifetime needed to critically examine nucleation theory. Hence, rupturing giant ({approx}20 {mu}m) membrane vesicles ultra-slowly to ultra-quickly with slow to fast ramps of tension, we demonstrate a method to directly quantify kinetic rates at which unstable holes form in fluid membranes, at the same time providing a range of kinetic rates from <0.01 to >100 s{sup -1}. Measuring lifetimes of many hundreds of vesicles, each tensed by precision control of micropipette suction, we have determined the rates of failure for vesicles made from several synthetic phospholipids plus 1:1 mixtures of phospho- and sphingo-lipids with cholesterol, all of which represent prominent constituents of eukaryotic cell membranes. Plotted on a logarithmic scale, the failure rates for vesicles are found to rise dramatically with an increase in tension. Converting the experimental profiles of kinetic rates into changes of activation energy versus tension, we show that the results closely match expressions for thermal activation derived from a combination of meso-scale theory and molecular-scale simulations of hole formation. Moreover, we demonstrate a generic approach to transform analytical fits of activation energies obtained from rupture experiments into energy landscapes characterizing the

  3. Kinetics of hole nucleation in biomembrane rupture

    Science.gov (United States)

    Evans, Evan; Smith, Benjamin A.

    2011-09-01

    The core component of a biological membrane is a fluid-lipid bilayer held together by interfacial-hydrophobic and van der Waals interactions, which are balanced for the most part by acyl chain entropy confinement. If biomembranes are subjected to persistent tensions, an unstable (nanoscale) hole will emerge at some time to cause rupture. Because of the large energy required to create a hole, thermal activation appears to be requisite for initiating a hole and the activation energy is expected to depend significantly on mechanical tension. Although models exist for the kinetic process of hole nucleation in tense membranes, studies of membrane survival have failed to cover the ranges of tension and lifetime needed to critically examine nucleation theory. Hence, rupturing giant (~20 μm) membrane vesicles ultra-slowly to ultra-quickly with slow to fast ramps of tension, we demonstrate a method to directly quantify kinetic rates at which unstable holes form in fluid membranes, at the same time providing a range of kinetic rates from 100 s-1. Measuring lifetimes of many hundreds of vesicles, each tensed by precision control of micropipette suction, we have determined the rates of failure for vesicles made from several synthetic phospholipids plus 1:1 mixtures of phospho- and sphingo-lipids with cholesterol, all of which represent prominent constituents of eukaryotic cell membranes. Plotted on a logarithmic scale, the failure rates for vesicles are found to rise dramatically with an increase in tension. Converting the experimental profiles of kinetic rates into changes of activation energy versus tension, we show that the results closely match expressions for thermal activation derived from a combination of meso-scale theory and molecular-scale simulations of hole formation. Moreover, we demonstrate a generic approach to transform analytical fits of activation energies obtained from rupture experiments into energy landscapes characterizing the process of hole nucleation

  4. Intraoperative endobronchial rupture of pulmonary hydatid cyst: An airway catastrophe

    Directory of Open Access Journals (Sweden)

    Richa Gupta

    2013-01-01

    Full Text Available Hydatid cyst disease of lungs may not be symptomatic. It may present as spontaneous rupture in pleura or a bronchus. During spontaneous breathing, cyst content of endobronchially ruptured pulmonary hydatid cyst is mostly evacuated by coughing. However, during positive pressure ventilation such extruded fragments may lodge into smaller airway leading to an airway catastrophe. We present such accidental endobronchial rupture of pulmonary hydatid cyst during surgery, its prompt detection, and management by rigid bronchoscopy.

  5. Spontaneous unscarred fundal rupture after normal vaginal delivery

    OpenAIRE

    Shreya Thapa; Anjali Rani; Uma Pandey; Nisha Rani Agrawal

    2014-01-01

    Uterine rupture is one of the most dangerous obstetric situation carrying an increased risk of maternal and perinatal morbidity and mortality, associated with poorly managed labour. The incidence of spontaneous rupture of unscarred uterus is around 1 in 8000 to 1 in 15000 deliveries. We report this unusual case of spontaneous unscarred fundal rupture after normal vaginal delivery. This case under reference developed shock soon after delivery and was explored due to suspected intraperitoneal h...

  6. Rupture of popliteal arterial aneurysm due to salmonella infection

    International Nuclear Information System (INIS)

    We report here on a case of popliteal aneurysm and rupture that occurred over a 10-day period and this was all secondary to salmonella infection. Computed tomography (CT) angiography of the extremity that was performed before and after aneurysmal rupture showed the aneurysm's rapid evolution to rupture over a short period of time. We also review the pathogenesis, clinical presentation, diagnostic approach and management of salmonella aneurysms

  7. A Rare Case of Adductor Longus Muscle Rupture

    Directory of Open Access Journals (Sweden)

    R. J. L. L. van de Kimmenade

    2015-01-01

    Full Text Available 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.

  8. Conservative management in infectious mononucleosis related spontaneous splenic rupture

    OpenAIRE

    EKINGEN, Gülşen; AZMAN, Bülent; ERKUŞ, Burak; GÜVENÇ, B. Haluk

    2010-01-01

    Spontaneous splenic rupture is a rare but potential lethal complication of infectious mononucleosis. Although splenectomy is still the treatment of choice for patients with spontaneous splenic rupture, non-surgical management should be considered in carefully selected patients. We describe the case of a 16-year-old girl with infectious mononucleosis and who had splenic rupture and who was treated by non-operative approach.

  9. Ruptur intrakranieller Aneurysmen in Abhängigkeit der Mondphasen

    OpenAIRE

    Ottomann, Christian

    2010-01-01

    ABSTRACT OBJECTIVE: To test the hypothesis that the incidence of intracranial aneurysm rupture increases at the time of a full moon period. DESIGN: Retrospective analysis SETTING: Time of rupture and neurosurgical treatment at a university hospital in the capital city of Germany. SETTING: 486 consecutive patients, irrespective of age and sex. MAIN OUTCOME MEASURES: Number of patients who attended an rupture of an intracranial aneurysm and surgical treatment during 1990 to 1998. Th...

  10. Rupture of non-comunicating rudimentary uterine horn pregnancy

    International Nuclear Information System (INIS)

    Unicomuate uterus with rudimentary horn is a rare type of uterine malformation associated with obstetrical complications. Rupture of pregnant rudimentary horn is the usual presentation resulting in severe haemoperitoneum with increased maternal morbidity, and at times, mortality. A case of ruptured rudimentary horn pregnancy in a 24-year-old, second gravida, is reported. Exploratory laparotomy revealed a ruptured rudimentary horn pregnancy of 14 weeks gestation with haemoperitoneum. Excision of the rudimentary horn was done and an uneventful recovery followed. (author)

  11. Rupture of non-communicating rudimentary uterine horn pregnancy.

    Science.gov (United States)

    Dhar, Hansa

    2008-01-01

    Unicornuate uterus with rudimentary horn is a rare type of uterine malformation associated with obstetrical complications. Rupture of pregnant rudimentary horn is the usual presentation resulting in severe haemoperitoneum with increased maternal morbidity, and at times, mortality. A case of ruptured rudimentary horn pregnancy in a 24-year-old, second gravida, is reported. Exploratory laparotomy revealed a ruptured rudimentary horn pregnancy of 14 weeks gestation with haemoperitoneum. Excision of the rudimentary horn was done and an uneventful recovery followed. PMID:18452672

  12. The enigmatic diagnosis of posterior tibialis tendon rupture.

    OpenAIRE

    Marcus, R E; Pfister, M. E.

