Royal Society of Medicine, Section of Proctology; Meeting 27 November 1974. President's Address. Anorectal incontinence.
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Biomedical subjects
Publications and source records attributed to A G Parks.
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In 33 patients with an intersphincteric abscess continuous anal pain was the commonest symptom and a lump in the wall of the anal canal the commonest sign.The importance of this condition as a cause of persistent undiagnosed anal pain is stressed.
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The smooth muscle from the human internal anal sphincter has been investigated pharmacologically in vitro. The upper and lower parts of the sphincter responded to catecholamines in a similar manner. Noradrenaline caused contraction which could be antagonized by phenoxybenzamine. After phenoxybenzamine, noradrenaline caused relaxation which could be blocked by pronethalol. Isoprenaline caused relaxation which could be specifically prevented by pronethalol. Adrenaline was variable in its effect: low concentrations caused relaxation and high concentrations caused contraction. It is suggested that the anal smooth muscle contains alpha-adrenergic receptors subserving contraction and beta-receptors subserving relaxation. The lower part of the sphincter was generally insensitive to acetylcholine and nicotine whereas the upper part of the sphincter contracted with acetylcholine and regularly relaxed with nicotine. The nicotine response was antagonized by hexamethonium, procaine, and pronethalol. It is suggested that nicotine stimulated some part of the nervous mechanism in the upper part of the sphincter and that a catecholamine was the mediator of the inhibitory response.
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