Neural Network Analysis of Anal Sphincter Repair

PURPOSE: Prediction of success after anterior sphincter repair for incontinence is difficult. Standard multivariate analysis techniques have only 75 to 80 percent accuracy. Artificial intelligence, including artificial neural networks, has been used in the analysis of complex clinical data and has proved to be successful in predicting the outcome of other surgical procedures. Using a neural network algorithm, we have assessed the probability of success after anterior sphincter repair. METHODS: Prospective anorectal physiology data of 72 patients undergoing anterior sphincter repair was collected between 1995 and 1999. Complete data sets of 75 percent of the series were used to train an artificial neural network; the remaining 25 percent were used for data validation. The output was continence grading, ranging from 0 to 4 (worse to continent). RESULTS: The outcome at 3, 6, and 12 months postoperatively was obtained and assessed. The best correlation between actual data value and artificial neural network value was found at 12 months (r = 0.931; P = 0.0001). Clear correlations also were found at three months (r = 0.898; P = 0.0001) and six months (r = 0.742; P = 0.002). Results of applying a net to details excluding pudendal nerve latency were poor. CONCLUSIONS: Artificial neural networks are more accurate (93 percent correlation) than standard statistics (75 percent) when applied to the prediction of outcome after anterior sphincter repair. This assessment also confirms the usefulness of pudendal latency in the prediction of anterior sphincter repair outcome. The results obtained highlight the obvious usefulness of artificial neural networks, which could now be used in a prospective evaluation for application of the technique.     

Pancreatic ductal system obstruction and acute recurrent pancreatitis

Acute recurrent pancreatitis is a clinical entity largely associated with pancreatic ductal obstruction. This latter includes congenital variants, of which pancreas divisum is the most frequent but also controversial, chronic pancreatitis, tumors of the pancreaticobiliary junction and sphincter of Oddi dysfunction. This review summarizes current knowledge about diagnostic work-up and therapy of these conditions.     

Analysis of velopharyngeal function and speech outcomes of Sommerlad palatoplasty combined with sphincter pharyngoplasty in surgical repair of older patients with cleft palate：experience from a major craniofacial surgery centre in eastern China

We aimed to evaluate velopharyngeal function and speech outcomes of Sommerlad palatoplasty combined with sphincter pharyngoplasty in surgical repair of cleft palate in patients over five years old. Fifty-eight patients were reviewed between the years 2013 and 2017, 31 of whom were treated with Sommerlad palatoplasty combined with sphincter pharyngoplasty, (mean age 15 (range 9 - 22) years), and 27 were treated with Sommerlad palatoplasty alone (mean age 18 (range 10-25) years). Velopharyngeal function was evaluated by radiographic lateral cephalometry and nasoendoscopy. Hypernasality, nasal emissions, and intelligibility were used to assess speech. The rate of velopharyngeal competence was 20/31 in the palatoplasty plus pharyngoplasty group and 7/27 in the palatoplasty alone group after surgical treatment (p = 0.003). The improvements in hypernasality (p = 0.024), air emission (p = 0.004), and speech intelligibility (p = 0.004) in the palatoplasty plus pharyngoplasty group was better than that in the palatoplasty alone group. It has been suggested that the surgical approach with the palatoplasty together with the sphincter pharyngoplasty has a higher rate of success in surgical repair of older patients with cleft palate.     

经会阴和经阴道三维肛外超声成像评估女性肛门括约肌的对比研究

通过经会阴和经阴道三维超声对比评估女性肛门括约肌,探讨不同肛外超声成像方式在评估女性肛门括约肌的应用价值。 方法 选取101例女性同时进行经会阴和经阴道三维超声检查对肛门括约肌进行成像,分别记为经会阴组和经阴道组。测量肛门内括约肌（IAS）和肛门外括约肌（EAS）在肛管横断面3、6、9、12点钟方向上的厚度,调节断层超声模式评估肛门括约肌损伤情况,记录结果并进行统计分析。 结果 IAS厚度测量值在肛管横断面12点钟方向上,经阴道组比经会阴组更薄,差异具有统计学意义（P<0.05）;EAS厚度测量值在肛管横断面6点、12点钟方向上,经阴道组比经会阴组更薄,差异具有统计学意义（P<0.05）。两组IAS及EAS测量值在肛管横断面全部4个方向上有良好的相关性且均具有统计学意义（P均<0.05）。经会阴组筛查出IAS损伤6例（5.94%）,EAS损伤16例（15.84%）,IAS合并EAS损伤13例（12.87%）;经阴道组筛查出IAS损伤8例（7.92%）,EAS损伤17例（16.83%）,IAS合并EAS损伤9例（8.91%）。两组在评估肛门括约肌损伤的一致性较好且具有统计学意义（Kappa=0.736,P<0.05） 结论 经会阴和经阴道三维超声在评估女性肛门括约肌具有较好的相关性和一致性,两者均为评估女性肛门括约肌良好的肛外超声成像方式。     

