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1.
Aliment Pharmacol Ther ; 41(4): 360-7, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25523288

RESUMO

BACKGROUND: Pyloric pressure and compliance have never been investigated in health nor gastroparesis. AIM: We hypothesised that pyloric pressure and/or compliance may be altered in gastroparesis. METHODS: Fasting pyloric pressure and compliance were investigated in 21 healthy volunteers (HV), 27 gastroparetic patients (GP) and 5 patients who had undergone oesophagectomy without pyloroplasty as positive controls. Under videofluoroscopic control, pyloric compliance and pressure were measured by the EndoFLIP technique. Gastric emptying half time (T1/2 ) using (13) C-octanoic acid breath test, as well as symptoms and quality of life (GIQLI score) were also monitored. RESULTS: Mean fasting pyloric compliance was measured at 25.2 ± 2.4 mm²/mmHg in HV, and was lower both in GP (16.9 ± 2.1 mm²/mmHg; P < 0.05) and patients with oesophagectomy (10.9 ± 2.9 mm²/mmHg; P < 0.05). By contrast, fasting pyloric pressure was not different among groups. Fasting pyloric compliance and pressure correlated with T1/2 in GP (R = -0.43; P = 0.04). Fasting pyloric compliance, but not pressure, correlated with symptoms and GIQLI score. Pyloric dilation in 10 GP with low fasting pyloric compliance (<10 mm²/mmHg) increased compliance from 7.4 ± 0.4 to 20.1 ± 4.9 mm²/mmHg (P < 0.01) and improved the GIQLI score from 72.5 ± 5.5 to 89.3 ± 6.1 (P = 0.04). CONCLUSION: This prospective study assessed pyloric compliance for the first time, and showed that fasting pyloric compliance is decreased in gastroparetic patients and is associated with T1/2 , symptoms and quality of life. This suggests that pyloric compliance may be a new relevant metric in gastroparetic patients, and may be useful to target patients for pyloric dilation or botulinum toxin injection.


Assuntos
Dilatação/métodos , Jejum/fisiologia , Esvaziamento Gástrico/fisiologia , Gastroparesia/fisiopatologia , Piloro/fisiopatologia , Adulto , Testes Respiratórios , Caprilatos/análise , Esofagectomia , Feminino , Gastroparesia/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida
2.
Colorectal Dis ; 14(3): 342-8, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21689287

RESUMO

AIM: Rectal hypercontractility can lead to faecal incontinence (FI). Botulinum toxin (BT) has been used successfully for the treatment of bladder overactivity. This study aimed to evaluate the therapeutic value of intrarectal injections of BT in inhibiting colorectal contractions and relieving FI in patients suffering from FI as a result of overactive rectal contractions. METHOD: A prospective open study was carried out in Rouen University Hospital. Six patients (four men and two women) with severe FI related to overactive rectal contractions underwent intrarectal submucosal injections of BT placed in three rows of 10, 1-ml injections (50 U/1 ml; Dysport(®)) starting 1 cm above the dentate line and repeated twice, at intervals of 5 cm proximally. The end-points included improvement in the FI score, in faecal incontinence quality of life (FIQL) and of manometric abnormality. RESULTS: All patients reported improvement in the FI score [18.2±1.1 at baseline vs 9.0±1.7 at 3 months (P=0.04)] and in FIQL. Rectal contractile activity was reduced. The frequency of contractions remained unaffected (28.1±6.6/h; P=0.46 vs baseline). High-amplitude contractions of >50 cmH(2)O were significantly decreased in all patients (16.6±3.9 vs 6.6±4.1/h; P=0.03). CONCLUSION: Patients with an 'overactive rectum' are a heterogeneous group, with varying causes of dysfunction. The dose of BT used was arbitrarily selected. Nevertheless, the study introduces a further therapeutic option in the treatment of FI caused by rectal overactivity.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Incontinência Fecal/tratamento farmacológico , Fármacos Neuromusculares/uso terapêutico , Reto/fisiopatologia , Adulto , Idoso , Incontinência Fecal/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Sigmoidoscopia , Resultado do Tratamento
3.
Gynecol Obstet Fertil ; 35(12): 1257-63, 2007 Dec.
Artigo em Francês | MEDLINE | ID: mdl-18035577