    1993-01-01

    Posterior tibialis tendon rupture is a diagnosis that is often missed. This is thought to be secondary to nonspecific clinical findings and the lack of any laboratory or radiographic test to reliably confirm the diagnosis. We report sixteen cases of surgically confirmed posterior tibialis tendon rupture. Based on our review of these patients, the diagnosis of posterior tibialis tendon rupture should be strongly suspected in the adult patient presenting with a history of a twisting ankle injur...

  13. Misdiagnosed Uterine Rupture of an Advanced Cornual Pregnancy

    OpenAIRE

    Christian Linus Hastrup Sant; Poul Erik Andersen

    2012-01-01

    Cornual pregnancy is a diagnostic and therapeutic challenge with potential severe consequences if uterine rupture occurs with following massive intraabdominal bleeding. We report a case of a misdiagnosed ruptured cornual pregnancy occurring at 21 weeks of gestation. Ultrasound examination and computer tomography revealed no sign of abnormal pregnancy. The correct diagnosis was first made at emergency laparotomy. Uterine rupture should be considered in pregnant women presenting with abdominal ...

  14. Can rupture detector for the reactor Osiris

    International Nuclear Information System (INIS)

    This report deals with the can rupture detection installation for the reactor Osiris and consists of two parts. The first part gives the calculations which were carried out during the designing of the installation for estimating its performances. The second part is an account of the tests carried out for calibrating the installation after the first power-run of the reactor. The measured sensitivity and detection threshold (16 counts/sec. for 1 cm2 of Unat and 2 cm2 of Unat) are fairly close to the calculated values (12 counts/sec. for 1 cm2 Unat and 1 to 2 cm2 Unat). (authors)

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

    OpenAIRE

    Low, Huey Chi; 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 geno...

  16. Comparison of hybribio genoarray and roche human papillomavirus (HPV) linear array for HPV genotyping in anal swab samples

    OpenAIRE

    Low, HC; Silver, MI; Brown, BJ; Leng, CY; Blas, MM; Gravitt, PE; Woo, YL

    2015-01-01

    © 2015, American Society for Microbiology. All Rights Reserved. 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 e...

  17. Blunt traumatic rupture of the right ventricle, with intrapericardial rupture of the diaphragm: successful surgical repair.

    Science.gov (United States)

    Le Treut, Y P; Herve, L; Cardon, J M; Boutboul, R; Bricot, R

    1981-07-01

    The authors report a case of chest injury causing rupture of the right ventricle and diaphragm, discovered during laparotomy for haemoperitoneum. This type of injury to the heart has rarely been cited in the literature since survival rates are low and the diagnosis often overlooked. PMID:7319634

  18. Tendon rupture associated with simvastatin/ezetimibe therapy.

    Science.gov (United States)

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

    2007-07-01

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

  19. RESECTION FOR RUPTURED DUODENAL VARICES SECONDARY TO PORTAL HYPERTENSION

    Institute of Scientific and Technical Information of China (English)

    Hai-quan Qiao; Bing Liu; Wen-jie Dai; Hong-chi Jiang

    2004-01-01

    @@ Apatient complicated by gastrointestinal bleeding was treated successfully using resection of ruptured duodenal varies. The paper reviewed the literatures and introduced surgical procedures and its indications.

  20. The prognostic value of ventricular rupture in cerebral hemorrhage.

    Science.gov (United States)

    Constantinovici, A; Savu, C; Ciubotaru, V; Simionescu, N; Carp, N

    1989-01-01

    Analysis of 41 cerebral hemorrhage cases associated or not with intraparenchymatous hematoma and ventricular rupture shows the role played by these associated phenomena in the evaluation and prognosis of these patients. The death rate was 56.25% in simple cerebral hemorrhage, 100% in hemorrhage associated with hematoma, 30.76% in hemorrhage associated with ventricular rupture and 80% in hemorrhage associated with hematoma and ventricular rupture. The authors point out that the mere presence of ventricular rupture is not a really aggravating factor. A particular severity resulting from association of hemorrhage with hematoma seems to be due to the extension of the cerebral lesion produced by the two conditions associated. PMID:2781234

  1. Current treatment options for management of anal intraepithelial neoplasia

    Directory of Open Access Journals (Sweden)

    Weis SE

    2013-06-01

    Full Text Available Stephen E Weis1,2 1Division of Dermatology, Department of Internal Medicine, University of North Texas Health Science Center at Fort Worth, 2Preventive Medicine Clinic, Tarrant County Public Health, Fort Worth, TX, USA Abstract: 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

  2. Long-term results after repair of ruptured and non-ruptured abdominal aortic aneurysm

    Directory of Open Access Journals (Sweden)

    Kuzmanović Ilija B.

    2004-01-01

    Full Text Available INTRODUCTION Abdominal aortic aneurysm can be repaired by elective procedure while asymptomatic, or immediately when it is complicated - mostly due to rupture. Treating abdominal aneurysm electively, before it becomes urgent, has medical and economical reason. Today, the first month mortality after elective operations of the abdominal aorta aneurysm is less than 3%; on the other hand, significant mortality (25%-70% has been recorded in patients operated immediately because of rupture of the abdominal aneurysm. In addition, the costs of elective surgical treatment are significantly lower. OBJECTIVE The objective of this study is to compare long-term survival of patients that underwent elective or immediate repair of abdominal aortic aneurysm (due to rupture, and to find out the factors influencing the long-term survival of these patients. MATERIAL AND METHODS Through retrospective review of prospectively collected data of the Institute for Cardiovascular Diseases of Clinical Center of Serbia, Belgrade, 56 patients that had elective surgery and 35 patients that underwent urgent operation due to rupture of abdominal aneurysm were followed up. Only the patients that survived 30 postoperative days were included in this review, and were followed up (ranging from 2 to 126 months. Electively operated patients were followed during 58.82 months on the average (range 7 to 122, and urgently operated were followed over 52.26 months (range 2 to 126. There was no significant difference of the length of postoperative follow-up between these two groups. RESULTS During this period, out of electively operated and immediately operated patients, 27 and 22 cases died, respectively. There was no significant difference (p>0,05a of long-term survival between these two groups. Obesity and early postoperative complications significantly decreased long-term survival of both electively and immediately operated patients. Graft infection, ventral hernia, aneurysm of

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

    Science.gov (United States)

    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,…

  4. THE PARTICIPATION OF THE NITRERGIC PATHWAY IN INCREASED RATE OF TRANSITORY RELAXATION OF LOWER ESOPHAGEAL SPHINCTER INDUCED BY RECTAL DISTENSION IN DOGS

    Directory of Open Access Journals (Sweden)

    Michel Santos PALHETA

    2014-04-01

    Full Text Available Context The rectal distension in dogs increases the rate of transitory lower esophageal sphincter relaxation considered the main factor causing gastroesophageal reflux. Objectives The aim of this study was evaluate the participation of the nitrergic pathway in the increased transitory lower esophageal sphincter relaxation rate induced by rectal distension in anesthetized dogs. Methods Male mongrel dogs (n = 21, weighing 10-15 kg, were fasted for 12 hours, with water ad libitum. Thereafter, they were anesthetized (ketamine 10 mg.Kg-1 + xylazine 20 mg.Kg-1, so as to carry out the esophageal motility evaluation protocol during 120 min. After a 30-minute basal period, the animals were randomly intravenous treated whith: saline solution 0.15M (1ml.Kg-1, L-NAME (3 mg.Kg-1, L-NAME (3 mg.Kg-1 + L-Arginine (200 mg.Kg-1, glibenclamide (1 mg.Kg-1 or methylene blue (3 mg.Kg-1. Forty-five min after these pre-treatments, the rectum was distended (rectal distension, 5 mL.Kg-1 or not (control with a latex balloon, with changes in the esophageal motility recorded over 45 min. Data were analyzed using ANOVA followed by Student Newman-Keuls test. Results In comparison to the respective control group, rectal distension induces an increase in transitory lower esophageal sphincter relaxation. Pre-treatment with L-NAME or methylene blue prevents (P<0.05 this phenomenon, which is reversible by L-Arginine plus L-NAME. However, pretreating with glibenclamide failed to abolish this process. Conclusions Therefore, these experiments suggested, that rectal distension increases transitory lower esophageal sphincter relaxation in dogs via through nitrergic pathways.

