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PubMed1996

Clinicopathological findings in human autopsy eyes with an Anis circular lens.

PURPOSE: To evaluate the long-term performance of the Anis circular intraocular lens (IOL). SETTING: Center for IOL Research, Storm Eye Institute, Charleston, South Carolina. MATERIALS: Fifteen human autopsy eyes with an Anis circular IOL submitted between 1985 and 1993 were evaluated. The eyes were sectioned at the equatorial plane, and the anterior segment containing the capsular bag and the IOL was photographed from the posterior perspective. Fixation, centration, capsular bag shape, zonular damage, central posterior capsule opacification (PCO), and Soemmering's ring formation were analyzed. The results were compared with those of a control group comprising human autopsy eyes with a one-piece (n = 15) or three-piece (n = 15) poly(methyl methacrylate) IOL with a C-loop design. RESULTS: All 15 Anis IOLs showed symmetrical in-the-bag fixation. Mean decentration in the Anis IOL eyes was significantly lower than in the control eyes (P = .02). Eyes with the Anis IOL had fewer zonular defects (P = .0005) and a better circular extension of the capsular bag (P = .003). There were no statistically significant differences in PCO (P = .29) or Soemmering's ring formation (P = .67). CONCLUSION: The Anis IOL with a circular haptic design had better centration and capsular bag morphology than the control eyes, although a difference in PCO and Soemmering's ring formation could not be shown.

Aged↗
PubMed2002

Relationship between levator ani contraction and motor unit activation in the urethral sphincter.

OBJECTIVE: The purpose of this study was to evaluate the relationship between levator ani contraction and motor unit action potential activation in the striated urethral sphincter. STUDY DESIGN: One hundred eight women who underwent preoperative evaluation at our referral center were studied. All women gave a urogynecologic history and underwent physical examination, multichannel urodynamic testing, and urethral sphincter electromyography. Manual muscle testing was used to grade levator ani contractions as poor, moderate, or strong; quantitative electromyography software was used to analyze motor unit action potential activation in the urethral sphincter. RESULTS: Levator ani contractions were graded as poor in 46% of the women, moderate in 31% of the women, and strong in 23% of the women. Manual muscle grade was not related to quantitative electromyography values in the urethral sphincter at rest or with voluntary pelvic floor contraction. Poor manual muscle grade was associated with detrusor instability (P =.004) and more advanced stages of prolapse (P =.037). Levator ani strength was not significantly related to age, genuine stress incontinence, urethrovesical junction hypermobility, menopausal status, or surgical cure rates. CONCLUSION: The ability to contract the levator ani does not appear to be related to the ability to activate motor unit action potentials in the urethral sphincter, which suggests that the function of the levator ani in maintaining urinary continence is independent from the role of the urethral sphincter.

Adult↗
PubMed2001

Estrogen, progesterone, and androgen receptor expression in levator ani muscle and fascia.

Previous studies have reported controversial data on estrogen receptor (ER) expression in levator ani muscle. We investigated ER expression in levator ani muscle and fascia and compared it with the expression of progesterone receptor (PR) and androgen receptor (AR). The study included 55 women undergoing surgery for gynecological (asymptomatic, n = 10) or urogynecological conditions (symptomatic, n = 45). The asymptomatic and 21 of the symptomatic women received no hormone replacement therapy (HRT). The remaining 24 symptomatic women received some form of HRT. Biopsies were taken from the levator ani muscle and the overlying fascia, and quantitative measurements of immunohistochemical staining by image analysis were made. None of the levator ani muscle samples showed any evidence of nuclear ER expression in striated muscle fibers, but some cells in the muscular stroma did express ER. However, PR and AR expression was found in both muscle and stromal cells. Levator ani fascia showed nuclear ER, PR, and AR expression to varying degrees. There was a significant increase (p < 0.03) in ER expression in levator ani fascia of symptomatic patients without HRT when compared with asymptomatic age-matched women. The ER expression was significantly lower (p < 0.001) in postmenopausal symptomatic women receiving long-term estrogen replacement compared with age-matched women without HRT. Our data indicate that ER expression is significantly higher in symptomatic women compared with age-matched asymptomatic females. However, long-term estrogenization causes significant decrease of ER expression.

