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Nasser Sanea - One of the best experts on this subject based on the ideXlab platform.
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The cutting seton
Diseases of the Colon & Rectum, 2001Co-Authors: William H. Isbister, Nasser SaneaAbstract:PURPOSE: A 30-percent gas incontinence rate has been reported after the use of the cutting seton in complex anal fistulas. This study was undertaken to determine the morbidity and efficacy of the cutting seton in the management of complex anal fistulas at the King Faisal Specialist Hospital. METHODS: All patients who had a cutting seton inserted in the colorectal unit at King Faisal Specialist Hospital between 1990 and 1998 were identified from a colorectal data base. The charts of these patients were examined and form the basis of this report. Setons were inserted and tied under general anesthesia after the fistula tract had been identified. All fistulas were transsphincteric, and if it seemed that more than 30 percent of the internal sphincter would need to be divided to “lay open” the tract, a seton was used. Fistulas were designated “high” if the internal opening was above the level of the anal crypts. Setons were tightened under general anesthesia at intervals of three to four weeks until cutting was complete. Patients were followed up until wounds had healed and fistula symptoms had resolved. RESULTS: Data from 47 patients were analyzed. The mean duration of disease before surgery was 39.1 months. Twenty-five patients had had previous anorectal abscess drainage. The mean number of previous fistula operations was 2.2. Before seton insertion five patients were incontinent to gas, two to Liquid stool, and none to solid stool. Continence status before seton surgery was unknown in 11 patients. There were 16 “high” fistulas. Methylene blue dye was used to identify the internal opening in 14 patients when simple probing failed. Setons were tightened on three or more occasions in 12 patients, twice in 19 patients, and once in 16 patients. Mean perineal wound healing time was six months. The mean length of follow-up was 1.1 years, and during this time one fistula recurred. After treatment a total of 17 patients (36.2 percent) were incontinent to gas, 4 to Liquid Feces (8.5 percent), and 1 to solid Feces (2.3 percent). Four patients complained of soiling. Of previously continent patients, 9.5 percent were significantly incontinent to gas, but in addition 21.4 percent were “occasionally” incontinent for gas. CONCLUSION: The use of the cutting seton resulted in a significant gas incontinence rate of 9.5 percent after a mean follow-up of 1.1 years. Only 1 fistula recurred.
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The cutting seton: an experience at King Faisal Specialist Hospital.
Diseases of the Colon & Rectum, 2001Co-Authors: William H. Isbister, Nasser SaneaAbstract:PURPOSE: A 30-percent gas incontinence rate has been reported after the use of the cutting seton in complex anal fistulas. This study was undertaken to determine the morbidity and efficacy of the cutting seton in the management of complex anal fistulas at the King Faisal Specialist Hospital. METHODS: All patients who had a cutting seton inserted in the colorectal unit at King Faisal Specialist Hospital between 1990 and 1998 were identified from a colorectal data base. The charts of these patients were examined and form the basis of this report. Setons were inserted and tied under general anesthesia after the fistula tract had been identified. All fistulas were transsphincteric, and if it seemed that more than 30 percent of the internal sphincter would need to be divided to “lay open” the tract, a seton was used. Fistulas were designated “high” if the internal opening was above the level of the anal crypts. Setons were tightened under general anesthesia at intervals of three to four weeks until cutting was complete. Patients were followed up until wounds had healed and fistula symptoms had resolved. RESULTS: Data from 47 patients were analyzed. The mean duration of disease before surgery was 39.1 months. Twenty-five patients had had previous anorectal abscess drainage. The mean number of previous fistula operations was 2.2. Before seton insertion five patients were incontinent to gas, two to Liquid stool, and none to solid stool. Continence status before seton surgery was unknown in 11 patients. There were 16 “high” fistulas. Methylene blue dye was used to identify the internal opening in 14 patients when simple probing failed. Setons were tightened on three or more occasions in 12 patients, twice in 19 patients, and once in 16 patients. Mean perineal wound healing time was six months. The mean length of follow-up was 1.1 years, and during this time one fistula recurred. After treatment a total of 17 patients (36.2 percent) were incontinent to gas, 4 to Liquid Feces (8.5 percent), and 1 to solid Feces (2.3 percent). Four patients complained of soiling. Of previously continent patients, 9.5 percent were significantly incontinent to gas, but in addition 21.4 percent were “occasionally” incontinent for gas. CONCLUSION: The use of the cutting seton resulted in a significant gas incontinence rate of 9.5 percent after a mean follow-up of 1.1 years. Only 1 fistula recurred.
