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Biomedical subjects

D C Bartolo

Publications and source records attributed to D C Bartolo.

At least 19 recordsLinked to original sources
PubMed1995

Island advancement flaps in the management of anal fissures.

The classic high-pressure fissure responds well to lateral internal sphincterotomy. The management of recurrent fissures and those that occur in patients with weak sphincters is open to debate. An island advancement flap technique used in 21 patients is described with the above criteria. Preoperative median resting anal pressure was 66 (range 43-90) cmH2O and median maximal squeeze pressure was 132 (range 76-193) cmH2O, values that were significantly lower than in controls and those with classic fissure. Endoanal ultrasonography in 15 of these patients showed defects in the anal sphincters. All flaps healed primarily with preservation of sensation. Perfect continence was maintained in all patients. Follow-up was for a median of 18 (range 2-28) months. There were no serious complications. All fissures healed with minimal postoperative discomfort. This procedure provides a useful alternative for symptomatic anal fissures, in which a sphincter-weakening procedure might jeopardize continence.

Adult↗
PubMed1994

Recovery of the internal anal sphincter and continence after restorative proctocolectomy.

The internal anal sphincter (IAS) was assessed prospectively using electromyography and manometry in 66 patients (48 men) undergoing restorative proctocolectomy to determine its role in the gradual return of continence. Twenty-nine patients received a J pouch and 37 a W reservoir. Some 38 pouches (J, ten; W, 28) were hand-sewn (mucosal proctectomy with endoanal anastomosis) and 28 (J, 19; W, nine) stapled (end-to-end pouch-anal anastomosis 1 cm above the dentate line). Twelve patients underwent a one-stage procedure (all J pouches), while the remainder had a covering loop ileostomy. Each patient was reassessed immediately after restorative proctocolectomy and again at 7 days, 1 month, 4 months, 9 months and 18 months after pouch formation. Internal sphincter electromyographic activity was greatly reduced after pouch-anal anastomosis (median preoperative frequency 0.51 Hz versus immediate postoperative frequency 0.21 Hz, P < 0.003) and gradually recovered from 4 months after surgery. At 18 months, measurements of IAS function had not fully recovered to preoperative values (median frequency 0.31 Hz; P < 0.03). Resting anal pressures (median preoperative value 99 cmH2O) decreased by over 50 per cent after surgery (median immediate postoperative resting pressure 44 cmH2O) and recovered gradually but incompletely (median pressure at 18 months 63 cmH2O). Eleven patients reported leakage in the follow-up period. The median (range) resting pressure in these patients (54 (40-71) cmH2O) was not significantly different at 9 months from that of those who were continent either before or after operation (59 (46-68) cmH2O). Prolonged recordings in patients with faecal leakage revealed evidence of high-pressure pouch waves that overwhelmed anal sphincter pressures and coincided with leakage. These episodes were most common during sleep, when anal sphincter activity was reduced.

Adolescent↗
PubMed1994

Two different glycosyltransferase defects that result in GalNAc alpha-O-peptide (Tn) expression.

This study shows for the first time that different glycosyltransferase defects in the biosynthesis of O-linked oligosaccharides give rise to the same GalNAc alpha-O-Ser/Thr determinant on Tn erythrocytes and colorectal carcinoma cells. The O-linked oligosaccharides isolated from the glycophorins of Tn erythrocytes contained predominantly alpha-N-acetylgalactosamine-O-Ser/Thr (Tn antigen) and sialyl-Tn. A marked reduction in normal sialylated oligosaccharides was also observed. Monoclonal antibody BRIC 111 raised against Tn erythrocytes reacted with both Tn erythrocytes and colorectal carcinoma tissues. Weak staining was detected in the supranuclear area and at the surface membranes in normal colorectal cells, but was absent from goblet cell vesicles. An increase in supranuclear staining over controls was found in tumour tissue and in the majority of resection margin specimens. The highest levels of staining were present in transitional mucosa, adjacent to the tumours where goblet vesicles were also positive. Glycosylation defects in the same patients were further studied by determination of the activity of glycosyltransferases in mucosal tissue from control and cancer patients. The reduction in or loss of beta 1-3 N-acetylglucosaminyl transferase activity to GalNAc-peptide in asialo-ovine submaxillary gland glycoprotein was detected by direct assay and by isolation of the oligosaccharides from the incubation products. No differences in N-acetylglucosaminyl-, galactosyl- or sialyl-transfer to Gal beta 1-3GalNAc in antifreeze glycoprotein or in sialyl transferase to asialo-ovine submaxillary gland glycoprotein were detected. Our study shows that the GalNAc alpha-O-Ser/Thr determinant on Tn erythrocytes and in colorectal carcinoma results from different glycosyltransferase defects in separate biosynthetic pathways for haematopoietic and epithelial tissues.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1994

The use of endoluminal ultrasound in the assessment of patients with faecal incontinence.

