Search PubMed⌕ Search

Biomedical subjects

A Shafik

Publications and source records attributed to A Shafik.

At least 217 records · Page 12Linked to original sources
PubMed1990

Detrusor sphincter dyssynergia syndrome. A new syndrome and its treatment by external sphincter myotomy.

A new syndrome in which there was persistent external anal sphincter contraction on rectal distension is described in 18 patients. 12 were females and 6 males. Average age was 38.3 years. The main complaint was chronic constipation and straining at stool. Rectal evacuation was performed manually or by enemas. Investigations comprised manometric and EMG studies of external anal sphincter. The average number of stools per week was 2.1. Rectal neck pressure recorded normal values at rest and on squeeze. The rectoinhibitory reflex registered high rectal neck pressure on rectal distension [average 136 +/- (SD) 12.3 mm Hg] which was lowered (average 13 +/- 2.2 mm Hg) after pudendal nerve block. External sphincter showed persistent high EMG activity during rectal distension. External sphincter myotomy was performed in 16 patients. Myotomy specimens showed no histologic abnormalities. The patients were followed up for 2-4 years after the operation. The stool frequency approached the normal range, and straining at stool disappeared. Rectal neck pressure during rectal distension dropped to normal values (average 36 +/- 10.3 mm Hg). Control disorders occurred in 2 patients but disappeared within 6 months after myotomy. External sphincter contraction on rectal distension leads to rectal neck obstruction with a resulting constipation and straining at stool. The cause of this contraction is unknown. Myopathy is excluded by the normal muscle integrity as evident from the normal EMG and biopsy findings. A disorder of the reflex arc may be considered.

Adult↗
PubMed1990

A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. The involuntary action of the external anal sphincter: histologic study.

The histologic changes in the external anal sphincter after internal anal sphincter excision were studied in 20 dogs. An external sphincter biopsy was taken before internal sphincterectomy and 2 weeks and monthly thereafter for 10 months. The excised material was studied microscopically after being stained with hematoxylin and eosin, Verhoeff-van Gieson and succinic dehydrogenase. 70% of external sphincter specimens before internal sphincter excision showed smooth muscle fibers scattered between the striated fibers. These smooth fibers could be responsible for the resting tone of the external sphincter. After internal sphincter excision, characteristic histologic changes could be identified in the external sphincter. From the 2nd week to the 5th month after excision, the external sphincter showed degenerative and hypertrophic changes. From the 6th to the 10th month, there were regeneration of the striated muscle fibers and increase in the number of smooth fibers so that by the 10th month a 'compound' muscle of striated and smooth fibers was identified. Two theories were put forward to explain the smooth fiber preponderance in the external sphincter after internal sphincter excision: mutant and replacement theories. The increased nonstriated element in the external sphincter seems to be a structural-functional adaptation so that the external sphincter takes on the involuntary function of the excised muscle.

Aging↗
PubMed1990

Inguinal pelviscopy. A new approach for examining the pelvic organs.

Inguinal pelviscopy is a new approach for examining structures in the extra- and intraperitoneal pelvic cavity. The total number of patients studied was 70. The method was used to visualize and take biopsies from masses in the presacral area (3 patients) and in the ovaries (8 patients). Ovarian biopsies were taken from 26 patients (14 with primary amenorrhea and 12 with elevated follicle-stimulating hormone), and ovarian cyst aspiration and biopsy were performed in 12 patients. Tubal sterilization was done in 18 cases and lysis of pelvic adhesions in 3 infertile patients. The procedure comprises entry of the extraperitoneal pelvic cavity through the inguinal canal. Intraperitoneal pelvic cavity examination can also be done by piercing the peritoneum at the deep inguinal ring or close to the fallopian tube. No complications were encountered except urinary retention in 1 patient with presacral tumor and abdominal wall hematoma in another patient. The approach is safe, direct and easy. It is performed on an outpatient basis.

