Citations

Sacral neuromodulation is a therapeutic option for women with detrusor overactivity and more recently has been used in patients with fecal incontinence and slow-transit constipation. A 47-year-old woman presented with chronic constipation since childhood. She used multiple laxatives, fiber supplements, and enemas, all without success, and defecated only once per week. Extensive investigations, including barium enema, colonoscopy, defecating proctography, pelvic magnetic resonance imaging, and anorectal manometry all were normal. A transit study showed delayed small-bowel emptying. Colonic transit could not be accurately interpreted because of the marked delayed in proximal transit. An ileostomy was being considered to defunction the colon after the patient become desperate for a better quality of life. She also complained of severe urinary frequency and incomplete emptying. A cystoscopy was normal, and a temporary sacral neuromodulation device was inserted as a staged procedure to improve her urinary symptoms. From the day of device placement and thereafter, the patient defecated without difficulty and has also been free of bladder symptoms. Repeat colonic transit has shown normalization of the stomach, small bowel, and colon.

Studying goalies, who play a key position in hockey requires examining psychophysiologic variables and their relationship to performance during games when the outcome is important [15]. This investigation tested all three aspects of emotion (subjective, physiologic changes, and performance). Nine male goalies completed questionnaires and provided salivary cortisol before, during, and after each game. Heart rate (ECG signal) was integrated with the goalie's performance video. Goalies rated on Likert Scales; headaches, stomach aches, insomnia, nervousness, and awareness of heart pounding. Data from 16 games were obtained. Of nine, two goalies provided data on three games each; one goalie was classified as a responder and the other a non-responder, based on salivary cortisol levels (SCL). The responder's SCL increased 572% between baseline and post-period assessments, whereas SCL in the non-responder increased 50% above baseline. The responder's SCL increased 8 times baseline when he faced 16 shots in a period. The responder goalie's game heart rates (HRs) were 160,152, and 167 beats per minute (bpm) and the non-responder's HRs were 147, 132, and 142 bpm for three games. Game performance was similar for both goalies.

AbstractPurposeManagement of anal fistula represents a balance between curing the condition and maintaining anal continence. Recent reports of the results of the porcine anal fistula plug have demonstrated excellent fistula healing rates without reporting significant complications.MethodsThe outcome of patients who underwent treatment for anal fistula with the Surgisis® anal plug was retrospectively reviewed.ResultsTwenty patients were treated; three underwent concomitant anal advancement flap at the time of plug placement. Seventeen patients had a trans‐sphincteric fistula, and three had an anoperineal fistula. Ten patients had previously undergone failed surgical therapy to cure their fistula, including anal advancement flap in four, muscle interposition flap in two, fistulotomy in two, and cutting seton placement in two. Mean follow‐up was 7.4 months. Only 4 of 17 (24%) patients treated with the plug alone had closure of their fistula. Acute postoperative sepsis was seen in 5 of 17 (29%) patients treated with the plug alone. Four developed perianal abscesses that required incision and drainage, and one intersphincteric abscess was treated with antibiotics. Two of the patients who underwent concomitant anal advancement flaps and plug placement healed successfully.ConclusionsContrary to other published series, the use of the Surgisis® anal plug was associated with a low rate of fistula healing and a high incidence of perianal sepsis. The addition of a transanal advancement flap to the procedure may improve success rates.