Fissure Group Research Articles

Karst fissures mitigate the negative effects of drought on plant growth and photosynthetic physiology.

Hard limestone substrates, which are extensively distributed, are believed to exacerbate drought and increase the difficulty of restoration in vulnerable karst regions. Fissures in such substrates may alleviate the negative effect of drought on plants, but the underlying mechanisms remain poorly understood. In a two-way factorial block design, the growth and photosynthesis of 2-year-old Phoebe zhennan seedlings were investigated in two water availabilities (high versus low) and three stimulated fissure habitat groups (soil, soil-filled fissure and non-soil-filled fissure). Moreover, the fissure treatments included both small and big fissures. Compared to the soil group, the non-soil-filled fissure group had decreased the total biomass, root biomass, total root length, and the root length of fine roots in the soil layer at both water availabilities, but increased net photosynthetic rate (Pn) and retained stable water use efficiency (WUE) at low water availability. However, there were no significant differences between the soil-filled fissure group and soil group in the biomass accumulation and allocation as well as Pn. Nevertheless, the SF group decreased the root distribution in total and in the soil layer, and also increased WUE at low water availability. Across all treatments, fissure size had no effect on plant growth or photosynthesis. Karst fissures filled with soil can alleviate drought impacts on plant root growth, which involves adjusting root distribution strategies and increasing water use efficiency. These results suggest that rock fissures can be involved in long-term plant responses to drought stress and vegetation restoration in rocky mountain environments under global climate change.

Simulating earth deformation evolution caused by groundwater pumping through ordinary state-based Peridynamics method

Earth deformation including land subsidence and the related earth fissures caused by the over-exploitation of groundwater resources is threatening countries all over the World. At present, the simulation of earth deformation of aquifer system is mainly based on continuum and contact mechanics. These approaches lead to two main challenges, i.e. the need of knowing the location of possible earth fissures in advance and using meshes that must be adjusted during the rupture propagation. Here, ordinary state-based Peridynamics method is firstly introduced to simulate the evolution of continuous and discontinuous earth deformation due to groundwater withdrawal. A failure criteria accounting for shear and tensile strain simultaneously is proposed. The approach is used to simulate the evolution of land subsidence and earth fissures in compressible sedimentary soils with buried rigid ridges. Two case studies are reproduced: one is a test carried out in laboratory and the other one concerns Guangming village, Yangtze River delta. In both cases, the presence of a shallow buried bedrock crossing the alluvial deposits is responsible for the initiation and growth of earth fissure that a satisfactory captured by the model. For the lab experiment, a 0.1 m deep fissure appearing above the rocky tip is computed. In Guangming village area, results show that some small fissure groups were initiated. Then, three main earth fissures developed rapidly with the maximum depth of 32.5 m. This study proposes a consistency modelling framework to simulate continuum earth deformation and discontinuous fissures due to groundwater withdrawal in specific geological settings, and supply a reliable scientific tool for early warning of this geo-hazard.

Application of ALCOCK Tube Ultrasound-guided Internal Pudendal Nerve Block in Postoperative Anal Analgesia

