[Hemisensory impairment in neuropathic pain following chronic radiculopathy]. / Hemisensorische Störungen bei neuropathischen Schmerzen im Rahmen chronischer Nervenwurzelreizsyndrome.

BACKGROUND: Modern pathophysiological concepts indicate that the central nervous system is important for chronification of pain in cases of neuropathic pain. Taking these concepts into consideration, what significance then do those hemisensory disorders have that appear sporadically in cases of chronic nerve root irritation syndrome? RESULTS: The typical clinical findings are illustrated by two case reports. In addition to persistent neuropathic pain, both patients experienced hemisensory impairment of the entire side of the body ipsilateral to the radicular symptoms. Perception of sensitivity to touch, pain, and temperature was decreased on the entire side of the body in contrast to the contralateral side. CONCLUSION: Hemisensory impairment in patients with chronic nerve root irritation syndromes can indicate a functional disorder in dealing with noxious impulses in the ventral posterior nucleus of the thalamus. They represent a clinical correlative to subcortical neuroplasticity, which could explain the resistance to therapy in severe chronic pain syndromes.

[Endo-anal and transperineal continence preserving closure techniques in surgical treatment of Crohn fistulas. A prospective long-term study of 186 patients]. / Endoanale und transperineale kontinenzschonende Verschlusstechniken bei der chirurgischen Behandlung der Crohn-Fisteln: Eine prospektive Langzeitstudie bei 186 Patienten.

UNLABELLED: Our aim was to review the results and to investigate the prognosis in a prospective study of aggressive surgical treatment in 186 patients (59% women, 41% men, age 18 to 65 years) treated during the past 9 1/2 years by conventional laying open of the fistula (n = 71), endorectal advancement flap repair (n = 89) and by fistulectomy without internal sphincterotomy (n = 37). 54 (29%) patients had intersphincteric, 57 (30.5%) transsphincteric, 10 (5.5%) suprasphincteric, 37 (20%) low rectovaginal and 28 (15%) had complex fistulas without internal opening. Four sphincter saving techniques were performed by the high and fistulas (n = 89) with primary occlusion of the intraanal ostium and endorectal mucosal flap (n = 29), endorectal advancement flap (n = 41), anodermal flap (n = 8) and transperineal repair with levator interposition (n = 11). Postoperatively 18 cases (20.2%) of suture leakage occurred, 27% in the mucosal flap group, 17.6% in the advancement flap group, 12.5% in the anodermal group, and 27% in the transperineal group. A complete primary healing of perianal wounds was noted in 73% of the patients within 6 months. The presence of rectal disease (n = 77) did not adversely influence the rate and duration of healing. Persistent or recurrent fistula occurs in 29 patients (15.6%), 22% in the sphincter saving group, 4% in the intersphincteric group and 32% in the complex type of fistulas. Disturbance of continence was observed in 9 patients (4.8%). Postoperatively, there was no significant change in resting anal pressure and maximum voluntary conctraction pressure in any fistula group (n = 104). CONCLUSION: The presented clinical and functional long term results of patients with Crohn's fistulas underline the importance of experience in the treatment of perianal fistula disease. A successful treatment depends primarily on an aggressive therapeutic strategy and the appropriate method of operation.

[What is the role of the pubococcygeal and puborectal muscles in patients with obstructive defecation disorders? An electromyography study]. / Welche Rolle spielen der M. pubococcygeus und M. puborectalis bei Patienten mit obstruktiven Defäkationsstörungen? Eine elektromyographische Studie.

BACKGROUND: We believe that the M. levator ani plays little or no role in obstructed defaecation, and that the concept of "paradoxical" puborectalis muscle activity is misleading. The main aim of the study was to investigate the function of the pubococcygeal muscle during simulated defaecation and to compare this with the electromyographic activity of the puborectal muscle. METHODS AND RESULTS: In a prospective electromyographic study of 18 women (average age 53 years) with obstructive defecation disorder the activity of the pubococcygeal muscle and the puborectal muscle was investigated at rest, during contraction and straining. The control group consisted of 18 healthy women with an average age of 54 years. The function of the pubococcygeal muscle and the puborectal muscle was largely the same in both, study and control group. No statistically significant differences in the amplitude were found between the two groups at rest during contraction and maximum strain. CONCLUSION: We therefore conclude that the increase in activity of the voluntary muscle of the pelvic floor observed on electromyography during defaecation does not indicate automatically a pathologic condition but is a possible functional state at this moment.

[Endorectal advancement flap-plasty vs. transperineal closure in surgical treatment of rectovaginal fistulas. A prospective long-term study of 88 patients]. / Endorectale Verschiebelappenplastik vs. transperinealer Verschluss bei der chirurgischen Behandlung der rectovaginalen Fisteln. Eine prospektive Langzeitstudie bei 88 Patientinnen.

