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Colorectal Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Jennie Grainger, Samson Tou, Steve Schlichtemeier, William Speake, Fung Joon Foo, Frank McDermott
When offering pouch surgery, what other aspects do you need to consider?Good anal sphincter function – risk of incontinence is high if not.Exclude Crohn's disease (high failure rate).Should not be performed in patients with active anal lesions (fissure, anorectal sepsis or ulceration).Exclude sclerosing cholangitis (relatively contraindicated due to high incidence of pouchitis).Fecundity – decrease in female infertility after pouch surgery (likely due to the rectal dissection), so either delay surgery or accept the risk of reduced fertility, which can generally be overcome with in-vitro fertilisation techniques.
Endocrinology and gonads
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
11.23. Which of the following statements is/are true of penile hypospadias?The chordee is often the major functional disability,The urethral meatus is often very narrow.Urethral sphincter is often deficient.Impotence is present in more than 20% of cases.Neonatal circumcision is absolutely contraindicated.
Smooth Muscle
Published in Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal, Principles of Physiology for the Anaesthetist, 2020
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal
Smooth muscles have diverse mechanical properties. These properties have evolved to fit the role carried out by the particular muscle. Some smooth muscles can shorten to much smaller fractions of their relaxed lengths. This is an important property in sphincter muscles.
Current development and clinical applications of artificial anal sphincter
Published in Expert Review of Medical Devices, 2023
Minghui Wang, Yunlong Liu, Qingjun Nong, Hongliu Yu
Artificial anal sphincters in animal studies and clinical applications are analyzed in this paper. The performance comparison of different artificial sphincter systems is shown in Table 1. The actuation principles, power supply type, rectal perception function, biomechanical compatibility and progressive stage are considered in this table to compare the existing artificial anal sphincters, which show that the existing artificial anal sphincters have different design concepts and functions. Four types of the existing artificial anal sphincters have entered clinical studies. The details of the clinical studies for artificial anal sphincter are shown in Table 2. The results of clinical studies indicate that each artificial anal sphincter has some complications.
Biomedical applications of muscle-derived stem cells: from bench to bedside
Published in Expert Opinion on Biological Therapy, 2020
Other clinical trials have been attempted using the local transplantation method due to the aforementioned reasons. One of the studies focused on applications in the functional recovery of the lower urinary tract, such as stress urinary incontinence (SUI). The lower urinary tract is mainly composed of smooth and skeletal muscle sphincters, and decreased tonus of these sphincters causes SUI. The supporting connective tissue networks are also considered to contribute to the sphincter tonus. Therefore, by using a mixture of myoblasts and myofibroblasts, a certain level of clinical improvement, such as an increase in thickness of the urethral sphincter and maximum urethral closure pressure, has been demonstrated [72–76]. Moreover, the patients did not present any adverse side effects, indicating the safety of this therapy, and the effects lasted at least up to 12 months [73,77]. Therefore, this therapy is potentially more effective as the engrafted cells have the capacity of vascular and peripheral nerve reconstitution [78].
Intraspinal dermoid and epidermoid cysts: Long-term outcome and risk factors
Published in The Journal of Spinal Cord Medicine, 2020
Xin Wang, Jun Gao, Tianyu Wang, Zhimin Li, Yongning Li
Intraspinal dermoid and epidermoid cysts are predominately caused by the separation of skin ectodermal tissue and nerve tissue during the embryonic period but can also be acquired by other causes including lumbar puncture or trauma, leading to the displacement of epithelial tissue.2,6 These cysts can occur at any position in the spinal cord, but the most commonly reported occurrence is in the lumbosacral and extramedullary regions, which is in accordance with our findings.7 In particular, three cases occurred in the cervical region in our study; only a few cases in this region have been previously reported.8 Typically, the disease onset occurs in young individuals. Because the tumor growth is slow, the course of the disease is generally long, and the cysts are not easy to detect early. Moreover, there is no obvious specificity of the clinical symptoms, with the first symptoms including pain in the back and lower limbs, weakness of the lower limbs and sphincter disturbances.7 The most common symptoms in our study were sphincter disturbances, which occurred in 52.63% of the patients. In addition, the disease is usually associated with scoliosis, dermal sinus, a tethered cord and other abnormalities, including an average of 50% patients with a complicated dermal sinus.9 However, only 10 patients were found with dermal sinus in our hospital.