Background: While surgery is the most effective treatment for anorectal diseases, traditional anesthesia methods are increasingly regarded not suitable for the clinical needs of anorectal patients. Although pudendal nerve block can play a good analgesic role in the anal region, the traditional pudendal nerve block is performed under blind probing, which is inaccurate in positioning, has poor anesthesia effect, and causes many complications. Objectives: At present, ultrasound-guided pudendal nerve block for analgesia has emerged in clinical practice. Therefore, the present study aimed to investigate the analgesic effect of ALCOCK tube ultrasound-guided internal pudendal nerve block in anal surgery. Methods: A prospective study was conducted. A total of 134 patients who underwent anal surgery in Hangzhou Lin'an District First People's Hospital from May, 2021 to July, 2022 were divided into three categories according to mixed hemorrhoids, anal fistula, and anal fissure and randomly divided into control and experimental groups. The two groups were treated with corresponding surgical treatment, and the experimental group was treated with bilateral pudendal nerve block under the guidance of ALCOCK tube ultrasound at the end of the operation. The operation time, blood loss, initial postoperative pain time, and visual analogue scale, postoperative pain score at each time point, incidence of complications, and patient satisfaction were recorded and analyzed. Results: The operation time of the experimental group was significantly longer than that of the control group, the bleeding volume of anal fistula in the experimental group was more than the control group, the first pain time of anal fistula in the experimental group was higher than that of the control group. The first pain score of anal fistula in the experimental group was lower than that of the control group. Follow-up showed that the pain scores of anal fistula and anal fissure groups were inconsistent 48 h after surgery. The total incidence of adverse reactions was lower, and the patient satisfaction was higher in the experimental group than in the control group. Conclusion: The application of internal pudendal nerve block under the guidance of ALCOCK tube ultrasound in anal surgery has a good analgesic effect and high patient satisfaction, which is worthy of promotion.

To Investigate the Association between the Extent of Lateral Internal Anal Sphincterotomy and Postoperative Fecal Incontinence in Individuals with Chronic Anal Fissure

Background: The primary objective of this investigation was to evaluate the prevalence of fecal incontinence after surgery in individuals who underwent open lateral internal anal sphincterotomy up to the dentate line compared to those undergoing anal sphincterotomy (open internal) up to the height of the anal fissure. Methodology: This study was randomized and controlled and was carried out in Abbasi Shaheed Hospital, Karachi, at the department of surgery between February 2021 and July 2022. The study enrolled patients who were 15 years or older and presented to the outpatient department with chronic anal fissure, regardless of gender. Patients with concomitant anal disease, those with previous history of anorectal surgery & those with systemic neurological disease leading to fecal incontinence were excluded. Analysis of the collected data was performed using SPSS version 23. For quantitative variables, such as age, standard deviation and mean were calculated. Conversely, the qualitative variables, such as gender, location of anal fissure, Browning and Park's classification of incontinence, and final outcome(i.e. fecal incontinence at 5th postoperative day), were assessed using percentages and frequency. Results: In this study, 198 individuals who are chorincally suffering from anal fissure were identified and divided into two groups, Group A and B, each consisting of 99 patients. Group A underwent an open lateral internal anal sphincterotomy up to the level of the dentate line (referred to as the "dentate line group"), while Group B received an open lateral internal anal sphincterotomy up to the height of the fissure (known as the "height of fissure group").Fecal incontinence was assessed and compared between both groups on 5th postoperative day by using Browning and Park’s classification. The findings of this investigation indicated that open lateral anal sphincterotomy up to the level of the dentate line was associated with an 11.1% incidence of fecal incontinence, while a 3% incidence of fecal incontinence was observed in individuals who underwent anal sphincterotomy (lateral internal) up to the height of the anal fissure. Practical Implication: present study suggests that lateral internal anal sphincterotomy up to the height of anal fissure may be associated with a lower risk of fecal incontinence compared to the dentate line group. Conclusion: The data obtained from this study suggested that open anal sphincterotomy (lateral internal) up to the height of the anal fissure was linked to reduced incidence rates of postoperative fecal incontinence on the fifth day after surgery, as compared to open anal sphincterotomy (lateral internal) up to the level of the dentate line. Therefore, this modification should be used in future regularly in order to reduce this morbidity. Keywords: Fecal incontinence, Chronic Anal Fissure, Sphincterotomy.

Robot-assisted thoracic surgery for lung cancer patients with incomplete fissure.

