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PubMedDate not supplied

[The 3rd national workshop on defecography: the functional radiology of (neo) rectal ampullae (ileal reservoir, colo-anal anastomosis, continent perineal colostomy)].

A survey was made in 13 Italian centers with a questionnaire concerning the (a) indications, (b) postoperative complications, (c) functional results and (d) diagnostic imaging modalities related to the making of an ileal or colonic (neo) rectum. Ulcerative colitis (100%), familial polyposis (61.5%) and Crohn's disease (15.3%) were the most common indications for an ileal pouch; rectal cancer (7.96%), chronic inflammatory diseases (15.3%), diverticulosis, rectal prolapse, redundant colon and imperforate anus (7.6% each) were the most common indications for a colonic pouch. Postoperative complications included pelvic abscess (14%), sinus tract/dehiscence (10%) and bowel obstruction (9%). When compared with the S and W variants, the J-shaped ileoanal pouch proved superior because urgency and fecal retention rates were lower (18.4% vs. 44.4% and 23% vs. 28.6%, p < 0.01 and p < 0.05, respectively), despite slightly more frequent staining episodes (15.8% vs. 11.1%; p < 0.05). As for colonic ampullae, fecal retention and provoked evacuation were more frequent in the J pouch and after gracileplasty; urgency and incontinence in the straight colo-anal anastomosis (33.3% vs. 22.2% and 41.6% vs. 33.3%, respectively). The functional outcome was assessed by anal endosonography (available in 4/13 centers), defecography and anorectal manometry. Abnormal findings included: (a) reduced capacity, barium leakage, anal gaping, sphincter damage (urgency and incontinence); (b) barium retention, pouch dilatation, split evacuation, knobs and strictures (fecal retention).

Defecation↗
PubMed1996

[Value of endo-anal ultrasonography in the assessment of anal incontinence].

Endoanal ultrasonography with a Brüel and Kjaer 7 mHz rotative probe allows precise evaluation of the different structures of the anus, the anal canal and the rectum. The integrity, thickness and length of the muscle layers can be measured in a reproducible way during contracture and at rest. In addition to the classic images, video recording can be carried out. We examined 96 consecutive patients with anal incontinence, comprising 82 female and 14 male patients. In 76 cases the origin were an obstetrical lesion, 7 were surgical lesions, in 9 cases the lesion was posttraumatic and in 2 cases a malformation. In 2 cases a rectal prolapse was associated. We found that endoanal ultrasonography permits a precise diagnosis of anal incontinence. The nature and the extent of sphincteric lesions can be determined and the surgical procedure can thus be planned. In the absence of organic lesions this examination serves to avoid unnecessary surgical treatment.

Adult↗
PubMed1996

Gastrointestinal manifestations in cystic fibrosis.

CFTR, or cystic fibrosis transmembrane conductance regulator, the gene product that is defective in cystic fibrosis, is present in the apical membrane of the epithelial cells from the stomach to the colon. In the foregut, the clinical manifestations are not directly related to the primary defect of the CFTR chloride channel. The most troublesome complaints and symptoms originate from the oesophagus as peptic oesophagitis or oesophageal varices. In the small intestinal wall, the clinical expression of CF depends largely on the decreased secretion of fluid and chloride ions, the increased permeability of the paracellular space between adjacent enterocytes and the sticky mucous cover over the enterocytes. As a rule, the brush border enzyme activities are normal and there is some enhanced active transport as shown for glucose and alanine. The results of continuous enteral feeding of CF patients clearly show that the small intestinal mucosa, in the daily situation, is not functioning at maximal capacity. Although CFTR expression in the colon is lower, the large intestine may be the site of several serious complications such as rectal prolapse, meconium ileus equivalent, intussusception, volvulus and silent appendicitis. In recent years colonic strictures, after the use of high-dose pancreatic enzymes, are being increasingly reported; the condition has recently been called CF fibrosing colonopathy. The CF gastrointestinal content itself differs mainly from the normal condition by the lower acidity in the foregut and the accretion of mucins and proteins, eventually resulting in intestinal obstruction, in the ileum and colon. Better understanding of the CF gastrointestinal phenotype may contribute to improvement of the overall wellbeing of these patients.

Colonic Diseases↗
PubMed1996

Hospitalized dysentery cases during an outbreak of Shigella dysenteriae type I: Ndanga District Hospital, Zimbabwe.

