Manejo Clínico ­ Quirúrgico de pacientes con Fisura Anal en la Unidad de Coloproctología del HECAM / Clinical-Surgical Management of patients with Anal Fissure in the Unit HECAM Coloproctology

La fisura anal es una de las enfermedades más antiguamente descritas, la misma que, ha tenido hasta el momento múltiples tratamientos tanto médicos como quirúrgicos, existiendo controversias en su algoritmo terapéutico. Constituye una de las patologías cuyo diagnóstico y tratamiento corresponde a la Especialidad de Coloproctología, afecta a ambos sexos y a cualquier edad y puede ser aguda o crónica. Proponemos el presente Protocolo para un adecuado manejo de la patología, de manera que sirva de guía en la toma correcta de decisiones basadas en la evidencia y el consenso de quienes integramos la Unidad Técnica de Coloproctología del Hospital de Especialidades Carlos Andrade Marín.

Anal fissure is one of the oldest described diseases, which has so far had multiple medical and surgical treatments, with controversies in its therapeutic algorithm. It is one of the pathologies whose diagnosis and treatment corresponds to the Coloproctology Specialty, it affects both sexes and any age and can be acute or chronic. We propose the present Protocol for an adequate management of the pathology, so that it serves as a guide in the correct decision making based on evidence and consensus of those who integrate the Technical Unit of Coloproctology of the Hospital de Especialidades Carlos Andrade Marín.

Research progress in pelvic floor ultrasound for assessing the morphology and function of levator ani muscle in women / 中南大学学报(医学版)

Pelvic floor ultrasound can clearly visualize the position and morphology of pelvic floor organs, observe the pelvic organ prolapse in real-time, and quantify and analyze the degree of the levator ani muscle injury, which is the most common imaging method to assess the morphology and function of the levator ani muscle to date. The different ultrasound imaging techniques provide a variety of indicators, each with its own advantages and limitations.Furthermore, two-dimensional ultrasound is the basis of imaging, but it fails to detect cross-sectional images of the pelvic floor; three-dimensional ultrasound can acquire the axial plane of the levator hiatus; tomographic ultrasound imaging allows real-time observation of the levator ani muscle injury; shear wave elastography can provide a quantitative assessment of the contractility and elastic characteristics of the levator ani muscle in real-time. It is of great significance to summarize the basic principles of various ultrasound imaging techniques, summarize the ultrasound image characteristics of levator ani muscle and its hiatus in different populations and different states, and explore the cut-off values and diagnostic criteria-related ultrasound parameters for improving the diagnostic efficiency of pelvic floor ultrasound for levator ani muscle injury, leading to reducing missed diagnosis and misdiagnosis of lesions.

Understanding pelvic floor in women

Change from quadruped to erect posture has resulted in changes in the human pelvis. This has resulted in pelvis supporting the abdominal viscera. The bony pelvis is deficient on inferior aspect. Muscles covered by fascia on superior and inferior aspect. A good knowledge of pelvic floor is very basic and mandatory for any gynecologist as pelvic floor is crucial to support the pelvic organs and is required to maintain urinary and fecal continence.

Congenital malformations in ruminants and its surgical management: a retrospective study of Sokoto veterinary clinic, Nigeria

Background:Congenital defects, abnormalities of structures or functions present at birth, maybe as a result ofgenetic or environmental factors or both and in most cases; the exact etiology is not clear but can occur in all animals. These abnormalities are responsible for slowing down of genetic progress and economic loss for the breeders, due to the death of animals.Methods:Available record of cases presented to Aliyu JedoVeterinary Clinic,Sokoto from December 2015 to 2019 was used to investigate congenital malformation in ruminants based on species and sex. Surgery was carried out in all the cases with local anaesthesia (infiltration technique) using lignocaine. Surgical procedures carriedout were rectopexy (atresia ani), gingivectomy (gingival fibromatosis), superficial keratectomy and temporary tarssorhaphy (dermoid cyst), casting and physiotherapy (contracted tendons). Results:A total of 47 congenital malformations; atresia ani 22 (46.8%), gingival fibromatosis 18(38.3%), dermoid cyst 6(12.8%), and contracted tendon 1(2.1%) were reviewed in the study.The ovine species had the highest incidence of cases load recorded 23(48.93%) followed by bovine 17(36.17%) and then caprine species7(14.89%). The incidence of all malformations was higher in males (68.1%) than in females (31.9%). All cases were attempted surgically with success in all the procedures.Conclusions:It can be concluded that male ruminants have the highest prevalence of congenital malformation. Congenital malformations are more frequently seen in ovine and least seen in caprine. Atresia ani appeared to be the most commonly reported cases

