Prevalence of Oral Lesions in the Elderly.

OBJECTIVE: Geriatric dentistry refers to dealing with oral diseases including prevention and treatment in old individuals. The aim of this investigation was to examine the types and frequency of oral lesions in the elderly. SUBJECTS AND METHODS: The study involved 75 elderly persons. The clinical diagnosis was established by correlating the aetiological factor associated with the lesion and by systematic examination of the oral mucosa and classifying those alterations according to the epidemiological guidelines for the diagnosis of oral mucosal diseases. During the clinical examination, the following elements were analysed: features of the lesion, anatomical location, extension, aetiological factors or related factors, dental status, alcohol, tobacco, trauma, use of prosthesis and if such were well adapted. RESULTS: Sixty lesions were diagnosed in 75 patients. These were classified according to clinical, histopathological and microbiological diagnosis and were distributed into 15 different clinical entities. The more prevalent pathologies were inflammatory, reactive and associated with long-term use of prostheses or ill-adapted prostheses, since 67% of the patients with lesions were using prostheses. Of the lesions related to prosthesis use, denture stomatitis was the most common one, representing 20 cases (33.3%). The second most frequent lesion was erythematous candidiasis (10%). The other most frequent lesions in this study were lingua plicata, xerostomia and pseudomembranous candidiasis. CONCLUSION: Oral and perioral tissues undergo different functional and structural changes with ageing. The role of the dentist and stomatologist includes the management of systemic, nutritional and pharmacological oral manifestations in order to establish an early diagnosis and subsequent accurate treatment.

LET dependence of the response of EBT2 films in proton dosimetry modeled as a bimolecular chemical reaction.

The dose response for films exposed to clinical x-ray beams is not linear and a calibration curve based on absorbed dose can be used to account for this effect. However for proton dosimetry the dose response of films exhibits an additional dependence because of the variation of the linear energy transfer (LET) as the protons penetrate matter. In the present study, we hypothesized that the dose response for EBT2 films can be mathematically described as a bimolecular chemical reaction. Furthermore, we have shown that the LET effect can be incorporated in the dose-response curve. A set of EBT2 films was exposed to pristine 161.6 MeV proton beams. The films were exposed to doses ranging from 0.93 to 14.82 Gy at a depth of 2 cm in water. The procedure was repeated with one film exposed to a lower energy beam (85.6 MeV). We also computed the LET and dose to water in the sensitive layer of the films with a validated Monte Carlo system, taking into account the film construction (polyester, adhesive and sensitive layers). The bimolecular model was able to accurately fit the experimental data with a correlation factor of 0.9998, and the LET correction factor was determined and incorporated into the dose-response function. We also concluded that the film orientation is important when determining the LET correction factor because of the asymmetric construction of the film.

Stem cells for periodontal regeneration.

Periodontal regeneration is considered to be biologically possible but clinically unpredictable. In periodontitis, inflammation manifests clinically as loss of supporting periodontal tissues and regeneration of damaged tissue is the main goal of treatment. For decades, periodontists have sought to repair the damage through a variety of surgical procedures, and use of grafting materials and growth factors, and of barrier membranes. Reports have emerged that demonstrate which populations of adult stem cells reside in the periodontal ligaments of humans and other animals. This opens the way for new cell-based therapies for periodontal regeneration. This review provides an overview of adult human stem cells and their potential use in periodontal regeneration.

Potential influence of tubular dysfunction on the difference between estimated and measured glomerular filtration rate after kidney transplantation.