OBJECTIVE: To describe the characteristics of patients admitted with bloody diarrhoea; to assess clinical management; and to identify organisms isolated in laboratories and their antimicrobial susceptibility pattern. DESIGN: This was a retrospective study which used data from case files of patients admitted for dysentery at Ndanga District Hospital. The three admission registers from the hospitals male, female and paediatric wards were examined for patients with dysentery as their admitting diagnosis from December 1993 to February 1994. Using case file numbers from the admission registers, we retrieved case files from the records office. SETTING: Ndanga District Hospital in Zaka, Masvingo Province, Zimbabwe. SUBJECTS: All patients admitted for dysentery at Ndanga District Hospital. MAIN OUTCOME MEASURES: Patients sex, age, clinical presentation, complications, drugs given, culture results, and antimicrobial susceptibility, duration of stay and outcome. RESULTS: The peak admission period was the last week of January, during which 17 patients were admitted with bloody diarrhoea. The age distribution of cases was bimodal, children less than five and those 15 to 29 being most likely to be hospitalized; 52pc of the patients were females. Signs and symptoms recorded were bloody diarrhoea 100pc, abdominal pain 45pc, dehydration 38pc, fever 34pc, vomiting 26pc, loss of appetite 20pc, weight loss 17pc and anaemia 5pc. Shigella dysenteriae type 1 (SD1) was isolated in 80pc of the 58 stools examined. Most cases were treated with kanamycin (67pc),nitrofurantion (61pc), and metronidazole (43pc). The average number of antibiotics given per patient was 2.3. Seventeen cases developed complications and four patients died, one each with renal failure, haemolytic uraemic syndrome, and severe anaemia. The other patient who died had developed rectal prolapse. CONCLUSIONS: 80pc of the patients in the study received multiple antibiotics. The most frequently used drugs were kanamycin and nitrofurantion, yet neither of these drugs has been shown to be effective in treating dysentery. While the organisms were largely sensitive to nalidixic acid, little of that was prescribed, almost certainly because it was not available until late in the study period. There is need for adherence to the Ministry's recommended dysentery treatment guideline: prompt treatment with an effective antimicrobial to which the organism has been recently shown to be sensitive, and supportive care and prompt referral if complications arise.

Anti-Bacterial Agents↗
PubMed1997

Spontaneous pathology of the gray short-tailed opossum (Monodelphis domestica).

The gray short-tailed opossum, Monodelphis domestica, is a newly established laboratory animal that is becoming increasingly important to biomedical research. Because little disease information is available for this species, we reviewed records for spontaneous gross and histologic lesions and microbiologic results in 150 M. domestica necropsies during an 11-year period. We identified 150 (91 female, 59 male) animals from 441 necropsy cases which were controls in experimental protocols or were members of the breeding colony. Initial statistical examinations indicated that the sample was representative of the living members of the breeding colony with respect to age, sex, and range of inbreeding. Causes of death and types of tumors were specifically evaluated. Females died earlier than males (22.6 +/- 13.0 months versus 30.9 +/- 11.9 months), but this difference was not associated readily with diet or inbreeding levels. The organ systems with the greatest lesion prevalences, in decreasing order, were the digestive, urogenital, cardiovascular, and respiratory systems. The most probable causes of all deaths were associated with the digestive system, followed by the cardiovascular and integumentary systems. The principal disease problems were rectal prolapse, congestive heart failure, and dermatitis. Neoplasia was found in 39 of the animals. The prevalence of neoplasia was greatest in the digestive system, followed by the endocrine, urogenital, integumentary, and hematopoietic systems. Pituitary adenoma was the most common neoplasm, followed by uterine leiomyoma and cutaneous lipoma. Specific microbially-induced diseases were not recognized, and endo- and ectoparasites were not found in colony-born M. domestica.

Animal Diseases↗
PubMed1997

[Cystic fibrosis: a new disease in adults].

OBJECTIVE: Cystic fibrosis (CF) has undergone substantial epidemiological changes. The life expectancy of CF patients and the proportion of affected adults are rising because of advances in diagnosis and treatment. In order to find out more about our current situation, we sent an anonymous questionnaire to all affected members of the Catalonian Association of CF. PATIENTS AND METHODS: The questionnaire was sent to 180 patients and their parents asking for information about demographical aspects, diagnosis, pulmonary function, microbiological data, complications, treatment, number of medical visits to CF centers, personal, social and professional development, and the degree of satisfaction with the medical care received. RESULTS: The questionnaire was correctly completed by 75 patients. Of these, 20% were older than 18 years of age. The mean age at diagnosis was 3.25 years. The initial symptoms were: meconium ileus (8%), growth retardation (24%), respiratory problems (34%) and gastrointestinal problems (36%). Sixty percent of the patients showed positive sputum cultures. The most frequently isolated microorganism was P. aeruginosa. Apart form the usual therapy with antibiotics, enzyme replacement and vitamin supplements, other therapeutic measures employed included: alimentary supplements (54%), mucolitics (27%), bronchodilators (45%) and inhaled anti-inflammatories (20%). Complications were present in 56% of the patients and these included hemoptysis, polyps, rectal prolapse, hepatic disease, diabetes, psychological changes, biliary litiasis, pneumothorax, infertility or pancreatitis. The proportion of positive sputum cultures, the type of germ identified and the complications observed changed according to the patient's age. CONCLUSIONS: National registers can be very useful tools to make public health plans. They are also good instruments to evaluate the progress made in the treatment of diseases such as CF.