Robot-assisted thoracic surgery has gradually been accepted as an alternative treatment for early-stage non-small-cell lung cancer (NSCLC) owing to its advantages. However, severe incomplete interlobar fissure may lead to a high rate of conversion and postoperative morbidity. This retrospective study was conducted to assess the safety and efficiency of robot-assisted lung resection for patients with incomplete fissures (IFs). A retrospective review of medical records was performed in our institution from March 2021 to November 2021, and 207 patients with NSCLC who underwent robot-assisted anatomic lung resection were included in this study. Patients were divided into the IF group and the complete fissure (CF) group according to the level of fissure, which was determined based on the anatomical classification of pulmonary fissures. The number of patients in the IF and CF groups was 87 and 120, respectively. In univariate analysis, there were no statistically significant differences between the two groups in terms of operative time (p = 0.66), intraoperative blood loss (p = 0.26), chest tube duration (p = 0.41), incidence of prolonged air leakage (PAL, p = 0.49), or length of postoperative hospital stay (p = 0.25). No patients experienced bronchopleural fistula, pneumonia, or cardiovascular complications. The total cost in the IF group was higher than that in the CF group (¥83,655 ± 13,314 versus ¥78,211 ± 11,980, p = 0.002). IF does not increase the difficulty of lung cancer surgery with robotic platforms. Robot-assisted anatomic lung resection using the tunnel technique is an effective and safe method for IF patients.

Thoracoscopic lobectomy through the pulmonary hilum approach for the treatment of congenital lung malformation.

Thoracoscopic lobectomy is widely accepted for the treatment of congenital lung malformations (CLM), owing to its advantages. However, severe incomplete interlobar fissure may lead to a high rate of conversion to thoracotomy and postoperational complications. Thoracoscopic lobectomy utilizing the pulmonary hilum approach may be an effective and safe method to resolve these problems. This retrospective study was conducted to estimate the safety and efficiency of this approach. A retrospective review of medical records was performed in our institution, from January 2014 to December 2019, and 432 patients with CLM who underwent thoracoscopic lobectomy through the pulmonary hilum approach were included in this study. Patients were divided into the incomplete fissure (IF) group and complete fissure (CF) group according to the level of fissure, which was proposed by an anatomical classification of pulmonary fissures. Patients in the IF and CF groups were 131 and 301, respectively. In univariate analysis, there were statistical significances between the two groups in terms of intraoperative blood loss (P = 0.04), surgical time (P = 0.01), the number of chest tube drainages (P < 0.01), and the total length of hospital stay (P = 0.03). However, no patients experienced bronchopleural fistula, postoperative pneumonia, or conversion to thoracotomy in either group. Five patients experienced prolonged air leakage in the IF group, and no prolonged air leakage occurred in the CF group. An IF would certainly increase the difficulty of CLM surgery, and thoracoscopic lobectomy using the pulmonary hilum approach is an effective and safe method for CLM patients.

Evaluation of the Mechanical Properties of Anorectal Tissues and Muscles by Shear Wave Elastography in Anal Fıssure Disease.

To evaluate the mechanical properties of the tissues and muscles in the anal region with the shearwave elastography for anal fissure etiology. Descriptive study. Adana City Training and Research Hospital, Turkey, from March2019 to March 2020. In this study, 30 patients (fissure group), who were diagnosed with anal fissure in the outpatient clinic; and 20 patients (control group), who did not have any problem in anal examination were included. The anorectal tissues and muscles mechanical properties(elasticity,compliance and stiffness) were compared with the shear wave elastography values.Fissure area,internal anal sphincter,external anal sphincter and levator ani muscles elastographic measurements was performed with 5-18 MHzin lithotomy position, at rest and with Valsalva maneuver. In elastographic measurement of fissure area (fissure) and normal anorectal tissue (control, AFE); control group values were significantly higher than the fissure group values (p<0.001, and padj <0.001, respectively). Control group valuesof internal anal sphincter in rest and Valsalva maneuver (IAS-R, and IAS-V, respectively) were significantly higher than the fissure group values (p<0.001, padj< 0.001, and p<0.001, padj <0.001, respectively). There was no significant difference between the elastographic measurement values in rest and valsalva maneuver of the external anal sphincter (EAS-R and EAS-V) (p>0.05). Elastographic measurement values of levator ani muscle (LAM) resting state; were significantly higher in thefissure group than the control group (p<0.001, and padj <0.001, respectively). Elastographic cut-off values that differentiate the fissure group from control group were found to be ≤1kPa forAFE group, ≤44 kPa forIAS-R, ≤0.4kPa forIAS-V,and >11kPa for LAM,respectively. Conclusıon: In anal fissure disease, tissues mechanical properties measured by shear wave elastography showed increased tissue stiffness, which may be added to etiology of this disease. Key Words: Anal fissure, Ultrasonography, Shear wave elastography, Anal sphincter, Tissue elasticity, Tissue stiffness.

