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Original Article
Malignant disease,Rectal cancer,Complication,Biomarker & risk factor
Cross-sectional area of psoas muscle as a predictive marker of anastomotic failure in male rectal cancer patients: Japanese single institutional retrospective observational study
Yusuke Mizuuchi, Yoshitaka Tanabe, Masafumi Sada, Koji Tamura, Kinuko Nagayoshi, Shuntaro Nagai, Yusuke Watanabe, Sadafumi Tamiya, Kohei Nakata, Kenoki Ohuchida, Toru Nakano, Masafumi Nakamura
Ann Coloproctol. 2022;38(5):353-361.   Published online April 12, 2022
DOI: https://doi.org/10.3393/ac.2022.00122.0017
  • 4,341 View
  • 167 Download
  • 8 Web of Science
  • 9 Citations
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary Material
Purpose
Preoperative sarcopenia worsens postoperative outcomes in various cancer types including colorectal cancer. However, we often experienced postoperative anastomotic leakage in muscular male patients such as Judo players, especially in rectal cancer surgery with lower anastomosis. It is controversial whether the whole skeletal muscle mass impacts the potential for anastomotic failure in male rectal cancer patients. Thus, the purpose of this study was to clarify whether skeletal muscle mass impacts anastomotic leakage in rectal cancer in men.
Methods
We reviewed the medical charts of male patients suffering from rectal cancer who underwent colo-procto anastomosis below the peritoneal reflection without a protective diverting stoma. We measured the psoas muscle area and calculated the psoas muscle index.
Results
One hundred ninety-seven male rectal cancer patients were enrolled in this study. The psoas muscle index was significantly higher in patients with anastomotic leakage (P<0.001). Receiver operating characteristic curve determined the optimal cut-off value of the psoas muscle index for predicting anastomotic leakage as 812.67 cm2/m2 (sensitivity of 60% and specificity of 74.3%). Multivariate analysis revealed that high psoas muscle index (risk ratio [RR], 3.933; P<0.001; 95% confidence interval [CI], 1.917–8.070) and super low anastomosis (RR, 2.792; P=0.015; 95% CI, 1.221–6.384) were independent predictive factors of anastomotic leakage.
Conclusion
This study showed that male rectal cancer patients with a large psoas muscle mass who underwent lower anastomosis had a higher rate of postoperative anastomotic leakage.