PURPOSE: Because no consensus exists regarding the most accurate calculation to estimate glomerular filtration rate (GFR) based on serum creatinine concentrations (sCr) after kidney transplantation, this study sought to assess the potential role of tubular dysfunction on GFR estimates using various equations as well as the effect of pharmacologic blockades on tubular secretion of creatinine on creatinine clearance (ClCr). METHODS: Iohexol GFR (mGFR) was performed in 17 stable kidney transplant recipients(R) at >24 months post-transplantation. Their mean age was 48.3 ± 11.3 years. All R were treated with a calcineurin inhibitor (CNI). At the time of study we measured sCr, 24 hour-ClCr, cystatin C, 24-hour proteinuria, microalbuminuria, FE Na, alfa1-microglobulinuria (alfa1-MG), and CNI concentrations. To block tubular secretion of Cr, recipients were prescribed cimetidine (2400 mg) 2 days before the sCr measurement. Additionally, to exclude dietary influences on sCr, R did not eat meat for 2 days before testing. GFR was estimated using the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Cockroft-Gault (C&G), and Cystatin C (Cyst C) GFR equations. Mean kidney graft function over the previous 6 months was used as the control. Pearson correlation was determined between the differences between mGFR and estimatedGFR: Iohexol minus MDRD, EPI, Cyst C or C&G GFR for paired estimates. The diagnostic accuracy of the eGFRs to detect an mGFR of 60 mL/min/1.73 m(2) was examined by receiver operating characteristic curves. RESULTS: Mean mGFR was 75.2 ± 35.8 mL/min/1.73 m(2). The sCr increased but the 24-hour ClCr, MDRD, EPI, and C&G decreased after vs before cimetidine. The difference was significant for sCr (F = 12.933; P = .002) and MDRD GFR (F = 15.750; P = .001). mGFR was not significantly higher than all pair values of eGFRs, and not significantly lower than 24-hour ClCr before and after cimetidine. However, in comparison to all eGFRs, ClCr after cimetidine most approached mGFR. A significant positive correlation was observed between alfa1-MG and the difference between mGFR and MDRD (before, r = .543 [P = .045]; after cimetidine, 0.568 [P = .034]), EPI (before, r = 0.516 [P = .050]; after cimetidine, r = 0.562 [P = .036]), and ClCr (r = 0.633; P = .016), C&G (P = .581; P = .029) before cimetidine. Accuracy of eGFRs to detect mGFR of 60 mL/min/1.73 m(2) showed EPI GFR before cimetidine to show diagnostic accuracy for patients with GFR >60 mL/min/1.73 m(2) with a sensitivity of 81.8% and a specificity of 71.4%. CONCLUSIONS: Because mGFR is unavailable in many transplant centers, determination of ClCr after cimetidine may help to achieve a more accurate diagnosis of CKD among transplant patients.

Determination of the quenching correction factors for plastic scintillation detectors in therapeutic high-energy proton beams.

Plastic scintillation detectors (PSDs) have many advantages over other detectors in small field dosimetry due to their high spatial resolution, excellent water equivalence and instantaneous readout. However, in proton beams, the PSDs undergo a quenching effect which makes the signal level reduced significantly when the detector is close to the Bragg peak where the linear energy transfer (LET) for protons is very high. This study measures the quenching correction factor (QCF) for a PSD in clinical passive-scattering proton beams and investigates the feasibility of using PSDs in depth-dose measurements in proton beams. A polystyrene-based PSD (BCF-12, ϕ0.5 mm × 4 mm) was used to measure the depth-dose curves in a water phantom for monoenergetic unmodulated proton beams of nominal energies 100, 180 and 250 MeV. A Markus plane-parallel ion chamber was also used to get the dose distributions for the same proton beams. From these results, the QCF as a function of depth was derived for these proton beams. Next, the LET depth distributions for these proton beams were calculated by using the MCNPX Monte Carlo code, based on the experimentally validated nozzle models for these passive-scattering proton beams. Then the relationship between the QCF and the proton LET could be derived as an empirical formula. Finally, the obtained empirical formula was applied to the PSD measurements to get the corrected depth-dose curves and they were compared to the ion chamber measurements. A linear relationship between the QCF and LET, i.e. Birks' formula, was obtained for the proton beams studied. The result is in agreement with the literature. The PSD measurements after the quenching corrections agree with ion chamber measurements within 5%. PSDs are good dosimeters for proton beam measurement if the quenching effect is corrected appropriately.

Oral piercing and its complications in two Serbian youths a case report and review of the literature / El piercing oral y sus complicaciones en dos jóvenes de Serbia reporte de caso y revisión de la literatura

OBJECTIVE: Historically, wearing adornments on pierced body parts has been associated with many cultures as manifestations of religious or cultural identities. Currently, its use has a broad acceptance among young people. In the oral cavity, the most common sites for piercings are the tongue and lower lip. RESULTS: Pain, swelling and infection are the most serious consequences associated with this procedure. Several complications may be associated with this practice with the most frequently observed being halitosis, periodontitis, tooth fracture, glossitis, and the formation of abscesses. Other adverse outcomes include mucosal or gingival trauma, increased salivary flow, and interference with speech, mastication and swallowing. CONCLUSION: This article presents case reports on lip and tongue piercings and literature review highlights of this procedure. Special attention is given to complications and dental implications associated with such a practice.

