Pneumoperitoneum due to pneumatosis cystoides intestinalis.
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Aged↗
Biomedical subjects
E Buch
Publications and source records attributed to E Buch.
[Vesico-appendicular fistula caused by appendicitis].
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Acute Disease↗
Can digital examination substitute anorectal manometry for the evaluation of anal canal pressures?
INTRODUCTION: Anorectal manometry provides objective information on the sphincter function of the anal canal. However, in many centers sphincter function is evaluated by digital examination, due to the unavailability of manometry. OBJECTIVE: A study is made to correlate the sensitivity and specificity of a quantitative digital examination in the analysis of sphincter tone with the pressures recorded by manometry, and to examine the capacity of both techniques to discriminate continent subjects and incontinent patients. PATIENTS AND METHODS: A total of 191 patients were divided into three groups: control (C), obstructive defecation (OD) and fecal incontinence (FI). Subjective quantitative digital evaluation of anal tone was performed on a scale of 0 to 5 points at rest, and 0 to 10 points at squeeze. A correlation analysis was performed, and the sensitivity and specificity of each fecal incontinence diagnostic test was determined. RESULTS: Digital examination found rectal tone to be diminished in elderly patients. A significant correlation was established between the digital and manometric tone readings, both at rest and at squeeze. Both techniques showed a low anal sphincter pressure in the FI group versus the C and OD groups. Differences in tone were recorded between the C and OD groups with manometry, but not with digital examination. The latter was in turn found to be more sensitive but less specific than manometry in differentiating between fecal continence and incontinence. CONCLUSIONS: Although digital examination does not substitute anorectal manometry, a good correlation exists between the two techniques. In this sense, digital examination may afford an approximate clinical evaluation of some fecal continence mechanisms in those centers where manometry is not available.
Adolescent↗
Anorectal function in patients with complete rectal prolapse. Differences between continent and incontinent individuals.
AIMS: A study is made of the alterations in anorectal physiology among rectal prolapse patients, evaluating the differences between fecal continent and incontinent individuals. PATIENTS AND METHODS: Eighteen patients with complete rectal prolapse were divided into two groups: Group A (8 continent individuals) and Group B (10 incontinent women), while 22 healthy women were used as controls (Group C). Clinical exploration and perineal level measurements were performed, along with anorectal manometry, electrophysiology, and anorectal sensitivity to electrical stimuli. RESULTS: The main antecedents of the continent subjects were excess straining efforts, while the incontinent women presented excess straining and complex deliveries. Pathological perineal descent was a frequent finding in both groups, with a hypotonic anal canal at rest (p < 0.001 vs controls) and at voluntary squeezing (p < 0.001 vs controls). In turn, the incontinent patients exhibited a significantly lower anal canal pressure at rest than the continent women (p < 0.05). There were no significant differences between Groups A and C in terms of pudendal motor latency, though latency was significantly longer in Group B than in the controls (p < 0.01). Moreover, pudendal neuropathy was more common, severe and often bilateral in Group B. There were no differences in rectal sensation to distention or in terms of the volumes required to relax the internal anal sphincter. In turn, both prolapse groups exhibited diminished anal canal and rectal sensitivity to electrical stimuli. CONCLUSIONS: Patients with rectal prolapse exhibit a hypotonic anal canal at rest, regardless of whether they are continent to feces or not. Continent patients have less pudendal neuropathy and therefore less pressure alterations at voluntary sphincter squeeze than incontinent individuals.
Adolescent↗
Transmucosal potential difference in experimental colitis in rats.
