Tolerable Volume Research Articles

Fecal Incontinence

Purpose: Fecal incontinence (FI) has been receiving increased attention from health care providers. Better characterization of patients is needed to improve understanding and treatment. Differentiation of patients based on frequency and severity of fecal incontinence includes major incontinence (MajorI) representing frequent (at least one episode per week) occurrence of urge or passive incontinence and minor incontinence (minorI) representing occasional leakage. Some patients with fecal incontinence may also have concomitant constipation and urinary incontinence. Aim: To characterize fecal incontinence (FI) using both symptoms and motility testing. Methods: Patients referred to the Temple University GI Motility Laboratory for anorectal manometry between January to May 2008 filled out a questionnaire using validated questions and underwent anorectal manometry (ARM), anal electromyography (EMG), and balloon expulsion testing (BET). Results: Thirty-nine patients with FI were evaluated; fifteen patients had MajorI and twenty-four had minorI. Patients with MajorI reported 34 ± 12 stools per week compared to only 7 ± 2 for patients with minorI (P= 0.01). Constipation was present in 5/15 (33%) MajorI patients but in 18/23 (78%) minorI patients (P= 0.01). MajorI patients described their stool as 5.1 ± 0.6 on the Bristol stool form scale compared to 3.4 ± 0.5 for minor I (P= 0.05). Urinary incontinence was present among 9/15 (60%) MajorI patients and 6/24 (38%) minorI patients (P= 0.20). Of the 39 patients with FI, physiologic abnormalities included low resting anal sphincter pressure (12 patients), low volitional contractile response of the external anal sphincter (16 patients), elevated threshold for first sensation (18 patients), paradoxical EMG response while bearing down (17 patients), and prolonged balloon expulsion (16 patients). Compared to patients with minorI, patients with MajorI tended to have lower resting basal anal pressure (63 ± 9 vs 68 ± 4 mmHg; P= 0.59) and volitional contractile response (57 ± 15 vs 73 ± 11 mmHg; P= 0.39), but higher threshold for first sensation (29 ± 3 vs 25 ± 2 ml; P= 0.10), desire to defecate (129 ± 33 vs 87 ± 8 ml; P= 0.41), and maximum tolerable volume (167 ± 20 vs 142 ± 15 ml; P= 0.32). Evidence for dyssynergic defecation was present among 5/15 (33%) patients with MajorI and 11/24 (46%) patients with minorI (P= 0.52). Conclusion: Patients with major incontinence reported more frequent bowel movements and looser stools than those with minor incontinence. Interestingly, patients with minor incontinence also frequently reported constipation. Careful symptom evaluation in patients with fecal incontinence complements anal manometry in characterizing patients with fecal incontinence.

Early Hypertension Is Associated With Reduced Regional Cardiac Function, Insulin Resistance, Epicardial, and Visceral Fat

Mild-to-moderate hypertension is often associated with insulin resistance and visceral adiposity. Whether these metabolic abnormalities have an independent impact on regional cardiac function is not known. The goal of this study was to investigate the effects of increased blood pressure, insulin resistance, and ectopic fat accumulation on the changes in peak systolic circumferential strain. Thirty-five male subjects (age: 47+/-1 years; body mass index: 28.4+/-0.6 kg m(-2); mean+/-SEM) included 13 with normal blood pressure (BP: 113+/-5/67+/-2 mm Hg), 13 with prehypertension (BP: 130+/-1/76+/-2 mm Hg), and 9 newly diagnosed with essential hypertension (BP: 150+/-2/94+/-2 mm Hg) who underwent cardiac magnetic resonance tissue tagging (MRI) and MRI quantitation of abdominal visceral and epicardial fat. Glucose tolerance, on oral glucose tolerance test, and insulin resistance were assessed along with the serum lipid profile. All of the subjects had normal glucose tolerance, left- and right-ventricular volumes, and ejection fraction. Across the BP groups, left ventricular mass tended to increase, and circumferential shortening was progressively reduced at basal, midheart, and apical segments (on average, from -17.0+/-0.5% in normal blood pressure to -15.2+/-0.7% in prehypertension to -13.6+/-0.8% in those newly diagnosed with essential hypertension; P=0.004). Reduced circumferential strain was significantly associated with raised BP independent of age (r=0.41; P=0.01) and with epicardial and visceral fat, serum triglycerides, and insulin resistance independent of age and BP. In conclusion, regional left ventricular function is already reduced at the early stages of hypertension despite the normal global cardiac function. Insulin resistance, dyslipidemia, and ectopic fat accumulation are associated with reduced regional systolic function.

