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At least 361 records · Page 20Linked to original sources
PubMed2006

Endoscopic transsphenoidal pituitary surgery with intraoperative magnetic resonance imaging.

OBJECTIVE: The two most recent significant advances in pituitary surgery have been the endonasal endoscopic approach and intraoperative magnetic resonance imaging (IMRI). Each provides improved visualization of intra- and parasellar anatomy with the goal of attaining a complete resection. The combination of the two techniques has not been previously reported in the literature. METHODS: We performed endoscopic, endonasal resection of pituitary macroadenomas in 15 patients using the Polestar N-10 (0.12T) IMRI (Odin Medical Technologies, Inc., Newton, MA). Eleven patients had nonfunctioning tumors, three had acromegaly, and one had a medication-resistant prolactinoma. The effect of the magnetic field on the cathode ray tube screen and the image quality of the IMRI images were assessed. The presence of residual tumor on IMRI was noted and then re-examined with the endoscope. RESULTS: Although the Polestar N-10 is a low Tesla magnet, the IMRI caused significant distortion of the cathode ray tube screen regardless of the viewing angle. This was overcome with the use of a wall-mounted plasma screen. IMRI images were obtained in all cases and were of sufficiently high quality to demonstrate adequate decompression of the optic chiasm and the removal of all suprasellar tumor. In three cases, residual tumor was found with IMRI that was resected endoscopically before the completion of surgery. In four other cases, potential residual tumor was examined endoscopically and found to be normal postoperative change. In eight cases no residual intrasellar tumor was seen on the IMRI. Preresection visual deficits improved in all cases and the insulin-like growth factor levels normalized in two of three cases. There were no delayed cerebrospinal fluid leaks. CONCLUSION: Combining intraoperative endoscopy and IMRI is feasible and distortion of the cathode ray tube screen can be overcome with the use of either a plasma or liquid crystal display screen. Each technology provides complementary information, which can assist the surgeon in safely maximizing the extent of resection. In this small series using a low-field magnet, rates of residual tumor following endoscopic transsphenoidal surgery were less than have been reported following microscope-based transsphenoidal surgery.

Adenoma↗
PubMed1975

Inactive pulmonary lesions: a potent risk factor of tuberculosis.

Case histories and previous chest X-ray films of 142 patients with bacteriologically confirmed active pulmonary tuberculosis from eastern Finland were re-examined. In 18% of the series the disease was a reactivation of previously diagnosed and treated tuberculosis. In 70% of the patients with first clinical attack of tuberculosis, previous RP-films revealed fibrotic lesions in the lungs. Only 23% of the whole series had no previous abnormality on chest X-ray examination or previous clinical tuberculosis. Fibrotic pulmonary lesions are therefore a significant risk factor in the epidemiology of pulmonary tuberculosis, which has been given too little attention.

Adolescent↗
PubMed2005

Relative stability of mixed [3 + 1] Tc and Re complexes: a computational and conceptual DFT study.

A computational and conceptual density-functional study has been performed on various [3 + 1] complexes of both Re(V) and Tc(V). The fully optimized complexes chloro(3-thiapentane-1,5-dithiolato)oxorhenium(V) and chloro(3-thiapentane-1,5-dithiolato)oxotechnetium(V) show geometries that compare favorably with the X-ray data. These structures were used as a starting point to investigate the relative stability of Tc(V) and Re(V) complexes with various ligands containing combinations of N, O, and S as chelating atoms and to evaluate the stabilizing/destabilizing influence of these N, O, and S combinations. For both Tc and Re complexes, the S content (number and position of S atoms) together with the presence of an oxygen as the central chelating atom turns out to be decisive in the stability of the tridentate complexes, the latter factor being strongly destabilizing and the former stabilizing. The stabilization sequences for both Tc and Re are shown to be identical in the gas phase and in aqueous solutions treated in a polarizable continuum model. The Re(V) complexes are found to be more stable than their Tc(V) analogues. All of the results are successfully interpreted in terms of the hard and soft acids and bases principle, applied at the local level. For this purpose, a softness value for Tc is obtained by interpolating softness trends in neighboring elements of rows 5 and 6 in the periodic table.

Journal Article↗
PubMed2003

Prospective randomized comparative study of the effectiveness and safety of electrohydraulic and electromagnetic extracorporeal shock wave lithotriptors.