  5. Endoscopic papillary balloon dilatation may preserve sphincter of Oddi function after common bile duct stone management: evaluation from the viewpoint of endoscopic manometry

    OpenAIRE

    Sato, H; Kodama, T; Takaaki, J; Tatsumi, Y.; Maeda, T; Fujita, S; Fukui, Y.; H. Ogasawara; Mitsufuji, S

    1997-01-01

    Background—Endoscopic papillary balloon dilatation (EPBD) has been reported as a safe and effective alternative to endoscopic sphincterotomy in the management of common bile duct (CBD) stones; its effect on papillary function has yet to be elucidated. 
Aim—To investigate sphincter of Oddi (SO) motility before and after EPBD to determine its effect on SO function. 
Patients and methods—The papillary function of 10 patients with CBD stones was studied using endoscopic manometry befo...

  6. Multiscale Entropy Analysis of Surface Electromyographic Signals from the Urethral Sphincter as a Prognostic Indicator for Surgical Candidates with Primary Bladder Neck Obstruction

    OpenAIRE

    Hsien-Tsai Wu; Yuan-Hong Jiang; An-Bang Liu; Chun-Wei Liu; Yu-Nian Ou; Hann-Chorng Kuo; Cheuk-Kwan Sun

    2015-01-01

    To explore information hidden in the electromyographic (EMG) signals of the urethral sphincter that may be of prognostic significance for patients with primary bladder neck obstruction (PBNO), 41 patients with voiding difficulty were divided into four groups: 1) patients with primary bladder neck obstruction (PBNO) with successful (Group 1, n = 14) and 2) unsuccessful (Group 2, n = 8) surgical outcomes, 3) patients with detrusor overactivity (Group 3, n = 7), and 4) patients with detrusor-ext...

  7. Analýza vybrané firmy

    OpenAIRE

    Rysková, Diana

    2013-01-01

    Bakalářská práce se zabývá zhodnocením situace vybraného podniku prostřednictvím analýz vnějšího a vnitřního okolí, mezi které patří SLEPTE analýza, SWOT analýza a Porterův model pěti konkurenčních sil. Teoretická část vystihuje podstatu jednotlivých analýz, které jsou následně aplikovány v praktické části bakalářské práce. Na základě výsledků z analýz jsou navržena řešení zjištěných problémových oblastí, směřující k upevnění postavení společnosti na trhu a jejího možného růstu. The bachel...

  8. The Anal Pap Smear: Cytomorphology of squamous intraepithelial lesions

    Directory of Open Access Journals (Sweden)

    Arain Shehla

    2005-01-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  10. Analýza vybrané firmy

    OpenAIRE

    Ligurská, Pavlína

    2014-01-01

    Bakalářská práce je zaměřena na analýzu vybrané firmy. Práce je rozdělena na teoretickou a praktickou část. V teoretické části jsou popsány metody, které byly použity pro analyzování firmy. V praktické části jsou aplikovány jednotlivé metody, Pro analýzu vnějšího prostředí byla použita analýza SLEPTE, pro analýzu odvětví byl použit Porterův model pěti konkurenčních sil, v další části se práce zabývá identifikací silných a slabých stránek firmy. V závěru práce jsou zhodnoceny výsledky analýz a...

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

    OpenAIRE

    Öz, Necdet; Kargı, 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 ...

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

    Institute of Scientific and Technical Information of China (English)

    László Madácsy; Roland Fejes; Gábor Kurucsai; IldikóJoó; András Székely; Viktória Bertalan; Attila Szepes; János Lonovics

    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 postendoscopic 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 type Ⅰ.ESOM demonstrated an elevated basal pressure in 25patients 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 type I and 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

  13. ACUTE GYNAECOLOGICAL EMERGENCY CAUSED BY RUPTURED DERMOID

    Directory of Open Access Journals (Sweden)

    Sweta

    2014-05-01

    Full Text Available Benign dermoid cyst makes up 10 to 15 percent of all ovarian tumors and tends to occur at a relatively early age. Dermoid cysts are bilateral in 12 percent of cases. Cystic teratomas and mucinous cystadenoma may often coexist in the same ovary. A dermoid cyst rarely grows beyond the size of a melon. The lining epithelium is stratified squamous and the cyst contains sebaceous material within, they also contain ectodermal elements like sebaceous glands, hair follicles and sometimes teeth. There is no specific tumor marker in clinical practice for dermoid tumor. CA 125 elevation in seen with epithelial ovarian tumor. CA 19-9 is elevated in mucinous ovarian malignancy and in gastrointestinal cancers. CEA levels higher than 5mg/L are seen elevated in mucinous cancers. Rupture of dermoid cyst is usually spontaneous but may occur from trauma or during labor, coitus or pelvic examination. Rupture is more likely if the wall of the cyst is already damaged by previous ischemic degeneration, if the cyst is papilliferous in type or if it is malignant. It presents with acute pain with the feeling of give away. There may be signs of peritoneal irritation.

  14. TMI-2 lower head creep rupture analysis

    International Nuclear Information System (INIS)

    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

  15. [Right atrium rupture due to blunt trauma].

    Science.gov (United States)

    Suzuki, Kazuhiro; Thuboi, H; Okada, H

    2008-03-01

    We report 2 cases of surgical treatment of blunt cardiac trauma. The postoperative course was uneventful in either case. Pericardial drainage in patients with cardiac rupture should be performed with preparation for thoracotomy. Case 1: A 34-year-old male, hit in the chest by a collapsing 700-kg steel rod, was transported to our hospital via ambulance. The patient was diagnosed as having a cardiac rupture by echocardiography and underwent emergency thoracotomy. The right atrium near the inferior vena cava (IVC) was damaged, though bleeding from the wound had already ceased. No suture hemostusis was needed. Case 2: A 63-year-old female was hit by a car and transported to our hospital due to blunt trauma to the chest. Low blood pressure and chest computed tomography demonstrated cardiac tamponade, and subxiphoid pericardial drainage was performed. Blood pressure was recovered, but persistent hemorrhage necessitated emergency thoracotomy, which revealed a laceration at the right atrium near IVC. The injury was sutured to achieve complete hemostasis. PMID:18323181

  16. Empaatia kogemus kunstiteoses kujutatud subjekti suhtes: fenomenoloogiline analüüs / Marge Paas

    Index Scriptorium Estoniae

    Paas, Marge, 1976-

    2015-01-01

    Analüüsitakse vaataja esteetilist kogemust kunstiteose suhtes. Autor tugineb Edith Steini empaatia kogemuse uurimusele ja fenomenoloogilisele uurimismeetodile. Vaataja empaatia kogemuse analüüs Maarit Murka maalisarjas "Hairpower" kujutatud subjekti suhtes

  17. Analýza vybrané firmy

    OpenAIRE

    Peš, Martin

    2010-01-01

    Hlavním cílem diplomové práce je analyzovat skutečný a aktuální stav společnosti Laufen CZ, s.r.o. a navržení opatření. Jedná se o analýzu vnitřního a vnějšího prostředí společnosti. Jak se firma vyrovnala s dopady finanční a hospodářské krize nám sdělí analýzy SWOT, SLEPT, Quick test, Fundamentální analýza a Porterův model 5 sil.

