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D Z Lubowski

Publications and source records attributed to D Z Lubowski.

63 records · Page 4Linked to original sources
PubMed1988

Do patients with haemorrhoids have pelvic floor denervation?

Straining at stool is found in patients with haemorrhoids, rectal prolapse and neurogenic (idiopathic) faecal incontinence. In the latter two conditions perineal descent and pudendal neuropathy occur. We have carried out anal manometry, measurement of perineal descent, pudendal nerve terminal motor latency (PNTML) and single fibre EMG in the external anal sphincter in 16 patients with haemorrhoids and 20 matched control subjects to determine whether patients with haemorrhoids have pudendal nerve damage. There was no significant difference in resting or voluntary contraction pressures or in the incidence of slow waves or ultra-slow waves between the patients with haemorrhoids and controls. There was a significant difference between the groups in the position of the perineum with respect to the ischial tuberosities at rest (p less than 0.025) and on defaecation straining (p less than 0.005). The mean PNTML was higher in the haemorrhoid group but this did not reach statistical significance (p = 0.07). The mean fibre density was significantly higher in the haemorrhoid group (p less than 0.025). These findings show that patients with haemorrhoids are more likely to have abnormal perineal descent with pudendal neuropathy.

Adult↗
PubMed1988

Internal anal sphincter in neurogenic fecal incontinence.

In neurogenic fecal incontinence there is denervation of the external anal sphincter and pelvic floor muscles but the role of the internal anal sphincter is incompletely understood. We have evaluated the internal anal sphincter in 6 patients with neurogenic incontinence undergoing postanal repair and in 7 control subjects. All the incontinent subjects, but none of the controls, had evidence of pudendal neuropathy. Surface electromyography studies of the internal anal sphincter showed absence of electrical activity in 4 of 6 incontinent subjects; in the remaining 2 subjects and in 6 of 7 controls normal slow waves were present. Internal sphincter muscle strips from control subjects showed normal in vitro responses to noradrenaline, isoprenaline, dimethyl-phenylpiperazinium, and electrical field stimulation; muscle strips from the incontinent patients showed complete insensitivity except in 2 patients in whom there was contraction to noradrenaline and relaxation to isoprenaline. Electron microscopy showed normal smooth muscle in 5 control subjects and minor changes in 1 subject; all the incontinent patients showed abnormalities in the smooth muscle cells of the internal anal sphincter. These findings indicate that in neurogenic fecal incontinence neurogenic weakness of the external anal sphincter and pelvic floor muscles is associated with damage to the internal anal sphincter.

Adult↗
PubMed1988

Ultrastructural changes in internal anal sphincter in neurogenic faecal incontinence.

The ultrastructural features of the internal anal sphincter (IAS) muscle were studied in biopsies from five patients with neurogenic anorectal incontinence and six control subjects undergoing anorectal excision for cancer, or for inflammatory bowel disease. In the patients with idiopathic neurogenic anorectal incontinence the internal anal sphincter showed loss of smooth muscle cells, disruption of the normal relationships of the remaining cells, stretching of elastic tissue, and increased collagen fibril content. These ultrastructural changes in the morphology of the internal anal sphincter, although probably not the primary cause of faecal incontinence, have functional relevance in the clinical syndrome, as shown by the reduction in resting anal canal pressure found in some patients with this syndrome.

Adult↗
PubMed1987

Restorative proctocolectomy: the four loop (W) reservoir.

The four loop (W) reservoir was developed with the aim of improving the functional results of the J reservoir and to avoid the need for catheterization often seen with the S reservoir. It is no more difficult to construct and results in better function. Sixty-four patients have undergone the procedure. There were no deaths. Mean hospital stay (including ileostomy closure) was 24 +/- 8 days. The reservoir has been removed in one patient (one week postoperatively) who was found to have a Dukes' B rectal carcinoma. Function has been assessed in 51 patients (mean follow-up 18.6 +/- 8.9 months). Frequency of defaecation per 24 h is 3.3 +/- 1.0 (range 1-8) with night evacuation in 14 per cent. Antidiarrhoeal medication is required by 20 per cent of patients. Continence is normal in 92 per cent, and 8 per cent have minor leakage. All patients defaecate spontaneously.

Adenomatous Polyposis Coli↗
PubMed1987

Neural control of internal anal sphincter function.

The effect on anal tone of electrical stimulation of the presacral (hypogastric) sympathetic nerves has been studied in eight patients during abdominal rectopexy or restorative proctocolectomy. A sharp fall in anal pressure occurred in seven patients (mean fall 59 cmH2O; range 35-80 cmH2O). In one patient given a beta- and alpha-sympathetic blocking drug (labetalol 200 mg) intra-operatively, the anal pressure decreased by 15 cmH2O. These observations show that stimulation of the presacral sympathetic nerves causes relaxation of the internal anal sphincter and implies that these nerves may induce relaxation of the sphincter in vivo. The pathway of the recto-anal reflex has been studied intra-operatively in three patients undergoing rectal excision. The recto-anal reflex is present after presacral nerve blockade and after full mobilization of the rectum, but is abolished by circumferential rectal myotomy. The reflex has a local intramural pathway. This observation validates the assumption that absence of this reflex is a feature of aganglionosis, as in Hirschsprung's disease.

Adrenergic Fibers↗
PubMed1987

Relation between perineal descent and pudendal nerve damage in idiopathic faecal incontinence.

In 60 patients with idiopathic anorectal incontinence, without neurological disease, there was a significant relationship, shown by regression analysis, between the pudendal nerve terminal motor latency and the extent of perineal descent during straining (r 0.59; p less than 0.001), and the plane of the perineum on straining (r -0.61; p less than 0.001). These data are consistent with the suggestion that perineal descent can lead to stretch-induced damage to the perineal nerves in this condition.

Action Potentials↗
PubMed1987

Is paradoxical contraction of puborectalis muscle of functional importance?

Paradoxical contraction of the puborectalis muscle during simulated defecation straining (anismus) has been cited as a cause of constipation. The functional specificity of this phenomenon was evaluated in 79 patients, 50 with constipation, 21 with idiopathic perineal pain, and eight with solitary rectal ulcer syndrome. Electromyogram evidence of paradoxical puborectalis contraction was observed in 38 (76 percent), ten (48 percent), and four (50 percent) of these patients, respectively. All patients with solitary rectal ulcer syndrome had difficulty defecating; defecation was normal in all patients with perineal pain. These observations suggest that paradoxical contraction of the puborectalis muscle is not a specific finding, and that it is not the sole cause of constipation in patients with anismus.

Adolescent↗
PubMed1987

Restorative proctocolectomy with ileal reservoir and ileoanal anastomosis: a clinico-physiological study.

The results of nine patients undergoing restorative proctocolectomy with ileal reservoir are presented. Mean frequency of defaecation per 24 h is 5.8. The reservoir was removed in one patient. Continence was normal in six patients and two had minor soiling. Manometry was normal in all except one with minor soiling and electromyography showed no features of sphincter denervation.

Adult↗