Toxicological Study of Leaf Extracts of Loranthus micranthus Linn Using Albino Wistar Rats

This study was aimed to investigate the effect of high sub-chronic doses of the aqueous and methanol leaf extracts of Loranthus micranthuson biochemical parameters of albino rats. Acute toxicity studies were performed according to standard methods. The animals were divided into 5 groups (n = 5). Aqueous and methanol extracts of L. micranthus leaves were administered in doses of 1000 and 2000 mg/kg body weight to four groups of rats respectively for 30 days through the intraperitoneal route. The fifth group served as control and received saline (5 ml/kg b.w, i.p). Blood samples were collected by retrorbital puncture and analyzed for biochemical and haematological parameters using assay kits. Acute toxicity studies indicated that both extracts had an LD50> 5000mg/kg. The results indicated significant (p<0.001) increases in alkaline phosphatase serum levels in both extract treated groups. The extracts also produced significant elevation in serum bilirubin levels when compared with normal control (p<0.05). Both extracts did not affect the levels of alanine and aspartate transaminases significantly (p>0.05). There were significant increase in the serum levels of urea in the extracts treated rats (p<0.05; p<0.01). The 2000 mg/kg aqueous extract produced significant increases in mean serum chloride and bicarbonate levels of treated rats when compared with control (p<0.01). The extracts produced significant decrease in the serum creatine kinase levels of treated rats in a non-dose related manner when compared with control (p<0.05). There were no significant changes in sodium and potassium levels of treated rats. The methanol extract had no significant effect on the haematological indices studied. The aqueous extract produced significant reductions in the haemoglobin and PCV of treated rats (p< 0.01). The total and differential leucocyte counts were not affected by extract treatment (p>0.05). From these results, the extracts caused significant biochemical changes but were not cytotoxic to leucocyte cell lines. Therefore, there should be caution in the long term use of these extracts

Rubber band ligation of hemorrhoids: a hospital based study

Background: Hemorrhoids are symptomatic anal cushions containing arteriovenous anastomosis. Patient with haemorrhoids can present as bleeding per rectum, something (mass) coming out per rectum, perianal itching, Anaemia due to occult blood loss. Various modalities of treatment have been developed to treat symptomatic haemorrhoids. This study was undertaken to determine the efficacy of rubber band ligation in the management of haemorrhoids.Methods: This study was a prospective study conducted in the Department of Surgery, Government Medical College, Srinagar from June 2015 to June 2018. Patients at any age with first, second- or third-degree internal haemorrhoids were included in the study. Patients with fourth degree, complicated haemorrhoids, previous anorectal surgery or anorectal pathology, and chronic liver disease were excluded. A total of 212 patients were included in the study. Rubber band ligation was done as an OPD procedure. The patients were followed at 2 weeks, 4 weeks, 3-month, 6 month and 1 year after the procedure.Results: In this study, out of 212 patients, 154(72.6%) were males and 58(27.4%) females. The mean age of this study was 38.7 yr. (Range 17-73 yr.). Patients presented with the complaints of bleeding (184, 86.8%), prolapse (114, 53.7%), constipation (116, 54.7%), priuritis ani (36, 17.0%), pain (12, 5.6%). Band ligation was successful in 188(88.8%) patients, 169(79.7%) patients were cured and in 19(8.9%) improvement was obtained. Various complications occurred after band ligation including vasovagal syncope (2, 0.9%), bleeding per anum (6, 2.8%), pain (12, 5.6%), fissure in ano (1, 0.5%). Recurrence after one year was seen in 9(4.2%) patients.Conclusions: Author concluded in this study that RBL is an effective outpatient treatment for grade II and III internal haemorrhoids without much complications.