RESUMO

Pelvic floor abnormalities often impact significantly the quality of life and result in a variety of symptoms, including chronic pelvic pain, fecal incontinence, and obstructed constipation. Fluoroscopic defecography and MR defecography enable identification of rectocele, rectal prolapse, enterocele, sigmoidocele with high prevalence in female patients with obstructed constipation, fecal incontinence, and chronic pelvic pain. In this manuscript, we describe the techniques and indications of the two techniques of defecography. We discuss the abnormalities of the posterior pelvic floor compartment at the origin of constipation, incontinence, chronic pelvic pain. Finally we compare the data obtained by clinical examination and defecography, remembering that 50% of enterocele and 100% of sigmoidocele are missed at clinical examination.


Assuntos
Constipação Intestinal/etiologia , Defecografia/métodos , Incontinência Fecal/etiologia , Diafragma da Pelve/anormalidades , Diafragma da Pelve/cirurgia , Dor Pélvica/etiologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Qualidade de Vida , Retocele
4.
Scand J Gastroenterol ; 37(12): 1411-6, 2002 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-12523590

RESUMO

BACKGROUND: The purpose of this study was to compare the manometric assessment of straining effort as if to defecate and rectoanal inhibitory reflex obtained with a rectosphincteric balloon probe and with a water-perfused catheter in the same subject. METHODS: Twelve healthy volunteers underwent two manometric assessments of anal sphincter function and electromyographic (EMG) surface recordings. one with a rectosphincteric balloon and one with a water-perfused catheter, 7 days apart in random order. RESULTS: Increased EMG activity in the external anal sphincter in the midst of the rectoanal inhibitory reflex (P < 0.001) and during straining for defecation (P < 0.001) was more frequently observed with the perfused system than with the balloon probe. There was a discrepancy between the EMG activity of the external anal sphincter and the anal pressures during straining recorded with the perfused system. Duration of the reflex elicited by rectal distension with 10 and 20 ml of air was significantly greater with the rectosphincteric balloon than with the perfused catheter (P = 0.02 and P = 0.05, respectively). CONCLUSION: Water instilled in the anal canal by the perfused system induces artifacts in EMG recording and active anal contractions. These artifacts and induced contractions could lead to an erroneous diagnosis of anismus, particularly if pelvic floor EMG is only taken into account for the diagnosis of anismus.


Assuntos
Canal Anal/fisiologia , Doenças do Ânus/diagnóstico , Constipação Intestinal/fisiopatologia , Defecação/fisiologia , Adulto , Artefatos , Cateterismo , Eletromiografia , Feminino , Humanos , Masculino , Manometria , Reflexo/fisiologia , Água
5.
Neurogastroenterol Motil ; 12(2): 149-54, 2000 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-10771496

RESUMO

The aim of this study was to determine whether the colonic motor profile of seven patients with constipation secondary to antidepressants differed from the motility of seven patients with idiopathic constipation and seven healthy volunteers. All constipated patients had very severe constipation. Colonic manometric recordings were performed for 24 h. The number of high amplitude propagating contractions (HAPC) was lower in the two groups of constipated patients than in controls. No HAPC were observed in 5/7 patients with constipation secondary to antidepressants and in 1/7 patients with idiopathic constipation. The overall area under the curve (AUC) in the left colon was lower in the two constipated patient groups than in controls. AUC increased after a 1000-kcal standard meal given at noon in controls but not in the two groups of constipated patients. In conclusion, in patients with constipation secondary to antidepressants, the overall AUC was as poor as in patients with idiopathic constipation, and no colonic response to eating was observed. Moreover, the number of HAPC was more markedly decreased in patients with constipation secondary to antidepressants than in patients with idiopathic constipation.


