The Experts below are selected from a list of 30900 Experts worldwide ranked by ideXlab platform
Torvid Kiserud - One of the best experts on this subject based on the ideXlab platform.
-
three dimensional endoanal ultrasound assessment of the anal Sphincters during rest and squeeze
Acta Obstetricia et Gynecologica Scandinavica, 2008Co-Authors: Ingrid Petrikke Olsen, Kare Augensen, Tom Wilsgaard, Torvid KiserudAbstract:Background. Current ultrasound assessment of the anal Sphincter is based on measurements during rest. However, active constriction plays a role in maintaining continence. Here we assess female anal dimensions during rest and squeeze. Methods. Thirty women were recruited for a cross-sectional endoanal ultrasound study after written consent according to an ethically approved protocol: nine 0-gravida, 10 with normal vaginal delivery, and 11 with complicated vaginal delivery (babies >4,500 g, operative vaginal delivery or perineal rupture). Endoanal three-dimensional (3D)-ultrasound volume was obtained during rest and squeeze. Length of anal canal and volume of the external and internal Sphincters were determined. Results. In the 0-gravida group, the mean anal canal at rest was 3.28 cm (SD: ±0.63) compared with 2.30 (±0.77) in those who had given birth (p =0.002). Correspondingly, the volume of the external Sphincter was 7.61 cm3 (±2.63) versus 4.80 (±2.02) (p =0.004), and for the internal Sphincter 2.63 (±1....
-
three dimensional endoanal ultrasound assessment of the anal Sphincters reproducibility
Acta Obstetricia et Gynecologica Scandinavica, 2008Co-Authors: Ingrid Petrikke Olsen, Kare Augensen, Tom Wilsgaard, Torvid KiserudAbstract:Objective. Volume measurement of the anal Sphincter can be a future method for assessing volume loss, muscle atrophy or laceration. Three-dimensional (3D) endoanal ultrasound is a technique for assessing the volume of the anal Sphincters, but the reproducibility of the method is scarcely known. Design. Cross-sectional, repeated measurements. Sample. Twenty women were recruited for the study after written consent according to an ethically approved protocol, nine 0-gravida and 11 with traumatic vaginal deliveries. Method. Endoanal 3D-ultrasound volume was obtained during rest and squeeze. The length of the anal canal and the volume of the external and internal Sphincters were determined by two observers. Observer 1 repeated the measurements three times for all 20 women, and observer 2 for the nine 0-gravida, and intra- and inter-observer variation was assessed. Results. During rest, the anal length measurement had intra-class correlation coefficients of 0.91 for observer 1 and 0.85 for observer 2. The limit...
Adil E Bharucha - One of the best experts on this subject based on the ideXlab platform.
-
relationship among anal Sphincter injury patulous anal canal and anal pressures in patients with anorectal disorders
Clinical Gastroenterology and Hepatology, 2015Co-Authors: David O Prichard, Doris M Harvey, Joel G Fletcher, Alan R Zinsmeister, Adil E BharuchaAbstract:Background & Aims The anal Sphincters and puborectalis are imaged routinely with an endoanal magnetic resonance imaging (MRI) coil, which does not assess co-aptation of the anal canal at rest. By using a MRI torso coil, we identified a patulous anal canal in some patients with anorectal disorders. We aimed to evaluate the relationship between anal Sphincter and puborectalis injury, a patulous anal canal, and anal pressures. Methods We performed a retrospective analysis of data from 119 patients who underwent MRI and manometry analysis of anal anatomy and pressures, respectively, from February 2011 through March 2013 at the Mayo Clinic. Anal pressures were determined by high-resolution manometry, anal Sphincter and puborectalis injury was determined by endoanal MRI, and anal canal integrity was determined by torso MRI. Associations between manometric and anatomic parameters were evaluated with univariate and multivariate analyses. Results Fecal incontinence (55 patients; 46%) and constipation (36 patients; 30%) were the main indications for testing; 49 patients (41%) had a patulous anal canal, which was associated with injury to more than 1 muscle (all P ≤ .001), and internal Sphincter ( P P = .09) or external Sphincter ( P = .06), injury. Internal ( P P = .02) and a patulous canal ( P P Conclusions Patients with anorectal disorders commonly have a patulous anal canal, which is associated with more severe anal injury and independently predicted anal resting pressure and squeeze pressure increment. It therefore is important to identify a patulous anal canal because it appears to be a marker of not only anal Sphincter injury but disturbances beyond Sphincter injury, such as damage to the anal cushions or anal denervation.