Progresses of pelvic floor ultrasound in assessing levator ani muscle injury in postpartum women / 中国医学影像技术

The levator ani muscle is the most important component of the pelvic floor support system, and levator ani muscle injury (LAMI) is a leading cause of female pelvic floor dysfunction (FPFD). Early diagnosis of changes of levator ani muscle structure and function in postpartum women is vital in preventing the occurrence of FPFD. Progresses of pelvic floor ultrasound in assessment of levator ani muscle injury in postpartum women were reviewed in this article.

Investigation for method of observing major muscle groups of levator ani in female by transvaginal two‐dimensional sonography / 中华超声影像学杂志

To evaluate and discuss feasibility and value of the transvaginal two‐dimensional sonography in distinguishing the major muscle groups of levator ani ,including puborectalis and iliococcygeus ,by observing the morphology and contraction form of these muscles . Methods Total of 145 nulliparous women were chosen . T he major muscle groups of levator ani were observed by transvaginal two‐dimensional sonography . T he images of puborectalis and iliococcygeus were obtained both at rest and contracting . T he features of the sonogram and the direction of muscle contraction were summarized . T he consistency between two sonographers was analyzed by ICC . Results T ransvaginal two‐dimensional sonography could be used to observe and distinguish the major muscle groups of levator ani . Puborectalis was showed distinctly as thick and uniform hyperechoic linear zone . Iliococcygeus was showed as triangle zone with sparse hyperechoic lines ,with one angle pointing to the caudal .During contracting ,puborectalis moved from the dorsal to the ventral while iliococcygeus contracted from the caudal to the cephalic . T he consistency between two sonographers for distinguishing the morphology and contraction form between the puborectalis( ICC＝0 .93 ,0 .89 ) and ilococcygeus ( ICC＝0 .78 ,0 .75 ) were remarkably high . Conclusions T ransvaginal two‐dimensional sonography could be used to observe dynamically and distinguish the morphology and contraction form of the levator ani muscles ,including puborectalis and iliococcygeus . It is a convenient and reproducible method to help study mechanism of levator ani injury and provide fine radiological evidence of making individual treatment .

Genomic identification and characterization of the elite strains Bradyrhizobium yuanmingense BR 3267 and Bradyrhizobium pachyrhizi BR 3262 recommended for cowpea inoculation in Brazil

ABSTRACT The leguminous inoculation with nodule-inducing bacteria that perform biological nitrogen fixation is a good example of an "eco-friendly agricultural practice". Bradyrhizobium strains BR 3267 and BR 3262 are recommended for cowpea (Vigna unguiculata) inoculation in Brazil and showed remarkable responses; nevertheless neither strain was characterized at species level, which is our goal in the present work using a polyphasic approach. The strains presented the typical phenotype of Bradyrhizobium with a slow growth and a white colony on yeast extract-mannitol medium. Strain BR 3267 was more versatile in its use of carbon sources compared to BR 3262. The fatty acid composition of BR 3267 was similar to the type strain of Bradyrhizobium yuanmingense; while BR 3262 was similar to Bradyrhizobium elkanii and Bradyrhizobium pachyrhizi. Phylogenetic analyses based on 16S rRNA and three housekeeping genes placed both strains within the genus Bradyrhizobium: strain BR 3267 was closest to B. yuanmingense and BR 3262 to B. pachyrhizi. Genome average nucleotide identity and DNA-DNA reassociation confirmed the genomic identification of B. yuanmingense BR 3267 and B. pachyrhizi BR 3262. The nodC and nifH gene analyses showed that strains BR 3267 and BR 3262 hold divergent symbiotic genes. In summary, the results indicate that cowpea can establish effective symbiosis with divergent bradyrhizobia isolated from Brazilian soils.

Determining "abnormal" levator hiatus distensibility using three-dimensional transperineal ultrasound in Chinese women / 医学前沿

The dimension of the levator hiatus is a possible predictor of pelvic organ prolapse (POP). This retrospective study investigated 360 women who went to urogynecological clinic for pelvic floor discomfort. Levator hiatus dimensions were obtained by three-dimensional transperineal ultrasound and results were compared between women with and without significantly objective prolapse (International Continence Society POP quantification, grade 2 or higher). Receiver operating characteristic (ROC) curve analyses were performed to determine valid screening index for detecting abnormal levator hiatus distensibility. Women with significantly objective prolapse had significantly higher levator hiatus dimensions than those without (all P < 0.001). ROC curve analyses confirmed that hiatal area (HA) of 19.5 cm during Valsalva maneuver can be used as single-screening index for abnormal levator hiatus distensibility with sensitivity of 0.80 and specificity of 0.70. In this study, we used a two-step method and achieved higher sensibility (0.80 vs. 0.87) without reducing specificity (0.70 vs. 0.71) compared with a single-screening index method. As a result, we suggest that HA ⩾ 19.5 cm during Valsalva maneuver is an indicator of abnormal levator hiatus distensibility in Chinese women and that the two-step method has higher sensitivity in detecting abnormal distensibility.

