Long-term outcome of sphincteroplasty with separate suturing of the internal and the external anal sphincter.

BACKGROUND: Sphincteroplasty is one of the treatment options for anal incontinence following obstetric injury. The aim of the study was to evaluate the long-term effect of sphincteroplasty with separate suturing of the internal and the external anal sphincter on anal continence. METHODS: A retrospective study was conducted on women who had sphincteroplasty for treatment of anal incontinence following obstetric injury. Women operated between January 1, 2011 and December 31, 2014 at Sykehuset Innlandet Hospital Trust Hamar, were invited to answer a questionnaire and participate in a clinical examination, including endoanal sonography. RESULTS: 111 (86.7%) women participated. Median postoperative follow-up was 44.5 months, and 63.8% of the participants experienced an improvement of at least three points in the St. Mark's incontinence score. Fecal urgency and daily fecal leakage persisted in 39.4% and 6.4% of the participants, respectively. The internal anal sphincter improvement persisted in 61.8% of the participants, and there was a median reduction of their St. Mark's score of 6.0 points between the preoperative value and the value at long-term follow-up. There was no significant change in the St. Mark's score of patients with persistent dehiscence of the internal anal sphincter. CONCLUSIONS: Sphincteroplasty, with separate suturing of the internal sphincter resulted in continence for stool maintained for at least 3 years in the majority of the patients, while there was an improvement in continence in nearly two-thirds.

Translation and validation of the Norwegian version of the fecal incontinence quality-of-life scale.

BACKGROUND AND AIM: Fecal incontinence quality-of-life scale (FIQLS) is a condition-specific health-related quality-of-life questionnaire composed of four scales: lifestyle, coping/behaviour, depression/self-perception and embarrassment. It has been widely translated and used as an evaluation tool for patients with fecal incontinence. Our aim was to translate the FIQLS, and to test some of the psychometric properties of the Norwegian version of the questionnaire. MATERIAL AND METHODS: The FIQLS was translated to Norwegian, and administered to a sample of 76 patients (73 women) who completed the questionnaire at baseline and again after three weeks. In addition, the severity of incontinence was assessed by phone-interviews (St. Mark's score). RESULTS: Three of four domains had good internal consistency in terms of Cronbach's alpha (.83-.91), the fourth (embarrassment) somewhat lower (.64). Stability over time was acceptable for all domains with ICC ranging from .74 to .86. Correlation with severity of incontinence (St. Mark's score) was medium to large for all four domains (-.46 to -.63) supporting the construct validity of the Norwegian FIQLS. CONCLUSION: The Norwegian version of fecal incontinence quality-of-life scale has been successfully translated and tested.

[Anal plug in fecal incontinence]. / Analpropp ved fekal inkontinens.

There is evidence that a considerable number of the adult population, most of them women (30-72 years), are suffering from faecal incontinence. Treatment is either conservative sphincter reconstruction or stoma when no other treatment is successful. As an alternative to stoma, the Conveen anal plug was tested in seven women not suitable for surgery. Three patients had substantially improved social life. One of these patients used the plug daily, the other two at specific occasions. The main advantages were that they did not have to use a pad and they were not bothered by inconvenient smell and sound. Four patients did not tolerate the plug because of urge to defecate and general inconvenience having the plug in the anal canal. The study confirms that the incontinence anal plug is a useful alternative to stoma in selected cases.

Third degree obstetric tears; outcome after primary repair.

