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Biomedical subjects

A Shafik

Publications and source records attributed to A Shafik.

At least 235 records · Page 13Linked to original sources
PubMed1984

Pelvic double-sphincter control complex. Theory of pelvic organ continence with clinical application.

A double-sphincter mechanism controlling the continence of pelvic organs is presented with a role-description of the involved pelvic musculature. The rectum and the urinary bladder identically have a detrusor with a neck related to a group of muscles which is responsible for its opening and closure. Whereas the levator ani and longitudinal muscle function to open the neck, the puborectalis and the internal sphincter are continent muscles. The puborectalis, not a part of the levator ani, gives origin to "individual" sphincters for each intrahiatal organ, and at the same time embraces all of them as their "common" sphincter. Thus, each intrahiatal organ is provided with a double voluntary sphincter apparatus consisting of "individual" and "common" sphincters. The mechanism of common sphincter, selective individual sphincter, and double-sphincter sphincter securative action is discussed. The external sphincter (anal and urethral) is an individual sphincter; the mechanism of its continent action is described. The different types of incontinence are outlined.

Anal Canal↗
PubMed1984

The pathogenesis of hemorrhoids and their treatment by anorectal bandotomy.

The role of the anorectal band in the genesis of hemorrhoids is studied. The anorectal band is a fibroepithelial tube which is a remnant of the anorectal sinus. Seventy-six hemorrhoid patients and 32 controls were studied. Rectal neck pressure recording was done for all subjects. Two biopsies were taken from the lower rectal neck of each individual of the hemorrhoid and the control group, and were examined microscopically. Rectal neck pressure was measured in 67 patients of the hemorrhoid group after internal sphincterotomy. The mean rectal neck pressure in the hemorrhoid patients was significantly higher than the controls. Postoperative pressure measurement showed normal values. Microscopic examination of the rectal neck specimens revealed the presence of fibrous bands in the lower rectal neck submucosa of all hemorrhoid patients and in only one control subject. Evidence suggests that this fibrous band is the anorectal band which is an embryonic vestige. A new theory of the pathogenesis of hemorrhoids is presented. Evidence in support of the theory is also shown. The treatment of hemorrhoids in view of this theory is discussed.

Anal Canal↗
PubMed1984

Anal cystography: new technique of cystography.

A new technique of cystography used in 32 patients with a normal anorectum is presented. Sodium amidotrizoate (Uroselectan) is injected into the anal submucosa just above the pectinate line, and serial x-ray films of the urinary tract are taken. The contrast medium diffuses from the anal submucosa to the vesical plexus. Within thirty minutes of injection, the whole bladder wall is opacified. In no film up to two hours did the dye appear in the pyelocalyceal system or the ureters. The route adopted by the contrast medium to show in the bladder wall is discussed, and the indications of the technique are outlined.

Adult↗
PubMed1983

Venous tension patterns in cord veins. II. After varicocele correction.

We studied 60 patients to evaluate the success of surgical correction of varicocele in lowering the venous tension in cord veins and to define the relationship of venous tension improvement to restoration of testicular function. Preoperative semen examination, testicular biopsy and venous tension measurements were performed. All patients had venous hypertension and reflux in the left cord. Venous tension was normal on the right side except in 6 patients with venous hypertension despite absent cord varicosities and reflux. An operation was done on the left side in all patients. Postoperative venous tension measurements and semen examination were performed. Of the 53 patients with improved venous tension postoperatively 39 had normal sperm counts with 17 resultant pregnancies. The semen quality in the 7 patients with persistent venous hypertension on the left side did not change except after surgical revision, which resulted in marked improvement in 4 patients with 2 pregnancies. The postoperative venous tension in the right cord veins remained normal. The 6 patients with venous hypertension on the right side had no change until an operation lowered the venous tension to normal, with subsequent improvement in semen quality in 4. The importance of varicosity and reflux in the evaluation of postoperative venous tension is emphasized. The factors involved in the prognosis after varicocele correction are mentioned. The cause of nonimprovement of semen character after a varicocele operation despite normalization of venous tension is discussed. The indications for postoperative venous tension measurement are outlined.