-
relationship between symptoms and disordered continence mechanisms in women with idiopathic faecal incontinence
Gut, 2005Co-Authors: Adil E Bharucha, Jasper R Daube, Joel G Fletcher, C M Harper, David M Hough, Craig W Stevens, Barbara M Seide, Stephen J Riederer, Alan R ZinsmeisterAbstract:Background and aims: Anal Sphincter weakness and rectal sensory disturbances contribute to faecal incontinence (FI). Our aims were to investigate the relationship between symptoms, risk factors, and disordered anorectal and pelvic floor functions in FI. Methods: In 52 women with “idiopathic” FI and 21 age matched asymptomatic women, we assessed symptoms by standardised questionnaire, anal pressures by manometry, anal Sphincter appearance by endoanal ultrasound and magnetic resonance imaging (MRI), pelvic floor motion by dynamic MRI, and rectal compliance and sensation by a barostat. Results: The prevalence of anal Sphincter injury (by imaging), reduced anal resting pressure (35% of FI), and reduced squeeze pressures (73% of FI) was higher in FI compared with controls. Puborectalis atrophy (by MRI) was associated (p Conclusions: Idiopathic FI in women is a multifactorial disorder resulting from one or more of the following: a disordered pelvic barrier (anal Sphincters and puborectalis), or rectal capacity or sensation.
-
magnetic resonance imaging of anatomic and dynamic defects of the pelvic floor in defecatory disorders
The American Journal of Gastroenterology, 2003Co-Authors: Joel G Fletcher, C M Harper, David M Hough, Stephen J Riederer, Reed F Busse, Thomas M Gluecker, Adil E BharuchaAbstract:Abstract Objective Endoanal ultrasound identifies anal Sphincter anatomy, and evacuation proctography visualizes pelvic floor motion during simulated defecation. These complementary techniques can evaluate obstructed defecation and fecal incontinence. Our aim was to develop a single, nonionizing, minimally invasive modality to image global pelvic floor anatomy and motion. Methods We studied six patients with fecal incontinence and seven patients with obstructed defecation. The anal Sphincters were imaged with an endoanal magnetic resonance imaging (MRI) coil and endoanal ultrasound (five patients). MR fluoroscopy acquired images every 1.4–2 s, using a modified real-time, T2-weighted, single-shot, fast-spin echo sequence, recording motion as patients squeezed pelvic floor muscles and expelled ultrasound gel; no contrast was added to other pelvic organs. Six patients also had scintigraphic defecography. Results Endoanal ultrasound and MRI were comparable for imaging defects of the internal and external Sphincters. Only MRI revealed puborectalis and/or external Sphincter atrophy; four of these patients had fecal incontinence. MR fluoroscopy recorded pelvic floor contraction during squeeze and recorded relaxation during simulated defecation. Corresponding comparisons for angle change and perineal descent during defecation were not significant; only MRI, but not scintigraphy, identified excessive perineal descent in two patients. Conclusions Pelvic MRI is a promising single, comprehensive, nonradioactive modality to measure structural and functional pelvic floor disturbances in defecatory disorders. This method may provide insights into mechanisms of normal and disordered pelvic floor function in health and disease.
Jonathan N. Lund - One of the best experts on this subject based on the ideXlab platform.
