Two-dimensional Endoanal Ultrasound Scan Correlates with External Anal Sphincter Structure and Function, but not with Puborectalis

AbstractBackgroundTo investigate the relevance of two-dimensional (2D) endoanal ultrasonic (EAUS) assessment of anal sphincter and puborectalis morphology by comparison to functional measures derived from patient symptoms and anorectal physiology.MethodsThirty women (mean age 44 years, mean parity 2) with anal incontinence underwent 2D EAUS, anorectal pull-through manometry, anorectal electosensitivity and sensation to rectal distension, pelvic floor dynamometry, and completed Wexner incontinence scores. EAUS images were reported blind to physiological assessments by a single experienced observer. The external and internal sphincters, and puborectalis were measured and scored for integrity and atrophy, and correlated with symptom load (Wexner score) and physiological data.ResultsThe mean Wexner score was 10 (range 1–20). The puborectalis could not be accurately measured in 12 patients (44%) on EAUS. Anal squeeze pressure correlated with integrity of the external sphincter (r = −0.4, p = 0.02) but not integrity or atrophy of the puborectalis. There were no other significant correlations between EAUS features and patient symptom load or anorectal physiology (r range, −0.42–0.26, p > 0.05).ConclusionTwo-dimensional EAUS can define sphincter integrity, has a limited role for assessment of muscular quality but is not useful for assessment of the puborectalis

Extracorporeal normothermic pancreas perfusion

Pancreas and islet transplantation are important treatment options for insulin dependent diabetes. However, one of the main challenges in pancreas and islet transplantation lies in organ (pancreas) preservation. Ischaemic injury post-retrieval causes significant damage the organ function and reduction in islet yield. It was hypothesised that extracorporeal normothermic perfusion of the pancreas would improve graft function post transplantation and pancreatic islet isolation when compared to traditional methods of organ preservation. The aims and objectives of the project included: • Conducting a systematic review of the literature in extracorporeal machine perfusion of the pancreas • Establishing an extracorporeal normothermic perfusion model of the porcine pancreas • Comparing the addition of kidney to the circuit of extracorporeal pancreas perfusion model A thorough systematic review of the available literature concluded the potential benefits of machine perfusion in pancreas preservation. Important insight into the experimental setup, perfusion parameters and vital outcome measures was also attained. A model of normothermic hemo-perfusion of the porcine pancreas with and without addition of the kidney as a dialysis organ was subsequently established. The organs were perfused for 120 minutes with stable perfusion parameters but sub-optimal acid-base environment. Addition of the kidney did not result in significant improvement of the acid-base environment.Thesis (M.Phil.) (Research by Publication) -- University of Adelaide, School of Medicine, 2016