Association between Magnetic Resonance Imaging Findings of the Pelvic Floor and de novo Stress Urinary Incontinence after Vaginal Delivery

OBJECTIVE: The study aimed to evaluate the contributions of levator ani muscle (LAM) injury, vesical neck movement, urethral length and mobility, and urethral sphincter dysfunction observed on magnetic resonance imaging (MRI) towards stress urinary incontinence (SUI) after vaginal delivery. MATERIALS AND METHODS: Fifty primiparous women after 6 months of delivery (15 with SUI and 35 without) and 35 nulliparous as continent controls underwent MRI at rest and Valsalva maneuver. A published levator ani scoring system was used to characterize morphological changes of LAM. The severity of the injury was divided into three categories as none, minor, and major. A series of common parameters including levator plate angle, iliococcygeal angle, and levator hiatus were used to describe the functional conditions of LAM. Urethral mobility was defined based on the rotation of the urethra between Valsalva and rest status. Vesical neck movement was evaluated by its distance to the pubococcygeal line. Urethral sphincter dysfunction was defined as the widening of the proximal urethra and/or funneling at the urethrovesical junction during Valsalva. RESULTS: Primiparous incontinent (PI) women had additional major levator ani defects (33.3% vs. 17.1%) while less minor defects (0.7% vs. 31.4%) than primiparous continent (PC) women. Vesical neck downward movement in PI women was more obvious than PC women (28.5 mm vs. 24.2 mm, p = 0.006). Urethral mobility was more active in primiparous women than in nulliparous continent controls (57.4 vs. 52.4), whereas no difference was observed on urethral mobility in the primiparous group (p = 0.25). Urethral sphincter dysfunction and funneling were present in 80% of PI women versus 22.9% in PC women (p < 0.001). CONCLUSION: The MRI findings revealed that de novo SUI was associated with major LAM injury, vesical neck downward movement as well as urethral sphincter dysfunction. Vesical neck funneling on sagittal images can be treated as a valuable predictor for SUI. The intervention for the PI should focus on the elevation of vesical neck, rehabilitation of LAM as well as recovery of the urethral sphincter muscle.

Analysis of the Effects of Different Delivery Methods on the Levator Ani Muscle of the Pelvic Floor by Transperineal Three - dimensional Ultrasound and TUI Imaging / 现代医院

Objective To investigate the effect of different delivery methods on the levator ani muscle of the pelvic floor by transperineal three-dimensional ultrasound and TUI imaging. Methods 200 cases of pregnant women from August2014 to August 2016 in our hospital were divided into selective cesarean section group (n = 85) and vaginal delivery group (n= 115). The vaginal group, according to the intraoperative lateral segmentation, was further divided into vaginal lateral incision group (n = 65) and vaginal delivery without lateral incision group (n = 50). At the same time, select 80 cases of nulliparous women (volunteers) as control group, relevant indicators by three-dimensional imaging and TUI imaging technique. Results The vaginal delivery without lateral incision group, lateral incision group vaginal delivery and cesarean section group levator hiatus diameter, anteroposterior diameter, perimeter and area were significantly higher than the control group(P＜0.05), and vaginal delivery side cut was significantly higher than the other three groups (P＜0.05), vaginal delivery in two sub-group and cesarean section group of levator ani muscle thickness were significantly lower than the control group(P＜0.05), vaginal delivery in two sub groups were significantly lower than that in the cesarean section group (P＜0. 05); vaginal delivery group of levator ani muscle injury rate was significantly higher than that in the cesarean section group (P＜0. 05); There was no significant difference in the rate of levator ani muscle injury in vaginal delivery group (P＞0.05). Conclusion Compared with cesarean section, vaginal delivery is more obvious in changing the morphology and integrity of levator ani muscle, and vaginal delivery is more obvious than that of vaginal incision.