Adult↗
PubMed1982

Obturator foramen approach. II. A new surgical approach for management of the short-pedicled undescended testicle.

A new approach for the management of the short-pedicled undescended testicle is presented. It was used in four patients with the testicle lying deep to the internal inguinal ring after all methods of cord elongation failed to bring the testicle down to the scrotum. The technique consists of passing the testicle through the obturator foramen to the scrotum. No complications were encountered, and the results have been satisfactory. Normally the vas deferens and testicular vessels describe a loop along their inguinal and pelvic course. The obturator foramen approach shunts this loop, which may be lacking in the undescended testicle lying deep to the internal inguinal ring.

Adolescent↗
PubMed1982

Obturator foramen approach. I. A new technique for reconstruction of the vas deferens after extensive resections.

A new approach for restoring continuity of the vas deferens after long segment resection is presented. The technique was used in six patients. It consists of passing the pelvic segment of the vas through the obturator foramen for anastomosis with the scrotal vasal segment. No complications were encountered, and the results were excellent. The vasal length was studied in 37 cadavers of different ages. The portion of the vas that could be spared by the obturator approach was calculated and found to represent as much as one third of the total vasal length. The indications for the technique are outlined.

Adolescent↗
PubMed1982

A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. XV. Chronic anal fissure: a new theory of pathogenesis.

Pathologic changes in chronic anal fissures were studied in 52 patients. In 40 patients, epithelial cells could be identified in the fissure floor superficial to the internal anal sphincter. The cells were rounded, oval, or columnar and were arranged in clumps or pseudoacinar formations. In 10 patients the anorectal sinus was detected in the fissure floor, whereas in 2 patients no epithelial cells could be found. It seems that chronic anal fissure results from disruption of the anal lining, which exposes epithelial cells or the anorectal sinus in the wound floor to repeated infection. It is believed that these epithelial cells are just anorectal sinus remnants that exist in the submucosa of the anal canal proper as epithelial debris or anorectal band. Epithelial cells act as multiple sequestra that harbor the infection and are responsible for fissure chronicity. These patients are predisposed to anal traumatization by feces, owing to the anorectal band's constricting effect on the anal canal proper. The exclusive fissure location in the anal canal proper and not in the rectal neck is due to the anorectal sinus remnants contained therein. The posterior and, rarely, anterior median fissure position is ascribed to the existence of two weak anal areas. The break commonly occurs posteriorly because the posterior anal wall lacks sufficient support. It is concluded that fissure excision, including anorectal bandotomy, at present, is the best treatment to achieve a radical cure.

Adult↗
PubMed1982

Randomized trial of aminoglutethimide versus tamoxifen in metastatic breast cancer.

We compared antiestrogen therapy (tamoxifen) with an estrogen suppression regimen (aminoglutethimide-hydrocortisone) in postmenopausal women with metastatic breast carcinoma. Fifteen of 39 patients (38%) who received tamoxifen experienced an objective tumor regression (3 complete, 12 partial remissions), whereas 13 of 36 women (36%) receiving aminoglutethimide responded (one complete remission, 12 partial remissions). The median duration of response was similar. The site of tumor involvement appears to be important in choosing between these hormonal treatments. Aminoglutethimide appears to offer a greater chance of response in patients with bone involvement.

Aminoglutethimide↗
PubMed1981

A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. XII. Anorectal mobilization: a new surgical access to rectal lesions. Preliminary report.

A new technique for the removal of inaccessible benign intrarectal lesions and malignant lower third rectal tumors with sphincter preservation is presented. The procedure was performed in eight patients, four with huge bilharzial papillomas and four with malignant lower third rectal tumors. The essential feature of the operation is preservation of the levator tunnel, which is responsible for maintaining normal, voluntary continence and defecation. The results were satisfactory. The technique provides easy access to the interior of the rectum, and it extends the indications for sphincter-saving operations to include malignant lower third rectal tumors. It is hoped that this procedure will eliminate the use of abdominoperineal excision in the treatment of rectal cancer.