Assuntos
Antidepressivos/efeitos adversos , Constipação Intestinal/induzido quimicamente , Transtorno Depressivo/tratamento farmacológico , Motilidade Gastrointestinal/efeitos dos fármacos , Adulto , Amitriptilina/efeitos adversos , Amitriptilina/farmacologia , Amitriptilina/uso terapêutico , Antidepressivos/farmacologia , Antidepressivos/uso terapêutico , Transtornos de Ansiedade/complicações , Catárticos/uso terapêutico , Antagonistas Colinérgicos/efeitos adversos , Antagonistas Colinérgicos/farmacologia , Antagonistas Colinérgicos/uso terapêutico , Clomipramina/efeitos adversos , Clomipramina/farmacologia , Clomipramina/uso terapêutico , Colo/efeitos dos fármacos , Colo/fisiopatologia , Colonoscopia , Constipação Intestinal/tratamento farmacológico , Constipação Intestinal/fisiopatologia , Transtorno Depressivo/complicações , Ingestão de Alimentos , Impacção Fecal/induzido quimicamente , Impacção Fecal/tratamento farmacológico , Impacção Fecal/fisiopatologia , Feminino , Humanos , Masculino , Manometria , Maprotilina/efeitos adversos , Maprotilina/farmacologia , Maprotilina/uso terapêutico , Pessoa de Meia-Idade , Transtornos do Humor/complicações , Contração Muscular , Paroxetina/efeitos adversos , Paroxetina/farmacologia , Paroxetina/uso terapêutico , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Inibidores Seletivos de Recaptação de Serotonina/farmacologia , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Tiazepinas/efeitos adversos , Tiazepinas/farmacologia , Tiazepinas/uso terapêutico , Viloxazina/efeitos adversos , Viloxazina/farmacologia , Viloxazina/uso terapêutico
6.
Neurourol Urodyn ; 18(6): 579-90, 1999.
Artigo em Inglês | MEDLINE | ID: mdl-10529706

RESUMO

A clinical questionnaire concerning anorectal symptoms and urodynamic tests was used to investigate 409 women consulting for stress urinary incontinence. To compare urodynamic data, patients were divided into three groups of women who had either stress urinary incontinence associated with incontinence for formed and/or liquid stools or with gas incontinence, or isolated stress urinary incontinence. To take in account the patients'age for data interpretation, a Mantel-Haenszel test or covariate analysis was performed. Anal incontinence was reported in 114 (28%) of the 409 women investigated. The prevalence of incontinence for gas only, for liquid, or for solid stools was 18.3, 9.3, and 1%, respectively. The duration of gas incontinence was longer than that of fecal incontinence or stress urinary incontinence. Difficult defecation was more frequently observed in patients with double incontinence than in patients with only stress urinary incontinence, and the difference was significant between patients with gas incontinence and patients with stress urinary incontinence (53% versus 37%, P = 0. 03). There was no difference in the number of bowel movements per week among the three groups of patients. The number of vaginal deliveries was surprisingly lower in patients with fecal incontinence associated with urinary incontinence than in others. There was no urodynamic feature that could distinguish patients with urinary incontinence and patients with double incontinence. This study confirmed the close relationship between anal and stress urinary incontinence. Neurourol. Urodynam. 18:579-590, 1999.


Assuntos
Incontinência Fecal/complicações , Incontinência Urinária por Estresse/complicações , Urodinâmica , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Incontinência Fecal/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Incontinência Urinária por Estresse/fisiopatologia
7.
Eur J Gastroenterol Hepatol ; 11(9): 1045-7, 1999 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-10503845

RESUMO

OBJECTIVE: To evaluate the manometric and clinical efficacies of electrostimulation to treat anal incontinence. PATIENTS AND METHODS: Thirty-three women suffering from anal incontinence self-administered anal electrostimulation twice daily for 15-min intervals for 4 months. RESULTS: After 4 months, the incontinence score decreased from 10.4+/-0.5 to 7.1+/-0.8 (P<0.001) but all patients except two remained incontinent The decrease in the incontinence score was more marked in patients receiving medical treatment for an associated bowel disorder, than in patients treated by electrostimulation alone. Anal resting pressures and the amplitude of voluntary anal contractions did not increase after 4 months. CONCLUSION: Electrostimulation decreased the incontinence score but all patients except two remained incontinent after 4 months, suggesting that electrostimulation is not a clinically effective treatment of anal incontinence.