Francesco Tonelli - One of the best experts on this subject based on the ideXlab platform.
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What affects continence after anterior resection of the rectum?
Diseases of the Colon & Rectum, 1991Co-Authors: Giacomo Batignani, Iacopo Monaci, Ferdinando Ficari, Francesco TonelliAbstract:Functional results after anterior rectal resections are commonly considered satisfactory but variable percentages of postoperative incontinence are often reported. Continence was evaluated after 20 low anterior resections (LAR) and 13 high anterior resections (HAR) by means of clinical assessment, anorectal manometry, and evacuation proctography. Whereas all HAR patients had perfect continence, 10 patients (50 percent of the LAR group had occasional episodes of soiling from Liquid Feces, 5 patients (25 percent had frequent soiling or occasional incontinence for solid Feces, and 1 patient (5 percent had frequent solid stool loss requiring surgical treatment. Anal canal resting pressure at 3 and 4 cm from the anal verge was significantly lower in the LAR group ( P < 0.02 and P < 0.05, respectively) than in the HAR group. However, the maximum voluntary contraction did not differ between the two groups. Rectoanal inhibitory reflex was found to be present in 17 of the 20 patients with LAR and in all patients with HAR. The volume at which the anal sphincter is continuously inhibited was significantly reduced in the LAR group ( P < 0.001). Also, the conscious rectal sensibility volumes were found to be significantly reduced for threshold, constant, and maximum tolerated volume. Threshold volume for internal sphincter relaxation was lower than the threshold volume for rectal sensation in some patients with LAR. This could allow postoperative fecal soiling. Rectal compliance was decreased ( P < 0.001) in the LAR group. Evacuation proctography, performed in six LAR patients affected by major soiling or solid stool loss, revealed an abnormal obtuse anorectal angle and pathologic lowering of the perineum at rest and during defecation. The concomitance of internal anal sphincter impairment, reduction in rectal compliance, and previous pelvic floor muscle damage are postulated as cause affecting continence in patients who underwent LAR .
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What affects continence after anterior resection of the rectum
Diseases of the Colon & Rectum, 1991Co-Authors: Giacomo Batignani, Iacopo Monaci, Ferdinando Ficari, Francesco TonelliAbstract:Functional results after anterior rectal resections are commonly considered satisfactory but variable percentages of postoperative incontinence are often reported. Continence was evaluated after 20 low anterior resections (LAR) and 13 high anterior resections (HAR) by means of clinical assessment, anorectal manometry, and evacuation proctography. Whereas all HAR patients had perfect continence, 10 patients (50 percent of the LAR group had occasional episodes of soiling from Liquid Feces, 5 patients (25 percent had frequent soiling or occasional incontinence for solid Feces, and 1 patient (5 percent had frequent solid stool loss requiring surgical treatment. Anal canal resting pressure at 3 and 4 cm from the anal verge was significantly lower in the LAR group (P
William H. Isbister - One of the best experts on this subject based on the ideXlab platform.
