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Biomedical subjects

A Shafik

Publications and source records attributed to A Shafik.

At least 199 records · Page 11Linked to original sources
PubMed1992

Involuntary action of the external anal sphincter. Manometric and electromyographic studies.

The changes in the rectal neck (anal canal) pressure and electromyography (EMG) of the external anal sphincter and levator ani muscle were studied in 20 dogs before and after internal anal sphincter excision by 2 weeks and monthly up to 10 months. The rectal neck pressure dropped to 41% of the preoperative level. It was then gradually elevated from the beginning of the 1st month following excision till it reached 88% of the level before excision at the 10th month. The external sphincter EMG basal activity after internal sphincterectomy by 2 weeks showed a decrease in the amplitude of the slow and high potential waves. From the 1st to the 7th month after excision, changes in the frequency and amplitude of the waves occurred, and by the 10th month, the external sphincter showed the characteristics of the EMG of both the internal and external anal sphincters. The basal activity of the levator ani muscle increased at the 10th month. As reported previously, the changes in the rectal neck pressure and in the EMG of the external anal sphincter after internal sphincterectomy seem to be due to the histological changes in the muscle and include striated and smooth muscle fiber hypertrophy and proliferation. These changes adapt the external sphincter to serve the function of not only voluntary but also involuntary continence.

Anal Canal↗
PubMed1992

Rectourethral reflex: description of a reflex and its clinical significance. A preliminary report.

The present communication studies the technique and clinical significance of a new reflex which I called 'rectourethral reflex'. The study comprised 29 subjects with normal anorectal and urinary functions. The procedure consisted of inflating the rectum with a balloon connected to the distal part of a catheter. The electromyographic activity of the external urethral sphincter was recorded using a concentric needle electrode inserted into the muscle. The procedure was repeated in 10 patients after muscle infiltration with Xylocaine or saline. Rectal distension evoked external urethral sphincter contraction in all the subjects. The amplitude of motor action potentials increased with increasing rectal distension. Anesthetized muscles did not respond, while saline-infiltrated muscles responded. The latency of the reflex decreased with increasing volume of rectal inflation. The reflex harmonizes the relation between defecation and micturition. It guards against involuntary micturition when the rectal detrusor is distended. Changes in amplitude and latency of the reflex may be significant in assessing rectourinary disorders. The reflex could thus be used as an investigative tool in the diagnosis of such disorders.

Adult↗
PubMed1992

Local excision of rectal cancer: report of a technique and results.

A technique for the local treatment of rectal cancer was performed in 29 patients who satisfied the criteria for local treatment. Four patients were classified as Dukes' stage A and 25 were stage B. Local treatment was performed by either direct excision or anorectal mobilization. The former was carried out in 13 patients in whom the tumor was located less than 7 cm from the dentate line. Excision after anorectal mobilization was performed in 16 patients with tumors located more than 7 cm from the dentate line. Patients were followed up for 5 to 10 years. They had normal rectal function after operation with normalization of rectal pressure and myoelectric activity of sphincteric muscles. Twenty four patients are alive and tumor-free. The five failures were Dukes' B category; four (30%) treated by direct excision and one (6%) by anorectal mobilization. They were subjected to a second, combined excision operation of the rectum: two patients died of distant metastasis and three are alive and tumor-free. The study showed that 12% of Dukes' B category patients had preoperative nodal deposits which escaped detection. Direct excision, owing to its high incidence of recurrence, should be restricted to Dukes' A category tumors, when the upper tumor edge is less than 7 cm from the dentate line. Otherwise, and with all Dukes' B category tumors, the anorectal mobilization operation is preferable.

Adenocarcinoma↗
PubMed1991

Straining puborectalis reflex: description and significance of a "new" reflex.

The present communication studies the technique and clinical significance of a new reflex, termed straining puborectalis reflex. Nineteen healthy volunteers with an average age of 38.2 years were studied, including ten males and nine females. The intravesical pressure, representative of intra-abdominal pressure, was measured by means of a balloon-tipped catheter introduced into the urinary bladder and connected to a pressure transducer. The electromyographic (EMG) activity of the puborectalis muscle was recorded using a concentric needle electrode inserted into the muscle. The EMG response of the puborectalis muscle to straining at different pressures was recorded. The response to two types of straining--sudden momentary and slow, sustained--was observed. The procedure was repeated in ten subjects after puborectalis infiltration with xylocaine or saline. Sudden straining evoked puborectalis contraction, whereas slow, sustained straining did not. Puborectalis contraction increased with the increase in straining intensity. These results were reproducible. The anesthetized puborectalis did not respond to straining, whereas the saline-infiltrated muscle did. The latency of the reflex was studied. Besides its role as a voluntary continent sphincter, the puborectalis seems to have a role also in the involuntary continence of the pelvic organs through the straining-puborectalis reflex. The muscle contracts on sudden straining, sealing the rectal and vesical necks and thereby preventing fecal or urinary leak. However, it is only on sudden straining that the puborectalis contracts. Slow, sustained straining as occurs during defecation and micturition does not evoke the reflex action. The straining puborectalis reflex is informative and may be incorporated as an investigative tool in patients with fecal and urinary control disorders.