BACKGROUND: Disruption of the anal sphincter occurs in 0.5 to 2.5% of women during delivery. Defects of the sphincter are major causes of fecal incontinence. More than 30% of women who suffer from third degree perineal tears develop incontinence. We sought to determine the incidence of symptoms and injury to the anal sphincter among women who gave birth during a 5 year period. We also investigated the sensitivity of manometry and endosonography as well as the correlation of these two diagnostic modalities. METHODS: Thirty-eight women were examined one to five years after delivery. We used a questionnaire to assess symptoms of anal incontinence. Anal manometry and endosonography were performed. RESULTS: Twenty (57%) women had symptoms; most of them (34%) in the form of flatulence incontinence. The rest were incontinent of either liquid or solid stools. Four of these women were re-operated. Seventeen percent of the women suffered from anal incontinence during sexual intercourse. Only seven women had been in contact with a doctor regarding these problems. CONCLUSION: The fact that 57% of the women that took part in this study reported complications, leads us to the conclusion that the primary repair of third degree anal sphincter tears is unsatisfactory. It is important to decide whether any changes in primary repair may improve results in the future. Sexual dysfunction is also a complication of third degree obstetric tear with primary repair. It is important that the women who suffer from anal sphincter tear, as well as doctors, are given information about possible symptoms and the treatment available.

[Transanal endoscopic microsurgery]. / Transanal endoskopisk mikrokirurgi.

Transanal endoscopic microsurgery was introduced by Buess and co-workers in 1984 for transanal removal of tumours up to 20 cm above anus. In the present study, 18 transmural and two mucosal resections were performed for rectal adenomas (16) and early rectal cancer (4). Median operation time was 85 minutes (55-140 minutes) and the median postoperative stay in hospital was 3 days (1-5). All tumours were removed radically and in none was there tumour involvement of the resection margin. There were no serious complications. After a median observation time of 10 months (1-17 months) there have been no recurrences. Functional results are excellent; none of the patients have developed incontinence. It is concluded that transanal endoscopic microsurgery (TEM) is an adequate method for removal of benign rectal tumours and, in selected cases, early rectal cancer.

[Peroperative lavage]. / Peroperativ tarmskylling.

Primary bowel anastomosis was performed after an on table lavage procedure in 29 patients who required surgery for colonic lesions. 13 patients were operated in the acute or subacute stage and 16 had inadequately prepared colons at the time of elective operations. The diagnoses were cancer of the colon in 23 patients, diverticulitis in three, stoma stricture in two and colonic bleeding in one. There were 26 left-sided colonic resections, two transverse colonic resections and one right-sided hemicolectomy. The procedure prolonged the operation time by 38 min. (median), range 16-80 min. The rate of complications was 14%, and there was no mortality. None of the patients presented clinical signs of anastomotic leakage. It is concluded that primary colonic anastomosis after on table lavage is a safe and reliable alternative to staged operations. It saves the patients the discomfort of a temporary stoma and possible morbidity from further operations.

[Head injuries in sports--evaluation during admission, follow-up and routine check-ups]. / Hodeskader innen idrett--evaluering på skadestedet, oppfølging og kontrollrutiner.

The authors review head injuries during sport. Among 3,206 such injuries treated at the Regional Hospital, Trondheim, in the course of one year, 12% were injuries to head and face. Minor injuries are classified as. Mild (no amnesia or loss of consciousness), no symptoms, the activity can continue, but one week of rest is recommended. Moderate (amnesia or loss of consciousness < 1 min), medical examination, and two weeks of rest are recommended. Major (loss of consciousness < 5 min), CT scan and one month of rest are recommended. With repeated moderate or triple mild traumas, CT and the possible termination of the sporting season should be considered. Serious head injuries with intracranial pathology will generally disqualify the person from further elite competition. The possible consequences of repeated head injuries during football and other contact sports are stressed, and more regular use of neurophysiologic methods (EEG) and magnetic resonance (MR) in selected cases is recommended. The authors also point out the advantages of using helmets and protective gear, and the doctors' role in advocating such equipment.

Accidents among children below school age. Changes of incidence after intervention.

Children aged 0 to 6 years old admitted to hospital due to an accident were registered. Registration was carried out for two yearly periods; September 1982 to September 1983 and June 1985 to June 1986. The incidence of accidents dropped from 125 per 1,000 a year to 116 accidents per 1,000 children a year. The youngest children showed the most significant decrease in incidence. Home accidents were the most common type of accidents in both registration periods. Accidents due to falling from heights and poisoning accidents increased in the second period. Children injured during the second registration period required 3.4 times fewer days of hospitalization compared with the first period. Fractures and thermal injuries demanded most hospital care in both registration periods.