PURPOSE: We compared the efficacy of 2 shock wave energy sources, electrohydraulic (Dornier MFL 5000, Dornier MedTech, Wessling, Germany) and electromagnetic (DLS, Dornier Lithotriptor S, Dornier MedTech), for the treatment of urinary calculi. MATERIALS AND METHODS: A prospective randomized study of 694 patients with urinary stones was conducted during 12 months to compare the efficacy of the 2 machines. Entrance criteria were radiopaque single or multiple stones at any location within the kidney or the ureter, 25 mm or smaller that had not previously been treated by any means. Patients with congenital anomalies were excluded from this study with all other contraindications for extracorporeal shock wave lithotripsy. Following lithotripsy a plain abdominal film and tomograms were done 1 week after each session to determine if there were residual stones and assess the need for re-treatment. Patients were evaluated 4 weeks after lithotripsy by plane abdominal x-ray and spiral computerized tomography. Success was defined as no residual stones. Univariate and multivariate statistical analyses were performed for different variables that may have an impact on the success rate, including the type of lithotriptor. Comparisons of treatment parameters, complications and success rate for both lithotriptors were done. RESULTS: Of 9 variables examined with univariate analysis 6 had a significant impact on the success rate. Of these 4 maintained their statistical impact on multivariate analysis. These were side, site of the stones, renal morphology and type of lithotriptor. Treatment time was significantly shortened for DLS (54 +/- 32.9 minutes compared to 65.7 +/- 44.7 for MFL, p <0.001). The re-treatment rate was lower for DLS at 34% versus 51.6% for the MFL (p <0.001). The overall success rate was 85.4%. It was 88.5% for DLS compared to 82.4% for MFL (p = 0.03). No statistically significant difference between the lithotriptors was noted for ureteral calculi (p >0.05). The success rate was higher in the DLS group for renal stones especially lower caliceal and pyelic stones (p <0.05). The success rate was higher in DLS group for stones 10 mm or smaller, 92.8% versus 85.3% for MFL (p = 0.03). The success rate was comparable in both groups for stones larger than 10 mm (81.8% for DLS versus 77.9% for MFL, p >0.05). No statistically significant difference was found in the complication rate for the groups. Steinstrasse were noted in 4% of patients treated with MFL and 3% of those treated with DLS. Subcapsular hematomas were noted in 2 patients in each group. No procedures after extracorporeal shock wave lithotripsy were needed in either group. CONCLUSIONS: The electromagnetic lithotriptor (Dornier lithotriptor S) has significant clinical advantages over the electrohydraulic lithotriptor (Dornier MFL 5000) in terms of treatment time, re-treatment rate and success rate, although there is no difference in the complication rate.

Adolescent↗
PubMed2004

Synthesis, characterisation and molecular structure of Re(III) 2-oxacyclocarbenes stabilised by a benzoyldiazenido ligand.

A family of new Fischer-type rhenium(III) benzoyldiazenido-2-oxacyclocarbenes of formula [(ReCl2[eta1-N2C(O)Ph][=C(CH2)nCH(R)O](PPh3)2][n = 2, R = H (2), R = Me (3); n = 3, R = H (4), R = Me (5)] have been prepared by reaction of [ReCl2[eta2-N2C(Ph)O](PPh3)2] (1) with omega-alkynols, such as 3-butyn-1-ol, 4-pentyn-1-ol, 4-pentyn-2-ol, 5-hexyn-2-ol in refluxing THF. The correct formulation of the carbene derivatives 2-5 has been unambiguously determined in solution by NMR analysis and confirmed for compounds 2-4 by X-ray diffraction methods in the solid state. All complexes are octahedral with the benzoyldiazenido ligand, Re[N2C(O)Ph], adopting a "single bent" conformation. The coordination basal plane is completed by an oxacyclocarbene ligand and two chlorine atoms. Two triphenylphosphines in trans positions with respect to each other complete the octahedral geometry around rhenium. The reactivity of 1 towards different alkynes and alkenes including propargyl- and allylamine has been also studied. With propargyl amine, monosubstituted or bisubstituted complexes, [(ReCl2[eta1-N2C(O)Ph][eta1-NH2CH2C triple bond CH]n(PPh3)(3-n)][n= 1 (6); n = 2 (7)], have been isolated depending on the reaction conditions. In contrast, the reaction with allylamine gave only the disubstituted complex [(ReCl2[eta1-N2C(O)Ph][eta1-NH2CH2CH=CH2]2(PPh3)] (8). The molecular structure of the monosubstituted adduct has been confirmed by X-ray analysis in the solid state.