Adult↗
PubMed1991

Anal submucosal injection: a new route for drug administration. VI. Chronic prostatitis: a new modality of treatment with report of eleven cases.

The anal submucosal route was used for the treatment of chronic bacterial prostatitis in 11 patients. Prior to presentation, the patients had received different antimicrobial agents; the symptoms disappeared only to recur whenever the drug was discontinued. After repeated failure, the patients were treated with gentamicin to which the organisms were sensitive, via the anal submucosal route. A daily injection was given for ten days on an outpatient basis. The technique of injection is described. The patients were followed up clinically and by segmented cultures for three years. No anorectal complications were encountered as had been demonstrated experimentally. The symptoms of chronic prostatitis disappeared, and culture was negative by the end of treatment and for two to three years thereafter in all patients. It appears that the antimicrobial agent, via anal route, reaches the prostatic tissues at a higher concentration than that of the serum. The route adopted by the drug to reach the prostate from the anal submucosa is presented.

Administration, Rectal↗
PubMed1991

Mobile epididymis. A new clinicopathologic entity in genesis of male infertility and its treatment by epididymopexy.

Mobile epididymis plays an important role in the genesis of male infertility. It constituted 9 percent of a consecutive series of idiopathic infertility. Of 200 patients examined (100 fertile and 100 infertile), mobile epididymis was detected in 9 infertile patients. The clinical picture is characteristic. Epididymis is widely separated from testicle and moves freely from side to side. Its body and tail are ill formed and the epididymovasal angle is obtuse. Azoospermia was persistent in 3 patients and intermittent in 6 patients. Testicular biopsy showed tubular dilatation. Epididymopexy was performed in the 9 patients to fix the epididymis to testicle: 3 patients showed improvement in semen quality with two resultant pregnancies. Failures were due to advanced testicular damage. Infertility in mobile epididymis appears to result from obstruction of efferent ductules, testicular ischemia, and/or interference with sperm maturation, transport, or delivery.

Adult↗
PubMed1991

Constipation--some provocative thoughts.

Constipation is a collective term with different definitions and manifestations. In the present communication, I hope to shed light on the pathogenesis, investigation, and treatment of these manifestations. The levator ani is the principal muscle of defecation; together with anorectal reflex actions, it conducts the act of defecation. Strainodynia is the term I give to excessive and exhaustive straining at defecation. Band strainodynia has normal stool character but elevated rectal neck pressure due to the presence of a fibrous band in the rectal neck. Diet strainodynia presents with lower stool weight and frequency than normal; the internal anal sphincter is fibrous. The stools in levator strainodynia have been repeatedly obstructed at defecation due to levator dysfunction. Idiopathic oligofecorrhea or infrequent defecation was studied in 146 patients. Three stages could be identified: the deep and the everted intersphincteric groove and the cone anus. Fecoflowmetry is introduced as a new method for investigating anorectal disorders. It measures the defecated volume per time unit, and provides quantitative as well as qualitative data concerning the act of defecation. Changes in the fecal flow parameters or curve configuration from normal point to a defecation disorder.

Adult↗
PubMed1991

Straining urethral reflex: description of a reflex and its clinical significance. Preliminary report.

The present communication describes a reflex, which I call 'straining urethral reflex', and discusses its clinical significance. The study was performed on 17 healthy volunteers with a mean age of 39.6 years. The intrarectal pressure (representative of the intra-abdominal pressure) was measured by means of a balloon-tipped catheter introduced into the rectum and connected to a pressure transducer. A concentric needle electrode was introduced into the external urethral sphincter. The subject was asked to strain, and the urethral sphincter electromyographic activity and the intrarectal pressure were recorded. Two types of straining were investigated: sudden and slow. The procedure was repeated in 10 subjects after urethral sphincter infiltration with xylocaine or saline. On sudden straining, the external urethral sphincter contracted. The anesthetized sphincter did not respond, while the saline-infiltrated sphincter responded to sudden straining. Slow sustained straining did not evoke the reflex response. The latency of the reflex was calculated. The external urethral sphincter contraction on sudden straining guards against the involuntary opening of the vesical neck and urinary leak under stress conditions of a sudden increase in the intra-abdominal pressure. The reflex may prove significant in the diagnosis of micturition control disorders. It can thus be included as an investigative tool in urologic practice.

Adult↗
PubMed1991

Idiopathic oligofecorrhea: a clinicopathologic entity--pathogenesis and treatment.