Adult↗
PubMed1981

A comparative study of the human external sphincter and periurethral levator ani muscles.

Specimens from the human male and female external urethral sphincter and the periurethral levator ani muscle have been examined using histochemical and electron microscopic techniques. In both sexes the external sphincter consists of a single population of type I (slow twitch) fibres with a mean diameter of 17.47 +/- 0.7 micrometers in the absence of muscle spindles. In contrast, the periurethral levator ani possesses muscle spindles and the constituent fibres form a heterogeneous population of type I and type II (fast twitch) fibres, with mean diameters of 45.5 +/- 0.8 micrometer and 59.5 +/- 3.4 micrometers respectively. These findings indicate that the external urethral sphincter is functionally adapted to maintain tone over prolonged periods and may be of considerable importance in producing active urethral closure during continence. The anatomical location and fibre characteristics of the levator ani muscle suggest that these fibres actively assist in urethral closure, particularly during events which cause elevation of intra-abdominal pressure. In view of the differences in fibre characteristics between the external urethral sphincter and the levator ani, EMG activity recorded from a single site in the levator ani may not be representative of the functional status either of other levator ani muscle fibres or of the external urethral sphincter.

Adenosine Triphosphatases↗
PubMed2006

Seropositivity to a major allergen of Anisakis simplex, Ani s 1, in dyspeptic patients with Helicobacter pylori infection: histological and laboratory findings and clinical significance.

Previous studies have demonstrated a high prevalence of seropositivity to the Ani s 1 protein in dyspeptic patients with Helicobacter pylori infection, but it is not known whether this represents episodes of anisakiasis misdiagnosis or previous exposure to the parasite without clinical relevance. To investigate the clinical significance of seropositivity to the Ani s 1 protein, a cohort study was performed with 87 consecutive dyspeptic patients who were treated for H. pylori infection. Fourteen (16.5%) patients were seropositive for the Ani s 1 protein, which was associated with the consumption of uncooked fish (p 0.0002). There were no differences in histological findings between subjects seropositive or seronegative for Ani s 1, but seropositive patients had increased eosinophil and basophil leukocyte counts (p < 0.05). Anti-Ani s 1 IgE was associated with a lack of improvement in the group of patients with non-ulcer dyspepsia after successful eradication of H. pylori (p 0.016). Thus, in at least a subset of patients with H. pylori infection, seropositivity to Ani s 1 could have clinical relevance. In addition, these data highlight that only anisakiasis associated with severe allergic or gastric symptoms is currently being diagnosed.

Adult↗
PubMed1977

[Comparative and functional morphology of musculus canalis ani in tetrapod mammals and primates].

Comparative anatomy of structure and function of the M. canalis ani in tetrapode mammals and primates is described for the first time. The muscle itself lies on the sphincter ani internus in the area between the anorectal ("pectinate") and anocutaneal ("white") lines and its circumference is intact around the entire anal canal. The canalis ani muscle orginates from the superior part of the sphincter ani internus and concomitantly receives additional fibers from the longitudinal muscle. Caudally the muscle dips back into the sphincter ani internus and, at the same time, a small portion of the fibers go to the longitudinal muscle and, likewise, a portion also sets itself on the perinaal skin. On the basis of its morphological relationship to the convoluted vessels of the rectal venous plexus, the canalis ani muscle appears to be able to complete the closing of the anus in the continence phase to such an extent that a complete closing of the anal lumen is guaranted.

Anal Canal↗
PubMed2004

Comparison study between electrogalvanic stimulation and local injection therapy in levator ani syndrome.