Sacral neuromodulation in patients with faecal incontinence: results of the first 100 permanent implantations

Faecal incontinence (FI) is a socially devastating problem. Sacral nerve modulation (SNM) has proven its place in the treatment of patients with FI. In this study, the first 100 definitive SNM implants in a single centre have been evaluated prospectively. Patients treated between March 2000 and May 2005 were included. Faecal incontinence was defined as at least one episode of involuntary faecal loss per week confirmed by a 3-week bowel habit diary. Patients were eligible for implantation of a permanent SNM when showing at least a 50% reduction in incontinence episodes or days during ambulatory test stimulation. Preoperative workup consisted of an X-defaecography, pudendal nerve terminal motor latency measurement, endo-anal ultrasound and anal manometry. The follow-up visits for the permanent implanted patients were scheduled at 1, 3, 6 and 12 months and annually thereafter. The bowel habit diary and anal manometry were repeated postoperatively during the follow-up visits. A total of 134 patients were included and received a subchronic test stimulation. One hundred patients (74.6%) had a positive test stimulation and received a definitive SNM implantation. The permanent implantation group consisted of 89 women and 11 men. The mean age was 55 years (range 26-75). The mean follow-up was 25.5 months (range 2.5-63.2). The mean number of incontinence episodes decreased significantly during the test stimulation (baseline, 31.3; test, 4.4; P < 0.0001) and at follow-up (36 months postoperatively, 4.8; P < 0.0001). There was no significant change in the mean anal resting pressure. The squeeze pressures were significantly higher at 6 months (109.8 mmHg; P = 0.03), 12 months (114.1 mmHg; P = 0.02) and 24 months postoperatively (113.5 mmHg; P = 0.007). The first sensation, urge and maximum tolerable volume did not change significantly. Twenty-one patients were considered late failures and received further treatment. Sacral neuromodulation is an effective treatment for FI. The medium-term results were satisfying.

Colonic perforation caused by anorectal manometry

Dear Editor: A 63-year-old male visited our hospital with a chief complaint of an anal protruding mass. On rectal examination, there were grade III hemorrhoids with partial mucosal prolapse. Anorectal manometry (ARM) was performed in order to inspect the anorectal function. ARM was done with using an eight-channel water-perfused system (TA 6000 Micropulsing®, Gould, Valley View, OH, USA) and a balloon-attached catheter (Zinetics Manometric Catheter®, Medtronic, Copenhagen, Denmark). The manometry results showed paradoxical contraction of the anal sphincter when straining but no other unusual features. During the examination, the patient only expressed a slight discomfort in the lower abdomen. When he arrived at home, he felt lower abdominal pain and had a large amount of hematochezia. The frequency and amount of hematochezia decreased, and at first, he observed this symptom without informing the clinician of it. He visited hospital after 2 days and complained of abdominal distension and nausea. His vital signs were as follows: a blood pressure of 129/ 108, a heart rate of 127 beats per minute, a respiratory rate of 22 breaths per minute, and a temperature of 36.5°C. The abdominal examination was notable for diffuse abdominal tenderness with guarding. The laboratory studies showed a white blood cell count of 13,580/mm, a hemoglobin level of 16.6 g/dl, and a platelet count of 188,000/mm. The plain abdominal films showed distended small bowel loops with air-fluid levels. A computed tomography showed a short segment of wall disruption on the sigmoid colon and a collection of fluid and extraluminal air surrounding the sigmoid colon. He was taken to the operation room for exploration. Exploratory laparotomy through a lower midline incision showed a severely distended small bowel. However, there was no fecal or purulent material throughout the peritoneal cavity. Examination of the sigmoid colon and rectum showed a full-thickness perforation at the level of the rectosigmoid junction. We performed a Hartmann’s procedure, with resection of the sigmoid colon and upper rectum, closure of the rectum beneath the site of perforation, and sigmoid end colostomy. A perforation of about 8 cm in length was measured in the resected specimen. Gas was passed through the stoma on the fourth postoperative day, and the postoperative course was uneventful. Manometry is an objective method of assessing anal sphincter function and it is an important tool for managing defecatory disorders. Manometry has been widely used for investigating patients with fecal incontinence to identify the presence of sensory or muscular defects, as well as to define functional weakness of the internal and/or external anal sphincter. Manometry is also used before performing procedures to document those sphincter functions that may affect continence or require optimizing continence. In addition, manometry has been regard as a safe procedure because there have been no reports on complications or problems while performing manometry. Lee et al. reported that they experienced two cases of colorectal rupture during the measuring the maximum tolerable volume [Lee et al. (1998) Colorectal rupture: an unusual complication of anorectal manometry. Korean J Gastrointest Motil 4:118–122]. Both patients were in their Int J Colorectal Dis (2008) 32:219–220 DOI 10.1007/s00384-007-0312-0