Oligofecorrhea is the term applied for infrequent defecation (2 or less stools per week). 146 patients with oligofecorrhea were studied. Investigations comprised radiologic, endoscopic, intestinal transit and rectal pressure studies. EMG for levator and sphincteric muscles as well as internal sphincter biopsy were done. The 146 patients could be categorized into 3 stages according to clinical and investigative results. However, the 3 stages share major abnormal findings which comprise high resting rectal neck pressure, reduced or absent recto-inhibitory reflex, internal sphincter hypertrophy and degeneration of the nerve plexus of the internal sphincter. A new theory of pathogenesis of oligofecorrhea is put forward. It is believed that innervation abnormalities of the internal sphincter interferes with the recto-inhibitory reflex action with a resulting failure of the internal sphincter to relax upon rectal distension. It seems that the degenerative changes of the nerve plexus affect mainly the parasympathetic supply leading to sympathetic overactivity. The latter leads to abnormal internal sphincter contraction which eventually results in muscle hypertrophy. Internal sphincter myotomy showed a mean improvement of 90.4% in all the cases. The stool frequency and rectal neck pressure were normalized.

Adult↗
PubMed1991

Dynamic study of the rectal detrusor activity at defecation.

The dynamics of the rectal detrusor at defecation was studied in 29 normal and 10 constipated subjects. The rectal pressure was measured by a ureteral catheter with terminal side holes, while the intra-abdominal pressure was measured by a Foley catheter introduced into the urinary bladder. Simultaneous recording of fecal flow was performed by fecoflowmetry. Assessment of the findings in normal subjects has shown a pre-evacuation rectal pressure elevation which reached its peak with the start of fecal flow and then fell gradually as the flow increased. This was in contrast to the constipated patients in whom the elevated pre-evacuation rectal pressure continued through the whole act of evacuation. Quantitative analysis of the rectal pressure curve could also differentiate between normal and constipated subjects. The significant parameters are the opening pressure and time, the pressure time and the evacuation pressure. The simultaneous recording of the intra-abdominal pressure demonstrates its share in the increase of the rectal pressure.

Adult↗
PubMed1991

Dilatation and closing anal reflexes. Description and clinical significance of new reflexes: preliminary report.

The present communication describes new reflexes which are called 'dilatation and closing anal reflexes', and discusses their clinical significance. The study comprised 21 healthy volunteers and 15 incontinent patients (7 with partial fecal incontinence and 8 with urinary stress incontinence). The technique comprised the introduction into the rectal neck of a balloon-tipped catheter. The balloon was inflated with air in increments of 10 ml up to 50 ml, and the EMG response of the external and urethral sphincters to balloon inflation and deflation was recorded. A new device called 'switch inflation' apparatus was used to inflate the balloon simultaneously with switching of the EMG apparatus. Rapid rectal neck inflation and deflation evoked external anal and urethral sphincter contraction. Slow and gradual inflation or deflation did not initiate the response. The anesthetized external anal sphincter did not respond to the stimulus, while the saline-infiltrated sphincter responded. The latency of the reflexes was recorded. In fecal incontinent patients, the external anal sphincter, on rapid rectal neck inflation or deflation, showed lower EMG activity and longer latency than in normal volunteers; the external urethral sphincter responded as in normal volunteers. In urinary stress incontinent patients, the external anal sphincter responded normally for both rectal neck inflation and deflation. The external urethral sphincter showed lower EMG activity and prolonged latency than normal on rectal neck inflation; it did not respond to deflation. The dilatation and closing reflexes seem to play a role in fecal and urinary continence as well as in fecal sampling. Detectable changes in latency or amplitude of the evoked response indicate a defect in the reflex pathway.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Levator-urethral reflex. A new reflex with clinical significance.

A preliminary study of a new reflex which I called "levator-urethral reflex" is presented. Twenty-three volunteers were studied. Two concentric needle electrodes were introduced: one in the levator ani muscle (stimulating electrode) and the other in the external urethral sphincter (recording electrode). Levator stimulation evoked external sphincter contraction in all the subjects. The anesthetized sphincter did not respond while the saline-infiltrated one responded. The mean latency of the reflex was 168 ms. The levator-urethral reflex regulates the relation between micturition and continence. Reflex external urethral sphincter contraction keeps micturition under control despite the involuntary opening of the vesical neck as a result of levator contraction. Measurement of the latency of the reflex could be an objective and accurate means of investigating micturition disorders.

Adolescent↗
PubMed1990

The scrotoscope. A new instrument for examining the scrotal contents.

A new instrument (the scrotoscope) is described. It was used in the diagnosis of questionable masses in the testis, epididymis and spermatic cord in 49 patients. Scrotal examination and testicular biopsy were performed in 31 infertile patients by means of the scrotoscope, together with pampiniform plexus venography in 1 patient and vasography in 2. Scrotoscopy allows the surgeon to view, study and treat intrascrotal lesions.

Adult↗