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sphincter muscle [keywords]
- Safety and efficacy of the modified peroral endoscopic myotomy with shorter myotomy for achalasia patients: a prospective study. [JOURNAL ARTICLE]
- Dis Esophagus 2014 Sep 12.
Peroral endoscopic myotomy (POEM) has been developed as a minimally invasive endoscopic treatment for achalasia for years. However, the optimal length of submucosal tunnel and myotomy of muscle bundles during procedure of POEM has not yet been determined, so we aim to assess safety and efficacy of modified POEM with shorter myotomy of muscle bundles in achalasia patients. Consecutive achalasia patients had been performed modified POEM with shorter myotomy, and assessed by symptoms, high-resolution manometry, and barium swallow examinations before and 3 months after POEM for safety and efficacy evaluation. Modified POEM with shorter submucosal tunnel (mean length 6.8 cm) and endoscopic myotomy of muscle bundles (total mean length 5.4 cm) were completed in 46 consecutive achalasia patients. During the 3-month follow up in all cases, significant improvement of symptoms (a significant drop in the Eckardt score 8.4 ± 3.2 vs. 2.7 ± 1.9; P < 0.001), decreased lower esophageal sphincter pressure (39.4 ± 10.1 vs. 24.4 ± 9.1 mmHg; P < 0.001) and integrated relaxation pressure (38.6 ± 10.4 vs. 25.7 ± 9.6 mmHg; P < 0.01), and a drop in height of esophagus barium-contrast column (5.4 ± 3.1 vs. 2.6 ± 1.8 cm; P < 0.001) were observed. The frequencies of adverse events were lower in those under endotracheal anesthesia and CO2 insufflations compared with intravenous anesthesia and air insufflations. Only three patients were found to have gastroesophageal reflux disease on follow up. Modified POEM with shorter myotomy under endotracheal anesthesia and CO2 insufflations shows its good safety and excellent short-term efficacy in the treatment of achalasia. But further studies are warranted to assess the long-term efficacy.
- [Catheter-related bladder discomfort after urological surgery: Importance of the type of surgery and efficiency of treatment by clonazepam]. [English Abstract, Journal Article]
- Prog Urol 2014 Sep; 24(10):628-33.
Bladder catheter can induce a Catheter-Related Bladder Discomfort (CRBD). Antagonist of muscarinic receptor is the gold standard treatment. Clonazepam is an antimuscarinic, muscle relaxing oral drug. The aim of this study is to look for a correlation between the type of surgical procedure and the existence of CRBD and to evaluate the efficiency of clonazepam.One hundred patients needing bladder catheter were evaluated. Sexe, age, BMI, presence of diabetes, surgical procedure and existence of CRBD were noted. Pain was evaluated with analogic visual scale. Timing of pain, need for specific treatment by clonazepam and its efficiency were noted. Correlation between preoperative data, type of surgical procedure, existence of CRBD and efficiency of treatment were evaluated.There were 79 men and 21 women (age: 65.9 years, BMI: 25.4). Twelve patients presented diabetes. Surgical procedure concerned prostate in 39 cases, bladder in 19 cases (tumor resections), endo-urology in 20 cases, upper urinary tract in 12 cases (nephrectomy…) and lower urinary tract in 10 cases (sphincter, sub-uretral tape). Forty patients presented CRBD, (pain 4.5 using VAS). This pain occurred 0.6 days after surgery. No correlation was found between preoperative data and CRBD. Bladder resection and endo-urological procedures were surgical procedures which procured CRBD. Clonazepam was efficient in 30 (75 %) out of 40 patients with CRBD. However, it was less efficient in case of bladder tumor resection.CRBD is frequent and occurred immediately after surgery. Bladder resection and endo-urology were the main surgical procedures which induced CRBD. Clonazepam is efficient in 75 %. Bladder resection is the surgical procedure which is the most refractory to treatment.5.