To determine the clinical value of endoanal ultrasonography in the assessment of patients with faecal incontinence, we have assessed 98 patients with neurogenic incontinence (median age 58 years, 85 women). Twenty-one patients with a history of previous anal surgery (13 men), 12 nulliparous women, and 73 women with an obstetric history (including eight with previous anal surgery) were assessed. All of the patients who had undergone surgery and 43 patients with a previous obstetric history had abnormalities identified by ultrasound. Endoanal ultrasound identified two internal sphincter injuries in patients who were suspected of having an external sphincter defect alone. In addition, in 18 patients who had an obstetric history but no documented obstetric trauma, defects were identified in the external sphincter by ultrasonography. The technique appears most useful in those patients with an obstetric history and/or a previous history of anal surgery. Symptoms of incontinence were most severe in those who had internal sphincter division.

Adult↗
PubMed1992

Abdominal rectopexy for rectal prolapse: a comparison of techniques.

To compare the methods of abdominal rectopexy and to elucidate the mechanism by which rectopexy restores continence in patients with rectal prolapse, the role of sphincter recovery, rectal morphological changes and improved rectal sensation were assessed in 68 patients (eight men, 60 women) of median age 63 (range 18-83) years undergoing resection rectopexy (n = 29), anterior and posterior Marlex rectopexy (n = 20), posterior Ivalon rectopexy (n = 9) or suture rectopexy (n = 10). Preoperative and postoperative manometry, radiology and electrosensitivity measurements were made. Age and duration of follow-up were similar in all groups and the prolapse was controlled in all patients. Significantly improved continence was seen in all but the Ivalon group. There was no evidence of increasing postoperative constipation. Sphincter length and voluntary contraction were unaltered, but improved resting tone was seen in the resection and suture groups. This was not seen in the prosthetic groups. Improved continence correlated with recovery of resting pressure. Upper and sensation was improved in all groups. Radiological changes did not correlate with improved continence. We conclude that continence is improved by all rectopexy procedures but seems better without prosthetic material. Sphincter recovery seems to be the most important factor.

Adult↗
PubMed1992

Restoration of continence following rectopexy for rectal prolapse and recovery of the internal anal sphincter electromyogram.

Twenty-two patients with full-thickness rectal prolapse underwent ambulatory fine wire electromyography of the internal and sphincter (IAS), external and sphincter and puborectalis, together with anorectal manometry, using a computerized system. Examinations were performed both before and 3 to 4 months after rectopexy. The median (interquartile range (i.q.r.)) preoperative IAS electromyogram (EMG) frequency was 0.18 (0.05-0.31) Hz and the median (i.q.r.) preoperative resting anal pressure was 28 (15-64) cmH2O. An improvement in the IAS EMG frequency, median (i.q.r.) 0.29 (0.19-0.38) Hz (P less than 0.03), and resting anal pressure, median (i.q.r.) 41 (20-72) cmH2O (P less than 0.05), was recorded after operation, but these variables remained significantly lower than those found in normal controls: median (i.q.r.) IAS EMG frequency 0.44 (0.36-0.48) Hz and median (i.q.r.) resting anal pressure 92 (74-98) cmH2O. We suggest that repair of the prolapse allows the IAS to recover by removing the cause of persistent rectoanal inhibition.

Adult↗
PubMed1992

Mucin changes in ileoanal pouches monitored by metabolic labelling and histochemistry.

The pattern of mucin synthesis and secretion in mucosal biopsies from the proximal ileum, distal ileum, rectum and pouch before and after ileostomy closure was monitored in patients undergoing restorative proctocolectomy by metabolic labelling with [3H]glucosamine and [35S]sulphate and compared with the mucin histochemistry in each patient. Metabolic labelling clearly demonstrated a reduction in sulphation associated with the rectal mucosa in colitis. Significant differences in the turnover of isolated secreted mucin between proximal and distal ileum and rectum were also found, as was a metaplastic change towards a colonic-type mucosa in the pouch before and after ileostomy closure relative to the proximal and distal ileum, and rectum. This technique can be used to monitor colonic metaplasia in the pouch mucosa and is suitable for comparative studies where mucin changes are implicated.

Adult↗
PubMed1991

Changes in anal canal sensation after childbirth.

