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Perianal sepsis is a common condition ranging from acute abscess to chronic anal fistula. In most cases, the source is considered to be a non-specific cryptoglandular infection starting from the intersphincteric space. Surgery is the main treatment and several procedures have been developed, but the risks of recurrence and of impairment of continence still seem to be an unresolved issue. This statement reviews the pertinent literature and provides evidence-based recommendations to improve individualized management of patients.

The aim of the present study was to assess the relationship between symptoms of obstructed defecation and findings on magnetic resonance (MR) defecography in males with obstructed defecation syndrome (ODS).Thirty-six males with ODS who underwent MR defecography at our institution between March 2013 and February 2016 were asked in a telephone interview about their symptoms and subsequent treatment, either medical or surgical. Patients were divided into 2 groups, one with anismus (Group 1) and one with prolapse without anismus (Group 2). The interaction between ODS type and symptoms with MR findings was assessed by multivariate analysis for categorical data using a hierarchical log-linear model. MR imaging findings included lateral and/or posterior rectocele, rectal prolapse, intussusception, ballooning of levator hiatus with impingement of pelvic organs and dyskinetic puborectalis muscle.There were 21 males with ODS due to anismus (Group 1) and 15 with ODS due to rectal prolapse/intussusception (Group 2). Mean age of the entire group was 53.6 ± 4.1 years (range 18-77 years). Patients in Group 1 were slightly older than those in Group 2 (age peak, sixth decade in 47.6 vs 20.0%, p 0.05). Symptoms most frequently associated with Group 1 patients included small volume and hard feces (85.0%, p 0.01), excessive strain at stool (81.0%, p 0.05), tenesmus and fecaloma formation (57.1 and 42.9%, p 0.05); symptoms most frequently associated with Group 2 patients included mucous discharge, rectal bleeding and pain (86.7%, p 0.05), prolonged toilet time (73.3%, p 0.05), fragmented evacuation with or without digitation (66.7%, p 0.005). Voiding outflow obstruction was more frequent in Group 1 (19.0 vs 13.3%; p 0.05), while non-bacterial prostatitis and sexual dysfunction prevailed in Group 2 (26.7 and 46.7%, p 0.05). At MR defecography, two major categories of findings were detected: a dyskinetic pattern (Type 1), seen in all Group 1 patients, which was characterized by non-relaxing puborectalis muscle, sand-glass configuration of the anorectum, poor emptying rate, limited pelvic floor descent and final residue ≥ 2/3; and a prolapsing pattern (Type 2), seen in all Group 2 patients, which was characterized by rectal prolapse/intussusception, ballooning of the levator hiatus with impingement of the rectal floor and prostatic base, excessive pelvic floor descent and residue ≤ 1/2. Posterolateral outpouching defined as perineal hernia was present in 28.6% of patients in Group 1 and were absent in Group 2. The average levator plate angle on straining differed significantly in the two patterns (21.3° ± 4.1 in Group 1 vs 65.6° ± 8.1 in Group 2; p 0.05). Responses to the phone interview were obtained from 31 patients (18 of Group 1 and 13 of Group 2, response rate, 86.1%). Patients of Group 1 were always treated without surgery (i.e., biofeedback, dietary regimen, laxatives and/or enemas) which resulted in symptomatic improvement in 12/18 cases (66.6%). Of the patients in Group 2, 2/13 (15.3) underwent surgical repair, consisting of stapled transanal rectal resection (STARR) which resulted in symptom recurrence after 6 months and laparoscopic ventral rectopexy which resulted in symptom improvement. The other 11 patients of Group 2 were treated without surgery with symptoms improvement in 3 (27.3%).The appearance of various abnormalities at MR defecography in men with ODS shows 2 distinct patterns which may have potential relevance for treatment planning, whether conservative or surgical.

