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Biomedical subjects

A Wald

Publications and source records attributed to A Wald.

At least 19 recordsLinked to original sources
PubMed1992

Comparative studies of esophageal function in systemic sclerosis.

Three modalities for assessing esophageal dysfunction in patients with systemic sclerosis were prospectively compared. Seventeen patients underwent (a) esophageal manometry with measurement of distal esophageal peak contraction pressure amplitude, percentage of peristaltic waves, and lower esophageal sphincter pressure; (b) cine-esophagography with scoring based on residual contrast and the character of visualized waves; and (c) esophageal transit scintigraphy with quantification of residual swallowed tracer. Highly significant correlations were found between scintigraphic residual and cine-esophagography score, between scintigraphic residual and manometric amplitude, and indeed between all pairs of measured esophageal function parameters except those involving lower esophageal sphincter pressure. In addition, scintigraphy and cine-esophagography showed comparable ability to discriminate between patients with abnormal and normal esophageal motor function. Symptoms did not significantly correlate with quantitative parameters, nor did they have diagnostic discriminating ability. Induction of Raynaud's phenomenon in a subgroup of patients had no detectable effect on esophageal function. It was concluded that these three diagnostic modalities are approximately equivalent in their ability to detect esophageal dysmotility in systemic sclerosis and measure its severity.

Adolescent↗
PubMed1992

[Hemi-arthroplasty of the hip joint: concentric or positive eccentric (self-centering) dual head prosthesis? A retrospective comparison].

In femoral neck fractures in the elderly, the least traumatic operative treatment is hemiarthroplasty. In our Trauma Unit, from August 1986 to December 1986 we implanted 22 concentric bipolar cups. During follow-up this cup proved to be associated with an unjustifiably high failure rate: system-caused interprosthetic dislocation in 4 patients (18%), and extraprosthetic dislocation in a further 3 (13%). In one of the latter, interprosthetic disconnection occurred during closed reduction. In all of these, i.e., in 31% out of the 22 patients, conversion to a total hip arthroplasty became necessary. Since March 1987 we have used a positive eccentric, self-centering bipolar head. Up to September 1990 322 such prostheses were implanted. Bearing in mind the reduced general physical condition of the patients, the complication rate is considered to be low (dislocations 3.4%, conversion to total hip arthroplasty 0.9%, deep wound infections 3.1%).

Aged↗
PubMed1992

Psychological evaluation of patients with severe idiopathic constipation: which instrument to use.

We prospectively evaluated 38 patients with chronic severe idiopathic constipation who failed to respond to conventional therapy. Colonic transit studies, the Hopkins Symptom Checklist (SCL-90-R), and the Minnesota Multiphasic Personality Inventory (MMPI) were completed. Colonic transit studies identified 23 patients with slow transit and 15 with normal transit. Patients with normal transit constipation scored higher than those with slow transit on every scale of both the SCL-90-R and MMPI, but the SCL-90-R appeared to detect greater differences between the two groups. We conclude that the SCL-90-R is the preferred psychological instrument to evaluate patients with chronic severe constipation who fail to respond to conventional therapy. It provides information similar to the MMPI with which to measure behavioral profiles of patients in an office setting, and it can be completed and scored more rapidly.

Adult↗
PubMed1991

Anorectal sensory and motor function in neurogenic fecal incontinence. Comparison between multiple sclerosis and diabetes mellitus.

We measured anorectal sensory and motor function in 11 patients with multiple sclerosis and fecal incontinence, 11 continent patients with multiple sclerosis, 10 diabetics with fecal incontinence, and 12 healthy control subjects. The threshold volume at which patients with multiple sclerosis and fecal incontinence experienced rectal sensation was higher than that in healthy controls (42.7 +/- 6.2 mL vs. 13.3 +/- 2.8 mL; P less than 0.01) and was similar to that in incontinent diabetics (36.5 +/- 5.7 mL). Patients with multiple sclerosis and incontinent diabetics also showed increased thresholds of phasic external sphincter contraction compared with controls (P less than 0.05). Diabetics with incontinence had reduced resting and maximal voluntary anal sphincter pressures compared with controls (P less than 0.05), whereas patients with multiple sclerosis and incontinence showed only decreased maximal voluntary anal sphincter pressures (P less than 0.01 vs. controls and diabetics). Incontinent patients with multiple sclerosis also required smaller volumes of rectal distention to inhibit internal sphincter tone compared with diabetics and controls (P less than 0.01). Decreased maximal voluntary squeeze pressures were less severe in continent patients with multiple sclerosis than in incontinent patients with multiple sclerosis. We conclude that impaired function of the external anal sphincter and decreased volumes of rectal distention to inhibit the internal anal sphincter or both may contribute to fecal incontinence in multiple sclerosis. In addition, increased thresholds of conscious rectal sensation in some incontinent patients with multiple sclerosis and diabetes mellitus may contribute to fecal incontinence by impairing the recognition of impending defecation.

Adult↗
PubMed1991

Evacuation proctography in normal volunteers.