Assuntos
Terapia por Estimulação Elétrica , Incontinência Fecal/terapia , Canal Anal , Feminino , Seguimentos , Humanos
8.
Dis Colon Rectum ; 42(6): 762-9, 1999 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-10378600

RESUMO

PURPOSE: It has been suggested that the severity of fecal incontinence, the presence of pudendal neuropathy, or an external anal sphincter defect does not preclude clinical improvement with biofeedback therapy. A discrepancy, however, is frequently found between subjective improvement and objective results after biofeedback therapy. Our aim was to assess whether severity of fecal incontinence, presence of pudendal neuropathy, or an external anal sphincter defect could influence the results of manometric parameters after biofeedback therapy in patients with fecal incontinence. METHODS: Biofeedback therapy was used to treat 27 patients with fecal incontinence (25 women; mean age, 53; range, 29-74 years), according to a strict protocol. Manometry, pudendal nerve terminal motor latency, and anal ultrasound were performed in all patients before biofeedback therapy. Manometric evaluation of external anal sphincter function was performed after the biofeedback sessions. RESULTS: Eight of 27 patients had a good clinical response to biofeedback, but with no significant difference in their mean amplitude and duration of squeeze pressure before and after biofeedback. There was no relationship between the clinical results of biofeedback therapy and the initial severity of fecal incontinence, pudendal neuropathy, or external sphincter defect. Patients with severe incontinence (incontinence to solids) and pudendal neuropathy failed to improve the amplitude and duration of their maximum voluntary contraction after biofeedback therapy. Patients with mild fecal incontinence (incontinence to flatus, liquids, or both) (P<0.04), without pudendal neuropathy (P<0.02), or with (P<0.05) and without (P<0.05) external sphincter defect improved their external anal sphincter function after biofeedback therapy. CONCLUSION: In patients with fecal incontinence, the severity of symptoms and pudendal neuropathy should be considered as two factors of poor prognosis of favorable manometric results after biofeedback therapy. Improvement, on the other hand, may be expected after biofeedback therapy despite an external anal sphincter defect.


Assuntos
Canal Anal/fisiopatologia , Biorretroalimentação Psicológica , Incontinência Fecal/terapia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Incontinência Fecal/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diafragma da Pelve/inervação , Nervos Periféricos/fisiopatologia , Índice de Gravidade de Doença
9.
Neurogastroenterol Motil ; 9(1): 13-8, 1997 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-9058387

RESUMO

We report four cases of difficult defaecation and/or faecal incontinence revealing a neurologic disease. These anorectal symptoms were associated with urinary disorders, but urinary symptoms always appeared several years after anorectal complaints. Clinical neurologic examination immediately led us to suspect a neurologic aetiology in two patients with the following signs: perineal hypoesthesia, absence of voluntary anal contraction and anal reflexes in one subject (final diagnosis: L1 neurinoma), and in the other a weakness in both thighs with absent tendon reflexes in the four limbs (final diagnosis: amiodarone neuropathy). In the two other patients with multiple cerebral infarction or multiple system atrophy, the neurologic aetiology was suspected on the absence of anal voluntary contraction contrasting with a normal perineal anatomy, but the final diagnosis was made only two years later when orthostatic arterial hypotension occurred.


Assuntos
Constipação Intestinal/etiologia , Incontinência Fecal/etiologia , Doenças do Sistema Nervoso/fisiopatologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
10.
Int J Colorectal Dis ; 12(6): 335-9, 1997.
Artigo em Inglês | MEDLINE | ID: mdl-9457526