Somatosensory evoked potentials (SEPs) of the pudendal nerve are a well-established diagnostic tool for the evaluation of pelvic floor disorders. However, the possible influence of sex differences on response latencies has not been established yet. The aim of this study was to standardize the procedures and to evaluate possible effects of gender differences on anal and penile/clitoral SEPs. The anal and dorsal penile/clitoral SEPs were recorded in 84 healthy subjects (40 males and 44 females; mean age 47.9 ± 16.6 years, range 16–81 years; mean height 168.3 ± 20.3 cm, range 155–187 cm). Pudendal SEPs were evoked with a bipolar surface electrode stimulating the clitoris or the base of the penis and the anal orifice and recorded using scalp electrodes. The latency of the first positive component (P1) was measured. The effect and possible interaction of (a) stimulation site and (b) gender on the two variables was explored by multivariate analysis of variance (MANOVA). The examination was well tolerated and a reproducible waveform of sufficient quality was obtained in all the subjects examined. In the female subjects, a mean cortical P1 latency of 37.0 ± 2.6 and 36.4 ± 3.2 ms for anal and clitoral stimulation, respectively, was found. In the male subjects, the cortical latencies were 38.0 ± 3.5 ms for the anal stimulation and 40.2 ± 3.7 ms for the penile stimulation. At MANOVA, a statistically significant main effect of stimulation site and gender as well as a significant interaction between the two variables was found. Anal and dorsal penile/clitoral SEPs represent a well-tolerated and reproducible method to assess the functional integrity of the sensory pathways in male and female subjects. Obtaining sex-specific reference data, by individual electrophysiological testing, is highly recommended because of significant latency differences between males and females, at least as far as penile/clitoral responses are concerned.

The paper offers an overview of the deep-space transponder (DST) equipment that has been developed by Thales Alenia Space-Italy over the last two decades in the framework of various European programs. It briefly describes major achievements, technologies, and characteristics relevant to the present class of DSTs operating in S- and X-band (Rosetta, Mars Express, and Venus Express missions). A complete overview of the novel DST equipment designed and developed for X- and Ka-band applications (BepiColombo mission) is provided.

Because of the drawbacks of defecography (radiation hazard and lack of standardization), a new method by introital sonography is described to assess the evacuation phenomenon in women as an alternative to contrast radiographic studies.Ten consecutive women (mean age, 41 years; range, 33-50; mean parity, 2; range, 1-4) without evacuation disturbances (history and physical examination) nor prior pelvic surgery underwent hypoechoic contrast-enhanced evacuation sonography in the squatting position and fluoroscopic defecography, when appropriate, within a 10-minute interval.Both techniques gave clear images of anal neck opening and funneling. While ultrasonography underestimated anorectal junction mobility, it showed soft tissue details (flap valve) not seen at defecography. Other advantages with sonography included lack of radiation hazard and prolonged observation time.Evacuation sonography may be useful as an alternative to defecography for research purposes and for screening of evacuation dysfunctions in women.

The aim of this study was to establish the impact of defecography on the management of patients with chronic constipation. The defecographic series of 581 patients (426 women, 155 men, mean age 51 ± 17 years) with evacuation dysfunctions was reviewed. Proper utilization of defecography was investigated by examining the structural interaction between presenting symptoms using a hierarchical log-linear model analysis. Then, to assess the impact of defecography on clinical decision-making, the multiple correspondence analysis was employed to calculate the relationship between eight radiographic findings (rectal prolapse/intussusception, rectocele, perineal descent, outlet obstruction, barium loss, delayed emptying, residue and rectal enlargement) and six clinical features (fecal blockade, provoked evacuation, tenesmus, feeling of prolapse, incontinence and mucus discharge) which occurred most frequently in the population under study. At the hierarchical log-linear analysis no more than one second-order three-symptom (i.e. fecal blockade, provoked evacuation and mucus discharge) and six first-order two-symptom interactions (including all other symptoms combined in various ways) were obtained, giving no evidence of overutilization of defecography in our constipated group. A close association (inertia, 34.4%) was found at the multiple correspondence analysis between delayed emptying, residue, outlet obstruction and rectal enlargement (relative weight 27.1%, 20.2%, 19.6% and 8.5%, respectively). Our results suggest labeling the first subdimension as the need for a conservative approach, while the second subdimension is surgery. The main value of defecography in chronic constipation is as a simple exploratory method for selecting patients who require admission to biofeedback and pelvic floor re-education.