Transperineal three-dimensional ultrasound in evaluation on impact of different delivery modes on levator ani muscle elasticity in early postpartum women / 中国医学影像技术

Objective To evaluate the impact of different delivery ways on levator ani muscle elasticity in early postpartum women with transperineal three-dimensional ultrasound.Methods Totally 60 postpartum women (30 in spontaneous transvaginal delivery group and 30 in selective cesarean delivery group) and 30 non-fertile women (control group) were enrolled.All subjects underwent transperineal three-dimensional ultrasound.The images were acquired at rest,Valsalva and maximal levator ani muscle contraction,respectively,and then the area (A),circumference (C) of levator hiatus and the length (L) of levator ani muscle were measured.The difference values of A,C,L (△A,△C,△L)were calculated between contraction and rest,and the strain rate (ε) was calculated at contraction.The difference of A,C,L (△A',△C',△L') were calculated between Valsalva and rest,and strain rate (ε') was calculated at Valsalva.Results The △A,△C,△L,ε in spontaneous transviginal delivery group and selective cesarean delivery group were smaller than those in control group (all P＜0.05),and △A',△C',△L',ε'in spontaneous transviginal delivery group and selective cesarean delivery group were larger than those in control group (all P＜0.05),while there was no statistical difference between spontaneous transviginal delivery group and selective cesarean delivery group of △A,△C,△L,ε,△A',△C',△L'nor ε'(all P＞0.05).Conclusion The levator ani muscle elasticity decreases in the early postpartum women,and selective cesarean delivery has limited role in protection of levator ani muscle.

Establishment of orthotopic implantation model of human U87-MG brain glioma cell line in nude mice / 中国药理学通报

Aim To establish human U87-MG glioma model in nude mice brain and to observe the characteristics of the tumor growth. Methods Human U87-MG glioma cells were cultured in vitro. 5 μL of cell suspension containing 3.0 ×1010·L-1, 4.0×1010·L-1and 5.0×1010·L-1respectively was inocula-ted into the right caudate nucleus of 18 male nude mice brain un-der the guidance of stereotaxic apparatus, separately, whereas another 6 nude mice as the control group, were inoculated into the same volume of Hanks solution. The moving and survival state of rats with gliomas were observed. The examinations of the tumors formation, volumes, metastasis and histopathology were performed and the obtained brain samples were stained with HE and immunohistochemistry. Results All the tested rats of dif-ferent inoculation doses developed brain tumors without extracra-nial metastasis. The mean survival time of three groups was (46.50 ± 3.27) d,(38.50 ± 3.28) d and (30.67 ± 3.51) d,respectively. The tumors showed the similar morphological fea-tures and immunophenotype to human glioma. There was positive expression of GFAP and S-100 in the tumors. Conclusions The orthotopic implantation model of human U87-MG glioma, by in-oculating quantitative U87-MG cells stereotaxically into the brains of the nude mice, is successfully established with 100 yield of intracranial tumor and no extracranial growth extension. It resembles the histopathological and morphological features of human glioma,which can be used as a reliable animal model for the study of the tumorigenesis, pathogenesis, biological charac-teristics and therapy of glioma.

Atresia anal com fístula retovaginal em ovino: relato de caso / Anal Atresia with rectovaginal fistula in sheep: case report

A atresia anal com fístula retovaginal, é considerada uma afecção congênita rara nos ovinos. Em virtude disso, buscou-se descrever o reparo cirúrgico e cuidados pós-operatórios em uma borrega que apresentava essa afecção. Nesse sentido, uma borrega, sem raça definida, de 25 dias de idade e pesando 7,2kg, apresentou sinais de distensão abdominal e defecação pela vulva. A afecção foi diagnosticada por meio do exame clínico e confirmada radiograficamente, constatando-se atresia anal do tipo III em associação com a fístula.(AU)

Atresia ani associated with rectovaginal fistula is considered a rare congenital anomaly in sheep. Therefore, the surgical correction and post-operative care of a lamb presenting atresia ani with rectovaginal fistula has been detailed in this case report. A 25-days old, mixed breed lamb, weighing 7.2 kg, showing signs of abdominal bloating, and stool passage through the vulva was admitted at our hospital. An atresia ani type III condition associated with rectovaginal fistula was diagnosed by clinical examination and confirmed by radiographic examination.(AU)

