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Biomedical subjects

A F Engel

Publications and source records attributed to A F Engel.

30 records · Page 2Linked to original sources
PubMed1994

Civilian and war injuries of the perineum and anal sphincters.

Patients with pelvic and perineal non-obstetric trauma were studied to determine the clinical outcome in relation to faecal continence. Between 1980 and 1992, 65 patients were referred for post-traumatic assessment of the anal sphincters and continence mechanism. All patients were continent before trauma. Using clinical examination, manometry, concentric-needle electromyography and most recently anal endosonography, external sphincter defects were identified in 56 patients, of whom 52 underwent overlapping sphincter repair. The external sphincter was considered to be intact in nine patients. At a median follow-up of 12 months a good result (continence grades 1 and 2) was achieved in 36 of 52 patients and a poor outcome (continence grades 3 and 4) in ten; six patients were lost to follow-up. A good clinical result was associated with a significant increase in resting pressure (median increase 15 cmH2O; P = 0.017) and squeeze pressure (median increase 35 cmH2O; P = 0.001). At postoperative assessment three patients with a poor outcome were shown to have a second unsuspected contralateral sphincter defect that had not been repaired. Physiological and endosonographic investigation combined with late surgical repair leads to a good outcome in most patients with traumatic sphincter damage.

Adolescent↗
PubMed1994

Anterior anal sphincter repair in patients with obstetric trauma.

Anterior sphincter repair for faecal incontinence related to obstetric trauma was performed in 55 patients: 32 with incontinence after delivery and 23 with late onset. Anal endosonography and physiological tests were performed before and after surgery. After a median of 15 (range 6-36) months, 42 patients had improved, 11 had not improved and two were awaiting colostomy closure. The postoperative squeeze pressure was increased (by 20 versus 5 cmH2O, P = 0.05) and the external sphincter was more frequently intact (32 of 35 versus five of 11, P = 0.003) in those with a good outcome. Patients with an intact external sphincter had higher postoperative squeeze pressures (50 versus 20 cmH2O, P = 0.004). Patients with late-onset incontinence were older than those who developed incontinence soon after delivery (median 59 versus 32 years, P < 0.001) and had longer pudendal nerve terminal motor latencies (2.3 versus 2.1 ms, P = 0.03). Failure of repair is related to persistent external sphincter defects. Late-onset incontinence, even with a prolonged pudendal nerve terminal motor latency, does not preclude a good outcome.

Adult↗
PubMed1994

Secondary surgery after failed postanal or anterior sphincter repair.

Secondary surgery after failed postanal repair or anterior sphincter repair was performed in eight female patients. After failed postanal repair in five patients, anterior sphincter plication and levatorplasty was the secondary procedure. In two patients a defect of the anterior external sphincter was corrected and in two patients an extremely thin external sphincter was augmented. This contributed to an excellent result in three and a good result in one patient. No improvement was achieved in one patient without anterior defect. After failed anterior sphincter repair in three patients, postanal repair was the secondary procedure. A good result was obtained in one patient and failure in two. Secondary surgery failed postanal or anterior sphincter repair may have a good result in the majority of patients.

Adult↗
PubMed1994

The acute effect of straining on pelvic floor neurological function.

Integrity of sensory and motor function is essential in the maintenance of continence. The pudendal nerve assumes a central role being a mixed sensory and motor nerve. Neuropathic changes may therefore lead to incontinence and stretch injury to the pudendal nerve has been implicated as an aetiological factor. However pudendal neuropathy, altered anal sensation and perineal descent do not always correlate in the same patient. To investigate this further we evaluated the effect of a simulated defaecation strain on pelvic floor neurological function in a group of patients with constipation and incontinence. Pudendal nerve terminal motor latency (PNTML) and anal electrosensitivity (AS) were measured at rest and after a simulated defaecation strain of 1 minute. At rest PNTML correlated with AS (r = 0.461, P = 0.003). Twenty-five patients had perineal descent of more than 1 cm on straining, and 13 had descent below the ischial tuberosities. After 1 minute of straining AS was significantly (P < 0.001) blunted and PNTML was significantly (P < 0.001) prolonged both changes returning to normal after 3 minutes. AS was significantly (P = 0.01) more blunted in patients with perineal descent of more than 1 cm. PNTML was significantly (P = 0.01) more prolonged in patients with perineal descent of more than 2 cm. Age was significantly correlated with AS (r = 0.45, P = 0.004) and PNTML (r = 0.49, P = 0.002). Anal sensation and PNTML are acutely affected by defaecation straining, and changes may occur in patients without perineal descent. Functional changes occur equally in constipated and incontinent patients.

Adult↗
PubMed1994

Colour flow imaging of the normal short saphenous vein.

Colour flow imaging was used to assess the functional anatomy of the short saphenous vein (SSV) system in 104 limbs of 52 healthy volunteers. Previous studies have shown that the majority of pathological SSVs join the popliteal vein (PV) at the level of the knee. This was not the case in nearly half of the healthy limbs in this study. In these limbs the SSV retained its early embryonic function of providing venous return from the superficial system of the lower leg into veins of the upper leg and buttock. Is this a developmental safety valve?

Adult↗
PubMed1994

Progressive systemic sclerosis of the internal anal sphincter leading to passive faecal incontinence.