We assessed the reliability of anorectal angle (ARA) measurement as an index of fecal incontinence. The "posterior" ARA was measured at rest, squeezing, and straining in 69 continent and 82 incontinent subjects all complaining of various evacuation dysfunctions. The two groups were homogeneous with regard to sex distribution (48.6% vs. 51.4% men and 44.7% vs. 55.3% women, n.s.) and age (56.5 +/- 10.2 vs. 59.3 +/- 9.7 years, n.s.). The incidence of rectal prolapse was the same in the two groups (40 each). The intraobserver agreement index from two independent measurements (Pearson's correlation coefficient), age, and gender interaction [T2 Hotelling test in multivariate analysis of variance (ANOVA)] and the most discriminating category of ARA measurement (Fisher's F test in ANOVA) were calculated. In addition, the relationship between ARA and severity of incontinence was assessed by the eta coefficient. Pearson's correlation coefficient was between 0.78 and 0.98 (P < 0.01). The mean ARA differed significantly between the continent and incontinent subjects (104.5 +/- 10.3 degrees vs. 116.2 +/- 23.6 degrees at rest, 84.5 +/- 14.2 degrees vs. 95.1 +/- 20.1 degrees on squeezing, and 133.7 +/- 21.7 degrees vs. 141.7 +/- 25.9 degrees on straining; T2 0.066, P < 0.05 in multivariate ANOVA). No interaction was noted between groups and gender (T2 = 0.023; F = 1.11, n.s.). Resting ARA was shown by ANOVA to be the most discriminating index (F = 9.4 P < 0.01) between the two groups. Overall, ARA measurement was correlated with the severity of fecal incontinence (eta coefficient: 0.894 at rest; 0.811 on squeezing; 0.695 on straining); its accuracy was 79%, the false-positive rate was 15.3% and the false-negative rate 26.5%. Irrespective of the underlying abnormality, namely rectal prolapse, ARA measurement by defecography can: (a) be reinterpreted reliably by the same observer and (b) differentiate continent from incontinent subjects.

Electrophysiological activation of the motor pathways can be obtained by electrical or magnetic stimulation. The latter has the great advantage of being painful and able to stimulate deeply situated nervous structures. Only a few reports describe responses obtained from pelvic floor muscles and external anal sphincter (EAS) by transcranial and lumbo-sacral magnetic stimulation. Our purpose is to present normative data of motor evoked responses from EAS in a group of healthy subjects (age range 19–80 years) using a standardized protocol of magnetic stimulation. Nine females and 7 males, with a mean age of 52.63 years, were included in this study. They had no known neurological and gastrointestinal disease. Magnetic shocks were delivered by a Magstim 200 (Novametrix) and a circular coil, centered on the vertex and on the lumbo-sacral region. Electromyographic recordings were taken from EAS using needle electrodes. The cortical magnetic stimulation was performed in two conditions: at rest and during a mild contraction of pelvic floor muscles. The mean values of motor evoked potentials (MEPs) latencies after cortical stimulation were 26.92±3.01 ms at rest and 23.31±2.70 ms during facilitation. Motor latency after lumbo-sacral root stimulation was 6.09±1.43 ms. The MEPs from EAS are easily obtained and stably reproducible in normal subjects. It can be suggested also as a useful adjunct in the assessment of faecal incontinence.