  18. HPV infection and intraepithelial lesions from the anal region: how to diagnose?

    OpenAIRE

    Newton Sérgio de Carvalho; Aliana Meneses Ferreira; Camila Caroline Tremel Bueno

    2011-01-01

    In the last years, the prevalence of HPV infection in the anal region has increased, especially in some groups like homosexual and HIV-positive people. Since this infection can be associated with the development of squamous anal cancer due to its progression from HPV infection to anal intraepithelial neoplasia (AIN) and finally to cancer, the screening and evaluation of these conditions are important. Anal cytology and high resolution anoscopy are good methods that are available and can be us...

  19. Salvia miltiorrhiza Induces Tonic Contraction of the Lower Esophageal Sphincter in Rats via Activation of Extracellular Ca2+ Influx

    Directory of Open Access Journals (Sweden)

    Ching-Chung Tsai

    2015-08-01

    Full Text Available Up to 40% of patients with gastroesophageal reflux disease (GERD suffer from proton pump inhibitor refractory GERD but clinically the medications to strengthen the lower esophageal sphincter (LES to avoid irritating reflux are few in number. This study aimed to examine whether Salvia miltiorrhiza (SM extracts induce tonic contraction of rat LES ex vivo and elucidate the underlying mechanisms. To investigate the mechanism underlying the SM extract-induced contractile effects, rats were pretreated with atropine (a muscarinic receptor antagonist, tetrodotoxin (a sodium channel blocker, nifedipine (a calcium channel blocker, and Ca2+-free Krebs-Henseleit solution with ethylene glycol tetraacetic acid (EGTA, followed by administration of cumulative dosages of SM extracts. SM extracts induced dose-related tonic contraction of the LES, which was unaffected by tetrodotoxin, atropine, or nifedipine. However, the SM extract-induced LES contraction was significantly inhibited by Ca2+-free Krebs-Henseleit solution with EGTA. Next, SM extracts significantly induce extracellular Ca2+ entry into primary LES cells in addition to intracellular Ca2+ release and in a dose-response manner. Confocal fluorescence microscopy showed that the SM extracts consistently induced significant extracellular Ca2+ influx into primary LES cells in a time-dependent manner. In conclusion, SM extracts could induce tonic contraction of LES mainly through the extracellular Ca2+ influx pathway.

  20. The association between acquired urinary sphincter mechanism incompetence in bitches and early spaying: a case-control study.

    Science.gov (United States)

    de Bleser, B; Brodbelt, D C; Gregory, N G; Martinez, T A

    2011-01-01

    A case-control study was conducted between December 2005 and August 2006 in London (1) to estimate the strength of association between early ovariohysterectomy (spaying) and urinary incontinence (sphincter mechanism incompetence), (2) to identify other risk factors for incontinence, and (3) to assess any implications of incontinence on the owner-pet relationship. Cases were defined as bitches that developed incontinence after spaying and were treated, and the controls comprised continent spayed bitches. Questionnaires from 202 cases were compared to 168 controls, and analysed using multivariable logistic regression. No significant association between early spaying and incontinence was detected although there was a tendency that early spayed bitches were less likely to be incontinent. Docked bitches were 3.8 times more likely to be incontinent than undocked bitches; bitches weighing over 10 kg were 3.7 times more likely to be incontinent than smaller dogs; and older bitches were more likely to be incontinent (OR=3.1-23.8) than younger animals. Some owners were found to have a negative attitude towards incontinence. PMID:20004121

  1. Hrvatsko nazivlje u analitičkoj kemiji

    OpenAIRE

    Kaštelan-Macan (ur.), M.

    2008-01-01

    U radu je prikazan povijesni razvoj prirodoslovnoga nazivlja s naglaskom na nazivlje u analitičkoj kemiji te današnje stanje i nastojanja da se to nazivlje ujednači i normira u skladu s hrvatskom jezičnom normom. Konačni cilj znanstvenoga projekta Hrvatsko nazivlje u analitičkoj kemiji, koji Ministarstvo znanosti, obrazovanja i športa podupire unutar znanstvenoga programa Hrvatska standardnojezična leksikologija i leksikografija jest izraditi cjeloviti enciklopedijski rječnik hrvatskoga anali...

  2. Ruptured Ovarian Dermoid Cyst Mimicking Peritoneal Carcinomatosis: CT and MRI

    OpenAIRE

    Gurcan Erbay

    2016-01-01

    Spontaneous rupture of ovarian dermoid cyst and chronic abdominal spillage of its content is a very uncommon condition, which causes granulomatous peritonitis and can be confused with peritoneal carcinomatosis. Here is presented such a case of ruptured dermoid cyst causing chronic granulomatous peritonitis with radiologic findings mimicking peritoneal carcinomatosis.

  3. Spontaneous rupture of hydatid cyst due to strain-defecation

    Institute of Scientific and Technical Information of China (English)

    Koray Daş; Selim Sözen; Abdurrahman Selçuk Uzun; Ebru Menekşe; Faruk Karateke; Ilhan Bali

    2012-01-01

    We report a case of strain-induced spontaneous rupture of hydatid cyst. Hydatid cyst rupture was diagnosed in a 19-year-old girl who presented with swelling and pain in the the right upper quadrant of sudden onset after straining for defecation.

  4. Ruptured bicornuate uterus mimicking ectopic pregnancy: A case report.

    Science.gov (United States)

    Singh, Nisha; Singh, Uma; Verma, Manju Lata

    2013-01-01

    Ruptured uterus presenting in first trimester of pregnancy is extremely uncommon and should raise the suspicion of uterine malformations. We report a case of a 24-year-old primigravida with 10 weeks of gestation presenting with acute abdomen and hemoperitoneum. Laparotomy revealed bicornuate uterus with ruptured rudimentary horn. The incidence, diagnosis and management of such cases is discussed. PMID:22691311

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

    Science.gov (United States)

    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

  6. Use of ICD-10 codes to monitor uterine rupture

    DEFF Research Database (Denmark)

    Thisted, Dorthe L A; Mortensen, Laust Hvas; Hvidman, Lone;

    2014-01-01

    OBJECTIVES: Uterine rupture is a rare but severe complication in pregnancies after a previous cesarean section. In Denmark, the monitoring of uterine rupture is based on reporting of relevant diagnostic codes to the Danish Medical Birth Registry (MBR). The aim of our study was to examine the vali...

