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Biomedical subjects

R Emblem

Publications and source records attributed to R Emblem.

At least 37 records · Page 2Linked to original sources
PubMed1994

The importance of anal endosonography in the evaluation of idiopathic fecal incontinence.

PURPOSE: The aim of the study was to evaluate the use of anal endosonography in idiopathic incontinence. METHODS: In 29 patients and 26 normal controls, the relationship between sonography images and physiologic parameters was studied. RESULTS: External anal sphincter function, measured as fiber density by single-fiber electromyography (P = 0.0001) and pudendal nerve terminal motor latency (P = 0.04), was significantly impaired in patients with idiopathic incontinence compared with controls. Both the external and internal and sphincter could be identified by anal endosonography, and the thickness directly measured. The thickness of the external anal sphincter was significantly negatively correlated to muscle fiber density (r = -0.65, P = 0.002) and to pudendal nerve distal conduction velocity (r = -0.74, P = 0.008). The thickness of the internal anal sphincter was significantly correlated to resting pressure (r = -0.67, P = 0.0001). CONCLUSION: The ratio between the thickness of the external and internal sphincter muscles measured on the sonography screen was significantly reduced in patients with neurogenic incontinence compared with controls (P < 0.01).

Adult↗
PubMed1994

Anal endosonography and physiology in adolescents with corrected low anorectal anomalies.

Sixteen patients aged 12 to 16 years (mean, 14.9) with corrected low anorectal anomalies, and eight age-matched controls were studied. Eight patients were totally continent, six had staining, and two had fecal soiling. Half the patients had trouble with constipation. The grade of incontinence was related to significantly reduced resting and squeeze pressure in the anal canal. Girls had significantly worse results than boys. The anal sphincter muscle complex was visualized by anal endosonography, and images of the external anal sphincter corresponded to the results of the surface electromyography. In addition, anal endosonography provided a detailed picture of all perianal structures including the internal anal sphincter. Anal endosonography supplements other imaging techniques for assessing the perianal structures in patients who have an accessible anal canal.

Adolescent↗
PubMed1994

A psychosocial follow-up of ten adolescents with low anorectal malformation.

Ten adolescents, aged 12-16 (mean 14.5) years, with corrected low anorectal anomalies were assessed with regard to somatic condition, psychopathology and psychosocial functioning by semistructured interviews and questionnaires. Half of the patients still had a persistent dysfunction involving problems with constipation and/or soiling. Six of 10 adolescents met the criteria for a psychiatric diagnosis and had scores indicating mild to severe impairment of psychosocial function. Psychosocial functioning was correlated with chronic family difficulties. The findings are in contrast to previous studies and reveal hidden problems and unmet social needs. To optimize their mental health and psychosocial functioning, children with low anorectal anomalies need both somatic and psychosocial follow-up.

Adaptation, Psychological↗
PubMed1993

Progress in the treatment of biliary atresia: a plea for surgical intervention within the first two months of life in infants with persistent cholestasis.

During the period 1984-1991, 21 infants with biliary atresia were treated with Kasai's portoenterostomy. The median survival in infants operated on before the age of 60 days (55 (range 5-82) months) was significantly longer than the survival of children operated on after the age of 60 days (15 (1.5-38) months). At present there are 10 survivors with a median age of 54 (17-96) months; 6 with portoenterostomy and 4 after liver transplantation. Eight patients died of progressive liver failure and 3 died of causes not related to biliary atresia. Apart from blood tests, ultrasonography was the most important investigation before laparotomy in infants with cholestatic jaundice. Scintigraphy and liver biopsy added no further decisive information. Because early diagnosis and surgical treatment is important, only the well documented presence of a normal gallbladder can warrant postponement of an operation.

Age Factors↗
PubMed1993

Current results of surgery for achalasia of the cardia.

Several treatment options are available in the management of achalasia of the cardia. Of a recent series of 14 children, 12 were treated by a modified Heller's myotomy combined with a floppy Nissen fundoplication. Symptoms were dramatically improved in nine during a mean follow up period of 3.9 years. Recurrent oesophageal pain was the most resistant symptom and continued to be moderately severe in three patients, two of whom obtained temporary relief by oesophageal balloon dilatation. Two patients treated by pneumatic dilatation alone have residual symptoms. These results support a primary surgical approach to the management of achalasia in children.

