P81 Intraoperative MEP recordings from a urethral sphincter electrode for spinal conus tumour surgery and its importance

2019 ◽  
Vol 90 (3) ◽  
pp. e43.2-e43
Author(s):  
A Shaikh ◽  
LA Hilaya ◽  
G Wilma ◽  
A Forster ◽  
S Ross
Keyword(s):  
Anal Sphincter ◽  
Foley Catheter ◽  
External Sphincter ◽  
Motor Evoked Potential ◽  
Sphincter Preservation ◽  
Urinary Continence ◽  
Urethral Sphincter ◽  
Avant Garde ◽  
The Uk ◽  
Intraoperative Nerve Monitoring

ObjectivesTo emphasise the importance of motor evoked potential (MEP) recordings from a simple urethral sphincter electrode along with routine use of bulbocavernosus reflex recordings, anal sphincter and other lower limb muscle free running and stimulated EMG and MEP’s, and SEP techniques for sphincter preservation.DesignCase report.SubjectsPatients with conus or other spinal lesions at risk of postoperative sphincter disturbance.MethodsTranscranial ‘train of 5’ stimulation (5 pulses, interstimulus interval 4msec, 200 µsec pulse width) was applied, with recordings from the urethral sphincter (small electrode taped to Foley catheter to lie just inside the urethra, referred to nearby needle anteriorly in mons pubis) and anal sphincter (paired needle electrodes in both left and right sides of external sphincter).ResultsIntraoperative stimuli of structures during dissection at one point gave a motor response confined to the urethral sphincter suggesting that these fibres may have been considered non-functional and cut had these not been assessed separately. Urethral sphincter MEP’s during the dissection confirmed that these motor fibres remained in continuity throughout.. The patient was intact after tumour removal.ConclusionsThis is an avant-garde technique by which we managed to save the nerve supply to the urethral sphincter and eventually urinary continence which would have been compromised if separate urethral monitoring was not attempted along with usual intraoperative nerve monitoring. We believe its first in the UK.

Urinary Continence in the Absence of an Intact External Sphincter

1969 ◽  
Vol 102 (2) ◽  
pp. 200-204 ◽  
Author(s):  
Norman J. Nemoy ◽  
Duncan E. Govan
Keyword(s):  
External Sphincter ◽  
Urinary Continence

scholarly journals Is an empirical approach to performing access in pediatric surgery in children safe?

2020 ◽  
pp. 43-50
Author(s):  
V.S. Konoplitskiy ◽  
◽  
R.V. Shavliuk ◽  
Keyword(s):  
Anal Sphincter ◽  
External Anal Sphincter ◽  
Pilonidal Disease ◽  
Muscle Fibers ◽  
External Sphincter ◽  
Average Diameter ◽  
Modern World ◽  
Anal Sphincters ◽  
Cross Sectional ◽  
Surgical Interventions

Objective: to determine the topical localization of the structural components of the anal sphincter and to formulate the basic postulates of the formation of safe anatomical access in pilonidal disease surgery in children. Materials and methods: the study was conducted on the corpses of 10 children who had no lifelong pathology of the sacrococcygeal region and pelvis aged 12 to 17 years, including 5 girls and 5 boys. Soft tissue columns 1 cm wide and up to 5 cm long were prepared at a distance of 1 cm from the anus by 12 h, 3 h, 6 h and 9 h according to the dial in the back position. After preparation and fixation of the drugs, their staining was performed and cross-sections of anal sphincters 5–7 μm thick were made. The analysis of the received morphometric data is carried out. The results of the study: it was found that the cross-sectional area of the bundle of muscle fibers of the external sphincter of the anus on average in adolescents ranged from 448±32 μm2 to 412±24 μm2. The diameter of its muscle fibers was 13.02±1.56 μm, and the bulk density of muscle fibers is 96.12±1.34%. Regarding the length of the internal anal sphincter, it was found that it is almost the same in different areas and is 1.3±0.03 at the level of 3 and 12 hours, 1.3±0.07 at the level of 6 hours and 1.2±0.03 at the level of 9 hours. In the study of the linear dimensions of the length of different portions of external anal sphincter in certain places of the biopsy revealed a predominance of parameters that were determined at 6 hours, respectively, 5.7±0.06 cm against 4.3±0.04 cm at 3 hours, and 12 hours, respectively 5.1±0.06 cm against 4.3±0.03 cm at 9 years. The thickness of the external sphincter of the anus at 6 hours, respectively 26.7±0.61 mm against 18.5±0.19 mm at 3 hours, (<0.01) and 12 hours, respectively 23.9±0.33 mm against 18.4±0.19 mm at 9 hours. Diameters of separate muscular fibers and bundles were explored. It is established that the average diameter of a muscle fiber makes 13.7±0.18 microns, and the average diameter of a muscular bundle is equal to 435.9±5.15 microns. Conclusions. 1. Existing anatomical descriptions of anal sphincters need in the modern world more thorough research to prevent their injury during surgery. 2. The external anal sphincter has the spatial form of the three-storeyed oval structure extended in the front-back direction with dominance of the caudal muscular portion. 3. When performing radical surgical interventions for pilonidal disease in children by cleft-lift method, it is necessary to complete the edge of surgical access at a distance of not less than 3 cm to the edge of the anal sphincter. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: pilonidal disease, children, morphometry, surgical intervention.

