Biomedical subjects

A Frudinger

Publications and source records attributed to A Frudinger.

6 recordsLinked to original sources

PubMed2003

[Endoanal MR imaging: diagnostic assessment].

Endoanal MR imaging is an alternative to anal endosonography for the acquisition of high-resolution images of the external and internal anal sphincter. A dedicated anal receiver coil is placed in the anus so that it spans the sphincter complex. Highly detailed images of the sphincters can be obtained in any plane and the morphological abnormalities found in various types of anal incontinence can be demonstrated. Whilst MR demonstrates external sphincter disruption with an efficacy similar to that of endosonography, it is better able to demonstrate external sphincter atrophy that is presumed secondary to neuropathy. The finding of coexisting muscular atrophy on MR may prejudice the effects of anal sphincter repair for obstetric disruption.

Anal Canal↗

PubMed2002

[Anal incontinence].

Anal incontinence, i.e. the loss of the voluntary control of intestinal contents, covers the spectrum from slight traces of stool in the underwear via the loss of wind to marked episodes of uncontrollable evacuation of soft or hard faeces. These are humiliating symptoms the causes of which can be multiple and complex. In women, the most frequent aetiological factor is injury to the pelvic floor due to birth trauma. Specialists and general practitioners do often not realize that anal incontinence can be treated, which may significantly improve the quality of life of the patients after the appropriate diagnostic tests and subsequent individual therapy.

Diagnosis, Differential↗

PubMed1999

Changes in anal anatomy following vaginal delivery revealed by anal endosonography.

OBJECTIVE: To investigate changes in anal canal anatomy following vaginal delivery in women without apparent sphincter injury. DESIGN: Prospective controlled observational study. SETTING: District general hospital. POPULATION: Consecutive parous and nulliparous women attending a gynaecology outpatient clinic. METHODS: All women were examined using anal endosonography, and parous subjects without apparent sphincter injury compared with age-matched nulliparous controls to determine any differences in general anal canal morphology. MAIN OUTCOME MEASURES: Individual anal canal components were measured at defined levels and subjects compared with controls. RESULTS: Twenty-one of 54 parous women had no anal sphincter scar. Compared with nulliparous women, they had significant anterior sphincter thinning (mean 3.7 mm vs 4.6 mm, P< 0.01) in association with lateral external sphincter thickening (mean 7.0 mm vs 4.4 mm, P<0.01), and longitudinal muscle thickening (mean 2.8 mm vs 2.1 mm, P< 001). CONCLUSIONS: Specific changes in anal morphology have been demonstrated following vaginal delivery in women without apparent sphincter injury.

Adult↗

PubMed1997

Perineal examination as a predictor of underlying external anal sphincter damage.

OBJECTIVE: To assess the relation between perineal inspection and sphincter integrity in parous women. DESIGN: Prospective observational study. SETTING: District general hospital. POPULATION: Fifty-seven consecutive parous women attending a gynaecology clinic for problems unrelated to the pelvic floor. METHODS: A detailed history of bowel function and mode of delivery obtained; the perineum inspected to determine the presence and position of scarring, and anal endosonography performed. RESULTS: In 19 women with an intact perineum on inspection, endosonography showed perineal scarring in five, with both perineal and sphincter scarring in three. Four had urge faecal incontinence. Three patients had a perineal tear only on inspection, but this group was too small for analysis and was discounted. Nine had an episiotomy scar only. Endosonography demonstrated perineal scarring in four, and combined perineal and sphincter scarring in two; one woman in this group had urge faecal incontinence. Twenty-six women had episiotomy and perineal tears on inspection. Endosonography revealed underlying perineal scarring in five women, with combined perineal and sphincter scarring in 14; six women in this group had urge faecal incontinence and one passive incontinence for flatus. Sonographically the scarring was anterior and circumferential rather than radial, and mostly left-sided, whereas on inspection episiotomy and perineal scarring were right sided. CONCLUSIONS: A normal perineum on clinical examination does not exclude underlying sphincter damage. The incidence of sphincter damage increases significantly when an episiotomy scar is associated with a perineal tear.

Adult↗

PubMed1997

Transvaginal versus anal endosonography for detecting damage to the anal sphincter.

OBJECTIVE: We undertook this study to establish the accuracy of transvaginal endosonography for detecting damage to the anal sphincter. SUBJECTS AND METHODS: Anal endosonography was performed in 47 parous patients and one nulliparous patient using a sonographic scanner, an 1850 endoprobe, and a 10-MHz transducer protected by a water-filled hard plastic cone. This procedure was followed by transvaginal sonography using the same system but with a water-filled balloon in 43 and a dedicated vaginal probe Type 8551 of 10-MHz frequency in five. Axial images were obtained as low in the perineum as possible. The transvaginal images were reviewed with the observer unaware of the findings from anal endosonography and were then compared with the anal endosonograms. RESULTS: The transvaginal images were inadequate for review in three patients. In the remaining 45 patients, anal endosonography showed internal sphincter defects in 18 and external sphincter tears in 21. Transvaginal endosonography showed eight internal and 10 external sphincter defects only, giving a sensitivity of 44% and a specificity of 96% for the detection of internal sphincter defects and a sensitivity of 48% and a specificity of 88% for external sphincter tears. CONCLUSION: Transvaginal examination is not accurate for assessing the anal sphincter because of the anatomic limitations this approach imposes on axial imaging of the anal canal.

Adult↗

PubMedDate not supplied

Examination techniques for endosonography of the anal canal.

BACKGROUND: To determine whether patient position or sphincter contraction influences sphincter thickness or defect assessment. METHODS: Anal endosonography was performed on 35 consecutive patients (30 women, five men). Twenty-five were scanned in the left lateral and prone positions, and the internal sphincter thickness was measured. In 10 patients, the internal sphincter, longitudinal muscle, external sphincter, and length of any defect were measured at rest and during anal squeeze. RESULTS: There was no significant difference in internal sphincter thickness measured in the prone and left lateral positions (95% limits of agreement, -0.12 to 0.06). The thickness of the internal sphincter, longitudinal muscle, and external sphincter at rest did not change significantly during straining (95% limits of agreement, -0.44 to 0.3, -0.28 to 0.24, and 0.33 to 0.71, respectively). The squeeze maneuver did not influence defect appearance or length (95% limits of agreement, -2.845 to 2. 379). Greater symmetry of the anterior part of the external sphincter and improved visualization of perineum was achieved in the prone position. CONCLUSION: Examination in the prone position is preferred. Squeeze maneuvers are of no diagnostic benefit.

Adult↗