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Biomedical subjects

U Karlbom

Publications and source records attributed to U Karlbom.

8 recordsLinked to original sources
PubMed1999

Defecographic study of rectal evacuation in constipated patients and control subjects.

PURPOSE: To validate a computer-based area calculation method of quantification of rectal evacuation by using defecography videotapes and to use that method to compare evacuation in constipated patients with that in control subjects. MATERIALS AND METHODS: For validation of the method, simultaneous defecography and weight measurements were compared in 36 patients with constipation or incontinence. Evacuation was calculated as the rate of change of the contrast medium-covered rectal area (percentage per second) or of the evacuated amount of contrast medium (percentage per second [relative] and grams per second [absolute]). After method validation, from a series of 215 consecutive constipated patients, individuals with an isolated radiologic diagnosis of intussusception greater than 0.6 cm (n = 27), rectocele greater than 2 cm (n = 19), enterocele (n = 12), or paradoxic puborectal muscle contraction (n = 12) were selected. Rectal evacuation in these groups was compared with that in 30 control subjects. RESULTS: Rectal evacuation rates measured at defecography correlated well with weighed amounts of evacuated contrast medium during the initial and total evacuation periods in 21 patients without contrast medium leak (r = 0.92, P < .001). Constipation overall, a rectocele greater than 2 cm, or paradoxic puborectal muscle contraction were associated with impaired evacuation (P < .001). CONCLUSION: Area calculations of rectal evacuation reflect rectal emptying. A rectocele greater than 2 cm or a paradoxic puborectal muscle contraction may be associated with obstructed defecation.

Adult↗
PubMed1998

Paradoxical puborectalis contraction is associated with impaired rectal evacuation.

The role of paradoxical puborectalis contraction in the aetiology of constipation and how to best diagnose this condition is controversial. The aims of this study were to investigate whether absolute or relative paradoxical electrical activity during electromyography (EMG) are related to rectal emptying and to compare EMG, defecography and digital examination in the diagnosis of paradoxical puborectalis contraction. Included in the study were 171 consecutive patients with idiopathic constipation; 136 of these cases were also classified as paradoxical or unclear or not paradoxical at digital examination. Absolute amplitudes and a strain/squeeze index were used to grade the EMG activity in the puborectalis and external sphincter muscle. Rectal evacuation was analysed by defecography with image analysis of rectal area. The results showed that 142 patients had paradoxical EMG activity during straining. There was a correlation between rectal evacuation and amplitudes (r = -0.20 to -0.03, P < 0.01) and between evacuation and index (r = -0.34 to -0.39, P < 0.0001). Forty-two patients with an index of > 50 had impaired rectal evacuation compared with those with an index < or = 50 (P < 0.0001). Thirty-three of 34 cases (n = 136) with an index of > 50 also were paradoxical at defecography whereas 19 were diagnosed digitally. In conclusion, paradoxical puborectalis contraction is associated with impaired rectal evacuation. The activity seems to be best reflected by a strain/squeeze index. The best correlation in diagnostic methods was between EMG and defecography.

Adult↗
PubMed1997

Results of biofeedback in constipated patients: a prospective study.

PURPOSE: The aims of this study were to assess the results of biofeedback treatment in constipated patients and to identify variables that might be used to predict the outcome. METHOD: Twenty-eight patients (5 men; median age, 46 (range, 22-72) years) with any degree of paradoxical activation measured with thin hook needle electromyography in the external sphincter or puborectalis muscle were included. The symptom duration varied between 1 and 30 (median, 9) years. The patients had eight outpatient training sessions with electromyography-based audiovisual feedback. All patients were followed up prospectively with a validated bowel function questionnaire from which a symptom index was created. RESULTS: At three months, nine patients had no improvement and underwent other treatments. The remaining 19 patients were followed up for a median of 14 (range, 12-34) months. Twelve patients (43 percent) stated they had improved rectal emptying. A good result was associated with increased stool frequency (P < 0.05), improved symptom index (P < 0.01), and reduction of laxative use (P < 0.05). A long symptom duration, a high pretreatment symptom index, and laxative use were related to a poor result (P < 0.01-0.05). The improved group had less perineal descent (P < 0.05), and a prominent puborectalis impression on defecography tended to be more common (P = 0.06). CONCLUSION: With the use of wide inclusion criteria, biofeedback was successful in 43 percent of patients, with a treatment effect lasting at least one year. The results suggest that biofeedback should be used as the initial treatment of constipated patients with a paradoxical puborectalis contraction.

Adult↗
PubMed1996

Does surgical repair of a rectocele improve rectal emptying?