Adolescent↗
PubMed1990

[Gender neutrality in medical research--possible and desirable?].

Medical science has been produced by men. A female surgeon concludes that, compared with complications in male patients, complications in female patients have been underrepresented in medical literature. In surgery the choice of fields of research and surgical methods is based mainly on the personal evaluations of the scientists, (female or male), and only partly on legitimatized scientific parameters. There are still very few women researchers in medical science. This science should be produced by both male and female researchers if it is to be equally fair and offer equally good medical service to female and male patients.

Female↗
PubMed1989

The effect of loperamide on bowel habits and anal sphincter function in patients with ileoanal anastomosis.

The effect of loperamide on stool frequency, volume, and weight and on the function of the internal (IAS) and the external (EAS) anal sphincter was investigated in 19 patients with straight ileoanal anastomosis. Nine patients had intact anal sphincter function (group I), and in the other 10 the function of the anal sphincters was impaired (group II). After 72 h without any medication, the patients were investigated on a standard diet on 2 consecutive days: the 1st day with placebo, and the 2nd day with loperamide (16 mg). Stool collection and anal sphincter manometry/electromyography (EMG) were done on both days. The median number of stools was reduced from 10 and 13.5 to 6 and 7 per 24 h (p less than 0.01), and the fecal weight reduced from 600 and 900 g to 400 and 500 g (p less than 0.01) from the placebo day to the loperamide day in groups I and II, respectively. The tone of the IAS was significantly increased by loperamide in group I but remained unchanged in group II patients. The EAS function, determined by EMG and pressure measurements, was not significantly changed in any group by loperamide.

Adult↗
PubMed1989

Anal sphincter function after colectomy, mucosal proctectomy, and ileoanal anastomosis.

Anal sphincter investigations were performed in 41 patients with straight ileoanal anastomosis and in 10 controls. In 20 patients (group I) the mucosal stripping had been performed from the abdominal side, leaving 1-2 cm of distal anal mucosa. In 21 patients (group II) the anal mucosa had been stripped from the perineal side as far as the dentate line. Continence was perfect in all patients in group I and poor in 6 of 17 patients in group II, when examined 12 months after the operation. Anal canal resting pressure was normal in group I. In group II the resting pressure was significantly decreased and correlated to continence function. The maximum anal canal squeeze pressure was the same in the two groups. The slope of the regression line between pressure rise and integrated electromyography proved to be a useful criterion of the external anal sphincter function and was significantly correlated to degree of incontinence. This variable was significantly smaller in group II patients than in group I and controls. Thus, function of the anal sphincters was normal after mucosal proctectomy performed from above with preservation of a mucosal brim. Dysfunction of the internal and external anal sphincter was found after perineal mucosal dissection and was correlated to continence function.

Adult↗
PubMed1989

Failed ileoanal anastomosis: correlations between clinical function and anal canal neurophysiologic and histologic examinations.

Ten patients with an ileoanal anastomosis had conversion to permanent ileostomy 13 (range, 6-29) months after the primary procedure. Causes for reoperation were incontinence in seven patients, unacceptable stool frequency without incontinence in two patients, and atypia in the mucosal remnant with perfect continence in one patient. Stool frequency, continence function, anal canal resting pressure, external anal sphincter (EAS) EMG/pressure relationship (in terms of slope, m), EAS fiber density (FD), and pressure in the distal ileum were registered, and the mucosa and the anal sphincter muscles were examined histologically. There were significant correlations between continence function and EAS changes in terms of both neurophysiologic tests (m and FD) and the histologic picture. The abnormalities in six incontinent patients were consistent with denervation of the EAS. The main reason for fecal leakage in one patient was the high amplitude of pressure waves in the distal ileum. Preservation of mucosal epithelium proximal to the dentate line per se did not seem essential to maintain continence.

