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Biomedical subjects

B Frenckner

Publications and source records attributed to B Frenckner.

At least 55 records · Page 3Linked to original sources
PubMed1985

Use of the recto-urethral fistula for reconstruction of the anal canal in high anal atresia.

A 6-month-old boy with high anal atresia was operated upon via a sacro-perineal approach. After division of the rectourethral fistula, pressure recordings from the rectal part of the fistula during electrical stimulation of the rectal mucosa showed a resting pressure and relaxations resembling internal anal sphincter activity. The fistula was used for the reconstruction of the anal canal and anastomosed to the skin in the anal incision. The postoperative course was uneventful. Six weeks after the operation ano-rectal manometry showed a high resting anal pressure and normal internal sphincter relaxations. It is concluded that the presented surgical technique may provide a functioning internal sphincter in at least some patients with high anal atresia with recto-urethral fistula.

Anus, Imperforate↗
PubMed1984

An unusual complication following the removal of a neuroblastoma.

A 17-month-old girl had a neuroblastoma with high preoperative urinary excretion of norepinephrine and a manifest hypertension. She developed during and after surgery circulatory complications similar to those seen when a pheochromocytoma is removed without prior sympathetic blockade. This complication in connection with a neuroblastoma has not been described previously. This case points to the necessity of careful preoperative evaluation of the circulatory function in cases of neuroblastomas in children. The paediatric surgeon and the anaesthetist should take a preoperative sympathetic blockade into consideration.

Adrenal Gland Neoplasms↗
PubMed1984

Lung function after repair of congenital diaphragmatic hernia.

To study lung development after repair of congenital diaphragmatic hernia 20 patients operated on between 1960 and 1976 were followed-up at 6-22 years of age. All had had an uneventful postoperative course, had no concomitant disease and were subjectively well with an ordinary physiological performance. The investigation showed a mean increase of residual volume by one third of predicted normal values. Fractional perfusion and ventilation were reduced by 20% on the hernia side compared with the contralateral side. Functional impairment owing to pulmonary hypoplasia was ruled out by the existence of a normal working capacity and maintenance of a normal alveolar gas exchange during exercise on a high work load.

Child, Preschool↗
PubMed1983

Ano-rectal function assessed by manometry and electromyography after endorectal pull-through for Hirschsprung's disease.

Since 1975 the endorectal pull-through operation for Hirschsprung's disease has been favoured in this department. Out of 16 patients, 12 were examined 8 months to 6 years later by ano-rectal manometry and external sphincter electromyography. The results indicate a normal postoperative rectal capacity and rectal sensibility. There was no internal sphincter relaxation in response to a rectal distention. Resting and reflex activity of the external and sphincter were normal.

Anal Canal↗
PubMed1983

Internal anal sphincter response after electrical stimulation of the rectal myenteric nerve plexus in the rabbit.

The internal anal sphincter response to electrical stimulation of the rectal mucosa was studied in six rabbits. The anal canal was dissected free and then opened with an anterior, longitudinal incision to yield a flat sphincter preparation. After the external sphincter had been paralysed, isometric recordings of internal sphincter activity were performed. Electrical stimulation applied to the rectal mucosa elicited sphincter relaxations in all rabbits. Division of the gut beneath the point of stimulation blocked the response, as did local submucous anaesthesia. The results show (1) that electrical stimulation of the rectum can elicit internal sphincter relaxation, and (2) that the response is mediated via the myenteric and submucosal nerve plexuses.

Anal Canal↗
PubMed1983

Rectal myenteric nerve plexus stimulation in Hirschsprung's disease and in healthy children.

The internal anal sphincter response was studied manometrically while applying electrical stimulation to the rectal mucosa. Seven patients with Hirschsprung's disease and ten healthy controls were investigated during general anaesthesia. In addition, six healthy controls were examined when awake. Internal sphincter relaxations elicited by electrical stimulation of the rectal myenteric nerve plexus were recorded in all anaesthetized controls, but in only two of the patients. The latter required a higher stimulation voltage. Rectal myenteric nerve plexus stimulation is a theoretical alternative for the diagnosis of Hirschsprung's disease. One advantage over conventional manometry is that it avoids the risk of mechanical artifacts. Further studies are necessary to evaluate whether the method can be of practical importance in neonatal diagnosis of Hirschsprung's disease.