Colon transmucosal potential difference (TPD), macro- and microscopic lesions, myeloperoxidase activity, and leukotriene levels were studied after the induction of experimental colitis in the rat. Forty-three male Wistar rats were subjected to the instillation of 200 mg/ml 2,4,6-trinitrobenzenesulfonic acid (TNB) solution through a rectal cannula. TPD measurements were made at different distances from the anus before and 24 h and one, two, three, and four weeks after lesion induction. Leukotriene B4 levels were assayed by intracolonic dialysis 24 h and one, two, three and four weeks after lesion induction. Macro- and microscopic evaluations were made of the bowel lesions, and myeloperoxidase activity was assayed. The mean basal TPD was -46.06 mV at 1 cm from the anus, and +10.86 mV in the proximal colon. Twenty-four hours after lesion induction the values proved markedly positive. This was correlated with an abrupt increase in LTB4 levels and myeloperoxidase activity. After one week the TPD values exhibited a greater electronegativity, returning to basal values by the fourth week after lesion induction. This coincided with an improved macroscopic lesion index, LTB4 levels, and myeloperoxidase activity. In conclusion, TPD is a useful indicator of acute colonic lesions and correlates well with LTB4 and myeloperoxidase assays. Moreover, the parameter is able to delimit lesion evolution, reflecting possible ad integrum restoration of the bowel mucosa.
Animals↗
Prevalence of pudendal neuropathy in fecal incontinence. Results of a prospective study.
PURPOSE: A prospective study was made of the prevalence and associations of pudendal neuropathy in 96 patients with fecal incontinence (72 females and 24 males). METHODS: Clinical exploration, perineal level measurement, anorectal manometry, and electrophysiologic evaluations (pudendal nerve terminal motor latency (PNTML) and external sphincter fiber density (FD)) were performed. RESULTS: Pudendal neuropathy (defined as PNTML > 2.2 ms or FD > 1.65) was found in 67 patients (69.8 percent) and was more common in females (75 percent) than in males (50 percent; P = 0.05). Pudendal neuropathy was also more frequent in patients with pathologic perineal descent (85 percent vs. 55 percent; P < 0.01) or exhibiting risk factors such as difficult labor or excessive defecatory straining (P < 0.01). Perineal level at staining correlated inversely with both PNTML and FD (P < 0.01). Manometric findings suggested greater external anal sphincter damage in patients with pudendal neuropathy than in those suffering fecal incontinence but no neuropathy (P < 0.05). Pressure caused by the striated anal sphincter was also inversely correlated to PNTML. Pudendal neuropathy was encountered in 37 of 33 (58.7 percent) patients with sphincter injury vs. in 31 of 33 (93.9 percent) patients with idiopathic fecal incontinence (P < 0.01). CONCLUSIONS: Pudendal neuropathy is an etiologic or associated factor often present in patients with fecal incontinence. In this sense, clinical, perineometric, and manometric findings correlate with pudendal neuropathy, though such explorations do not suffice to detect it.
Adolescent↗
Prevalence and management of childhood diarrhoea.
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Child, Preschool↗
The effects of cluster sampling in an African urban setting.
Cluster sampling was popularised by the sampling procedure promoted by the WHO/UNICEF for the evaluation of the expanded programme of immunisation (EPI). Without a clear understanding of the limitations of the sampling strategy used, this sampling strategy has been extended to other types of surveys. This article shows how to approach the assessment of cluster sampling techniques scientifically by calculating design effects (DEFFs) and rates of homogeneity (roh) and illustrates this scientific assessment with three case studies from Alexandra in South Africa. We report on the DEFFs and rohs for variables studied in these surveys. The DEFF for all the variables relating to housing tended to exceed two and was as high as 6.99 for the variable new development. The variables relating to health service utilisation and health practices, namely immunisation status, nutrition status, presence of Road to Health Cards (RTDCs), breast-feeding and knowledge of diarrhoea and oral rehydration all had a DEFF close to one. The variables relating to contraception use, literacy and schooling had DEFFs close to one and a half. For a few variables the DEFFs were below one and the rates of homogeneity less than zero. The highest values of roh were for environment factors (all above 0.1433). Rohs for factors related to utilization of PHC services were mostly between 0.0200 and 0.0499. No single class of factors seemed to be related to very low values of roh. These results are then discussed.
Cluster Analysis↗
Immunisation coverage and reasons associated with non-immunisation in Alexandra township, September 1988.