Action Potentials↗
PubMed1988

Straight ileoanal anastomosis with preserved anal mucosa for ulcerative colitis and familial polyposis.

Thirty-two patients were treated with colectomy, mucosal proctectomy, and straight ileoanal anastomosis. Mucosal dissection was performed from the abdominal side, and an anal mucosal brim of 1-2 cm was preserved. Diverting ileostomy was not used, and four patients developed anastomotic leak with pelvic sepsis. Three patients had take-down of the anastomosis for reasons related to the operative method. The remaining patients are all completely continent day and night and have a median stool frequency of 6/24 h 1 year after the operation. The frequency was significantly higher in patients with ulcerative colitis (UC) than in patients with familial polyposis (FP). No dysplasia, ulceration, or stricture formation was found in the preserved mucosa in the UC patients. Regrowth of polyps in the mucosal brim occurred in 10 of 13 FP patients, with atypia in 1. The FP patients had more late complications attributed to extracolonic manifestations of the FP disease.

Adenomatous Polyposis Coli↗
PubMed1988

Mucosal proctectomy with straight ileoanal anastomosis. A comparison of two methods.

Straight ileoanal anastomosis was performed in 59 patients. In 32 patients (group I) mucosal dissection was performed from above with preservation of a distal mucosal brim. In 27 patients (group II) the mucosectomy was performed to the dentate line--in 26 patients from the perineal side and in 1 patient from the abdominal side. Diverting loop ileostomy was used in group II but not in group I. The results in group II were in every respect inferior to those in group I, with significantly more intestinal obstruction and more conversions to permanent ileostomy because of poor functional results. The patients with ulcerative colitis (UC) in group II had higher stool frequency (10 (6-12) versus 7.3 (5-8) per 24 h; p = 0.01) and significantly less 'neorectal' capacity and distensibility than the UC patients in group I at 12 months after the operation. Anal continence was perfect in group I. In group II, 5 of 15 of the patients had significant incontinence problems 12 months postoperatively. The differences in results are ascribed to the differences in surgical technique between the two groups, and especially to the harmful effect of anal dilatation.

Adult↗
PubMed1988

Operative treatment of ulcerative colitis: conventional proctectomy with Brooke ileostomy versus mucosal proctectomy with ileoanal anastomosis.

Fifty-four patients with ulcerative colitis were operated on during a 3-year period; 35 had conventional proctectomy and Brooke ileostomy, and 19 had mucosal proctectomy, performed from the abdominal side, leaving 1-2 cm of the distal anal mucosa, and a straight ileoanal anastomosis (IAA) without diverting ileostomy. There were no operative deaths. In the ileostomy group 19 (54%) of the patients had a total of 38 reoperations: 10 laparotomies and 28 revisions of a perineal sinus. Three (16%) of the IAA patients had a total of five reoperations: four laparotomies and one closure of a loop ileostomy. All IAA patients had perfect continence day and night and a median stool frequency of 7.5/24 h 1 year after the operation. Ileostomy patients had significantly longer time out of work, and more urinary, sexual, and social dysfunctions than the IAA patients. After 2-3 years' follow-up study, all differences in results are greatly in favour of the ileoanal procedure.

Adult↗
PubMed1985

Ferrochelatase deficiency in the bone marrow in a syndrome of congenital hypochromic microcytic anemia, hyperferremia, and iron overload of the liver.

Two sisters had congenital hypochromic microcytic anemia with hyperferremia, heavy iron deposits in the liver, and reduced bone marrow iron. Liver ferrochelatase activity was within normal limits, but in the bone marrow ferrochelatase activity was only 20% of that in healthy controls. There were no findings suggestive of lead intoxication, sideroblastic anemia, or erythropoietic protoporphyria.

Adult↗
PubMed1985

Adult Wilms tumor. A case report.

We report a case of Wilms tumor in an adult. Pictorial and descriptive pathology information is included. The tumor was stage IV with pulmonary metastasis at diagnosis. The patient was treated with surgery and combined chemotherapy according to protocols used in childhood Wilms tumor. The patient is clinically free of disease at 21 months postoperatively.

Adolescent↗