1/16. Neurological complications in insufficiency fractures of the sacrum. Three case-reports.Three cases of nerve root compromise in elderly women with insufficiency fractures of the sacrum are reported. Neurological compromise is generally felt to be exceedingly rare in this setting. A review of 493 cases of sacral insufficiency fractures reported in the literature suggested an incidence of about 2%. The true incidence is probably higher since many case-reports provided only scant information on symptoms; furthermore, sphincter dysfunction and lower limb paresthesia were the most common symptoms and can readily be overlooked or misinterpreted in elderly patients with multiple health problems. The neurological manifestations were delayed in some cases. A full recovery was the rule. The characteristics of the sacral fracture were not consistently related with the risk of neurological compromise. In most cases there was no displacement and in many the foramina were not involved. The pathophysiology of the neurological manifestations remains unclear. We suggest that patients with sacral insufficiency fractures should be carefully monitored for neurological manifestations.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/16. fecal incontinence induced by spontaneous internal anal sphincter relaxation: report of a case.It has been previously suggested that an increase in the frequency of internal anal sphincter relaxations may cause fecal incontinence in patients in whom a structural lesion of the anal sphincter or its nerve supply is not ruled out. We here report a case of fecal incontinence in which the sphincter and its innervation was not damaged, and prolonged recordings of anal resting pressure detected frequent and prolonged internal anal sphincter relaxations. Moreover, a spontaneous improvement in fecal incontinence occurred at the same time as a reduction in the frequency and duration of internal anal sphincter relaxations. This case suggests that prolonged recordings of anal resting pressure are advisable in incontinent patients without detectable lesions of the anal sphincter or its nerve supply to detect any increase in the frequency of internal anal sphincter relaxations as a possible cause of fecal incontinence.- - - - - - - - - - ranking = 2keywords = nerve (Clic here for more details about this article) |
3/16. Bilateral sacral spinal nerve stimulation for fecal incontinence after low anterior rectum resection.BACKGROUND AND AIMS: The somatomotor innervation pattern has been shown to differ in patients undergoing percutaneous nerve evaluation for sacral nerve stimulation. In some patients bilateral stimulation might improve clinical outcome; however, only single-channel pulse generators have until now been available. We report a patient with fecal incontinence after surgery for rectal carcinoma in whom a dual-channel, individually programmable, pulse generator permitted implantation of neurostimulation electrodes bilaterally. patients AND methods: Intractable fecal incontinence developed in a 48-year-old man who underwent low anterior rectum resection, owing mainly to reduced internal anal sphincter function. The morphology of the anal sphincter was without defect. Based on the findings of unilateral and bilateral temporary sacral nerve stimulation the patient underwent placement of foramen electrodes on S4 bilaterally. Both electrodes were connected to a dual-channel impulse generator for permanent low-frequency stimulation. RESULTS: The percentage of incontinent bowel movements decreased during unilateral test stimulation from 37% to 11%, during bilateral test stimulation to 4%, and with chronic bilateral stimulation to 0%. The Wexner continence score improved from 17 preoperatively to 2, and quality of life (ASCRS score) was notably enhanced. Anorectal manometry revealed improved striated anal sphincter function; the internal anal sphincter remained unaffected. CONCLUSION: Sacral nerve stimulation can effectively treat incontinence after rectal resection, and bilateral stimulation can improve the therapeutic effect.- - - - - - - - - - ranking = 8keywords = nerve (Clic here for more details about this article) |
4/16. Sacral nerve stimulation for treatment of fecal incontinence in a patient with muscular dystrophy: report of a case.fecal incontinence is a common condition that causes major impairment of social life. Sacral nerve stimulation is a promising treatment in idiopathic fecal incontinence when conventional treatments have failed. However, new indications for sacral nerve stimulation are emerging. The present case shows that sacral nerve stimulation for treatment of fecal incontinence may be justified in other diseases in which fecal incontinence is a major problem.- - - - - - - - - - ranking = 7keywords = nerve (Clic here for more details about this article) |