Adult↗
PubMed1990

Anal submucosal injection: a new route for drug administration in pelvic malignancies. III. Misonidazole distribution in serum, uterus and vagina: an experimental study.

The anal and oral administration routes were compared in 40 rats to study the distribution of misonidazole (MIS), a radiation sensitizer, in the serum, uterus and vagina. 14C-labelled MIS was administered in a dose of 0.2 ml water/100 g body weight containing 1 microCi MIS. The dose was given orally in 20 rats and was injected in the anal submucosa in another 20 rats. Animals were then sacrificed after 15, 30, 60 or 120 min or after 24 h. Serum samples was taken at the time of sacrifice; organs were dissected and radioactivity was determined in each by the internal standard method. The study has shown that the highest drug concentration in uterus and vagina relative to serum was achieved by the anal submucosal route. They showed a drug concentration of 10 and 8 times, respectively, of the serum level after 15 min in contrast to oral administration, which in the same period of time produced a drug concentration of 1/5 and 1/4 the serum level. The anal route thus offers an adequate channel for MIS administration to promote radiation responsiveness in cancer of uterus and vagina.

Administration, Oral↗
PubMed1990

Anal submucosal injection: a new route for drug administration in pelvic malignancies. V. Advanced prostatic cancer: results of methotrexate treatment using the anal route--preliminary study.

The present study compares the effectiveness of methotrexate injected per anum (group 1, 19 patients) versus that administered intravenously (group 2, 17 patients) in the treatment of advanced metastasizing prostatic carcinoma. The dose in both groups was 50 mg every 5 days for 5 consecutive doses. The course was repeated at 3-week intervals. Patients received treatment as outpatients. In group 1, 5 of the 19 patients showed complete tumor regression and were alive 14-39 months after the start of treatment. Fourteen patients showed partial response. Hematologic reserve remained unchanged. Three patients had mild toxicity. The 17 patients of group 2 showed partial response in 6 and progression in 11. Eleven patients had severe toxic manifestations and 9 of them received blood transfusions due to myelosuppression. These results demonstrate the effectiveness of submucosal anal injection of methotrexate in the treatment of advanced metastasizing prostatic carcinoma. It is safe, well tolerated and can be used on an outpatient basis.

Aged↗
PubMed1989

Anal submucosal injection: a new route for drug administration in pelvic malignancies. IV. Submucosal anal injection in the treatment of cancer of uterine cervix--preliminary study.

Seven patients with advanced cancer of the uterine cervix were treated by anal submucosal injection of methotrexate. Each course consists of five injections, one every 5 days; each injection contains 100 mg of methotrexate. The course was repeated at 3-week intervals and was given on an outpatient basis. Investigations were performed before, during, and after treatment. Methotrexate blood level was measured 4 and 24 hours after administration. Complete response occurred in all seven patients. Relapse occurred in four but could be controlled by further methotrexate administration. Average duration of survival is 46 1/2 months. No side effects were encountered as a result of a low methotrexate serum level that was recorded 4 hours after administration, 0.82 mumol after anal injection compared with 2.8 mumol for the intravenous route. The beneficial effect seems to be the result of the high methotrexate concentration in uterine and tumor tissue. The route adopted by the drug to reach the uterus from the anal submucosa is through the hemorrhoidogenital communicating veins. This preliminary study demonstrates that anal injection of methotrexate is effective in the treatment of advanced cancer. It is safe, well tolerated, and can be used as an outpatient treatment.

Aged↗
PubMed1989

Experimental model of varicocele.