Impact of total fascia preservation on early recovery of urinary continence after radical prostatectomy

2017 ◽  
Vol 11 (4) ◽  
pp. 293-298
Author(s):  
Masanori Nishimura ◽  
Ryu Utsugi
Keyword(s):  
Radical Prostatectomy ◽  
Foley Catheter ◽  
Three Dimensional ◽  
Urinary Continence ◽  
Rank Test ◽  
Early Recovery ◽  
Level Of Evidence ◽  
Kaplan Meier ◽  
Early Return ◽  
Pelvic Fascia

The objective was to investigate the effect of preserving the total fascia surrounding the prostate (lateral pelvic fascia (LPF) and posterior musculofascial plate) on the early return of urinary continence after three-dimensional laparoscopic radical prostatectomy (3D-LRP). Data from 70 consecutive patients who underwent 3D-LRP from April 2015 to February 2017 were collected prospectively and analyzed retrospectively. Patients were categorized into two groups: with or without LPF preservation; each group consisted of 35 consecutive patients. The rates of urinary continence within 12 weeks (no pad and no urinary leakage) were compared between groups using a 24-hour pad test and questionnaires of the Expanded Prostate Cancer Index Composite (EPIC). Immediately after Foley catheter removal, accumulated recovery rates of continence with the Kaplan–Meier method were 65.7% (23/35) and 14.3% (5/35) for LPF preservation and non-preservation groups, respectively. Four weeks after surgery, continence rates increased to 80% (28/35) and 20% (7/35), respectively. A log-rank test showed a statistical difference between groups ( p < 0.001). The hazard ratio (HR) was 3.341 (95% confidence interval, 1.772–6.301). Our results demonstrated the effectiveness of total fascia preservation for the early recovery of urinary continence after radical prostatectomy. Level of evidence: Not applicable for this multicenter audit.

scholarly journals A Simple, Reproducible and Low-cost Simulator for Teaching Surgical Techniques to Repair Obstetric Anal Sphincter Injuries

2018 ◽  
Vol 40 (08) ◽  
pp. 465-470 ◽  
Author(s):  
Roxana Knobel ◽  
Lia Volpato ◽  
Liliam Gervasi ◽  
Raquel Viergutz ◽  
Alberto Trapani
Keyword(s):  
Anal Sphincter ◽  
Low Cost ◽  
Internal Sphincter ◽  
Surgical Techniques ◽  
External Sphincter ◽  
Rectal Mucosa ◽  
Obstetric Anal Sphincter Injuries ◽  
Fourth Degree ◽  
Anatomy And Physiology ◽  
Application Techniques

Objective To describe and evaluate the use of a simple, low-cost, and reproducible simulator for teaching the repair of obstetric anal sphincter injuries (OASIS). Methods Twenty resident doctors in obstetrics and gynecology and four obstetricians participated in the simulation. A fourth-degree tear model was created using low-cost materials (condom simulating the rectal mucosa, cotton tissue simulating the internal anal sphincter, and bovine meat simulating the external anal sphincter). The simulator was initially assembled with the aid of anatomical photos to study the anatomy and meaning of each component of the model. The laceration was created and repaired, using end-to-end or overlapping application techniques. Results The model cost less than R$ 10.00 and was assembled without difficulty, which improved the knowledge of the participants of anatomy and physiology. The sutures of the layers (rectal mucosa, internal sphincter, and external sphincter) were performed in keeping with the surgical technique. All participants were satisfied with the simulation and felt it improved their knowledge and skills. Between 3 and 6 months after the training, 7 participants witnessed severe lacerations in their practice and reported that the simulation was useful for surgical correction. Conclusion The use of a simulator for repair training in OASIS is affordable (low-cost and easy to perform). The simulation seems to improve the knowledge and surgical skills necessary to repair severe lacerations. Further systematized studies should be performed for evaluation.