- Influence of Serotonergic Mechanisms on the Urine Flow Rate in Male Rats. [JOURNAL ARTICLE]
- Am J Physiol Regul Integr Comp Physiol 2014 Sep 10.
This study extensively examined the role of a 5-HT1A receptor in controlling voiding function in anesthetized male rats. A simultaneous recording of the intravesical pressure (IVP), external urethral sphincter (EUS)-electromyography (EMG), and urine flow rate (UFR) during continuous cystometry was utilized. 8-Hydroxy-2-(di-n-propylamino)-tetralin (8-OH-DPAT), a 5-HT1A receptor agonist, significantly improved the voiding efficiency (VE) as detected by increases in the evoked contraction amplitude, EUS burst period, and silent period, and decreases in the volume threshold, pressure threshold, and residual volume. Interestingly, the UFR during voiding was reduced by 8-OH-DPAT, as evidenced by decreases in the maximal UFR and mean UFRs of the voiding period, spike duration, and inter-spike interval. Conversely, treating rats with WAY-100635, a 5-HT1A antagonist, produced effects opposite to those produced by 8-OH-DPAT. These findings suggest that 8-OH-DPAT improved the voiding efficiency by enhancing the detrusor contractile ability and prolonging EUS burst period, which would compensate for the lower UFR resulting from urethral smooth muscle contractions and longer EUS silent periods during voiding. The present study contributes to our understanding of the role of 5-HT1A receptors in controlling the urine flow rate in male rats.
- [Stretch sphincter of the esophagus : Paradoxical sphincter with angiomyoelastic architecture.] [JOURNAL ARTICLE]
- Chirurg 2014 Sep 11.
The investigations described in this article clearly show that the lower esophageal sphincter (LES) represents a variation of circular muscular occlusive mechanisms found elsewhere in the gastrointestinal tract. The LES is a double layer stretch sphincter that operates in an apparently paradoxical manner: it closes when under stretch but opens when the muscle fibers contract. Impedance manometry studies demonstrate that the entire esophagus is involved in the normal functioning of the esophagus as well as in esophageal disorders. The pronounced elasticity of esophageal tissue is a functional feature that has its basis in the singular architecture of elastic fibers located between the muscle layers. All traditional forms of operative treatment of gastroesophageal reflux disease (GERD) impede the natural functioning of the stretch sphincter to a greater or lesser degree by locking it up. The cause of GERD is mainly by contraction of the esophagus brought about by the cephalad transposition of the stretch sphincter segment into the chest. In a sense this is an incipient axial hernia that frequently remains undiagnosed in the early stages. The operative repositioning of the stretch sphincter segment into the abdominal cavity provides sufficient restoration of the natural topographic relationships to achieve a cure of GERD. Whether this straightforward repair restores the function of the entire esophagus remains to be elucidated. The concept of the stretch provides a good explanation of the pathophysiology of achalasia, a condition in which a paralyzed paradoxical ring sphincter remains occluded. Successful myotomy approaches only split the muscularis propria layer of the stretch sphincter while leaving subepithelial muscle fibers intact that remain paralyzed. This limited intervention provides a good relief of symptoms.
- Optimizing the selection of low rectal cancer patients for intersphincteric resection by evaluating vertical invasion to the levator and external sphincter. [JOURNAL ARTICLE]
- Colorectal Dis 2014 Sep 10.
The indications for intersphincteric (ISR) anterior resection are not clearly defined. The aim of this study was to evaluate vertical extension of T2 or T3 low rectal cancer treated by rectal amputation to optimize patient selection for ISR.The abdominoperineal excision specimens of T2 or T3 low rectal cancer from 53 patients treated between 1992 and 2004 were retrospectively reviewed. Vertical invasion was quantified by measuring the shortest distance between the tumour and the striated muscle (T-SM), assuming that this represented the surgical margin that would have be achieved had an ISR been performed.Involvement of the dentate line (DL) and intramural distal spread were independent risk factors for T-SM ≤2 mm. T-SM was less when the inferior border of the tumour was on the distal side of the DL (r =0.572, p <0.001). The probability of involvement of the DL, intramural distal spread, or either one of these being associated with T-SM ≤2 mm was 43%, 46%, and 43%. All patients without both intramural distal spread and involvement of the DL had a T-SM greater than 2 mm.We recommend that ISR be performed only for patients with T2 or T3 low rectal cancer in whom the lowest edge of the tumour is above the DL and there is no intramural distal spread. Such patients are relatively unlikely to have a T-SM of or equal to 2 mm. This article is protected by copyright. All rights reserved.