Citations

Citations to this article as recorded by  
  • Sex Disparities in Rectal Cancer Surgery: An In-Depth Analysis of Surgical Approaches and Outcomes
    Chungyeop Lee, In Ja Park
    The World Journal of Men's Health.2024; 42(2): 304.     CrossRef
  • Unraveling the role of computed tomography derived body composition metrics on anastomotic leakages rates in rectal cancer surgery: A protocol for a systematic review and meta-analysis
    Mark Broekman, Charlotte M. S. Genders, Ritchie T. J. Geitenbeek, Klaas Havenga, Schelto Kruijff, Joost M. Klaase, Alain R. Viddeleer, Esther C. J. Consten, Ozlem Boybeyi-Turer
    PLOS ONE.2024; 19(7): e0307606.     CrossRef
  • Association of computed tomography‐derived body composition and complications after colorectal cancer surgery: A systematic review and meta‐analysis
    Claire P.M. van Helsdingen, Job G.A. van Wijlick, Ralph de Vries, Nicole D. Bouvy, Mariska M.G. Leeflang, Robert Hemke, Joep P.M. Derikx
    Journal of Cachexia, Sarcopenia and Muscle.2024; 15(6): 2234.     CrossRef
  • Prognostic Value of Artificial Intelligence-Driven, Computed Tomography-Based, Volumetric Assessment of the Volume and Density of Muscle in Patients With Colon Cancer
    Minsung Kim, Sang Min Lee, Il Tae Son, Taeyong Park, Bo Young Oh
    Korean Journal of Radiology.2023; 24(9): 849.     CrossRef
  • Impact of Postoperative Naples Prognostic Score to Predict Survival in Patients with Stage II–III Colorectal Cancer
    Su Hyeong Park, Hye Seung Woo, In Kyung Hong, Eun Jung Park
    Cancers.2023; 15(20): 5098.     CrossRef
  • Fluorescence-guided colorectal surgery: applications, clinical results, and protocols
    Jin-Min Jung, In Ja Park, Eun Jung Park, Gyung Mo Son
    Annals of Surgical Treatment and Research.2023; 105(5): 252.     CrossRef
  • Preventing Anastomotic Leakage, a Devastating Complication of Colorectal Surgery
    Hyun Gu Lee
    The Ewha Medical Journal.2023;[Epub]     CrossRef
  • Can the cross-sectional area of the psoas muscle be a predictor of anastomotic failure in male rectal cancer patients?
    Myong Hoon Ihn
    Annals of Coloproctology.2022; 38(5): 333.     CrossRef
  • Psoas Muscle Index – Could It Be an Indicator of Postoperative Complications in Colorectal Cancer? Case Presentation and Review of the Literature
    Georgiana Alexandra Scurtu, Zsolt Zoltán Fülöp, Botond Kiss, Patricia Simu, Diana Burlacu, Tivadar Bara
    Journal of Interdisciplinary Medicine.2022; 7(4): 100.     CrossRef
Video
Malignant disease, Rectal cancer
Robotic Partial Excision of Levator-Ani Muscle for Locally Advanced Low Rectal Cancer Invading Ipsilateral Pelvic Floor
Seung Yoon Yang, Nam Kyu Kim
Ann Coloproctol. 2020;36(6):415-416.   Published online December 31, 2020
DOI: https://doi.org/10.3393/ac.2020.06.29
  • 4,130 View
  • 84 Download
  • 10 Web of Science
  • 6 Citations
AbstractAbstract PDFSupplementary Material
Tumors at the level of the anorectal junction had required abdominoperineal resection (APR) to achieve an adequate resection margin. However, in the cases of tumor invading ipsilateral levator-ani muscle (LAM), en-bloc resection of the rectum with LAM including tumor would be possible. This video is to show the critical anatomic steps of this procedure. A video was produced from the robotic right partial excision of LAM (PELM) performed in a 57-year-old female patient with rectal cancer at 3 cm from the anal verge, invading the ipsilateral anorectal ring, who had received neoadjuvant chemoradiotherapy. The patient discharged at postoperative day 8 without complication. The pathology of the surgical specimen revealed ypT3N1bM0. The secure resection margin from the tumor was achieved. Robotic PELM is the sphincter-preserving technique that can be an alternative treatment option for low rectal cancer invading the ipsilateral LAM, which has been an indication for APR or extralevator APR.

