Abstract：
INTRODUCTION:The internal anal sphincter (IAS) is an important structure that is responsible for the majority of resting tone of the sphincter complex. It has a central role in continence and damage to the muscle has serious implications. Injury is most frequently from obstetric trauma though iatrogenic injury from proctological surgery is also common. This review expands on how developments in understanding of the pharmacology of IAS might identify drug treatments as alternatives for proctological conditions such as anal fissure, avoiding the risk of sphincter injury. It also examines the role of pharmacology in treatment of those patients with established incontinence. RESULTS:Much of the basic physiology and pharmacology of the IAS has been established through in vitro analysis, particularly in the superfusion organ bath. Further analysis has been undertaken using animal models such the pig. Clinical trials have established the efficacy of a number of agents for reducing IAS tone including glyceryl trinitrate and botulinum toxin. These drugs are probably safer, but less effective, than surgery for sphincter spasm, as is seen in anal fissure, though surgery alone or in combination with drug treatment may be appropriate for some patients. In vitro analysis and small-scale clinical trials suggest that phenylephrine and methoxamine may have a role in treating patients with incontinence primarily attributable to inadequate IAS function. CONCLUSIONS:The pharmacology of IAS has been extensively studied in the laboratory, both in vitro and in animal models. In a short time, this laboratory work has been applied to clinical problems after testing in clinical trials. It is likely, however, that the best drugs and the optimal targets for manipulation have not yet been identified.
journal_name
Ann R Coll Surg Engljournal_title
Annals of the Royal College of Surgeons of Englandauthors
Jones OMdoi
10.1308/003588407X205576subject
Has Abstractpub_date
2007-09-01 00:00:00pages
574-9issue
6eissn
0035-8843issn
1478-7083journal_volume
89pub_type
abstract：:Orthopaedic outpatient waiting lists are long and the majority of referrals are for conditions that do not respond to surgical intervention. Many of these patients are best managed by physiotherapy, orthotics or steroid injections, which can be administered by an appropriately trained physiotherapist. The effectivenes...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1995-03-01 00:00:00
abstract：:Rectus femoris origin injuries in adult athletes are uncommon. In the acute phase, conservative treatment seems to have a favourable outcome, with surgical repair reserved for unsuccessful cases only. However, a group of patients may develop chronic pain and disability after recovery from the acute phase due to heter...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/003588412X13171221589333
更新日期：2012-04-01 00:00:00
abstract：INTRODUCTION:The aim of this study was to develop a standardised management plan for boys with abnormal appearance of meatus at circumcision for balanitis xerotica obliterans (BXO). METHODS:Between 1995 and 2008, 107 boys underwent circumcision for BXO (confirmed on histology). Of these, 23 had abnormal appearance of ...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/003588411X587145
更新日期：2011-09-01 00:00:00
abstract：:Luc's abscess is a rare but important complication of acute otitis media (AOM), whereby infection spreads from the middle ear, resulting in a subperiosteal collection beneath the temporal muscle. Unlike other extracranial abscesses relating to AOM, Luc's abscess is not believed to involve the mastoid bone. We present ...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/003588414X13946184901281
更新日期：2014-07-01 00:00:00
abstract：INTRODUCTION:Minimally-invasive, video-assisted thyroidectomy (MIVAT) was developed to reduce scarring/trauma associated with cervical incisions used in open thyroidectomy. Results from various centres have been published internationally but none from the UK. This study reports the first results from the UK and compare...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章,多中心研究,评审
doi：10.1308/003588410X12628812459977
更新日期：2010-07-01 00:00:00
abstract：:This study compares the assessment of lymph nodes by the surgeon, at the time of operation, with the pathologist's assessment on the resected specimen in 85 cases of total gastrectomy with extended lymphadenectomy for gastric carcinoma. There was correlation in 67% of cases, in 28% the disease was overstaged, and in o...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1989-09-01 00:00:00
abstract：:The purpose of this article is to examine current orthopaedic training in the UK and objectively compare this with other English-speaking countries. ...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/003588409X359303
更新日期：2009-04-01 00:00:00
abstract：:A high incidence of complications related to bleeding was observed after open prosthetic inguinal hernia repair. The site of injection of low-dose heparin into the abdominal wall was thought to be a possible causal factor for these complications. The wound complication rate after repair of primary unilateral inguinal ...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 临床试验,杂志文章,多中心研究
doi：
更新日期：1998-01-01 00:00:00
abstract：:The plasma fibrinogen concentration is directly related to blood viscosity, which in turn is inversely related to blood flow. The way in which the plasma fibrinogen level affects the clinical status of patients with peripheral vascular disease is discussed with reference to both retrospective and prospective studies o...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1976-11-01 00:00:00
abstract：:A new surgical approach to the sublingual salivary gland is described, the key feature of which is the use of a flap rather than the usual incision. The flap includes the submandibular duct and, because of the relationship of the duct and lingual nerve, allows early identification of the latter before dissection of th...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1994-03-01 00:00:00
abstract：BACKGROUND:Peripheral angioplasty is increasingly the first choice intervention in patients with peripheral vascular disease. The aim of the current study was to audit prospectively all major complications, especially the requirement for emergency surgical intervention. PATIENTS AND METHODS:A prospective audit of outc...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：2002-01-01 00:00:00
abstract：:Severe hand injuries constitute the largest number of acute referrals to this plastic surgery unit, the admission of these patients often displacing routine admissions due to bed shortages, thus increasing waiting list time. This study showed that a high percentage of these injuries were alcohol-related and were there...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1992-09-01 00:00:00