  7. Diverse rupture processes in the 2015 Peru deep earthquake doublet.

    Science.gov (United States)

    Ye, Lingling; Lay, Thorne; Kanamori, Hiroo; Zhan, Zhongwen; Duputel, Zacharie

    2016-06-01

    Earthquakes in deeply subducted oceanic lithosphere can involve either brittle or dissipative ruptures. On 24 November 2015, two deep (606 and 622 km) magnitude 7.5 and 7.6 earthquakes occurred 316 s and 55 km apart. The first event (E1) was a brittle rupture with a sequence of comparable-size subevents extending unilaterally ~50 km southward with a rupture speed of ~4.5 km/s. This earthquake triggered several aftershocks to the north along with the other major event (E2), which had 40% larger seismic moment and the same duration (~20 s), but much smaller rupture area and lower rupture speed than E1, indicating a more dissipative rupture. A minor energy release ~12 s after E1 near the E2 hypocenter, possibly initiated by the S wave from E1, and a clear aftershock ~165 s after E1 also near the E2 hypocenter, suggest that E2 was likely dynamically triggered. Differences in deep earthquake rupture behavior are commonly attributed to variations in thermal state between subduction zones. However, the marked difference in rupture behavior of the nearby Peru doublet events suggests that local variations of stress state and material properties significantly contribute to diverse behavior of deep earthquakes. PMID:27386585

  8. Ruptured hepatocellular carcinoma following chemoembolization:a western experience

    Institute of Scientific and Technical Information of China (English)

    Narendra Battula; Parthi Srinivasan; Mansoor Madanur; Srinivas Prabhu Chava; Oliver Priest; Mohamed Rela; Nigel Heaton

    2007-01-01

    BACKGROUND:Transcatheter arterial chemoembolization (TACE) is a recommended ifrst line therapy for unresectable hepatocellular carcinoma (HCC). Serious complications such as neutropenic sepsis and hepatic decompensation are well known, but rupture of HCC following TACE is a rare and potentially fatal complication. The aim of this study was to identify the incidence of ruptured HCC following TACE and the associated risk factors. METHODS:A retrospective analysis was performed using our liver database with key words "chemoembolization","ruptured HCC" covering the patients who received chemoembolization from January 1995 to December 2005. There were no exclusions. RESULTS:A total of 294 patients received chemoemboliza-tion in 530 sessions during the 10-year period. Of these, 2 ruptured following treatment (incidence 0.68%). The mean age was 65 years and the interval between the treatment and rupture was 2 and 24 days. The common factors were male sex, large tumor size (range 11-13 cm), and exophytic tumor growth. One patient died 2 days after rupture with hepatic decompensation while the second is alive after a 6-month follow up without tumor recurrence. CONCLUSIONS:Ruptured HCC following TACE is a rare but serious complication. Large tumor size, male sex, and exophytic growth of tumor may be predisposing factors for rupture.

  9. Use of fluroquinolone and risk of Achilles tendon rupture

    DEFF Research Database (Denmark)

    Sode, Jacob; Obel, Niels; Hallas, Jesper;

    2007-01-01

    OBJECTIVE: Several case-control studies have reported that the use of fluoroquinolone increases the risk of rupture of the Achilles tendon. Our aim was to estimate this risk by means of a population-based cohort approach. SETTING: Data on Achilles tendon ruptures and fluoroquinolone use were...... retrieved from three population-based databases that include information on residents of Funen County (population: 470,000) in primary and secondary care during the period 1991-1999. A study cohort of all 28,262 first-time users of fluoroquinolone and all incident cases of Achilles tendon ruptures were...... identified. MAIN OUTCOME MEASURES: The incidence rate of Achilles tendon ruptures among users and non-users of fluoroquinolones and the standardised incidence rate ratio associating fluoroquinolon use with Achilles tendon rupture were the main outcome measures. RESULTS: Between 1991 and 2002 the incidence of...

  10. Malignant fibrous histiocytoma presenting as hemoperitoneum mimicking hepatocellular carcinoma rupture

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Malignant fibrous histiocytoma (MFH) is a pleomorphic mesenchynal sarcoma. It is uncommonly arises primarily from the intra-peritoneal cavity. Primary peritoneal MFH with tumor bleeding and rupture is rare. We describe the imaging features of a 70-year-old patient presenting with ruptured hemorrhagic peritoneal MFH at subhepatic area, accompanied by massive hemoperitoneum,mimicking a ruptured pedunculated hepatocellular carcinoma. Computed tomography (CT) revealed a large heterogeneous enhanced subhepatic mass with adjacent liver, gallbladder and colon invasion. Tumor hemorrhage and rupture complicated with peritoneal seeding and massive bloody ascites were also detected.Angiography showed a hypervascular tumor fed by enlarged right hepatic arteries, cystic artery and omental branches of gastroepiploic artery. The patient underwent laparotomy for tumor resection, but the tumor recurred one month after operation. To our knowledge, the CT appearance of ruptured intraperitoneal MFH complicated by hemoperitoneum has not been previously described.

  11. Misdiagnosed uterine rupture of an advanced cornual pregnancy

    DEFF Research Database (Denmark)

    Sant, Christian Linus Hastrup; Andersen, Poul Erik

    2012-01-01

    Cornual pregnancy is a diagnostic and therapeutic challenge with potential severe consequences if uterine rupture occurs with following massive intraabdominal bleeding. We report a case of a misdiagnosed ruptured cornual pregnancy occurring at 21 weeks of gestation. Ultrasound examination and com...... computer tomography revealed no sign of abnormal pregnancy. The correct diagnosis was first made at emergency laparotomy. Uterine rupture should be considered in pregnant women presenting with abdominal pain and haemodynamic instability.......Cornual pregnancy is a diagnostic and therapeutic challenge with potential severe consequences if uterine rupture occurs with following massive intraabdominal bleeding. We report a case of a misdiagnosed ruptured cornual pregnancy occurring at 21 weeks of gestation. Ultrasound examination and...

  12. Unresponsive primipara after rupture of membranes.

    Science.gov (United States)

    Buechel, Johanna; Berset, Andreas; Lehmann, Michael A; Lapaire, Olav

    2015-01-01

    Amniotic fluid embolism, also called anaphylactoid syndrome of pregnancy, is a rare but severe problem in obstetrics. It occurs in 8/100,000 births and the maternal mortality is up to 90%. We report the case of a patient with amniotic fluid embolism who was transferred to our hospital. The initial presentation was an unresponsive patient after spontaneous rupture of the membranes. The massive hypotension and coagulopathy as well as fetal bradycardia of 60 bpm led, after stabilisation of the mother, to an emergency caesarean section. The neonate expired hours later, despite neonatological intensive care. During the operation, we had to deal with massive bleeding due to the coagulopathy. Through interdisciplinary teamwork including Bakri postpartum balloon insertion through the obstetrics team, uterine artery embolism by the interventional radiologists and transfusion of blood products, the maternal life was saved and the patient was discharged 9 days after admission. PMID:25883261

  13. Achilles tendon rupture; assessment of nonoperative treatment

    DEFF Research Database (Denmark)

    Barfod, Kristoffer Weisskirchner

    2014-01-01

    -related quality of life in the weight-bearing group (p=0.009). Compared to the unaffected limb, the affected limb had decreased stiffness (77%, p < 0.001) and strength (93%, p = 0.009) of the plantar flexor muscle-tendon complex. Study IV showed excellent intra-rater reliability (ICC 0.96, SEM 3.7 mm and MDC 10...... trial (RCT). In study III, the effect of immediate weight-bearing on the biomechanical properties of the plantar flexor muscle-tendon complex was investigated in an RCT. In study IV, validity, reliability and agreement of a novel ultrasound measurement of Achilles tendon length and elongation was tested...... Sweden. Immediate weight-bearing was found to be safe and recommendable in non-operative treatment of acute Achilles tendon rupture. The novel ultrasound measurement showed excellent reliability and acceptable validity and agreement....