Obstetic trauma predisposes to faecal incontinence. Anal canal sensation is impaired in incontinent patients. To assess the effect of childbirth on anal canal sensation anal mucosal electrosensitivity was measured in 122 primiparous patients in the immediate postnatal period and in 74 at 6 months postpartum. There were 35 normal vaginal deliveries, 36 forceps deliveries, 20 ventouse extractions, ten vaginal breech deliveries and 21 caesarean sections. Sensation was impaired in the lower, mid and upper anal canal immediately after delivery in those patients who had a normal vaginal delivery or a forceps delivery when compared with controls or with those delivered by caesarean section. Women who had ventouse deliveries had impaired sensation immediately after delivery in the mid anal canal compared with controls and those undergoing caesarean section. By 6 months there were no differences between any group. Patients who sustained a division of the external anal sphincter at delivery had impaired sensation which persisted in the upper anal canal at 6 months.

Anal Canal↗
PubMed1991

Anismus in patients with normal and slow transit constipation.

This study examined differences in anorectal function, with particular reference to anismus, which might explain why some patients with intractable constipation have slow and others have normal whole gut transit times. Twenty-four patients were studied; 13 with slow transit (all female, median age 32 years, range 16-52 years) and 11 with normal transit (eight women, three men, median age 37 years, range 21-60 years). Videoproctography with synchronous sphincteric electromyography and anorectal manometry was performed. There were no differences between the two groups, suggesting that slow transit constipation is not secondary to any abnormality in anorectal function and may therefore be a primary disorder of colonic motility. There was no correlation between electromyographic evidence of anismus (pelvic floor contraction on defaecation) and the ability of the patient to evacute the rectum or symptoms of obstructed defaecation. Electromyography findings alone can be misleading and should be related to proctographic evidence of incomplete rectal evacuation before functional anismus can be said to be present.

Adolescent↗
PubMed1991

Surgical management of intestinal radiation injury.

The management of 14 cases of radiation injury to the intestinal tract over a 4-year period is evaluated. The longest latent interval between radiation treatment and symptoms was 30 years. Eight patients were treated surgically; six were treated conservatively by laser therapy or application of formalin to the affected mucosa. The indications for surgery were rectovaginal fistula (four), rectal stricture (one), radiation proctitis (eight), and small bowel obstruction (one). Seven patients underwent large bowel resection. These consisted of four anastomoses with coloanal J-reservoirs, two low anterior resections, and one coloanal anastomosis without reservoir. There was no perioperative mortality. Morbidity occurred in one of the eight surgical cases. Radical resection of the radiation-damaged rectum has been shown to be a safe and reliable treatment for rectovaginal fistulas, rectal strictures, and proctitis unresponsive to medical measures. Coloanal J-reservoir is the procedure of choice to avoid urgency and frequency symptoms associated with coloanal sleeve anastomosis. Laser therapy for hemorrhagic proctitis can achieve an important place in the management of this problem without recourse to surgery.

Adult↗
PubMed1991

Anorectal physiology testing. A survey of availability and use.

Survey forms were sent to all members of the Coloproctology Section of the Royal Society of Medicine and the American Society of Colon and Rectal Surgeons to obtain their opinions of the availability, actual use, and perceived helpfulness of different methods for the evaluation of the physiology of the colon and rectum. Responses revealed a similarity in age and practice patterns in both groups. Of the 19 methods surveyed, greater than 90 percent of respondents in both groups rely on three traditional methods of patient evaluation: patient history, digital examination, and sigmoidoscopy. Four other methods have gained acceptance by the majority of respondents in both groups: colon transit studies, defecography, perfused-catheter manometry, and rectal compliance. The three methods ranked lowest in availability, actual use, and helpfulness by both groups were single-fiber electromyography, use of a perineometer, and evoked potential studies. Our study provides a baseline for future surveys on the investigative efforts of physicians studying the physiology of the colon, rectum, and anus.

Anal Canal↗
PubMed1991

Rectopexy is an ineffective treatment for obstructed defecation.

The symptoms of obstructed defecation have been attributed to rectal intussusception, and thus rectopexy has been advocated in the surgical management. In this study, patients with obstructed defecation underwent manometry and proctography before and after rectopexy. Seventeen patients (16 females and one male, mean age 51.6 years) were studied. Eleven underwent anterior and posterior fixation of the rectum and six had posterior fixation only. Preoperatively five patients demonstrated rectoanal intussusceptions. Fifteen had significant pelvic descent. No significant change in maximum resting pressure, maximum voluntary contraction, pelvic descent, or anorectal angle was seen postoperatively. In the initial follow-up, many patients had significant amelioration of symptoms. However, on longer follow-up (mean 30.8 months) only two had long-term improvement. The remainder had a poor clinical result in spite of complete resolution of rectal intussusception. Many reported a worsening of symptoms as reflected by an increase in tenesmus and stool frequency. In the two cases with a satisfactory result, both could empty the rectum completely and demonstrated rectoanal intussusception on preoperative evacuation proctography. In those with poor results, four had complete emptying and three had rectoanal intussusception. In conclusion rectopexy is an ineffective treatment for obstructive defecation in most patients.