PURPOSE: This study was undertaken to assess results of surgical repair of rectocele and to identify possible determinants of outcome from patient's history and preoperative defecography. Another aim was to evaluate how surgery affects rectal evacuation. METHOD: Thirty-four women with constipation and rectal emptying difficulties underwent surgery with a transanal technique. A preoperative defecography was performed in each patient. They were followed up after a median of 10 (range, 2-60) months with a questionnaire (n = 34) and a defecography (n = 31). Computer-based image analysis of defecographies was used to evaluate rectal evacuation. RESULTS: In 27 patients (79 percent), the result of surgery was good with subjectively improved emptying. The need for vaginal or perineal digitation preoperatively was related to a good result (P < 0.05), whereas a previous hysterectomy (P < 0.01) and a large rectal area on defecography (P < 0.01) related to a poor result. Preoperative use of enemas, motor stimulants, or several types of laxatives also related to a poor outcome (P < 0.05). Surgical treatment resulted in reduction of the rectocele (P < 0.001), an elevated position of the anorectal junction (P < 0.05), and improved rectal evacuation on defecographies (P < 0.001). CONCLUSIONS: Surgical repair reduces the size of the rectocele and improves rectal emptying. These changes are accompanied by a symptomatic improvement in the majority of patients. Preoperative patient data and defecography may help in selecting patients for surgery.

Adult↗
PubMed1996

Evaluation of a questionnaire in the assessment of patients with faecal incontinence and constipation.

BACKGROUND: A self-reported questionnaire may be a useful instrument in assessing patients with faecal incontinence and constipation. METHODS: Reliability, discrimination, validity, and sensitivity were evaluated in 16 control subjects 36 patients with faecal incontinence, and in 38 with constipation. The reliability was measured by a test-retest procedure (kappa (kappa) statistics or Spearman rank test), and validity by comparing the questionnaire and a diary. Discrimination was assessed by comparing the patient groups with the controls, and sensitivity by comparing selected answers before and after treatment. RESULTS: Overall reliability (faecal incontinence group, mean kappa = 0.57; constipation group, mean kappa = 0.60; controls, mean kappa = 0.95) and validity were judged acceptable. In the incontinence group occurrence of faecal incontinence per se was reproducible (kappa = 0.66), as was the need to wear a pad (kappa = 0.85). Stool frequency, percentage toilet time spent straining and digitation was reproducible in patients with constipation (kappa = 0.80, r = 0.56; p < 0.001, kappa = 0.83 respectively). Several items distinguished both patient groups from healthy controls (p < 0.05 to p < 0.001). Sensitivity to surgical treatment was seen in several items in both patient groups. CONCLUSIONS: The questionnaire appears to be a valid measure of symptoms in faecal incontinence and constipation with sufficient discriminatory capacity.

Case-Control Studies↗
PubMed1996

Functional results after abdominal suture rectopexy for rectal prolapse or intussusception.

OBJECTIVE: To assess the functional outcome after suture rectopexy in patients with rectal prolapse or intussusception. DESIGN: Retrospective study. SETTING: University hospital, Sweden. SUBJECTS: 33 patients with rectal prolapse and 19 patients with intussusception treated by abdominal suture rectopexy 1969-1992. MAIN OUTCOME MEASURES: Bowel function evaluated by a questionnaire a median of 97 months after operation. RESULTS: 10/33 patients (30%) reported less constipation after rectopexy in the prolapse group compared with 3/19 (16%) in the intussusception group (p = 0.33). Rectal emptying improved in 14/33 (42%) and 1/19 (5%), respectively (p = 0.005), and incontinence in 12/33 (36%) and 3/19 (16%), respectively (p = 0.20). Seventeen patients (52%) with prolapse and 3 (16%) with intussusception described the result of operation as excellent or good (p = 0.02). CONCLUSION: There is a reasonable chance of improved rectal emptying and continence in patients undergoing suture rectopexy for rectal prolapse, whereas bowel symptoms commonly worsen postoperatively in patients treated for intussusception.

Adult↗
PubMed1995

Relationships between defecographic findings, rectal emptying, and colonic transit time in constipated patients.

The relations between defecographic findings, rectal emptying, and colonic transit time were analysed in 80 constipated patients (median age 49 years, range 22-87). Patients were classified into three clinically defined groups (slow transit, outlet obstruction, and a mixed group). Rectal evacuation was evaluation was evaluated by computer-based area calculation. There were no differences in defecographic findings except that evacuation was less efficient in the slow transit group compared with the mixed group (p < 0.01) and with the outlet obstruction group (P < 0.05). Transit time was prolonged in the slow transit and mixed groups compared with the outlet group (p < 0.001). Prominent impression of the puborectalis muscle during straining and the size of a rectocoele correlated with rectal emptying (p < 0.01). Perineal descent, anorectal angles, enterocoele, or intussusception were not significantly related to emptying. Prominent impression of the puborectalis muscle (p < 0.05) and impaired rectal emptying (p < 0.05) were more frequent in patients with prolonged transit time (six or more days). There was no significant correlation between transit time and rectal evacuation in the total study population. There was, however, an inverse relation between these variables (r = 0.40, p < 0.02) when all patients who claimed infrequent defecation (two or fewer/week) were analysed separately. These results did not confirm a direct relation between rectal evacuation and colonic transit time in constipated patients overall. The results are consistent with the suggestion that impaired colonic function may develop secondary to outlet obstruction in some patients.

Adult↗