Loperamide improves anal sphincter function and continence after restorative proctocolectomy

The physiological and clinical effects of loperamide treatment versus placebo were investigated in a randomized, double-blind, crossover study in patients operated with restorative proctocolectomy. Sixteen patients operated with endoanal mucosectomy and a handsewn ileal pouch-anal anastomosis and 14 patients operated with abdominal proctocolectomy and stapling of the pouch to the top of the anal canal were studied. While loperamide treatment increased resting anal pressure in both groups of patients by approximately 20% (P<0.05), squeeze pressure was not affected. Loperamide did not affect pouch volume or contractility. Sensory thresholds and the recto/pouch-anal inhibitory reflex were not influenced by loperamide treatment. Clinical function was improved, with a reduced bowel frequency and an improved nighttime continence, with less soiling (P<0.05) as well as need to wear a protective pad.This investigation was supported by grants from the Swedish Medical Research Council (17X-03117), the University of Göteborg, Göteborgs Läkarsällskap, Assar Gabrielssons Fond, AB Skandias 100-årsfond and Ingabritt och Arne Lundbergs Forskningsfond.     

糖尿病对大鼠尿道外括约肌功能的损害

目的利用大鼠模型研究糖尿病（DM）对尿道外括约肌功能的影响。方法以雌性SD大鼠制成DM模型,6-8周后测定DM大鼠和正常对照（NC）大鼠膀胱等容收缩状态下的膀胱内压、尿道充盈压和括约肌肌电图（EUS-EMG）。结果与NC大鼠对比,DM大鼠体重明显降低,血糖明显升高,膀胱容量明显增大;膀胱排尿收缩时尿道压力病理性增高;EUS-EMG表现为排尿过程中应有的尿道外括约肌高频舒张收缩减弱或消失,引发的尿道压力曲线上的高频振动波振幅降低或消失。结论DM在损伤大鼠膀胱功能的同时,还损伤排尿时尿道外括约肌正常的高频收缩舒张功能。     

The use of sling vs sphincter in post‐prostatectomy urinary incontinence

The artificial urinary sphincter (AUS) is considered the ‘gold standard’ in post‐prostatectomy urinary incontinence. However, in recent years, male slings have gained much popularity due to the ease of surgery, good functional results and low complications rates. This review systematically shows the evidence for the different sling systems, describes the working mechanism, and compares their efficacy against that of the AUS. Furthermore subgroups of patients are defined who are not suited to undergo sling surgery.     

Diffuse esophageal spasm: not diffuse but distal esophageal spasm (DES)

Diffuse esophageal spasm is an uncommon motility disorder that is found in less than 5% of patients undergoing esophageal motility testing for dysphagia. It is defined manometrically by the presence of 20% or more simultaneous contractions in the distal esophageal body with normal peristalsis. This motility abnormality has been traditionally identified as occurring primarily in the smooth muscle portion of the distal esophagus yet, the term diffuse persists in the medical literature to identify DES. The aim of our study was to assess the diffuse or limited nature of this entity by evaluating the prevalence of simultaneous contractions in both proximal and distal esophagus in patients with DES. We reviewed esophageal motility tracings of 53 consecutive patients (32 F, 21 M) with DES and compared them with 53 age-matched patients with manometric normal studies. In the distal esophagus we found 195 simultaneous contractions (37% of swallows) with a median of 3 and range of 2–7 per patient. Of the 53 patients with DES a total of 13 simultaneous contractions (2% of swallows) occurred in the proximal esophagus with only 3 (5.6%) of the 53 patients having 2 or more simultaneous contractions in 10 swallows. None of the patients with normal manometry showed more than one simultaneous contraction in either proximal or distal esophagus. In conclusion, these findings suggest that the term diffuse esophageal spasm is a misnomer and the DES is more appropriately described as distal esophageal spasm.