Journal Article↗
PubMed1997

Synthesis and Characterization of Rhenium(III) and Technetium(III) Organohydrazide Chelate Complexes. Reactions of 2-Hydrazinopyridine with Complexes of Rhenium and Technetium.

The organohydrazide chelate complexes M(III)(NNpy)(PPh(3))(2)Cl(2) (1, 3) (M = Re, Tc) have been synthesized using the organohydrazine 2-hydrazinopyridine. The chelated organohydrazide is a diazenido(1-) ligand that forms a five-membered ring with the metal center. An X-ray structural analysis of 1 indicates that there is a delocalized pi-system formed by the chelate ring. These octahedral, d(4) metal complexes have diamagnetic (1)H NMR spectra. Complex 1, C(41.50)H(34)Cl(2)N(3)O(0.5)P(2)Re, crystallizes in the triclinic space group P&onemacr; with a = 10.5549(7) Å, b = 12.2699(8) Å, c = 16.8206(12) Å, alpha = 105.9050(10) degrees, beta = 95.8930(10) degrees, gamma = 111.0100(10) degrees, V = 1906.1(2) Å(3), Z = 2, and R = 0.0650 based on 5268 unique reflections. The FABMS+ in (p-nitrobenzyl alcohol) of 3 reveals a parent ion peak at m/z 799.2. The complex [Re(HNNpy)(NNpy)(PMe(2)Ph)(2)Cl](+)[Cl](-) (2) contains a chelated, neutral organodiazene ligand and a linear, diazenido(1-) ligand. The X-ray structural analysis of 2, C(26)H(30)Cl(2)N(6)P(2)Re, indicates a delocalized pi-system formed by the chelate ring. The (1)H NMR spectrum of 2 is not paramagnetically shifted. Complex 2 crystallizes in the orthorhombic space group Pna2(1) with a = 17.383(4) Å, b = 13.967(3) Å, c = 12.002(2) Å, V = 2913.9(10) Å(3), Z = 4, and R = 0.0384 based on 3083 unique reflections.

Journal Article↗
PubMed2002

Aryl cyclopentadienyl tricarbonyl rhenium complexes: novel ligands for the estrogen receptor with potential use as estrogen radiopharmaceuticals.

The need for imaging agents for estrogen receptor positive (ER+) tumors that are both cost effective and widely available, as well as the need for novel radiotherapeutic agents for the treatment of breast cancer, has prompted us to investigate cyclopentadienyl tricarbonyl metal [CpMet(CO)(3), Met=Re, Tc-99m] complexes that bind well to the ER. Thus, we have prepared a series of p-hydroxyphenyl-substituted CpRe(CO)(3) complexes and evaluated them (and, in some cases, their cyclopentadiene precursors) for binding to ER. These compounds constitute a new class of structurally integrated organometallic ligands for ER in which the CpMet(CO)(3 )organometallic unit forms the very structural core of these molecules and thus is necessarily intimately involved in their interaction with the receptor. The CpRe(CO)(3) compounds were prepared by reaction of the lithium salt of the arene-substituted cyclopentadiene with a suitable Re(CO)(3)(+) precursor, followed by deprotection of the methyl ether. The X-ray crystal structure of one of these analogues shows that it has the classical 'piano stool'-like geometry, with the alkyl groups directed upward, away from the tripodyl metal carbonyl base. The aryl-substituted CpRe(CO)(3) complexes that we have prepared all bind to the ER, some with affinity as great as 20% that of the native ligand, estradiol. In general, at least two p-hydroxyphenyl substituents and one to two alkyl groups attached to the organometallic cyclopentadienyl core are needed for high ER affinity. Where we have been able to make comparisons, the metal complexes bind to ER with an affinity greater than their cyclopentadiene precursors. The high affinity of some of these complexes indicates that the bulky Re(CO)(3) unit is able to exploit the considerable volume in the center of the ER ligand binding pocket that is not occupied by most ligands, a consideration that is supported by molecular modeling. The preparation of the best of these agents in technetium-99m labeled form is currently being investigated.

