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Biomedical subjects

R Farouk

Publications and source records attributed to R Farouk.

48 records · Page 3Linked to original sources
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

Evidence of electromechanical dissociation of the internal anal sphincter in idiopathic fecal incontinence.

PURPOSE: This study was designed to evaluate the relationship between internal sphincter electromyographic frequency and ambulatory anal pressures in order to clarify the pathophysiology of internal anal sphincter dysfunction in fecal incontinence. METHODS: Seventy-two patients of median age 55 years (range, 24-75; 63 females) with neurogenic fecal incontinence and 33 normal subjects of median age 48.5 years (range, 25-74; 21 females) underwent fine-wire anal sphincter electromyography and anal manometry. RESULTS: The median internal anal sphincter electromyographic frequency was incontinent 0.25 Hz (0.2-0.34) and the control was 0.44 Hz (0.36-0.55; P < 0.03). Ambulatory resting pressures were incontinent median 54 cm of H2O (34-68 cm of H2O) and control 94 cm of H2O (72-102; P < 0.01). Internal sphincter electromyographic frequency correlated with anal resting pressures in both groups (P < 0.002). Internal sphincter electromyographic silence not attributable to electrode movement or the rectoanal inhibitory reflex, lasting 0.5 to 4 minutes occurred in all but two of the incontinent patients. The anal pressure during this period did not significantly change (P > 0.1). No recruitment of the external sphincter or puborectalis was noted during these episodes. Such electromechanical dissociation was not seen in the control group. The frequency of transient internal sphincter relaxation was 4 (ranges 2-6) per hour in controls and 8 (ranges, 6-12) per hour in incontinent patients (P < 0.01). Rectal pressures did not exceed midanal pressures in any of the controls but did in all of the incontinent patients on at least one occasion per hour in the incontinent group. CONCLUSION: Internal anal sphincter activity exhibits electromechanical dissociation and relaxes abnormally in incontinent patients.

Adult↗
PubMed1994

Sustained internal sphincter hypertonia in patients with chronic anal fissure.

PURPOSE: This study was designed to determine whether functional variations of internal sphincter activity occur in order to differentiate between patients with anal fissures from those with hemorrhoids. METHODS: Thirty patients with chronic anal fissure (median age, 28 years; 12 females), 22 patients with hemorrhoids (median age, 37 years; 7 females), and 33 control volunteers (median age, 48.5 years; 21 females) underwent ambulatory anal sphincter fine-needle electromyography and anorectal manometry. RESULTS: The median internal sphincter electromyography frequency was similar: fissure group, 0.49 Hz; hemorrhoid group, 0.46 Hz (P > 0.05), and control group, 0.44 Hz (P > 0.05). Median anal resting pressures were similar in the fissure group (132 cm. H2O) and the hemorrhoids group (116 cm of H2O) (P > 0.05), but significantly greater than those in the control group (94 cm. H2O) (P < 0.05). The median number of transient relaxations of the internal and sphincter with an associated rise in rectal pressure and fall in anal pressure was 1 (range, 0-4) per hour in the fissure group, 6 (range, 4-7) per hour in the hemorrhoid group, and 4 range, 3-6) per hour in the control group. Six patients with fissures were reassessed following lateral internal sphincterotomy. Median and pressure was 102 cm of H2O (P > 0.1 vs. controls) and the number of internal sphincter relaxations increased to 4 per hour (P < 0.01 vs. preoperative number). CONCLUSIONS: Internal anal sphincter relaxation occurs on fewer occasions in patients with chronic anal fissures that have failed to heal in comparison to patients with hemorrhoids and normal controls. This evidence further supports the hypothesis that internal sphincter hypertonia may be relevant to the pathogenesis of this disorder.

Adult↗
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↗
PubMed1993

Internal anal sphincter dysfunction in neurogenic faecal incontinence.

Forty-eight patients of median age 57 years with neurogenic faecal incontinence and 44 normal subjects of median age 51 years underwent fine-wire anal sphincter electromyography and anal manometry. The median (interquartile range (i.q.r.)) internal anal sphincter (IAS) electromyogram frequency was 0.26 (0.21-0.32) Hz for patients with faecal incontinence and 0.44 (0.31-0.55) Hz for controls (P < 0.01). The median (i.q.r.) ambulatory resting pressure was 48 (34-68) cmH2O for patients and 86 (72-102) cmH2O for controls (P < 0.01) and median (i.q.r.) frequency of transient IAS relaxations 9 (7-12) and 4 (3-7) per h respectively (P < 0.05). Mid-anal pressure fell to a greater extent in patients with incontinence during these episodes of transient IAS relaxation. Rectal pressure during such relaxation did not exceed mid-anal canal pressure in controls; for the patient group, rectal pressure increased during relaxation and exceeded mid-anal canal pressure in 36 cases. Frequent abnormal episodes of IAS relaxation may cause occult faecal leakage in patients with neurogenic faecal incontinence.

Adult↗
PubMed1993

The clinical contribution of integrated laboratory and ambulatory anorectal physiology assessment in faecal incontinence.