The purpose of this investigation was to create a varicocele model in animals and to study the subsequent alterations in testicular physiology. The study comprised 22 dogs divided into 2 groups: test and control. In the test group (17 dogs), excision of a longitudinal strip of the fasciomuscular tube of the spermatic cord was done on one side only. In the control group (5 dogs), the spermatic cord was exposed without interference with the tube. Testicular temperature was measured, and biopsies from the 2 testicles and semen specimens were examined. Re-examination for variceal changes was performed in 3 dogs at the 4th postoperative week; in 3 dogs at the 6th, and in 16 dogs (11 test and 5 control) at the 8th postoperative week. Sections from spermatic cord and testicle were examined microscopically. Serum levels of testosterone follicle-stimulating hormone, luteinizing hormone and prolactin were assayed preoperatively and at the time of re-examination. Manifest varicocele was detected in 16 of 17 detubated dogs. It was huge in all dogs re-examined after 8 weeks. Semen showed decreased sperm count in all test animals except 1. The animals with induced varicocele had higher testicular temperature than the controls. Microscopically, the detubated spermatic cords have shown variceal changes and the testicle degenerative changes in all the test animals. Similar changes were encountered in the contralateral testicle in the animals re-examined at 8th week. Radioimmunoassay showed a significant decrease of serum testosterone and increase of prolactin postoperatively. Follicle-stimulating hormone and luteinizing hormone showed no significant change from the preoperative level.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

Pelvic organ venous communications. Anatomy and role in urogenital diseases; a new technique of cystovaginohysterography.

A study of the communicating veins between the venous plexuses of the pelvic organs was performed on 21 female cadavers. Thirteen cadavers were studied radiologically after being injected with barium sulfate and 8 were examined after injection of a plastic material. Two groups of communicating veins could be recognized: rectovaginal and vaginovesical; their anatomic features are described. The communicating veins were unidirectional; they transmitted the dye from the rectal to the vaginovesical plexuses, but not in the reverse direction. A new concept was proposed to explain the high Escherichia coli incidence in genitourinary infections. It explains also the cause of some of the idiopathic genitourinary lesions such as recurrent cervicitis and recurrent bacteriuria. A "cystovaginohysterography" could be obtained by injecting the inferior mesenteric vein with barium sulfate. The rectogenital communicating veins have been used in both the diagnosis and the treatment of lesions in pelvic organs.

Adolescent↗
PubMed1988

Anal submucosal injection: a new route for drug administration in pelvic malignancies. II. Methotrexate anal injection in the treatment of advanced bladder cancer. Preliminary study.

The clinical efficacy of submucosal anal injections of methotrexate in advanced bladder cancer is investigated. An experimental study on 20 mice has shown that methotrexate injected into the anal submucosa has no clinicopathological effect on the anorectum. The clinical study comprised 18 patients with advanced bladder cancer (13 with stage T3 and 5 with stage T4 disease) as a test group in whom methotrexate was injected into the anal submucosa and 8 (6 with stage T3 and 2 with stage T4 cancer) treated concurrently with intravenous methotrexate. The dose in both groups was 50 mg. every 5 days for 5 consecutive doses. The course was repeated at 3-week intervals. Most patients received methotrexate as outpatients. Methotrexate blood levels were measured 4 and 24 hours after administration in both groups. In the test group 10 of the 18 patients showed complete tumor regression and were alive 21 to 50 months after the start of treatment. Partial regression was observed in 8 patients. Hematological reserve remained unchanged. Mild toxicity occurred in 3 patients. Of the 8 patients treated intravenously the tumor showed partial regression in 1, was stable in 3 and progressed in 4. Side effects were severe in 5 patients. Our results show that methotrexate injection is highly effective in the treatment of advanced bladder cancer. It is safe, well tolerated and can be used on an outpatient basis.

Adult↗
PubMed1988

A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. XXXI. "Strainodynia": an etiopathologic study.