BACKGROUND AND AIMS: Two theories have been reported for the pathophysiology of levator ani syndrome: the spastic cycle hypothesis and the local inflammation (Tendinitis) hypothesis. This study compared two treatment modalities in order to determine which of the two hypotheses is more appropriate. SUBJECTS AND METHODS: In this prospective study, Group EGS (n=22) underwent electrogalvanic stimulation twice a week. Group LI (n=31) underwent a local injection of a 40-mg triamcinolone acetonide mix with 1 ml 2% lidocaine into the maximal tender point of the arcus tendon in the levator ani muscle. RESULTS: The most common location of tenderness was the left anterior of the arcus tendon of the levator ani muscle. At the last follow-up (12 months), the LI group showed more relief, more improvement, and fewer failures than the EGS group. No difference was seen between the mean pain scores (verbal analog scale: 0-100) of the two groups at either the 1-week or the 12-month follow-up. However, the LI group showed better results at the 1-month, 3-month, and 6-month follow-ups. CONCLUSION: The LI group showed better short-term results than the EGS group. Therefore, the tendinitis hypothesis seems to be the more reliable one for levator ani syndrome. However, because the subjective responses of the patients indicated that a sufficient level of patient satisfaction had not been achieved, we cannot positively conclude that the tendinitis hypothesis is the more reliable one for the pathophysiology of levator ani syndrome.

Adult↗
PubMed1984

Androgen-estrogen synergy in rat levator ani muscle: glucose-6-phosphate dehydrogenase.

The effects of castration and hormone administration on the activity of glucose-6-phosphate dehydrogenase in the rat levator ani muscle were studied. Castration caused a decrease in enzyme activity and in wet weight of the levator ani muscle. Chronic administration of testosterone propionate increased glucose-6-phosphate dehydrogenase activity in the levator ani muscle of castrated rats; the magnitude of the recovery of enzyme activity was related to the length of time of exposure to testosterone propionate after castration as well as to the length of time the animals were castrated. The longer the period of castration before exposure to testosterone propionate, the greater the effect. This result may be related to previously reported castration-mediated increases in androgen receptor binding in muscle. Dihydrotestosterone was less effective than testosterone propionate in enhancing glucose-6-phosphate dehydrogenase activity in the levator ani muscle from castrated rats; estradiol-17 beta alone was ineffective. Combined treatment with estradiol-17 beta and dihydrotestosterone, however, was as effective as testosterone alone. Thus, androgens and estrogens may exert synergistic effects on levator ani muscle.

Androgens↗
PubMed1994

Development of the levator ani muscle in human fetuses.

The development of the levator ani muscle was studied in 300- to 700-microns thick sections through the pelves of 9- to 37-week-old fetuses and newborn children. During early fetal development, the anlage of the levator ani muscle can already be subdivided into three portions. The planes of cleavage between them become clearly evident in fetuses during the middle trimester when all points of origin and insertion of the levator ani muscle can be recognized. The tendinous arch of the pelvic fascia plays an important role in the differentiation between the pubococcygeus and the iliococcygeus parts of the levator ani muscle. The funnel-shaped form of the pelvic diaphragm is completed by about the 14th week of fetal development. Differences between the male and female levator ani muscles are already marked before birth.

Embryonic and Fetal Development↗
PubMed2006

Magnetic resonance imaging of the levator ani in the squirrel monkey: a comparison of muscle volume between a cohort with pelvic organ prolapse and matched normals.

OBJECTIVE: Magnetic resonance imaging was used to test whether squirrel monkeys with pelvic organ prolapse have reduced pelvic muscle volumes, compared with matched normals. STUDY DESIGN: Levator ani and obturator internus volumes obtained from T1-weighted axial scans of matched groups were measured. Muscle volumes and weights were compared for animals necropsied after magnetic resonance imaging. RESULTS: Two observers concurred on measures of levator ani and obturator internus (Kendal tau > or = 0.60 with P < .003). Levator ani volume was related to mass (R2 = 0.62, P = .0009). Animals with pelvic organ prolapse did not differ (P = .67, Wilks multivariate test) from those without pelvic organ prolapse in age, parity, and weight. Levator ani differed between groups (pelvic organ prolapse = 520 mm3 versus normals = 392 mm3, P = .015) and not sides (P = .80). The obturator internus did not differ between groups (P = .29) or sides (P = .72). CONCLUSION: Magnetic resonance imaging demonstrates that levator ani volumes in parous squirrel monkeys with pelvic organ prolapse were not reduced, suggesting that prolapse is not related to pelvic muscle size reduction in this species.