-
nitric oxide deficiency in the internal anal Sphincter of patients with chronic anal fissure
International Journal of Colorectal Disease, 2006Co-Authors: Jonathan N. LundAbstract:Anal fissure is a common condition affecting young to middle-aged adults. It causes severe pain on defecation and rectal bleeding. The aetiology remains uncertain. Spasm of the internal anal Sphincter is a constant feature. Nitric oxide (NO) is the major inhibitory neurotransmitter of the internal anal Sphincter (IAS). In other spasmodic conditions of the GI tract a lack of normal nitric oxide synthase (NOS) activity has been reported. The aim of this preliminary study was to compare the presence of NOS in the internal Sphincters of patients with and without chronic anal fissure. Internal anal Sphincter biopsies were taken under general anaesthesia from patients having lateral internal Sphincterotomy for chronic anal fissure and from Sphincter of patients having abdominoperineal resections as controls. Sections of IAS were stained to show the presence of NADPH diaphorase (and hence presence of NOS). Internal anal Sphincter was taken from 6 patients with chronic anal fissure and 6 controls. IAS taken from patients with chronic anal fissure showed little NOS presence compared with controls. It may be that there is an abnormal failure of relaxation of internal Sphincter in those patients who develop chronic anal fissure caused by an intrinsic lack of neural NOS in the internal anal Sphincter.
Janusz Sluszniak - One of the best experts on this subject based on the ideXlab platform.
-
Sphincter preservation following preoperative radiotherapy for rectal cancer report of a randomised trial comparing short term radiotherapy vs conventionally fractionated radiochemotherapy
Radiotherapy and Oncology, 2004Co-Authors: Krzysztof Bujko, M Bebenek, M Pudelko, M Kryj, J Oledzki, J Szmeja, Wojciech Michalski, Anna Nasierowskaguttmejer, Marek P Nowacki, Janusz SluszniakAbstract:Background and purpose: The aim was to verify whether preoperative conventionally fractionated chemoradiation offers an advantage in Sphincter preservation in comparison with preoperative short-term irradiation. Patients and methods: Patients with resectable T3‐4 rectal carcinoma without Sphincters’ infiltration and with a lesion accessible to digital rectal examination were randomised into: preoperative 5 £ 5 Gy short-term irradiation with subsequent total mesorectal excision (TME) performed within 7 days or chemoradiation to a total dose of 50.4 Gy (1.8 Gy per fraction) concomitantly with two courses of bolus 5fluorouracil and leucovorin followed by TME after 4‐6 weeks. Surgeons were obliged to base the type of operation on the tumour status at the time of surgery. Results: Between 1999 and 2002, 316 patients from 19 institutions were enrolled. The Sphincter preservation rate was 61% in the 5 £ 5G y arm and 58% in the radiochemotherapy arm, P ¼ 0:57: The tumour was on average 1.9 cm smaller ðP , 0:001Þ among patients treated with chemoradiation compared with short-term schedule. For patients who underwent Sphincter-preserving procedure, the surgeons generally followed the rule of tailoring the resection according to tumour downsizing; the median distal bowel margin was identical (2 cm) for both randomised groups. However, in the chemoradiation group, five patients underwent abdominoperineal resection despite clinical complete response. Conclusions: Despite significant downsizing, chemoradiation did not result in increased Sphincter preservation rate in comparison with short-term preoperative radiotherapy. The surgeons’ decisions were subjective and based on pre-treatment tumour volume at least in clinical complete responders. q 2004 Elsevier Ireland Ltd. All rights reserved.
Joel G Fletcher - One of the best experts on this subject based on the ideXlab platform.