- Anorectal autotransplantation in a canine model: the first successful report in the short term with the non-laparotomy approach. [Journal Article]
- Sci Rep 2014.:6312.
Colostomy is conventional treatment for anal dysfunction. Recently, a few trials of anorectal transplantation in animals have been published as a potential alternative to colostomies; however, further development of this technique is required. In this study, we utilized a canine model of anorectal transplantation, evaluated the patency of our microsurgical anastomoses, and assessed the perfusion of the transplanted anus. We designed a canine anorectal transplantation model, wherein anorectal autotransplantation was performed in four healthy beagle dogs by anastomoses of the lower rectum, the bilateral pudendal arteries (PAs) and veins (PVs), and pudendal nerves (PNs). Postoperative graft perfusion was measured by indocyanine green (ICG) angiography and histological examination. The length of the anorectal graft including perianal skin, anal sphincter muscle, bilateral PAs, PVs, and PNs was 4.9 ± 0.3 cm. All diameters of the PAs, PVs, and PNs were large enough to be microscopically anastomosed. Both ICG angiography and histological examination demonstrated good graft perfusion, except for one case that lead to venous congestion. These results show that anastomosis of the bilateral PAs, PVs, and PNs is required for anorectal transplantation. This is the first successful report of canine anorectal autotransplantation.
- Quantitative evaluation of age-related alteration of swallowing function: Videofluoroscopic and manometric studies. [JOURNAL ARTICLE]
- Auris Nasus Larynx 2014 Sep 5.
Swallowing function progressively deteriorates with advancing age, leading to high morbidity and mortality in the elderly population. To establish strategies for treatment of age-related swallowing disorders, the mechanisms of such disorders must be quantitatively clarified. The purpose of this paper was to elucidate the swallowing function of healthy elderly individuals by comparison with that of young adults by videofluorographic and manometric examinations.The subjects were 70 healthy volunteers with no history of diseases affecting swallowing function. They were classified into three groups according to age: the young adult group (21-32 years of age, n=8), early elderly group (60-69 years of age, n=39), and late elderly group (70-83 years of age, n=23). Their swallowing functions were quantitatively evaluated by videofluorographic and manometric studies.Videofluorographic examination showed no significant differences in the moving distances of the hyoid bone and larynx in the pharyngeal swallowing phase between the young and elderly groups. The pharyngeal transit time (PTT) of the bolus in the elderly group was longer and the percentage of laryngeal elevation (%LE) was lower than those in the young group. Manometric examination revealed higher hypopharyngeal swallowing pressure in the elderly groups. The traveling velocity of the swallowing pressure in the upper esophageal sphincter (UES) region and the UES relaxation time decreased with aging. Reduction of the UES pressure during the pharyngeal swallowing phase was insufficient in 15.4% of the early elderly group and 30.4% of the late elderly group. Additionally, the UES zone was broadened in 20.5% of the early elderly group and 26.1% of the late elderly group.Videofluorographic and manometric examinations quantitatively demonstrated that the swallowing reflex was delayed and UES opening was impaired by aging. UES dysfunction may develop secondary by increased tonicity and decreased elasticity of the cricopharyngeal muscle. Stimulation of oropharyngeal sensory function and exercising the laryngeal levator muscles may be effective for age-related swallowing disorders.
- A novel animal model for external anal sphincter insufficiency. [JOURNAL ARTICLE]
- Int J Colorectal Dis 2014 Sep 4.
