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Biomedical subjects

A Shafik

Publications and source records attributed to A Shafik.

At least 181 records · Page 10Linked to original sources
PubMed1993

Fecoflowmetry: a new parameter assessing rectal function in normal and constipated subjects.

Fecoflowmetry is a new technique by which the fecal flow rate is studied through recorded curves representing the changes that occur in the flow against time. Fecal flow rate is the product of rectal detrusor action against outlet resistance. The technique was performed on 36 normal volunteers and 88 chronically constipated patients. Simultaneous recording of the fecal flow rate and intra-abdominal and rectal neck pressures were performed. A water or paste enema was given to the individual. Upon feeling the desire to defecate, he or she was placed on a fecoflowmeter commode and was asked to defecate. Evaluation of the obtained defecation flow curve comprises the reporting on the defecated volume, flow time, mean and maximum flow rates, time to maximum flow, and shape of the curve. In the 88 constipated patients, two fecoflowmetric patterns were recognized: nonobstructive (inertia) and obstructive. They differ from each other in parameters and curve configuration. The defecated volume as well as mean and maximum flow rates were lower in outlet obstruction than in the inertia type, whereas flow time and time to maximum flow were longer. The ascending limb in the obstructive-type curve rose less steeply than in inertia; the curve had a long plateau, and the descending limb sloped more gradually. To conclude, fecoflowmetric studies could differentiate between defecation of normal and constipated subjects, and in the latter between the obstructive and inertia types of constipation. The technique was developed to simulate natural defecation. It provides quantitative and qualitative data concerning the defecation act. The technique is simple, easy, noninvasive, and nonradiologic. It can be used as a screening tool in defecation disorders.

Abdomen↗
PubMed1993

Vesicolevator reflex. Description of a new reflex and its clinical significance.

A new reflex which I call "vesicolevator reflex" was studied in 21 healthy volunteers with a mean age of 36.3 years. The technique comprised the introduction of a catheter, with a balloon at its distal part, into the empty urinary bladder. A concentric needle electrode was inserted into the levator ani muscle. The vesical balloon was inflated with air in increments of 50 mL and the levator myoelectric activity recorded by a standard EMG apparatus. Vesical balloon was then removed, and levator EMG response to sudden suprapubic vesical compression was recorded with urinary bladder both empty and filled with saline in increments of 50 mL. Vesical balloon distention evoked levator muscle contraction; duration of contraction increased with increased vesical distention. Levator response to vesical distention did not occur when air-filling was below 50 mL air and when muscle was anesthetized. The latency of the reflex was calculated. Suprapubic manual compression of the empty urinary bladder did not cause levator contraction; yet, compression of distended bladder evoked the response. Compression should be sudden, while the patient is lying supine. Slow insidious compression did not evoke levator contraction. The vesicolevator reflex seems to play a role in the act of micturition, and hence could serve as a tool in investigating patients with micturition disorders.

Abdominal Muscles↗
PubMed1993

Intratunical injection of methotrexate for the treatment of seminoma of the testicle.

A bilateral testicular seminoma in a 32 year old man is reported. The patient was unmarried and refused bilateral orchidectomy for its sterile result. He was treated with four courses of methotrexate (MXT) injected in the tunica vaginalis sac. Each course comprised the administration of 50 mg MXT in each tunical sac every 5 days for five consecutive doses followed by 3 weeks rest. No toxicity was encountered. Testicular biopsy 6 months after the start of treatment was negative for malignant cells. A temporary drop of sperm count occurred during treatment. Treatment was performed 6 years ago, and the patient has had no recurrence and is fertile. The treatment was done on an outpatient basis.

Adult↗
PubMed1993

Role of warm-water bath in anorectal conditions. The "thermosphincteric reflex".

