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Biomedical subjects

V Loening-Baucke

Publications and source records attributed to V Loening-Baucke.

14 recordsLinked to original sources
PubMed1992

Further evaluation of the afferent nervous pathways from the rectum.

To evaluate the visceral afferents from the rectum, we recorded cerebral evoked potentials (EPs) in 26 healthy subjects after electrical stimulation of the rectum, pudendal nerve, and posterior tibialis nerve. We found two distinctly different EPs after rectal stimulation, with differences in latencies and pattern. In 13 subjects (group 1), the EP after rectal stimulation had multiple prominent peaks with early onset latencies ranging from 22 to 29 ms (mean 26 ms). In 13 subjects (group 2), the EP after rectal stimulation had a trifid configuration due to a very prominent negative peak between 97 and 108 ms (mean 101 ms) and longer onset latencies ranging from 50 to 61 ms (mean 55 ms). Latencies after pudendal nerve and posterior tibialis nerve stimulation were similar in the two groups. On further study, we found that both types of afferent pathways are present in the distal colon, since both types of EPs were found in the same subjects either in the rectum or in the rectum and sigmoid. We speculate that the early onset EP is a visceral pathway using the same afferents as the pudendal nerve because the early onset EP after rectal stimulation appears similar in number of peaks and interpeak latencies to EPs recorded after pudendal nerve stimulation, and the late onset EP is a visceral pathway using afferents along the pelvic nerve. Early onset EPs were also recorded after sigmoid stimulation, suggesting that both kinds of EPs are visceral afferents.

Adult↗
PubMed1991

Lichen sclerosus et atrophicus in children.

The symptoms, findings, associated conditions, and treatment of lichen sclerosus et atrophicus were studied in 10 girls and one boy. Lichen sclerosus et atrophicus is a benign but chronic condition of the anogenital area of girls and, less frequently, of boys. The characteristic lesions are hypo-pigmented plaques in a figure-of-8 pattern surrounding the vulva and anus and often involving the natal cleft. The affected hypopigmented skin is sharply demarcated from the normal skin. Hemorrhagic, bullous lesions are uncommon. Fissures and ulcers are seen on the labia, between the labia, and on the perineum, anus, and natal cleft in many children and on the glans penis in boys. Lichen sclerosus et atrophicus causes painful defecation and anal and vulval bleeding. In two patients, one girl and one boy, anal stenosis due to lichen sclerosus et atrophicus and laxative treatment developed. Lichen sclerosus et atrophicus mimics sexual abuse and has led to false accusation and investigations. The anogenital lesions cleared in three patients at the ages of 9, 11, and 12 years, but lesions can persist into adulthood.

Anus Diseases↗
PubMed1991

Persistence of chronic constipation in children after biofeedback treatment.

We investigated the efficacy of biofeedback treatment and evaluated anorectal factors that might be responsible for persistence of chronic constipation with or without encopresis in a group of 38 children with abnormal contraction of the pelvic floor during straining and persistence of chronic constipation with encopresis after conventional treatment. Nine children were unsuccessful in learning to relax the pelvic floor during straining with biofeedback treatment, and one patient had contraction of the pelvic floor on follow-up despite successful biofeedback treatment; none recovered. Twenty-eight children were able to relax the pelvic floor on follow-up; 14 recovered and 14 did not recover from chronic constipation. Nonrecovered patients who learned to relax the pelvic floor had significantly decreased rectal and anal responsiveness to rectal distension as compared to recovered patients during the initial and follow-up anorectal manometric study. Psychological factors such as social competence and behavior problems did not appear to be responsible for recovery or nonrecovery from chronic constipation and encopresis.

Adolescent↗
PubMed1990

Modulation of abnormal defecation dynamics by biofeedback treatment in chronically constipated children with encopresis.