"Strainodynia" is the name I give to the excessive and exhaustive straining that may accompany defecation. Eighty-six patients with strainodynia were studied; the investigations comprised study of the stool character, proctoscopy, colonoscopy, barium enema, intestinal transit rate, EMG, manometry, and rectal biopsy. These patients were classified into 3 groups: band, diet, and levator strainodynia. The first, band strainodynia, more common in men, presented with a normal stool character. However, the rectal neck pressure was elevated, and a fibrous band could be demonstrated by a rectal neck biopsy. Bandotomy relieved the strainodynia. Diet strainodynia, more common in women, presented with stool frequency and weight less than normal. Rectal neck pressure was normal or elevated, and the rectosphincteric reflex was diminished. There was internal sphincter fibrosis. Improvement occurred after dietary management or internal sphincterotomy. Levator strainodynia was due to levator dysfunction syndrome. Stools were repeatedly obstructed at defecation despite normal stool character. Rectal neck pressure was elevated only on straining. There was reduced levator myoelectric activity. Levatorplasty cured the condition.

Adolescent↗
PubMed1988

Closed prostatic commissurotomy. An endoscopic technique for the treatment of benign prostatic hypertrophy.

Closed prostatic commissurotomy was performed in 27 patients with benign prostatic hypertrophy. The procedure was done under local anaesthesia. Through a 1-cm suprapubic incision, the retropubic space was insufflated with carbon dioxide or nitrous oxide and the endotherm introduced. The laparoscope was also introduced into the retropubic space through a second puncture. The prostatic commissure was identified, coagulated and divided, sparing the mucosa of the prostatic urethra. Commissurotomy causes urethral decompression, which is the aim of any treatment for benign prostatic hypertrophy. The result was satisfactory in 85% of patients. Failures were due to incomplete commissurotomy; laparoscopic revision led to good results. Urethral stricture, incontinence or epididymitis did not occur. Ejaculation was normal. The technique is simple and easy and the patient can leave the hospital on the same day.

Aged↗
PubMed1987

A concept of the anatomy of the anal sphincter mechanism and the physiology of defecation.

A review of the new concepts of the anatomy of the anal sphincter mechanism and the physiology of defecation is presented. The external sphincter is a triple-loop system; each loop can function as a separate sphincter through voluntary inhibition action and mechanical compression. Stress defecation resulting from internal sphincter damage is described. A new technique for repair of rectal incontinence is presented, which depends on inducing continence not only by mechanical compression, but also by voluntary inhibition. The mechanism of defecation and rectal continence is described and four types of incontinence presented. Also, the mechanism of both the levator dysfunction syndrome and prolapse is demonstrated and a technique of repair is presented. The study defines two types of rectal anomalies; suprahiatal and infrahiatal. The role of the embryonic anorectal sinus, anorectal band, and epithelial debris in the genesis of perirectal suppuration, chronic anal fissure, pruritus ani, and hemorrhoids is described. The communicating veins, identified between the hemorrhoidal and vesical plexuses, offer an explanation for the vague pathologic aspects of recurrent bacteriuria, urethral discharge, cervicitis, and vaginitis, and provide a proper line for their treatment. They also serve to perform a new radiographic technique--anal cystography--and to administer drugs, including chemotherapeutics, in the treatment of pelvic malignancies.

Anal Canal↗
PubMed1986

A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. Reversion to normal defecation after combined excision operation and end colostomy for rectal cancer.

Twenty-one patients with combined excision operation for rectal cancer were subjected to electromyographic study of the levator ani muscle, the puborectalis muscle, and the external anal sphincter. Myoelectric activity of the puborectalis and levator ani muscles was detected in 12 patients, 6 of whom had normal activity of both muscles. Of the remaining six patients, there was reduced activity of the levator ani muscle in four and of the puborectalis muscle in all six. These patients underwent training and electric stimulation of these muscles. To verify the myoelectric findings, 15 specimens removed at combined excision operation were examined grossly and microscopically for the muscles removed at operation. Eight specimens were found to be free of the levator and puborectalis muscles, which indicated that these muscles were not excised. The 12 patients with myoelectrically active levator and puborectalis muscles were operated on to restore defecation by way of the normal perineal route. The technique comprises freeing of the colostomy and mobilization of the entire left side of the colon. The perineal scar is then excised and the colonic end fixed to the perineal skin and thus is controlled by the levator and puborectalis muscles. Full fecal control was achieved in seven patients and incomplete control in five. It is concluded that excision of the levator ani muscle, the puborectalis muscle, and the external anal sphincter should not be considered a standard part of the radical operation for cancer of the lower or middle third of the rectum, and that a combined excision operation has no place in the treatment of rectal cancer.