Comparison of the cardioprotective effects of cardos and losartan in rats with experimental chronic cardiac insufficiency

Cardioprotective effect of cardos was revealed on rat model of experimental cardiac insufficiency induced by injectionof isoproterenol. Cardos improved exercise tolerance, cardiac output, and stroke volume. Cardos administered for 28 days was no less effective than losartan.

Effects of Herbal Medicine Dai-Kenchu-To on Anorectal Function in Children with Severe Constipation

We administered the herbal medicine Dai-Kenchu-To (DKT) to children with severe chronic constipation or with severe constipation after surgery for anorectal malformations. We then objectively assessed the effect of DKT on anorectal function by manometric study in addition to using a clinical scoring system. Ten children with severe chronic constipation and 5 children with severe constipation after surgery for anorectal malformations were assessed. These 15 children received 0.3 g/kg/day of DKT for periods ranging from 3 months to 1 year. We objectively assessed their bowel function, sphincter function and rectal reservoir function by anorectal manometry and clinical scoring. In 10 children with severe chronic constipation, the clinical score after administration of DKT (7.2 +/- 0.8) improved significantly compared with that before administration of DKT (4.6 +/- 2.9) (p < 0.02). The threshold sensation volume and the maximum tolerable volume after administration of DKT significantly (p < 0.05; p < 0.01) decreased (128 +/- 63 ml vs. 69 +/- 18 ml; 229 +/- 99 ml vs. 144 +/- 47 ml), and rectal compliance after administration of DKT also significantly (p < 0.05) decreased (12.4 +/- 10.9 ml/cmH(2)O vs. 4.7 +/- 3.9 ml/cmH(2)O). The present study demonstrated that DKT had a favorable clinical effect on severe constipation in children, and anorectal manometry showed an improvement in their rectal reservoir functions. It appears that the results were secondary to DKT-stimulated peristalsis of the intestine, which promoted regular bowel habits.

Iatrogenic colorectal perforation induced by anorectal manometry: Report of two cases after restorative proctectomy for distal rectal cancer

There are no reports regarding perforation of the colorectum induced by anorectal manometry. We report two cases of colorectal perforation that occurred during manometry in the patients undergoing restorative proctectomy for distal rectal cancer. In the first patient, computed tomography showed an extraperitoneal perforation in the pelvic cavity and a rupture of the rectal wall. A localized perforation into the retroperitoneum was managed conservatively. In the second patient, a 3 cm linear colon rupture was detected above the anastomotic site. A primary closure of the perforated colon and proximal ileostomy were conducted, but the patient died 2 wk later. We hypothesize that the perforation induced by anorectal manometry may be associated with the relative weakening of the proximal bowel wall due to anastomosis, decreased compliance, and abnormal rectal sensation. We suggest that measurement of the maximum tolerable volume should not be routinely performed after restorative proctectomy for distal rectal cancer.