RESUMO

The aim of this study was to assess the reliability of cortical evoked potentials after electrical stimulation of the anal canal. Cortical evoked potentials were recorded on 243 patients presenting with perineal pain (28 patients), impotence (55 patients), anal incontinence (52 patients), urinary continence (30 patients), constipation (49 patients), and on 29 neurological patients, by stimulating the external anal sphincter and penis (or clitoris). The inter- and intra-observer reproducibility was studied by coding recordings interpreted by three different observers on two separate occasions. The influence of recording characteristics and clinical data were assessed. To study operator dependence, five operators investigated the patients. Only one of them was well trained in this technique. The interpretation of the coded curves by the observers was poorly reproducible in about 15% of cases, depending on time between the two readings and the quality of recordings. The interpretation of cerebral responses after anal stimulation were observer-dependent and influenced by the knowledge of clinical data. This was also observed with cortical evoked potentials after electrical stimulation of the penis or clitoris, but to a lesser extent. The cerebral evoked potentials method was also operator-dependent, mainly after anal stimulation. When a study of cortical evoked potentials by perineal stimulation is needed in clinical practice, it seems logical to prefer cortical evoked potentials by penile or clitoral stimulation as they seem easier to obtain than those evoked by anal stimulation if the investigators are not well trained for the performance of electrophysiological studies as the former are much less operator- and observer-dependent.


Assuntos
Canal Anal/inervação , Potenciais Evocados , Adulto , Idoso , Idoso de 80 Anos ou mais , Clitóris/inervação , Estimulação Elétrica , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Pênis/inervação , Reprodutibilidade dos Testes
11.
Eur J Gastroenterol Hepatol ; 7(1): 75-9, 1995 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-7866816

RESUMO

OBJECTIVE: To determine (1) whether patients complaining of straining at stool have pelvic floor descent and anal abnormalities similar to those of patients with anal incontinence and (2) whether these patients are prone to develop anal incontinence. METHODS: To answer the first question we used defecography to study perineal floor position at rest, during maximal contraction of the anal sphincter and during straining, and we performed anorectal manometry in 46 women with straining at stool but without anal incontinence at the beginning of the study, and in 46 women with idiopathic anal incontinence, matched for age. To answer the second question, we performed a 5-year follow-up study to determine whether anal incontinence had developed in those women with straining at stool. RESULTS: Perineal floor position at rest, during maximal contraction of the sphincter and during straining, resting pressure in the upper part of the anal canal, maximal amplitude and duration of the voluntary contraction were similar in the 46 women with straining at stool and the 46 women with idiopathic anal incontinence. In the follow-up study, 24 of the 46 women with straining at stool were contacted. The incidence of anal incontinence after 5 years was higher among these 24 women than in a control group of 20 women (13 out of 24 versus three out of 20, for women with straining at stool versus controls respectively; P < 0.01). The 13 patients with straining at stool who became incontinent had, at the initial investigation, a lower maximal amplitude of voluntary contraction, greater perineal descent at rest and less elevation of the pelvic floor during maximal contraction of the anal sphincter than the other women (P < 0.05). CONCLUSION: Women with chronic straining at stool have perineal descent at rest and during straining similar to that of incontinent women. Women with chronic straining are also prone to develop anal incontinence, suggesting that perineal descent at defecography in women with straining at stool may predict future anal incontinence.


Assuntos
Defecação , Incontinência Fecal/diagnóstico por imagem , Períneo/diagnóstico por imagem , Idoso , Canal Anal/fisiopatologia , Incontinência Fecal/diagnóstico , Incontinência Fecal/fisiopatologia , Feminino , Humanos , Manometria , Pessoa de Meia-Idade , Períneo/fisiopatologia , Valor Preditivo dos Testes , Radiografia , Reto/fisiopatologia
12.
Gastroenterol Clin Biol ; 17(2): 116-20, 1993.
Artigo em Francês | MEDLINE | ID: mdl-8500698

RESUMO

The aim of this study was to evaluate clinical symptoms, disease past-history, and parameters of anorectal manometry, defecography, and radiopaque pellet transit time in anal incontinence by multivariate analysis. We studied 76 patients, 68 women and 8 men, who complained of anal incontinence, excluding that due to obstetrical lesions. All patients were asked to complete a standard questionnaire. Results indicated that: a) hemorrhoidectomy, hysterectomy, and cholecystectomy appeared to play a role, b) daily incontinence for air or liquid stools is more frequent after hemorrhoidectomy, c) decreased resting pressure of the upper part of the anal canal was observed mainly after hysterectomy, d) decreased resting pressure of the upper part of the anal canal could be a factor of poor prognosis after treatment, e) anal incontinence in men was secondary to traumatic lesions of the anal sphincter in 7 of 8 cases.