Adult↗
PubMed1986

Anal submucosal injection: a new route for drug administration in pelvic malignancies. Part I. Experimental study of misonidazole distribution in serum and tissues, with special reference to urinary bladder. Preliminary report.

The anal and oral administration routes were compared in 30 rats to study the distribution of misonidazole, a radiation sensitizer, in the serum and tissues with special reference to the urinary bladder. 14C-labelled misonidazole was administered in a dose of 0.2 ml water/100 gm body weight containing 1 mu Ci misonidazole. The dose was given orally by stomach tube in 15 rats, and was injected in the submucosa of the anal canal in another 15. Animals were then killed after 15, 30, 60, or 120 minutes or after 24 hours. Organs were dissected, and radioactivity was determined in each by the internal standard method. The study has shown that the highest drug concentration in the bladder tissue relative to the serum was achieved with the anal submucosal route. Its level was eight and five times that of the serum 15 and 30 minutes after administration, respectively, in contrast to the oral route in which the drug concentration was one-quarter and equal to the serum level at the same time intervals. The anal route would thus provide the adequate channel required for misonidazole to promote radiation responsiveness in bladder carcinoma.

Administration, Oral↗
PubMed1986

Prostatic commissurotomy. A simple technique for the treatment of benign prostatic hypertrophy.

Division of the anterior prostatic commissure and the bladder neck (but sparing the mucosa) achieves "urethral decompression". This simple technique for the treatment of benign prostatic hypertrophy was performed in 68 poor risk patients. The results were very satisfactory, especially in large prostates with lateral lobe enlargement. No patient required blood transfusion. Immediate and late post-operative complications were not encountered and the hospital stay was short. The obstructive manifestations and the maximal urinary flow rate improved in 91% of patients. Failures were due to incomplete prostatic commissurotomy.

Aged↗
PubMed1985

Role of hemorrhoids in the pathogenesis of recurrent bacteriuria with a new approach for treatment.

A new approach for the pathogenesis and treatment of recurrent bacteriuria is presented. Ten patients with recurrent bacteriuria were studied. Episodes started 3-8 years prior to presentation. Different antimicrobial therapy and surgical procedures had no influence on the recurrence of infection. Urinary tract investigations were normal except for bladder neck and urethral congestion in all patients. Urine cultures identified Escherichia coli in all episodes of each individual and were identical to those of anal flora. All patients had hemorrhoids and 3 had chronic cervicitis. An etiological concept for recurrent bacteriuria is put forward. Hemorrhoids are considered to be the source of recurrent infection, the E. coli being transmitted to the genitourinary organs through the rectogenital veins. Treatment of hemorrhoids and rectogenital vein obliteration resulted in the disappearance of bacteriuric episodes during a follow up period of 1.5-6 years. Urine cultures remained free. Chronic cervicitis is cured.

Adult↗
PubMed1984

A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. Treatment of hemorrhoids: report of a technique.

A technique for the treatment of hemorrhoids has been presented. It is based on a recent study in which the persistence of the anorectal band, a remnant of the anorectal sinus, and failure of rectal neck remodeling are considered responsible for the initiation of the hemorrhoid disease. The constricting effect of the anorectal band on the rectal neck results in elevation of its pressure, straining at defecation, and prolapse of the rectal mucosa. There were 502 patients with third and fourth degree hemorrhoids. The preoperative rectal neck pressure was high in all of them. The technique comprises division of the anorectal band and hemorrhoid ligation. The results were satisfactory, and the complications were negligible. The rectal neck pressure was normalized and straining disappeared. The procedure is simple and easy. Compared with the other techniques for hemorrhoid treatment, it offers the advantage of dealing with the primary etiologic factor.

Adult↗