A Novel Technique to Identify Patients with Megarectum

Traditional methods of identifying patients with persistent dilation of the rectum, or megarectum, are associated with inherent methodologic limitations. The purpose of this study was to use a barostat to establish criteria for the diagnosis of megarectum and to assess rectal diameter during isobaric (barostat) and volumetric (barium contrast) distention protocols in constipated patients with megarectum on anorectal manometry. During fluoroscopic screening, rectal diameter was measured at minimum distending pressure of the rectum, achieved using a barostat. It was also measured during evacuation proctography (volumetric distention). Having established a normal range in 25 healthy volunteers, 30 constipated patients with evidence of megarectum on anorectal manometry (elevated maximum tolerable volume on latex balloon distention) were studied. A further 10 constipated patients without evidence of megarectum were studied (normal rectum). Megarectum was diagnosed when the rectal diameter was greater than 6.3 cm at minimum distending pressure. Rectal diameter at minimum distending pressure was increased in 20 patients (67 percent) with megarectum on anorectal manometry, but was normal in the remaining 10 patients (33 percent) and all patients with a normal rectum on anorectal manometry. Rectal diameter was increased at evacuation proctography in only 15 patients (50 percent) with evidence of megarectum on anorectal manometry. The prevalence of megarectum is overestimated and underestimated when rectal diameter is assessed using anorectal manometry and contrast studies, respectively. Controlled (pressure-based) distention combined with fluoroscopic imaging allowed accurate identification of patients with megarectum on the basis of a rectal diameter greater than 6.3 cm at the minimum distention pressure. Measurement of rectal diameter at minimum distention pressure may be useful in those patients with an elevated maximum tolerable volume on anorectal manometry when surgery is being contemplated.

Clinical Presentation of Fecal Incontinence and Anorectal Function: What Is the Relationship?

Fecal incontinence is classified into various types: passive, urge, and combined. Its clinical presentation is thought to be related to the underlying physiological or anatomical abnormality. The aim of the present study was to evaluate the associations between the frequency of clinical symptoms and anatomic and functional characteristics of the anorectum of patients with severe fecal incontinence. Associations were explored in a consecutive series of 162 patients (91% women, mean age 59 [SD +/- 12] yr) with a mean Vaizey incontinence score of 18 (SD +/- 3). Urge incontinence was reported as "daily" by 55%, "often" by 27%, and "sometimes" by 7% of all patients. No significant associations were observed between the frequency of urge incontinence and either manometric data, anal mucosal sensitivity testing, or defects of internal anal sphincter (IAS) or external anal sphincter (EAS). A significant relation was observed between the frequency of urge incontinence and maximal tolerable volume (P= 0.03) and atrophy of the EAS (P= 0.05). Passive incontinence was reported as "daily" by 14%, "often" by 30%, and "sometimes" by 14% of all patients. Resting and maximal squeeze pressure were both associated (P < 0.001) with the frequency of passive incontinence. No relationship could be detected between clinical presentation and rectal sensation, anal mucosal sensitivity, defects, or atrophy of IAS or EAS. Most patients reported combined incontinence (59%) and underlying pathophysiologic abnormalities were identified. The hypothesized associations between urge and passive incontinence and functional and anatomical impairment of the anorectum are less clear-cut than previously assumed. Patients presenting with fecal incontinence should undergo physiologic investigation.

Structural, microstructural and dielectric studies of tin-doped barium niobate perovskite

Monophasic oxides of the type Ba(Nb1-xSnx) O3 (0 ≤ x ≤ 1) have been synthesized by solid-state reaction method. All these compounds are found to have tetragonal structure except x = 1. The cell parameters and their variation with composition x have been determined. The X-ray density is found to increase gradually with increase of dopant concentration. Tolerance factor and volume of unit cell was found to be almost constant for all the compositions. Scanning electron microscopy showed the presence of grains of approximately 1 μm in size. Dielectric measurements in the frequency range 100 Hz to 1 MHz and in the temperature range from − 100°C to 500°C has been carried out to determine the dielectric parameters. A strong frequency dependence of both dielectric constant (ɛ′) and dielectric loss (D) is observed in the frequency range 100 Hz to 100 kHz. At low frequency, the piling up of mobile charge carriers at the grain boundary produces interfacial polarization giving rise to high dielectric constant. Dielectric loss showed a typical behaviour in the temperature and frequency range studied.

Rectal Volume Tolerability and Anal Pressures in Patients With Fecal Incontinence Treated With Sacral Nerve Stimulation