Anesthesia↗
PubMed1983

Electrical activity of the external anal sphincter at different ages in childhood.

In EMG recordings of the external anal sphincter there is a brief contraction in response to rapid rectal distension, and a preserved or increased activity during a prolonged substantial rectal distension in healthy adults. In order to determine if this activity develops during childhood 30 healthy children, aged 2 months to 15 years, were examined with their parents' consent. EMG of the external anal sphincter during rest and during rectal distension was performed. All those children who had gained voluntary anal control showed an EMG recording similar to the adults. The 10 youngest children who had not gained voluntary control showed another EMG pattern. Instead of a brief contraction they had a brief loss of activity in response to rectal distension. During a prolonged rectal distension the external sphincter activity decreased and finally ceased. An intermediate state was found in the two youngest children who had gained voluntary control. The EMG pattern showed a good correlation with the maturation and gain of voluntary control of defaecation.

Adolescent↗
PubMed1982

Pulmonary function after lobectomy for congenital lobar emphysema and congenital cystic adenomatoid malformation. A follow-up study.

Eight patients with congenital lobar emphysema and eight with congenital cystic adenomatoid malformations were operated upon between 1970 and 1978. A lobectomy was performed in all cases. At follow-up after 3 to 11 years all of the patients without concomitant disease or malformations were subjectively well with a physical performance equal to those of their playmates. Lung function tests indicated lung volumes of about 90% of predicted normal values, indicating some compensatory growth of the remaining lung tissue. Functional impairment owing to loss of lung tissue or residual disease was ruled out by the existence of a normal working capacity and maintenance of the alveolar gas exchange during intense exercise.

Carbon Dioxide↗
PubMed1982

Results of surgical treatment of lung metastases in children.

Between 1970 and 1979, 14 patients were operated on for pulmonary metastases. In 9 of these the primary tumour was a Wilms' nephroblastoma. Five out of the 14 patients are presently alive and free from disease (3 to 10 years after pulmonary resection). Primary tumours of the survivors were Wilms' tumour in 3 cases, an ovarian teratoma in one patient and a Ewing's sarcoma in one patient. Two of survivors had bilateral involvement and one had multiple metastases of one lung with pleural exudation. The disease-free interval was the same among the survivors and the non-survivors. It is apparent from the present material that some patients with a very poor prognosis as predicted from different prognostic factors can be cured after surgical excision of the metastases. The surgical procedure in children involves a very small risk and only moderate discomfort. An active surgical approach is therefore recommended.

Adolescent↗
PubMed1980

Activity of the internal anal sphincter during the first days of life.

Manometric recordings of the internal anal sphincter activity are frequently used in the diagnosis of Hirschprung's disease. Normally, there is a relaxation of the internal sphincter in response to a rectal distension, but this is absent in Hirschprung's disease. In order to study the normal physiology during the first days of life, 17 healthy full-term infants were examined daily with ano-rectal manometry during the first four days of life. Resting anal pressure was lower than in older children. Internal sphincter relaxation was recorded in all infants but one on the first day, in all on the second and finally in all but one on the third and fourth days. The results indicate that anorectal manometry may be used in the diagnosis of Hirschprung's disease also in the newborn period. However, repeated examinations may be necessary and the diagnostic reliability may be somewhat lower than in older children.

Age Factors↗
PubMed1979

Influence of general anaesthesia on ano-rectal manometry in healthy children.

According to several investigations ano-rectal manometry is a valuable diagnostic test of Hirschsprung's disease. In order to yield accurate results it requires a quiet, calm child who cooperates. In the few instances when this is not possible, general anaesthesia may be desirable. Manometric recordings of the internal and sphincter activity were therefore performed in 15 healthy children when awake and during general anaesthesia. The tonic activity at rest was significantly reduced during anaesthesia. Relaxations of the internal sphincter in response to rectal distension were recorded in all children both when awake and during anaesthesia. They were, however, significantly less pronounced during anaesthesia. These findings strongly suggest that ano-rectal manometry in the diagnosis of Hirschsprung's disease may be performed with advantage during general anaesthesia if the child does not cooperate when awake.

Anal Canal↗
PubMed1978

Ano-rectal manometry in the diagnosis of Hirschsprung's disease in infants.