Why anorectal pain is relieved by sitting in a warm-water bath was investigated in 18 healthy volunteers and 28 patients with painful anorectal disease (18 patients with fissures and 10 with hemorrhoids). Investigations consisted of measuring rectal and interstitial sphincter temperature, rectal and rectal neck pressures, and electromyographic activity of both the external and internal anal sphincters before and after the subjects sat in a warm-water bath at temperatures of 40, 45, and 50 degrees C for 10 min each time. Pain relief was more evident and lasted longer at higher bath temperatures. The rectal and interstitial sphincter temperatures were unchanged before and after bath in both the healthy volunteers and patients. The rectal neck pressure and internal and sphincter electromyographic activity dropped significantly in the bath, but increased gradually to pretest levels 25-70 min after exiting the bath. The higher the bath temperature, the greater the drop in rectal neck pressure and internal sphincter EMG activity, and the longer the time needed to return to pretest levels. Pain relief after Sitz bath seems to be the result of internal anal-sphincter relaxation with a resulting diminution of the rectal neck pressure. The relaxation of the internal sphincter following the warm bath postulates a relationship, but direct action was ruled out. A neural pathway through a "thermosphincteric reflex" seems most likely.

Adult↗
PubMed1993

Anorectal tightening reflex: role in fecal incontinence.

The present study describes the clinical significance of the anorectal tightening reflex (ATR) in normal and incontinent subjects. It was examined in 16 healthy volunteers and 11 subjects incontinent to flatus and fluid stools; 5 of the latter had in addition fecal soiling. The rectum was distended by a condom inflated with carbon dioxide, while the rectal and rectal neck (RN) (anal canal) pressures were measured, and the external (EAS) and internal anal sphincter (IAS) EMG activity was recorded. The rectum was inflated at two rates: slow and rapid. In normal subjects, the RN pressure increased upon slow rectal inflation; the IAS EMG was augmented. Pudendal nerve block and phentolamine administration revealed that this pressure increase is due to increased IAS tone which tightens the RN against the slow rectal filling by the time adaptive reaction occurs. Rapid rectal filling evoked Gower's rectoinhibitory reflex. Thus, while increased IAS tone in the ATR protects against involuntary incontinence upon 'slow' rectal filling, the increased EAS tone of Gower's reflex protects in the case of 'rapid' filling. Of the 11 incontinent patients, the 5 with fecal soiling did not show ATR, and investigative results pointed to the IAS as being responsible for incontinence. The other 6 patients had normal ATR but nonresponsive EAS on rapid filling. Findings suggest that the ATR plays a role in maintaining continence during slow rectal distension and that a disordered ATR due to IAS dysfunction leads to fecal incontinence. Thus ATR may be useful as an investigative tool in anorectal disorders.

Adult↗
PubMed1993

Basic testing of an artificial pacemaker in the normal and incontinent anorectum.

The role of an artificial pacemaker (AP) in the control of idiopathic fecal incontinence was studied in 15 healthy volunteers (mean age 49.6 years) and 11 patients with idiopathic fecal incontinence (mean age 45.9 years). In the latter, EMG activity of the external anal sphincter (EAS) was diminished, and that of the internal sphincter (IAS) was normal. The pacemaker consisted of a needle, a flat metal piece, a battery and a telegrapher's key. The needle was applied to the IAS and EAS. The rectal and rectal neck pressures were measured by water-perfused tubes, and rectal distension was achieved by a condom-ended catheter. In normal subjects, electric pulsing of either the IAS or EAS caused a significant rectal neck pressure increase (p < 0.01), but insignificant changes in rectal pressure (p > 0.05). Rectal distension with 100 ml of air effected a rectal neck pressure decrease (p < 0.01) and balloon expulsion. IAS pulsing with the rectum distended led to a rectal neck pressure increase (p < 0.001) and rectal pressure decrease (p < 0.0001), but not to balloon expulsion. The rectal neck pressure increased more with EAS pulsing than with IAS pulsing (p < 0.01). In incontinent subjects, IAS pulsing produced a significant rectal neck pressure increase (p < 0.001), while EAS pulsing resulted in an insignificant one (p > 0.05). In the same subjects, IAS pulsing with rectal distension (50 ml air) caused a significant rectal neck pressure increase (p < 0.001) and a significant rectal pressure decrease (p < 0.0001); the rectal balloon was not expelled.(ABSTRACT TRUNCATED AT 250 WORDS)

Anal Canal↗
PubMed1993

Polyester but not cotton or wool textiles inhibit hair growth.

