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Biomedical subjects

P Arhan

Publications and source records attributed to P Arhan.

At least 19 recordsLinked to original sources
PubMed1992

Ureterorectal diversion with rectal augmentation. Morphological and manometric study in the dog.

Uretersigmoidostomy in the adult has progressively been abandoned because of its high complication rate (both metabolic and functional). We have studied the feasibility of a new model of ureterorectal diversion in 12 Beagle dogs, with the aim of increasing rectal capacity and decreasing rectal pressure. A segment of the ileum was isolated and opened along its antimesenteric border to obtain a patch into which the right ureter was implanted, the left ureter being left intact to allow comparison of the kidneys postoperatively. The patch was then sutured to the edges of a large anterior rectotomy. Modifications of rectal physiology were studied by recording the rectal pressure after distension by a latex balloon both preoperatively and 3 months postoperatively, so that it was possible to evaluate the elasticity of the rectal wall. Radiographic studies and examination of autopsy specimens after 3 months yielded the impression of a reservoir added to the rectal space. Intrarectal pressure was significantly decreased (50% of the preoperative value) for a given distension volume following rectal augmentation (P less than 0.01). The elasticity of the rectal wall was not modified but the capacity of the reservoir was increased. The ureteroileal implantation was patent in two of the five evaluable dogs out of seven implantations performed. In these cases, signs of pyelonephritis were found in the right kidneys. In the remaining cases the implantation became obstructed for reasons mainly related to canine anatomy and experimental conditions. These technical difficulties in the dog make it impossible to assess the quality of this reimplantation technique in this model.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

What is the meaning of colorectal transit time measurement?

This study was done to understand the different available methods used to calculate colorectal transit times. A single abdominal radiograph is taken following six successive daily ingestions of the same number of identical radiopaque markers. This method correlates well (P less than 0.001) with that using a single ingestion of markers with daily x-ray films until total expulsion. In techniques used to measure colorectal transit time with multiple ingestion of markers, the number of days of ingestion depends on the kinetics of marker defecation. This was found to differ markedly in various groups of control subjects and constipated patients (P less than 0.001) and can be used to obtain reliable data, even in subjects with severe constipation. When they ingest 20 markers, constipated patients are found to retain eight or more markers three days after ingestion, and taking a plain film of the abdomen on that day is sufficient to make a diagnosis of constipation. Transit time studies are reproducible from month to month in patients with an irritable bowel syndrome. Control subjects who claim that their bowel habits are not modified by stress have shorter transit times, similar in both sexes, than those who say they are (P less than 0.001). This may explain why a large percentage of constipated patients have been found by most authors to have "normal" colorectal transit times. The choice of control subjects is thus a key element in studies of functional bowel motor disorders. Stool frequency and consistency, in health, correlate only to rectosigmoid transit time.

Adult↗
PubMed1991

Achalasia of the esophagus in childhood. Surgical treatment in 35 cases, with special reference to familial cases and glucocorticoid deficiency association.

Achalasia of the esophagus is a relatively rare problem in children, but it may be the cause of severe lung disease, growth retardation and respiratory death in young infants. Surgical esophago-cardio-myotomy remains the treatment of choice, and this article details 25 years of experience with 35 children with achalasia of the esophagus and their late post-operative follow-up. The occurrence of achalasia in the first six months of life, the existence of a familial factor, the prevalent possible association with genetic diseases (familial dysautonomia, glucocorticoid insufficiency, Rozycki syndrome) suggest that achalasia in childhood may in certain cases represent a congenital problem, somewhat different from the adult form, which is considered to be an acquired disease.

Child↗
PubMed1990

[Irritable bowel syndrome in children].