Citations

Citations to this article as recorded by  
  • Tailoring rectal cancer surgery: Surgical approaches and anatomical insights during deep pelvic dissection for optimal outcomes in low‐lying rectal cancer
    Youn Young Park, Nam Kyu Kim
    Annals of Gastroenterological Surgery.2024; 8(5): 761.     CrossRef
  • Recent advances in functional bismuth chalcogenide nanomaterials: Cancer theranostics, antibacterial and biosensing
    Qian Wang, Jun Du, Ruizhuo Ouyang, Baolin Liu, Yuqing Miao, Yuhao Li
    Coordination Chemistry Reviews.2023; 492: 215281.     CrossRef
  • Robotic APR with en bloc TAH/BSO and posterior vaginectomy
    M. S. Meece, L. P. Horner, S. J. Danker, A. K. Sinno, N. Paluvoi
    Techniques in Coloproctology.2023; 27(12): 1381.     CrossRef
  • Current status and role of robotic approach in patients with low-lying rectal cancer
    Hyo Seon Ryu, Jin Kim
    Annals of Surgical Treatment and Research.2022; 103(1): 1.     CrossRef
  • Robot-Assisted Colorectal Surgery
    Young Il Kim
    The Ewha Medical Journal.2022;[Epub]     CrossRef
  • Outcomes of robotic partial excision of the levator ani muscle for locally advanced low rectal cancer invading the ipsilateral pelvic floor at the anorectal ring level
    Seung Yoon Yang, Min Soo Cho, Nam Kyu Kim
    The International Journal of Medical Robotics and Computer Assisted Surgery.2021;[Epub]     CrossRef
Original Articles
Benign proctology
Puborectalis Muscle Involvement on Magnetic Resonance Imaging in Complex Fistula: A New Perspective on Diagnosis and Treatment
Hong Yoon Jeong, Seok Gyu Song, Woo Jung Nam, Jong Kyun Lee
Ann Coloproctol. 2021;37(1):51-57.   Published online September 18, 2020
DOI: https://doi.org/10.3393/ac.2020.08.26.1
  • 3,715 View
  • 111 Download
  • 5 Web of Science
  • 5 Citations
AbstractAbstract PDF
Purpose
According to recent studies, magnetic resonance imaging (MRI) assessment of complex fistulas provides a significant benefit compared to fistulography, computed tomography, and ultrasonography. The aim of this study was to describe the accuracy of MRI and the importance of identifying puborectalis muscle involvement on MRI in patients with complex fistula.
Methods
All patients who were clinically diagnosed with ‘complex’ or showed multiple fistula tracts underwent fistula MRI. Eligible patients were consecutive patients who underwent fistula MRI between September 2018 and September 2019 at our hospital.
Results
A total of 83 patients (74 males, 9 females; 116 tracts) were included in this study. The sensitivity and specificity of MRI in diagnosing fistula tracts were 94.8% and 98.2%, respectively. The sensitivity and specificity in identifying internal opening were 93.9% and 97.3%, respectively. Of the 35 patients with puborectalis muscle involvement in the MRI, 31 images of suprasphincteric-type patients on the Park’s classification were classified. The patients of puborectalis involvement were divided into 2 groups according to the surgical procedure that was performed. There were 12 sphincter-saving procedures and 19 sphincter division procedures performed. Recurrence was seen in 2 patients in the sphincter-saving procedure group, while no case was seen in the sphincter division procedure group. Five complications were found in the sphincter division procedure group, of which 2 reported incontinence.
Conclusion
Fistula MRI is a highly accurate examination for evaluating complex fistulas, and the puborectalis muscle involvement findings are very important for diagnosis and treatment.

Citations

Citations to this article as recorded by  
  • Efficacy and safety of transanal opening of intersphincteric space in the treatment of high complex anal fistula: A meta‑analysis
    Chunqiang Wang, Tianye Huang, Xuebing Wang
    Experimental and Therapeutic Medicine.2024;[Epub]     CrossRef
  • Comparison of loose combined cutting seton and traditional cutting seton for high anal fistula: a meta-analysis
    Yi SUN, Chunqiang WANG, Tianye HUANG, Xuebing WANG
    Gazzetta Medica Italiana Archivio per le Scienze Mediche.2023;[Epub]     CrossRef
  • Guidelines to diagnose and treat peri-levator high-5 anal fistulas: Supralevator, suprasphincteric, extrasphincteric, high outersphincteric, and high intrarectal fistulas
    Pankaj Garg, Vipul D Yagnik, Sushil Dawka, Baljit Kaur, Geetha R Menon
    World Journal of Gastroenterology.2022; 28(16): 1608.     CrossRef
  • What Does Puborectalis Muscle Involvement on Magnetic Resonance Imaging Indicate in Patients With Complex Anal Fistula?
    Sung Uk Bae
    Annals of Coloproctology.2021; 37(1): 3.     CrossRef
  • Anal fistula at roof of ischiorectal fossa inside levator-ani muscle (RIFIL): a new highly complex anal fistula diagnosed on MRI
    Pankaj Garg, Sushil Dawka, Vipul D. Yagnik, Baljit Kaur, Geetha R. Menon
    Abdominal Radiology.2021; 46(12): 5550.     CrossRef
Correlation of Histopathology With Anorectal Manometry Following Stapled Hemorrhoidopexy
Young Ki Hong, Yoon Jung Choi, Jung Gu Kang
Ann Coloproctol. 2013;29(5):198-204.   Published online October 31, 2013
DOI: https://doi.org/10.3393/ac.2013.29.5.198
  • 4,325 View
  • 34 Download
  • 8 Citations
AbstractAbstract PDF
Purpose

The removal of smooth muscle during stapled hemorrhoidopexy raises concerns regarding its effects on postoperative anorectal function. The purpose of this study was to evaluate the correlation between the amount of muscle removed and changes in anorectal manometry following stapled hemorrhoidopexy.

