Reduced somatosensory cortical activation in experimental models of neuropathic fecal incontinence.

PURPOSE: Alteration in cortical awareness may be the underlying abnormality in patients with neuropathic fecal incontinence. The cortical effects of inferior rectal nerve injury were determined using somatosensory evoked cortical potential recordings in an experimental model of neuropathic fecal incontinence. METHODS: Eighteen female virgin Wistar rats were assigned equally to one of three groups: an unoperated control group, a nerve crush group (positive control), and a nerve balloon compression group. Four weeks following the injury, all animals underwent somatosensory evoked cortical potential recordings. Following this, the inferior rectal nerve was harvested, resin-embedded, sectioned (1 microm thickness), and axonal counts and axonal cross-sectional areas were analyzed using Scion Image software. RESULTS: Somatosensory evoked cortical potentials were reduced in the nerve crush and balloon compression groups compared with controls (P = 0.024, P = 0.03, respectively). The inferior rectal nerve was harvested in 14 of the 18 animals (4 control, 5 nerve crush, 5 balloon compression). There were no differences in median inferior rectal nerve total axonal counts (P = 0.69) or in the frequency distribution of axonal cross-sectional area between groups (control vs. nerve crush and control vs. balloon compression: P = 0.92, P = 0.17, respectively). CONCLUSIONS: Somatosensory evoked cortical potential amplitude is reduced following crush or compression injury to the inferior rectal nerve. In neuropathic fecal incontinence, alteration in cortical awareness may be the result of processing modification at a central and not peripheral level.

The effects of low-frequency endo-anal electrical stimulation on faecal incontinence: a prospective study.

BACKGROUND AND AIMS: Faecal incontinence is a distressing problem that is often not amenable to surgical correction. Chronic low-frequency electrical stimulation of damaged axons is thought to reduce synaptic resistance, increase the size of motor units by axonal sprouting and increase the rate of conduction of the pudendal nerve. The aim of this study was to prospectively evaluate the effect of chronic low-frequency endo-anal electrical stimulation on faecal incontinence using a home-based unit and hospital-supervised therapy. MATERIALS AND METHODS: Forty-eight patients with faecal incontinence completed a prospective randomised trial. Patients were allocated randomly to one of two groups; group 1 was exposed to endo-anal pudendal nerve stimulation daily at home with a portable home unit, group 2 attended the physiotherapy department for endo-anal electrical stimulation under supervision. RESULTS: Continence scores improved significantly after treatment in both groups (p<0.001). Both groups showed improved manometric scores, although only group 1 showed significant improvement in both resting and squeeze pressures (mean total resting pressure 184-224 mmHg, p<0.001; mean total squeeze pressure 253-337 mmHg, p<0.001). This was also reflected by an improvement in quality of life in both groups. CONCLUSIONS: Low-frequency endo-anal electrical stimulation significantly improves continence scores and quality of life in patients with faecal incontinence not amenable to surgical correction. It leads to improved manometric values when carried out on a daily basis with a portable home unit.

Primary squamous cell carcinoma of the breast: value of positron emission tomography scanning in confirming the diagnosis.

Pure primary squamous cell carcinoma of the breast is rare. Controversy exists as to whether a pure form exists or whether described cases represent extreme squamous metaplasia within an adenocarcinoma. We present a case of pure primary squamous cell carcinoma of the breast confirmed histopathologically with the absence of a distant primary tumor excluded using positron emission tomography. Because of the paucity of guidelines in the literature for this rare tumor, it is difficult to draw firm conclusions regarding the optimal treatment modality or the overall prognosis.