Adult↗
PubMed1991

Comparison of anterior sphincteroplasty and postanal repair in the treatment of idiopathic fecal incontinence.

Both postanal repair and anterior sphincteroplasty with levatorplasty have been advocated in the treatment of idiopathic fecal incontinence. To assess the functional results of these procedures, physiologic and radiologic measurements were carried out prospectively in 33 patients with idiopathic incontinence undergoing operative treatment, and 12 age- and sex-matched controls. Sixteen patients had anterior sphincteroplasty and levatorplasty and 17 had postanal repair. A satisfactory postoperative outcome was defined as perfect continence or incontinence of flatus only. Ten patients in the anterior sphincteroplasty group had satisfactory results (64 percent) and 10 in the postanal repair group (59 percent). Preoperatively, both groups had decreased resting and squeeze pressures, impaired and mucosal electrosensitivity, and marked pelvic descent vs. controls. Postoperatively, significant improvement in sphincter pressures and mucosal electrosensitivity was seen in both groups. No significant change in anorectal angle was demonstrated in the postanal repair group, whereas it was made significantly more obtuse in the anterior sphincteroplasty group. It is likely that the improved continence resulting from either of these two procedures is secondary to better anal sphincter muscle function and improved and sensation. It would appear that the anorectal angle is not crucial in maintaining continence.

Adult↗
PubMed1991

Gastroenterological options in faecal incontinence.

Faecal incontinence may be due to a trauma, a rectal prolapse, or a neurological disorder. Obstetric trauma: If the sphincter has been severed, direct repair is indicated. In the case of neurological damage, plication of the levators can provide significant improvement; while the post-anal repair has become popular, anterior sphincter plication and levatorplasty, provide equivalent results. Rectal prolapse: Full thickness rectal prolapse is frequently associated with incontinence. Two categories of operations have been described: local operative procedures (Delorme's plicature, perineal resection) provide poor results in term of restoration of continence and should be reserved to unfit and elderly patients; abdominal operations combine an extensive rectal mobilisation and they differ by the type of fixation. The Ripstein operation (fixation to the promontory by an encircling sling of non absorbable mesh) has long been popular in the United States, but is followed by severe constipation. In the simple suture rectopexy, the rectum is fixed to the pelvic floor and the presacral fascia by non absorbable procedures. In the Ivalon sponge rectoprexy, a polyvinyl alcohol mesh in secured between the sacrum and the rectum, and provides a dense fibrous reaction. In the antero-posterior Marlex rectopexy, a sheet of Marlex mesh is fixed posteriorly to the rectum, and a sling is interposed anteriorly in order to support the anterior wall. In the resection rectopexy, a sigmoid resection in added to the rectal fixation in order to suppress the redundant sigmoid which is responsible for the constipation frequently following rectopexy. Results of abdominal rectopexy are satisfactory in terms of recurrence and restoration of continence.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Control of presacral bleeding in rectal surgery.

A technique for controlling life-threatening presacral bleeding is described. This consists of a sterilised metallic drawing pin pushed through the synthetic coagulant Surgicel (Johnson and Johnson) directly into the bleeding point in the sacrum. Two patients are described in which this technique was used with a successful outcome.

Adult↗
PubMed1990

The physiological evaluation of operative repair for incontinence and prolapse.

Women with incontinence were divided into 30 with anorectal incontinence and 63 with complete rectal prolapse. The former group comprised 14 with a sphincter disruption and the remainder with intact sphincters. After anterior sphincter repair 70% were restored to acceptable continence. Success was associated with a rise in resting and voluntary contraction pressures and improved anal sensation. Patients with prolapse underwent either anterior and posterior rectopexy, or resection rectopexy. Continence was improved in both groups. Postoperatively, 90% following resection rectopexy and 80% following anterior and posterior rectopexy were restored to acceptable continence. Postoperative defaecatory straining and incomplete evacuation were reduced, with no significant differences between the two procedures. Restoration of continence was not associated with any change in sphincter pressures. However, rectal sensory threshold and anal sensation were both improved.

Adult↗