Methods

Patients with symptomatic II, III, or IV degree hemorrhoids that underwent stapled hemorrhoidopexy between January 2008 and May 2011 were included in this study. Anorectal manometry was performed preoperatively and at three months postoperatively. The resected doughnuts were examined histologically, and the thicknesses of muscle fibers were evaluated.

Results

Eighty-five patients (34 males) with a median age of 47 years were included. Muscularis propria fibers were identified in 63 of 85 pathologic specimens (74.1%). The median thickness of the muscle fibers was 1.58 ± 1.21 mm (0 to 4.5 mm). The mean resting pressure decreased by approximately 7 mmHg after operation in the 85 patients (P = 0.019). In patients with muscle incorporation, there was a significant difference in mean resting pressure (P = 0.041). In the analysis of the correlation of the difference in anorectal manometry results ([the result of postsurgical anorectal manometry] - [the result of presurgical anorectal manometry]) to the thickness of muscle fibers, no significant differences were seen. No patients presented with fecal incontinence.

Conclusion

Although the incidence of fecal incontinence is very low, muscle incorporation in the resected doughnuts following stapled hemorrhoidopexy may affect anorectal pressure. Therefore, surgeons should endeavor to minimize internal sphincter injury during stapled hemorrhoidopexy.

Citations

Citations to this article as recorded by  
  • The prevalence of incontinence after excisional hemorrhoidectomy and stapled hemorrhoidopexy: A systematic review and meta-analysis
    James Z. Jin, Velia Men, Praharsh Bahl, Harshitha Penneru, Robin Yang, Niket Shah, Andrew G. Hill
    Surgery.2025; 180: 109139.     CrossRef
  • Anatomical Anal Stenosis after PPH: Insights from a Retrospective Study and Rat Model
    Chia-Cheng Wen, Shih-Ming Huang, Yi-Wen Wang
    International Journal of Molecular Sciences.2024; 25(6): 3543.     CrossRef
  • Evaluation of Clinical Manifestations of Hemorrhoidal Disease, Carried Out Surgeries and Prolapsed Anorectal Tissues: Associations with ABO Blood Groups of Patients
    Inese Fišere, Valērija Groma, Šimons Svirskis, Estere Strautmane, Andris Gardovskis
    Journal of Clinical Medicine.2023; 12(15): 5119.     CrossRef
  • Association of Muscle Fibers with Histopathology in Doughnut Specimens Following Stapled Hemorrhoidopexy and Their Impacts on Postoperative Outcomes
    Chetty Y. V. Narayanaswamy, M. R. Sreevathsa, G. Akhil Chowdari, Koteshwara Rao
    The Surgery Journal.2022; 08(03): e199.     CrossRef
  • Anorectal Functional Outcomes Following Doppler-Guided Transanal Hemorrhoidal Dearterialization: Evidence from Vietnam
    Le Manh Cuong, Vu Nam, Tran Thai Ha, Tran Thu Ha, Tran Quang Hung, Do Van Loi, Tran Manh Hung, Nguyen Van Son, Vu Duy Kien
    Advances in Therapy.2020; 37(3): 1136.     CrossRef
  • Post-surgical fecal incontinence
    Filippo Pucciani
    Updates in Surgery.2018; 70(4): 477.     CrossRef
  • Magnetic resonance imaging and endorectal ultrasound for diagnosis of rectal lesions
    Franciszek Burdan, Iwona Sudol-Szopinska, Elzbieta Staroslawska, Malgorzata Kolodziejczak, Robert Klepacz, Agnieszka Mocarska, Marek Caban, Iwonna Zelazowska-Cieslinska, Justyna Szumilo
    European Journal of Medical Research.2015;[Epub]     CrossRef
  • Histopathology and Physiological Alterations After Procedure for Prolapsed Hemorrhoids
    Do Sun Kim
    Annals of Coloproctology.2013; 29(5): 179.     CrossRef
Electrophysiological Characteristics of Human Colon Circular Muscle.
Choe, Eun Kyung , Ryoo, Seung Bum , Moon, Sang Hui , Moon, Jung Sun , Park, Kyu Joo
J Korean Soc Coloproctol. 2010;26(2):105-110.
DOI: https://doi.org/10.3393/jksc.2010.26.2.105
  • 3,624 View
  • 8 Download
AbstractAbstract PDF
PURPOSE
