Melt blending of polylactic acid (PLA) and a chain-extended polyethylene glycol (CE-PEG) have been performed in an effort to toughen the PLA without significant loss of modulus and ultimate tensile strength. The chain-extended PEG was prepared with melt condensation of a low molecular weight PEG and 4,4 0 -methylenebis(phenylisocyanate) (MDI) for enhancement of the molecular weight of PEG. The thermal and mechanical properties, miscibility and phase morphologies of blends were investigated. By using thermal and fracture surface analysis, the blends were found to be a partially miscible system with shifted glass transition temperatures. The addition of CE-PEG leads to slight decrease in tensile strength and modulus, while the elongation at break is characterized by an important increase (540%), compared with neat PLA and PLA/PEG (low molecular weight PEG, M n ¼ 35,000). The relative ductility of PLA/CE-PEG is 40 times higher than that of neat PLA. The brittle fracture of neat PLA was transformed into a ductile fracture by the addition of CE-PEG.
PurposeA retrorectal developmental cyst (tailgut cyst, epidermoid cyst, dermoid cyst, teratoma, and duplication) is very rare disease, and the symptoms are not characteristic so that sometimes this disease is still misdiagnosed as a supralevator abscess or a complex anal fistula. We would like to present a clinical approach to this disease.MethodsWe retrospectively examined the charts of 15 patients who were treated for retrorectal cysts from January 2001 to November 2009.ResultsAll 15 patients were female. The average age was 41 years (range, 21 to 60 years). Fourteen patients (93.3%) were symptomatic, and the most common symptom was anal pain or discomfort. Nine patients (60%) had more than one previous operation (range, 1 to 9 times) for a supralevator abscess, an anal fistula, etc. In 12 patients (80%), the diagnosis could be made by using the medical history and physical examination. Thirteen cysts (80%) were excised completely through the posterior approach. The average diameter of the cysts was 4.8 cm (range, 2 to 10 cm). Pathologic diagnoses were 8 tailgut cysts (53.3%), 5 epidermoid cysts (33.3%) and 2 dermoid cysts (13.3%). The average follow-up period was 18.3 months (range, 1 to 64 months).ConclusionIn our experience, high suspicion and physical examination are the most important diagnostic methods. If a female patient has a history of multiple perianal operations, a retrorectal bulging soft mass, a posterior anal dimple, and no conventional creamy foul odorous pus in drainage, the possibility of a retrorectal developmental cyst must be considered.
The purpose of this study was to determine whether levator ani deficiency (LAD) scores and minimal levator hiatus (MLH) areas affect Pelvic Organ Prolapse Quantification (POP-Q) stage. Methods: This study was a retrospective chart review of patients with pelvic organ prolapse (POP) at Seoul Songdo Hospital between August 2019 and August 2020. Three-dimensional (3D) pelvic floor ultrasound, preoperative anal manometry, and other physiological tests were performed in 78 patients with POP symptoms. We divided the patients into mild prolapse and severe prolapse groups based on the POP-Q. We examined the LAD and MLH areas. LAD scores were categorized as mild, moderate, or severe. Results: There were 32 patients (41.0%) in the mild prolapse group (POP-Q stage I and II) and 46 (59.0%) in the severe prolapse group (POP-Q stage III and IV). The mean LAD score was significantly higher in severe prolapse group (13.33 ± 2.49 vs. 8.19 ± 2.92, P < 0.001), and the rate of severe deficiency was also significantly higher in the severe prolapse group (29 [63.0%] vs. 2 [6.3%], P < 0.001). The mean MLH was also significantly larger in the severe prolapse group (17.91 ± 2.74 cm 2 vs. 14.95 ± 2.60 cm 2 , P < 0.001). In addition, both MLH and LAD scores tended to increase at each stage. Conclusion: There is a strong positive correlation between the POP-Q stage and the MLH and LAD scores that can be seen on 3D pelvic floor ultrasound. The findings of this study, by objectively demonstrating LAD and MLH in women with POP, are an important contribution to POP.
Purpose: The aim of this study was to determine the accuracy of 3-dimensional (3D) pelvic floor ultrasonography and compare it with defecography in assessment of posterior pelvic disorders.Methods: Eligible patients were consecutive women undergoing 3D pelvic floor ultrasonography at one hospital between August 2017 and February 2019. All 3D pelvic floor ultrasonography was performed by one examiner. A total of 167 patients with suspected posterior pelvic disorder was retrospectively enrolled in the study. The patients were divided into 3 groups according to the main symptoms.Results: There were 82 rectoceles on defecography (55 barium trapping) and 84 on 3D pelvic floor ultrasonography. Each modality identified 6 enteroceles. There were 43 patients with pelvic floor dyssynergia on defecography and 41 on ultrasonography. There were 84 patients with intussusception on defecography and 41 on 3D pelvic floor ultrasonography. Agreement of the 2 diagnostic tests was confirmed using Cohen’s kappa value. Rectocele (kappa, 0.784) and enterocele (kappa, 0.654) both indicated good agreement between defecography and 3D pelvic floor ultrasonography. In addition, pelvic floor dyssynergia (kappa, 0.406) showed moderate agreement, while internal intussusception (kappa, 0.296) had fair agreement.Conclusion: This study showed good agreement for detection of posterior pelvic disorders between defecography and 3D pelvic floor ultrasonography.
A c c e p t e d A r t i c l e 0 ABSTRACT Purpose To evaluate the incidence of vasovagal reactions (VVRs) and the efficacy of a lidocaine injection to prevent its occurrence. MethodsPatients (n=117) diagnosed with hemorrhoids and scheduled to undergo a stapled hemorrhoidopexy (SH) were randomly divided according to the submucosal injection used on the rectum into: lidocaine (n=53, lidocaine injected just before full closure of the stapler) and control groups (n=58). Outcomes compared included baseline patient characteristics (ASA class, body mass index, diabetes mellitus, hypertension, previous VVR history), vital signs during the operation, the incidence of VVRs (hypotension, bradycardia, dizziness, diaphoresis, nausea/vomiting), and postoperative complications (pain, bleeding, urinary retention). Statistical analysis of patient data was performed using the paired t-test and the chi-square test. ResultsBaseline characteristics were similar between groups. The number of patients with lower abdominal pain after firing the stapler and the incidence of dizziness were lower for the lidocaine group than for the control group (9.4% vs 25.9%, p=0.017; 0% vs 8.6%, p=0.035, respectively). However, there were no significant between-group differences in the incidence of nausea and diaphoresis (0% vs 3.4%, p=0.172) and syncope (1.9% vs 3.4%, p=0.612). Fewer patients in the lidocaine group complained of postoperative pain (41.5% vs 58.6%, p=0.072) and these patients used analgesics less frequently than those in the control group (28.3% vs 36.2%, p=0.374). ConclusionPatients who received a submucosal lidocaine injection prior to SH experienced lesser lower abdominal pain and dizziness, than those who received standard treatment. A larger, more detailed prospective study is needed for further analysis. A c c e p t e d A r t i c l e 1
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