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The cutting seton
Diseases of the Colon & Rectum, 2001Co-Authors: William H. Isbister, Nasser SaneaAbstract:PURPOSE: A 30-percent gas incontinence rate has been reported after the use of the cutting seton in complex anal fistulas. This study was undertaken to determine the morbidity and efficacy of the cutting seton in the management of complex anal fistulas at the King Faisal Specialist Hospital. METHODS: All patients who had a cutting seton inserted in the colorectal unit at King Faisal Specialist Hospital between 1990 and 1998 were identified from a colorectal data base. The charts of these patients were examined and form the basis of this report. Setons were inserted and tied under general anesthesia after the fistula tract had been identified. All fistulas were transsphincteric, and if it seemed that more than 30 percent of the internal sphincter would need to be divided to “lay open” the tract, a seton was used. Fistulas were designated “high” if the internal opening was above the level of the anal crypts. Setons were tightened under general anesthesia at intervals of three to four weeks until cutting was complete. Patients were followed up until wounds had healed and fistula symptoms had resolved. RESULTS: Data from 47 patients were analyzed. The mean duration of disease before surgery was 39.1 months. Twenty-five patients had had previous anorectal abscess drainage. The mean number of previous fistula operations was 2.2. Before seton insertion five patients were incontinent to gas, two to Liquid stool, and none to solid stool. Continence status before seton surgery was unknown in 11 patients. There were 16 “high” fistulas. Methylene blue dye was used to identify the internal opening in 14 patients when simple probing failed. Setons were tightened on three or more occasions in 12 patients, twice in 19 patients, and once in 16 patients. Mean perineal wound healing time was six months. The mean length of follow-up was 1.1 years, and during this time one fistula recurred. After treatment a total of 17 patients (36.2 percent) were incontinent to gas, 4 to Liquid Feces (8.5 percent), and 1 to solid Feces (2.3 percent). Four patients complained of soiling. Of previously continent patients, 9.5 percent were significantly incontinent to gas, but in addition 21.4 percent were “occasionally” incontinent for gas. CONCLUSION: The use of the cutting seton resulted in a significant gas incontinence rate of 9.5 percent after a mean follow-up of 1.1 years. Only 1 fistula recurred.
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The cutting seton: an experience at King Faisal Specialist Hospital.
Diseases of the Colon & Rectum, 2001Co-Authors: William H. Isbister, Nasser SaneaAbstract:PURPOSE: A 30-percent gas incontinence rate has been reported after the use of the cutting seton in complex anal fistulas. This study was undertaken to determine the morbidity and efficacy of the cutting seton in the management of complex anal fistulas at the King Faisal Specialist Hospital. METHODS: All patients who had a cutting seton inserted in the colorectal unit at King Faisal Specialist Hospital between 1990 and 1998 were identified from a colorectal data base. The charts of these patients were examined and form the basis of this report. Setons were inserted and tied under general anesthesia after the fistula tract had been identified. All fistulas were transsphincteric, and if it seemed that more than 30 percent of the internal sphincter would need to be divided to “lay open” the tract, a seton was used. Fistulas were designated “high” if the internal opening was above the level of the anal crypts. Setons were tightened under general anesthesia at intervals of three to four weeks until cutting was complete. Patients were followed up until wounds had healed and fistula symptoms had resolved. RESULTS: Data from 47 patients were analyzed. The mean duration of disease before surgery was 39.1 months. Twenty-five patients had had previous anorectal abscess drainage. The mean number of previous fistula operations was 2.2. Before seton insertion five patients were incontinent to gas, two to Liquid stool, and none to solid stool. Continence status before seton surgery was unknown in 11 patients. There were 16 “high” fistulas. Methylene blue dye was used to identify the internal opening in 14 patients when simple probing failed. Setons were tightened on three or more occasions in 12 patients, twice in 19 patients, and once in 16 patients. Mean perineal wound healing time was six months. The mean length of follow-up was 1.1 years, and during this time one fistula recurred. After treatment a total of 17 patients (36.2 percent) were incontinent to gas, 4 to Liquid Feces (8.5 percent), and 1 to solid Feces (2.3 percent). Four patients complained of soiling. Of previously continent patients, 9.5 percent were significantly incontinent to gas, but in addition 21.4 percent were “occasionally” incontinent for gas. CONCLUSION: The use of the cutting seton resulted in a significant gas incontinence rate of 9.5 percent after a mean follow-up of 1.1 years. Only 1 fistula recurred.
Giacomo Batignani - One of the best experts on this subject based on the ideXlab platform.
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What affects continence after anterior resection of the rectum?