Regular annual measles outbreaks in Alexandra prompted a revision of immunisation strategies at the Alexandra Health Centre and University Clinic (AHC) and an immunisation coverage survey in September 1988. Forty-five clusters of 7 children aged 12-23 months were studied. Eighty-two per cent of mothers were in possession of a 'Road to Health' card, 12% said they had the card elsewhere, 3% reported it lost and 3% had never had a card. Thirty-three per cent of the children completed the immunisation schedule on time, 50% by 1 year of age and 61% by the time of the interview. The influence of sociodemographic, immunisation knowledge, and health service access variables on immunisation rates were analysed. Those children with a non-AHC 'Road to Health' card (P less than 0.01), the squatters (P less than 0.05), and those living farthest away from the clinic (P less than 0.05) were the only groups with a statistically significant lower on-time immunisation rate. Those children with a non-AHC 'Road to Health' card (P less than 0.01) and those whose caregivers could not or had difficulty reading a simple message in English (P less than 0.01 and P less than 0.05, respectively) had a significantly lower immunisation rate by 1 year of age and by interview. A child health outreach programme, started immediately after the survey, has begun to address some of the determinants of immunisation uptake described in this survey.
Adult↗
Did suturing services at Alexandra Health Centre need upgrading?
Due to financial restrictions patients at the Alexandra Health Centre (AHC) were sutured under conditions of cleanliness but not complete asepsis. A study was undertaken in 1987 to determine the need and priority for upgrading suturing services at AHC by determining the rate of wound sepsis after suturing in 348 consecutive patients during 1 month. One hundred and thirty-nine (40%) returned for removal of sutures, of whom 31 (22.3%) were assessed as having septic wounds, 15 (10.8%) with mild sepsis (inflammation only) and 16 (11.5%) severe (pus present). Depending on whether one considers mild or only severe sepsis and how one takes account of the effect of non-responders, the overall sepsis rate is between 4.6% and 22.3%. The only factor found to be a predictor of sepsis was clinically evident wound contamination. A follow-up study, undertaken to investigate the reasons for so many patients not returning to the AHC for removal of sutures, found that most patients removed their sutures at home. The literature is reviewed and the problems in defining sepsis and handling poor response rates are discussed. In all, we recommended that the introduction of complete asepsis should not occur at the expense of other priorities at the AHC.
Adolescent↗
Developing a health information system for a primary health care centre in Alexandra, Johannesburg.
The development of a health information system, which went through 6 overlapping phases, appropriate for a primary health care centre at the Alexandra Health Centre and University Clinic (AHC) is reviewed. The three essential concepts were data, information and indicators. The system at the AHC moved from unused data to unused information and to operational indicators. It also moved from a concern with data and information to one concerned with communication of information. The way a health information system evolves is, to a large extent, a reflection of the information needed by the group that is planning the system. In the AHC information needs were initially felt by senior management and attempts to involve other staff failed because of lack of timely feedback and a lack of management skills at all levels. In the process of trying to involve people and of getting to the correct type and amount of information, it became obvious that a health information system is complex and involves data as the major outputs, with people being the common thread of the system.
Community Health Centers↗
Support systems, facilities and staffing of clinics in Mhala, Gazankulu--are they adequate?
A study comprising in-depth interviews of sisters in all 15 rural clinics in the Mhala district of Gazankulu showed them to experience major problems with support systems: radiophone communication was unreliable (and even absent in 3 clinics); transport was inadequate; the cold chain was not well maintained and essential drugs and equipment were absent (only 1 clinic had all the equipment to manage a neonatal resuscitation adequately). There were also serious deficiencies in facilities, lack of running water and electricity posing the most serious problems (resulting in deliveries and suturing of episiotomies by candlelight). Other pressing problems include inadequate waiting space and patient privacy. Staffing at the clinics fell well below what is required, yet the commitment of staff was often inspiring. The state of the clinics must be seen within the constraints of 'homeland' policy and the unequal distribution of the country's health care resources. Despite these limitations the clinic service can be improved. Recommendations are made for this, concentrating on improving support structures rather than on the more costly improvement of facilities.
Ambulatory Care Facilities↗
Measuring environmental health status in Oukasie, 1987.