In the adult, the irritable bowel syndrome is characterized by intestinal transit disorders associated or not with chronic abdominal pain. Two different forms can be seen: in one, pain and constipation are predominant, while in the other, pain and diarrhea alternate. The second form is encountered with predilection in the child. Various terms can be used to name the syndrome including colitis, non specific or benign colitis, irritable bowel syndrome in the child, infantile diarrhea, and others, all of which attests to our ignorance of the pathophysiology of this disorder. This syndrome is by far the most frequent cause of chronic or recurrent diarrhea in the child. Before the age of 3 or 4 years, the principal syndrome is diarrhea, which usually appears before the age of 6 months. Onset is generally brutal, as in acute enteritis or an extradigestive infection (ENT...) but persists, or else, more often, the syndrome appears insidiously over several days. The child has soft or liquid stools of fetid odor in most cases, very rarely sourish, inhomogeneous and in which intact aliments can be found. Stools are often associated with mucous discharge, rarely with blood, and do not contain any pus. Stools are not fatty but occasionally they are sticky and adhere to the pot. During the day, stools change from well formed in the morning to soft in the evening. Their frequency varies from one day to another as well as during a given 24 hour period, ranging from one or two to 10 per day.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1989

Idiopathic constipation by colonic dysfunction. Relationship with personality and anxiety.

The personality of two groups of constipated women (by delayed colonic transit or by colonic inertia) was compared to that of two control groups of arthritic patients (rheumatoid or degenerative disease) with the Minnesota Multiphasic Personality Inventory (MMPI). All subjects suffered from chronic pain. Constipated women were found to have significantly higher scores on the hypochondria, hysteria, control, and low back pain scales and a lower score on the masculinity-femininity scale. Discriminant analysis permitted us to sort out constipated from arthritic patients in 83% of the cases, on the basis of only the personality data. In women with constipation by delayed colonic transit, multiple regression analysis demonstrated a close link (r = 0.90; P less than 0.001) between transit time in the ascending colon and levels of anxiety. It is concluded that women with constipation of colonic origin have a different pattern of personality than arthritic women and that severe constipation may play the role of a defense mechanism, where psychophysiologic responses to life stresses replace normal emotional reactions.

Adolescent↗
PubMed1989

Functional evaluation of gastric transplants used in esophageal reconstruction.

Gastric transplants using the Akiyama method were used to treat esophageal carcinoma in 12 patients. Endoscopic examination, prolonged manometry (greater than 30 min), and 24 h pH monitoring were performed postoperatively to evaluate functional results. All patients could swallow without difficulty at the time of examination and had no dysphagia, regurgitation, heartburn, or sensation of abdominal fullness. Histologic examinations of residual esophagus showed microscopic esophagitis in 5 patients. Percentage of time that pH less than 4 was 42.6 +/- 10.9% (mean +/- SEM) and median pH was 4.3 +/- 1.0. The manometric examination showed no 'esophageal-like' peristaltic waves, but synchronous contractions were demonstrated in 9 patients, gastric type activity in two patients, and no activity was detected in one patient. We conclude that retained gastric peristaltic function is not a prerequisite for a good clinical outcome for swallowing and that despite vagotomy, the stomach continues to produce enough acid to maintain an acidic pH.

Aged↗
PubMed1989

Morphology and rheology of the rectum in patients with chronic idiopathic constipation.

To evaluate whether there is a relationship between the viscoelastic properties of the rectum and its surface, barium enema and rectal accommodation studies were performed under standard conditions in 46 subjects (25 adults, 21 children) with chronic idiopathic constipation. In adults, a significant correlation was found between rectal surface at barium enema and the minimum radius of rectal distention with a balloon necessary to higher wall tension changes (r = 0.68; P less than 0.01). In both adults (r = 0.48; P less than 0.05) and children (r = 0.57; P less than 0.01), negative correlations were found between the surface of the rectum and its elasticity. It is concluded that rectal accommodation studies produce data comparable to those of radiologic examinations and may therefore be used repetitively, and without fear of radiation, as follow-up studies on constipated patients.

Adult↗
PubMed1989

[Sigmoid motility stimulated by luminal distention. Changes in the motility response in constipation by the slowing down of left colonic transit].

