Manometric diagnosis of anal sphincter injuries.
ABSTRACT A manometric technique of anal pressure vectography has been developed for the detection of anal sphincter injuries. Manometric symmetry of the anal sphincter can be visualized on the pressure vectorgram and quantified as a vector symmetry index. The mean vector symmetry index in asymptomatic women was 0.76, compared with 0.33 in incontinent women with a known sphincter injury (p = 0.0001). Among women who were incontinent without having a recognized sphincter injury, nearly half of those who had a previous episiotomy had subnormal (less than 0.60) vector symmetry indices (p = 0.0003). The values were in the same range as those from known injuries, suggesting the presence of an occult sphincter injury. In contrast, normal symmetry indices were found in all those who had never had an episiotomy or who presented with outlet constipation. We conclude that the vector symmetry index can expose occult anal sphincter injuries and may have a role in the selection of patients for sphincter repair.
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ABSTRACT: In order to minimize the mass of a spaceplane, fuel cells are being used instead of batteries. For HERMES the development of a state of the art fuel cell system which can operate under micro-gravity conditions is under way. A modular simulation program SANFU (System Analyzer for FUel cells) has been developed and applied within the HERMES fuel cell project. All major parameters which influence the component or system performance are taken into account and have been simulated: temperatures, heat and mass flow, chemical reactions within the fuel cell, electrical interfaces and controller logic. Three different fuel cell systems are included in the standard program: immobile electrolyte, mobile electrolyte and ion exchange membrane fuel cells. To incorporate heat flux to external structural parts a software interface with the thermal analyzer ESATAN is provided.
Article: Fecal Incontinence: Introduction[Show abstract] [Hide abstract]
ABSTRACT: Continence depends on a number of factors that include stool consistency, the capacity of the sigmoid colon to retard progress of stool, the compliance and sensation of urgency of the rectum, phasic contractions of the puborectalis muscle to form a normal anorectal angle, a normal internal (IAS) and external anal sphincter (EAS) function, and normal sensation in the anal canal [1–3].
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ABSTRACT: Anorectal manometry is used extensively in the assessment of patients with disorders of the pelvic floor. The present study investigated the repeatability of anorectal manometry in healthy volunteers and patients. A total of 30 healthy volunteers (15 men and 15 women) and 10 patients with fecal incontinence (4 men and 6 women) underwent perfusion manometry and volumetry. Intraindividual variability was evaluated using the intraindividual correlation coefficient (ICC). Interindividual variability was expressed as the standard deviation from the calculated mean values. We found a high intraindividual correlation for the squeezing pressure (ICC 0.75-0.95), vector volume (ICC 0.88-0.97), and rectal perception (ICC 0.82-0.98). The anal resting pressure showed moderate repeatability (ICC 0.60-0.72). However, with regard to sphincter asymmetry, rectal compliance, and the rectoanal inhibitory reflex, a wide range of variability was found. In the female volunteers, the squeezing pressure and vector volume were lower than in those in the male volunteers. The anal pressure, vector volume, thresholds for urgency, and the maximum tolerable volume were lower in the incontinent patients than in the healthy volunteers. The squeezing pressure, vector volume, and rectal perception allow a reliable analysis of anal sphincter function. Sphincter asymmetry, rectal compliance, and the rectoanal inhibitory reflex were of limited diagnostic value.Journal of Surgical Research 06/2013; · 2.12 Impact Factor