  14. FASTEF Heat exchanger tube rupture CFD simulation

    Energy Technology Data Exchange (ETDEWEB)

    Moreau, V., E-mail: moreau@crs4.it [CRS4, Centre for Advanced Studies, Research and Development in Sardinia, Polaris, Edificio 1, 09010 Pula, CA (Italy)

    2012-11-15

    The aim of this technical note is to present CFD simulations of a tube rupture incidental scenario in a Primary Heat eXchanger (PHX)/Primary Pump (PP) assembly for two design variants of the FAst-Spectrum Transmutation Experimental Facility FASTEF ongoing design, in the framework of the FP7 Central Design Team (CDT) European project. The simulation domain reproduces with some simplification the entire primary coolant loop. The objective is to understand whether it is necessary take some counter-measures to avoid the ingress of steam in the cold plenum. The simulation has been performed on two successive updates of the design and of the nominal operation. The simulations show a good resistance to steam ingress, under the condition that provision is made to avoid an excessive accumulation of steam at the top of the PHX/PP assembly casing.

  15. Ruptured Giant Omphalocele. A Case Report

    Directory of Open Access Journals (Sweden)

    Víctor Manuel González Valdez

    2013-10-01

    Full Text Available Omphalocele is one of the abdominal wall defects. It can be associated with other malformations including imperforate anus, agenesis of the colon, bladder exstrophy and cardiovascular disease, frequently leading to non-viable fetuses. A case of a female newborn who was prematurely delivered (35.3 weeks in Belize with low birth weight (1860 g is presented. This first-born child required emergency surgery at ten hours of life for ruptured giant omphalocele associated with tetralogy of Fallot, hypoglycemia, and severe general malaise. The aim of this report is to present the diagnostic and therapeutic procedures in such cases. Given the appropriate prenatal diagnosis implemented in Cuba, it is unusual for Cuban doctors, except those working abroad, to treat these patients; hence, this paper may be useful in the teaching context.

  16. CFD modeling of a boiler's tubes rupture

    International Nuclear Information System (INIS)

    This paper reports the results of a study on the reason for tubes damage in the superheater Platen section of the 320 MW Bisotoun power plant, Iran. The boiler has three types of superheater tubes and the damage occurs in a series of elbows belongs to the long tubes. A three-dimensional modeling was performed using an in-house computational fluid dynamics (CFD) code in order to explore the reason. The code has ability of simultaneous solving of the continuity, the Reynolds-Averaged Navier-Stokes (RANS) equations and employing the turbulence, combustion and radiation models. The whole boiler including; walls, burners, air channels, three types of tubes, etc., was modeled in the real scale. The boiler was meshed into almost 2,000,000 tetrahedral control volumes and the standard k-ε turbulence model and the Rosseland radiation model were used in the model. The theoretical results showed that the inlet 18.9 MPa saturated steam becomes superheated inside the tubes and exit at a pressure of 17.8 MPa. The predicted results showed that the temperature of the steam and tube's wall in the long tubes is higher than the short and medium size tubes. In addition, the predicted steam mass flow rate in the long tube was lower than other ones. Therefore, it was concluded that the main reason for the rupture in the long tubes elbow is changing of the tube's metal microstructure due to working in a temperature higher than the design temperature. In addition, the structural fatigue tension makes the last elbow of the long tube more ready for rupture in comparison with the other places. The concluded result was validated by observations from the photomicrograph of the tube's metal samples taken from the damaged and undamaged sections

  17. EP 1000 steam generator tube rupture analyses

    International Nuclear Information System (INIS)

    European electrical utility organizations together with Westinghouse and Ansaldo are participating in a program to utilize the Westinghouse passive nuclear plant technology to develop a plant which meets the European Utility Requirements (EUR) and is expected to be licensable in Europe. The program was initiated in 1994 and the plant is designated EP1000. The EP1000 design is notable for simplicity that comes from a reliance on passive safety systems to enhance plant safety. The use of passive safety systems has provided significant and measurable improvements in plant simplification, safety, reliability, investment protection and plant costs. These systems use only natural forces such as gravity, natural circulation, and compressed gas to provide the driving forces for the systems to adequately cool the reactor core following an initiating event. The EP1000 builds up on the Westinghouse passive nuclear plant technology to enhance plant safety and meet European Utility Requirements and specific European National Safety Criteria. This paper summarizes the main results of the Steam Generator Tube Rupture (SGTR) analysis activity, performed in Phase 2B of the European Passive Plant Program. The purpose of the study is to provide evidence that the passive safety system performance provides a significant improvement in terms of safety, providing significant margins to steam generator overfilling and reducing the need for operator actions. The behavior of the EP1000 plant following SGTR accidents has been analyzed by means of the RELAP5/Mod3.2 code. Sensitivity cases were performed, to address the impact of varying the number of steam generator tubes that rupture, and the potential adverse interactions that could result from operation of control systems (i.e., Chemical and Volume Control System, Startup Feedwater). Analyses have also been performed to define and verify improved protection system logic to avoid possible steam generator safety valve challenges both in the

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

    Directory of Open Access Journals (Sweden)

    Yvette Godwin, FRCS

    2014-11-01

    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.

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

    OpenAIRE

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

    2015-01-01

    Identifying factors, including human papillomavirus (HPV) genotypes, associated with abnormal anal cytology in HIV-infected women have implications for anal squamous cell cancer (SCC) prevention in HIV-infected women. Anal and cervical samples were collected for cytology, and tested for high-(HR-HPV) and low-risk HPV (LR-HPV) genotypes in a cross-sectional analysis of the IPEC Women's HIV Cohort (Rio de Janeiro, Brazil). Multivariate log-binomial regression models estimated prevalence ratios ...

  20. Assessment of risks of stenosis of the anal canal during a prostatic radiotherapy; evaluation des risques de stenose du canal anal lors de la radiotherapie prostatique

    Energy Technology Data Exchange (ETDEWEB)

    Almokhles, H.; Pan, Q.; Calitchi, E.; Diana, C.; Muresan, M.; Jiang, M.W.; Wu, J.F.; Wang, X.W.; Lu, H.J.; Lagrange, J.L. [Hopital Henri-Mondor, Creteil (France)

    2011-10-15

    The authors report a study which aimed at assessing the late tolerance of a prostatic irradiation at the rectum and anal canal level. They assessed the length of the rectum and of the anal canal after prostate irradiation or surgery in patients who suffered from a prostate adenocarcinoma. Data of 154 patients have been analyzed regarding the number of cases of stenosis of rectum or anal canal. They highlight the importance of the irradiated length and dose level. Short communication

  1. Aspectos funcionales de la psicoterapia analítico funcional.

    Directory of Open Access Journals (Sweden)

    Javier Virués Ortega

    2003-01-01

    Full Text Available Se considera una nueva psicoterapia de orientación conductual: la Psicoterapia Analítico Funcional. Se describen brevemente sus fundamentos teóricos, metodológicos y aplicados. Se discuten sus aspectos funcionales desde un punto de vista contextual.

