Early recognition of pelvic floor dyssynergia and colorectal assessment in Parkinson's disease associated with bowel dysfunction.

AIM: Slow colonic transit time (CTT) and pelvic floor dyssynergia (PFD) are major contributors to constipation in patients with Parkinson's disease (PD). However, no symptom survey yet exists that effectively differentiates the contributing aetiologies. The significance of individual pelvic floor musculature behaviours and their relationship with colorectal dysmotility in constipated patients with PD are still controversial and need further clarification. We aimed to investigate how differentiated constipation-related symptoms of PD patients with constipation may identify constipation groupings and to register the pathophysiological features of the pelvic musculature. METHOD: Our subjects undertook CTT, defaecography and the Knowles-Eccersley-Scott Symptom questionnaire. The pathological aetiologies were categorized as group 1 (slow CTT) and/or group 2 (puborectalis syndrome) and/or group 3 (pubococcygeus syndrome), in accordance with the CTT and defaecography results. RESULTS: Constipation-related symptoms such as incomplete evacuation and defaecation difficulty yielded high post-test probabilities (81% and 88%, respectively) in groups 3 and 2, but a low post-test probability in group 1 (58%). Changes in the anorectal angle and perineum descent during straining were significantly correlated with CTT (r = 0.57 and r = 0.61, respectively) and with each other (r = 0.82). CONCLUSION: Our findings that neural control of the puborectalis and pubococcygeus, along with colorectal peristalsis, were in a similar state of degeneration is key information that should assist physicians to instigate more effective management for colonic dysmotility or PFD.

Managing an animal health emergency in Taipei China: foot and mouth disease.

Taipei China had been free from foot and mouth disease (FMD) over 68 years before the disease occurred in March 1997. The first suspected case was recorded on a pig farm in the Hsinchu Prefecture on 14 March 1997. Based on clinical signs, gross histopathological findings, and results of enzyme-linked immunosorbent assays and reverse-transcriptase polymerase chain reaction tests, diagnosis of FMD was confirmed by the Taiwan Animal Health Research Institute on 19 March 1997 and was reconfirmed by the FMD World Reference Laboratory in Pirbright (United Kingdom), on 25 March 1997. By the end of July 1997, 6,147 pig farms (about a quarter of the pig farms in Taipei China), were affected. The disease was well under control within two months by means of stamping-out and blanket vaccination. The Government purchased 21 million doses of inactivated oil-adjuvant FMD vaccine, which allowed for two injections per pig and one injection of other cloven-hoofed animals. Before the vaccine was used, the stamping-out policy was implemented, ensuring that all pigs in the affected farms were destroyed. After blanket vaccination, a partial stamping-out policy was adopted, i.e. only pigs showing clinical signs were destroyed.

Correlation of three-dimensional tumor volumetry with cervical cancer prognostic parameters.

OBJECTIVE: Estimation of tumor size by a single diameter is used in the current Federal International Gynecology Oncology (FIGO) cervical cancer staging system. However, the role of three-dimensional volumetry is rarely mentioned. In this study, three kinds of tumor volume estimations were performed and the relationship of these volume estimations among associated cervical cancer prognostic parameters were evaluated. METHODS: Thirty patients with newly diagnosed cervical cancer at Taipei Veterans General Hospital were enrolled in the study. Final pathology and associated parametric information was obtained by chart review. The original magnetic resonance (MR) image was reappraised by an experienced radiologist and the tumor volume was estimated using either three axial measurements or the longest axial measurement. The corresponding three-dimensional (3-D) volume was calculated by the integration of lesion areas in different images using volumetric software developed by engineers at National Central University, Taiwan. All data were analyzed separately for correlation with clinical staging, histological differentiation, pelvic lymph node metastasis and survival status. RESULTS: A statistically significant difference in tumor volume estimates was found between 3-D-integration and one-dimensional estimates among tumors with lymph nodes metastasis, cell differentiation and parametrial involvement. CONCLUSION: This study found that the parameters of lymph node metastasis, parametrial involvement and tumor differentiation are volume-dependent. 3D-tumor volumetry showed superior discrimination of these parameters compared to current single diameter evaluation suggesting its potential as a rapid method for initial prediction of prognostic factors in cervical cancer.

The assessment of stability and reliability of a virtual reality-based laparoscopic gynecology simulation system.

PURPOSE OF INVESTIGATION: Surgeons require practiced skills in laparoscopic surgery. A virtual reality-based simulator system was developed for extensive training. The purpose of this study was to assess the feasibility of a virtual reality-based laparoscopic gynecology simulation system. METHODS: Laparoscopic tools and three-dimensional virtual environments were included in the simulation system. Ten healthy, non-disabled volunteers were recruited. The surgical procedure is a process of tubal sterilization by cauterization. Volunteers followed the training procedure, 15 trials in the first test and retest, respectively. RESULTS: Stable performances were obtained after about seven trials for all subjects. The intraclass correlation coefficients were 0.935 and 0.425 for task time and error frequency, respectively. CONCLUSION: The results of this study indicate that the system is stable and has a fair high test-retest reliability. Therefore, the VR-based laparoscopic gynecology system is feasible.

The development of a VR-based treatment planning system for oncology.

In this study, an oncology treatment planning system was developed by integrating the techniques of computer graphics, virtual reality (VR) and three dimensional (3D) image reconstruction. The virtual treatment room was constructed according to the real space, and the 3D data of patient's body was reconstructed from computer tomography (CT) slices in order to provide the 3D clinical information to compare with the therapy in real world. In addition, the virtual multi-leaf collimator (MLC) was constructed to simulate and visualize both the radiation and irradiation fields. All objects in the system had been scaled down according to the true size. The system can be expected to save the preparation time and can be used for teaching and training prior to a real therapy.

Unusual proximal migration of ventriculoperitoneal shunt into the heart.

Quite a number of cases of upward shunt migration have already been reported in the literature. In this paper, the intracardiac migration of a peritoneal shunt tube of a ventriculoperitoneal shunt system is reported. This is a rare complication of ventriculoperitoneal shunting and was diagnosed by a plain radiograph of the chest and a direct open heart surgery. To the author's knowledge this is the first reported case of migration of a peritoneal shunt tube into the heart. The authors postulate possible mechanisms and a physioanatomical explanation on the basis of the surgical findings.