Interstitial cells of Cajal (ICC) play a core function in colonic motility as a pacemaker by regulating the slow wave. We intended to investigate the electrophysiological characteristics of the circular smooth muscle in the human colon, especially in Koreans.
METHODS
Colon tissues were obtained from patients undergoing an elective colectomy for non-obstructive lesions. Tissues were immediately stored in oxygenated Krebs-Ringer's bicarbonate solution, and conventional microelectrode recordings of the colonic circular muscle were done from muscle cells.
RESULTS
The trans-membrane potentials from 100 tissues were recorded. Regular slow-wave patterns were observed in 36 patients, and 64 patients showed irregular wave patterns. In the tissues exhibiting regular slow-wave patterns, 20 tissues were recorded from the proximal colon and 16 from the distal colon. The frequency of the slow wave from the proximal part was significantly higher than that from the distal part. The resting membrane potential, the upstroke amplitude, the spike amplitude, and the maximal rate of rise showed no significant difference between the two parts, but the time to reach half amplitude did show a significant difference between the two parts. No significant differences in parameters were observed based on the patients' demographics such as sex and age (younger or older than 60). We were able to divide the irregular waves into 3 groups. Irregular slow waves were observed in 35 tissues, irregular slow waves mixed with spike waves were observed in 26 tissues, and spike waves alone were observed in 3 tissues.
CONCLUSION
We analyzed the electrophysiological characteristics of the human colonic circular smooth muscle, especially those of the slow wave originating from ICC of patients who had not been pretreated with drugs.
Review
Muscle Regeneration: Research for the Treatment of Fecal Incontinence.
Kang, Sung Bum , Lee, Taek Gu
J Korean Soc Coloproctol. 2010;26(1):1-7.
DOI: https://doi.org/10.3393/jksc.2010.26.1.1
  • 2,414 View
  • 40 Download
  • 3 Citations
AbstractAbstract PDF
Fecal incontinence remains a socially isolating condition, which can have a profound impact on all aspects of quality of life. It affects 2% to 17% of people living in the community and is an iatrogenic disease that develops after a restorative proctectomy for rectal cancer. Conservative management, such as biofeedback and medication, or surgical therapy may be ineffective, the symptomatic benefit being disappointing. In a few recent reports, autologous myoblasts injected into the urinary or anal sphincter were used successfully for the treatment of incontinence, and these cells improved the muscle function. These autologous cell therapies can avoid adverse events, such as tumor formation, compared to the use of embryonic stem cells. However, the limited regenerative capacity of cell therapy has prompted the development of replacing dysfunctional muscle tissue. Regenerative medicine for functioning muscles may be a therapeutic tool for fecal incontinence in the future. Now, many challenges remain to be overcome prior to reaching the ultimate goal of a fully functional 3-D vascularized engineered muscle: These include development of highly organized 3-D scaffolds, development of scaffolds that specifically direct cellular differentiation, development of co-culture systems of multiple cell types on smart surfaces, development of vascularized constructs, reduction of serum dependence, and innervation into constructed muscle. The successful generation of functional muscle tissues requires an in-depth knowledge of both muscle tissue physiology and advanced engineering practices. The recent advances in tissue engineering technique and cell biology suggest that artificially-derived muscle constructs may be used in clinical settings in the near future.