UNLABELLED: A prospective study was carried out on 88 patients with rectovaginal fistulae to evaluate the value of two sphincter-saving techniques: primary occlusion of the intraanal ostium and endorectal advancement flap (n = 37) or transperineal repair with levator interposition (n = 34). Causes were Crohn's disease 35, obstetric injury 31, proctological-gynecological operation 11, cryptoglandular 11. Perineal group: 11 patients underwent concomitant anterior sphincter plication. Crohn group (n = 35): endorectal advancement flap was performed in 8 patients only, and 10 with intra- or supraanal stenosis were treated by transperineal approach, 12 (34%) with extended perianal fistula complaints required primary proctectomy, and operative therapy was not possible in 5 with persistent rectal inflammation. No deaths occurred. Postoperatively 12 cases (17%) of suture leakage occurred (flap group (FG): 16.2%, transperineal group (TPG): 17.6%). Persistent or recurrent fistula occurred in 8 patients (11%), 5.4% FG, 17.6% TPG. Disturbance of continence was observed in one patient after endorectal approach. Postoperatively there were no significant changes in the resting anal pressure and maximum voluntary contraction pressure. A complete primary healing with no further recurrence (follow-up 3 months to 9.5 years) was noted in 78.4% FG and 64.7% TPG. One patient with postoperative incontinence after the endorectal flap, had undergone anterior levator plication with perineal body reconstruction. CONCLUSIONS: Endorectal advancement flap allows preservation of the sphincter and is an effective method for repair of rectovaginal fistulae. The endorectal advancement flap proved to result in a better primary healing rate with 85% than the mucosal advancement flap with 65%. Perineal procedures are indicated in selected patients with simultaneous sphincter plication and in Crohn's fistulae associated to intra- or supraanal stenosis.

[Long-term follow-up of Parks posterior repair. An electromyographic, manometric and radiologic study of 31 patients]. / Langzeitergebnisse der posterioren Raffung nach Parks. Eine elektromyographische, manometrische und radiologische Studie bei 31 Patienten.

This study was carried out to document the long-term results of postanal repair for idiopathic faecal incontinence. Thirty-one patients (mean age 65.6 years) were followed up for 2-7.5 years (median 4.2 years). Continence was improved in 16 (52%) patients, only 2 (6%) of whom regained normal continence. No significant change in resting and pressure, maximum squeeze pressure, pelvic descent or anorectal angle was seen postoperatively. The electromyographical signs, e.g. duration and amplitude of action potentials, average amplitude, and integrals of the curves did not change significantly after the operation. The mean right pudendal nerve terminal motor latency (PNTML) increased from 2.38 ms before to 2.59 ms after surgery (P > 0.05). No significant change in the continence and defaecation index was seen postoperatively.

[Surgical therapy of rectal prolapse using rectopexy and resection. Effect of resection treatment on postoperative constipation and sphincter muscle function--a follow-up study of 112 patients]. / Chirurgische Therapie des Rectumprolapses mittels Rectopexie und Resektion. Einfluss der Resektionsbehandlung auf postoperative Obstipation und Schliessmuskelfunktion--eine Follow-up-Studie bei 112 Patienten.

Between 1985 and 1991, 112 patients underwent posterior abdominal rectopexy (n = 59 Ivalon sponge, n = 53 Vicryl-rectopexy) for complete rectal prolapse. The follow-up period was 3 months to 9 1/2 years. 25 patients with severe constipation and rectal prolapse were treated by rectopexy combined with colectomy (left colectomy n = 18, sigmoidectomy n = 3, ileo-sigmoidostomy n = 4). Left colectomy combined with Ivalon or Vicryl-rectopexy does not seem to increase operative and postoperative morbidity but tends to diminish constipation in 84% of patients. There were no complications attributable to bowel resection or anastomosis. Following abdominal rectopexy without resection constipation was reduced 7.5% only, the bowel function was unchanged in 69% and obstipation was improved after the operation in 23%. In the group of patients without evident constipation (n = 74) treated with synchrone resection has no benefit with regard to the new occurred constipation, recurrence prolapse and continence ability. Infection around the prosthesis developed in 1.5% in the resection group, and in 2.1% in the rectopexy alone group. The prolapse recurrence rate was 2.6%. Conclusion. Resection in conjunction with abdominal rectopexy tends to diminish postoperative constipation does not seem to increase operative morbidity, and is indicated in patients with constipation only.

[Electromyographic activity of the external anal sphincter muscle and the puborectal muscle in the defecation test in patients with obstructive defecation disorders]. / Elektromyographisches Aktivitätsverhalten des M. sphincter ani externus und M. puborectalis im Defäkationstest bei Patienten mit obstruktiven Entleerungsstörungen.

In a prospective electromyographic and manometric study on 23 women (average age 52 years) with obstructive defecation disorder the activity of the external anal sphincter muscle and the puborectal muscle was investigated at rest and during contraction and straining. The control group consisted of 22 healthy women with an average age of 53 years. The main aim of the study was to investigate the functioning of the two muscles during simulated defecation (maximum strain) and to examine any changes in the pressure ratio in the rectum and the anal canal during this stimulation. There were no significant differences in the resting pressure, the contraction pressure and the straining pressure (in the rectum and the anal canal) between the two groups. The functioning of the puborectal muscle and the external anal sphincter muscle was largely the same in both the study group and the control group. No statistically significant differences were found between the two groups except in the amplitude of contraction. When we tried to list the change in the activity of the muscle as an index of anism, we were not able to objectify such a change for either the external anal sphincter muscle or the puborectal muscle. We therefore conclude that the increase in the activity of the voluntary muscle of the pelvic floor observed on electromyography during defecation does not indicate a pathologic condition but is a functional state.