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Biomedical subjects

W H Jost

Publications and source records attributed to W H Jost.

At least 55 records · Page 3Linked to original sources
PubMed1999

[Diagnostic evaluation of the rectum and pelvic floor in chronic constipation].

In outlet constipation an exact diagnostic evaluation is always necessary because of the different etiologies, multiple combinations in primary and secondary lesions and the number of therapeutic alternatives. Basic diagnostics start with the very important, structured evaluation of the patient's history, colorectal examination including inspection, palpation, procto-, recto-, sigmoidoscopy and anorectal manometry. Depending on the results of this primary evaluation the following methods are indicated: neurophysiologic evaluation (basic neurological examination, EMG, PNTML), defecography ev. including colon contrast enema and gastrointestinal transit time studies. If the complete problem could not be ruled out till that point, the following examinations might be helpful: dynamic pelvic floor MRI, anorectal endosonography, rectal motility studies, fecoflowmetry, colonoscopy, urological und gynecological examinations.

Adult↗
PubMed1998

Defecatory disorders in de novo Parkinsonians--colonic transit and electromyogram of the external anal sphincter.

Constipation is very common in Parkinson's disease. It is still not known whether constipation is due to a slow transit of the colon or an outlet obstruction. We examined 25 patients (11 women, 14 men, mean age 62 years) with newly diagnosed idiopathic Parkinson's disease. All patients had typical clinical symptoms (with an average score of 11.4 points on the Webster scale); the diagnosis was confirmed by 18F-Dopa-PET. In all patients the colon transit time was measured with radioopaque markers. Pudendal nerve lesions were excluded by neurography of the pudendal nerve. Electromyography of the external anal sphincter was performed with concentric needle electrodes in the right and left lateral position. Colon transit time in the patients averaged 3.7 days, with pathologically prolonged transit (> 4 days) in 6 patients (24%). Four patients (16%) showed mild neurogenic changes on sphincter EMG (16%). In three other cases (12%) long duration and large amplitude of motor unit action potentials (MUAPs), and a reduced interference pattern during maximal voluntary effort indicated a severe neurogenic lesion. One patient presented with involuntary contractions of the external anal sphincter at rest, which increased during strain (anism).

Adult↗
PubMed1998

Electrostimulation in fecal incontinence: relevance of the sphincteric compound muscle action potential.

PURPOSE: Continence scores and anal manometry are commonly used to assess the effect of electrostimulation in fecal incontinence. This study determined the increase of muscular compound potentials in electroneurography of the pudendal nerve after three months of electrostimulation treatment. PATIENTS AND METHODS: Thirty women were tested; their average age was 46.8 (standard deviation, 9.82) years. Electrostimulation was applied twice daily for 15 minutes in each case. RESULTS: Before treatment, amplitudes were, on average, 0.54 mV (standard deviation, 0.2). After three months of electrostimulation, the amplitudes had increased to 0.84 mV (standard deviation, 0.2). The continence score was improved from 8.73 to 7.1 points. CONCLUSION: We believe that by electrostimulation the atrophic muscle can be trained to stabilize the pelvic floor, thus increasing anal pressure and, thereby, creating a basis for adequate voluntary contraction. Electrostimulation is, therefore, especially suitable for functional deficits of the external anal sphincter (insufficient voluntary contractions because of atrophic muscle) without identifiable muscular lesion.

Action Potentials↗
PubMed1998

Involuntary contractions of the striated anal sphincters as a cause of constipation: report of a case.

PATIENT HISTORY: We present a case of anismus in a 36-year-old patient. He complained of therapy refractory constipation that had been present for 15 years, with delayed micturition and voiding by stages. METHODS AND RESULTS: During digital examination of the anal canal, we found spontaneous contractions of the sphincters at rest. The urethral pressure profile showed irregular contractions during micturition. The electromyogram, which was performed with concentric needle electrodes from the external anal sphincter, puborectalis, and external vesical sphincter, revealed synchronous contractions of these muscles. Injections of botulinum toxin into the sphincters showed good effects and no incontinence. CONCLUSION: Focal dystonia of the striated anal and vesical sphincters is a very rare cause of constipation but should be included in the differential diagnosis.

Adult↗
PubMed1998

Treatment of erectile dysfunction by an external ischiocavernous muscle stimulator.

OBJECTIVE: The aim of the present study was to evaluate the therapeutic potency of an electrotherapy of striated ischiocavernous muscles in patients with erectile dysfunction. PATIENTS AND METHODS: Transcutaneous electrostimulation of striated ischiocavernous muscles by self-adhesive penile or perineal skin electrodes was performed in 48 patients with erectile dysfunction. 6/48 patients (R) responded to intracavernous pharmacotherapy while 42/48 (NR) did not show significant penile rigidity even to intracavernous papaverine/phentolamine/PGE1 triple drug medication. RESULTS: Within the observation time of 3 months, 10/48 patients dropped out. 22/38 patients reported a penile rigidity for sufficient sexual intercourse whereby 3/22 NR required additional intracavernous pharmacotherapy. Penile rigidity could be objectivated by triple drug medicaton in 12/14 NR after ischiocavernous muscle stimulation (EIS) therapy. 5/6 R were treated successfully for premature erection loss. During EIS treatment neither discomfort nor complications could be observed. CONCLUSION: Transcutaneous electrostimulation of ischiocavernous muscles is a new, noninvasive therapy for the improvement of penile rigidity. The clinical results underline the importance of the striated ischiocavernous muscles for penile rigidity.

