OBJECTIVE. The purposeof thisstudywasto determineif MR findingsarepredictiveof long-term outcome in a cohort of patients whose initial surgery was performed without access to the findings of MR imaging.
SUBJECTS AND METHODS. Forty patientswith surgicallyprovenperianal fistulasunderwent preoperative dynamic contrast-enhanced MR imaging. The MR and surgical find ings were independently recorded on an identical anatomic form. Three patients were subse quently lost to follow-up. The outcome for the remaining 37 patients was determined from surgical review, case notes, and questionnaires. Minimum follow-up period was 14 months (range, 14â€"39 months).Outcomewas determinedby one observerwho was unawareof the initial MR grading and had not been present during surgery. Outcome was considered unsatis factory if further surgery was required. RESULTS. MR imagingwasbetterthansurgical explorationin predictingoutcome(for MR imaging:positivepredictivevalue,73%; negativepredictivevalue,87%; sensitivity, 89%; and specificity, 68%; for surgical exploration: positive predictive value, 57%; negative predictive value, 64%; sensitivity, 73%; and specificity, 47%). MR classification of fistulas was signifi cantlyassociated with outcome(p = .0004), andsurgical classification wasnot significantlyas sociated with outcome (p = .22, chi-square test). Also MR grades differed significantly for patientswith satisfactory and unsatisfactoryoutcomes(p < .001, Mann-Whitney U test).CONCLUSION. MR imaging is valuablein the managementof patientswith perianal fistulas.MR imagingaccuratelyrevealssurgicalanatomyandcanbe usedto makebetterpre dictionsregardingpatientoutcomethansurgicalfindings.
To determine the optimum temperature at which the in situ kidney should be maintained while it is ischaemic, 47 mongrel dogs were studied. 35 of these underwent 90 minutes of left renal ischaemia with the kidney temperature maintained at 37 degree, 30 degree, 22 degree, 15 degree and 0 degree C respectively. The effect on renal function was determined by measurements of G.F.R. before and at regular 15-minute intervals after the inschaemic period. Computer statistical analysis exposed the optimum temperature to be 15 degree C. Renal artery blood flow, renal histology, 15-Cr labelled platelets and renal arteriography were used to determine the mechanism of ischaemic injury. Quantitation of renal cell injury confirmed that no additional protection to ischaemia could be gained by colling below 15 degree C. 15 degree C is recommended as the optimum temperature for use in clinical renal hypothermia.
Dynamic contrast-enhanced magnetic resonance imaging better predicts clinical outcome of patients with fistula-in-ano than initial surgical exploration.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.