Breast Neoplasms↗
PubMed2006

X-ray absorption spectroscopic study of LiCoO2 as the negative electrode of lithium-ion batteries.

Lithium cobalt oxide (LiCoO(2)) particles are modified using rotor blade grinding and re-annealing and used as the active electrode material versus lithium in the 3-0 V potential interval, in which a maximum capacity of 903 mA h g(-1) is achieved. X-ray absorption near edge structure spectra reveal the complete reduction of Co(3+) to Co metal at 0 V. Cell recharge leads to an incomplete reoxidation of cobalt. A maximum reversible capacity of 812 mA h g(-1) is obtained, although a poor capacity retention upon prolonged cycling may limit its application.

Journal Article↗
PubMed2002

Site-differentiated hexanuclear rhenium(III) cyanide clusters [Re(6)Se(8)(PEt(3))(n)()(CN)(6)(-)(n)()](n)()(-)(4) (n = 4, 5) and kinetics of solvate ligand exchange on the cubic [Re(6)Se(8)](2+) Core.

The site-differentiated, cyanide-substituted hexanuclear rhenium(III) selenide clusters cis- and trans-[Re(6)Se(8)(PEt(3))(4)(CN)(2)] and [Re(6)Se(8)(PEt(3))(5)(CN)](+) have been prepared from heterogeneous reactions of the corresponding iodo clusters with AgCN in refluxing chloroform. Isolated yields are 68%, 46%, and 64% for cis-[Re(6)Se(8)(PEt(3))(4)(CN)(2)], trans-[Re(6)Se(8)(PEt(3))(4)(CN)(2)], and [Re(6)Se(8)(PEt(3))(5)(CN)](+), respectively. The new compounds are air- and water-stable and are characterized by X-ray diffraction crystallography, (31)P NMR and IR spectroscopies, and FAB mass spectrometry. In related work, the solvent exchange rates of two site-differentiated monosolvate clusters, [Re(6)Se(8)(PEt(3))(5)(MeCN)](SbF(6))(2) and [Re(6)Se(8)(PEt(3))(5)(Me(2)SO)](SbF(6))(2), in neat solvents were measured by (1)H NMR. These clusters are substitutionally inert; k approximately 10(-)(5)-10(-)(6) s(-)(1) at 318 K. Activation parameters indicate a dissociative ligand exchange mechanism; DeltaH() values obtained from least-squares fitting of temperature-dependent kinetics data exceed RT by a factor of ca. 50 over the temperature range studied. These results demonstrate that the substitutional lability encountered in a previous study of cluster photophysics (Gray, T. G.; Rudzinski, C. M.; Nocera, D. G.; Holm, R. H. Inorg. Chem. 1999, 38, 5932) cannot result from ground-state thermal reactions.

Journal Article↗
PubMed1986

Rare-earth pneumoconiosis: a new case.

A new case of rare-earth (RE) pneumoconiosis is described. The subject had worked as a photoengraver for 13 years and had not been exposed for 17 years. Chest X-ray showed a diffuse nodular pattern (q 2/3-ILO/1980). The patient was asymptomatic despite a restrictive spirometric impairment. The diagnosis derived from the finding, in the bronchoalveolar lavage fluid, of abnormal levels of La, Ce, Nd, Sm, Tb, Yb, and Lu. The presence of these elements was demonstrated by two methods: the neutron activation analysis and (as regards Ce alone) the X-ray energy spectrometry of mineral particles observed with electron microscope. Abnormal levels of rare earths were demonstrated also in the nails, suggesting an absorption of the RE from the lung.

Cerium↗
PubMed1989

[Postoperative bronchopleural fistula--diagnostic significance of masked cases and results of early re-operation].