The aim of our study was to develop a new technique of sigmoid manometry using standardized luminal distensions and to compare patterns of colonic motility following distension in normal subjects and in constipated patients. Eight subjects without colonic disturbances and 8 constipated patients with delayed transit time of the left colon as shown by radiopaque markers were investigated. Sigmoid motor activity was recorded by measuring pressure in a distending latex balloon placed at 25 cm from the anus. Inflations were maintained during 250 s and separated by 60 s recovery periods of deflation. Volumes of air (V) were increased until the patient reported abdominal pain (VMT). For each distension level, the resistance to distension of the bowel wall evaluated by the baseline adaptative pressure (P) and the contractile activity (A) quantified by planimetry of the active contractile activity (A) quantified by planimetry of the active contraction waves superimposed to P were assessed. In normal subjects, VMT was 147 +/- 9 ml. P increased linearly with V (p less than 0.03) up to 4,336 +/- 876 Pa. A increased with V until VMT/2 reached the maximum of 389 +/- 72 Pa*; for higher volumes A decreased significantly with to 166 +/- 46 Pa for VMT. Reference to controls, the constipated patients had a decreased VMT (61 +/- 4 ml). P increase at VMT (5,084 +/- 753 Pa) and A maximal value (387 +/- 176 Pa) were not different.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1979

[Constipation in the infant (author's transl)].

The authors studied 102 cases of constipation in children. 76 of them went through a protocol of investigations : clinical, psychological, radiological and manometric. The authors suggest that so-called functional constipation is more often organic than is commonly thought.

Adolescent↗
PubMed1979

Traumatic constipation.

In 4 patients, trauma to the lumbosacral area produced abnormalities similar to those seen after resection of the nervi erigentes. Mechanisms of the resulting constipation and fecal incontinence for liquid stools included a prolonged transit time through the entire colon, a low rectal pressure, spasticity of the anal canal, and abnormal anal reflexes. Previous trauma to the lower spine must be considered in the differential diagnosis of chronic constipation.

Adolescent↗
PubMed1978

Viscoelastic properties of the rectal wall in Hirschsprung's disease.

Viscoelastic properties of the rectal wall were compared with Hirschsprung's disease. The elasticity of the rectal wall after accomodation to distension was found to be significantly greater (P less than 0.001) in patients, and the time taken by the rectum to accomodate was also found to be longer (P less than 0.001). The increased elasticity correlated well with severity of the illness, but none of the parameters correlated with length of aganglionic segment. Measuring elastic properties of the rectal wall may help to assess the severity of illness in patients with Hirschsprung's disease.

Adolescent↗
PubMed1978

Some parameters of large bowel motility in normal man.

This study presents normal values of bowel habits, colonic transit times of radioopaque markers, and anorectal pressure obtained from 114 normal subjects. Their stool frequency ranged from 3 to 11 per 7 days, whereas their diet contained an average of 14.4 g of crude fibers. Radioopaque markers progressed regularly along the large bowel and a range of transit times was established for its different segments. Manometric studies included measurements of anal pressure at rest, amplitude and duration of the rectoanal inhibitory reflex, anal inflation reflex, and amplitude of rectal contraction in response to rectal distension. Normal ranges were established. Amplitude, duration and magnitude (as measured by planimetry) of anal relaxation elicited by rectal distensions were related to rectal distending volume (P less than 0.001). The incidence of spontaneous variations of anal pressure at rest and of overshoot of pressure after the inhibitory reflex was also established. These data obtained on normal subjects may be compared to those obtained in patients with constipation in order to define the symptoms and to understand pathophysiological mechanisms. This has been done in a companion study.

Adolescent↗
PubMed1978

Mechanisms of idiopathic constipation: outlet obstruction.

Anorectal myectomy was performed in 62 patients suffering from symptoms attributed to ineffective colonic motility. Indications for surgery rested on the presence of one or more of the following three criteria: abnormally reduced stool frequency, prolonged transit of radioopaque markers, and abnormal anorectal manometry. One year after myectomy in the 50 patients with less than three stools per week the average number of stools per week increased from 1.2 to 4.2 (P less than 0.001). The remaining 12 patients, who had more than three stools per week, were completely relieved of their symptoms. In all cases with improved symptoms, myectomy acclerated the transit of radioopaque markers through the large bowel. Organic constipation amenable to surgical treatment is more frequent than previously thought. Idiopathic constipation may result from colonic inertia or outlet (anorectal) obstruction.

Adolescent↗