Sacral nerve stimulation has proven to be a promising treatment for fecal incontinence when conventional treatment modalities have failed. There have been several hypotheses concerning the mode of action of sacral nerve stimulation, but the mechanism is still unclear. This study was designed to evaluate the results of rectal volume tolerability, rectal pressure-volume curves, and anal pressures before and six months after permanent sacral nerve stimulation and to investigate the mode of action of sacral nerve stimulation. Twenty-nine patients with incontinence (male/female ratio = 6/23; median age, 58 (range, 29-79) years) underwent implantation of a permanent sacral electrode and neurostimulator after a positive percutaneous nerve evaluation test. Wexner incontinence score, rectal distention with thresholds for "first sensation," "desire to defecate," and "maximal tolerable volume," rectal pressure-volume curves, anal resting pressure, and maximum squeeze pressure were evaluated at baseline and at six months follow-up. Median Wexner incontinence score decreased from 16 (range, 6-20) to 4 (range, 0-12; P < 0. 0001). Median "first sensation" increased from 43 (range, 16-230) ml to 62 (range, 4-186) ml (P = 0.1), median "desire to defecate" from 70 (range, 30-443) ml to 98 (range, 30-327) ml (P = 0.011), and median "maximal tolerable volume" from 130 (range, 68-667) ml to 166 (range, 74-578) ml (P = 0.031). Rectal pressure-volume curves showed a significant increase in rectal capacity (P < 0.0001). The anal resting pressure increased significantly from 31 (range, 0-109) cm H(2)O to 38 (range, 0-111) cm H(2)O (P = 0.045). No significant increase in maximum squeeze pressure was observed. For patients with fecal incontinence successfully treated with sacral nerve stimulation, there was a significant increase in rectal volume tolerability and rectal capacity. A significant increase in anal resting pressure, but not in maximum squeeze pressure, was found. We suggest that sacral nerve stimulation causes neuromodulation at spinal level.

Radiation-induced liver disease in three-dimensional conformal radiation therapy for primary liver carcinoma: The risk factors and hepatic radiation tolerance

To identify risk factors relevant to radiation-induced liver disease (RILD) and to determine the hepatic tolerance to radiation. The data of 109 primary liver carcinomas (PLC) treated with hypofractionated three-dimensional conformal radiation therapy (3D-CRT) were analyzed. Seventeen patients were diagnosed with RILD and 13 of 17 died of it. The risk factors for RILD were late T stage, large gross tumor volume, presence of portal vein thrombosis, association with Child-Pugh Grade B cirrhosis, and acute hepatic toxicity. Multivariate analyses demonstrated that the severity of hepatic cirrhosis was a unique independent predictor. For Child-Pugh Grade A patients, the hepatic radiation tolerance was as follows: (1) Mean dose to normal liver (MDTNL) of 23 Gy was tolerable. (2) For cumulative dose-volume histogram, the tolerable volume percentages would be less than: V5 of 86%, V10 of 68%, V15 of 59%, V20 of 49%, V25 of 35%, V30 of 28%, V35 of 25%, and V40 of 20%. (3) Tolerable MDTNL could be estimated by MDTNL (Gy) = -1.686 + 0.023 * normal liver volume (cm3). The predominant risk factor for RILD was the severity of hepatic cirrhosis. The hepatic tolerance to radiation could be estimated by dosimetric parameters.

Blending Hard White Wheat to Improve Grain Yield and End‐Use Performances

ABSTRACTTwo hard white wheats (Triticum aestivum L.), ‘Betty’ with high protein and good processing quality and ‘Trego’ with good yield potential, were blended at percentages of 0, 10, 30, 50, 70, 90, and 100% Betty and planted at three locations in western Kansas during 2001 to 2003. Grain yield and wheat end‐use quality were evaluated to assess the impact of blending two cultivars in an attempt to optimize yield and processing quality. A significant two‐way interaction between blend and location was observed for grain yield, test weight, grain protein, single kernel properties, flour extraction, mixograph tolerance, and bread loaf volume per gram of protein. The different yield and quality response of the Betty–Trego blends among locations resulted, in part, from the presence of stripe rust (caused by Puccinia striiformis Westend.) during 2 of the 3 yr (2001 and 2003). Test weight, single kernel weight and size, grain yield, and flour extraction decreased in response to increasing Betty in the blend, whereas grain protein, kernel hardness index, mixograph water absorption, mixograph tolerance, and bread loaf volume increased with the blending level of Betty. Some variables did not exhibit a statistical linear response to the percentage of Betty, indicating that blending Betty and Trego was a good strategy to stabilize agronomic performance and end‐use quality.

