Short-term effect of a close-fitting type of walking assistive device on spinal cord reciprocal inhibition.

One of the major problems with walking encountered by patients with spastic hemiplegia is diminished toe clearance due to spasticity of their leg muscles. To improve their walking, a specialized robot assist for ankle movements (RE-Gait) has been utilized. The present study examined the neurophysiological effects whether spinal cord reciprocal Ia inhibition (RI) in the leg was altered by using RE-Gait. Sixteen patients with a clinical diagnosis of stroke were divided into the two groups, RE-Gait walking group (Group R) and normal (controlled) walking group (Group C). In each group, they walked on a flat floor for 15 min with or without RE-Gait. The depression of soleus (Sol) H-reflexes conditioned by common peroneal nerve stimuli with the conditioning-test (C-T) intervals of 1, 2, 3, and 4 ms were assessed before and immediately after each walking session. After the intervention, the LSM (SE) of Sol H-reflex amplitude with 1, 2 and 3 ms C-T interval conditions were significantly decreased in group R (1 ms: 88.15 (4.60), 2 ms: 86.37 (4.60), 3 ms: 89.68 (4.62)) compared to group C (1 ms: 105.57 (4.56), 2 ms: 100.89 (4.58), 3 ms: 107.72 (4.58)) [1 ms: p = 0.012, 2 ms: p = 0.035, 3 ms: p = 0.011]. Walking assistive robot that targets ankle movements might be a new rehabilitation tool for regulating spinal cord excitability.

Analysis of Deep Posterior Anal Fistulas by Magnetic Resonance Imaging: Site of Primary Abscess and Extension Patterns According to the Primary Abscess Depth.

OBJECTIVES: The aim of this study was to use magnetic resonance imaging (MRI) to elucidate the site and depth of the primary abscesses associated with deep posterior anal fistulas and their extension patterns. METHODS: We analyzed 176 consecutive patients with deep posterior anal fistulas and classified the fistulas according to whether the MRI-detected site of the primary abscess was at a superficial or a deep external anal sphincter (EAS) level. RESULTS: The distance between the anal center and the primary abscess center was significantly shorter than the length of the EAS and radius at an angle of 45°. In addition, deep posterior anal fistulas with primary abscesses located at the deep EAS level penetrated the EAS significantly more laterally and made external openings at a significantly more lateral site than when the primary abscess was located at a superficial EAS level. CONCLUSIONS: Primary abscesses associated with deep posterior anal fistulas are located in the posterior intersphincteric space or in the EAS muscle itself, not in Courtney's space, as had previously been claimed.

Rules for anal fistulas with scrotal extension.

OBJECTIVES: To evaluate the rules for anal fistulas with scrotal extension, in particular, whether a high transsphincteric or suprasphincteric fistula, of which internal openings are usually located posteriorly, would extend into the scrotum. METHODS: We retrospectively analyzed 446 consecutive male patients who underwent definitive anal fistula surgery. We compared fistulas with scrotal extension according to the location of the internal opening and divided them into anterior and posterior groups. RESULTS: Forty-six (82.1%) of the 56 anal fistulas with scrotal extension had anterior internal openings. After excluding recurrent fistulas, 42 (87.5%) of the 48 anal fistulas with scrotal extension had anterior internal openings. The relative risk of scrotal extension in the anterior group was 14.22 times higher than that in the posterior group (95% CI: 7.43-27.21; p<0.0001). After excluding recurrent fistulas, this relative risk rose to 18.67 (95% CI: 8.18-42.58), (p<0.0001). CONCLUSIONS: Anal fistulas with scrotal extension are mostly low transsphincteric or intersphincteric with anterior internal openings. High transsphincteric or suprasphincteric fistulas rarely extend into the scrotum, except in recurrent cases.