The Experts below are selected from a list of 3708 Experts worldwide ranked by ideXlab platform
Thilo Wedel - One of the best experts on this subject based on the ideXlab platform.
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internal anal sphincter nerves a macroanatomical and microscopic description of the extrinsic autonomic nerve supply of the internal anal sphincter
Colorectal Disease, 2018Co-Authors: Sigmar Stelzner, M Bottner, J Kupsch, W Kneist, P Quirke, Nicholas P West, Helmut Witzigmann, Thilo WedelAbstract:Background: The internal anal sphincter (IAS) contributes substantially to anoRectal functions. While its autonomic nerve supply has been studied at the microscopic level, little information is available concerning the macroscopic topography of extrinsic nerve fibres. This study was designed to identify neural connections between the pelvic plexus and the IAS, provide a detailed topographical description, and give histological proof of autonomic nerve tissue. Methods: Macroscopic dissection of pelvic autonomic nerves was performed under magnification in seven (5 males, 2 females) hemipelvises obtained from body donors (67-92 years). Candidate structures were investigated by histological and immunohistochemical staining protocols to visualize nerve tissue. Results: Nerve fibres could be traced from the anteroinferior edge of the pelvic plexus to the anoRectal junction running along the neurovascular bundle anterolaterally to the rectum and posterolaterally to the prostate/vagina. Nerve fibres penetrated the longitudinal Rectal Muscle layer just above the fusion with the levator ani Muscle (conjoint longitudinal Muscle) and entered the intersphincteric space to reach the IAS. Histological and immunohistochemical findings confirmed the presence of nerve tissue. Conclusions: Autonomic nerve fibres supplying the IAS emerge from the pelvic plexus and are distinct to nerves entering the rectum via the lateral pedicles. Thus, they should be classified as internal anal sphincter nerves. The identification and precise topographical location described provides a basis for nerve-sparing Rectal resection procedures and helps to prevent postoperative functional anoRectal disorders.
Ming Zhang - One of the best experts on this subject based on the ideXlab platform.
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denonvilliers fascia in men a sheet plastination and confocal microscopy study of the preRectal space and the presence of an optimal anterior plane when mobilizing the rectum for cancer
Colorectal Disease, 2018Co-Authors: P H Chapuis, Leslie Bokey, Ming ZhangAbstract:Aim The aim of this study was to investigate the detailed, in situ, morphology of Denonvilliers fascia (DVF) in cadavers using sheet plastination and confocal microscopy and to review and describe the optimal anterior plane for mobilisation of the distal rectum.. Method Six, male cadavers (age range, 46-87 years) were prepared as six sets of transverse (x2), coronal (x1) and sagittal (x3) plastinated sections which were examined under a confocal laser scanning microscope. Results In this study a consistent space between the anterior Rectal wall and the posterior surface of the prostate and seminal vesicles above the level of the perineal body was termed the preRectal space. Within that preRectal space we identified fibres which take their origin from the external urethral sphincter (EUS), together with others from the longitudinal Rectal Muscle (LRM) and the connective tissue sheaths of neurovascular bundles. Neither the EUS- nor the LRM-originated fibres were continuous with the endopelvic fascia;they are interposed laterally and cranially by multiple neurovascular bundles. Further, our results suggest that the peritoneum does not descend deep within the preRectal space. Conclusion This study reveals the undisturbed, in situ, structural detail of membrane-like structures in the preRectal space and confirms that the optimal plane for anterolateral mobilization of the rectum is posterior to the multilayered DVF. This article is protected by copyright. All rights reserved.
Sigmar Stelzner - One of the best experts on this subject based on the ideXlab platform.
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internal anal sphincter nerves a macroanatomical and microscopic description of the extrinsic autonomic nerve supply of the internal anal sphincter
Colorectal Disease, 2018Co-Authors: Sigmar Stelzner, M Bottner, J Kupsch, W Kneist, P Quirke, Nicholas P West, Helmut Witzigmann, Thilo WedelAbstract:Background: The internal anal sphincter (IAS) contributes substantially to anoRectal functions. While its autonomic nerve supply has been studied at the microscopic level, little information is available concerning the macroscopic topography of extrinsic nerve fibres. This study was designed to identify neural connections between the pelvic plexus and the IAS, provide a detailed topographical description, and give histological proof of autonomic nerve tissue. Methods: Macroscopic dissection of pelvic autonomic nerves was performed under magnification in seven (5 males, 2 females) hemipelvises obtained from body donors (67-92 years). Candidate structures were investigated by histological and immunohistochemical staining protocols to visualize nerve tissue. Results: Nerve fibres could be traced from the anteroinferior edge of the pelvic plexus to the anoRectal junction running along the neurovascular bundle anterolaterally to the rectum and posterolaterally to the prostate/vagina. Nerve fibres penetrated the longitudinal Rectal Muscle layer just above the fusion with the levator ani Muscle (conjoint longitudinal Muscle) and entered the intersphincteric space to reach the IAS. Histological and immunohistochemical findings confirmed the presence of nerve tissue. Conclusions: Autonomic nerve fibres supplying the IAS emerge from the pelvic plexus and are distinct to nerves entering the rectum via the lateral pedicles. Thus, they should be classified as internal anal sphincter nerves. The identification and precise topographical location described provides a basis for nerve-sparing Rectal resection procedures and helps to prevent postoperative functional anoRectal disorders.
