Fecoflowmetric Analysis of Anorectal Motor Function in Postoperative Anal-Preserving Surgery Patients With Low Rectal Cancer Comparison With the Wexner Score and Anorectal Manometry

The aim of this study was to elucidate whether fecoflowmetry (FFM) could evaluate more detailed evacuative function than anorectal manometry by comparing between FFM or anorectal manometric findings and the clinical questionnaires and the types of surgical procedure in the patients who received anal-preserving surgery. Fifty-three patients who underwent anal-preserving surgery for low rectal cancer were enrolled. The relationships between FFM or the manometric findings and the clinical questionnaires and the types of procedure of anal-preserving surgery were evaluated. There were significant differences between FFM markers and the clinical questionnaire and the types of the surgical procedure, whereas no significant relationship was observed between the manometric findings and the clinical questionnaire and the types of the surgical procedure. FFM might be feasible and useful for the objective assessment of evacuative function and may be superior to manometry for patients undergoing anal-preserving surgery.Key words: Anorectal manometry, Anal-preserving surgery, Fecoflowmetry, Incontinence, Rectal cancerSphincter preservation has been one of the key issues of rectal cancer surgery. Low anterior resection (LAR)¹ and internal and external sphincter resection (ISR and ESR) are anal-preserving surgeries.^2,3 The aim of these procedures is to restore the normal process of defecation, along with its function, and to improve the quality of life of patients by avoiding permanent colostomy. However, anal-preserving surgery is often associated with evacuative dysfunction and various degrees of incontinence.^4–7Most studies that have assessed the evacuation function have used clinical questionnaires, which are subjective and may vary according to the patient perception.⁷ There are many factors that can affect the evacuative function, such as the stool consistency, rectal capacity, anal sphincters, pelvic floor muscles, and intra-abdominal pressure. Although manometry with or without the clinical score has also commonly been used, fecoflowmetry (FFM) has been reported to be more accurate and useful for assessing the postoperative anorectal motor function.^8–13 FFM was first introduced by Shafik and is a dynamic method for examining the anorectal motor activity that simulates the natural act of defecation.¹⁴ Some studies have shown its usefulness in postoperative patients with anorectal disease,^8–11 but only a few studies have been performed to examine the evacuative function following anal-preserving surgery.^12,13 The aim of this study was to evaluate the evacuative function in the postoperative period following anal-preserving surgery in patients with low rectal cancer using FFM, and to compare the results with the Wexner score and anorectal manometry.¹⁵     

Clinical evaluation of the temporomandibular joint following orthognathic surgery--multiple logistic regression analysis

This study compares temporomandibular joint dysfunction (TMD) symptoms before and after bilateral sagittal split ramus osteotomy, and identifies predictive factors for the postoperative TMD symptoms by assessing the adjusted odds ratio using multiple logistic regression analysis. A consecutive series of 37 cases treated only with bilateral sagittal split ramus osteotomy were evaluated. New postoperative TMD symptoms appeared in 9 cases, preoperative TMD symptoms disappeared in 6 cases, and TMD symptoms were unchanged in 5 cases. The median period until the interincisal opening range attained 40 mm was 5 months (range, from 2 to 15 months). Age was a positive factor in patients with postoperative TMD symptoms, with an odds ratio of 1.43 (95 percent confidence interval, from 1.05 to 1.93). In addition, the maximum value of the bilateral setback distance of more than 9 mm was a positive factor of 6.95 (95 percent confidence interval, from 1.06 to 45.42). We concluded that surgical correction in skeletal malocclusion may affect temporomandibular joint dysfunction symptoms.     

Arthroscopic removal of nodules of synovial chondromatosis of the temporomandibular joint

In this report we describe a new method for removing nodules of TMJ synovial chondromatosis using arthroscopic surgery instead of open surgery. We used two steps during arthroscopy. In the first, we lavaged the cavity with sterile saline. In the next step, the second cannula was replaced with ethmoid forceps. Under arthroscopic guidance through the first cannula, all loose bodies were removed using the forceps. Since the loose bodies are not fragmented during this procedure, the time needed for removal is shortened. Based on this experience, we suggest the use of ethmoid forceps should be considered as an alternative procedure when nodules are unable to pass through the cannula by lavage with sterile saline.     

Application of interdental distraction osteogenesis to unilateral cleft lip and palate patients

Distraction osteogenesis is widely used for the treatment of craniofacial deformities. In patients with cleft lip and palate, distraction osteogenesis can be employed to repair the alveolar cleft. In this report, we describe the management of three cases of unilateral cleft lip and palate by interdental distraction osteogenesis. Interdental distraction osteogenesis of the maxillary bone was performed to reduce the width of the alveolar cleft in these patients in conjunction with orthodontic treatment. Tooth-tooth type distraction devices were fabricated and delivered at the same time as osteotomy. Distraction was continued until the midline of the dentition coincided with the facial midline, and until the width of the alveolar cleft was reduced to the width of lateral incisor or had closed. One month after distraction was complete, orthodontic treatment with an edgewise appliance was initiated, and neighboring teeth were moved into the newly created bone. A favorable treatment outcome was achieved in all three cases.     