This article reports on some aspects of the physical environment and on environmental health services at Oukasie. The data were collected over a weekend in August 1987 by an interview and by direct inspection of the environment using a standard schedule. We had a 100% response rate on the interviews. There was a mean of 2.2 +/- 1.6 persons per room in the households, with brick houses being less crowded than non-brick houses. Private yards were generally kept very clean. Bucket latrines were unhygienic and used by an average of 4 families. No latrine was built to accepted standards. Garbage collection and emptying of the bucket latrines by the municipality seemed to be unsatisfactory. Our overall impression was that where responsibility for maintenance of hygiene is either undefined, such as the collection chambers of bucket latrines, or a responsibility of the public authorities, such as garbage collection and water drainage, there is an unsatisfactory state of hygiene. Where maintenance of cleanliness is clearly a private responsibility, such as the maintenance of the cleanliness of private yards, the general status of hygiene is good.
Black or African American↗
Community health survey of Oukasie, 1987.
A series of surveys were conducted at the request of the community of Oukasie to determine certain public health information in the township, a peri-urban black community. This article describes two of these surveys. The first, a census and partial demographic survey, showed that the total black population was around 6,300 with a mean household occupancy of 4.1. Some of the estimated vital statistics calculated were an infant mortality rate of 36.6/1,000, a crude birth rate of 28.0/1,000, a crude death rate of 6.5/1,000, and a general fertility rate of 99.3/1,000. The second survey into the nutritional and immunisation status of children aged under 5 years showed that 20% of children were underweight and nearly half were incompletely immunised at 1 year of age. These studies, involving local community and student volunteers, were rapidly and inexpensively done and provide basic public health information.
Adolescent↗
South African nurses' opinions of different organizations: policy implications.
There has been considerable debate in South Africa as to what type of organization would best represent the interests of nurses and facilitate their contribution to the achievement of changes in health care. This paper reports their background to and findings of the opinions of nurses in South Africa of different organizations, namely a professional nursing association, a health worker organization and a trade union. The results of the survey show that the South African Nursing Association has performed reasonably in meeting nurses' professional needs, but poorly in meeting their socio-economic needs. There is dissatisfaction with some of the Association's policies, widespread ignorance about trade unions and health worker organizations and resistance to strike action. The policy implications of the findings for the future organization of nurses in South Africa are explored.
Attitude of Health Personnel↗
[The usefulness of a difference in the transmucosal potential in the functional evaluation of ileoanal reservoirs].
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Adult↗
Unmet health care needs in the aged in two rural South African communities.
An evaluation of the unmet health care needs of all the aged people in two rural villages in the northern Transvaal was undertaken by assessing 7 indicators of health status to determine the prevalence of significant health problems and of receipt of health care for such problems. Oral health problems were found in 81% of the sample, visual problems in 62%, low peak expiratory flow in 48%, significant gastrointestinal symptoms in 38%, significant urinary symptoms in 32%, anaemia in 23%, and a lack of independence in 14%. There were 283 problems needing care, for which treatment had been received in the last year in only 30 instances (11%). The lack of care is attributed mainly to the inaccessibility of health services and the lack of health care resources in 'homeland' areas.
Black or African American↗
Urbanisation and health: methodological difficulties in undertaking epidemiological research in developing countries.
Rapid urbanisation has historically resulted in complex societal changes which have had both beneficial and adverse effects on the health of communities. Recently, it has been recognised that the urban poor in developing countries are at greatest risk for several adverse health effects. The epidemiologist has a key role to play in planning to meet current and future health needs of urban communities. Epidemiological research needs to focus on understanding the relationship between the changes that occur with urbanisation and their impact on health, in order to identify those at greatest risk, to identify the important risk factors that are amenable to intervention, and to evaluate the effectiveness of interventions aimed at improving the health of urban communities. This paper addresses several methodological difficulties in conducting epidemiological research on urbanisation and health in developing countries, with particular reference to Southern Africa. These relate to the definition of urban areas and residence thereof, the comparability across areas of exposure and outcome information, the identification of intra-urban variability, selection bias in cross-sectional studies, associating outcomes with specific urban exposures in analytic studies, and determining appropriate interventions and means of evaluation. Ways of overcoming these difficulties are suggested. Epidemiologists need to address these issues in order to make a valuable contribution to the improvement of health in urban communities.
Bias↗