Citations

Citations to this article as recorded by  
  • Feasibility of Neurovascular Antropylorus Perineal Transposition With Pudendal Nerve Anastomosis Following Anorectal Excision: A Cadaveric Study for Neoanal Reconstruction
    Abhijit Chandra, Ashok Kumar, M Noushif, Nitish Gupta, Vijay Kumar, Navneet Kumar Chauhan, Vishal Gupta
    Annals of Coloproctology.2013; 29(1): 7.     CrossRef
  • Functional New Sphincter Ani Reconstruction by Using Neurovascualr Antropylorus Transposition After an Anorectal Excision
    Bong Hwa Lee, Min Jung Kim, Hyoung Chul Park
    Annals of Coloproctology.2013; 29(1): 5.     CrossRef
  • Injection of porous polycaprolactone beads containing autologous myoblasts in a dog model of fecal incontinence
    Sung-Bum Kang, Hye Seung Lee, Jae-Young Lim, Se Heang Oh, Sang Joon Kim, Sa-Min Hong, Je-Ho Jang, Jeong-Eun Cho, Sung-Min Lee, Jin Ho Lee
    Journal of the Korean Surgical Society.2013; 84(4): 216.     CrossRef
Case Reports
Skeletal Muscle Metastasis from Colorectal Cancer: Report of a Case.
Choi, Pyong Wha , Kim, Chul Nam , Kim, Han Seong , Lee, Jung Min , Heo, Tae Gil , Park, Je Hoon , Lee, Myung Soo , Chang, Surk Hyo
J Korean Soc Coloproctol. 2008;24(6):492-496.
DOI: https://doi.org/10.3393/jksc.2008.24.6.492
  • 1,946 View
  • 11 Download
  • 2 Citations
AbstractAbstract PDF
Metastases from colorectal cancer can occur by either lymphatic or hematogenous spread, and the sites most commonly involved are the liver and lung. Although skeletal muscle comprises a considerable portion of body mass and receives abundant blood supply, it is one of the most unusual sites of metastasis from any malignancies. We report a case of skeletal muscle metastasis from colorectal cancer. An 83-year-old female patient presented with a painful mass in the right posterior thigh. She had already undergone low anterior resection and right lobectomy of liver for rectal cancer with liver metastasis (T2N1M1) about 4 years ago. Although a follow-up computed tomography scan showed a metastatic solitary pulmonary nodule in the left lobe 2 years after the primary operation, she refused further aggressive treatment. Magnetic resonance imaging showed a localized mass in the semimembranosus muscle of the right thigh, and fine-needle aspiration cytology demonstrated clusters of atypical cells compatible with adenocarcinoma. The patient underwent excision of the painful mass located in the right semimembranosus muscle. Histologically, the thigh mass proved to be adenocarcinoma identical to the primary lesion. The patient died of heart failure on the 2nd postoperative day.