Abdominal Muscles↗
PubMed2006

Measurement of the pubic portion of the levator ani muscle in women with unilateral defects in 3-D models from MR images.

OBJECTIVE: Develop a method to quantify the cross-sectional area of the pubic portion of the levator ani muscle, validate the method in women with unilateral muscle defects, and report preliminary findings in those women. METHOD: Multi-planar proton density magnetic resonance images of 12 women with a unilateral defect in the pubic portion of their levator ani were selected from a larger study of levator ani muscle anatomy in women with and without genital prolapse. Three-dimensional bilateral models of the levator ani were reconstructed (using 3-D Slicer, version 2.1b1) and divided into iliococcygeal and pubic portions. Muscle cross-sectional areas were calculated at four equally spaced locations perpendicular to a line drawn from the pubic origin to the visceral insertion using the I-DEAS computer modeling software. RESULTS: The cross-sectional area of the muscle on the side with the defect was smaller than the normal side at all the four locations. The average bilateral difference was up to 81% at location 1 (nearest pubic origin). Almost all of the volume difference (13.7%, P=0.0004) was attributable to a reduction in the pubic portion (24.6%, P<0.0001), not the iliococcygeal portion (P=0.64), of the muscle. CONCLUSIONS: A method was developed to quantify cross-sectional area of the pubic portion of the levator ani perpendicular to the intact muscle direction. Significant bilateral cross-sectional area differences were found between intact and defective muscles in women with a unilateral defect.

Case-Control Studies↗
PubMed2004

Mild dystrophic damage in the androgen-sensitive levator ani muscle of the mdx mouse.

The time course of muscular dystrophy on the androgen-sensitive levator ani muscle was compared to that of the diaphragm of dystrophic (mdx) mice aged 1-20 months. Muscle growth, isometric contractile properties and caffeine-induced contractures were determined to assess the hormone myotrophic effect, muscle strength and sarcoplasmic reticulum function, respectively, of both control and dystrophic muscles. Histological analysis of mdx muscles showed variable fiber size, centronucleated cells, infiltration of connective tissue, and necrosis which was less severe in the levator ani than in the diaphragm muscle. Tetanic tension per unit weight in the mdx levator ani was reduced (29%) after aging, while the contraction time remained unchanged. The tetanic tension of the mdx diaphragm muscle decreased with age from 3 to 20 months (20-64%), and the relaxation time was prolonged after aging (22%). Gonadectomy of young adult mdx mice caused atrophy of the levator ani muscle, accelerated muscle wasting, reduced the tetanic force (31%), but it did not affect the contraction time and caffeine responses. The results showed that testosterone does not prevent the progress of muscle disease in the mdx levator ani, but androgen withdrawal accelerates muscle wasting suggesting a normonal beneficial effect.

Age Factors↗
PubMed2003

The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery.

OBJECTIVE: To describe the appearance and occurrence of abnormalities in the levator ani muscle seen on magnetic resonance imaging (MRI) in nulliparous women and in women after their first vaginal birth. METHODS: Multiplanar proton density magnetic resonance images were obtained at 0.5-cm intervals from 80 nulliparous and 160 vaginally primiparous women. These had been previously obtained in a study of stress incontinence, and half the primiparas had stress incontinence. All scans were reviewed independently by at least two examiners blinded to parity and continence status. RESULTS: No levator ani defects were identified in nulliparous women. Thirty-two primiparous women (20%) had a visible defect in the levator ani muscle. Defects were identified in the pubovisceral portion of the levator ani in 29 women and in the iliococcygeal portion in three women. Within the pubovisceral muscle, both unilateral and bilateral defects were found. The extent of abnormality varied from one individual to the next. Of the 32 women with defects, 23 (71%) were in the stress incontinent group. CONCLUSION: Abnormalities in the levator ani muscle are present on MRI after a vaginal delivery but are not found in nulliparas.