To determine the clinical value of anorectal physiology testing, we have assessed 73 patients with neurogenic incontinence (median age 55 years, 60 female) and 115 controls (median age 48 years, 81 female). All the faecally incontinent patients displayed abnormal anal mucosal electrosensitivity and prolonged pudendal nerve latencies. Rectal compliance was poor in 14% of patients with neurogenic incontinence. Twenty-seven sphincter injuries were identified by endoanal ultrasonography in patients with neurogenic incontinence. Anal sphincter electromyographic abnormalities were demonstrated in all the incontinent patients. Anal pressures were lower in the incontinent group. Frequent, abnormal internal sphincter relaxations were observed in patients with incontinence during ambulatory assessment. These tests provide objective evidence of injury but do not frequently affect clinical decision making. Endoanal ultrasonography and ambulatory assessment provided clinical information of the mechanism of incontinence in 60% of patients.

Adult↗
PubMed1993

[Intermittent electromechanical dissociation of the internal anal sphincter in idiopathic fecal incontinence].

Ten patients with median age of 51 years (range 24-75; 9 female) presenting idiopathic faecal incontinence and twelve normal subjects with median age of 34 years (range 25-71; 5 female) underwent fine wire anal sphincter electromyography and anal manometry. The results were analysed using non-parametric methods of statistical analysis. The median IAS EMG was 0.30 Hz (range 0.18-0.38), in incontinent and 0.48 Hz (range 0.31-0.55) in controls; p. < 0.01. Ambulatory resting pressures were a median of 66 cmH2O (range 49-83 cmH2O), for the incontinent and 82 cmH2O (range 66-120) for controls; p < 0.04. IAS EMG frequency correlated with resting anal pressures in both groups (p < 0.003). IAS EMG silence not attributable to electrode movement or to the recto-anal inhibitory reflex, lasting 0.5-4 minutes, occurred in all but two of the incontinent patients. No recruitment of the external sphincter or puborectalis muscle was noted during these episodes. Such electromechanical dissociation was not seen in the control group.

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

Excessive wastage of blood resources in elective colorectal surgery.

A prospective study of perioperative blood transfusion requirements for elective colorectal surgery over a 6-month period has been conducted. A total of 106 procedures was performed, 94 of which were for malignancy. A median of 2 units of packed red cells was cross-matched per patient. Twenty-three patients (21.7%) required a transfusion in the postoperative period. Fourteen of these patients required a second cross-match sample because their transfusion occurred more than 48 h after the original request. The greatest transfusion requirements were for patients undergoing abdominoperineal resection or subtotal colectomy. Routine perioperative cross-matching and reservation of blood for elective colorectal surgery may be an unnecessary expense, resulting in wastage of resources. A selective policy of serum being retained for grouping in these patients is justified.

Adult↗
PubMed1990

Malignant left-sided large bowel obstruction managed by subtotal/total colectomy.

Of 60 patients presenting with acute obstructing carcinoma of the left colon, 49 underwent immediate resection either by radical subtotal/total colectomy (31 patients, group I) or by radical segmental resection (18 patients, group II) of whom three had immediate anastomosis after on-table bowel irrigation and 15 had a planned staged procedure. The operative mortality rate was 3 per cent in group I and 11 per cent in group II (not a statistically significant difference). However, substantial differences were found for major morbidity (6 versus 44 per cent in groups I and II respectively; P less than 0.01) and mean length of hospital stay (17 days in group I versus 35 days in group II; P less than 0.05). All three patients who had on-table lavage developed anastomotic leaks which necessitated a second operation to form a stoma. Six patients (19 per cent) in group I required antidiarrhoeal medication in the immediate postoperative period. However, subsequent improvement in stool frequency was noted in all patients. It is concluded that subtotal/total colectomy is an acceptable means of managing patients with obstructing carcinoma of the left colon in that it is associated with a low morbidity and mortality rate and good functional results.

Aged↗
PubMedDate not supplied

[The functional recovery of the internal anal sphincter and the restoration of continence after rectopexy for rectal prolapse].

Eleven patients with full thickness rectal prolapse underwent ambulatory fine wire electromyography (EMG) of the internal anal sphincter (IAS), external anal sphincter and puborectalis muscle, and anorectal manometry using a computerised system. Examinations were performed preoperatively and at 3 months following rectopexy. The median preoperative IAS EMG frequency was 0.21 Hz (range = 0.05-0.30) and the median preoperative resting anal pressure (RAP) was 13 cmH2O (range = 2-84 cmH2O). A significant improvement in the IAS EMG frequency (median = 0.31 Hz; 0.23-0.47 Hz; p < 0.02) and RAP (median = 30 cmH2O; 20-84 cmH2O; p < 0.01) was noted post-rectopexy but these parameters remained significantly different from a group of normal controls (median IAS EMG frequency = 0.48 Hz; 0.25-0.61 Hz; median RAP = 76 cmH2O; 22-120 cmH2O). We suggest that repair of the prolapse allows the IAS to recover by removing the cause of persistent recto-anal inhibition.

Adult↗