Anal sphincters defects--verification of the anal ultrasound diagnosis in 'bimanual' examination.

The aim of this is to evaluate the diagnostic value of anal endosonography performed during pressing anterior wall of anal canal with a finger introduced into the lumen of vagina for the identification of anal sphincter defects. Anal ultrasound (AUS) with a finger introduced into the lumen of vagina was performed in a group of 55 women with anal sphincter defects recognized initially in standard AUS. This technique prevented false positive diagnoses of sphincter defects in 12 out of a group of 55 women (21.8%).     

Preclinical development of SMA artificial anal sphincters.

This article presents some progress in the development for preclinical trials of an artificial anal sphincter using shape memory alloys. The novel device has been proposed and developed by the author's group at Tohoku University. It has two dominant features different from other systems, which are either clinically available or still under development. One is that a solid driving element, a combination of shape memory alloy (SMA) ribbons and silicone elastomer sheets with a layered structure, is adopted for the opening and closing functions of the artificial sphincter. The other is a sandwich mechanism for the closing of bowel to reduce the risk of buckling induced ischemia which has been reported in hydraulically driven artificial sphincters with a radial squeezing mechanism. The device has fewer parts inside the body and therefore be implanted more easily. A new design eliminating the risk of heat burns enables long-term implantation and brings the device closer to practical use. Functionality and safety of the device have been proved in three-month animal experiments.     

Preclinical development of SMA artificial anal sphincters

This article presents some progress in the development for preclinical trials of an artificial anal sphincter using shape memory alloys. The novel device has been proposed and developed by the author's group at Tohoku University. It has two dominant features different from other systems, which are either clinically available or still under development. One is that a solid driving element, a combination of shape memory alloy (SMA) ribbons and silicone elastomer sheets with a layered structure, is adopted for the opening and closing functions of the artificial sphincter. The other is a sandwich mechanism for the closing of bowel to reduce the risk of buckling induced ischemia which has been reported in hydraulically driven artificial sphincters with a radial squeezing mechanism. The device has fewer parts inside the body and therefore be implanted more easily. A new design eliminating the risk of heat burns enables long‐term implantation and brings the device closer to practical use. Functionality and safety of the device have been proved in three‐month animal experiments.     

肝外伤的超声造影分级及与CT、手术结果对照研究

目的探讨肝外伤的超声造影分级。方法对45例肝外伤患者行超声造影检查,其中21例行手术探查,32例行CT检查,超声造影分级结果分别与手术、CT进行对照。结果与手术结果对照,超声造影分级符合率为95.2%（20/21）,与CT对照符合率为87.5%（28/32）。结论肝外伤超声分级与CT、手术探查范围对应性好,可以较准确地反映肝损伤程度并指导治疗方案的选择。     

Correlations of obstetric anal sphincter injury (OASIS) grade,specific symptoms of anal incontinence,and measurements by endoanal and transperineal ultrasound

PurposeThe aim of the study was to investigate the association between the initial grade of obstetrical anal sphincter injury (OASIS), and Wexner score parameters, with ultrasonographic findings by endoanal ultrasound (EAUS, golden standard) and transperineal ultrasound (TPUS) 6 months post-partum.MethodsFifty-nine women after primary repair of OASIS were included at Helsingborg Hospital, Sweden, 2016–2017. Six months post-partum the women filled in a questionnaire regarding symptoms of anal incontinence by the Wexner score and were scanned with EAUS and TPUS (resting state and contracting state) for classification of the residual defect by a modified Starck score.ResultsCorrelations were found between the OASIS grade and residual defects; length (r_s = 0.41, P = 0.003), depth (r_s = 0.38, P = 0.006) and angle (r_s = 0.40, P = 0.004) of the external anal sphincter (EAS) measured with TPUS in resting state. Using EAUS, correlation between OASIS grade and EAS depth (r_s = 0.35, P = 0.007) and angle (r_s = 0.37, P = 0.004) were similar, but there was no correlation with length (r_s = 0.20, P = 0.14). Between incontinence to gas and the angle of the residual defect in the IAS using TPUS in resting state, correlation was moderate (r_s = 0.42, P = 0.003). Regarding incontinence to liquid stool, measurements by TPUS in resting state of EAS residual defect depth (r_s = 0.46, P < 0.001) and angle (r_s = 0.44, P = 0.001) also correlated moderately. Both corresponding correlations using EAUS were weaker.ConclusionDefects measured with EAUS and TPUS six months post-partum correlated to initial OASIS grade and symptoms of anal incontinence. Specific symptoms correlated with specific anatomical defects, and TPUS was not an inferior method to EAUS.     