Manometric recordings of internal sphincter activity were performed during distension of the rectum in 10 healthy control infants and in 9 infants with clinical signs of Hirschsprung's disease. In 8 of the healthy infants relaxations of the internal sphincter were obtained, which were maximal 4 to 7 secs after rectal distension. This was also the case in 5 of the patients who were later proven not to have Hirschsprung's disease. In 3 patients no relaxations of the internal sphincter could be recorded. Subsequent rectal biopsy revealed absence of ganglion cells, confirming the diagnosis Hirschsprung's disease. The remaining 3 infants (2 controls and 1 patient) could not be calmed during the examination and the results were inconclusive. It is concluded that ano-rectal manometry is a valuable method of examination in the diagnosis of Hirschsprung's disease in infants. No false results were obtained in this study. Furthermore, it is an easy procedure without risk or discomfort for the patient.

Age Factors↗
PubMed1976

Function of the anal sphincters in patients with intussusception of the rectum.

Patients with intussusception of the rectum--six with anal incontinence and nine continent--were examined with respect to the function of the anal sphincters. Anal pressure was recorded continuously during rest, during maximal voluntary squeezing of the anal muscles, and during gradual expansion of the rectum by means of a balloon inserted into the rectal ampulla. The maximal anal pressure at rest, which is mainly due to activity of the internal anal sphincter, was lower (P less than 0-001) in the incontinent patients (31 mmHg +/- 5-6) than the continent (67 mmHg +/- 4-3) and the former had significantly smaller relaxations of the internal sphincter upon rectal distension (P less than 0-05). The increase in anal pressure during voluntary squeezing, a function of the external sphincter, did not differ significantly compared with healthy subjects in either incontinent or continent patients. On the basis of the above findings, it is concluded that the function of the internal sphincter is impaired in the incontinent patients.

Aged↗
PubMed1976

Influence of autonomic nerves on the internal and sphincter in man.

The internal and sphincter receives its parasympathetic nerve supply from the sacral outflow and its sympathetic supply from the thoracicolumbar outflow of the spinal cord. In order to investigate the influence of the tonic discharge of these nerves, eight healthy subjects receiving high spinal anaesthesia (T 6-T 12) and five receiving low spinal anaesthesia (L 5-S 1) were examined. Continuous recordings of anal pressure and electromyographic activity from the external sphincter were obtained during rest and during expansion of the ampulla recti by means of an air-filled balloon. The results were compared with those obtained in an earlier study from 10 subjects with a bilateral pudendal block which paralysed the striated sphincter muscles without affecting the autonomic nerve supply to the internal sphincter. Anal pressure at rest decreased significantly more with high spinal anaesthesia (32 +/- 3-2 mm Hg) than with low (11 +/- 7-1 mm Hg) or with pudendal block (10 +/- 3-9 mm Hg) and the relaxations of the internal sphincter induced by rectal distension were somewhat smaller with high spinal anaesthesia. However, the remaining anal pressure at maximal relaxation, induced by a substantial rectal distension, was essentially the same with the three forms of anaesthesia. It is concluded that, at rest, there is a tonic excitatory sympathetic discharge to the internal anal sphincter in man. However, this seems to be without excitatory effect when the sphincter is relaxed after a substantial rectal distension. Furthermore, the results indicate that at rest there is no tonic parasympathetic discharge affecting the sphincter tone.

Adult↗
PubMed1975

Influence of pudendal block on the function of the anal sphincters.

The function of the anal sphincters has been studied by obtaining continuous recordings of the pressure in the anal canal and the electromyographic activity in the striated sphincter muscles during expansion of the ampulla recti by means of an air balloon. Ten healthy subjects were examined before and after the striated muscles had been entirely paralysed by bilateral pudendal block, making it possible to record the activity from the internal sphincter alone. The results show that the internal sphincter contributes about 85% of the pressure in the anal canal at rest but only about 40% after a sudden substantial distension of the rectum. During constant substantial rectal distension, the internal sphincter accounts for about 65% of the anal pressure. It is concluded that the internal sphincter in the adult is chiefly responsible for anal continence at rest. In the event of sudden substantial distension of the rectum, continence is maintained by the striated sphincter muscles, whereas both sphincter systems probably have an important function during constant distension of the rectum.

Adolescent↗