Diseases of the Colon & Rectum, 1991Co-Authors: Giacomo Batignani, Iacopo Monaci, Ferdinando Ficari, Francesco TonelliAbstract:Functional results after anterior rectal resections are commonly considered satisfactory but variable percentages of postoperative incontinence are often reported. Continence was evaluated after 20 low anterior resections (LAR) and 13 high anterior resections (HAR) by means of clinical assessment, anorectal manometry, and evacuation proctography. Whereas all HAR patients had perfect continence, 10 patients (50 percent of the LAR group had occasional episodes of soiling from Liquid Feces, 5 patients (25 percent had frequent soiling or occasional incontinence for solid Feces, and 1 patient (5 percent had frequent solid stool loss requiring surgical treatment. Anal canal resting pressure at 3 and 4 cm from the anal verge was significantly lower in the LAR group ( P < 0.02 and P < 0.05, respectively) than in the HAR group. However, the maximum voluntary contraction did not differ between the two groups. Rectoanal inhibitory reflex was found to be present in 17 of the 20 patients with LAR and in all patients with HAR. The volume at which the anal sphincter is continuously inhibited was significantly reduced in the LAR group ( P < 0.001). Also, the conscious rectal sensibility volumes were found to be significantly reduced for threshold, constant, and maximum tolerated volume. Threshold volume for internal sphincter relaxation was lower than the threshold volume for rectal sensation in some patients with LAR. This could allow postoperative fecal soiling. Rectal compliance was decreased ( P < 0.001) in the LAR group. Evacuation proctography, performed in six LAR patients affected by major soiling or solid stool loss, revealed an abnormal obtuse anorectal angle and pathologic lowering of the perineum at rest and during defecation. The concomitance of internal anal sphincter impairment, reduction in rectal compliance, and previous pelvic floor muscle damage are postulated as cause affecting continence in patients who underwent LAR .
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What affects continence after anterior resection of the rectum
Diseases of the Colon & Rectum, 1991Co-Authors: Giacomo Batignani, Iacopo Monaci, Ferdinando Ficari, Francesco TonelliAbstract:Functional results after anterior rectal resections are commonly considered satisfactory but variable percentages of postoperative incontinence are often reported. Continence was evaluated after 20 low anterior resections (LAR) and 13 high anterior resections (HAR) by means of clinical assessment, anorectal manometry, and evacuation proctography. Whereas all HAR patients had perfect continence, 10 patients (50 percent of the LAR group had occasional episodes of soiling from Liquid Feces, 5 patients (25 percent had frequent soiling or occasional incontinence for solid Feces, and 1 patient (5 percent had frequent solid stool loss requiring surgical treatment. Anal canal resting pressure at 3 and 4 cm from the anal verge was significantly lower in the LAR group (P
Richard D Goeden - One of the best experts on this subject based on the ideXlab platform.
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Life history and description of adults and immature stages of Goedenia stenoparia (Steyskal) (Diptera: Tephritidae) on Gutierrezia californica (De Candolle) Torrey and A. Gray and Solidago californica nuttall (Asteraceae) inSouthern California
2002Co-Authors: Richard D GoedenAbstract:Goedenia stenoparia (Steyskal) is an oligophagous, multivoltine fruit fly (Diptera: Tephritidae) that feeds in the flower heads of hosts belonging to the family Asteraceae, tribe Astereae, and subtribe Solidagininae, likeall other known hosts of Goedenia spp. Newly reported hosts are Ericameria parishii (E. Greene) H. M. Hall, Gutierrezia californica (de Candolle) Torrey and A. Gray, Hazardia squarrosa (Hooker and Arnott) E. Greene, Lessingia glandulifera A. Gray, and Solidago californica Nuttall. Variations in taxonomic characters of adults are described. The third-instar larvae and puparia are described and figured, and selected characteristics of these stages are compared with the same stages of three other species of Goedenia. The prothorax and gnathocephalon of the third instar is smooth and mostly free of the minute acanthae that circumscribe most other body segments. The third instar of G. stenoparia lacks oral ridges, as do the third instars of three other congeners studied to date. The anterior thoracic spiracle bears two papillae. Minute acanthae cover the center of the truncated, posteriorly sclerotized, caudal segment, that also is perforated by scattered pores, and this central area is ringed by concentric, incomplete series of shallow, elliptical depressions. The life cycle is of the aggregative type. Overwintering limitedly occurs as sexually immature adults, but mainly in dead flower heads as prepuparial third instars and puparia in apically open, vasiform cells consisting of floret and achene fragments glued together with dried Liquid Feces and sap. Overwintered puparia of G. stenoparia were parasitized by chalcidoid Hymenoptera in the genera Eurytoma (Eurytomidae), Pteromalus (Pteromalidae), and Torymus (Torymidae) as probable, primary, solitary, larval-pupal endoparasitoids.