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

    Science.gov (United States)

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

    2015-09-01

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

  3. Primary radiation therapy in the treatment of anal carcinoma

    International Nuclear Information System (INIS)

    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 N0 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

  4. Analýza vybrané firmy

    OpenAIRE

    Zavoralová, Eva

    2012-01-01

    Diplomová práce je zaměřena na analýzu realitní společnosti M&M reality holding, a.s.. V rámci mapování společnosti se zaměřuji na rozbor oborového okolí pomocí PEST analýzy, Porterův model pěti konkurenčních sil, SWOT analýzu a finanční analýzu. V závěru práce navrhuji doporučení, která by měla vést ke zlepšení současné situace. The master´s thesis is focused on the analysis of real estate company M&M reality holding, a.s.. The mapping of the analysis focuses on the professional environme...

  5. Computerised biofeedback achieving continence in high anal atresia.

    OpenAIRE

    Owen-Smith, V H; Chesterfield, B W

    1986-01-01

    Computerised biofeedback has been used to attempt to improve continence in three boys with high anal atresia. The results obtained so far have been extremely encouraging. Over a period of six months progressive improvement has taken place and been maintained in each child.

  6. Primary radiation therapy in the treatment of anal carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Cantril, S.T. (Children' s Hospital of San Francisco, CA); 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.

  7. Human papillomavirus, anal cancer, and screening considerations among HIV-infected individuals.

    Science.gov (United States)

    Cachay, Edward R; Mathews, William Christopher

    2013-01-01

    Invasive anal cancer has become an important cause of non AIDS-related cancer among HIV-infected individuals. Human papillomavirus is the main etiological agent. This review explains the pathophysiologic role of human papillomavirus in the development of invasive anal cancer, summarizes recent epidemiological trends of invasive anal cancer, and reviews the evidence to address common clinical questions posed when screening for anal cancer in HIV-infected patients. The effect of highly active antiretroviral therapy on human papillomavirus oncogenesis is still unclear, but given the increased clinical burden of invasive anal cancer among HIV-infected patients, many clinics have implemented screening programs for anal cancer and its precursors. Despite the availability of several modalities for treatment of precursors of anal cancer, evidence that current treatment modalities favorably alter the natural history of human papillomavirus oncogenesis in the anal and perianal regions is still inconclusive. However, there is sufficient evidence to state that the accuracy of anal cancer screening procedures (cytology and high-resolution anoscopy directed biopsy) is comparable to the accuracy of those used in screening for cervical cancer precursors. Studies that systematically assess the efficacy of these anal cancer screening programs in reducing the incidence of and morbidity and mortality from invasive anal cancer among HIV-infected patients are needed. PMID:23681437

  8. Abnormal anal cytology risk in women with known genital squamous intraepithelial lesion.

    Science.gov (United States)

    do Socorro Nobre, Maria; Jacyntho, Claudia Marcia; Eleutério, José; Giraldo, Paulo César; Gonçalves, Ana Katherine

    2016-01-01

    The purpose of this study was to assess the risk of abnormal anal cytology in women with known genital squamous intraepithelial lesion. This study evaluated 200 women with and without genital squamous intraepithelial lesion who were recruited for anal Pap smears. Women who had abnormal results on equally or over atypical squamous cells of undetermined significance were classified as having abnormal anal cytology. A multiple logistic regression analysis (stepwise) was performed to identify the risk for developing abnormal anal cytology. Data were analyzed using the SPSS 20.0 program. The average age was 41.09 (±12.64). Of the total participants, 75.5% did not practice anal sex, 91% did not have HPV-infected partners, 92% did not have any anal pathology, and 68.5% did not have anal bleeding. More than half (57.5%) had genital SIL and a significant number developed abnormal anal cytology: 13% in the total sample and 17.4% in women with genital SIL. A significant association was observed between genital squamous intraepithelial lesion and anal squamous intraepithelial lesion (PR=2.46; p=0.03). In the logistic regression model, women having genital intraepithelial lesion were more likely to have abnormal anal Pap smear (aPR=2.81; p=0.02). This report shows that women with genital squamous intraepithelial lesion must be more closely screened for anal cancer. PMID:27037113

  9. Closed ruptures of the flexor digitorum tendons: MRI evaluation

    International Nuclear Information System (INIS)

    Objective. To assess the MRI findings in cases of closed rupture of the flexor digitorum tendons (FDT). Patients and design. Ten patients with a clinical suspicion of rupture of FDT underwent MRI before surgery. None of the patients presented a skin injury. Fingers were imaged using axial T1-weighted SE sequences, three-dimensional GE images, and curved reconstructions. Results. Twelve FDT had surgical confirmation of rupture. Flexor digitorum profundus (FDP) and flexor pollicis longus (FPL) tendons were more frequently ruptured (n=8) than flexor digitorum superficialis (FDS) tendons (n=4). MR images accurately depicted the level of the rupture. The gap between the tendon ends (mean 45 mm, range 21-70 mm) was assessed best with curved reconstructions and was well correlated with the surgical findings. The proximal end mainly retracted into the palm or the carpal tunnel (n=8), and less frequently into the digital canal (n=4). In two cases, the proximal end curled up in the palm, clinically simulating a rupture of a lumbrical muscle in one case. MRI also showed the appearance of the adjacent tendons. Conclusion. MRI accurately depicted the level of rupture and the gap between the tendon ends, which assisted the surgical choice between suture, graft or tendon transfer. (orig.)

  10. Closed ruptures of the flexor digitorum tendons: MRI evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Drape, J.-L.; Chevrot, A. [Service de Radiologie B, Hopital Cochin, Paris (France); Tardif-Chastenet de Gery, S.; Silbermann-Hoffman, O.; Benacerraf, R. [Department of Skeletal Radiology, Hopital Bichat, Paris (France); Houvet, P.; Alnot, J.-Y. [Department of Orthopedics, Hopital Bichat, Paris (France)

    1998-11-01

    Objective. To assess the MRI findings in cases of closed rupture of the flexor digitorum tendons (FDT). Patients and design. Ten patients with a clinical suspicion of rupture of FDT underwent MRI before surgery. None of the patients presented a skin injury. Fingers were imaged using axial T1-weighted SE sequences, three-dimensional GE images, and curved reconstructions. Results. Twelve FDT had surgical confirmation of rupture. Flexor digitorum profundus (FDP) and flexor pollicis longus (FPL) tendons were more frequently ruptured (n=8) than flexor digitorum superficialis (FDS) tendons (n=4). MR images accurately depicted the level of the rupture. The gap between the tendon ends (mean 45 mm, range 21-70 mm) was assessed best with curved reconstructions and was well correlated with the surgical findings. The proximal end mainly retracted into the palm or the carpal tunnel (n=8), and less frequently into the digital canal (n=4). In two cases, the proximal end curled up in the palm, clinically simulating a rupture of a lumbrical muscle in one case. MRI also showed the appearance of the adjacent tendons. Conclusion. MRI accurately depicted the level of rupture and the gap between the tendon ends, which assisted the surgical choice between suture, graft or tendon transfer. (orig.) With 7 figs., 2 tabs., 40 refs.