Occurrence of injuries in a defined population.

A 1-year study of all registered accidents was carried out. All patients treated for an injury at the Trondheim University Hospital, Norway, were recorded. This is the only institution in the region treating injuries. Hence, this is a total injury registration in a defined population. The incidence rate was 114 injuries per 1000 inhabitants. Home accidents were the most common type. Accidents occurring at institutions, in traffic areas and at home caused the longest hospitalization. Most of the injuries were minor; 0.4 per cent of the accidents were fatal. Traffic accidents and home accidents were responsible for the highest percentage of fatal accidents. The demand for preventive measures and reduction of accidents has been based on mortality rates in comparable studies. The mortality rate is well reported for most of the civilized world but this does not tell us anything about the morbidity rate due to accidents. By reducing the accidents needing the longest hospitalization, the economic consequences for the national health system would also be decreased.

Occurrence of fractures in a defined population: a 1-year study.

All injured patients admitted to Trondheim University Hospital during the period June 1985 to June 1986 were recorded. Patients sustaining fractures and living in Trondheim city were selected for this study. A total of 2973 patients with 3060 fractures were reported, giving an incidence rate of 22.8 fractures per 1000 inhabitants. The patients sustaining fractures represented 20 per cent of all cases. Patients with fractures occupied 87 per cent of all days in hospital required by patients involved in accidents. The patients with fractures of the upper end of the femur occupied 53 per cent of these. The types of fractures and the mechanism causing the accidents varied according to the age of the patient. Forearm fractures were the most common fracture. The age of the patient seemed to be the most important factor influencing the outcome of the accident. The percentage of hospitalization increased with increasing age.

Sport accidents in childhood.

Injuries among children during sporting activities are common. This study is a one year study including children between five and fourteen years of age who sustained their injuries during sporting activities and were treated at Trondheim Regional and University Hospital. Sport accidents account for 27 per cent of all childhood accidents in this age group. Fifty-three per cent of the injured were boys, and 47 per cent were girls. The boys sustained more severe injuries than the girls. Soccer caused the greatest number of injuries. Horse riding and alpine skiing were the cause of the most severe injuries. A more widespread use of protective guards, better technique and body control, better coaching and not allowing the younger children to take part in technically advanced sporting activities might reduce the number and the severity of the sport injuries in children.

[Injuries in handball players]. / Skader hos håndballspillere.

The study involves 421 patients who had suffered injury while playing handball. It describes mechanism and trauma, the injuries and their consequences, and data on training and technical conditions. 2/3 of the injured were female and one half belonged to the younger age-classes. The incidence of injury was highest among senior players. Distortion was the most frequent type of injury, followed by contusions and fractures. Half of the injuries were to the upper limbs, but the most frequent single injury was injury to the ankle joint. Many fractures were seen in fingers, forearm, hand and ribs. Wounds occurred most frequently to the face. The most serious injuries were ruptures of the ligaments in the knee joint. Protective equipment, such as braces, was seldom used. A small minority of the players were given adequate first aid. Important measures to prevent injury include better basic training, better technical training conditions, good first aid, and some changes in the rules of competition.

Alpine skiing injuries.

Alpine skiing accidents admitted to the Trondheim Regional and University Hospital during one year were recorded. Of the 339 injured, 67 per cent were male and 33 per cent were female. Eighty-seven per cent were outpatients, and 13 per cent were hospitalized. Falling accidents (67 per cent), followed by collision accidents (17 per cent), were the most common cause of injury. The injuries in the lower extremities were caused by falling and the head injuries were mostly caused by collisions. Knee ligament strains were the most common injuries, and 17 per cent of these were hospitalized and required operative treatment. Of the minor knee strains, all 44 per cent were not fully recovered after two and a half years. Seventeen patients sustained tibial fractures, eleven of them spiral fractures and six transverse fractures. The patients with spiral fractures were younger than the patients with transverse fractures. Head injuries were the most severe injuries, with eleven concussions and two epidural haematomas.