-
relationship among anal Sphincter injury patulous anal canal and anal pressures in patients with anorectal disorders
Clinical Gastroenterology and Hepatology, 2015Co-Authors: David O Prichard, Doris M Harvey, Joel G Fletcher, Alan R Zinsmeister, Adil E BharuchaAbstract:Background & Aims The anal Sphincters and puborectalis are imaged routinely with an endoanal magnetic resonance imaging (MRI) coil, which does not assess co-aptation of the anal canal at rest. By using a MRI torso coil, we identified a patulous anal canal in some patients with anorectal disorders. We aimed to evaluate the relationship between anal Sphincter and puborectalis injury, a patulous anal canal, and anal pressures. Methods We performed a retrospective analysis of data from 119 patients who underwent MRI and manometry analysis of anal anatomy and pressures, respectively, from February 2011 through March 2013 at the Mayo Clinic. Anal pressures were determined by high-resolution manometry, anal Sphincter and puborectalis injury was determined by endoanal MRI, and anal canal integrity was determined by torso MRI. Associations between manometric and anatomic parameters were evaluated with univariate and multivariate analyses. Results Fecal incontinence (55 patients; 46%) and constipation (36 patients; 30%) were the main indications for testing; 49 patients (41%) had a patulous anal canal, which was associated with injury to more than 1 muscle (all P ≤ .001), and internal Sphincter ( P P = .09) or external Sphincter ( P = .06), injury. Internal ( P P = .02) and a patulous canal ( P P Conclusions Patients with anorectal disorders commonly have a patulous anal canal, which is associated with more severe anal injury and independently predicted anal resting pressure and squeeze pressure increment. It therefore is important to identify a patulous anal canal because it appears to be a marker of not only anal Sphincter injury but disturbances beyond Sphincter injury, such as damage to the anal cushions or anal denervation.
-
relationship between symptoms and disordered continence mechanisms in women with idiopathic faecal incontinence
Gut, 2005Co-Authors: Adil E Bharucha, Jasper R Daube, Joel G Fletcher, C M Harper, David M Hough, Craig W Stevens, Barbara M Seide, Stephen J Riederer, Alan R ZinsmeisterAbstract:Background and aims: Anal Sphincter weakness and rectal sensory disturbances contribute to faecal incontinence (FI). Our aims were to investigate the relationship between symptoms, risk factors, and disordered anorectal and pelvic floor functions in FI. Methods: In 52 women with “idiopathic” FI and 21 age matched asymptomatic women, we assessed symptoms by standardised questionnaire, anal pressures by manometry, anal Sphincter appearance by endoanal ultrasound and magnetic resonance imaging (MRI), pelvic floor motion by dynamic MRI, and rectal compliance and sensation by a barostat. Results: The prevalence of anal Sphincter injury (by imaging), reduced anal resting pressure (35% of FI), and reduced squeeze pressures (73% of FI) was higher in FI compared with controls. Puborectalis atrophy (by MRI) was associated (p Conclusions: Idiopathic FI in women is a multifactorial disorder resulting from one or more of the following: a disordered pelvic barrier (anal Sphincters and puborectalis), or rectal capacity or sensation.
-
magnetic resonance imaging of anatomic and dynamic defects of the pelvic floor in defecatory disorders
The American Journal of Gastroenterology, 2003Co-Authors: Joel G Fletcher, C M Harper, David M Hough, Stephen J Riederer, Reed F Busse, Thomas M Gluecker, Adil E BharuchaAbstract:Abstract Objective Endoanal ultrasound identifies anal Sphincter anatomy, and evacuation proctography visualizes pelvic floor motion during simulated defecation. These complementary techniques can evaluate obstructed defecation and fecal incontinence. Our aim was to develop a single, nonionizing, minimally invasive modality to image global pelvic floor anatomy and motion. Methods We studied six patients with fecal incontinence and seven patients with obstructed defecation. The anal Sphincters were imaged with an endoanal magnetic resonance imaging (MRI) coil and endoanal ultrasound (five patients). MR fluoroscopy acquired images every 1.4–2 s, using a modified real-time, T2-weighted, single-shot, fast-spin echo sequence, recording motion as patients squeezed pelvic floor muscles and expelled ultrasound gel; no contrast was added to other pelvic organs. Six patients also had scintigraphic defecography. Results Endoanal ultrasound and MRI were comparable for imaging defects of the internal and external Sphincters. Only MRI revealed puborectalis and/or external Sphincter atrophy; four of these patients had fecal incontinence. MR fluoroscopy recorded pelvic floor contraction during squeeze and recorded relaxation during simulated defecation. Corresponding comparisons for angle change and perineal descent during defecation were not significant; only MRI, but not scintigraphy, identified excessive perineal descent in two patients. Conclusions Pelvic MRI is a promising single, comprehensive, nonradioactive modality to measure structural and functional pelvic floor disturbances in defecatory disorders. This method may provide insights into mechanisms of normal and disordered pelvic floor function in health and disease.