Plaque accumulation on Teflon-coated metal

This study demonstrated that plaque accumulation was reduced and plaque removal facilitated by the TFE coating. These findings suggest that the TFE coating has a practical application for pontics and the proximal and cervical surfaces of crowns. These inaccessible surfaces are not easily cleaned by brushing.     

The effects of mandibular retractive force on the growing rat mandible

The purpose of this study was to investigate the three-dimensional effects of a mandibular retractive force on the growing rat mandible and mandibular growth after the force was removed. Eighty 4-week-old male Wistar rats served as experimental animals and 100 4-week-old male Wistar rats served as the control group. The experimental rats were divided into four groups. Thirty grams of retractive force was applied to each mandible for 4 weeks. Each group was then killed after 4-, 8-, 10-, 12-, or 16-week periods. At the time of death, tibia, skull, and mandible were removed, measurements of those bone specimens were taken, and histologic examinations were performed. Compared with the control group, the experimental group demonstrated no significant differences in body weight nor in the length of measurements of the tibia, skull, and proximal end of the tibia. The mandibles of the experimental group demonstrated shorter anteroposterior length, higher coronoid processes, and a thicker corpus in the retromolar region and condylar neck. The condylar cartilages of the experimental group showed moderate adaptation in the histologic sections. However, mandibles of the experimental animals did not show any catch-up growth behavior after removal of the force. It was concluded that the mandibular retractive force could produce overall growth retardation and transformation of growing rat mandibles, but the force had no effect on the growth behavior after the appliance was removed.     

Teeth contacting habit as a contributing factor to chronic pain in patients with temporomandibular disorders

Many different factors are known to cause and perpetuate the symptoms of temporomandibular disorders (TMD). However, the roles of parafunctional factors have not been clearly elucidated. We found one of these habits in the clinical setting. This parafunctional habit involves daily light touching of the upper and lower teeth, when the mouth is closed. We named this habit Teeth Contacting Habit (TCH). [OBJECTIVES] To investigate the following hypotheses: 1) TCH is associated with perpetuation of chronic pain of TMD patients; 2) TCH is associated with other behavioral factors. [METHODS] Two hundred and twenty-nine TMD outpatients with chronic pain were analyzed with multivariate logistic regression models. [RESULTS] TCH was found in 52.4% of patients. Patients with TCH and pain lasting for more than four months were less likely to experience improvements in pain at the first visit (OR = 1.944, p = 0.043). Other factors associated with TCH were as follows: unilateral chewing (OR = 2.802) and involvement in a precision job (OR = 2.195). [CONCLUSION] TCH can prolong TMD pain and is associated with other behavioral factors.     

Safety and effectiveness of ferric citrate hydrate in serum phosphorus management of patients with chronic kidney disease: a long-term,real-world,observational, post-marketing surveillance study

Clinical and Experimental Nephrology - Ferric citrate hydrate (FC) is an oral iron-based phosphate binder that is used to treat hyperphosphatemia in patients with chronic kidney disease (CKD). This...     

Process design for efficient and controlled drug incorporation into polymeric micelle carrier systems.

For the efficient and well-controlled incorporation of the anti cancer drug adriamycin (ADR) into the inner core of a thermo-responsive polymeric micelle carrier system, we have analyzed and optimized the incorporation procedure in this paper. A dialysis method was used for preparing the micelle solution and ADR incorporation simultaneously. Quantities of ADR and triethylamine (TEA) were varied and the effects of their quantities were analyzed. Solvent composition at the starting time of dialysis was also varied. The initial dialysis condition, solvent with 40% water, brought about the largest amount and yield of ADR incorporation. With the initial 40% water content, it was considered that the block polymers formed a micelle-like association with a swollen hydrophobic core. This swollen core may be suitable for a large amount of ADR incorporation, since this core, swollen by an organic solvent-water mixture, is expected to show a liquid-state character to allow ADR molecules entry into the cores. By starting the dialysis procedure at this 40% water content, this swollen core suitable for the ADR incorporation is considered to be maintained for a much longer period than a case starting with a polymer-ADR solution in a solvent with a water content of less than 40%, and, therefore, ADR is expected to be incorporated efficiently. Preparation temperature of 20-25 degrees C was found to provide the most effective ADR incorporation in this thermo-responsive polymeric micelle system. These results indicate that the efficient incorporation of ADR can be achieved in consideration of the dynamic micelle formation and drug incorporation processes.