Hongwei Zhang - One of the best experts on this subject based on the ideXlab platform.
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Rectal mucosa stripping and pull through from Rectal Muscle sheath of blind pouch in the treatment of congenital high anal atresia in the newborn
Chinese Journal of Gastrointestinal Surgery, 2014Co-Authors: Baobiao Zhuo, Hongwei ZhangAbstract:Objective To explore the value of Rectal mucosa stripping and pull-through from Rectal Muscle sheath of blind pouch in the treatment of congenital high anal atresia in the newborn. Methods Clinical data of 232 newborns diagnosed as congenital high anal atresia undergoing operation from January 2001 to December 2010 were retrospectively analyzed. Among these patients, 168 underwent Rectal mucosa stripping and pull-through from Rectal Muscle sheath of blind pouch through the previous of sagittal approach (intrathecal pull-through group) , and 64 cases underwent the Pena procedure (Pena group). Patients were followed up for two years. Kelly score was used to estimate postoperative anoRectal function. Defecography was used to examine the morphology of anorectum. Rectal pressure was measured as well. Results Two years after operation, Kelly score revealed that 126 (75.0%) cases in the intrathecal pull-through group and 54 cases (84.4%) in the Pena group had good control defecation (P>0.05) , while constipation rate was significantly lower in intrathecal pull-through group[8.3% (14/168) vs. 21.9% (14/64) , P 0.05). AnoRectal manometry showed Rectal maximum capacity threshold value was (91.4+15.2) ml in the intrathecal pull-through group and (95.1±18.6) ml in the Pena group (P>0.05). There were no significant differences in defecography, anal bowel function and anoRectal manometry between the two groups postoperatively (all P>0.05). Conclusions Rectal mucosa stripping and pull-through from Rectal Muscle sheath of blind pouch through the former sagittal can be completed with one-stage operation in newborn for the treatment of congenital high anal atresia, the efficacy of which is similar to the classic Pena operation. This procedure can avoid other operations, ameliorate the pains of newborns, decrease the burden of family, and has lower constipation rate, therefore it is a valid surgical option. Key words: Congenital high anal atresia; Pena surgery; Stripping the Rectal mucosa and drawing from Rectal Muscle sheath of blind bag; Treatment outcomes
P H Chapuis - One of the best experts on this subject based on the ideXlab platform.
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denonvilliers fascia in men a sheet plastination and confocal microscopy study of the preRectal space and the presence of an optimal anterior plane when mobilizing the rectum for cancer
Colorectal Disease, 2018Co-Authors: P H Chapuis, Leslie Bokey, Ming ZhangAbstract:Aim The aim of this study was to investigate the detailed, in situ, morphology of Denonvilliers fascia (DVF) in cadavers using sheet plastination and confocal microscopy and to review and describe the optimal anterior plane for mobilisation of the distal rectum.. Method Six, male cadavers (age range, 46-87 years) were prepared as six sets of transverse (x2), coronal (x1) and sagittal (x3) plastinated sections which were examined under a confocal laser scanning microscope. Results In this study a consistent space between the anterior Rectal wall and the posterior surface of the prostate and seminal vesicles above the level of the perineal body was termed the preRectal space. Within that preRectal space we identified fibres which take their origin from the external urethral sphincter (EUS), together with others from the longitudinal Rectal Muscle (LRM) and the connective tissue sheaths of neurovascular bundles. Neither the EUS- nor the LRM-originated fibres were continuous with the endopelvic fascia;they are interposed laterally and cranially by multiple neurovascular bundles. Further, our results suggest that the peritoneum does not descend deep within the preRectal space. Conclusion This study reveals the undisturbed, in situ, structural detail of membrane-like structures in the preRectal space and confirms that the optimal plane for anterolateral mobilization of the rectum is posterior to the multilayered DVF. This article is protected by copyright. All rights reserved.