Feasibility study of MR T2-mapping for evaluating birth-related levator ani muscle injury / 实用放射学杂志

Objective To investigate MR T2-mapping in evaluating birth-related levator ani muscle injury.Methods 25 primiparas at 6 weeks after first vaginal delivery as primiparous group and 12 nulliparous volunteers as control group were prospectively studied. All the subjects underwent pelvic MRI including T2-mapping,mDIXON-T2 WI sequences.Levator ani muscle were divided into two subgroups:levator ani muscle injury group and non-injury group according to if there were edema,avulsion,or rupture in each levator ani muscle subdivisions[puborectal muscle(PRM);iliococcygeal muscle(ICM)],which were showed on mDIXON-T2 WI images.Two radiologists evaluated T2 values of PRM,ICM and observed artificial color images respectively.The consistency between two observers for T2 values of PRM,ICM were evaluated using the intraclass correlation coefficient (ICC ),the difference of T2 values in each levator ani muscle subdivisions among control group,non-injury group and muscle injury group were analyzed using ANOVA .Results There were 26 PRM injury cases and 24 non-injury cases in primiparous group on mDIXON-T2 WI images,and no ICM injured cases in our study.Inter-rater reliability for T2 values between two observers were good(ICC >0.75).T2 values in PRM injury group,non-injury group and control group were(62.78±1.23)ms,(49.75±3.17)ms,(49.96±4.37)ms respectively and the difference was significant. There were significant difference between PRM injury group and non-injury group,control group respectively(P =0.000,P =0.000). The T2 values of ICM in PRM injury group,non-injury group and control group were(70.80±6.50)ms,(62.41±7.32)ms,(62.78±6.91)ms and there were significant difference(P =0.000),meanwhile the difference between PRM injury group and non-injury group,control group were significant respectively(P =0.000,P =0.000).The color gradation of PRM in PRM injury group were mixed with blue, green,and yellow,and tone were lightened on T2-mapping artificial color images;ICM color gradation were uneven with green and yellow, a d tone were higher than those of control group and non-injurygroup.Conclusion T2-mapping can quantitatively assess birth-related levator ani muscle injury and T2-mapping artificial color images show the range and degree of levator ani muscle injury visually.It is hopeful to find micro lesions that T2 WI images are difficult to find.

Progresses of ultrasound in evaluation of pelvic organ prolapse / 中国介入影像与治疗学

Ultrasonography can clearly show pelvic anatomic structures,as well as the location and length of mesh after pelvic floor reconstructive operation.The consistency of ultrasonic diagnosis of severe pelvic organ prolapse with pelvic organ prolapse quantitation is good.Furthermore,ultrasonography can provide imaging basis for evaluating the safety and efficacy of pelvic floor reconstruction.The progresses of ultrasound in diagnosis of severe pelvic organ prolapse and postoperative evaluation of pelvic floor reconstruction were reviewed in this article.

Feasibility study of MR T2-mapping for evaluating birth-related levator ani muscle injury / 实用放射学杂志

Objective To investigate MR T2-mapping in evaluating birth-related levator ani muscle injury.Methods 25 primiparas at 6 weeks after first vaginal delivery as primiparous group and 12 nulliparous volunteers as control group were prospectively studied. All the subjects underwent pelvic MRI including T2-mapping,mDIXON-T2 WI sequences.Levator ani muscle were divided into two subgroups:levator ani muscle injury group and non-injury group according to if there were edema,avulsion,or rupture in each levator ani muscle subdivisions[puborectal muscle(PRM);iliococcygeal muscle(ICM)],which were showed on mDIXON-T2 WI images.Two radiologists evaluated T2 values of PRM,ICM and observed artificial color images respectively.The consistency between two observers for T2 values of PRM,ICM were evaluated using the intraclass correlation coefficient (ICC ),the difference of T2 values in each levator ani muscle subdivisions among control group,non-injury group and muscle injury group were analyzed using ANOVA .Results There were 26 PRM injury cases and 24 non-injury cases in primiparous group on mDIXON-T2 WI images,and no ICM injured cases in our study.Inter-rater reliability for T2 values between two observers were good(ICC >0.75).T2 values in PRM injury group,non-injury group and control group were(62.78±1.23)ms,(49.75±3.17)ms,(49.96±4.37)ms respectively and the difference was significant. There were significant difference between PRM injury group and non-injury group,control group respectively(P =0.000,P =0.000). The T2 values of ICM in PRM injury group,non-injury group and control group were(70.80±6.50)ms,(62.41±7.32)ms,(62.78±6.91)ms and there were significant difference(P =0.000),meanwhile the difference between PRM injury group and non-injury group,control group were significant respectively(P =0.000,P =0.000).The color gradation of PRM in PRM injury group were mixed with blue, green,and yellow,and tone were lightened on T2-mapping artificial color images;ICM color gradation were uneven with green and yellow, a d tone were higher than those of control group and non-injurygroup.Conclusion T2-mapping can quantitatively assess birth-related levator ani muscle injury and T2-mapping artificial color images show the range and degree of levator ani muscle injury visually.It is hopeful to find micro lesions that T2 WI images are difficult to find.