The effect of different types of textile fabrics on hair growth was investigated in 40 mongrel dogs divided into 5 groups. An area of 10 x 20 cm on the dog's back was shaved; half of this area was covered by a textile patch of 100% polyester material in the 1st group, 100% cotton in the 2nd group, 100% wool in the 3rd group and a 50%/50% polyester/cotton blend in the 4th group. The remaining half of the shaved area in the 4 groups as well as the whole area in the 5th group (control) were left uncovered. The textile patch was worn for 2 months. The polyester-covered hair grew at a significantly lower rate and density than in the uncovered area of the same animal and the controls (p < 0.01). The hair color was similar to that of the surrounding uncovered hair. This is in contrast to cotton- and wool-covered skin area which showed nonsignificant differences in hair density, growth rate and color (p > 0.05) against the uncovered area and controls. In the polyester-covered skin, a thinning of the epidermis of the skin was noted microscopically with fragmentation and vacuolation of the hair follicle pulp. The study has shown that the polyester material generated electrostatic potentials, which may have inhibited hair growth, whereas cotton and woolen textiles did not. Friction between the polyester textile and the skin generates electrostatic charges which are suggested to create an 'electrostatic field' that seems to be responsible for the inhibited hair growth.

Animals↗
PubMed1993

Role of warm water bath in inducing micturition in postoperative urinary retention after anorectal operations.

The relation of micturition to sitting in a warm water bath was studied in 30 healthy volunteers and 21 patients with urinary retention after hemorrhoidectomy. The rectal temperature, vesical and urethral pressures as well as the EMG activity of the external urethral sphincter were recorded before sitting in and immediately after getting out of the sitz bath at 40, 45 and 50 degrees C. In the 40 degrees C bath, 16 of the 30 normal subjects reported spontaneous micturition and 14 voluntarily induced micturition. The number of spontaneous micturitions increased with higher-temperature baths. Spontaneous micturition occurred in 19 patients with urinary retention when they sat in the sitz bath; 2 patients did not micturate and were catheterized. The urethral pressure in both the normal and retention subjects showed significant reduction which increased with higher-temperature baths. There were no significant changes in the vesical pressure or EMG activity of the external urethral sphincter with water baths. Micturition on sitting in a warm water bath seems to be initiated by reflex internal urethral sphincter relaxation. A thermo-sphincter reflex is likely to be involved.

Adult↗
PubMed1993

Vaginocavernosus reflex. Clinical significance and role in sexual act.

The action and clinical significance of the vaginocavernosus reflex was studied in 17 healthy women with a mean age of 36.6 years. The response of the bulbo- and ischiocavernosus muscles to rapid vaginal distension by balloon was recorded by a needle electrode inserted in each muscle and displayed on the screen of an EMG apparatus. The two cavernosus muscles contracted on vaginal distension; the amplitude of contraction increased with the increase of volume of vaginal inflation. The reflex contraction was not evoked after frequent successive or slow inflations or upon inflation of the anesthetized vagina. The latency of the reflex decreased with increased volume of vaginal inflation. The reflex cavernosus muscle contraction on vaginal distension during the sexual act seems to enhance both the clitoris and penile erection. This is believed to result from the compression exerted on both the deep dorsal vein of the penis and the erectile cavernous tissue. Also, cavernosus muscles contraction may help to milk the semen in the penile urethra into the vagina while the penis is being withdrawn from the vagina after ejaculation. Furthermore, vaginal distension by the fetal head during delivery induces cavernosus muscles contraction, which is suggested to support the head during its descent and prevent vaginal and perineal tears.

Action Potentials↗
PubMed1993

Effect of different types of textiles on sexual activity. Experimental study.

The effect of wearing different types of textiles on sexual activity was studied in 75 rats which were divided into five equal groups: four test groups and one control. Each of the four test groups were dressed in one type of textile pants made of either 100% polyester, 50/50% polyester/cotton mix, 100% cotton or 100% wool. Sexual behaviour was assessed before and after 6 and 12 months of wearing the pants and 6 months after their removal. The rate of intromission to mounting (I/M) was determined. The electrostatic potentials generated on penis and scrotum were also measured by electrostatic kilovoltameter. At 6 and 12 months of wearing the polyester and polyester-cotton mix pants, the I/M ratio was significantly reduced compared to the pre-test levels and the controls (p < 0.0001). The reduction was more manifest in the polyester than in the polyester-cotton mix group, and at the 12th month than at the 6th month of examination. The I/M ratio of the cotton and wool groups showed insignificant changes (p > 0.05) at the 6th month of the study and a significant increase at the 12th month (p < 0.01). Six months after removal of the pants, the I/M ratio returned to the pre-test levels (p > 0.05) in the four groups. The polyester-containing pants generated electrostatic potentials while the other textiles did not. These potentials seem to induce 'electrostatic fields' in the intrapenile structures, which could explain the decrease in the rats' sexual activity.