Constipated patients evaluated by evacuation proctography may be subjected to vigorous medical therapy or surgery, even colectomy, based on radiographic findings that have been called "abnormal" in the literature. Criteria for normal defecography are not uniformly established, nor has correlation of structural or functional findings with symptoms been clearly documented. We prospectively studied 21 asymptomatic volunteers to assess the frequency of findings in a control population, and to establish a quantitative measure of normal rectal emptying. Standard defecography technique demonstrated rectocele, intussusception, pelvic descent, or puborectalis spasm in 14/21 volunteers (67%). The range of rectal emptying was 12.5% to 100%, with four subjects (19%) evacuating less than or equal to 40% of the barium paste. There was no correlation between severity of radiographic findings and degree of evacuation. Defecography results in patients being considered for symptomatic intervention should be interpreted cautiously, given the wide range of normal variation in a control population.

Defecation↗
PubMed1990

Contributions of evacuation proctography and anorectal manometry to evaluation of adults with constipation and defecatory difficulty.

We prospectively evaluated 36 patients who complained of chronic constipation and/or defecatory difficulties to determine the role of anorectal manometry and evacuation proctography in delineating the pathogenesis of these complaints. Twenty patients with constipation also underwent a colonic transit study with radioopaque markers, which identified one group with normal transit (N = 10) and another with slow transit (N = 10). Nine of 36 patients (25%) had inappropriate puborectalis muscle contraction or exhibited weak expulsion efforts during evacuation proctography, and these correlated highly with poor rectal emptying of barium paste (20 +/- 6% vs 61 +/- 5% in patients with normal relaxation; P less than 0.01). However, poor rectal emptying did not correlate with the presence of high-grade intussusceptions, large rectoceles, anorectal angles at rest or with straining, rectal diameter, clinical features, or colonic transit. Moreover, abnormal expulsion patterns as seen with anorectal manometry correlated poorly with the presence of inappropriate puborectalis contraction and decreased rectal emptying by proctography. Although anatomic abnormalities occurred frequently in patients with constipation and/or defecatory difficulties, they were also prevalent in asymptomatic controls. In view of these findings, surgical intervention to correct anatomic abnormalities in patients with constipation and/or defecatory difficulties should be considered only with great caution.

Administration, Oral↗
PubMed1990

Prevalence of bowel dysfunction in multiple sclerosis. A population survey.

An unselected outpatient population of 280 individuals with multiple sclerosis was surveyed to determine the prevalence of bowel dysfunction and to define their characteristics and their relationship to the nongastrointestinal manifestations of the disease. Constipation was present in 43%, was similar in frequency in both sexes, and was more common in patients, regardless of degree of disability, than in a control population. Frequency of constipation also correlated with duration of disease and genitourinary symptoms but did not correlate with use of any medications in mildly disabled patients. Fecal incontinence had occurred at least once in the preceding 3 mo in 51% of patients and once per week or more frequently in 25% of patients who were questioned in more detail with a follow-up questionnaire. Correlations of fecal incontinence with disability, duration of disease, and presence of genitourinary symptoms were similar to constipation. The prevalence of bowel dysfunction (constipation and/or fecal incontinence) in the multiple sclerosis population was 68%, and this manifestation was common even in mildly disabled subjects. Bowel dysfunction can be a source of considerable ongoing social disability in patients with multiple sclerosis. Further studies are needed to characterize the pathophysiology of this common disorder so that effective therapeutic strategies can be identified.

Adult↗
PubMed1990

Constipation and fecal incontinence in the elderly.

The successful management of constipation and fecal incontinence in the elderly requires an understanding of colorectal function, careful delineation of the patient's complaint, and in selected patients, specialized studies of colonic and anorectal function. This article reviews (1) the prevalence and nature of lower bowel dysfunction in the elderly population: (2) colonic and anorectal physiologic changes that are associated with aging; (3) the causes, consequences, and approaches to the management of constipation in the elderly; and (4) the causes of fecal incontinence in this age group and the treatment available.

Age Factors↗
PubMed1990

Gastric emptying in patients with bulimia nervosa and anorexia nervosa.

A dual radioisotope technique was used to measure gastric emptying of a mixed liquid and solid meal in 11 patients with bulimia nervosa, and was compared with 10 patients with anorexia nervosa and a sex-matched control population. The relationship of body weight and gastrointestinal symptoms to gastric emptying was also examined. Gastric emptying of solids in patients with bulimia nervosa was similar to that in controls (gastric T1/2 131 +/- 15 min vs 119 +/- 7 min; mean +/- SEM). In contrast, patients with anorexia nervosa had overall delayed emptying (182 +/- 31 min; p less than 0.05); six patients had normal emptying of the solid components of the meal and four had markedly delayed emptying. Gastric emptying of liquids was similar in the bulimics and controls (gastric T1/2 48 +/- 5 min and 49 +/- 4 min, respectively), whereas the anorexics tended to have prolonged gastric emptying (65 +/- 11 min, p = NS). There was no correlation between body weight, gastrointestinal symptoms, and gastric emptying in either group. These findings suggest that gastrointestinal symptoms are unreliable indicators of gastric emptying in patients with eating disorders, and that gastric emptying studies should be performed in such patients before treatment with prokinetic agents is considered.

Adolescent↗