Novel anal sphincter saving procedure with partial excision of levator-ani muscle in rectal cancer invading ipsilateral pelvic floor

PURPOSE: Tumors at the level of the anorectal junction had required total levator-ani muscle excision to achieve an adequate resection margin. However, in the cases of tumor invading ipsilateral levator-ani muscle and intact external sphincter, en bloc resection of rectum with levator-ani muscle including tumor would be possible. This hemilevator excision (HLE) technique enables preserving the anal sphincter function while obtaining oncologic clearance and avoiding permanent colostomy in those patients. This study aimed to evaluate the surgical outcomes and feasibility of HLE. METHODS: Data on 13 consecutive patients who underwent HLE for pathologically proven low rectal cancer were retrospectively collected. All 13 patients presented low rectal cancer at the anorectal ring level that was suspected to invade or abut to the ipsilateral side of the levator-ani muscle. RESULTS: A secure resection margin was achieved in all cases, and anastomotic leakage occurred in 2 patients. During follow-up, 3 patients experienced tumor recurrence (2 systemic and 1 local). Among 6 patients who underwent diverting ileostomy closure after the index operation, 2 complained of fecal incontinence. The other 4 patients without fecal incontinence showed <10 times of bowel movement per day. Accessing their incontinence scale, mean Wexner score was 9.4. CONCLUSION: HLE is a novel sphincter-preserving technique that can be a treatment option for low rectal cancer invading ipsilateral levator-ani muscle, which has been an indication for abdominoperineal resection (APR) or extralevator APR. However, the long-term oncologic and functional outcomes of this procedure still need to be assessed to confirm its validity.

Static and dynamic MRI evaluation before and after operation of pelvic organ prolapse / 实用放射学杂志

Objective To explore the value of static and dynamic MRI before and after operation of pelvic organ prolapse (POP). Methods 29 patients with POP (POP group)and 12 normal women (control group)underwent static and dynamic MRI.The morphologic changes of pelvic floor were observed on MR images.The measurements of bladder,uterus,Douglas pouch to pubococcygeal line (B-PCL,U-PCL,D-PCL),the puborectal hiatus line (H-line),muscular pelvic floor descent (M-line),the levator hiatus size (LHS),the levator plate angle (LPA),the iliococcygeus angle (ICA)and the urethral inclination angle (UA)were recorded on dynamic MR images.Results 19 cystoceles,28 uterine prolapses,4 rectoceles and 14 hernias of Douglas pouch were detected with MRI.29 cases of pelvic floor relaxation,27 cases of levator ani muscle defect and 24 cases of pubocervical fascial defect were found.The values of B-PCL,U-PCL, D-PCL,H-line,M-line,LHS,LPA,ICA and UA of POP group were larger than control group (P<0.01).The positions of pelvic organ returned to normal in 9 cases of 21 postoperative cases,while 12 cases remained prolapses.There was no displacement of mesh in 8 cases of mesh implant.The values of B-PCL,U-PCL,D-PCL,UA after operation were smaller than those before operation (P<0.05).Conclusion Static and dynamic MRI can evaluate morphological and functional changes of pelvic floor before and after operation of POP comprehensively,and may reveal those invisible pelvic floor dysfunction and postoperative remnant defects.