Animals↗
PubMed1993

Constipation. Pathogenesis and management.

Constipation is a collective term for different manifestations of different aetiology, pathology and treatment. It can be a symptom of organic disease or may disclose a colonic or anorectal functional disorder of unknown aetiology--this is called chronic idiopathic constipation (CIC). CIC could be due to colonic or anorectal dysmotility. The latter presents as rectal inertia or outlet obstruction. Outlet obstruction manifests with excessive straining (strainodynia), although stools are soft and bulky. Four types of strainodynia can be identified: band, sphincter, levator and detrusor. Idiopathic infrequent defecation (oligofaecorrhoea) is revealed by hypertrophy and degenerated nerve plexus of the internal anal sphincter. It presents clinically with 'cone anus'. The 'mass squeeze contraction' theory describes rectal motility; the wave starts at the rectosigmoid junction (RSJ) and spreads distally. A 'pacemaker' was suggested to exist at the RSJ, organising rectal motility. Indeed, studies on electromechanical rectal activity revealed pacesetter and action potentials originating at the RSJ. Faecoflowmetry and water enema tests are new methods for investigating anorectal dysmotility, and reflexometry is important in assessment. The treatment of CIC is problematic and controversial. However, the patient should be given the chance to try pharmacological treatment at the start before embarking on surgery. Biofeedback may be helpful, especially in outlet obstruction constipation. Sphincter myotomy and myectomy, partial rectal resection and colectomy have been used, with variable results. Medical treatment with a fibre-rich diet or orally or rectally administered laxative agents may be indicated in the treatment of constipation, especially when a cause can not be identified. However, it is important to stress that the untoward effects which may result from laxative abuse could be greater than those of constipation.

Constipation↗
PubMed1993

The recto-levator reflex: the description of a new reflex and its clinical application. Preliminary report.

This communication embodies the description of a technique of recording a new reflex which I call "recto-levator reflex". The study was performed on 32 normal volunteers. The technique comprises the introduction of a balloon connected with a catheter into the rectum. A concentric needle electrode was introduced into the levator ani. The rectal balloon was distended and the levator myoelectric activity was recorded. In 12 patients, the procedure was repeated after levator infiltration with xylocaine or saline. When the rectal balloon was inflated with air, the levator muscle contracted. Levator contraction increased with increasing rectal distension. Anesthetized muscle did not respond, while saline-infiltrated muscle responded to rectal distension. Latency of the reflex was calculated. The recto-levator reflex seems to play an important role at defecation. On rectal distension with stools, levator contraction opens the rectal neck. Changes in the latency or amplitude of the reflex would indicate a defect in the reflex pathway. The reflex may thus prove of diagnostic significance in defecation disorders.

Adult↗
PubMed1992

Contraceptive efficacy of polyester-induced azoospermia in normal men.

The contraceptive effect of a polyester sling applied to the scrotum was studied in 14 men. The suspensor was worn for 12 months. Follow-up investigations comprised periodic check of semen character, testicular size, rectal-testicular temperature difference, serum reproductive hormones and testicular biopsy. The electrostatic potentials generated by friction between the polyester suspensor and the scrotal skin were determined. Female partners used contraceptives until the men became azoospermic. After 12 months, the suspensor was abandoned and the aforementioned investigations were performed again. In the suspensor-wearing period, all men became azoospermic after a mean of 139.6 +/- 20.8 sd days, with decrease in both testicular volume (P less than 0.05) and rectal-testicular temperature difference (P less than 0.001). Serum reproductive hormones showed no significant change (P greater than 0.05). Seminiferous tubules revealed degenerative changes. No pregnancy occurred during this period. The polyester suspensor generated electrostatic potentials (mean 366.4 +/- 30.5 sd volt/cm2 by day and 158.3 +/- 13.6 sd volt/cm2 by night). In the suspensor-release period, the sperm concentration returned to the pre-test level in a mean period of 156.6 +/- 14.8 sd days. Likewise, the testicular volume and rectal-testicular temperature difference were normalized. The 5 couples, who had planned to become pregnant, conceived. The azoospermic effect of the polyester sling seems to be due to two mechanisms: 1) the creation of an electrostatic field across the intrascrotal structures, and 2) disordered thermoregulation. To conclude, fertile men can be rendered azoospermic by wearing the polyester sling. It is a safe, reversible, acceptable and inexpensive method of contraception in men.