Analysis and comparison of two types of ground fissures in Dali County in the Weihe Basin, China

Dali County is located in the eastern Weihe Basin where frequent ground fissure disasters occur. Dali ground fissures are macroscopically part of the ground fissure group in the Weihe Basin and have caused serious damage to infrastructure and agricultural production in this area. In this paper, 25 ground fissures in Dali County are identified through investigation, and two typical ground fissures in Fengcun and Weizhuang are selected for research. Through field investigation, trench excavation, geophysical exploration, soil water content tests and collapsibility coefficient tests, the basic features, shallow structural characteristics, deep structural characteristics and genetic mechanisms of the two ground fissures are revealed. The strike of the Fengcun ground fissure is 45°, almost parallel to the Shuangquan-Linyi Fault; the length is 2 km, and the profile is ladder-like and extends deep with synsedimentary characteristics. The Weizhuang ground fissures are circular in plan view with a length of 315 m and trumpet-shaped in profile; they disappear in the paleosol layer. The mechanism of the Fengcun ground fissure is related to basin extension and fault activity. The ground fissures are the surface reflections of deep faults. The mechanism of the Weizhuang ground fissures is related to loess collapsibility and seepage. The Malan loess has differential settlement in collapsible and noncollapsible areas, and ground fissures are the boundary line for differential settlement of loess. Finally, based on the genetic mechanisms of ground fissures, Dali ground fissures can be divided into two types: tectonic and nontectonic.

Development characteristics and mechanisms of the Taigu–Qixian earth fissure group in the Taiyuan basin, China

Since the 1980s, increasing human activity and continuing over-exploitation of groundwater resources have caused the earth fissures in the rift basin in Shanxi, China, to enter an active phase. Buildings along these earth fissures have been seriously damaged. Four massive earth fissures that developed in the Taigu and Qixian areas of the eastern Taiyuan basin endanger the operational safety of the high-speed railway that passes through this region. Using field observations, measurements, and exploration, we determined that the four earth fissures are parallel to each other, have a northeast trend, and are separated by approximately equal distances. The rupture zones of these earth fissures are generally 10–50 m wide and are formed by the main fissures and secondary fissures. The width of the zone affected by the earth fissures is 20–50 m based on deformation and the damage done to buildings. These fissures formed on the Earth’s surface; their hanging walls are lower than their foot walls, forming normal faults; and the ground surface around the fissures exhibits ridges and depressions. The fissures are connected to deep hidden faults. The fault displacement increases with increasing depth, which is characteristic of syn-sedimentary faults. These earth fissures are characterized by vertical displacement, and their average annual activity rate is 1–3 cm. We believe that the formation of this large-scale fissure group may be related to the tectonic structure of the hidden faults in the basin and may also be affected by the continuous regional extensional stress of the basin. The current increased level of activity could be caused by the over-exploitation of groundwater in the area.

T category of non–small cell lung cancer invading the fissure to the adjacent lobe