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

    Science.gov (United States)

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

    1990-12-01

    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

  12. Studies of the etiology of chronic pancreatitis with special reference to endoscopic manometry of sphincter of Oddi and quantitative cholescintigraphy

    International Nuclear Information System (INIS)

    This study was designed to elucidate the etiology of chronic pancreatitis. In a total of 23 patients with alcoholic (8) or idiopathic (18) pancreatitis, motor activity of the Oddi's sphincter was recorded by endoscopy to measure systolic pressure, diastolic pressure, motor cycle, the area surrounded by phasic waves and the base line for one minute (index A), and the area surrounded by phasic waves and the line connecting each bottom of the waves for one minute (index B). In addition, cholescintigraphy was performed in a total of 27 patients with alcoholic (4) or idiopathic (23) pancreatitis to obtain the time from appearance of common hepatic duct image to that of duodenal image (CD time). Systolic pressure (48.9±16.1 mmHg), diastolic pressure (33.9±14.3 mmHg), index A (10.4±3.2 cm2/min), and index B (3.1±0.9 cm2/min) were significantly higher than those in controls (28.3±8.3 mmHg, 19.5±7.6 mmHg, 6.1±1.7 cm2/min, and 1.7±0.9 cm2/min, respectively). Similarly. CD time was significantly longer for chronic pancreatitis than controls (44.1±22.4 min vs 18.5±17.3 min). In conclusion, chronic pancreatitis was associated with increased papillary resistance, resulting in retension of pancreatic juice. Papillary dysfunction has proved to be responsible for pathogenesis of chronic pancreatitis. (N.K.)

  13. Stent placement above the sphincter of Oddi permits implementation of neoadjuvant chemotherapy in patients with initially unresectable Klatskin tumor

    Science.gov (United States)

    Kubota, Kensuke; Hasegawa, Sho; Iwasaki, Akito; Sato, Takamitsu; Fujita, Yuji; Hosono, Kunihiro; Nakajima, Atsushi; Mori, Ryutaro; Matsuyama, Ryusei; Endo, Itaru

    2016-01-01

    Background and study aims: Neoadjuvant chemotherapy (NAC) may lead to a successful margin-negative resection in patients with initially unresectable locally advanced Klatskin tumor (IULAKT). Use of removable plastic stents is preferable for the safe implementation of NAC in patients with IULAKT to reduce the risk of recurrent cholangitis. Our aim was to evaluate the efficacy associated with the use of plastic stents placed across the stenosis and above the papilla (above stent) during NAC. Patients and methods: In this study, we stratified the patients into two groups chronologically with respect to the period of stent placement: above stent group (n = 17) and across stent group (n = 23) (plastic stent across the sphincter of Oddi). Results: The median stent patency period was 99 days in the above stent group and 31 days in the across stent group (P < 0.0001). The number of stents (P = 0.017) and the rate of emerging undrained cholangitis areas (P = 0.025) were significantly reduced in the above stent group than the counterpart. Regarding time to recurrent biliary obstruction, the above stent group had a longer duration than the across stent group (log rank test, P = 0.004). Length of hospital stay was significantly shorter for the above stent group than the across stent group (P = 0.0475). Multivariate analysis revealed that above stent placement (odds ratio = 33.638, P = 0.0048) was significantly associated with stent patency over a period of 90 days. Conclusions: Above stent placement should be considered for the relief of biliary obstruction and potentially reduces the cost for patients with IULAKT scheduled to receive NAC. PMID:27092322

  14. Diagnosis of breast implant rupture using magnetic resonance imaging

    International Nuclear Information System (INIS)

    At least 20,000 Norwegian woman have silicone breast implants, either for breast augmentation or for reconstruction. One of the complications associated with breast implants is rupture of the implants. Magnetic resonance imaging (MRI) has been shown to be the most accurate imaging modality for evaluating the integrity of breast implants. Recognition of the different types of implants and the appearance of normal implants on MRI is very important for distinguishing these from intracapsular and extracapsular ruptures. Examples are shown of MRI findings in normal and ruptured implants. 16 refs., 6 figs

  15. Design and Experimental Research on a New Pipe Rupture Valve

    Institute of Scientific and Technical Information of China (English)

    HU Guo-liang; XU Bing; YANG Hua-yong; ZHANG Yi-ding

    2006-01-01

    A new pipe rupture valve for hydraulic elevator is designed.Mathematical models established for the hydraulic elevator system are used in numefical simulations on the Simulink environment of Matlab kits.The effects of different viscous damping diameters.inlet pressures of pipe rupture valve.and elevator loads on the hydraulic elevator system's dynamic performance are analyzed.Expefimenml research is also carried out using a hydraulic elevator experiment rig.The numerical simulations accord with experimental results in general.Dynamic performance indexes are assessed by the EN812 standard.The results show that the newly designed pipe rupture valve meets the designing requirement for hydraulic elevators.

  16. CT diagnosis of traumatic bronchial rupture in children

    International Nuclear Information System (INIS)

    Bronchial rupture is a rare and serious complication of blunt chest trauma in children. The diagnosis of this injury is challenging and requires a high degree of clinical suspicion. It is frequently associated with other severe injuries that may draw the focus of attention away from this potentially catastrophic but treatable injury. The radiographic findings of bronchial rupture have been reported in very few series. We report the findings in two children with bronchial rupture diagnosed by CT, in whom CT resulted in a significant change in patient management. (orig.)

  17. Bilateral patellar tendon rupture associated with statin use

    OpenAIRE

    Kearns, Marie C.; Singh, Vinay K

    2016-01-01

    Patellar tendon rupture is an uncommon clinical presentation, which generally affects the under 40s who are active in sport. Bilateral rupture of both tendons is much rarer. It occurs most frequently in patients with predisposing factors such as corticosteroid use or systemic diseases. The authors present the case of a 56-year-old male on long-term statin therapy who sustained this injury following a fall on ice. He had no known risk factors for tendon rupture. Surgical treatment involved ten...

  18. The stress-rupture properties of irradiated AGR cladding

    International Nuclear Information System (INIS)

    In the event of a loss-of-coolant accident in a CAGR, pressure inside the pins might cause some to rupture. The rupture properties of both the can body and the end-cap are needed in the evaluation of the number of pins which might fail. The can-body stress-rupture properties first measured on fuel irradiated in WAGR are analysed and compared with similar data now being obtained on fuel from the CAGR's. A method of predicting the deformation of end-caps by an internal pressure is described and the limiting deformation which will result in fracture discussed. (author)

  19. Ruptured ileocolic artery aneurysm: An unusual cause of hemoperitoneum

    Directory of Open Access Journals (Sweden)

    Zakaur R Siddiqui

    2012-01-01

    Full Text Available Ruptured aneurysm of a branch of ileocolic artery is a rare finding and is an unusual cause of haemoperitoneum. Rapid diagnosis, and surgical or endovascular intervention are necessary to avoid devastating consequences and high mortality rates following an emergency operation after rupture. Resection is a good choice for surgical intervention for some aneurysms that are not suitable for endovascular repair. This report describes the case of a middle-aged man with a ruptured superior mesenteric artery branch aneurysm and his subsequent surgical management.

  20. Ruptured Ileocolic Artery Aneurysm: An Unusual Cause of Hemoperitoneum

    Science.gov (United States)

    Siddiqui, Zakaur R.; Yousif, Omer F.; Halliday, Mark W.; Hubaishah, Nasser A.; Adam, Khalid A.

    2012-01-01

    Ruptured aneurysm of a branch of ileocolic artery is a rare finding and is an unusual cause of haemoperitoneum. Rapid diagnosis, and surgical or endovascular intervention are necessary to avoid devastating consequences and high mortality rates following an emergency operation after rupture. Resection is a good choice for surgical intervention for some aneurysms that are not suitable for endovascular repair. This report describes the case of a middle-aged man with a ruptured superior mesenteric artery branch aneurysm and his subsequent surgical management. PMID:23006464