Adult↗
PubMed1992

Anourethral reflex. Description of a reflex and its clinical significance: preliminary study.

A new reflex which I call the 'ano-urethral reflex' is described and its clinical significance discussed. It was studied in 16 volunteers with normal vesical and rectal functions. A concentric needle electrode was introduced into the external and sphincter (stimulating), and another one into the external urethral sphincter (recording). The reflex response was recorded by EMG apparatus. The external urethral sphincter basal activity was increased with stimulation of the external anal sphincter. This reflex response was absent when the external and sphincter was anesthetised. The average latency of the reflex was 129.5 ms. Reflex urethral sphincter contraction at defecation guards against involuntary micturition which may result from rectal distension and levator contraction. The anourethral reflex can be a valuable diagnostic tool in routine investigations of patients with urological and proctological complaints.

Adult↗
PubMed1992

Intratunical versus parenteral administration of methotrexate.

Methotrexate (MXT) distribution in serum, testicle and epididymis after administration into the tunica vaginalis cavity or intravenously was studied in 36 dogs. The dogs were divided into two equal groups: (1) an intratunical group in which 20 mg MXT solution was injected into the tunica vaginalis sac of each dog and (2) a parenteral group in which the same MXT dose was administered intravenously. The MXT concentration in serum, testicle and epididymis was determined 2, 4 and 24 h after MXT administration. Clinical and histologic examination of the tunica vaginalis was performed weekly for four consecutive weeks. The intratunical route, in contrast to the parenteral route, achieves a high MXT level in the testicle and epididymis with a low serum level, resulting in low toxicity and high drug efficacy. This route may therefore be suitable for a more effective treatment of testicular and epididymal lesions, notably malignant tumors.

Animals↗
PubMed1992

Uninhibited anal sphincter relaxation syndrome. A new syndrome with report of four cases.

I report a new syndrome, in four patients, all male. Patients ranged from 36 to 43 years of age. The main complaint was fecal urgency with occasional fecal soiling. Physical examination as well as pressure and EMG studies of anal sphincters and levator ani muscle were all normal. The only positive finding was an abnormal rectoinhibitory reflex. The external anal sphincter did not contract either reflexively or voluntarily on rectal distension, leaving the relaxing internal sphincter unprotected and uncontrolled. The patients could not oppose the urge to defecate if conditions are inopportune, with resulting urgency and occasional fecal soiling. The cause is unknown, but biofeedback effected improvement in all four cases.

Adult↗
PubMed1992

Fecoflowmetry in fecal incontinence.

The fecoflowmetric pattern of fecal incontinence was studied in 38 patients. 21 patients had complete and 17 partial incontinence. Twenty normal controls of matching sex and age were also studied. EMG of external anal sphincter and puborectalis as well as the measuring of anal pressure were done. The fecal flow rate was determined by means of the fecoflowmeter. In complete incontinence, the EMG of the rectal sphincters showed no activity, and the anal pressure was lower than controls at rest and on squeezing (p less than 0.0001). The fecoflowgram showed as 'minicurve' because the patients had leaked most of the enema before the test started. In partial incontinence the enema before the test started. In partial incontinence EMG of the sphincters showed subnormal activity on squeezing. The anal pressure recorded values lower than in the normal controls at rest (p less than 0.001) and on voluntary squeezing (p less than 0.0001), though they were higher than those of complete incontinence. The flow rate parameters and curve were characteristics. The evacuated volume as well as the mean and maximum flow rate were higher (p less than 0.001), while the flow time (p less than 0.001) and the time to maximum flow (p less than 0.01) were shorter than in normal subjects. The ascending limb of the flow curve rose more steeply and was smooth. There was no plateau. The descending limb sloped more gradually and showed fluctuations. Fecoflowmetry could thus be an investigative tool not only in diagnosing but also in identifying the type of fecal incontinence.

Adult↗