Adolescent↗
PubMed1997

Gastrointestinal manifestations of progressive systemic sclerosis.

Management of patients with progressive systemic sclerosis requires a thorough gastroenterological examination and a profound knowledge of possible gastrointestinal manifestations of the disease. The esophagus is the gastrointestinal segment most often involved. Smooth muscle atrophy leads to a loss of esophageal peristalsis, a defect of the lower esophageal sphincter, and gastric hypomotility, thus predisposing to severe reflux esophagitis. A rational diagnostic approach includes standard manometry and endoscopy. The prevention of strictures is the main aim of therapeutic efforts that may consist of lifestyle changes, prokinetic drugs, long-term application of proton pump inhibitors, and, if inevitable, surgical intervention. Involvement of the small intestine and colon is less common but may lead to life-threatening complications like chronic pseudoobstruction or pneumatosis cystoides intestinalis. The main therapeutic options consist of antibiotics for bacterial overgrowth and nutritional supplementation. Recently, a preliminary study with octreotide yielded promising results. Anorectal dysfunction can lead to fecal incontinence or rectal prolapse.

Digestive System↗
PubMedDate not supplied

[Colitis cystica profunda. A case report].

OBJECTIVE: To present a pathology not previously informed in national literature. BACKGROUND: Colitis cystica profunda (CCP) is a rare benign entity and with an unknown etiology. There are 148 cases documented in world literature at the present time. Histologically it is defined as the obliteration of lamina propria by fibroblasts and the presence of submucous cysts. It comes in localized, segmental or diffuse forms and associated to other entities as solitary rectal ulcer, rectal prolapse, alterations in the pelvic floor, etc. Treatment can be medical or surgical according to severity of its manifestations. METHOD: A case of CCP is revised as well as the treatment effectuated. RESULTS: A case of patient with the diagnosis of CCP of localized type is presented, which principal symptom was transanal mucous secretion; on physical exploration a sessile mucous polypoid formation at 8 cm from anal verge was found and was treated with surgical resection with a satisfactory outcome. CONCLUSIONS: In a patient with alterations in pelvic floor or puborectal bundle contraction and sigmoidorectal intussusception CCP must be suspected. Treatment can be medical with a high percentage of failure being optimal treatment the surgical one.

Adult↗
PubMed1997

Subacute toxicity of ebrotidine in rats and dogs.

Subacute toxicity studies of ebrotidine (N-[(E)-[[2-[[[2-[(diaminomethylene)amino]-4-thiazolyl]methyl] thio]ethyl]amino]methylene]-4-bromo-benzenesulfonamide, CAS 100981-43-9, FI-3542) were performed in Spragu-Dawley rats and Beagle dogs. Both animal species were administered with the same dose levels (50, 200 and 500 mg/kg) for 4 and 7 weeks, respectively. In a previous 4-week subacute toxicity study in the rat, ranitidine and cimetidine at 500 mg/kg were used as reference drugs. The results indicated that ebrotidine was well tolerated at 50 mg/kg, while there were dose-related effects at 200 and 500 mg/kg. Probably due to its pharmacokinetics, ebrotidine was more toxic in dogs than in rats, since the most severe effects were the death or sacrifice in extremis of two dogs from the high dose group which had undergone rectal prolapse, while no deaths occurred in the rats. The changes that were very likely related to treatment (500 mg/kg) were a lower weight in both species, a slight decrease of hematocrit and red blood cells in rats, single increments of transaminases, alkaline phosphatase and lactate dehydrogenase in dogs (some animals of the 200 mg/kg dose group were also affected) and a higher liver weight. These effects with a few exceptions were found to be common to cimetidine and ranitidine.

Animals↗
PubMed1997

Expansion of the phenotype in Hennekam syndrome: a case with new manifestations.

We report on a female with lymphedema, facial anomalies, intestinal lymphangiectasia, and moderate mental retardation consistent with the diagnosis of Hennekam syndrome. In addition, she had a number of other anomalies not previously described in this autosomal recessive disorder, including a congenital heart defect, atretic ear canals, vesicoureteral reflux, and rectal prolapse.

Abnormalities, Multiple↗
PubMed1977

Mycotic enteritis in a chameleon and a brief review of phycomycoses of animals.

Rectal prolapse in an adult chameleon was surgically replaced. The animal was given tetracycline and dextrose orally, but became comatose 7 days postoperatively and was euthanatized. Necropsy revealed intussusception of the terminal portion of the colon. Phycomycotic hyphae accompanied by necrosis and a mixed leukocytic infiltrate were found in the area of intussusception.