Assuntos
Incontinência Fecal/fisiopatologia , Trânsito Gastrointestinal/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colecistectomia/efeitos adversos , Incontinência Fecal/diagnóstico por imagem , Incontinência Fecal/etiologia , Feminino , Humanos , Histerectomia/efeitos adversos , Masculino , Manometria , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Radiografia
14.
Dis Colon Rectum ; 35(9): 847-9, 1992 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-1511644

RESUMO

The aim of this work was to analyze clinical symptoms in light of anorectal manometry results. We compared the frequency of clinical symptoms in relation with the presence or absence of functional anomalies. Using this methodology, the following relationships may be suggested: the need to wear a pad, with a decreased resting pressure at the upper part of the anal canal; the inability to delay rectal evacuation, with decreased anal voluntary contraction; interference of incontinence with social activities, with decreased duration of anal voluntary contraction; urinary symptoms, with an increased threshold volume of rectal distention needed to elicit the rectoanal inhibitory reflex; and complete rectal prolapse, with reduced length of the anal canal.


Assuntos
Canal Anal/fisiopatologia , Incontinência Fecal/fisiopatologia , Reto/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Incontinência Fecal/psicologia , Incontinência Fecal/reabilitação , Humanos , Tampões Absorventes para a Incontinência Urinária , Relações Interpessoais , Masculino , Manometria , Pessoa de Meia-Idade
15.
Gastroenterol Clin Biol ; 16(6-7): 552-7, 1992.
Artigo em Francês | MEDLINE | ID: mdl-1526417

RESUMO

Our aim was to assess the efficacy of photodynamic therapy in inoperable patients with small esophageal carcinoma. Eleven patients were treated for squamous cell carcinomas ranging in size from 1 to 3 cm2. Hematoporphyrin (between 3 and 5 mg/kg) was injected intravenously and then the tumor irradiated at endoscopy 72 hours later with a dye laser (630 nm) at an energy of 250 joules/cm2. Complete destruction of the lesion was obtained in 6 cases with negative biopsies at 1 month. In all 6 patients, no recurrence was seen after a median follow-up of 4 months (range: 2-38). Partial destruction of the tumor was obtained in 4 cases while treatment was a complete failure in the last patient. Two instances of mild cutaneous photosensitization occurred. Two patients treated for recurrence after radiotherapy, died of esophageal perforation directly related to the procedure. Photodynamic therapy appears to be a possible effective treatment for esophageal squamous cell carcinoma in inoperable patients when other curative treatment modalities are not possible.


Assuntos
Carcinoma de Células Escamosas/tratamento farmacológico , Neoplasias Esofágicas/tratamento farmacológico , Fotorradiação com Hematoporfirina/métodos , Terapia a Laser , Idoso , Carcinoma de Células Escamosas/mortalidade , Neoplasias Esofágicas/mortalidade , Seguimentos , Fotorradiação com Hematoporfirina/efeitos adversos , Fotorradiação com Hematoporfirina/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos Prospectivos
16.
Dis Colon Rectum ; 34(5): 409-15, 1991 May.
Artigo em Inglês | MEDLINE | ID: mdl-2022148