OBJETIVO: Históricamente, el llevar adornos en partes del cuerpo perforadas ha sido asociado en muchas culturas como manifestaciones de identidades religiosas o culturales. Actualmente, su uso tiene amplia aceptación entre los jóvenes. En la cavidad oral, los sitios más comunes para el piercing son la lengua y el labio inferior. RESULTADOS: Dolor, inflamación e infección son las consecuencias más serias asociadas con este procedimiento. Varias complicaciones pueden asociarse con esta práctica, siendo la halitosis, la periodontitis, la fractura de dientes, la glositis, y la formación de abscesos, las más frecuentemente observadas. Otros resultados adversos incluyen traumas de la mucosa y la encía, aumento del flujo salival, e interferencia con la articulación del habla, la masticación, y la deglución. CONCLUSIÓN: Este artículo presenta reportes de caso de piercing del labio y la lengua, y resalta aspectos de este procedimiento como parte de una revisión de la literatura. Se presta especial atención a las complicaciones y las implicaciones dentales asociadas con tal práctica.

SU-E-T-435: Automatic Monte Carlo Dose Calculations of Proton Treatment Plans.

PURPOSE: Providing a user friendly automated Monte Carlo dose computation system for proton treatments using passively scattered and intensity modulated proton therapy plans, developed at the proton therapy facility of the M.D. Anderson Cancer Center. METHODS: In house software was developed to automatically extract patient CT images, as well as the setup geometry and proton beam parameters from DICOM files, to create a Monte Carlo (MCNPX) model simulating the beam line arrangements of the various beams used in any given proton treatment plan. A graphical user interface provides an easy and intuitive workspace. A library of phase space files provides source proton beams with the desired modulation width and range in water. Energy deposition is scored in the voxelized CT volume, converted to dose and compared to results of analytical dose computations. RESULTS: Monte Carlo models of patient specific beam line equipment, such as the brass collimator and the range compensator, as well as avoxelized model of the patient, are automatically created and implemented into the model of the simulated beam. Simulation of proton beams result in energy deposition distributions in a volume of interest defined by the user during program start. CONCLUSIONS: Current efforts focus on production ofthe phase space library and final debugging of the program flow. It is expected that a prototype version of the system will be functional in summer 2012.

SU-E-T-474: Monte Carlo Phase Space Production to Model Magnetically Scanned Proton Beams for IMPT.

PURPOSE: Accurate dose predictions in proton beam therapy using magnetically scanned beams are highly dependent on the accurate modeling of the lateral dose profiles. This study was performed to provide proton phase spaces for Monte Carlo simulations, used to accurately simulate doses at distances up to 12 cm from the central axis of the beam. METHODS: Measured lateral dose profiles at various depths in water were compared to Monte Carlo simulations of doses for 90 discreet initial proton energies. Phase spaces were produced using a one dimensional energy distribution, and a combination of several two dimensional spatial and directional distributions. Simulations were performed iteratively using variations in the initial phase space distributions to achieve acceptable agreement between measured and simulated lateral dose profiles, i.e. differences in FWHM < 0.5 mm and dose differences less that 0.1% at distances up to 12.5 cm. RESULTS: 90 phase spaces of proton sources for different initial beam energies were created for use in Monte Carlo simulations of scanned proton beam therapy patient plans. At a depth of 2 cm in water, the simulated and measured FWHM of the lateral dose profiles differed in in-plane direction by an average of 0.05 mm, in cross-plane direction by 0.13 mm. All simulated profiles were within 0.1% of the measured doses at distances between 2cm and 12.5 cm from the central beam axis. CONCLUSIONS: A library of 90 phase space files has been created to accurately simulate magnetically scanned proton beams for IMPT, providing accurate dose distributions up to 12 cm distance from the central beam axis. This project is supported in part by P01CA021239 from the National Cancer Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.

SU-E-T-484: Potential Clinical Impact of Dosimetric Uncertainties in Proton Therapy.