The aim of this study was to evaluate the use of a magnetic resonance (MR)-based classification system of obstructive defecation syndrome (ODS) to guide physicians in patient management. The medical records and imaging series of 105 consecutive patients (90 female, 15 male, aged 21–78 years, mean age 46.1 ± 5.1 years) referred to our center between April 2011 and January 2012 for symptoms of ODS were retrospectively examined. After history taking and a complete clinical examination, patients underwent MR imaging according to a standard protocol using a 0.35 T permanent field, horizontally oriented open-configuration magnet. Static and dynamic MR-defecography was performed using recognized parameters and well-established diagnostic criteria. Sixty-seven out of 105 (64 %) patients found the prone position more comfortable for the evacuation of rectal contrast while 10/105 (9.5 %) were unable to empty their rectum despite repeated attempts. Increased hiatus size, anterior rectocele and focal or extensive defects of the levator ani muscle were the most frequent abnormalities (67.6, 60.0 and 51.4 %, respectively). An MR-based classification was developed based on the combinations of abnormalities found: Grade 1 = functional abnormality, including paradoxical contraction of the puborectalis muscle, without anatomical defect affecting the musculo-fascial structures; Grade 2 = functional defect associated with a minor anatomical defect such as rectocele ≤2 cm in size and/or first-degree intussusception; Grade 3 = severe defects confined to the posterior anatomical compartment, including >2 cm rectocele, second- or higher-degree intussusception, full-thickness external rectal prolapse, poor mesorectal posterior fixation, rectal descent >5 cm, levator ani muscle rupture, ballooning of the levator hiatus and focal detachment of the endopelvic fascia; Grade 4 = combined defects of two or three pelvic floor compartments, including cystocele, hysterocele, enlarged urogenital hiatus, fascial tears enterocele or peritoneocele; Grade 5 = changes after failed surgical repair abscess/sinus tracts, rectal pockets, anastomotic strictures, small uncompliant rectum, kinking and/or lateral shift of supra-anastomotic portion and pudendal nerve entrapment. According to our classification, Grades 1 and 2 may be amenable to conservative therapy; Grade 3 may require surgical intervention by a coloproctologist; Grade 4 would need a combined urogynecological and coloproctological approach; and Grade 5 may require an even more complex multidisciplinary approach. Validation studies are needed to assess whether this MR-based classification system leads to a better management of patients with ODS.

Real-time transperineal sonography has enhanced the appreciation of morphology and dynamics of the pelvic floor. Standard images are obtained from longitudinal and axial planes by placing the transducer between the vagina and rectum. This fast, effective, noninvasive and inexpensive examination represents the preferred initial diagnostic imaging tool for women with pelvic floor dysfunctions, such as prolapse and incontinence.

The present study compared the outcome of a small series of patients (7 cases) who underwent total proctocolectomy without mucosal proctectomy and stapled ileal pouch-anal anastomosis made at the apex of the anal transitional zone, with our previous experience (17 cases) in which the ileal pouch was anastomosed at the dentate line after mucosectomy. Though not statistically significant, our limited experience showed excellent clinical results with better continence and discriminating ability of flatus from faeces in the former group. The resting anal pressure profile was not changed postoperatively. The operation time was significantly reduced compared with our previous approach which was a time-consuming procedure. There was an indication that risk of complications (pelvic sepsis and haemorrhage) was less.

Anal endosonography (AES) has become an essential part of the pre-operative diagnostic workup in both organic and functional anal diseases.Nine Italian centres with an average volume activity of10 exams/week each were surveyed with the aim of determining the concordance with respect to indications for the procedure and interpretation of the results.Overall, anal sepsis, faecal incontinence and anorectal tumours were the more common indications for AES while evacuation dysfunctions and anal pain were not always considered indications. All centres use the same diagnostic criteria for simple and complicated perirectal sepsis and sphincteric defects, but adopt different classifications for stage 1 and stage 2 anal tumours. Participants agreed in that lymph-node staging by AES is less precise than tumour staging, especially after chemoradiation therapy.A list of recommendations and guidelines based on the groups's experience has been produced for those radiologists and coloproctologists interested in the use of AES and accreditation of their centres.