Long-Term Functional Outcome of Colonic J-pouch Reconstruction After Low Anterior Resection for Rectal Cancer

To evaluate the long-term functional outcome of colonic J-pouch reconstruction after low anterior resection (LAR) for rectal cancer in a prospective study. We compared the functional outcome of 46 patients who underwent J-pouch reconstruction (J-group) and 49 patients who underwent straight anastomosis (S-group) after LAR for rectal cancer. We evaluated clinical function using a 17-item questionnaire about different aspects of bowel function. Physiologic reservoir function was evaluated by manovolumetry. Among the patients with an ultralow anastomosis (<or=4 cm from the anal verge), those in the J-group had fewer bowel movements during the day and at night, and less urgency, soiling, protective pad use, incontinence, and dissatisfaction with bowel function than those in the S-group. Among the patients with a low anastomosis (5-8 cm from the verge), those in the J-group had fewer bowel movements at night, and less urgency and soiling than those in the S-group. Moreover, reservoir function (reflected by the maximum tolerable volume, threshold volume, and compliance) was better in the J-group than in the S-group in both the ultralow and low anastomosis groups. J-pouch reconstruction after low anterior resection creates a better stool reservoir than straight anastomosis, especially when the anastomosis is less than 4 cm from the anal verge, resulting in a better quality of life 3 years after rectal cancer resection.

Clinical and Physiologic Outcomes After Transvaginal Rectocele Repair

This study was designed to evaluate the clinical and physiologic outcomes after transvaginal rectocele repair. Between June 2000 and January 2003, 30 females (mean age, 62 (range, 45-78) years) with a symptomatic large rectocele (>3 cm) underwent transvaginal rectocele repair (anterior levatorplasty). Six months after surgery, a physiologic evaluation was performed by using defecography (depth of rectocele) and anorectal manometry (maximum resting pressure, maximum squeeze pressure, rectal threshold, and maximum tolerable volume). Using a questionnaire, a clinical evaluation was performed one year after surgery to analyze symptoms, including difficult evacuation, digital support, sexual discomfort, as well as patient satisfaction. Follow-up of all patients was conducted during a median duration of 38 (range, 23-54) months. There were no operative complications, such as hematoma, wound infection, or rectovaginal fistula. Difficult evacuation improved in 27 of 30 patients (90 percent) and completely disappeared in 9 patients. Postoperatively, digital support was no longer necessary during evacuation in 15 of 21 patients (71 percent). Overall patient satisfaction reached 25 of 30 (83 percent). Although mild sexual discomfort was observed in nine patients, it disappeared gradually and only one patient complained of persistent symptoms. No patient reported symptomatic recurrences at the end of the follow-up. The radiologic mean depth of the rectocele was significantly reduced: preoperative, 3.9 cm; postoperative, 0.5 cm. None of the physiologic parameters significantly changed after surgery. Transvaginal rectocele repair can provide excellent long-term symptomatic relief and a high rate of patient satisfaction without any alteration in anorectal physiologic function.

Difference in rectal dosimetry between pre-plan and post-implant analysis in transperineal interstitial brachytherapy for prostate cancer

Background and Purpose To investigate differences in rectal dosimetry between pre-plan ultrasonography (US) and post-implant computed tomography (CT). Patients and Methods Subjects comprised 49 patients who underwent prostate brachytherapy using 125I seed implants. Prescribed dose was 145 Gy to the periphery of the prostate. Differences in rectal dosimetry between pre-plan US and post-implant CT analysis were evaluated. In addition, patients were divided into two groups according to timing of pre-planning (pre-plan group, n=28; intraoperative pre-plan group, n=21), and differences in rectal dosimetry between groups were assessed. Results The average of volume differences between pre-plan and post-implant analysis (pre-plan minus post-implant analysis) for all patients were follows: −0.08 cm 3 in V60 (volume of rectal wall receiving 60% of prescribed dose); −0.05 cm 3 in V70; −0.16 cm 3 in V80; −0.38 cm 3 in V90; −0.40 cm 3 in V100; −0.32 cm 3 in V110; −0.22 cm 3 in V120; −0.15 cm 3 in V130; −0.10 cm 3 in V140; −0.07 cm 3 in V150; and −0.05 cm 3 in V160. Apparent differences between pre-plan US and post-implant CT in rectal dosimetry were small. However, considering the steep curve of the relationship between tolerable volume and dose, a large actual difference should be assumed. No advantage was identified for the intraoperative pre-plan group. Safe volume to avoid proctitis tended to be smaller on ultrasonography than on CT at 1 month. Conclusions The present work shows that direct comparison of CT analysis and pre-plan US is unfavorable due to large differences in these modalities and overestimation of tolerable volume. However, by comprehending the degree of difference, comparison of data from CT analysis with a US pre-plan may be feasible and useful for providing feedback between these modalities.