abstract：:Twenty-one patients have been studied in the 48 h after valve replacement to determine the possible contribution of abnormalities of left ventricular myocardial blood flow and oxygen consumption to the impaired cardiac performance which is sometimes evident in such patients. In the 14 patients making an uneventful rec...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1975-08-01 00:00:00
abstract：:The pattern of preoperative investigation was audited in 256 patients entering hospital for elective surgery over a 12-week period. During the initial 6 weeks (phase one), no guidance was given to the house surgeons and the investigations were assessed as being 'indicated' or 'not indicated' according to preset criter...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1993-05-01 00:00:00
abstract：:A prospective study of all weekday emergency surgery performed in a district general hospital over an 18-month period was undertaken to assess the impact of a fully staffed, daytime operating theatre for emergency surgery on night-time operating and on consultant supervision of trainees. In the 12 months following the...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1993-11-01 00:00:00
abstract：:A postoperative radiograph demonstrated a folded radio-opaque structure in the nasopharynx, resembling a retained throat pack, despite her not having any respiratory symptoms. Retention of a throat pack is a never event. ...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/rcsann.2020.0047
更新日期：2020-07-01 00:00:00
abstract：:INTRODUCTION Laparoscopic surgery has become the standard for colorectal cancer resection in the UK but it can be technically challenging in patients who are obese. Patients whose body fat is mainly inside the abdominal cavity are more challenging than those whose fat is mainly outside the abdominal cavity. Abdominal ...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/rcsann.2016.0251
更新日期：2017-01-01 00:00:00
abstract：:Over 700 cerebral vascular operations have been undertaken on the Surgical Unit of St Bartholomew's Hospital, London, for stroke prophylaxis, the majority being carotid endarterectomies. One of the unique features of the latter procedure is the marked instability of postoperative blood pressure. The relation of this c...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1980-09-01 00:00:00
abstract：:In the differential diagnosis of a swollen elbow, the palpation of the supratrochlear glands is useful. They are not enlarged in a traumatic elbow joint. They are enlarged, discrete and shotty in rheumatoid arthritis. In tuberculosis, they are enlarged, matted and they may caseate and form a cold abscess on the medial...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章,评审
doi：
更新日期：2001-11-01 00:00:00
abstract：:Spondylodiscitis is often iatrogenic in nature. We report the case of a 69-year-old man presenting with spondylodiscitis and associated epidural abscess following transrectal ultrasonography guided prostate biopsy despite ciprofloxacin cover. To our knowledge, this is the first case of spondylodiscitis secondary to fl...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/003588415X14181254790563
更新日期：2015-07-01 00:00:00
abstract：:Perirectal sepsis is a potentially severe complication which may follow minor anorectal intervention and be slow to be diagnosed and treated. We report the presentation and outcome of three patients with perirectal sepsis of differing aetiologies. Awareness of the possible diagnosis, urgent investigation with cross-se...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/147870808X303047
更新日期：2008-07-01 00:00:00
abstract：:The results of a 12-month prospective study of 113 patients show that intravenous urography has no place in the management of men with acute urinary retention without haematuria. ...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1989-03-01 00:00:00
abstract：:Despite published criteria predicting poor survival after operation for ruptured abdominal aortic aneurysm (RAAA), little is known about the factors which influence surgeons not to operate. Questionnaires were sent to all 404 members of the Vascular Surgical Society of Great Britain and Ireland, posing questions about...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1998-05-01 00:00:00
abstract：:Although much is known about the late intestinal side effects of radiation, comparatively little has been published about its acute complications. We present a case of a small bowel obstruction due to acute radiation enteritis. As radiotherapy continues to expand its role in the management of oncological disease, cli...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/10.1308/147870811X602122
更新日期：2011-10-01 00:00:00
abstract：:The outcome of loop ileostomy closure was evaluated in 40 patients who had previously undergone restorative proctocolectomy. A standard operative technique was used which incorporated a circumstomal incision, non-resectional reconstruction and primary skin closure. Thirty-six patients (90%) enjoyed an uncomplicated re...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1990-07-01 00:00:00
abstract：INTRODUCTION:The effect of primary total knee replacement on the employment status of 56 patients under 60 years of age was examined at a mean follow-up of 64 months. PATIENTS AND METHODS:A total of 56 primary total knee replacements performed on patients under the age of 60 years by two surgeons between 1996 and 2003...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/003588409X391785
更新日期：2009-07-01 00:00:00
abstract：:Introduction Trauma and orthopaedics is a popular surgical specialty in the UK. Recent changes to the National Health Service have suggested an imbalance with fewer jobs yet more trainees. Furthermore, subspecialisation is emerging within all surgical disciplines. The aim of this study was to examine whether there wer...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章,评审
doi：10.1308/rcsann.2017.0123
更新日期：2017-11-01 00:00:00
abstract：:Introduction Patients with large ptotic breasts undergoing immediate implant-based reconstruction often require skin-reducing mastectomy to optimise the aesthetic outcome. However, healing complications, especially at the resulting inverted T-junction, leading to wound dehiscence, infection, skin necrosis, implant exp...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/rcsann.2018.0127
更新日期：2018-08-16 00:00:00
abstract：:The results of the secretin-pancreozymin test, duodenal aspirate cytology and hypotonic duodenography (the Triple Test), performed during a single duodenal intubation in patients with pancreatic or ampullary carcinoma, chronic pancreatitis and non-pancreatic disease were analysed retrospectively. Thirty-five of 36 car...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1983-05-01 00:00:00
abstract：:A technique of dissection of the sinuatrial node and of the atrioventricular node and main conducting bundles of the ox heart, without injection, is described. Museum specimens prepared in this way are illustrated. ...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1975-01-01 00:00:00
