Sacral Nerve Stimulation Can Be Successful in Patients With Ultrasound Evidence of External Anal Sphincter Disruption

PURPOSE This study was designed to determine whether patients with fecal incontinence and endoanal ultrasound evidence of anal sphincter disruption may be successfully treated by sacral nerve stimulation.METHODS Five consecutive females with incontinence to solids and endoanal ultrasound evidence of anal sphincter disruption were treated by a two-week trial of sacral nerve stimulation. If successful, patients then proceeded to permanent sacral nerve stimulation implantation.RESULTS Five patients, aged 34 to 56 years, were treated by temporary sacral nerve stimulation. Four had symptoms starting after childbirth. Two had previously had an anterior sphincter repair. After a two-week trial, three females reported full continence and an improvement in all aspects of their Rockwood fecal incontinence quality of life scores. These three females underwent permanent sacral nerve stimulation implantation. The remaining two patients reported no improvement and underwent dynamic graciloplasty or end colostomy respectively.CONCLUSIONS Sacral nerve stimulation may successfully restore bowel continence in some patients with endoanal ultrasound evidence of a defect in their external anal sphincter.     

Another HLA-B/C Recombination

Another case of an HLA-B/HLA-C recombination is presented which shows that the locus HLA-C is situated between HLA-A and HLA-B.     

On the possible involvement of ascorbic acid and copper proteins in leukemia: I. Electron spin resonance (ESR) investigations on native blood,erythrocytes, and leukocytes

Summary Addition of ascorbic acid to native blood or to erythrocytes and leukocytes of healthy persons results in an ESR spectrum which is identical to the one obtained with blood or its fractions of leukemic patients. After an initial increase the spin concentration decreases at higher (> 100 mM) concentrations of ascorbic acid. These findings confirm observations made thus far that cancerous tissue, finally, exhibits a lower spin concentration and a higher concentration of antioxidants than its corresponding healthy tissue. Application of oxidizing substances, such as KMnO₄ or CuCl₂, to erythrocytes either before or after administration of vitamin C compensates the effect of the latter substance depending, of course, on the concentration used.The effect produced by ascorbic acid on blood and its fractions seems to be unique since neither vitamin E or vitamin A or catechol and its amines noradrenaline, adrenaline, dopamine, and its precursor amino acid dopa, cytochrome c, FMN, NADH, Na₂S₂O₄, ethylenglycol, glyceraldehyde, or tyrosine produce this effect. Ascorbic acid seems to play, thus, an important role in the balance of health and disease, as has been pointed out by Szent-Györgyi [16]. Its possible receptor(s) and its implication in the formation of cancer, or at least leukemia, will be discussed in detail elsewhere [9].This work was supported in part by Euratom grant EUR No. 213-76-7 BIO D.     

Perianal Crohn's disease—Is it all bad news?

PURPOSE: The outcome of treatment of perianal Crohn's disease was assessed in 127 patients. METHODS: A retrospective review of the case notes of 415 patients who were seen in the North East of Scotland between 1985 and 1989 was undertaken. RESULTS: A total of 127 of 415 patients with Crohn's disease had perianal involvement. In 56 patients, perianal disease was the presenting complaint. Ninety-nine of the 127 patients had colonic involvement. Thirtytwo were treated with metronidazole, and 41 were treated with azathioprine, with at least temporary improvement in 91 and 68 percent, respectively. Seventy patients had treatment for fistula-in-ano, and in 50 percent of patients permanent healing was achieved. In general, treatment and outcome were largely related to the extent and severity of gut involvement. Proctectomy was performed in 32 patients (in 11 because of ongoing colonic disease). Only seven patients had proctectomy solely because of perianal disease. Proctectomy was necessary in 32 of 99 patients with colitis and perianal disease but in none of 28 patients without colonic involvement. Primary healing of the perineal wound was obtained in 17 patients, and only one patient has an unhealed perineal wound at the time of reporting. CONCLUSION: Perianal Crohn's disease does not inevitably lead to panproctocolectomy. Cautious surgery for fistula when rectal inflammation is quiescent is worthwhile. Loss of bowel continuity is more likely when colitis coexists with perianal disease. Panproctocolectomy is often indicated because of the combination of colitis and perianal disease rather than for perianal disease alone.     

The effects of ventricular hypertrophy on the coronary circulation

Recent animal studies suggest that cardiac hypertrophy compromises the coronary circulation. Although flow per gram of ventricle in most animal models of hypertrophy is normal, coronary vasodilator responses to pharmacological or physiological stimuli are mildly impaired. Studies of regional perfusion indicate that the limitation of coronary vasodilator capacity in hypertrophied ventricles primarily affects the endocardium. In contrast to studies in animals, measurements of coronary reactive hyperemia in man suggest that coronary dilator responses are profoundly depressed in patients with severe left ventricular hypertrophy secondary to aortic stenosis. These studies in man demonstrate that alterations in the coronary circulation secondary to cardiac hypertrophy are of sufficient magnitude to contribute to the development of angina and heart failure (secondary to endocardial fibrosis) in patients with aortic stenosis.     

Apolipoprotein E epsilon4 allele is associated with left ventricular systolic dysfunction

Background

Apolipoprotein (APOE) ?4 allele has been associated with cardiac dysfunction in Alzheimer's disease and β-thalassemia. We investigated the association between APOE genotypes and left ventricular dysfunction in a population of community-dwelling elderly subjects.

Methods

This study was performed in the Rotterdam Study, a population-based prospective cohort study among elderly subjects. For 2206 participants, a baseline echocardiogram and blood specimens for APOE typing were available. Cardiac dysfunction was considered present when fractional shortening was ≤25%. Multivariate logistic regression was used to calculate odds ratios (ORs). The ?3/?3 genotype served as a reference category.

Results

In participants who were homozygous for the ?4 allele, the odds of cardiac dysfunction was increased 3-fold (OR, 3.1; 95% CI, 1.2-8.1), whereas the odds of cardiac dysfunction in persons with APOE ?3/?4 was not significantly increased (OR, 1.5; 95% CI, 0.9-2.5). There was a significant allele-effect relationship for the ?4 allele (P-trend <.05). These elevated odds remained after adjustment for cholesterol levels and atherosclerosis parameters. Risks associated with APOE ?4/?4 and APOE ?3/?4 were more pronounced in participants aged ≥65 years.

Conclusion

The APOE ?4 allele is an independent risk factor for cardiac dysfunction in elderly people. Besides well-known effects on atherosclerosis and cholesterol levels, there may be other mechanisms, such as apoptosis, through which this allele exerts negative effects on myocardial performance.     

Entrapment of a Pacing Lead within a Chiari Network: Utility of Intracardiac Echo and a Laser Sheath

Although rare, Chiari networks are elaborate embryological remnants that can pose distinct challenges for catheter and pacing lead manipulation within the right atrium. Device entrapment may require open thoracotomy for removal, with significant morbidity. We report an unusual case of pacing lead entanglement within this structure, followed by prompt intracardiac echocardiographic identification and laser sheath removal.