对比增强超声对猪肝轻度损伤的初步研究

目的应用对比增强超声来探索肝割裂伤口的位置、范围及图像特征。方法两只巴马小型猪,用手术刀经皮经肝作深20mm,宽10mm的切口。静脉注入超声造影剂(SonoVue)来显示伤口的位置、范围和图像特点。结果经皮经肝形成的割裂口,于裂口的位置用二维声像图(基波和谐波模式)上无法显示伤口的位置和范围。注入造影剂后,肝实质高回声消退后,呈线状强回声的割裂口显示十分清晰,此处的强回声一直持续时间较长。另外,紧贴裂口处的肝包膜下,可见线状强回声。肝实质内造影剂完全消除后,将造影模式转换成灰阶模式,仍见裂口处的强回声条索,并见其后方的弱声影。再反转成彩色血流成像模式,于裂口处彩色血流明显增强。结论由于造影剂的原因,割裂口在对比增强超声图上显示为强回声。因此,对比增强超声能反映肝脏损伤的程度和损伤区的部位、形态和范围。     

Simple ultrasound evaluation of the anal sphincter in female patients using a transvaginal transducer.

OBJECTIVE: Fecal incontinence affects 0.2% of women aged 15-64 years and about 1.3% of women over 64 years. Most cases are related to instrumental deliveries affecting the anal sphincter complex. We propose a simple technique using the generally available transvaginal transducer to evaluate the anal sphincter complex. METHODS: Ninety-two patients underwent ultrasound examination. Group I consisted of 53 nulliparous patients. In Group II there were six patients with normal spontaneous vaginal deliveries without episiotomies. In Group III there were 14 patients with vaginal deliveries and one to three episiotomies but no lacerations. In Group IV there were nine postpartum patients with recently repaired (48 h to 3 weeks) third- and fourth-degree lacerations. All women in Groups I-IV were asymptomatic. Group V consisted of 10 patients symptomatic for fecal incontinence. We used a vaginal probe (5-9-MHz) with the footprint placed in the fourchette pointing towards the anus in a transverse and then in a median (sagittal) plane. If seen, the combined internal and external anal sphincter thickness at the 12 o'clock location was measured. We visualized normal star-shaped mucosal folds on the transverse section and described the sonographic anatomy in both planes. RESULTS: The mean sphincter thickness measured at 12 o'clock in Group I was 2.3 (range, 1.0-4.7) mm, in Group II it was 2.9 (range, 2.4-3.4) mm, and in Group III it was 2.3 (range, 1.0-3.7) mm. The differences between these three groups were not significant. Patients from Group IV showed thinning or discontinuous sphincter anatomy at the 12 o'clock position. All symptomatic patients from Group V showed abnormal sphincter anatomy, and the normal star-like appearance of the anal mucosa on the transverse section was deformed, radiating from the point of the sphincter damage. Four of the 10 patients in this group underwent surgical repair. In these patients the sonographic findings were confirmed. CONCLUSIONS: The images obtained using this imaging modality show the sphincter muscle anatomy as well as the possible pathology. Due to its simplicity the technique can be applied in any place where a vaginal transducer is available.     

Use of Penrose drains to treat certain anal fistulas: a primary operative seton

In 20 selected patients with a complex anal fistula, a seton consisting of a 1/4- to 5/8-inch Penrose drain was passed through the anal fistulous tract and then sutured to maintain tension. This elastic seton not only provides drainage of the fistulous abscess but also, by pressure necrosis of the enclosed sphincter muscle, "cuts through" the muscle and accomplishes primary fistulotomy or, when placed without tension, serves as a marker for later fistulotomy. All 20 patients had a good result. One patient complained of occasional leakage of mucus. Two others were periodically incontinent of loose stools but were socially continent and employable. Use of a seton should be considered in patients with complex fistulas that involve the puborectal muscle.     