BackgroundDispute arises in the tumor category of non–small cell lung cancer invading the fissure to the adjacent lobe. The purpose of this study is to determine the long-term prognosis of non–small cell lung cancer with such an invasion and to propose an appropriate T category. MethodsIn total, 53 cases of non–small cell lung cancer invading the fissure to the adjacent lobe (fissure group) were identified in patients who underwent pulmonary resection from 1997 to 2014. Propensity score matching was applied to balance known confounders for prognosis between each paired group, resulting in 3 matched sets (fissure vs T2a, fissure vs T2b, and fissure vs T3). The overall survival of the fissure group was compared with the survival of patients with T2a, T2b, and T3 diseases, as classified in the eighth edition of TNM classification. ResultsThe 5-year survivals of the T2a, T2b, T3, and fissure groups were 64.2% (95% confidence interval, 53.2-72.6), 54.6% (95% confidence interval, 44.7-65.8), 35.8% (95% confidence interval, 22.8-44.2), and 38.6% (95% confidence interval, 25.0-52.2), respectively. Specifically, the difference between the fissure group and T2a is statistically significant at P = .01; between the fissure group and T2b at P = .02; and between the fissure group and T3 at P = .93. Multivariate analyses indicate that the fissure group had a similar risk of dying as the T3 disease group (hazard ratio, 1.10; 95% confidence interval, 0.69-1.37) and was at a significantly higher risk compared with the T2a group (hazard ratio, 2.34; 95% confidence interval, 1.50-3.39) and T2b group (hazard ratio, 1.71; 95% confidence interval, 1.19-2.76). ConclusionsOn the basis of our single-institution study, we propose that non–small cell lung cancer invading the fissure to the adjacent lobe should be further investigated and the impact on patients’ prognoses validated as a T3 disease.

Fluid-Signal Structures in the Cervical Spinal Cord on MRI: Anterior Median Fissure versus Central Canal.

Hyperintense fluid-signal anterior median fissure and hyperintense foci resembling the central canal are seen on cervical spine axial T2 MR imaging. They may also be associated with a channel-like T2-hyperintense craniocaudad line on sagittal images. We hypothesized that the hyperintense foci and the sagittal line may represent the base of the anterior median fissure. In this exploratory study, 358 cervical MR images were analyzed for recording and comparing the incidence/numbers of hyperintense foci, anterior median fissure, and sagittal line as hyperintense foci, anterior median fissure, and sagittal line per patient when present alone or together, both with and without the sagittal line. Hyperintense foci were identified on 238/358 (66.5%) studies; an anterior median fissure, on 218/358 (60.9%). The hyperintense foci/anterior median fissure ratio was 3.7/2.3 (P = .00001). Anterior median fissures were seen alone less commonly than hyperintense foci were seen alone (P = .045). We identified increased anterior median fissure/patient in a hyperintense foci +anterior median fissure group compared with an anterior median fissure-only group (4.0 versus 3.2, P = .05), with similar hyperintense foci/patient in the hyperintense foci+anterior median fissure and hyperintense foci-only groups (5.5 versus 5.8, P = .35), and proportional distribution of both across the hyperintense foci+anterior median fissure subgroups (hyperintense foci/anterior median fissure ratio, 1.3). The sagittal line in 89 (24.9%) patients was associated with increased hyperintense foci and anterior median fissure/patient. Greater correlation of anterior median fissure/patient to sagittal line presence was seen in sagittal line subgroup analysis. This exploratory analysis found an increased anterior median fissure per patient in conjunction with hyperintense foci presence, a proportional increase of both across the hyperintense foci+anterior median fissure group, and greater correlation of anterior median fissure per patient with the sagittal line. These findings suggest that anterior median fissure and hyperintense foci are structurally related, that hyperintense foci may commonly be the base of the anterior median fissure, and that the sagittal line is a manifestation primarily of an anterior median fissure, occasionally appearing as channels that may simulate the central canal.

Anterior anal fissures are associated with occult sphincter injury and abnormal sphincter function

