Search

Purpose: In this study, a comparison was made of the accuracy and clinical usefulness of anal endosonography and fistulography in the preoperative classification of fistulas-in-ano., Materials and Methods: A total of 113 patients with a clinical diagnosis of cryptoglandular fistula-in-ano who were awaiting surgery were included in this retrospective review. Patients were preoperatively investigated by anal endosonography and/or modified fistulography by inserting a Foley catheter into the rectum and a metal ring close to the anus. The catheter and ring served as radiopaque anal markers. Fistula classification obtained by the two diagnostic modalities was compared with surgical classification as the criterion standard., Results: Endoanal ultrasound and fistulography identified 82.8% and 100% of primary tracks, 79% and 74.2% of internal openings, 98% and 91.8% of secondary tracks and 92.9% and 87.8% of abscesses, respectively., Conclusions: Anal endosonography and fistulography with radiopaque markers are important complements to surgical exploration for investigating anal sepsis and may be of value to the surgeon in planning a therapeutic strategy.

A survey was made in 13 Italian centers with a questionnaire concerning the (a) indications, (b) postoperative complications, (c) functional results and (d) diagnostic imaging modalities related to the making of an ileal or colonic (neo) rectum. Ulcerative colitis (100%), familial polyposis (61.5%) and Crohn's disease (15.3%) were the most common indications for an ileal pouch; rectal cancer (7.96%), chronic inflammatory diseases (15.3%), diverticulosis, rectal prolapse, redundant colon and imperforate anus (7.6% each) were the most common indications for a colonic pouch. Postoperative complications included pelvic abscess (14%), sinus tract/dehiscence (10%) and bowel obstruction (9%). When compared with the S and W variants, the J-shaped ileoanal pouch proved superior because urgency and fecal retention rates were lower (18.4% vs. 44.4% and 23% vs. 28.6%, p < 0.01 and p < 0.05, respectively), despite slightly more frequent staining episodes (15.8% vs. 11.1%; p < 0.05). As for colonic ampullae, fecal retention and provoked evacuation were more frequent in the J pouch and after gracileplasty; urgency and incontinence in the straight colo-anal anastomosis (33.3% vs. 22.2% and 41.6% vs. 33.3%, respectively). The functional outcome was assessed by anal endosonography (available in 4/13 centers), defecography and anorectal manometry. Abnormal findings included: (a) reduced capacity, barium leakage, anal gaping, sphincter damage (urgency and incontinence); (b) barium retention, pouch dilatation, split evacuation, knobs and strictures (fecal retention).

Twenty-five subjects with no pelvic floor dysfunctions at defecography were examined with direct coronal CT scans of the pelvis at rest and on straining. Three compartments with different characteristics were delimited by two planes-the anterior one being tangent to the ischiatic foramen and the posterior one to the ischial tuberosities. At rest, the average length of the levator ani muscle and the surface of the supralevator space were significantly lower posteriorly than in the other two compartments (48.3 mm +/- 7.9; 48.8 mm +/- 7; 42.6 mm +/- 9.4, p < 0.05 and 70.6 cm2 +/- 7.5; 66.9 cm2 +/- 11.2; 27.2 cm2 +/- 4.8, p < 0.01, respectively). On straining, maximum muscle lengthening occurred posteriorly, as indicated by similar average values (63.7 mm +/- 12.7; 63.3 mm +/- 9.5 and 60.5 mm +/- 14) and the corresponding increase (+12.5%) in the supralevator space occurred in the middle compartment (73.8 cm2 +/- 7.6; 75.3 cm2 +/- 11.6 and 30.2 cm2 +/- 5.2). To conclude, our method proved reliable enough (intra- and interobserver correlation index > 80%) and promising for future clinical applications and studies of pelvic floor dysfunctions.

This paper deals with the problems of hypercholesterolaemia in the elderly. We have significant results that show an important relationship between serum cholesterol and cardiovascular diseases in the adult, but the same has not yet been definitely established for the elderly. After examination of the available data, the Authors suggest that--after a through clinical evaluation--the elderly should also be treated given that there are data to suggest and hypothesize the positive action of a hypolipemic diet until at least the age of seventy five years. The therapy, whenever possible, could be dietetic; but from relevant results obtained, used together with HMG-CoA reductase inhibitors, these drugs are a good therapeutic approach to the problem, also in the elderly. To support this opinion, the Authors show the results obtained with the use of Simvastatin in a group of old patients.