Aims We performed urodynamics and perineal ultrasound in female patients with urinary incontinence to assess morphology and function of the bladder base-urethra complex and of the detrusor muscle, and to find the correlation between these investigations in the diagnosis of (a) bladder neck and urethral hypermobility and (b) detrusor overactivity; we wanted to compare the tolerabililty of the urodynamic investigation and of the perineal ultrasound. Methods We considered 66 female patients referred to our outpatient clinic for urinary incontinence; we also studied 14 healthy control patients. After accurate case-history collection and physical examination, urodynamic investigation and perineal ultrasound were performed, with recording of parameters specific to both investigations. The statistical analysis was performed by ANOVA, Bonferroni post hoc test, and Spearman correlation test. The tolerability index between the diagnostic investigations performed was assessed by a 3-point scale suggested by the patient. Results In patients with stress incontinence the posterior urethro-vesical angle, the angle of urethral inclination, and the proximal pubo-urethral distance are significantly different under stress compared to the resting phase; in patients with urge incontinence, the detrusor wall is thicker and is accompanied by an increase in opening detrusor pressure and detrusor pressure at maximum flow; it is also accompanied by detrusor overactivity with increased urethral functional length. Increased urethral functional length is suggested on axial US images by alteration of its normal characteristic target-like appearance with four concentric rings of different echogenicity. In all cases the tolerability of perineal ultrasound has been higher than that of urodynamics. Conclusions There is a good correlation between urodynamic and perineal ultrasound in the diagnosis of bladder neck and urethral hypermobility; perineal ultrasound can also be useful in the diagnosis of urge incontinence. Functional compressive urethral obstruction can be diagnosed on the basis of the ultrasound aspect of the urethral sphincter. Neurourol. Urodynam. 26:176–182, 2007. © 2006 Wiley-Liss, Inc.

This paper presents the Koreasat 5 secure communication system that has been design and developed by Alcatel Alenia Space-Italy (AAS-I) for Agency for Defense Development-South Korea.

Aim of the paper is to present a novel digital platform for the transmitting side (NDP-Tx) of a deep space transponder which has been developed by Alenia Spazio in the frame of the ESA study on "Digital Techniques for TT&C Transponder". The proposed design has unique features in terms of flexibility and interfacing with the spacecraft command data sub-system (CDS). The NDP-Tx supports standard telemetry modulation formats based on residual carrier and more advanced schemes aiming to improve the space-to-earth link performance. In fact, in case of limited available power, as for satellite transmitters, the power efficiency is maximised driving the power amplifier in saturation, i.e. in the non-linear region of its transfer characteristic. Using constant (i.e. GMSK) or quasi-constant (i.e. Square-Root Raised Cosine SRRC-Filtered OQPSK) envelope modulation allows the transmitter stage to operate in saturation without the drawback of the non-linear distortion (i.e. adjacent channel interference due to sidelobes spreading and regeneration).

This paper deals with the design of a digital demultiplexer based on a multirate filter bank. In particular a digital architecture for replacing an analog filter bank composed of six surface acoustic wave (SAW) filters have been developed. This analog structure is used, at present, by Alenia Space Division in the Hot-Bird satellites. An extensive comparison between alternative algorithms for the demultiplexer implementation has been carried out. Moreover different implementations have been compared in terms of the computational complexity and accuracy with respect to the quantization effects. Starting from the simulation results, the obtained architecture has been mapped on six Altera Flex 10 K-100 devices. The final test bed, that includes a complete interface to the Alenia demodulator has been implemented on a four-layer PCB.

We read with interest the article by Abercrombie et al which describes the pathophysiology and surgical management of faecal incontinence in two siblings with severe myotonic dystrophy.1 In the authors’ experience, long term results of both medical and surgical management of the faecal incontinence were unsatisfactory, as proved by the fact that postanal sphincter repair restored faecal continence only for a brief time. The authors’ pessimistic conclusions suggest that “faecal incontinence in myotonic dystrophy is difficult to relieve by any currently available treatment other than colostomy”. It should be noted, however, that the …