The pathogenesis of chronic anal fissure (CAF) remains incompletely understood but most are associated with a high resting anal pressure and reduced perfusion at the fissure site. To date, no major distinction has been made between anterior and posterior anal fissures and their aetiology and treatment. We compared anterior and posterior fissures in patients who have failed to respond to medical treatment with respect to their underlying aetiology, anal canal pressures and sphincter muscle integrity. Seventy consecutive patients (54 female:16 male) with a symptomatic CAF and 39 normal controls (19 female:20 male) without evidence of significant ano-rectal pathology were prospectively assessed by manometry and anal endosonography. Anterior anal fissures were identified in a younger age group [33 years (IQR 26-37) vs 41 years (IQR 36-52)] and predominantly in women. Anterior fissure patients were significantly more likely to have underlying external anal sphincter defects compared with posterior fissures [OR 10.9 (95% CI 3.4-35.4)]. Maximum resting pressure was not significantly elevated for anterior fissures compared with controls (P = 0.316) but was significantly elevated in posterior fissures (P = 0.005). The maximum squeeze pressure was significantly lower in the anterior fissure group [167 cmH2O (IQR 126-196) vs 205 cmH2O (IQR 174-262), P = 0.004]. A history of obstetric trauma was significantly associated with anterior fissure location [OR 13.9 (95% CI 3.4-55.7)]. Anterior anal fissures are associated with occult external anal sphincter injury and impaired external anal sphincter function compared with posterior fissures. These findings have implications for treatment, especially if a definitive procedure, such as lateral internal sphincterotomy, is considered.

Resting Anal Pressure Following Hemorrhoidectomy and Lateral Sphincterotomy

The role of high anal pressure in the pathophysiology of hemorrhoids and anal fissures is debated. We compared resting anal pressures following left lateral sphincterotomy and hemorrhoidectomy in a prospective manometric study with emphasis on the recovery of the internal anal sphincter activity. Included in the study were 38 patients with third-degree or fourth-degree symptomatic hemorrhoids who underwent hemorrhoidectomy, 50 patients with anal fissure who underwent sphincterotomy, and 12 healthy patients who served as controls. All patients with anal fissure or hemorrhoids underwent periodic manometric evaluation: 1 month before surgery and 1, 3, 6, and 12 months after surgery. The control group had three manometric evaluations 6 months apart. Baseline pressure measurement in the fissure group was significantly higher than in the hemorrhoid group, which was significantly higher than in the control group (138 +/- 28.4 mmHg vs. 108.4 +/- 23 mmHg vs. 73 +/- 5.9 mmHg, P < 0.0001). Twelve months after surgery, anal resting pressure remained significantly lower than the baseline measurements in both the fissure (110 +/- 18.2 vs. 138 +/- 28.4, P < 0.0001) and hemorrhoid groups (103.6 +/- 21.5 vs. 108 +/- 23, P < 0.0001), but both remained higher than the control group (103.6 +/- 21.5 mmHg vs. 73 +/- 5.9 mmHg, P < 0.0001). Resting pressure is elevated in hemorrhoid and anal fissure patients. After surgery the anal resting pressure is reduced but is still higher than in the control group. Further studies are required to investigate the protective effect of postsurgical reduction of anal resting pressure against recurrence.

Internal Anal Sphincter Function Following Lateral Internal Sphincterotomy for Anal Fissure

Anal fissure is a common and painful disorder. Its relation to hypertonic anal sphincter is controversial. The most common surgical treatment of chronic anal fissure is lateral internal sphincterotomy. The aim of this study was to evaluate long-term manometric results of sphincter healing following lateral internal sphincterotomy. Between 2000 and 2003, 50 patients with anal fissure were included in this study and underwent sphincterotomy; 12 healthy patients served as controls. All patients with anal fissure underwent manometric evaluation using a 6-channel perfusion catheter. All patients were examined 1 month before surgery and 1, 3, 6, and 12 months following surgery. The control group had 3 manometric evaluations 6 months apart. The mean basal resting pressure before surgery was 138 +/- 28 mm Hg. One month after surgery, the pressure dropped to 86 +/- 15 mm Hg (P < 0.0001) and gradually rose to a plateau at 12 months (110 +/- 18 mm Hg, P < 0.0001). At 12 months, the manometric pressure was significantly lower than the baseline (P < 0.0001). However, manometric measurements in the fissure group were still significantly higher than in the control group (110 +/- 18 versus 73 +/- 4.8 mm Hg, P < 0.0001). All patients were free of symptoms at the 12-month follow-up. Lateral internal sphincterotomy caused a significant decline in the resting anal pressure. During the first year following surgery, the tone of the internal anal sphincter gradually increased, indicating recovery, but still remained significantly lower than before surgery. However, postoperative resting pressures were higher than those in the control, and no patient suffered any permanent problems with incontinence, so this decrease may not be clinically significant.

