Development of a Physical Simulation of the Human Defecatory System for the Investigation of Continence Mechanisms

Faecal incontinence is a highly debilitating condition, prevalent across the population worldwide. Coupled with a large unmet need for clinically viable treatment options, a paucity of research into the biomechanics of continence inhibits the development of treatments which address multi-faceted challenges associated with the condition. Consequently, this thesis presents a method to fabricate, measure and control a physical simulation of the human defecatory system to investigate individual and combined effects of anorectal angle and sphincter pressure on continence. To illustrate the capabilities and clinical relevance of the work, the influence of a passive-assistive artificial anal sphincter (FENIX) is evaluated. A model rectum and associated soft tissues, based on geometry from an anonymised computerised tomography dataset, was fabricated from silicone and showed behavioural realism in terms of their morphology to the biological system and ex-vivo tissue. Simulated stool matter with similar rheological properties to human faeces was developed. Instrumentation and control hardware were used to regulate injection of simulated stool into the system, define the anorectal angle and monitor stool flow rate, intra-rectal pressure, anal canal pressure and puborectalis force. Studies were conducted to examine the response of anorectal angles at 80°, 90° and 100° with simulated stool. Tests were then repeated with the inclusion of a FENIX device. Stool leakage was reduced as the anorectal angle became more acute. Conversely, intra-rectal pressure increased. Overall inclusion of the FENIX reduced faecal leakage, while combined effects of the FENIX and an acute anorectal angle showed the greatest resistance to faecal leakage. These data demonstrate that the anorectal angle and sphincter pressure are fundamental in maintaining continence. Furthermore it demonstrates that use of the FENIX can increase resistance to faecal leakage and reduce anorectal angles required to maintain continence. The physical simulation of the defecatory system is an insightful tool to better understand, in a quantitative manner, the effects of the anorectal angle and sphincter pressure on continence. This work is valuable in helping improve our understanding of the physical behaviour of the continence mechanism and facilitating improved technologies to treat severe faecal incontinence

Aerospace Medicine and Biology: Cumulative index, 1979

This publication is a cumulative index to the abstracts contained in the Supplements 190 through 201 of 'Aerospace Medicine and Biology: A Continuing Bibliography.' It includes three indexes-subject, personal author, and corporate source

Pharma-engineering of multifunctional microneedle array device for application in chronic pain

Chronic pain poses a major concern to modern medicine and is frequently undertreated, causing suffering and disability. Transdermal delivery is the pivot to which analgesic research in drug delivery has centralized especially with the confines of needle phobias and associated pain related to traditional injections, and the existing limitations associated with oral drug delivery. Highlighted within this thesis is the possibility of further developing transdermal drug delivery for chronic pain treatment using an Electro-Modulated Hydrogel- Microneedle array (EMHM) prototype device for the delivery of analgesic medicatio

Medical Robotics

The first generation of surgical robots are already being installed in a number of operating rooms around the world. Robotics is being introduced to medicine because it allows for unprecedented control and precision of surgical instruments in minimally invasive procedures. So far, robots have been used to position an endoscope, perform gallbladder surgery and correct gastroesophogeal reflux and heartburn. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. The use of robotics in surgery will expand over the next decades without any doubt. Minimally Invasive Surgery (MIS) is a revolutionary approach in surgery. In MIS, the operation is performed with instruments and viewing equipment inserted into the body through small incisions created by the surgeon, in contrast to open surgery with large incisions. This minimizes surgical trauma and damage to healthy tissue, resulting in shorter patient recovery time. The aim of this book is to provide an overview of the state-of-art, to present new ideas, original results and practical experiences in this expanding area. Nevertheless, many chapters in the book concern advanced research on this growing area. The book provides critical analysis of clinical trials, assessment of the benefits and risks of the application of these technologies. This book is certainly a small sample of the research activity on Medical Robotics going on around the globe as you read it, but it surely covers a good deal of what has been done in the field recently, and as such it works as a valuable source for researchers interested in the involved subjects, whether they are currently “medical roboticists” or not

Practical Clinical Andrology

This open access book offers a valuable resource for understanding the correct pathways in the context of sexual disorders, couple reproduction, gender identity dysphoria, conditions for which patients commonly ask for consultation and treatment. Based on clinical evidence, international guidelines and experts experience, practical clinical management strategies are presented for each condition. Each clinical care pathway is based on updated algorithm, level of evidence, photos and video-clips that describes the clinical presentations and the best practice management through diagnostic tools and medical or surgical treatment. Leading experts from the most important center of excellence in the field of sexual medicine joined to cover the field of andrology in its entirety, each of them dealing with a single topic from the top of their recognized experience and providing a complete and update textbook that will help urologists and other physicians in their daily clinical practice. This book is thought to be a practical and valuable reference for urologists, gynecologists, endocrinologists, psychiatrics and psychologists, and residents who are not specialty trained in andrology. It is designed for both young fellows training in different specialties and coming into contact with andrological issues for the first time and also more experienced clinicians and surgeons requiring updated guidelines and clear advice on the most controversial issues. This book will represent an invaluable quick consulting tool, updated in its scientific contents and rich in tables, images and video-clips

Practical Clinical Andrology

This open access book offers a valuable resource for understanding the correct pathways in the context of sexual disorders, couple reproduction, gender identity dysphoria, conditions for which patients commonly ask for consultation and treatment. Based on clinical evidence, international guidelines and experts experience, practical clinical management strategies are presented for each condition. Each clinical care pathway is based on updated algorithm, level of evidence, photos and video-clips that describes the clinical presentations and the best practice management through diagnostic tools and medical or surgical treatment. Leading experts from the most important center of excellence in the field of sexual medicine joined to cover the field of andrology in its entirety, each of them dealing with a single topic from the top of their recognized experience and providing a complete and update textbook that will help urologists and other physicians in their daily clinical practice. This book is thought to be a practical and valuable reference for urologists, gynecologists, endocrinologists, psychiatrics and psychologists, and residents who are not specialty trained in andrology. It is designed for both young fellows training in different specialties and coming into contact with andrological issues for the first time and also more experienced clinicians and surgeons requiring updated guidelines and clear advice on the most controversial issues. This book will represent an invaluable quick consulting tool, updated in its scientific contents and rich in tables, images and video-clips

A Textbook of Advanced Oral and Maxillofacial Surgery

The scope of OMF surgery has expanded; encompassing treatment of diseases, disorders, defects and injuries of the head, face, jaws and oral cavity. This internationally-recognized specialty is evolving with advancements in technology and instrumentation. Specialists of this discipline treat patients with impacted teeth, facial pain, misaligned jaws, facial trauma, oral cancer, cysts and tumors; they also perform facial cosmetic surgery and place dental implants. The contents of this volume essentially complements the volume 1; with chapters that cover both basic and advanced concepts on complex topics in oral and maxillofacial surgery