Browsing by Author "Hutchinson, R."

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    Fistulas in ano: endoanal ultrasonographic assessment assists decision making for surgery
    (British Medical Assosiation, 1994) Deen, K.I.; Williams, J.G.; Hutchinson, R.; Keighley, M.R.; Kumar, D.
    Eighteen patients with a clinical impression of a complex fistula in ano, had anal endosonography to delineate the anatomy of the fistula track and identify associated areas of sepsis. The clinical impression of a complex fistula was refuted by endosonography and subsequent surgical exploration in two cases. Horseshoe tracks were identified in nine (50%) patients and fluid collections, not evident on clinical examination were identified in eight (45%) patients. Accurate identification of the internal opening with a 7 MHz transducer was possible in two (11%) cases. External sphincter damage was evident in four (22%) patients. Surgical findings matched endosonographic appearances in all but one case (94%). Anal endosonography is an accurate and minimally invasive method of delineating the relation of fistula tracks to the anal sphincters and identifying deep areas of sepsis in relation to such fistulas.
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    Scintigraphic defecography: quantitative and dynamic assessment of anorectal function
    (Lippincott Williams and Wilkins, 1993) Hutchinson, R.; Mostafa, A.B.; Grant, E.A.; Smith, N.B.; Deen, K.I.; Harding, L.K.; Kumar, D.
    PURPOSE: Conventional assessment of anorectal function with defecating videoproctography is semiquantitative and the high radiation exposure precludes prolonged or repeated testing. The aim of this study was to develop a dynamic scintigraphic method of assessing anorectal function. METHODS: Fourteen patients with fecal incontinence, 18 patients with chronic constipation, and 8 control subjects were assessed by scintigraphicdefecography. This involves introduction of a technetium-99m-radiolabeled artificial stool into the rectum of the subject and acquisition of gamma camera images during evacuation. RESULTS: Mean evacuation rate was 2.8 percent/second in incontinent patients and 0.9 percent/second in constipated patients (P < 0.001). The mean anorectal angles were 136 degrees and 133 degrees, respectively. There were 18 cases of pelvic floor descent and 6 rectoceles. Scintigraphicdefecography provides quantitative information on rectal evacuation. Anorectal angle and pelvic floor movement can be examined. The radiation dose to pelvic organs is significantly less than with videoproctography. CONCLUSION: We believe that scintigraphic defecography is the investigation of choice for objective and dynamic assessment of anorectal function