Study of fissured-rock seepage flow with isotope tracer method in single borehole

A systematic summary is presented describing the application of isotope tracer method in detecting seepage flow in a single borehole. In a single borehole, many hydraulic coefficients, such as flow velocity, direction of flow, vertical flow etc., Can be obtained by using isotope tracer method. There are three conditions if a fissure intersects a borehole: vertical, parallel and tilt. According to each different condition, the formulation of flow velocity deduced by isotope dilution method is different. At the same time, well theory of blended borehole about fissure groups including single fissure group and multi-fissure groups, has also been discussed.

Does an incomplete interlobar fissure influence survival or recurrence in resected non-small-cell lung cancer?

Objective: There have been various reports on prognostic factors in non-small-cell lung cancer (NSCLC) under a complete resection, but an incomplete interlobar fissure has not been discussed yet. We attempted to clarify whether this influences survival or recurrence. Patients and methods: From 1981 to 1994, 239 patients (43%) who had a single lobectomy with mediastinal lymph node dissection were pathologically diagnosed as stage IA/IB or IIA/IIB (excluding T3N0M0). These patients were divided in two groups: patients with a complete interlobar fissure group (group L); and patients with an incomplete one (group NL). Postoperative survivals and cancer-free periods were retrospectively assessed. Patients’ characteristics had no statistical difference between groups L and NL by N category. Results: The 5-year survival was 77.0% in group L-N0, 79.3% in group NL-N0, 48.7% in group L-N1, and 66.2% in group NL-N1. No statistical difference was found between groups L-N0 and NL-N0, L-N1 and NL-N1, L-T1N0 and NL-T1N0, L-T1N1 and NL-T1N1, L-T2N0 and NL-T2N0, and L-T2N1 and NL-T2N1. The 5-year-relapse-free survival was 81.2% in group L-N0, 85.4% in group NL-N0, 69.4% in group L-N1, and 72.2% in group NL-N1. No statistical difference was found between groups L-N0 and NL-N0, L-N1 and NL-N1, L-T1N0 and NL-T1N0, L-T1N1 and NL-T1N1, L-T2N0 and NL-T2N0, and L-T2N1 and NL-T2N1. There was no statistical difference in recurrent sites between groups L-N0 and NL-N0, and L-N1 and NL-N1. Conclusion: We conclude that the incomplete interlobar fissure does not influence the prognosis of resected stage I or II NSCLC (excluding T3N0M0).

Effect of catheter diameter on resting pressures in anal fissure patients.

Controversy exists as to whether fissure patients have elevated resting pressures when compared with control patients. The diameter of manometry catheters used in past studies varies widely (1.5-25 mm) and may have contributed to differences observed in resting pressures. A prospective study was undertaken to determine the influence of manometry catheter diameter on maximum resting pressure in patients with idiopathic chronic anal fissures. A total of 28 fissure patients and 28 control patients had manometry performed with both a 1.8-mm and a 4.8-mm (external diameter) water-perfused catheter. Mean maximum resting pressure (RP) for fissure patients as measured with the 1.8-mm catheter was 86 (range, 65-115) mmHg and 83 (range, 47-117) mmHg with the 4.8-mm catheter (P = 0.65). Mean maximum RP for control patients with the 1.8-mm catheter was 70 (range, 30-108) mmHg and 72 (range, 35-109) mmHg with the 4.8-mm catheter (P = 0.07). When fissure and control patients were compared, a significantly higher mean RP was observed in the fissure group for both the 1.8-mm catheter (86 vs. 70 mmHg, respectively; P = 0.01) and the 4.8-mm catheter (83 vs. 72 mmHg, respectively; P = 0.03). There was no significant difference in length of the high-pressure zone within each group or when the fissure group and controls were compared, regardless of catheter used. For both groups of patients, there was a significantly higher incidence of ultraslow waves (USWs) observed with the 4.8-mm catheter when compared with the 1.8-mm catheter. The USW frequency was not significantly different when fissure and control groups were compared with either catheter type. Catheter size did not influence measured maximum RP in fissure patients. The maximum RP was significantly greater for fissure patients overall when compared with the control group, regardless of catheter used. There was an increased frequency of USWs noted with the larger catheter size in all patients; however, these USWs only became apparent when catheter was left at each station until a true baseline RP was obtained.