Adult↗
PubMed2002

Specific IgE determination to Ani s 1, a major allergen from Anisakis simplex, is a useful tool for diagnosis.

BACKGROUND: The most serious limitation of the serodiagnosis of parasitoses is the occurrence of cross-reactions. OBJECTIVE: The possible use of Anisakis simplex major allergen Ani s 1 for diagnosis. PATIENTS AND METHODS: Forty-nine non-fish-allergic patients with Anisakis simplex hypersensitivity, 21 patients without allergic episodes suffering intestinal anisakiasis with obstruction of the intestinal lumen, and 10 unrelated sera as a control were included in this study to determine specific immunoglobulin (Ig)E and IgG to Anisakis simplex major allergen Ani s 1 by immunoblotting. RESULTS: Eighty-six percent of patients with Anisakis simplex hypersensitivity showed specific IgE directed to Ani s 1. Identical result was obtained for IgG detection in this group. Among patients with intestinal anisakiasis, 86% showed specific IgE, but only 29% had specific IgG (P < 0.001, two-tailed Fisher exact test). One of the 10 control subjects was positive both for IgE and IgG (P < 0.001). CONCLUSIONS: Determination of specific IgE directed to Anisakis simplex major allergen Ani s 1 is a useful tool for the diagnosis of hypersensitivity and intestinal anisakiasis. Further, measurement of specific IgG directed to Anisakis simplex major allergen Ani s 1 is only valid for Anisakis simplex allergy.

Allergens↗
PubMed2003

Three-dimensional magnetic resonance imaging assessment of levator ani morphologic features in different grades of prolapse.

OBJECTIVE: The study was undertaken to identify the morphologic changes in the levator ani in different grades of prolapse by using reconstructed three-dimensional models of magnetic resonance images (MRI) and to subclassify prolapse into different categories on the basis of their levator ani morphologic characteristics. STUDY DESIGN: Sixty-one women were studied, 8 women in stage I, 15 women in stage II, 22 women in stage III, 7 women in stage IV prolapse, and 9 asymptomatic volunteers with stage 0 prolapse. Axial, sagittal, and coronal T2-weighted pelvic magnetic resonance scans were obtained with the patient in the supine position. The three-dimensional models were reconstructed from the source images by using manual segmentation and surface modeling. The morphologic characteristics of the puborectalis were assessed on these reconstructed models by measuring (1). the levator symphysis gap, (2). the width of the levator hiatus, and (3). the length of the levator hiatus. To assess the iliococcygeus, we measured (1). the maximum width of the iliococcygeus, (2). the direction of its fibers that was assessed by measuring the iliococcygeal angle, and (3) the levator plate angle. Nine nulliparous asymptomatic women were studied as controls. RESULTS: Alterations in levator ani morphologic features are not dependent on the grade of the prolapse, and not all women with pelvic floor prolapse have abnormal morphologic features. In healthy control subjects, the iliococcygeal width measured less than 40 mm and the iliococcygeal angle measured less than 20 degrees. On the basis of the MRI findings, four patterns of changes in the levator ani have been identified. Both the levator symphysis gap and the levator hiatus, which is dependent on the puborectalis function, widen with increasing grade of prolapse. CONCLUSION: It is possible to subclassify prolapse on the basis of morphologic changes in the levator ani by using MRI. This may be a very useful predictor as to which patients have recurrent prolapse develop after surgery.

Female↗
PubMed1988

Clinical evaluation of the Vitek ANI card for identification of anaerobic bacteria.