Re-Imagining Westphalia

2021 ◽  
pp. 145-198
Author(s):  
M.I. Franklin
Keyword(s):  
Civil Rights ◽  
Electronic Music ◽  
Early Years ◽  
Karlheinz Stockhausen ◽  
Avant Garde ◽  
Miles Davis ◽  
The Us ◽  
The Uk ◽  
Sound Transformation ◽  
The Cold War

Chapter 5 focuses on a work from Karlheinz Stockhausen entitled Hymnen (Anthems). Stockhausen’s influence on the electronic music avant-garde, in classical and popular music domains, on those from his native Germany to the UK, the US, and elsewhere, is legendary. The techniques Stockhausen was refining were also being put to work by the Beatles, Miles Davis, and Frank Zappa, to name a few. Working with national anthems that are sampled and transformed, Hymnen is a landmark work that I argue is as much about “remembering” as it is a research-based experiment in the early years of electronic and acoustic sound transformation. This work, completed during 1960s, evokes the cold war years where space exploration, civil rights, and nuclear (dis)armament standoffs between the communist East and the capitalist West predominated. It is also the decade of Woodstock, political assassinations, civil rights, and antiwar movements in the US and around the world. Hymnen still has a lot to offer for contemporary explorations into the geopolitics of any music-politics nexus.

Fuzzy Reliability Theory

2021 ◽  
pp. 222-259
Author(s):  
Ingrid N. Pinto-López ◽  
Cynthia M. Montaudon-Tomas
Keyword(s):  
United States ◽  
Bibliometric Analysis ◽  
Science Research ◽  
The United States ◽  
Reliability Theory ◽  
Fuzzy Reliability ◽  
Avant Garde ◽  
China And India ◽  
The World ◽  
The Uk

This chapter analyzes fuzzy reliability theory using bibliometric analysis. Different aspects of fuzzy have already been analyzed using bibliometric analysis, and a series of bibliometric tools have also been used. VOSviewer software was used to identify maps showing the most relevant trends. The analysis includes scientific articles, citations, journals, authors, universities, keywords, and countries. Results show that countries belonging mainly to Asia are at the avant-garde in terms of research in the field, China and India being the most productive countries in terms of the number of articles published, citations, and universities invested in the topic. Other countries in North America, such as Canada and the United States, and in Europe, the UK, Poland, Italy, and France, also show a great interest in this area of science. Research on the topic is relatively recent. The first articles were published in 1991; therefore, it presents excellent opportunities that will quite possibly attract researchers and universities from different regions of the world.

scholarly journals External Urethral Sphincter Pressure Measurement: An Accurate Method for the Diagnosis of Detrusor External Sphincter Dyssynergia?

PLoS ONE ◽  
2012 ◽  
Vol 7 (5) ◽  
pp. e37996 ◽  
Author(s):  
Carlos H. Suzuki Bellucci ◽  
Jens Wöllner ◽  
Flavia Gregorini ◽  
Dorothee Birnböck ◽  
Marko Kozomara ◽  
...  
Keyword(s):  
Pressure Measurement ◽  
External Sphincter ◽  
Accurate Method ◽  
Sphincter Pressure ◽  
Urethral Sphincter ◽  
External Urethral Sphincter

scholarly journals From Microphone to the Wire: Cultural change in 1970s and 1980s music writing

2019 ◽  
Vol 16 (3) ◽  
pp. 531-555
Author(s):  
STEPHEN GRAHAM
Keyword(s):  
United States ◽  
Cultural Change ◽  
White Male ◽  
Experimental Music ◽  
Avant Garde ◽  
Music Scenes ◽  
Independent Music ◽  
Attitude And Practice ◽  
The 1960S ◽  
The Uk

AbstractIn this article I examine localized cultural change that nevertheless serves as an applied instance of broader change. Focusing mostly on British, white male musicians and music writers active in the improvised and experimental music scenes of the UK (and, to a lesser extent, United States and Europe) across the 1970s and early 1980s, I identify clear shifts in taste, attitude, and practice. These shifts arc across what Ben Piekut calls the ‘mixed avant-garde’ of the 1960s to what I describe as the ‘unpop avant-garde’ of the late 1970s and 1980s, in which influences from popular and non-Western music play more significant roles than before and liminal, quasi-popular practices such as noise are in the emergence. I trace the appearance of the unpop avant-garde through independent music publications from the period, most prominently Microphone, Musics, Collusion, Impetus, and Re/Search, using these published scene discourses as barometers of the musical atmosphere of the time.

Neuroanatomy of the External Urethral Sphincter: Implications for Urinary Continence Preservation During Radical Prostate Surgery

1995 ◽  
Vol 153 (2) ◽  
pp. 337-341 ◽  
Author(s):  
Perinchery Narayan ◽  
Badrinath Konety ◽  
Khalid Aslam ◽  
Sherif Aboseif ◽  
Walter Blumenfeld ◽  
...  
Keyword(s):  
Urinary Continence ◽  
Urethral Sphincter ◽  
External Urethral Sphincter
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