Two female patients aged 62 and 44 years with progressive systemic sclerosis and passive faecal incontinence are described. Both had the typical gut motility disorders of dysphagia, heartburn, and constipation. Anorectal physiology tests showed a low resting pressure in both and an absent rectoanal inhibitory reflex in one. In both patients anal endosonography showed a thin internal anal sphincter with changed reflectivity suggestive of fibrosis. In both patients anorectal sensation and pudendal nerve function were normal. Histological examination of the rectum in one patient showed collagenous replacement of the rectal muscularis propria with prominent atrophy of the musculature. This study suggests that the internal sphincter may be selectively affected by progressive systemic sclerosis, which may lead to passive faecal incontinence.

Adult↗
PubMed1994

Late results of anterior sphincter plication for traumatic faecal incontinence.

OBJECTIVE: To assess the long term clinical results of anterior sphincter plication for traumatic rupture of the anal sphincters. DESIGN: Retrospective study. SETTING: University hospital, The Netherlands. SUBJECTS: 28 consecutive patients with traumatic faecal incontinence after injury to the anal sphincters. MAIN OUTCOME MEASURES: Clinical outcome and its correlation with anorectal manometry. RESULTS: After a mean (SD) follow up of 50 (37) months 21 patients were classified grades 1 and 2 (satisfied) and seven patients were grades 3 and 4 (classified). There were significant differences after operation between the 21 patients in grades 1 and 2 compared with the 7 in grades 3 and 4 in median resting pressure (43 compared with 25 mmHg, p = 0.004, 95% CI 9 to 40), and squeeze pressure (100 compared with 40 mmHg, p = 0.001, 95% CI 15 to 80) but not in length of high pressure zone (3.5 compared with 2.3 cm, p = 0.14, 95% CI -0.2 to +2.2). (Mann Whitney U test was used.) CONCLUSION: Long term follow up of patients after anterior sphincter plication showed good results in three quarters of patients, and 57% were fully continent. Good postoperative results correlate with significant increases in resting and squeeze pressures.

Abdominal Muscles↗
PubMed1994

Late results of postanal repair for idiopathic faecal incontinence.

OBJECTIVE: To assess the long term clinical results of postanal repair for idiopathic faecal incontinence. DESIGN: Retrospective study. SETTING: University hospital, The Netherlands. SUBJECTS: 38 patients with idiopathic faecal incontinence. MAIN OUTCOME MEASURES: Clinical outcome and its correlation with anorectal manometry. RESULTS: After a median follow up of 43 months (15-126) 19 patients were classified grades 1 and 2 (satisfied) and 19 patients grades 3 and 4 (dissatisfied). Six patients deteriorated and went from grades 1 or 2 to grade 3 or 4. Satisfied patients had a significant rise in resting pressure (median 13.5 mmHg, p = 0.01, 95% CI 5 to 25) and dissatisfied patients did not. CONCLUSION: Long term follow up of patients after postanal repair shows that half the patients have a good result, although only 21% are fully continent. Long term follow up is necessary as a number of patients deteriorate.

Anal Canal↗
PubMed1991

[Injuries due to fireworks at the turn of the year 1990/'91].

During the festivities at the turn of the year 1990, 58 patients with firework-related injuries were seen. A 200% increase in relation to previous years was observed. Minor blast injuries of the hand were the most frequent. Many children of Turkish and Moroccan nationality were involved. It was surmised that illegal and unsafe fireworks in combination with careless behaviour were causative factors. Prevention should be achieved through amending the law on use and distribution of fireworks and through intensifying and fine-tuning the annual information campaigns.

Adolescent↗
PubMed1991

Preoperative localisation of the saphenopopliteal junction with duplex scanning.

The anatomy of the saphenopopliteal junction shows considerable variation, and clinical localisation of this junction is inaccurate. Duplex scanning in preoperative mapping of the saphenous vein system in bypass surgery has been shown to be highly effective. In 62 patients with clinical evidence of insufficiency of the saphenopopliteal junction, preoperative localisation with duplex scanning was performed in 66 extremities. In 62 extremities duplex localisation matched the operative findings and in four extremities a difference of 2 cm or more was found. There was 1 false negative surgical exploration. In 93% of the cases exact localisation of the junction enabled us to perform flush ligation of a small saphenous vein through minimal exposure. Preoperative duplex scanning of the saphenopopliteal junction is highly accurate.

Female↗
PubMed1990

Transscaphoid perilunate fracture dislocation and pseudarthrosis of the scaphoid.

The results of conservative treatment of a perilunate fracture dislocation were retrospectively studied. In six patients, the treatment consisted of closed reduction and immobilization in a below the elbow cast for 12 to 16 weeks. Five patients had a compromised healing of the scaphoid fracture. The frail vascularization of the scaphoid, extensive ligamentous injury and possible mid-carpal instability in case of perilunate fracture dislocation as well as a non-anatomical reduction of a scaphoid fracture are causative factors in ensuing scaphoid pseudarthrosis. If anatomical reduction of a perilunate fracture dislocation cannot be obtained, open reduction and internal fixation should be considered. This will offer the scaphoid the best chance at fracture healing and will restore the stabilizing function on the mid carpus.

Adult↗