Purpose: To provide quantitative data by a modern cross-sectional imaging technique (CT) for defining normal physiological values of pelvic floor structures. Patients and methods: Twenty seven subjects, 7 males, 20 females, aged 20 – 75 yrs (mean 46.3±5 yrs) without pelvic floor or defecation dysfunction underwent Direct Coronal (DC) CT scanning of the pelvis with the patient seated instead of lying. Scans obtained at rest and on straining were compared by bony landmarks. Three anatomical compartments, i. e. anterior, middle and posterior, were identified by two planes drawn tangential to the ischial for-amina and the ischial tuberosities, respectively. Measurements of (1) Levator ani muscle length (mm); (2) Levator-anal angle (degrees); (3) Rectal floor-to-ischial line distance (mm) and (4) Supra/Infralevator spaces (square cm) were independently performed twice by two radiologists. The statistical analysis included calculation of intra and interobserver agreement (correlation coefficient). The differences between the means of the resting and straining values from each compartment (Student's t test) and the correlation between parameters (Pearson's coefficient) to evaluate whether resting values allowed a prediction of those on straining were determined. Results: DC scans of diagnostic quality were obtained in all but two patients (92.5%). Both intra- and interobserver agreement indices were always greater than 80% (except for a 0.63 value by one observer obtained in the infralevator space from the anterior compartment at rest). A significant difference between the resting and straining values of all parameters was noted in the three compartments. At rest the levator ani muscle length was significantly shorter and the supralevator space smaller in the posterior compartment (48.3±7.9 mm vs 48.8±7 mm vs 42.6±9.4 mm, P

Two groups of patients with altered bowel habit and pelvic floor dysfunction, but comparable epidemiologic characteristics (i.e. n = 105 each; mean age and SD 47.3 +/- 15.8 yrs vs. 54.9 +/- 16.7 yrs; range 15-80 yrs vs. 9-88 yrs; F/M ratio 28:1 vs. 2.6:1) with the exception of the absence (or presence) of fecal incontinence, were examined with defecography, taking into account criteria other than anorectal angle values and anorectal junction mobility. At the Receiver Operating Characteristic (ROC) analysis a "barium leak sign", occurring either at rest or on straining was found to be a highly reliable index of fecal incontinence (specificity: 100% and 92-93%, respectively, intraobserver agreement K value = 0.82, Z = 21.58, p0.001). A false negative rate of 14.2% was limited to "minor" incontinence only, i.e., incontinence to gas and/or occasional staining episodes. In the search for an etiologic diagnosis, useful adjunctive criteria included (a) anal diameter10 mm at rest; (b) poor stop test (inability to interrupt the barium stream); (c) rectal diameter6.5 cm and4 cm (abnormally increased and reduced compliance, respectively). Defecography is a useful diagnostic tool in fecal incontinence and should precede anal endosonography, manometry and electromyography for proper therapeutic decision-making and in risk conditions, e.g., in the patients about to undergo elective pelvic surgery.

The plica transversalis recti (K Kohlrausch's plica or Houston's valve) shows a preferential double (52%) rather than triple (38%) localization and is absent in as much as 16% of cases. It is alternatively found on the left and right sides, 3-4 and 8-9 cm from the anal margin respectively. Both its detection rate and radiographic features depend on the technique used as follows: (a) 92%, contour indentation and/or linear filling defect, 4 to 5 mm thick at barium enema studies; (b) 67%, the same as in (a) plus 1/3 narrowing of the maximum diameter at defecography; and (c) 90%, two opposite and overlapping folds at coronal CT. Evidence is given that neither organic nor functional anorectal conditions affect the radiographic appearance of the fold, its likely role being to fix the proximal margins during the expulsion of feces.

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, p0.05 and 70.6 cm2 +/- 7.5; 66.9 cm2 +/- 11.2; 27.2 cm2 +/- 4.8, p0.01, 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 index80%) and promising for future clinical applications and studies of pelvic floor dysfunctions.

Restorative proctocolectomy with various types of reservoir is widely used in the elective surgery of ulcerative colitis and familial adenomatous polyposis. Both, advantages and disadvantages of this procedure are well known and documented. Straight ileo-anal anastomosis (IAA) yields unsatisfactory clinical results due to the lack of storage capacity of the distal ileum and the frequency of bowel movements related to high pressure ileal waves. In an attempt to create an alternative to the above procedures, we have performed a straight ileo-anal anastomosis with two rectangular (10 cm x 1 cm) myectomies down to 2 cm, above the anastomotic line. The two myectomies are spaced at 120 degrees to each other and to the mesenteric border of the ileal loop. The rationale of this approach is to reduce the peristaltic drive of the ileum by weakening the muscular wall. This study presents the results in three patients operated on with this new method in the last year.