Sustained internal sphincter hypertonia in patients with chronic anal fissure

This study was designed to determine whether functional variations of internal sphincter activity occur in order to differentiate between patients with anal fissures from those with hemorrhoids. Thirty patients with chronic anal fissure (median age, 28 years; 12 females), 22 patients with hemorrhoids (median age, 37 years; 7 females), and 33 control volunteers (median age, 48.5 years; 21 females) underwent ambulatory anal sphincter fine-needle electromyography and anorectal manometry. The median internal sphincter electromyography frequency was similar: fissure group, 0.49 Hz; hemorrhoid group, 0.46 Hz (P > 0.05), and control group, 0.44 Hz (P > 0.05). Median anal resting pressures were similar in the fissure group (132 cm. H2O) and the hemorrhoids group (116 cm of H2O) (P > 0.05), but significantly greater than those in the control group (94 cm. H2O) (P < 0.05). The median number of transient relaxations of the internal and sphincter with an associated rise in rectal pressure and fall in anal pressure was 1 (range, 0-4) per hour in the fissure group, 6 (range, 4-7) per hour in the hemorrhoid group, and 4 range, 3-6) per hour in the control group. Six patients with fissures were reassessed following lateral internal sphincterotomy. Median and pressure was 102 cm of H2O (P > 0.1 vs. controls) and the number of internal sphincter relaxations increased to 4 per hour (P < 0.01 vs. preoperative number). Internal anal sphincter relaxation occurs on fewer occasions in patients with chronic anal fissures that have failed to heal in comparison to patients with hemorrhoids and normal controls. This evidence further supports the hypothesis that internal sphincter hypertonia may be relevant to the pathogenesis of this disorder.

Combining law with medical ethics.

A postgraduate Diploma in Medical Ethics and Law was started in October 1984 by the Centre of Medical Law and Ethics at King's College. It is a part-time one year course designed so as to enable students to continue with full-time employment if they wish. It is multidiscipinary and is open to all who have a first degree in a relevant discipline, for example law, philosophy, theology, medicine and nursing studies. It is unique in combining medical law and medical ethics and has attracted students of high calibre from a variety of backgrounds during its first three years. Building on the experience of the diploma the course is being upgraded to an MA in 1987-88. It will be available either full-time for one year or part-time for two years.

4. The New Classification of Anal Fissure and the Treatment

Anal fissure treatment must be decided by objective macroscopic finding than subjective symptom that is serious or not.Anal fissure group into three classes according to the progress.First degree anal fissure ; it is a new simple fissure of anal canal.Second degree anal fissure ; it is ulceration, surface of the ulcer change the fiberous in the lateral edges where undermine.Third degree anal fissure ; it combined with big sentinel tag, hypertrophied anal papilla, haemorrhoids and fistula in ano, etc.On the other hand, the treatment classification three big classes.1) Concervative treatment : Avoidance of constipation. It use an internal medicine ointment and suppository.2) Intermediate treatment : Lapis cautery. Use of an anal dilatator and streching of the anal sphincter, and lockal anaesthetics.3) Operative treatment : L. S. I. S. (Lateral subcutaneous anal internal sphincterotomy).S. S. G. (Excision with sliding skin grafts).Excision and sphincterotomy.Cryosurgical fissurectomy.These three groups are fit for three treatments, and I've been tried to treatment.During the past two years, 1 treated 326 patents, and get the satisfying answer.This method help to simplify a treatment, and can use an example for biginners. 1 believe this method is very useful.