Short‐term effects of magnetic sacral dermatome stimulation for idiopathic slow transit constipation: Sham‐controlled, cross‐over pilot study

An increase in recto-sigmoid colon activity through electrical stimulation of the sacral dermatomes has previously been reported. It has not been evaluated whether or not sacral dermatome stimulation has beneficial effects on constipation symptoms and anorectal function in constipated patients. Our aim was to evaluate short-term effects of magnetic stimulation of the sacral dermatomes on constipation symptoms and anorectal function in patients with idiopathic slow transit constipation. Fourteen patients with idiopathic slow transit constipation were enrolled. Constipation symptoms, stool form and anorectal function were assessed before treatment, and at 3 and 6 weeks of treatment. Six-week treatment consisted of either a 3-week period of sham treatment or a 3-week period of magnetic stimulation of the S2-S3 dermatomes, which was performed in a randomized cross-over design. During the stimulation period, the frequency score of spontaneous bowel movements decreased in eight of the 14 patients (2.9 [2-3]vs 1.4 [0-2]), whose threshold volumes for urge to defecate and maximum tolerable volumes were significantly greater than those of the non-responders, and significantly decreased at the end of treatment. The degree of straining on defecation also significantly decreased in the responders. Responders had shorter right colonic transit time and longer left colonic transit time compared to the non-responders. Sham treatment did not affect constipation symptoms, stool form and rectal sensation. Sacral dermatome stimulation may offer potential for therapeutic benefit for a subset of patients with idiopathic slow transit constipation, particularly constipated patients with rectal hyposensation or hindgut dysfunction.

Function after anoabdominal rectal resection and colonic J pouch-anal anastomosis

Twenty-eight patients undergoing anoabdominal resection of the rectum with construction of a colonic J reservoir and eight patients without a reservoir were studied 2 years after surgery. Frequency of defaecation and daytime soiling were inversely correlated with the maximum tolerable volume of the colonic J pouch. The distensibility and threshold volume of those with a pouch were significantly greater than in those without a pouch 6 months or more after stoma closure. Anal resting pressure, squeeze pressure, anal canal length and a positive inhibitory reflex were similar in both groups. Anal resting pressure, squeeze pressure and pouch distensibility correlated with frequency of defaecation in the stable phase. Pouch construction may improve the patient's quality of life in the adaptation phase.

Correlation of clinical and manometric abnormalities of rectal function following chronic radiation injury.

Continuous fluid-inflation proctometrograms were performed in men with the symptoms of chronic radiation proctitis and in age and sex-matched control subjects (n = 10). Rectal volumes and compliance were measured. There was a significant reduction in the rectal volumes at sensory threshold, constant sensation and maximal tolerance and in rectal compliance (P less than 0.01). Comparable pressure measurements did not demonstrate significant differences. The maximum tolerable volume, symptomatic and sigmoidoscopic scoring correlated to rectal compliance (r = 0.77, -0.8, -0.73; P less than 0.01, less than 0.01, less than 0.02, respectively). Reduction in volume and compliance is often not obvious radiologically. Histological evidence suggests that smooth muscle hypertrophy and myenteric plexus damage are contributory.

Anorectal function following coloanal sleeve anastomosis for chronic radiation injury to the rectum

Anorectal manometry and electrophysiological studies of the pelvic floor were performed in eight patients who had undergone anterior resection of the rectum with mucosal proctectomy and colo-anal sleeve anastomosis for radiation rectal injury. There is a severe reduction in the compliance of the neorectum and in the maximal tolerable volume. Maximum basal anal canal pressure and physiological sphincter length are also significantly reduced although the 'squeeze' pressure of the external anal sphincter and the latency of the pudendo-anal reflex were unaffected. Four patients had an absent rectosphincteric reflex, four patients involuntarily expelled the test balloon at the maximal tolerable volume during a proctometrogram and four patients demonstrated increased EMG activity of the pelvic floor on straining and on rectal distension. These abnormalities help to explain many of the patients' symptoms. Histological abnormalities of the myenteric plexus were a prominent feature in all the excised specimens and may be responsible for some of the functional abnormalities.