Adult↗
PubMed1981

Urethral discharge, constipation, and hemorrhoids. New syndrome with report of 7 cases.

A new syndrome in which 7 cases share common clinical features of urethral discharge only at defecation, constipation, and hemorrhoids is reported. The discharge occurred only with constipation. The relationship between urethral discharge, constipation, and hemorrhoids is discussed. The concept that hemorrhoids lead to prostatic venous congestion is put forward. The urethral discharge at defecation seems to be the result of "milking" of the congested prostate by the hard stools. The mechanism of fecal and urinary "milking" of the prostate is discussed. The role of the congested prostate in infertilogenesis is presented. It seems that metabolic accumulation in the prostatic, vesicular, and ampullary secretions affected the spermatogenic activity as it similarly does in varicocele. Permanent disappearance of urethral discharge and improvement of semen quality were achieved on anoprostatic decongestion by medical treatment, hemorrhoid injection, or hemorrhoidectomy. The syndrome of prostatorrhea, constipation, and hemorrhoids should be considered in patients with idiopathic urethral discharge and in infertile patients.

Adult↗
PubMed1981

Scrotal lipomatosis.

The anatomy of scrotal fat was studied histologically and by dissection in 28 normal cadavers and 44 idiopathic infertile subjects. Two fat patterns were described: normal and infertile. In the normal pattern, a small posterior extratunicary pad of fat was constantly encountered. Intratunicary fat occurred as small granules between the cord veins. Thirty-eight of the 44 idiopathic infertile subjects had scrotal lipomatosis, of which 2 types were recognised: extratunicary and intratunicary. The latter showed 2 patterns: diffuse and lobular. The diffuse pattern occurred in obese subjects and those of normal build, and the fat was firmly adherent to the cord veins. The lobular pattern occurred exclusively in the obese, and the lobules were loosely connected to the cord. The anatomical features of the normal fat pattern in relation to maximal testicular thermoregulatory efficiency were discussed. The role of scrotal lipomatosis in infertility was clarified and the relationship of scrotal lipomatosis to obesity presented.

Adipose Tissue↗
PubMed1981

Lipectomy in the treatment of scrotal lipomatosis.

Scrotal lipectomy was performed in 102 infertile patients with scrotal lipomatosis; suprapubic lipectomy was included in 22 patients who had redundant suprapubic fat. Improvement in semen quality was obtained in 64.7% and pregnancy occurred in 19.6%. Statistically, the improvement was significant in both the sperm count and motility of the total series and only in the sperm count in the cases which produced pregnancy. The technique is described and the factors to which the results may be attributed are discussed.

Adipose Tissue↗
PubMed1980

A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. X. Anorectal sinus and band: anatomic nature and surgical significance.

A study, comprising dissection and microscopic examination of the pectinate area with special consideration to anal glands, was performed in 29 cadavers varying from fully mature neonatal deaths to 52 years of age. At the junction of the anal canal proper with the rectal neck, an "anorectal sinus" (a submucosal anal circumferential depression) was identified in 18 specimens; in 6 specimens, the anorectal sinus was replaced by a fibroepithelial band ("anorectal band"); in 5 specimens, the anorectal sinus was absent, and in 3 of the 5 specimens only scattered epithelial cells ("epithelial debris" of the anorectal sinus) were detected. These findings suggest that the anorectal sinus is an embryonic vestige which results from hindgut "invagination" by the proctodeum. Its persistence or partial obliteration would result in the formation of tubular structures which are considered by investigators as anal glands. The sinus may be completely obliterated or may leave behind a submucosal "anorectal band" or scattered "epithelial debris." Evidence in favor of this new concept is put forward. The role of anorectal sinus, anorectal band, and epithelial debris in the genesis of some idiopathic anal lesions is discussed.

Adenocarcinoma↗