Medium-term outcome of percutaneous tibial nerve stimulation in the treatment of fecal incontinence

Introduction

Fecal incontinence (FI) is a multifactorial disease that affects patients’ quality of life. The aim of this study was to evaluate the efficacy of posterior tibial nerve stimulation (PTNS) in the treatment of FI and to assess the medium-term results.

Methods

A prospective cohort of patients with FI treated with PTNS between 2012 and 2014 was analysed. Endoluminal ultrasound and anorectal physiologic studies were performed in all patients. The efficacy of PTNS was assessed using a validated questionnaire (Cleveland Clinic Incontinence Score) at baseline, after treatment, and 2 years later. The Vaizey score was also used at 2-year follow-up to assess urge incontinence.

Results

Fifty-six patients (38 females; mean age 59.7 years) with FI were treated. The causes of FI were mainly obstetric injury and previous colorectal surgery. A decrease of 50% from baseline CCIS was seen in 41.1% of patients after PTNS. One-third maintained a minimum of 50% decrease of their initial CCIS after 2 years. Comparing CCIS at baseline, after treatment, and at 2-year follow-up, a statistically significant difference was observed (p?<?0.0001 and p?<?0.0004 respectively). Medium-term improvement was not maintained in patients with passive and mixed FI, while it was maintained in those with urge incontinence. At 2 years, patients with mild incontinence maintained the greatest response.

Conclusions

PTNS is a safe, effective, non-invasive treatment for FI with good results in almost half of the patients at the end of the treatment. There is also an acceptable maintained response at 2-year follow-up. It seems to be most successful in patients with mild incontinence and urge incontinence.

     

Spinal abnormalities in pediatric patients: MR imaging findings compared with clinical, myelographic, and surgical findings

Eighty-one pediatric patients with a variety of spinal disorders, including suspected dysrhaphism, scoliosis, neoplasia, and neurofibromatosis, underwent magnetic resonance (MR) imaging. The results were retrospectively compared with those of myelography followed by computed tomography (CT) and surgery. In patients with dysrhaphism, most abnormalities, including hydromyelia, inclusion tumors, and sites of cord tether, were demonstrated with MR imaging. Diastematomyelia and small hydromyelic cavities were indistinguishable on routine coronal and sagittal T1-weighted images; axial images with T2 weighting were optimal for this differentiation. MR imaging did not enable direct visualization of a thickened filum or evaluation of tethering with a thin, dorsally positioned neural placode. Congenital or severe scoliosis required lengthy studies with multiple planes of imaging or myelography and CT. Milder curvatures were readily evaluated with MR imaging, and neoplastic lesions, with the exception of intrathecal tumor seeding, were adequately defined.     

Cytokine-specific regulation of urokinase receptor (CD87) expression by U937 mononuclear phagocytes

Mononuclear phagocytes concentrate urokinase-type plasminogen activator (uPA) at the cell surface by expressing membrane uPA receptors (uPAR). This study examines the ability of exogenous cytokines to alter expression of membrane-associated uPA and uPAR in U937 mononuclear phagocytes. Cells were stimulated with recombinant interferon gamma (IFN gamma) or tumor necrosis factor alpha (TNF alpha), followed by immunolabeling for uPA or uPAR and flow cytometry. IFN gamma increased surface uPA 2.2-fold relative to unstimulated controls (P < .001), whereas TNF alpha had no significant effect. Likewise, maximal uPA binding capacity was increased 2.8-fold by IFN gamma (P < .02), but was not affected by TNF alpha. In unstimulated cells, 50% of receptors were occupied by endogenously generated uPA, and this proportion was not affected by either cytokine. IFN gamma upregulated uPAR 2.1-fold relative to unstimulated controls (P < .001), whereas TNF alpha had no effect. In contrast to effects on surface protein, TNF alpha induced a substantial increase in uPAR mRNA, equaling the effect of IFN gamma. In addition, both cytokines doubled the intracellular uPAR pool (P < .01). By contrast, TNF alpha induced a 2.5-fold increase in the level of uPAR protein released into conditioned medium (compared with unstimulated cells), whereas IFN gamma had no effect. These results indicate that uPAR expression is regulated in a cytokine-specific fashion. Some stimuli, such as TNF alpha, may increase uPAR synthetic activity without a corresponding change in membrane expression, because of enhanced release of uPAR from the cell. Cytokine-specific modulation of uPAR may be important in regulating the function of mononuclear phagocytes in inflammation and tissue repair.     

Directional needle for antegrade guide wire placement with vertical arterial puncture

A directional needle with a closed pencil-point tip and a distal side hole was developed to permit antegrade guide wire placement by way of a 90 degrees puncture angle. It has been used in over 25 patients without technical difficulties or complications. It has been very effective for catheterization of the superficial femoral artery for angioplasty, diagnostic studies, and chemotherapy infusion, providing easy antegrade access in patients in whom the traditional antegrade approach may be difficult.     

Retrievable Gianturco-coil introducer

A new delivery system for placement of Gianturco coils has been devised that permits retrieval of the coil if malposition occurs. The delivery system itself consists of a very fine coaxial cannula that will cut the monofilament once the coil is properly placed. It has been successfully used on three patients in whom a total of 48 coils were employed to occlude great vein of Galen aneurysms. The system is applicable for routine coil embolization but has particular application in treating high-flow vascular lesions (arteriovenous fistulas or malformations).     

HENOCH-SCHONLEIN PURPURA ASSOCIATED WITH RANITIDINE

Ranitidine is one of the widely prescribed H₂ receptor antagonists in the treatment of peptic ulcer. It is well tolerated and has few side-effects. Vasculitic rash occurring in association with ranitidine has been described.¹ We report a case of a 39-year-old man who developed a purpuric rash, polyarthritis, abdominal pain, melaena and impaired renal function characteristic of Henoch-Schonlein purpura, following treatment with ranitidine.     

Long term language deficiencies in children with otitis media during their first year of the life

A cohort of lower socio-economic children who experienced multiple and prolonged episodes of otitis media (OM) during their first year of life were compared to an equivalent group of children who were largely free of OM during their first year. Both groups were followed until 9 years of age. The data indicate that children with positive histories of OM performed poorer on a variety of Iinguisitc tasks across the nine year age span than the children with the positive histories of OM. The results suggest that the effect of the otitis media and its accompanying hearing loss on communication skills may extend throughout childhood.