Reliable animal models are essential to evaluate future therapeutic options like cell-based therapies for external anal sphincter insufficiency. The goal of our study was to describe the most reliable model for external sphincter muscle insufficiency by comparing three different methods to create sphincter muscle damage.In an experimental animal study, female Lewis rats (200-250 g) were randomly assigned to three treatment groups (n = 5, each group). The external sphincter muscle was weakened in the left dorsal quadrant by microsurgical excision, cryosurgery, or electrocoagulation by diathermy. Functional evaluation included in vivo measurements of resting pressure, spontaneous muscle contraction, and contraction in response to electrical stimulation of the afferent nerve at baseline and at 2, 4, and 6 weeks after sphincter injury. Masson's trichrome staining and immunofluorescence for skeletal muscle markers was performed for morphological analysis.Peak contraction after electrical stimulation was significantly decreased after sphincter injury in all groups. Contraction forces recovered partially after cryosurgery and electrocoagulation but not after microsurgical excision. Morphological analysis revealed an incomplete destruction of the external sphincter muscle in the cryosurgery and electrocoagulation groups compared to the microsurgery group.For the first time, three different models of external sphincter muscle insufficiency were directly compared. The animal model using microsurgical sphincter destruction offers the highest level of consistency regarding tissue damage and sphincter insufficiency, and therefore represents the most reliable model to evaluate future therapeutic options. In addition, this study represents a novel model to specifically test the external sphincter muscle function.
- Upper esophageal sphincter resting pressure varies during esophageal manometry. [Journal Article]
- Arq Bras Cir Dig 2014 Sep; 27(3):182-3.
The upper esophageal sphincter is composed of striated muscle. The stress of intubation and the need to inhibit dry swallows during an esophageal manometry test may lead to variations in basal pressure of this sphincter. Upper esophageal sphincter is usually only studied at the final part of the test. Was observed during the performance of high resolution manometry that sphincter pressure may vary significantly over the course of the test.To evaluate the variation of the resting pressure of the upper esophageal sphincter during high resolution manometry.Was evaluated the variation of the basal pressure of the upper esophageal sphincter during high resolution manometry. Were reviewed the high resolution manometry tests of 36 healthy volunteers (mean age 31 years, 55% females). The basal pressure of the upper esophageal sphincter was measured at the beginning and at the end of a standard test.The mean time of the test was eight minutes. The basal pressure of the upper esophageal sphincter was 100 mmHg at the beginning of the test and 70 mmHg at the end (p<0.001). At the beginning, one patient had hypotonic upper esophageal sphincter and 14 hypertonic. At the end of the test, one patient had hypotonic upper esophageal sphincter (same patient as the beginning) and seven hypertonic upper esophageal sphincter.A significant variation of the basal pressure of the upper esophageal sphincter was observed in the course of high resolution manometry. Probably, the value obtained at the end of the test may be more clinically relevant.
- [Blepharoplasty in aesthetic facial surgery]. [English Abstract, Journal Article]
- Ned Tijdschr Tandheelkd 2014 Jul-Aug; 121(7-8):395-400.
Blepharoplasty is the most commonly performed procedure in aesthetic facial surgery. The upper eyelid is part of the same aesthetic subunit as the eyebrow and the lower eyelid is part of the same aesthetic subunit as the cheek. In upper eyelid blepharoplasty the excess skin and possibly also a portion of the sphincter is removed. A low-hanging eyebrow is preferably corrected by lifting the brow instead of over excising the redundant eyelid skin. Blepharoplasty of the lower eyelid is generally carried out by a very limited excision of the skin and the orbicularis oculi muscle in order to prevent lower lid retraction (ectropion). Rejuvenation in the lower lid region is also achieved by fat resection or redistribution, by means of which the double convex contour deformity is reduced. Blepharoplasty is generally performed under local anaesthesia and complications are rare. Patient satisfaction is generally high.