To determine whether outcome in chronically constipated and encopretic children with abnormal defecation dynamics could be improved with biofeedback training, we randomly assigned patients, 5 to 16 years of age, to receive conventional treatment alone (n = 19) or conventional plus biofeedback treatment (n = 22) and evaluated physiologic outcome at 7 months and clinical outcome at 7 and 12 months. Eighty-six percent of patients learned normal defecation dynamics with up to six biofeedback sessions. At 7 months, 13% of conventionally treated and 77% of biofeedback-treated patients had normal defecation dynamics (p less than 0.01); one conventionally treated (5%) and 12 biofeedback-treated patients (55%) had recovered (p less than 0.01). Learning normal defecation dynamics was correlated with clinical recovery (p less than 0.01). At 7 months, 11% of patients with normal defecation dynamics after biofeedback treatment had abnormal defecation dynamics, and 71% of the biofeedback-treated patients with normal defecation dynamics recovered. At 12 months, 16% of conventionally treated and 50% of biofeedback-treated patients had recovered (p less than 0.05). Balloon defecation did not improve significantly in those who learned normal defecation dynamics. Therefore the ability to defecate balloons is apparently not dependent on the normal function of the external and sphincter and pelvic floor muscles alone. Biofeedback treatment is complementary to a good conventional therapeutic regimen in patients with abnormal defecation dynamics.

Adolescent↗
PubMed1990

Efficacy of biofeedback training in improving faecal incontinence and anorectal physiologic function.

The efficacy of biofeedback treatment on faecal incontinence and anorectal function was evaluated in eight patients with faecal incontinence treated with biofeedback training and medical therapy. Outcome and anorectal function were compared with nine faecal incontinent patients who received medical therapy alone. Three month follow up showed that 50% of patients in the biofeedback plus conventional treatment group and 56% of those treated conventionally only had improved. One year follow up showed that 13% in the biofeedback group were free of soiling and an additional 25% had improved. The results were similar in the conventionally treated group--11% were free of soiling and an additional 44% improved. Anal pressures at rest and squeeze, the rectal distension volume that induced sustained inhibition of both the external and internal anal sphincter, and continence to rectally infused saline were significantly reduced in both groups of patients compared with controls (p less than 0.05). Biofeedback treatment had no effect on these abnormal anorectal functions in either patients who improved or those who did not. The improvement in faecal incontinence was probably due to medical intervention or regression of symptoms with time, or both, and not the result of biofeedback training.

Adult↗
PubMed1989

Factors determining outcome in children with chronic constipation and faecal soiling.

To evaluate factors which might contribute to treatment failure in children with chronic constipation and soiling, we evaluated the history, physical findings, defecation dynamics, and anorectal function in 97 patients. We treated them with milk of magnesia, high fibre diet, and bowel training techniques and evaluated outcome at one year when 43% had recovered. Recovery rates were similar for boys and girls. Fifty seven per cent of the patients had not recovered. This group at the outset had more frequent soiling episodes, more severe constipation, were less likely to defecate water filled rectal balloons and to relax the external sphincter during defecation. In general girls had more severe constipation, abdominal pain, and a previous urinary tract infection than boys. Girls were more compliant during treatment and had less frequent soiling episodes at one year. Stepwise logistic regression showed that severe constipation, abnormal contraction of the external sphincter and pelvic floor during attempted defecation, and inability to defecate the 100 ml balloon in less than or equal to 1 min was significantly related to treatment failure. Defecation of smaller balloons, volumes for threshold of rectal sensation, critical volume and rectal contraction, and compliance with treatment could not predict treatment failure.

Adolescent↗
PubMed1989

Anorectal manometry in active and quiescent ulcerative colitis.

Anorectal function was measured in 11 patients with active medically intractable ulcerative colitis, seven patients with quiescent ulcerative colitis, and 18 healthy subjects. The anal resting pressure, squeeze pressure, and ability to defecate a balloon were similar in all groups. Significantly lower rectal distention volumes were required for rectal sensation, critical volume, and to induce rectal contractility in patients with active disease compared to controls or patients with quiescent disease. Rectal compliance was significantly reduced in patients with active and quiescent disease. The increased rectal sensitivity and contractility in patients with active colitis appear to be related to active mucosal inflammation and ulceration. Episodes of mucosal inflammation may be responsible for chronic changes in the rectal wall resulting in fibrosis and decreased compliance in patients with quiescent disease. The frequency and urgency of defecation and the fecal incontinence may be due to a hypersensitive, hyperactive, and poorly compliant rectum.

Adult↗
PubMed1989

Rectosigmoid motility in patients with quiescent and active ulcerative colitis.