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Life history and description of immature stages of goedenia setosa (foote) (Diptera: Tephritidae) on Ericameria brachylepis (A. Gray) H. M. Hall in Southern California
2002Co-Authors: Richard D GoedenAbstract:Goedenia setosa (Foote) is a rare, monophagous or nearly monophagous, univoltine fruit fly (Diptera: Tephritidae) that feeds in the flower heads of Ericameria brachylepis (A. Gray) H. M. Hall in southern California. This sole, newly reported host belongs to the family Asteraceae tribe, Astereae, and subtribe Solidagininae, like all other known hosts of Goedenia spp. The third-instar larvae and puparia are described and figured, and selected characteristics of these stages are compared with the same stages of two other species of Goedenia. The prothorax and gnathocephalon of the second and third instars are smooth and mostly free of the minute acanthae that circumscribe most other body segments. The third instar of G. setosa lacks oral ridges, as do the third instars of two other congeners studied to date. The anterior thoracic spiracle bears two papillae in the third instar. Minute acanthae cover the center of the posterior end of the truncated, posteriorly sclerotized, caudal segment, that also is perforated by scattered, open pores, and this central area is ringed by concentric series of shallow, elliptical depressions. The life cycle is of the aggregative type. Overwintering limitedly occurs as sexually immature adults, but more frequently in dead flower heads as prepuparial third instars and puparia in apically open, vasiform cells consisting of floret and achene fragments impregnated and hardened with dried Liquid Feces and sap. The flattened, sclerotized posterior of the caudal segment of the overwintering prepuparium serves to plug the apical opening of the cell and thus possibly helps to shield it at least from predators. However, Colotrechnus sp. (Eulophidae), Eurytoma sp. (Eurytomidae), Eupelmus sp. (Eupelmidae), Halticoptera (Pteromalidae), and Mesopolobus sp. (Pteromalidae) are chalcidoid, primary parasitic Hymenoptera commonly reared from the overwintered puparia.
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Life history and description of adults and immature stages of Goedenia steyskali, n. sp. (Diptera: Tephritidae) on Grindelia hirsutula Hooker and Arnott var. halli (Steyermark) M. A. Lane (Asteraceae) in Southern California.
2002Co-Authors: Richard D GoedenAbstract:Goedenia steyskali, n. sp., is a nearly monophagous, univoltine fruit fly (Diptera: Tephritidae) reared from and studied in the flower heads of Grindelia hirsutula Hooker and Arnott var. halli (Steyermark) M. A. Lane belonging to the family Asteraceae, tribe Astereae, and subtribe Solidagininae, like all other known hosts of Goedenia spp. This tephritid also has been reared from Grindelia camporum E. Greene. A key to Goedenia spp. in North America North of Mexico is provided that incorporates this new species. This new species is distinguished from all other North American congeners by the combination of its extensively darkened legs, an uninterrupted discal wing band that rarely attains the posterior wing margin, and the prominent, central, tawny or yellow area on the scutellum. The second- and third-instar larvae and puparium also are partially described and figured, and selected characteristics of these stages are compared with the same stages of other species of Goedenia. The anterior thoracic spiracle bears four papillae in the second instar and three papillae in the third instar. The third instar of G. steyskali lacks oral ridges, as do the third instars of four other congeners studied to date. Among these same congeners, the third instar of G. steyskali has the fewest minute acanthae and pores in the center of the truncated, posteriorly sclerotized, caudal segment. In turn, these structures and a pair of posterior spiracular plates are ringed by two to three, concentric, incomplete series of shallow, elliptical depressions. The life cycle is of the aggregative type. The first and second instars feed on ovules and soft achenes, but the latter instar after or near final molt begins to feed like the third instar in the receptacle, which may be mined extensively, and on sap. Overwintering occurs as sexually immature adults, or mainly as prepuparial third instars and puparia in flower heads on dead plants in apically open, thin-walled, vasiform cells consisting of floret and achene fragments glued together with dried Liquid Feces and sticky sap. The flattened, dark, sclerotized caudal segment of the third instar serves as a plug that tightly closes the mouth of the cell, yet allows repiration, and thus apparently also may serve to shield the larva from arthropod predators during overwintering. Overwintered puparia of G. steyskali were parasitized by chalcidoid Hymenoptera in the genera Eurytoma (Eurytomidae), Pteromalus (Pteromalidae), and Torymus (Torymidae) as probable, primary, solitary, larval-pupal endoparasitoids.