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Fecal incontinence is most common among elderly individuals, but is also common among institutionalized patients. Many patients with this disorder are embarrassed to report their symptoms to their physician, and many go without treatment. Normal fecal continence depends on proper function of the brain, the colon, the rectum and the sphincter of the anus, and on the amount and consistency of feces produced. A wide variety of medical conditions may cause fecal incontinence. Individuals with conditions that such as diabetes that cause abnormal function of the nervous system may develop fecal incontinence. Fecal incontinence of unknown cause occurs most commonly in women. Individuals with fecal incontinence usually undergo a rectal examination and different physiological and radiologic tests to determine the underlying cause. Patients with fecal incontinence are treated with dietary therapy, drugs, biofeedback and surgery. Many patients with fecal incontinence have an underlying disorder such as gastrointestinal disease that should be treated. Patients who do not respond to treatment usually undergo a colostomy.

Background and Study Aim: Cecal intubation rate (CIR) is an established performance indicator of colonoscopy. In some patients, cecal intubation with acceptable tolerance is only achieved with additional sedation. This study proposes a composite Performance Indicator of Colonic Intubation (PICI), which combines CIR, comfort, and sedation. METHODS : Data from 20 085 colonoscopies reported in the 2011 UK national audit were analyzed. PICI was defined as the percentage of procedures achieving cecal intubation with median dose (2 mg) of midazolam or less, and nurse-assessed comfort score of 1 - 3/5. Multivariate logistic regression analysis evaluated possible associations between PICI and patient, unit, colonoscopist, and diagnostic factors. RESULTS : PICI was achieved in 54.1 % of procedures. PICI identified factors affecting performance more frequently than single measures such as CIR and polyp detection, or CIR + comfort alone. Older age, male sex, adequate bowel preparation, and a positive fecal occult blood test as indication were associated with a higher PICI. Unit accreditation, the presence of magnetic imagers in the unit, greater annual volume, fewer years' experience, and higher training/trainer status were associated with higher PICI rates. Procedures in which PICI was achieved were associated with significantly higher polyp detection rates than when PICI was not achieved. CONCLUSIONS : PICI provides a simpler picture of performance of colonoscopic intubation than separate measures of CIR, comfort, and sedation. It is associated with more factors that are amenable to change that might improve performance and with higher likelihood of polyp detection. It is proposed that PICI becomes the key performance indicator for intubation of the colon in colonoscopy quality improvement initiatives. [ABSTRACT FROM AUTHOR]

Intercellular cysts are described between the prolactin cells in the adenohypophysis of the nine-spined stickleback. Pungitius pungitius. The cysts were found in adult animals collected from a freshwater habitat at all times of the year, but were most common in June August, when 50 % of the population had cysts. When animals killed in July were examined at autopsy, cysts were equally common in adult males and females, but were virtually absent from juveniles. Seasonal changes in the incidence of cysts were associated with seasonal changes in the prolactin cells. These cells were smallest when cysts were most common. When fish were transferred to seawater for 3 and 6 days in July, the prolactin cells became smaller, but cyst incidence did not increase--in contrast to previous findings relating to winter fish. Transferring fish to deionised water for 7 and 15 days in the winter, also did not increase cyst incidence, but did increase the size of the prolactin cells. The significance of the cysts is discussed. [ABSTRACT FROM AUTHOR]

Cysts were mainly restricted to the prolactin zone of the rostral pars distalis. Although must cysts were devoid of stainable contents, those examined at autopsy retained fluid under pressure. Cyst walls contained prolactin cells, non-granulated (stellate) cells, blood vessels, occasional neurosecrelory fibres and cells of unknown function characterised by sparse and small secretory granules. Some cysts were lined by a distinct and continuous basal lamina. In such pituitaries, the prolactin cells were separated from the cyst lumen by non-granulated (stellate) cells. There was no evidence of exocytosis from these remaining prolactin cells. Cyst cavities contained isolated cells, neurosecretory fibres, disintegrating cells and macrophages. It is suggested the term 'cyst' embraces a great variety of pituitary structures that are not necessarily similar in origin and significance in different animals. It is concluded that cysts in Pungitius form by a secondary degeneration of cells and are not of any embryological significance. [ABSTRACT FROM AUTHOR]

The majority of bile duct stones in Western patients originate in the gallbladder. Many patients with bile duct stones are asymptomatic. However, the acute complications of bile duct calculi--jaundice, cholangitis, and pancreatitis--may present in isolation or In combination with each other. Successful treatment of cholangitis and severe biliary pancreatitis requires urgent biliary decompression, which is best achieved by endoscopic sphincterotomy. Similarly, endoscopic sphincterotomy is the most appropriate method of relieving obstructive jaundice caused by biliary stones and, in some patients, may be the sole treatment required. Surgical intervention rarely is necessary in the acute stage, although definitive surgery may be required later, when the patient's clinical condition has improved. [ABSTRACT FROM AUTHOR]

We reviewed the long-term functional results of colon resection and suture rectopexy for complete rectal prolapse in 47 patients followed for more than 3 yr (mean 65 months). Thirty-three patients underwent sigmoidectomy, eight patients underwent subtotal colectomy, and four patients underwent sigmoidectomy with subsequent subtotal colectomy. Three patients (6.3%) developed recurrent full-thickness prolapse, and four patients (8.5%) developed rectal mucosal prolapse. Twenty patients presented with constipation, 10 (50%) of whom improved after surgery. Constipation improved in seven (70%) patients who underwent subtotal colectomy. Twenty-one patients presented with incontinence, eight (38%) of whom improved. Continence worsened in six patients, and four patients developed significant diarrhea. These complications did not correlate with the extent of bowel resection. Three patients required subsequent stomas. Colon resection and rectopexy provides long-term control of rectal prolapse with an acceptable recurrence rate. Subtotal colon resection is frequently helpful in patients with associated constipation. However, colon resection of any magnitude entails a small risk of chronic diarrhea and/or diminished continence. [ABSTRACT FROM AUTHOR]

Assesses the relevance of Henri Hartmann's operation in the 1920s, for resection of a cancer in the distal sigmoid and upper rectum, resulting in a permanent sigmoid colostomy, in the 21st century. Problems with the procedure; Reported rate of reversal of colostomy following Hartmann's operation; Results of a study published in a 2005 issue of "Digestive Surgery," using Hartmann's procedure.