Tailored lateral internal sphincterotomy in management of chronic anal fissure with hypertonic internal anal sphincter. a modified minimal invasive technique and its clinical and manometric outcome

To do tailored lateral internal sphincterotomy extending up to upper end of fissure in patients having hypertonic internal sphincter [IAS] by technique has advantages of open and closed methods to keep continence. Clinical and anomanometric outcome will be assessed. 70 patients and 70 controls were subjected to anal manometric study. All patients had hypertonic IAS compared with controls. Sphincterotomy was done through 5-7mm perianal incision just lateral to lower edge of IAS. It extended up to upper end of fissure. Sentinel tags, anal polyps and fibrotic fissure were excised. Results were assessed as persistence of symptoms, complications, healing, postoperative resting anal pressure [RAP] and recurrence. Preoperative RAP significantly higher in patients [132.89 +/- 6.61 cm H2o] than controls [79.64 +/- 71, P >0.001]. Sepsis of sphincterotomy wound occurred in 1.4%, bruising in 1.4%, transient minor soiling in 11.4% and no incontinence. In 97.2%, fissures healed within 6 weeks, postoperative RAP dropped significantly [78.09 +/- 6.62 cm H2o, P >0.001]. After 15.8 months mean follow up period, recurrence occurred in 4.3%. tailored lateral internal sphincterotomy is effective treatment of CAF with anal hypertonia. Our technique is safe and does not affect continence

Estimation of post-revascularization left ventricular ejection fraction an ischemic heart disease patients by using cavity to myocardial ratio of thallium reinjection image

Background: we reported the high correlation between cavity-to-myocardial [CM] count ratio at stress and rest thallium SPECT, and stress-rest ejection fraction [EF] calculated by MUGA test, this was confirmed by others. This correlation was explained partially by the functional mass. On the other hand, two important prognostic parameters should be considered before any revascularization technique: [1] Identification of viable myocardium and its amount, [2] Prediction of EF improvement post revascularization

Aim of the Study: correlating EF[C/M] on rest-redistribution [RD] and reinjection [RI] images [EF[RD]and EF[RI]] image to actual EF pre-revascularization [EF[1]] and 1-year post revascularization EF[2]

Patients and Methods: 78 patients with CAD [68 males and 10 females with mean age of 54.2 +/- 9 years] had been subjected to [1] Standard RD-RI thallium SPECT with assessment of reversible or fixed perfusion defects and calculation of CM and consequently the EFCM at the three settings. [2]Assessment of EF by MUGA at rest pre and 1-year post revascularization EF[1] and EF[2] respectively. These patients had been subjected to revascularization either by PTCA and stent [23/78 i.e. 29.5%] or by CABG [55/78, i.e. 70.5%]

Results: out of the 1560 myocardial segments [20 segments X 78 patients], 780 [50%] segments had abnormal resting wall motion. 441/780 [56.5%] of these segments were either of normal thallium uptake or with reversible perfusion defects while the rest [43.5%] showed fixed defects. 233/441 [52.8%] of those normal uptake or reversible segments showed recovery of wall motion post revascularization [PRV] while only 29/339 [15.1%] showed similar improvements. EFRI was found higher than EFRD in 44/78 of patients, no change in 23/78 patients and worsened in 11/78 patients with total agreements of 63/78 [80.8%] with EF2. On the other hand, EFRD was matched with EF1 in 64/78 of patients. 30/64 [46.9%] showed higher EF2, 23/64 [35.9%] showed similar EF2 while 11164 [17.2%] showed lower EF2. The rest of cases 14/78 showed mismatch between EFRD and EF1 with higher values of EFRD. These patients still had higher values of EFRI and EF2 than EFRD

Conclusion: [1] Mismatch between EFRD and EF1 is an indication of presence of stunning myocardium and of good prognosis. [2] EF[RI] can be used to predict EF2 and so helps on selecting patients who can benefit from revascularization