We studied the pathophysiology of diarrhea in ulcerative colitis by evaluating and comparing rectosigmoid motility before, during, and after a 900-cal meal in healthy subjects, patients with quiescent ulcerative colitis, and patients with active ulcerative colitis. Three intraluminal pressure transducers were used for recording of rectosigmoid motility. Motility during fasting, eating, and after eating a meal was similar in patients with quiescent disease and controls. Motility increased significantly during eating in controls, but not in patients with quiescent disease. In patients with active colitis, motility was significantly reduced during fasting, eating, and after eating, compared with controls. Motility increased significantly during eating in patients with active disease. Propagated activity was similar in the three study groups; therefore, the decreased motility was due to decrease in segmental contractions. These findings suggest that diarrhea in patients with active colitis may be related to the loss of normal segmental contractions which delay distal stool transport.

Adult↗
PubMed1988

Anorectal function and defecation dynamics in patients with rectal prolapse.

Seven female patients with clinical rectal prolapse and nine healthy female control subjects were studied with anorectal manometry, external sphincter electromyography, and a saline continence test. Resting anal tone, maximum voluntary squeeze, and rectal functional capacity were significantly decreased in the rectal prolapse patients (p less than 0.02). During defecation attempts, external sphincter or pelvic floor electromyographic activity decreased in all of the control subjects, whereas six prolapse patients showed increased electromyographic activity and one had no change in activity (p less than 0.01). Continence to saline solution was also significantly impaired in prolapse patients (p less than 0.001). Postoperative studies in three patients who underwent repair revealed persistence of abnormal anorectal function and defecation dynamics. Patients with rectal prolapse have impaired resting and voluntary sphincter activity, decreased functional rectal capacity, and impaired continence. The failure of normal relaxation of the external sphincter or pelvic floor during defecation attempts, as demonstrated in the patients described herein, may contribute to the development of prolapse and denervation sphincter injury seen in such patients.

Anal Canal↗
PubMed1988

Biofeedback training for patients with myelomeningocele and fecal incontinence.

This study evaluated the efficacy of biofeedback training for fecal in continence in patients with myelomeningocele. 12 patients were randomized to receive conventional treatment alone, or in conjunction with biofeedback. Anorectal manometric functions were evaluated before and after treatment, six and 12 months later. 16 control children were also studied. Three of eight patients in the biofeedback group and three of the four given conventional treatment alone reported greater than or equal to 75 per cent improvement in frequency of soiling 12 months later. Biofeedback training did not improve anal squeeze, rectal sensation or continence of rectal infused saline. The number of patients who improved in both treatment groups was not different.

Adolescent↗
PubMed1979

Clinical problem solving and clinical knowledge.

Videotape and simulated patients were used for evaluating third year medical students' performances in solving familiar and unfamiliar clinical problems. To assist the doctor to rate the students' performances by the review of videotapes, criteria were set up for students' behaviours that could be construed as evidence that the students recognized cues obtained by interviewing the patient and the information content of such cues. Criteria for data use by the students were also set. A mean of 90% of the pertinent medical history data was collected by the students. The amount of pertinent historical data collected was found to correlate very closely with student-patient interaction analysis score for the familiar and unfamiliar problems (r = 0.89 and r = 0.92, respectively). Significant differences in mean scores for data generation (P less than 0.001) and for data use (P less than 0.01) were found between those students who solved and those who failed to solve the familiar problem. With the unfamiliar problem a significant difference was found between the mean scores for data generation (P less than 0.01), but not for data use. The implications of these findings in medical education are discussed.

Clinical Competence↗
PubMedDate not supplied

Cerebral evoked potentials after rectal stimulation.

We obtained reproducible cortical evoked potentials (EPs) in response to electrical stimulation of the rectum with 1 Hz frequency. We found 2 distinctly different EPs in response to rectal stimulation. In 5 females, the EP had an early onset latency (mean 26 msec) with multiple positive and negative peaks. In 10 females, the EP had a later onset latency (mean 52 msec) and a trifid configuration, having a very prominent negative peak. The early onset EPs after rectal stimulation appeared very similar to the wave form of the cortical EPs recorded after pudendal nerve stimulation. Finding similar interpeak latencies in the early onset EP after rectal stimulation and the EP after pudendal nerve stimulation suggests that either the same pathway was used or that rectal stimulation also stimulated the pudendal nerve. It appears that we stimulated visceral afferents when we recorded late onset EPs, because the large EP amplitude declined rapidly with faster stimulation rates and also with greater number of averaging, and the sensation threshold was very unstable, all different to somatosensory EPs.

Adult↗