5/16. urinary retention during sacral nerve stimulation for faecal incontinence: report of a case.Sacral nerve stimulation (SNS) was proposed for the treatment of patients with urologic symptoms in 1967 but was not used until 1981. SNS has also proven to be a promising treatment in idiopathic faecal incontinence when conventional treatments have failed. The modality has been used for faecal incontinence since the mid-1990s. Eighty percent of the patients who were selected for percutaneous nerve evaluation (PNE) because of faecal incontinence report an improvement in the symptoms and qualify for a permanent implantation. Accordingly, SNS is now used for faecal incontinence and urologic symptoms. reflex interactions between the bladder and the distal gastrointestinal tract are well known. The present case shows that SNS for faecal incontinence may significantly influence bladder function.- - - - - - - - - - ranking = 6keywords = nerve (Clic here for more details about this article) |
6/16. Polyglucosan body disease.adult polyglucosan disease has been described in 15 cases. All had signs of peripheral neuropathy, upper motor neuron signs, and 12 of the 15 had sphincter problems. dementia was prominent in 8 of 15 cases. We reported 2 cases that contained these clinical features. Electrophysiological studies showed axonal neuropathy. Somatosensory evoked potentials on the second patient were abnormal. sural nerve biopsy showed clusters of polyglucosan bodies. Although the presence of polyglucosan bodies in biopsy is nonspecific, the number as well as the clinical features are necessary to make the diagnosis. Branching enzyme activity in muscle extracts of the muscles were normal. Hence, a specific enzyme abnormality is not yet known.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
7/16. Neuroprostheses in the management of incontinence in myelomeningocele patients.A 16-year-old boy and a 17-year-old girl underwent successful closure of the meningomyelocele defect in childhood but they continued to suffer incontinence of stool and urine. After a 5-day trial with percutaneous electrostimulation of the pudendal nerve both patients received permanent neuroprosthetic implants. They became completely continent of stool and exhibited greater than 90% improvement in urinary control. These patients demonstrate that there is a small subset of meningomyelocele patients who, despite absence of spontaneous reflex tonus in the urinary and bowel sphincters, nevertheless have preserved motor capabilities.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
8/16. Intermittent parasympathetic symptoms in lumbar spinal stenosis.Symptoms related to autonomic nervous dysfunction are uncommon in spinal stenosis. Involvement of nerve roots S2-S5 has previously been reported only in a few cases. Of great interest is the occurrence of phenomena such as intermittent penile erections and fecal incontinence on walking in patients with compromise of the lower lumbar spinal canal. We report on two patients, one of whom presented because of fecal incontinence and the other with penile erections on walking. In both cases, these manifestations resolved after decompressive laminectomy. These patients are compared to six other patients, with parasympathetic disturbances due to lumbar spinal stenosis, described previously.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
9/16. Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence.Functional deficits of the striated anal sphincteric muscles without any apparent gross defect often result in a lack of ability to postpone defaecation by intention or in faecal incontinence in response to increased intra-abdominal or intra-rectal pressure. We applied electrostimulation to the sacral spinal nerves to increase function of the striated muscles of the anal sphincter. Of three patients followed for 6 months, two gained full continence and one improved from gross incontinence to minor soiling. Closure pressure of the anal canal increased in all. Preliminary data indicate that anal closure pressure increases with the duration of stimulation. Continuous stimulation of sacral spinal nerves can help some patients with faecal incontinence. It may be possible to promote continence with intermittent stimulation.- - - - - - - - - - ranking = 6keywords = nerve (Clic here for more details about this article) |
10/16. Stimulated gracilis neosphincter--not as good as previously thought. Report of four cases.PURPOSE: We report the outcome of four patients who had stimulated gracilis neosphincter for fecal incontinence to highlight functional problems, particularly in patients with impaired rectal evacuation. methods: The gracilis neosphincter operation consisted of a three-stage procedure in four patients with intractable incontinence, three of whom had had a pelvic floor repair. RESULTS: Despite successful muscle transposition and nerve stimulation, only one of four patients has a functioning neosphincter. One patient could not tolerate stimulation, and two were unable to evacuate the rectum. All three now have stomas, and even the functioning neosphincter patient requires regular bisacodyl (Dulcolax; CIBA Consumer Pharmaceuticals, Woodbridge, NJ) suppositories to achieve evacuation. CONCLUSION: The neosphincter is a successful sphincter but has no role for patients who cannot evacuate from the rectum.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
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