PURPOSE: The analytical algorithms which are used widely for proton treatment planning in the current clinical practice may have significant dosimetric uncertainties in highly heterogeneous regions. The aim of this study is the assessment of the potential clinical impact of these uncertainties. METHODS: A cohort of 8 patients with local (in field) recurrences, originally treated for lung cancer at our institution, was selected for this study. CT scans and treatment plans were used to assemble the input files for the Monte Carlo (MC) code MCNPX. The total energy deposition inside the patient volume was computed with statistical uncertainty of less than 2% and converted to dose-in-water. The results were compared to the dose computed by the clinical treatment planning system (TPS). The area of the recurrence was contoured on the follow-up PET/CT study for each of the patients and registered to the planning CT. RESULTS: While there is acceptable agreement between the TPS and the Monte Carlo dose in homogeneous regions, there are noticeable differences caused by heterogeneities. The regions of largest differences are the points around and beyond the distal edge and points around the lateral penumbra and in several patients the target has received lower then the prescribed dose. The area of the recurrence corelates well with the MC predicted underdosed area of the target. CONCLUSIONS: The uncertanties in analytical dose algorithms used in clinical TPSs may result in suboptimal target coverage increasing the possibility of tumor recurrence. Accurate Monte Carlo simulations can be used to predict and avoid the situations in which the analytical algorithms have high uncertanties providing for more robust treatment planning.

WE-E-BRB-02: Evaluation of Analytical Proton Dose Predictions with a Lung-Like Plastic Phantom.

PURPOSE: Former studies have shown that in homogeneities in the path of therapeutic proton beams can lead to a degradation of the distal edge of the Bragg peak. These studies mostly investigated bone-air interfaces. This study focuses on distal edge degradation caused by finely structured soft tissue - air interfaces, which can be found in lung tissue. METHODS: A randomly filled voxelized lung-like phantom was designed and produced using rapid prototyping methods. The results of transmission measurements on this phantom were used to validate Monte Carlo (MC) calculations, which were then used as gold standard to calculate doses in several lung equivalent geometries (phantoms). The results were compared to the results of analytical dose calculation engines. RESULTS: Transmission measurements showed that the distal falloff width (from 90 % of the peak dose to 10 %) in water increased from 3.32 mm by 117 % to 7.19 mm for an initial proton energy of 140 MeV, and from 5.95 mm to 9.03 mm (52 %) for 200 MeV. The peak dose in the degraded beam was only 70 % (for 140 MeV) and 84 % (for 200 MeV) of the value observed in non-degraded beams. These findings were in contrast to the results obtained with analytical dose computation engines, but are in agreement with MC calculations. CONCLUSIONS: If not predicted correctly, Distal Edge Degradation in lung cancer therapy can lead to severe under-dosage of the target region and unwanted dose in organs at risk distal to the Bragg peak. Therefore clinically used dose calculation algorithms have to be extended to take lateral in homogeneities into account.

Oral piercing and its complications in two Serbian youths: a case report and review of the literature.

OBJECTIVE: Historically, wearing adornments on pierced body parts has been associated with many cultures as manifestations of religious or cultural identities. Currently, its use has a broad acceptance among young people. In the oral cavity, the most common sites for piercings are the tongue and lower lip. RESULTS: Pain, swelling and infection are the most serious consequences associated with this procedure. Several complications may be associated with this practice with the most frequently observed being halitosis, periodontitis, tooth fracture, glossitis, and the formation of abscesses. Other adverse outcomes include mucosal or gingival trauma, increased salivary flow, and interference with speech, mastication and swallowing. CONCLUSION: This article presents case reports on lip and tongue piercings and literature review highlights of this procedure. Special attention is given to complications and dental implications associated with such a practice.

Radicality of surgical treatment for cervical cancer.

Analyses were carried out on 545 Wertheim-Meigs radical hysterectomies performed at the Institute of Gynecology and Obstetrics of the Clinical Center of Serbia during a four-year period from 2002 to 2006. More than ten lymphatic glands in 84.4% of patients were removed. The apical part of the vagina was removed in 77.8% of cases, and 77.6% of patients had the right part of the vagina removed. Distribution of surgical radicality according to FIGO stage of disease has been demonstrated. Comparison of research results in the period from 1996 to 2000 shows a significantly more radical approach concerning the number of lymphatic glands removed during this period.

Uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis.

This is a case report of twoo patients how have uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis with different clinical manifestations. Progressive abdominal pain after menarche, anuria or obstipation with the existing paravaginal tumor indicates this rare anomaly. Initially, the anomaly remains unrecognized, while patients most frequently refered to surgeons for assistance. The method of choice for diagnosis is clinical examination, ultrasonography and magnetic resonance (MR) imaging. Transvaginal excision of the septum is appropriate mode of treatment.

Processing sites are different in the generation of HLA-A2.1-restricted, T cell reactive tumor antigen epitopes and viral epitopes.

In order to improve the processing efficiency of T cell tumor antigen epitopes, this bioinformatic study compares proteolytic sites in the generation of 47 experimentally identified HLA-A2.1-restricted immunodominant tumor antigen epitopes to those of 52 documented HLA-A2.1-restricted immunodominant viral antigen epitopes. Our results show that the amino acid frequencies in the C-terminal cleavage sites of the tumor antigen epitopes, as well as several positions within the 10 amino acid (aa) flanking regions, are significantly different from those of the viral antigen epitopes. In the 9 amino acid epitope region, frequencies differed somewhat in the secondary-anchored amino acid residues on E3 (the third aa of the epitope), E4, E6, E7 and E8; however, frequencies in the primary-anchored positions, on E2 and E9, for binding in the HLA-A2.1 groove, remained almost identical. The most frequently occurring amino acid pairs in both N-terminal and C-terminal cleavage sites in the generation of tumor antigen epitopes were different from those of the viral antigen epitopes. Our findings demonstrate for the first time that these two groups of epitopes may be cleaved by distinct sets of proteasomes and peptidases or similar enzymes with lower efficiencies for tumor epitopes. In the future, in order to more effectively generate tumor antigen epitopes, targeted activation of the immunoproteasomes and peptidases that mediate the cleavage of viral epitopes could be achieved, thus enhancing our potential for antigen-specific tumor immunotherapy.

Blood flow through axially symmetric sections of compliant vessels: new effective closed models.

Due to a tremendous complexity of the human cardiovascular system it remains unfeasible to numerically simulate larger sections of the circulatory system using the full three-dimensional (viscous, incompressible Navier-Stokes) equations for blood flow in compliant vessels. Several "effective" one-dimensional models have been used to simplify the calculation in the axially symmetric sections. All of the one-dimensional models assume an ad hoc axial velocity profile to obtain a closed system of equations, and the Law of Laplace (the independent ring model) to model the vessel wall behavior. In this work we obtain an effective system of equations with the following two novel features: (1) the effective equations do not require an ad hoc closure assumption (the closure follows from the analysis of the original three-dimensional equations) and (2) the vessel wall is modeled as a nonlinearly elastic shell using the Koiter model or the nonlinear membrane model. The first novelty provides a higher-order accurate solution to the original three-dimensional problem, and the second allows deformations of the vessel wall that are not necessarily small.

Opposite effects of dexamethasone and ACTH on the adrenal cortex response to ethane dimethanesulphonate (EDS).

Recently we have reported that ethane dimethane-sulphonate (EDS), the Leydig cell cytotoxin, caused marked atrophy of the adrenal cortex of adult male rats. The aim of this work was to examine whether a 9-day treatment with dexamethasone (0.25 mg/kg/d) or ACTH (40 IU/kg/d), which started 4 days prior to administration of a single dose of EDS (75 mg/kg), influenced the response of the inner adrenocortical zones to the toxin. On day 15 after administration of EDS, adrenal weight was significantly decreased in saline treated rats, but glandular and serum corticosterone levels were not altered. In dexamethasone-suppressed rats, the effect of EDS was augmented; an additional decrease in adrenal weight was accompanied by reduced adrenal and serum corticosterone levels. In ACTH-treated animals EDS was ineffective. These results demonstrate that the deleterious effects of EDS on rat adrenal cortex can be prevented by ACTH and potentiated by dexamethasone.

The role of phospholipase A2 in the pathogenesis of respiratory damage in hemorrhagic necrotizing pancreatitis--assessment of a new experimental model.

