ABSTRACT
The use of artificial urinary sphincter around the urethra or bladder neck for the management of urinary incontinence secondary to intrinsic urethral sphincter deficiency is now well accepted. However, its use around the bowel to serve as a sphincter in urinary pouches is still anecdotal. Its use in experimental models has been met with failure because of ischemic bowel necrosis at the cuff site. To obviate these difficulties, a new technique was devised using a flap of rectus muscle that acted as a cushion between the cuff and the bowel wall. Results in five dogs showed that bowel wall ischemia is avoided with cuff pressure of 51-60 cm applied constantly for four weeks while providing pressure to leak around the closed cuff with a pressure of 62-75 cm water. Further study is needed to confirm the long-term effect of this technique on the bowel wall and the ability of the sphincter to maintain continence.
Subject(s)
Abdominal Muscles/surgery , Ileum/surgery , Ischemia/prevention & control , Urinary Reservoirs, Continent , Urinary Sphincter, Artificial , Animals , Dogs , Ileum/blood supply , Ileum/pathology , Intestinal Mucosa/pathology , Surgical FlapsABSTRACT
A retrospective review of the radiologic findings in 31 patients less than 21 years old who underwent laminotomy for lumbar disk herniation revealed six cases of associated avulsion fracture of the vertebral end plate, a prevalence of 19%. All fractures were found in the 14-17-year-old subgroup (six of 19), a prevalence of 32%. In four patients, plain radiographs did not reveal the fracture. Computed tomographic (CT) findings were diagnostic in all six cases. Magnetic resonance (MR) images, obtained in three patients, demonstrated the avulsed cortical fragment and what are assumed to be the attached Sharpey fibers. On sagittal MR images, these structures had a configuration with the appearance of a "Y" or "7". Four of these six patients underwent bilateral laminotomies. The need for more extensive surgical resection may not be apparent at plain radiography or myelography but can be predicted with CT and MR imaging.
Subject(s)
Intervertebral Disc Displacement/diagnosis , Lumbar Vertebrae/injuries , Spinal Fractures/diagnosis , Adolescent , Humans , Intervertebral Disc Displacement/complications , Intervertebral Disc Displacement/epidemiology , Magnetic Resonance Imaging , Prevalence , Retrospective Studies , Spinal Fractures/complications , Spinal Fractures/epidemiology , Technology Assessment, Biomedical , Tomography, X-Ray ComputedABSTRACT
There is a well-documented synergistic cytotoxic effect when heat is combined with ionizing radiation. An integral component of hyperthermia treatments is the placement of thermocouple probes used for thermal dosimetry. With the surge in interest in the clinical use of hyperthermia, our department is performing an increasing number of thermocouple placements under computed tomographic (CT) guidance. We describe our technique for CT-guided thermocouple placement with two different systems: a trocar introduction system and a peel-away needle introduction system. We discuss the rationale for thermocouple placement, our early experience with this technique, and some potential complications.
