Stubborn rectal prolapse in systemic sclerosis.

Systemic sclerosis (SSc) is an autoimmune connective tissue disorder. Anorectal involvement might typically cause fecal incontinence and rarely rectal prolapse. Here we report three female patients, who were admitted with a mean history of 10 years suffering from SSc. All patients presented with the initial symptom of anal incontinence, in all cases this was associated with rectal intussusception or rectal prolapse. The three women faced prolapse recurrence, independent of the initial procedure. After surgical removal of the prolapse, the incontinence remained. In SSc rectal prolapse syndrome might occur at an earlier age, and a primary prolapse of the ventral aspect of the rectal wall seems to be typical for this disease. If patients with prior diagnosis of SSc appear with third degree of fecal incontinence, it is suspected to be associated with rectal prolapse. The prolapse recurrence rate after surgery in SSc patients is high.

Passive time-multiplexing super-resolved technique for axially moving targets.

In this paper we present a super-resolving approach for detecting an axially moving target that is based upon a time-multiplexing concept and that overcomes the diffraction limit set by the optics of an imaging camera by a priori knowledge of the high-resolution background in front of which the target is moving. As the movement trajectory is axial, the approach can be applied to targets that are approaching or moving away from the camera. By recording a set of low-resolution images at different target axial positions, the super-resolving algorithm weights each image by demultiplexing them using the high-resolution background image and provides a super-resolved image of the target. Theoretical analyses as well as simulations and preliminary experimental validation are presented to validate the proposed approach.

Total fistulectomy with simple closure of the internal opening in the management of complex cryptoglandular fistulas: long-term results and functional outcome.

BACKGROUND: Total fistulectomy with simple closure of the internal opening has been used for the management of complex anal fistulas. This approach involves complete removal of the fistula tract and closure of the internal opening with sutures. OBJECTIVE: This study aimed to report long-term outcomes in patients with complex cryptoglandular fistulas who undergo this procedure. DESIGN: This is a retrospective review of a prospectively collected consecutive series. SETTINGS: This study was conducted at a community-based hospital with a specialized colorectal unit. PATIENTS: : Patients included in this study had cryptoglandular fistulas and underwent total fistulectomy with simple closure of the internal opening between 1997 and 2007. MAIN OUTCOME MEASURES: The main outcome measures were success rate and postoperative continence (Cleveland Clinic Florida Fecal Incontinence Scale). Treatment was considered successful if the external opening was closed and no drainage was present at the last follow-up. RESULTS: Success was achieved in 187 (74%) patients with a median follow-up time of 70 (range, 14-141) months. Patients with posterior transsphincteric or suprasphincteric fistulas had a higher success rate than those with other types of fistulas (82% vs 67%;p = 0.014), and patients for whom the procedure failed were significantly younger than those for whom the procedure was a success (mean, 45 vs 50 years; p = 0.010). Of 160 patients with success who had no previous surgery, 89 (56%) had normal continence postoperatively (CCF-FI score = 0). LIMITATIONS: The limitations of this study include its retrospective nature, the potential for selection bias, and the lack of preoperative continence scores. CONCLUSIONS: Total fistulectomy with simple closure of the internal opening is effective for the long-term closure of complex cryptoglandular fistulas.However, this procedure may affect continence despite its sphincter-sparing quality. Nonetheless, the high success rate in patients with posterior transsphincteric or suprasphincteric fistulas renders this procedure a reasonable option in this subgroup of patients with complex fistulas.

Successful management of esophageal necrosis after endovascular repair of chronic type B aortic dissection.

We report the case of a 65-year-old patient with esophageal necrosis that developed after thoracic endovascular aortic repair (TEVAR) of a previously stented, ruptured chronic type B aortic dissection. The cause of this complication may have been related to an infected mediastinal hematoma causing esophageal compression. Emergent esophagectomy was performed with success.