Citations

Citations to this article as recorded by  
  • Skeletal muscle metastasis from colorectal adenocarcinoma: A literature review
    Nikhil Kulkarni, Ahmed Khalil, Shruti Bodapati
    World Journal of Gastrointestinal Surgery.2022; 14(7): 696.     CrossRef
  • Cardiac metastasis from colorectal cancer: A case report
    Pyong Wha Choi, Chul Nam Kim, Sun Hee Chang, Woo Ik Chang, Chang Young Kim, Hyun Min Choi
    World Journal of Gastroenterology.2009; 15(21): 2675.     CrossRef
Levator Ani Muscle Posterior Midline Incision Method for Diffrentiation of Anal Fistulas Involving Ischioretal and Pelvirectal Spaces.
Lim, Seok Won
J Korean Soc Coloproctol. 2008;24(1):72-74.
DOI: https://doi.org/10.3393/jksc.2008.24.1.72
  • 1,596 View
  • 18 Download
AbstractAbstract PDF
The difference between anal fistulas involving the ischioretal space and pelvirectal space is that in the former the involvement of the anal fistula is low the levator ani muscle whereas in the latter it is above the levator ani muscle. The levator ani muscle posterior midline incision method, which is introduced here, is thought not to injure the anal sphincter; thus, it does not affect the anal function. The method also allow the surgeon to assess readily and accurately whether or not the fistula has invaded the pelvirectal space.
Original Articles
Change of alpha-SM Actin Expression Induced by the Antibody for TGF-beta in Fibroblast NIH3T3 Culture: The basic research for the inhibition of wound contracture.
Lee, Bong Hwa , Kang, Hyung Kil , Kim, Jeong Jin , Kim, Dong Kun , Yoon, Dae Won
J Korean Soc Coloproctol. 2001;17(3):113-118.
  • 971 View
  • 21 Download
AbstractAbstract PDF
PURPOSE
The purpose of this experiment is to measure the expression of TGF-beta and alpha-SM actin (smooth muscle actin) from fibroblast culture by the duration of culture days and to analyze the inhibition of alpha-SM actin expression in fibroblast by the antibodies for TGF-beta.
METHODS
The levels of alpha-SM actin from the paired NIH3T3 cell cultures with TGF-beta 1 containing medium (10 ng/ml) and with the antibody (for TGF-beta) medium (1 or 2 ug/ml) were determined by SDS PAGE for cell lysate protein, Western blot with ECL autoradiography and immuno - slot blot.
RESULTS
In NIH3T3 culture, the expression of alpha-SM actin increased at culture days 4, 5, 6. TGF-beta was expressed from 2nd day of culture and increased by day 7. The addition of TGF beta (10 ng/ml) did not increased the expression of alpha-SM actin. But alpha-SM actin expression decreased in the presence of anti-TGF beta antibody. The decrease of expression was proportional to the concentration of antibody and duration of exposure to the antibody.
CONCLUSIONS
Endogenous TGF-beta produced by fibroblast cultures is sufficient to express the alpha-SM actin from the myofiboblast. There was no additive expression of alpha-SM actin with exogenous TGF-beta 1. The antibody for TGF- beta inhibits the production of the alpha-SM actin during wound healing and may prevent the wound contracture.
Gluteus Maximus Transposition for Anal Incontinence.
Chang, Ji Young , Kim, Cheong Tong , Kim, Kweon Cheon , Min, Young Don
J Korean Soc Coloproctol. 1997;13(1):137-144.
  • 1,095 View
  • 17 Download
AbstractAbstract PDF
Anal incontinence following pelvic trauma, surgery or neurologic disorder has significant medical and social implications. When no known functioning sphincter muscles are present, surgical correction of this distressing condition other than by stomal fecal diversion is aimed at recreating a sphincter mechanism under voluntary control. The use of the gluteus maximus encircling the neorectum with a contractile muscualr ring provides an active control of continence and reserves the anorectal angulation. The sacrifice of the entire gluteus maximum muscle in an ambulatory patient will cause difficulty in climbing stairs; however, the use of the anatomically dissected lower half will preserve its function. With careful dissection, the lower half of the g1uteus maximus muscle together with its neurovascular supply can be developed for anal sphincter reconstruction. Three Patient, (two men and one woman) underwent g1uteus maximus transposition for complete anal incontinence. The indication for operation were sphincter destruction secondary to extensive soft tissue necrosis on perianal, perineal and buttock area due to necrotizing fascitis(n=2), and soft tissue defect on perianal, buttock area due to trauma(n=1). The procedure is performed with the use of a diverting colostomy. The inferior portion of the origin of each gluteus maximus is detached from the sacrum and coccyx, bifurcated,and tunneled subcutaneously to encircle the anus. The ends were sutured together to form two opposing slings of voluntary muscles. Postoperatively two patient regained continence to solid stool, one to liquid stool as well. The technique of constructing sphincter is simple and utilizes principles of muscle tendon transfer without jeopardizing function of gait. Furthermore the gluteus maximus muscle, being an accessory muscle of anal continence, is an ideal structure for this reconstruction.
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