Chronic constipation is probably the most common symptom resulting in a referral of patients for a dynamic radiologic investigation of the GI tract. The primary usefulness of defecography in chronic constipation is to provide details about the dynamic phenomenon of evacuation which cannot be elicited by any other medical technique. It is employed to demonstrate or rule out the presence of an anatomical deformity (prolapse, rectocele, intussusception) and/or a localized dysfunction (outlet obstruction, rectal inertia) of the distal GI tract. Defecography can distinguish between a grossly obstructed pattern and an overtly normal one, but a definitive diagnosis is made by manometry and electromyographic studies. On the other hand, it should be noted that a failure to show abnormalities by defecography does not necessarily imply a normal anorectal function. A better understanding of anorectal physiology is expected in the future from combined video-pressure studies, which will provide the exact timing between the pressure drop and barium passage through the distal colon.

The physiopathologic and anatomic findings of bronchial asthma are shortly reviewed. A description follows of the radiologic patterns based on personal experience. Only seldom the radiologic investigations provide the possibility to reach the correct diagnosis of bronchial asthma. But they always complete the clinical evaluation and allow the demonstration of the numerous and frequent complications which influence the evolution and prognosis of the disease.

The upsurge of interest in dynamic radiology of the oral pharyngeal phases of deglutition can be explained by: (a) the increased survival-rate in neuromuscular diseases; (b) the improved results in head and neck surgery and radiotherapy; (c) the awareness of the existence of a "silent" form of dysphagia. This paper is aimed at divulgating the radiological dynamic investigation of deglutition by videorecording, and at assessing the findings of a study on 119 consecutive non-dysphagic patients (55 males and 64 females; mean age 54 years) as a control group for future studies on dysphagic patients. Seventy-nine out of 119 subjects (66.4%) were found to be normal. Various abnormalities were observed in the remaining 40 (33.6%), such as barium penetration in the subepiglottic or supraglottic space (20 cases), dysmotility of the epiglottis (14 cases), transient and mild cricopharyngeal muscle dysfunction (17 cases), diverticula (6 cases). Further studies are needed to evaluate the true significance and implication of these findings in asymptomatic patients. Finally, a more widespread use of this method is hoped for, in order to establish its diagnostic and clinical efficacy.

Three atypical patterns of cardiac failure and pulmonary edema, as frequently seen in chronic obstructive pulmonary diseases, are described; I. regional; II. miliary-like; III. Swiss-cheese like. Their importance in early diagnosis of pulmonary edema is discussed in the light of a review of a series of 98 patients whose pulmonary function was also investigated. Examples and statistical data are drown from this series.

A comparison between the radiographical findings and the haemodynamic data was made in 53 cases of chronic bronchial obstruction. The results were used in an assessment of the reliability of standard chest X-rays in the diagnosis of pulmonary hypertension. Reference is also made to quantitative indices. Several cases are presented by way of example.

The clinical and radiologic findings of the chronic eosinophilic pneumonia are presented. A personal observation of one case is reported. This should be the first in the Italian roentgenologic literature. The importance of radiology in the diagnosis and in the evolution of the disease is stressed.

Colpocystography consists of a static and dynamic study of the opacified pelvic viscera (bladder, vagina, rectum) in lateral projection. This method is non traumatic and easy to perform. It is an useful diagnostic complement in the evaluation of bladder, uterine, rectal prolapse and urinary stress incontinence.

A method that can be profitably employed in the clinical and functional evaluation of nevrogenic bladder is illustrated and discussed. It is primarily based on retrograde and micturition urethrocystography and urography with high doses of contrast medium.

Two groups of patients were studied with serial correlated radiological functional analysis. Each group had a previous history of chronic obstructive pulmonary disease; however, on admission, only one group exhibited the clinical signs of this superimposed disease. The results of this research showed that chronic pulmonary disease is better defined by functional studies while cardiac failure (even in early stages) is always revealed by radiological examination.

Conventional lung tomography may not clearly reveal the component of a pathologic mass at a hilum. Oblique cuts proved to be superior in the visualization of enlarged lymph nodes, parenchymal shadows and great fissures. Several cases are presented.