We studied recent-day cases of postoperative bronchopleural fistula from 1982 to 1985. And in 1985, postoperative chest X-ray films were intensively compared with previous ones. Radiological signs for bronchopleural fistula and/or alveolar fistula such as increases in air content and/or falls in air-fluid level of pleural space were seen in 11 (7.1%) of 155 pulmonary resection cases in 1985. Among them, 8 of these cases were confirmed as bronchopleural fistulas. So one half of cases with these radiological findings were bronchopleural fistulas. But 2 of these 8 cases were masked bronchopleural fistulas which were not recognizable by bronchofiberscope and soon or later, bronchopleural fistulas developed which were recognizable by bronchofiberscope. For differential diagnosis between the bronchopleural fistula and alveolar fistula, serial chest X-ray films which was compared with previous one, were useful. In masked bronchopleural fistula cases, abnormal findings as mentioned above were seen more than three times, but in alveolar fistula cases were seen less than two times. On the bronchoscopic examination, bronchopleural fistulas were mainly located at the side of the residual lobe on the stump. Bronchopleural fistula cases which were re-operated for re-amputation, re-suture, and coverage of the stump within 48 hours, were all cured. So we concluded early re-operation is the best choice for bronchopleural fistula patient, because of short administration, no cosmetical problems and no disadvantage for lung function.

Bronchial Fistula↗
PubMed2006

[An improved fast algorithm for ray casting volume rendering of medical images].

Ray casting algorithm can obtain better quality images in volume rendering, however, it presents some problems such as powerful computing capacity and slow rendering velocity. Therefore, a new fast algorithm of ray casting volume rendering is proposed in this paper. This algorithm reduces matrix computation by the matrix transformation characteristics of re-sampling points in two coordinate system, so re-sampled computational process is accelerated. By extending the Bresenham algorithm to three dimension and utilizing boundary box technique, this algorithm avoids the sampling in empty voxel and greatly improves the efficiency of ray casting. The experiment results show that the improved acceleration algorithm can produce the required quality images, at the same time reduces the total operations remarkably, and speeds up the volume rendering.

Algorithms↗
PubMed2006

Thermally stable luminescent composites fabricated by confining rare earth complexes in the two-dimensional gallery of titania nanosheets and their photophysical properties.

Fluorescent composite materials of exfoliated titania nanosheets, Ti(0.91)O(2), and rare earth (RE) complexes, Eu(phen)(2)Cl(3).2H(2)O and Tb(phen)(2)Cl(3).2H(2)O (phen = 1,10-phenanthroline), were synthesized via flocculation between them. X-ray diffraction measurements and transmission electron microscopy observations confirmed a restacked lamellar structure for the composites, and elemental analysis revealed a high RE complex content of 15 wt %. The decomposition temperature of the complexes trapped in the composites was improved to 420 degrees C from 250 degrees C for the free form. The restacked composite composed of Ti(0.91)O(2) nanosheets and Eu(phen)(2) exhibited characteristic red emission from the complex, while the composite with Tb(phen)(2) gave featureless emission originated from the ligand. This phenomenon can be explained by a shift of triplet state level of the ligand after encapsulation in the host titania nanosheets. The quantum yield of europium complex in the composite was enhanced 1.6 times more than that of the pure complex.

Journal Article↗
PubMed2004

Frequency and outcome of re-interventions after endovascular repair for abdominal aortic aneurysm: a prospective cohort study.

PURPOSE: To describe frequency, type, and outcome of re-intervention after endovascular aortic aneurysm repair (EVAR). METHODS: Between September 1996 and December 2003, 308 patients were treated, with data collected prospectively. No patient was lost to follow up, but two were excluded (one primary conversion, and one post-operative death). Vanguard, Talent, Excluder, Zenith, and Quantum devices were used. Follow up required a CT scan before discharge. Initially, a CT scan was done at each follow up. Subsequently, we used duplex ultrasound and abdominal X-ray, with CT scan used selectively. RESULTS: Mean follow-up was 36+/-22 months. Re-interventions were required in 47 (15%) patients, 31 (66%) elective and 16 (34%) emergency cases. In 32 patients, the primary re-intervention was successful; in 15 patients an additional 13 secondary and four tertiary re-interventions were required. A total of 72 adjunctive manoeuvres were performed: 49 endovascular (68%) and 23 open (32%). The success of endovascular re-interventions was 80%. The success of open re-interventions was 96%. Open conversions were required in nine patients (3%). There was no mortality. CONCLUSION: EVAR was associated with a low burden of re-interventions, with only 15% patients requiring re-intervention. Our long-term follow up, without regular CT, was simple and effective.

Aged↗
PubMed2003

Macromolecular assembly of Helicobacter pylori urease investigated by mass spectrometry.