Animals↗
PubMed1997

Laparoscopic colorectal surgery and cancer.

Review article of the actual level of knowledge about laparoscopic colorectal surgery and laparoscopic-assisted procedures. At present time laparoscopy for the cure of colorectal neoplasia should only be performed within prospective randomized trials. In the meantime it is perfectly appropriate to perform laparoscopy for palliation of metastatic disease. Patients with benign colorectal neoplasms can achieve better outcome if treated by laparoscopy rather than laparotomy. Other areas in which laparoscopy may be useful include enterolysis and possibly, treatment of rectal prolapse. Laparoscopy can be appropriately applied for the treatment of terminal ileal Crohn's disease, sigmoid diverticulitis, reversal of Hartmann's pouches and the construction of stomas.

Aged↗
PubMed1998

Pelvic prolapse: diagnosing and treating cystoceles, rectoceles, and enteroceles.

The current generation of women is maintaining a healthier and more active lifestyle into an older age. Treatable conditions such as stress urinary incontinence and pelvic prolapse detract from this active lifestyle. In many cases, an improved quality of life can be maintained by treating pelvic prolapse conditions with relatively minor surgical procedures. Optimal treatment requires a knowledge of pelvic floor anatomy, an understanding of the various pelvic floor defects, and experience in selecting the appropriate procedure. The unequivocal diagnosis of pelvic prolapse conditions can only be made on physical examination. Each section of the vagina -- anterior, posterior, lateral, and apex -- must be inspected and evaluated separately to define the true nature and degree of prolapse. The examination should be performed with a moderate amount of urine in the bladder, and the patient must strain forcefully during the procedure. In some cases, this requires that the patient stand or sit upright during part of the examination to allow all areas of prolapse to become manifest. When the proper procedures are performed, excellent long-term results can be anticipated. The successful treatment of cystoceles requires an evaluation for both lateral and central defects, as inadequate treatment of either defect will lead to recurrences. The treatment of rectoceles is more controversial: Most clinicians would repair symptomatic rectoceles, but many choose not to treat asymptomatic rectoceles because there is little documented benefit to justify the risk of postoperative dyspareunia. Small asymptomatic enteroceles may be treated with a pessary; however, large symptomatic enteroceles usually require surgery.

Female↗
PubMed1998

The role of estrogen in female urinary incontinence and urogenital aging: a review.

Urogenital aging is a complex of urogenital symptoms involving the lower urinary tract, the genital tract and the pelvic floor. These symptoms involve hypoestrogenism in the menopausal woman. This review concludes that irritative urinary and local vaginal symptoms are quite amenable to estrogen therapy. Urinary incontinence is thought to be benefited by treatment with estrogen, although controversy exists. There is a limited role for estrogen in problems of urogenital prolapse, rectal symptoms, and sexuality in menopause.

Aged↗
PubMed1998

[Diagnosis and therapy of constipation].

Prevalence of chronic constipation is around 3% in youth, 8% in middle age, and 20% in the elderly, respectively. There are three etiologic groups: 1. Diet poor in fibre. Most constipated persons, however, do not eat less fibre than controls. 2. Organic diseases accompanied by constipation such as autonomous neuropathies (e.g. in diabetes), endocrine disorders, and neurologic diseases (e.g. Parkinsons disease). 3. Functional outlet obstruction. This may be due to disturbed sphincter function, internal rectal prolapse, or rectocele. The basic treatment of all forms of constipation consists in a diet rich in fibre. In selected cases of functional outlet obstruction, surgery may be successful. Otherwise, treatment with laxatives is justified.

Adolescent↗
PubMed2005

Hemorrhoids and rectal internal mucosal prolapse: one or two conditions? A national survey.

The surgical modalities for the treatment of hemorrhoids are quite numerous due to the rapid diffusion of new surgical techniques and to the different approaches to the pathophysiology of the disease by the proctologists. Stapled hemorrhoidopexy, one of the most recent surgical options proposed, emphasizes the role of rectal internal mucosal prolapse (RIMP) as the main cause of the disease. We performed a national survey among the most important proctologists on this particular clinical condition, in order to better define the indications for the surgical treatment of hemorrhoids. A questionnaire concerning the main clinical features of RIMP was mailed to 84 coloproctology centers. Two-thirds of the 41 proctologists who responded found RIMP in a minority of patients with hemorrhoids, whereas only one-third found RIMP in more than half of their patients. A circumferential RIMP was identified by only 10% of the surgeons, whereas a coincidence between pre- and postoperative diagnoses of this condition was possible in half of proctologists' patients. RIMP is not frequently associated with hemorrhoids. Therefore, it is unlikely to be a cause of hemorrhoidal disease, and many surgeons still recognize it as a difficult clinical condition to define.

Attitude of Health Personnel↗