Is there a correlation between levator ani and urethral sphincter complex status on 3D ultrasonography?

INTRODUCTION AND HYPOTHESIS: To determine the correlation between levator ani deficiency (LAD) and urethral sphincter complex measurements as visualized on 3D endovaginal ultrasonography, and to compare the LAD score with continence status. METHODS: This was a retrospective analysis of patients seen at our institution between January 2011 and August 2013. Patients were dichotomized into those with urodynamic stress urinary incontinence (SUI) and those with no SUI. Levator ani status was evaluated using a validated scoring system yielding scores of 0 - 6 (normal levator ani/mild LAD), 7 - 12 (moderate LAD), and 13 - 18 (severe LAD). The length, horizontal diameter, and cross-sectional area of the urethra, and the length, width, and the area of the rhabdomyosphincter and smooth muscle sphincter were likewise measured using 3D ultrasound volumes. RESULTS: Of the 80 patients included, 54 (67.5%) had SUI and 26 (32.5%) were continent. 18 (22.5%) had evidence of mild LAD, 54 (67.5%) had moderate LAD, and 8 (10.0%) had severe LAD. Among patients with SUI, those with normal levator ani muscles or mild LAD had greater urethral smooth muscle width than those with moderate and severe LAD (p = 0.0238). A greater proportion of patients with SUI also had moderate to severe LAD than continent patients (p = 0.0177, OR 3.59, 95% CI 1.21 - 10.65). There was no difference in LAD distribution by type of stress incontinence (presence or absence of intrinsic sphincter deficiency; p = .2377). CONCLUSIONS: LAD and urethral sphincter complex status, as visualized on 3D ultrasonography, are independent factors. Moderate to severe LAD is more prevalent in patients with SUI.

An ultrasound approach to the posterior compartment and anorectal dysfunction.

INTRODUCTION AND HYPOTHESIS: Patients with anorectal dysfunction are common and can be quite challenging to diagnose. The common underlying causes for such conditions are usually anatomical in nature, which may be difficult to fully evaluate by clinical examination alone. The aim of this video was to demonstrate how multicompartmental ultrasound imaging can be utilized clinically in the evaluation of patients with anorectal dysfunction. METHODS: Pertinent ultrasound findings of the common anatomical causes of defecatory dysfunction were discussed in this video. RESULTS: Different ultrasound techniques were shown. CONCLUSION: In conclusion, multicompartmental ultrasound imaging is an easy, cost-efficient, and valuable tool in the evaluation of patients with anorectal dysfunction.

Interpersonal attractiveness and clinical decision in alcoholism treatment.

The authors investigated the interactive contribution of patient characteristics and staff perceptions of the patient to decisions concerning the provision of continued alcoholism treatment following an initial 2-week evaluation period. Staff perceptions contributed significantly more to an individual's acceptance or rejection than did patient characteristics. A high interpersonal attractiveness rating also led to a significantly more positive evaluation of the patients' level of intelligence, knowledge of current events, morality, and adjustment. The present results and research findings with general psychiatric populations are compared.

Screening for cognitive impairment among inpatients.

Screening hospital patients for cognitive impairment is often required for effective treatment planning. Awareness of cognitive deficit is particularly important in working with patients who have drinking problems because of the relationship between alcohol consumption and cognitive impairment. Trail-Making Test is examined as an economic, quick, and accurate indicator of cognitive impairment in non-neurological sample of patients in a Veterans Administration Hospital. Results show that performance discriminates between normal and deficient cognitive function as assessed by established IQ and neuropsychological tests--the Wechsler Bellevue Intelligence Scale and the Halstead Reitan Battery. Nonsignificant correlations with personality variables suggest discriminant validity for the Trail-Making Test as an indicator of cognitive impairment.

Drinking patterns of alcoholics differing in levels of perceived and experienced control.

In men alcoholics, control orientation appears to be related to perceived benefits of drinking, while the level of control experienced in social situations appears to be related to the consequences of drinking.

Changes in perceived and experienced control among inpatient alcoholics.

The Locus of Control and Experienced Control Scales were administered to 40 alcoholics shortly after admission to a rehabilitation program and again after approximately 6 weeks of treatment. During the course of treatment, the Ss evidenced an overall shift toward a more internal locus of control, an increase in the magnitude and relative degree of control experienced over interpersonal and intrapersonal pressures, and a decrease in the magnitude of control exerted on them by such pressures. The overall increase in the proportionate control experienced appeared to be accounted for by shifts made by those Ss who entered treatment with an initially internal locus of control.

Relationship of alcoholic personality subtypes to treatment follow-up measures.

The present study investigated the relationship of a multivariate classification of alcoholic patients based upon Minnesota Multiphasic Personality Inventory profiles taken at admission to psychopathology and drinking behavior at a 6- to 12-month follow-up interval. It was found that a subtype of patients characterized as psychoneurotic, with reactive anxiety and/or depression, evidenced significantly higher levels of psychopathology at follow-up than the remaining three subtypes. Furthermore, this subtype demonstrated higher levels of physical, social, and psychological impairment from post-treatment drinking episodes. No differences were found among the four subtypes with respect to outpatient therapists' ratings of personality change and adjustment. The findings suggest that such a multivariate classification of Minnesota Multiphasic Personality Inventory profiles has predictive utility. The results also suggest that the present subtypes would be useful in investigating the potential utility of differential therapeutic intervention strategies for different patients.