The accuracy of ultrasound evaluation in foot and ankle trauma

ObjectivesFoot and ankle injuries that result in sprains or fractures are commonly encountered at the emergency department. The purpose of the present study is to find out the accuracy of ultrasound (US) scanning in injuries in the aforementioned areas.MethodsOttawa Ankle Rules–positive patients older than 16 years who presented to the emergency department with foot or ankle injuries were eligible. For all patients, US evaluation of the whole foot and ankle was performed by an emergency physician before radiographic imaging. All radiographic images were evaluated by an orthopedic specialist and compared with the interpretations of the US.ResultsOne hundred thirty-one patients were included in the study. Radiographic evaluation enabled the determination of fractures in 20 patients, and all of these were identified with US imaging. Moreover, US evaluation radiographically detected a silent ankle fracture in 1 patient. The sensitivity of US scanning in detecting fractures was 100% (95% confidence interval [CI], 83.8-100), the specificity was 99.1% (95% CI, 95-99.8), the positive predictive value was 95.2% (95% CI, 89.6-98), and the negative predictive value was 100% (95% CI, 96.4-100), respectively. The most common fractures were detected at the lateral malleolus and at the basis of the fifth metatarsal.ConclusionsUltrasound imaging permits the evaluation of foot and ankle fractures. Because it is a highly sensitive technique, US can be performed in the emergency department with confidence.     

Diagnosis of anal sphincter defects by three-dimensional transperineal ultrasound in women with anal incontinence

Purpose

To assess the utility of transperineal three-dimensional (3D) ultrasound for diagnosing anal sphincter defects and evaluating the function of the anal canal in women with anal incontinence.

Methods

The study subjects were 13 women with anal incontinence. Symptoms of fecal incontinence were assessed by Wexner score. The anal canal of each woman was examined ultrasonically with both a convex transperineal 3D scanner and a radial transanal scanner to compare the accuracy of the two approaches for diagnosis of anal sphincter defects. The anorectal angle and the length of the anal canal were also measured by utilizing the functionality of the transperineal 3D ultrasound.

Results

The mean age was 58.9?±?14.9?years (±SD), and the mean Wexner score was 8.4?±?5.6. In terms of ultrasound diagnosis of anal sphincter defects, the two methods showed consistent results in each woman. The length of the portion where both the internal and external anal sphincters were intact was significantly correlated with the Wexner score, whereas the total length of the anal canal was not.

Conclusions

Less invasive transperineal 3D ultrasound provides accurate evaluation of the internal and external anal sphincters in women with anal incontinence, and the method is potentially useful for detection of anal sphincter abnormalities.     

Transperineal three-dimensional ultrasound in evaluating anal sphincter muscles.

OBJECTIVES: To evaluate whether transperineal three-dimensional (3D) ultrasound can be used to depict normal anal sphincter anatomy and to measure the thickness of muscle layers and the anteroposterior length of the levator hiatus. METHODS: The study included 22 normal nulliparous female volunteers. Transperineal 3D sonographic evaluation of the anal canal included assessment of sphincter shape, echogenicity, marginal definition and muscle thickness. Measurements of the thickness of the internal anal sphincter (IAS) and puborectalis muscle (PRM) were determined with the women at rest and during squeezing by two observers, and interobserver reliability was determined. The anteroposterior length of the levator hiatus at rest and during squeezing was measured. RESULTS: The proximal end of the anal canal (towards the rectum) consisted of overlapping IAS and PRM, and the distal end (towards the anus) consisted of overlapping IAS and external anal sphincter (EAS). At the PRM level, the mean +/- SD IAS thickness was 2.3 +/- 0.5 mm at rest and 2.5 +/- 0.4 mm during squeezing, and at the mid-EAS level it was 2.9 +/- 0.5 mm at rest and 2.8 +/- 0.5 mm during squeezing. The PRM thickness was 6.5 +/- 1.0 mm at rest and 6.4 +/- 1.2 mm during squeezing. The difference in muscle thickness of the sphincter layers with the woman at rest and during squeezing was not significant. The anteroposterior length of the levator hiatus was 51.7 +/- 5.0 mm at rest and 47.4 +/- 4.1 mm during squeezing (P < 0.01). CONCLUSION: Transperineal 3D ultrasound may be useful in evaluating the anatomy of the anal canal.     

Peritoneal metastases: evaluation with contrast-enhanced ultrasound

Objectives  

The aim of this study is to evaluate the contrast-enhanced ultrasound (CEUS) features of peritoneal metastases.