The cavernoso-anal reflex: response of the anal sphincters to cavernosus muscles' stimulation / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To prove the hypothesis that cavernosus muscles' contraction during coitus affects the reflex contraction of anal sphincters.</p><p><b>METHODS</b>Electromyographic response of external and internal anal sphincters to ischiocavernosus and bulbocavernosus muscle stimulation was studied in 17 healthy volunteers (10 men, 7 women, mean aged 38.3+/-11.6 years). The test was repeated after individual anesthetization of anal sphincters and the two cavernosus muscles, and after using saline instead of lidocaine.</p><p><b>RESULTS</b>Upon stimulation of each of the two cavernosus muscles, external and internal anal sphincters recorded increased electromyographic activity. Anal sphincters did not respond to stimulation of the anesthetized cavernosus muscles nor did anesthetized anal sphincters respond to cavernosus muscles' stimulation. Saline infiltration did not affect anal sphincteric response to cavernosal muscles' stimulation.</p><p><b>CONCLUSION</b>Cavernosus muscles' contraction is suggested to evoke anal sphincteric contraction, which seems to be a reflex and mediated through the "Cavernoso-anal reflex". Anal sphincteric contraction during coitus presumably acts to close the anal canal to thwart flatus or fecal leak.</p>

Haemagel 4% versus hydroxyethyl starch 6%: effect on blood coagulation, hemostasis, renal functions and platelet aggregation in patients undergoing major abdominal surgery

Background: Hydroxyethyl starch [HES] and Haemagel [Gelatin] may affect blood coagulation, platelet aggregation and renal functions. Our aim is to select which of them is better when given in large doses [> 20 mg/kg] for replacement of losses in patients undergoing major abdominal surgery

Methods: Patients were allocated randomly to receive Haemagel 4% [n=20], or HES 6% [Hestril] [n=20]. The infusion was started after induction of anesthesia and continued until the 1[st] postoperative day to maintain central venous pressure between 8 and 12 mmHg. Prothrombin concentration, thrombin time, platelet count and activated partial thromboplastin time for coagulation assessment, platelet aggregation for platelet function and creatinine clearance for renal function. Measurements were performed after induction of anesthesia [T0], 2 hours intraoperatively [T1], at the end of surgery [T2], 6 hours after surgery [T3] and on the morning, of postoperative day after surgery [T4]

Results: Significantly more HES 6% than Haemagel 4% was given. Blood loss was greatest in the HES group than Haemagel group. Coagulation measurements were significantly affected at the 2[nd] hour intraoperatively, end of surgery, 6 hours after surgery and on the first postoperative day in HES group than Haemagel group. Platelet aggregation was significantly inhibited in both groups compared to base line [T0]. In between groups platelet aggregation was significantly inhibited more in HES group compared to Haemagel group [p value < 0.05] at T1, T2, T3 and returned to near base line values at T4. Renal function investigated by creatinine clearance was significantly decreased in HES group compared to Haemagel group

Conclusion: HES 6% adversely affected measures of platelet function, coagulation parameters and renal functions significantly more compared to Haemagel 4% when given in large amounts [>20 ml/Kg] in patients undergoing major abdominal surgery. Beside the relative less cost of Haemgel compared to HES group. In conclusion the use of Haemagel colloid for blood loss replacement is safer and costs less than other available colloids