The new experimental model has been set as a standard with the purpose to explore and analyze the role of phospholipase A2 in predicting the severity of acute pancreatitis with specific interest for the onset of hemorrhagic necrotizing pancreatitis and pleuropulmonary complications. The experiments were performed on dogs (n = 25), and acute pancreatitis was induced with the injection of 10% sodium-taurocholate into pancreatic duct. Four experimental groups of animals were formed, so that 2 groups had lymph held by draining the thoracic duct. In the other two groups, the lymph had been put into system circulation, so that the nylon bag was set around the pancreas in order to prevent pancreatic juice to be spilt into abdominal cavity. The analyses of the levels of amylase, lipase, pancreatic amylase and phospholipase A2 in of serum, lymph and exudate were performed. The positive correlation was found between increased concentration of phospholipase A2 in serum and reduction of partial pressure of oxygen and pH of blood and the degree of severity of respiratory failure. The speed and intensity of development of the acute hemorrhagic necrotizing pancreatitis, as well as the severity of pulmonary complications might be estimated upon the of increase of the levels of phospholipase A2 in serum and lymph. This experimental model enables the studying of pathogenesis of acute pancreatitis and systemic complications.

Plasma and urinary serotonin and 5-hydroxyindol-3-acetic acid in adults with migraine and tension-type headache.

Each headache can be a complex diagnostic, therapeutic, prognostic and social problem. The pain in the head can be connected with many organic and non-organic causes. In this work, the levels of plasma and urinary free 5-HT and 5-HIAA were investigated in eight migraine (aged 23-59 years) and ten tension-type headache suffers (aged 38-61 years). Based on the data obtained and their correlation with clinical features and in comparison with a control group, the following can be stated: (1) there is involvement of serotonin in migraine and tension-type headache during the attacks, although the positive 5-HT values from plasma were small; (2) urinary 5-HT values in migraine and tension-type headache were normal in comparison to the control group; (3) significantly decreased values of 5-HIAA in urine were found both in migraine and tension-type headache groups. These findings show that catabolism of 5-HT is probably decreased during headache periods; (4) visual aura was found in five out of ten subjects with tension-type headache.

Plasma and urinary serotonin and 5-HIAA in children treated with lamotrigine for intractable epilepsy.

Alteration of monoamine levels by some antiepileptic drugs (AEDs) was elucidated in this study. Lamotrigine (LTG) is a new AED, acting the sodium-channels. LTG was given as add-on therapy to 16 patients aged 4.5-18 yrs with intractable epilepsy and comedicated with carbamazepine or valproate. An equal group of epileptics with comparable clinical characteristics and treatment served as control. Plasma and urinary (24 h-samples) serotonin and 5-HIAA were determined before onset of LTG therapy and after 2-3 months. HPLC and electrochemical detection was used for the determination of serotonin (5-HT) and 5-hydroxy indoleacetic acid (5-HIAA). No significant effect of LTG on both urinary 5-HT and 5-HIAA levels was found, whereas plasma 5-HT concentrations significantly decreased in comparison with levels before LTG starting and relevant values in controls. This findings was noted in 7/16 children with favourable response to LTG. Increased serotonin catabolism may be result of LTG action.

[War injuries of the rectum and perineum]. / Ratne povrede rektuma i perineuma.

The treatment results of 35 wounded with rectal and perineal lesion, treated in the period from 1991 to 1993 were analyzed retrospectively. In military hospitals, 82% of wounded were primarily surgically managed. The majority (65.8%) was with injury of intraperitoneal rectal segment, 10 patients (28.5%) were with the lesion of extraperitoneal segment and 2 patients (5.7%) were with the injury of anal tract and perineum. The injuries were mostly inflected by the bullets of various calibers (42.6%). Multiple or combined injuries were found in 91.6% of wounded with rectal injury and 38.2% of them were managed within 6 hours after injury. Different surgical procedures, most frequently the lesion suture and proximal colostomy (n = 14) were primarily used. Postoperative complications occurred in 10 wounded (28.6%). In 3 wounded it was reintervened by Hartmann's procedure. Mortality rate was 8.5% (n = 3). Anorectal war injuries are the most severe of all the colonic injuries. To our experience and the unique war surgical doctrine in the primary treatment of rectum injury, the most important is to perform terminal colostomy, injury suture (always intraperitoneal, and extraperitoneal if possible, including the sphincter muscles approximation) and presacral drainage.