RESUMO

Six patients with complete transection of the spinal cord and six healthy volunteers were examined by using anorectal manometry together with electromyographic (EMG) recording of the external anal sphincter composed of striated muscle. Anal pressure and EMG activity of the external anal sphincter were continuously recorded at rest and during gradual rectal distention (10, 20, 30, 40, and 50 ml) by means of an air-filled balloon eliciting a rectoanal inhibitory reflex (RAIR) at the upper part, and an inflation reflex (IR) at the lower part of the anal canal. All patients and controls had a RAIR for each rectal distention volume. A relationship between the duration of the RAIR and the rectal distention volume was present in controls only. In controls the IR was present for each rectal distention volume, whereas it was present in only one patient for a 40-ml volume. During the resting period, all controls showed continuous tonic EMG activity of the external anal sphincter, but after 30 minutes all the patients showed a decrease and ultimately in five cases a disappearance of the tonic EMG activity of the external anal sphincter. In spinal patients, the presence or absence of EMG activity of the external anal sphincter did not modify the anal canal pressure. These results indicate that: 1) the tonic EMG activity of the external anal sphincter seems to be under the control of supraspinal structures, because in spinal patients it disappears in the absence of sensitive inputs toward the spinal cord; 2) the absence of EMG activity at rest indicates that the external anal sphincter is not implicated in the RAIR disturbances observed in spinal patients; 3) the IR is not a spinal reflex but is under voluntary control, because it is not present in spinal humans; 4) in spinal humans the tonic EMG activity of the external anal sphincter does not play a role in the maintenance of the anal pressure at rest.


Assuntos
Canal Anal/fisiopatologia , Reto/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologia , Adolescente , Adulto , Eletromiografia , Feminino , Humanos , Masculino , Manometria , Pressão , Reflexo Anormal , Análise de Regressão
19.
Int J Colorectal Dis ; 3(1): 53-8, 1988 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-3361225

RESUMO

The aim of this study was to assess (a) the incidence of perineal descent and (b) the relationship between radiological abnormalities of the pelvic floor and rectoanal manometric disturbances in patients consulting for constipation. Lateral radiographs in both the left lateral and supine positions studied pelvic floor descent. Results obtained in the 25 patients (mean age 47 years) studied were compared with those of 12 controls (mean age 58 years). Pelvic floor descent, never seen in controls, was demonstrated in 14 patients who were older (53 +/- 3 years, mean +/- SD) than the 11 with a normal radiological examination (38 +/- 3 years, p less than 0.05). Anal low pressures (3 cases) and a low amplitude of rectoanal inhibitory reflex (RAIR) (5 cases) were shown only in patients with perineal descent and anal high pressures only in those with normal radiology. Our results suggest that (a) perineal descent is a common finding in over 50% of constipated patients and (b) anorectal motility is related to pelvic floor function.


Assuntos
Canal Anal/fisiopatologia , Constipação Intestinal/fisiopatologia , Pelve/diagnóstico por imagem , Reto/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Canal Anal/diagnóstico por imagem , Constipação Intestinal/diagnóstico por imagem , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Pelve/fisiopatologia , Pressão , Radiografia , Reto/diagnóstico por imagem
20.
Gastroenterol Clin Biol ; 12(3): 198-201, 1988 Mar.
Artigo em Francês | MEDLINE | ID: mdl-3371595

RESUMO

Two patients with acute colectasia, and acute urinary retention following pregnancy (case n. 1) and Klebsiellae septicemia (case n. 2) requiring endoscopic exsufflation in both cases, were seen. At onset, both patients had esophageal and anorectal manometric abnormalities with right colonic transit delay, and in case n. 2 urodynamic perturbation. Several months later, abnormalities disappeared in case 1, but remained unchanged in case 2. Jejunal manometry performed in case 2 showed decreased interdigestive complex frequency. These data suggest that: 1) acute colectasia may be major expression of digestive and urinary motility disorders, 2) acute colectasia can be the first symptom of a chronic disease, suggesting the usefulness of manometric studies in these patients, once the acute episode is over.


Assuntos
Pseudo-Obstrução do Colo/complicações , Sistema Digestório/fisiopatologia , Motilidade Gastrointestinal , Pseudo-Obstrução Intestinal/complicações , Doenças da Bexiga Urinária/fisiopatologia , Bexiga Urinária/fisiopatologia , Adulto , Doenças do Sistema Digestório/complicações , Doenças do Sistema Digestório/fisiopatologia , Esôfago/fisiopatologia , Feminino , Humanos , Doenças da Bexiga Urinária/complicações , Urodinâmica
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