An evaluation of the Vitek Anaerobe Identification (ANI) card was performed with 341 bacterial isolates, including 313 clinical isolates and 28 stock strains of anaerobic microorganisms. Identifications obtained with the ANI card were compared with those determined by conventional methods. The card identified 73.2% of 149 anaerobic gram-negative bacilli, 63.6% of 44 Clostridium spp., 65.8% of 38 anaerobic nonsporeforming gram-positive bacilli, and 69.1% of 110 anaerobic cocci, with no further testing required. When genus-level identifications were included, 83.9% of the anaerobic gram-negative bacilli, 70.5% of Clostridium spp., 73.7% of the anaerobic nonsporeforming gram-positive bacilli, and 73.6% of the anaerobic cocci were identified. Nineteen isolates (5.6%) produced identifications of good confidence but marginal separation or questionable biotype, in which the correct identification was listed with one or two other possible choices and extra tests were required and suggested. A total of 28 (8.2%) were not identified and 29 isolates (8.5%) were misidentified by the ANI card. Among the commonly isolated clinically significant anaerobes, the ANI card identified 100% of 55 Bacteroides fragilis and 100% of 8 Clostridium perfringens. Use of supplemental tests and expansion of the data base to include additional strains of organisms that are difficult to separate even with conventional methods may improve the accuracy of the ANI card as a method for identification of anaerobic bacteria in the clinical laboratory.

Bacteria, Anaerobic↗
PubMed2003

[Study of morphological changes in levator ani muscle of patients with stress urinary incontinence].

OBJECTIVE: To observe the the histological changes of levator ani muscle in patients with stress urinary incontinence (SUI) or pelvic organ prolapse (POP) and to determine the alteration that contributed to pathogenesis. METHODS: Biopsy specimens of levator ani muscle were obtained from 15 patients with SUI, 19 patients with POP and 3 asymptomatic control with rectal cancer during operation. Levator ani muscle's structure was examined with routine histological techniques. At the same time, fiber distribution and diameters were also measured. RESULTS: The morphological features of levator ani muscle in SUI and POP group included the muscular fiber density decreased and separated by large amounts of dense connective tissue. The mean diameter of levator ani muscle in 4 SUI patients containing striated muscle fibers was (24 +/- 9) micro m, the mean diameter in 3 POP patients was (24 +/- 5) micro m, and the mean diameter in 3 control cases was (54 +/- 11) micro m. There was no diameter difference between SUI and POP group (P > 0.05), and the mean fiber diameters of SUI and POP patients were significantly smaller than that of the control group (P < 0.05). The proportion of type I fibers in SUI and POP patients had the tendency to increase (79.6%, 97.2% and 77.2%), with relative decrease of type II fibers. In control group the mean diameter of muscle fiber decreased significantly with age and menopausal time (P = 0.000). CONCLUSIONS: There was obvious fibrosis and the muscle fiber atrophy in SUI and POP group, which resulted in the weakness of pelvic floor. The prevalence of type I fibers might be disadvantage to forceful contraction during straining. Aging also contributed to neuromuscular degeneration and then associated with urinary incontinence in elderly women.

Aged↗
PubMed2004

[Study of morphological changes in levator ani muscle of patients with stress urinary incontinence or pelvic organ prolapse].

OBJECTIVE: To investigate the morphological characteristics of levator ani muscle in patients with stress urinary incontinence (SUI) or pelvic organ prolapse (POP) and to explore whether the alterations could contribute to pathogenesis of the diseases. METHODS: Biopsy specimens of levator ani muscle were obtained from 15 patients with SUI, 19 patients with POP and 3 asymptomatic controls with rectal cancer during operation. The structure of levator ani muscle was examined with routine histological techniques: HE staining, modified Gomori trichrome staining, NSE staining, ACP staining, and adenosine triphosphatase (ATPase) staining. RESULTS: There was no significant difference in age, parity, menopausal time, disease severity and leak point pressure between SUI patients with or without muscle fibers (P > 0.05). The muscular fiber density of levator ani muscles in SUI and POP groups was decreased, fibers were arranged in disorder and separated by large quantities of dense connective tissues with infiltrating inflammatory cells. The muscle fiber fascicles showed obvious grouped denervative atrophy, fiber type grouping and angular in shape. And also there was myopathic degeneration such as centrally located nuclei, peripheral phagocytosis and vacuolated necrosis. CONCLUSIONS: There are both neurogenic and myopathic alterations in levator ani muscle's structure in patients with SUI and POP. The presence of both acute and chronic abnormalities indicates that the weakness of pelvic floor is a consequence of prolonged denervation.

Aged↗