Adult↗
PubMed1998

[Electrophysiologic studies of fecal incontinence in the woman].

The cause of urinary or fecal incontinence may be a complex one. A central or peripheral neurogenic lesion is frequently found to be accounting for the problem. The diagnosis should be specified by neurologic examinations and adequate neurophysiologic workup prior to any conservative or surgical treatment. Of particular expressiveness are, neurological history, both neurography of the pudendal nerve and electromyography of the external anal sphincter. Additional measures such as recording of the motor or sensory potentials, determination of reflex latencies and an electromyogram of other striated muscles of the pelvic floor may be taken as needed. Close co-operation of gynecologists, proctologists, and neurophysiologically trained neurologists will help to improve the prospects of treatment and avoid inappropriate therapeutic approaches.

Anal Canal↗
PubMed1997

Long-term results with cisapride in Parkinson's disease.

In this study, we examined whether there is a long-term effect of cisapride on colonic transit in Parkinson's disease. Twenty-five patients (11 women, 14 men; average age, 64.4 years; moderate symptoms) were studied and treated initially with cisapride, 5 mg, twice a day, and after the first week with cisapride, 10 mg, twice a day. Colonic transit was measured by radioopaque markers at various stages: after 1 week, 6 months, and 1 year. In untreated patients, transit took 131 h; after 1 week with cisapride, it was accelerated to 81 h. After 6 months, colonic transit time amounted to 99 and 118 h, respectively, after 1 year. Cisapride seems to be highly effective initially. After 6 months, a significant but reduced effect was seen, and after 1 year, only a small effect could be demonstrated.

Aged↗
PubMed1997

One hundred cases of anal fissure treated with botulin toxin: early and long-term results.

PURPOSE: Sphincterotomy still is considered the therapy of choice to eliminate sphincter spasm in the treatment of uncomplicated chronic anal fissure. The surgery is weighted with the possible surgical risk and the risk of subsequent fecal incontinence. This study reports the effect of botulin toxin injections within the first six months. PATIENTS AND METHODS: One hundred patients were treated (43 females; average age, 34.7 years). The injection of botulin toxin (2.5-5 units of Botox each) was done bilaterally to the fissure, thereby causing paresis of the sphincters for approximately three months. Patients were re-examined after one week and three and six months. RESULTS: Within the first week, 78 percent of patients were free of pain. In 82 percent of patients, complete healing of the fissure occurred within the first three months. Eight patients experienced relapses within the first six months of therapy, three of whom needed surgical intervention. The healing rate after six months was 79 percent. No healing occurred in 21 patients, and they had to undergo surgery. Transitory fecal incontinence resulted in seven cases. CONCLUSIONS: Injection of botulin toxin enables us to treat chronic, uncomplicated anal fissures with increased sphincter tone. It is well tolerated, can be administered on an outpatient basis, does not cause any lesion of the continence organ, and subsequently, does not lead to any permanent latent or apparent fecal incontinence.

Adult↗
PubMed1997

[Electromyography of the sphincter vesicae externus muscle. Technique, indications and outcome].

Electrophysiological examinations provide important findings for the clarification of urogenital dysfunctions. A routine electromyogram (EMG) of the external anal sphincter is used together with stimulation of the pudendal nerve to determine lesions of the somatomotor tract. An alternative is the electromyographical examination of the external vesical sphincter. This special method requires more time and sufficient experience. We see an indication for EMG of the voluntary vesical sphincter in urogenital dysfunctions that cannot be sufficiently differentiated with EMG of the external anal sphincter and also in disturbances that selectively affect the external vesical sphincter.

Electromyography↗
PubMed1997

Gastrointestinal motility problems in patients with Parkinson's disease. Effects of antiparkinsonian treatment and guidelines for management.

Gastrointestinal (GI) motility disorders are frequent in patients with Parkinson's disease, manifesting mainly as dysphagia, disorders of gastric emptying and constipation. The most likely causes of these disorders are cerebral degeneration and degeneration of the myenteric plexus. Although the effect of antiparkinsonian medication is largely overestimated, it certainly has an influence and should be adapted accordingly in patients with GI motility disorders. In particular, anticholinergic drugs should be avoided, and anamnesis, clinical examination and, if necessary, diagnostic tests performed. Domperidone, a peripheral dopamine antagonist, is the drug of choice for motility disorders of the upper GI tract, although cisapride is an alternative. In the lower GI tract, conservative therapeutic options should be used in the first instance. The administration of cisapride leads to a marked temporary improvement in symptoms in lower GI disorders, while rare forms of anism (involuntary dystonic contraction of the anal sphincter) may be treated with botulinum toxin.

Adult↗
PubMed1997

[Neurophysiologic diagnosis in proctology].

Functional diagnostic exploration in proctology is ever-expanding and becoming more differentiating. Neurophysiologic examinations can take over an essential share. They have in part already been introduced into routine diagnostic workup. Both afference and efference, as well as the muscular system can be investigated in functional neurologic disorders of the pelvic floor. The electromyogram using concentric needle electrodes constitutes the most significant tool. It provides us with a better verification of the neurogenic lesion, and enables us to discriminate between acute and chronic and comment on severity and prognosis. The diagnostic program is additionally supplemented by motor and sensory evoked potentials, electroneurography of the pudendal nerve, and measurements of vegetative nerve paths.

Afferent Pathways↗