The supramolecular assembly of Helicobacter pylori urease was studied by nanoflow electrospray ionization orthogonal time-of-flight mass spectrometry. The measured molecular mass of the urease complex of 1.06 MDa corresponds to a dodecameric (alphabeta)(12) assembly of urease alpha (26 kDa) and beta (61 kDa) subunits. The dodecamer disassembles readily into (alphabeta)(3) subunits in solution and under controlled collisional-induced dissociation in the gas phase. This is in strong support of an ((alphabeta)(3))(4) architecture consistent with the recently published x-ray structure. In vitro, the alpha and beta subunits are capable of re-assembling to (alphabeta)(3), but not further to the dodecameric complex.

Amino Acid Sequence↗
PubMed2005

Association of red blood cell 5-methyltetrahydrofolate folate with bone mineral density in postmenopausal Iranian women.

Recent studies have suggested that hyperhomocysteinemia and low plasma folate are associated with fracture and also bone mineral density (BMD) and that they may contribute to the pathogenicity of osteoporosis in postmenopausal women. However, as plasma total homocysteine (tHcy) and plasma folate can be regarded as short-term markers when compared to a long-term variable such as BMD, in this study we tested the hypothesis that low red blood cell 5-methyltetrahydrofolate (RBC 5-MTHFR) as a long-term marker of the folate status may be a better predictor of BMD than plasma 5-MTHF, and its deficiency may contribute to the pathogenicity of osteoporosis in postmenopausal Iranian women. The BMD at the femoral neck and lumbar spine (measured by dual-energy X-ray absorptiometry, DXA) together with anthropometric and biochemical components of the homocysteine re-methylation pathway including plasma tHcy, 5-MTHF and vitamin B12, RBC 5-MTHF and creatinine were determined in 366 postmenopausal women. RBC 5-MTHF was more highly correlated with BMD at the lumbar spine (r=0.21, P=0.001) and femoral neck (r=0.19, P=0.004) than was plasma 5-MTHF (lumbar spine; r=0.14, P=0.03 and femoral neck; r=0.17, P=0.006). Stepwise multiple linear regression analyses revealed that RBC 5-MTHF was one of the predictors of BMD explaining 4.3 and 4.0% variance of BMD at the lumbar spine and femoral neck, respectively, whereas plasma 5-MTHF was excluded in the model and not determined to be a predictor of BMD at both the lumbar spine and femoral neck when adjusted for age, BMI, years since menopause and RBC 5-MTHF. This study suggests that RBC 5-MTHF is a better predictor of BMD than plasma 5-MTHFR when compared to a long-term marker such as BMD, and its deficiency is associated with low BMD that may contribute to the pathogenicity of osteoporosis in postmenopausal women.

Absorptiometry, Photon↗
PubMed1970

Radiosensitivity of mammalian cells. IV. Effects of x-irradiation on the DNA synthetic period in synchronized cells.

The effect of X-irradiation on the timing of DNA synthesis in the Chinese hamster ovary cells has been investigated. Mitotically synchronized cells irradiated in mitosis or early G(1) exhibited a fixed, dose-independent (150-2000 rad) delay of 1.6 hr in entry into S, while the duration of S was unaffected. Cells irradiated during late G(1) or the first 0.8 hr of S were not affected either in time of initiation or duration of S. However, when cells 0.8 hr or more into S were irradiated, completion but not initiation of DNA synthesis was delayed, indicating a very precise separation of X-ray effects upon initiation and replication. There was no indication of a re-ordering of cells following irradiation and recovery, since cells in G(2) at the time of irradiation always divided before cells irradiated in S. The results suggest that two separate functions required for initiation and continued replication of DNA may be differentially sensitive to X-irradiation.

Animals↗
PubMed1981

Reverse smooth muscle plasty: a new method of treating anorectal incontinence in infants with high anal and rectal atresia.

A new technique of treating anorectal incontinence in infants with high anal and rectal atresia is described. In the first stage of this new operation an abdominosacroperineal pull-through procedure according to Rehbein, Romualdi, and Kiesewetter is performed. In the next step of this new method the circular and longitudinal muscle layers of the pulled-through colon are turned back 180 degree and fixed to the pulled-through bowel. The mucosa of the turned back bowel is removed. Then the whole muscle cuff is re-pulled into the puborectalis sling. Pressure studies as well as X-ray investigations showed a good sphincter function of the newly established internal sphincter equivalent.

Anal Canal↗