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Biomedical subjects

A Shafik

Publications and source records attributed to A Shafik.

At least 307 records · Page 17Linked to original sources
PubMedDate not supplied

Electrovesicography in benign prostatic hyperplasia.

The electric activity of the urinary bladder (UB) as demonstrated by electrovesicogram (EVG) was studied in 26 patients with benign prostatic hyperplasia (BPH) and in 10 healthy volunteers. Ten of the BPH patients were in the compensated stage and 16 were in the decompensated stage. Three electrodes were applied to the skin of the hypogastric area and one reference electrode was applied to the lower limb. Recordings were made from the full and empty UB and after the residual urine had been evacuated. In healthy volunteers, pacesetter potentials (PPs) were recorded as triphasic waves from the full and empty UB. Amplitudes were lower in the empty than in the full UB (p < .05), and were reproducible in the individual subject. The EVG of the compensated prostatic patients showed, in both the full and empty UB, PPs of higher frequency, amplitude, and velocity than that of the controls (p < .01 and p < .05, respectively), a condition called "tachyvesica." In the decompensated prostatic patients, the EVG showed a bradyarrhythmic pattern in the full UB and a silent pattern in the empty UB. It would appear that EVG recorded for BPH could be used to differentiate the compensated from the decompensated hyperplastic prostate. The technique is simple, easy, noninvasive, nonradiologic, and without complications when compared with other investigative methods.

Aged↗
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Pudendal artery syndrome with erectile dysfunction: treatment by pudendal canal decompression.

Pudendal artery syndrome (PAS) was studied in 10 patients with erectile dysfunction (ED). Ages ranged from 38 to 55 years. All had chronic constipation and straining at stool, absent nocturnal penile tumescence, low penobrachial pressure index (p < .01), low peak flow velocity (p < .001), and a diameter increase (p < .0001) upon duplex ultrasonography screening. Four of the 10 patients had perineal hypoesthesia, prolonged bulbocavernosus reflex (p < .05), and pudendal nerve terminal motor latency (p < .05), and weak anal reflex and EMG activity of the external anal sphincter. The levator EMG activity was reduced in all patients. Intracavernous papaverine injection induced partial erection after a period longer than normal. Selective pudendal arteriography showed narrowing or obstruction of the distal part of the internal pudendal artery (IPA) on both sides with poorly or non-visualized penile arteries. A generalized arterial disease was excluded and pudendal artery compression in the pudendal canal (PC) was suspected as causing ED. The narrow or obstructed part of the IPA corresponds to the part in the PC. Four of the 10 patients had manifestations of pudendal neuropathy in addition to IPA compression. Pudendal canal decompression (PCD) was performed through a perineal approach. ED improved in 8 of the 10 patients 3-6 months postoperatively. Two of the 4 patients who had pudendal arteriopathy combined with neuropathy did not improve. In conclusion, the 10 patients with ED had common clinical and investigative findings that constitute the pudendal artery syndrome. PCD effected improvement in 80% of the cases.

Adult↗
PubMedDate not supplied

Treatment of tuberculous epididymitis by intratunical rifampicin injection.

The results of treating 4 patients with tuberculous epididymitis by rifampicin injection into the tunica vaginalis sac were compared with the results in another 4 patients treated with the common oral antituberculous drugs. Oral treatment consisted of daily administration of rifampicin (600 mg), isoniazid (300 mg), and ethambutol (25 mg/kg body weight). Rifampicin (600 mg) was injected intratunically every 4 to 6 days. Treatment continued for 6 months in both groups, with 3 months follow-up thereafter. Periodic clinical assessment as well as semen and hydrocele fluid examination were performed. In the intratunical injection group, epididymal swellings disappeared in 3 to 6 months; semen and hydrocele fluid became sterile in 4 months. The oral group showed partial diminution of the epididymal mass in one patient only; one patient developed scrotal fistula. Semen remained positive for tubercle bacilli, and hydrocele fluid became negative in one patient only. The satisfactory results with the intratunical rifampicin administration seem to be due to the drug reaching the epididymis in high concentrations. The tunica vaginalis is a part of the peritoneum and, like it, is believed to have a high absorptive power. Furthermore, the intratunical injection treatment uses a single drug, in contrast to the oral therapy, which, by its multidrug administration, enhances the incidence of side effects.

Adult↗
PubMedDate not supplied

Electrovasogram in normal and vasectomized men and patients with obstructive azoospermia and absent vas deferens.

The electric activity of the vas deferens (VD) or the electrovasogram (EVG) was recorded in 34 healthy volunteers (mean age 39.3 +/- 7.6 [SD] years), 22 patients with obstructive azoospermia (mean age 38.8 +/- 9.2 years), 10 after epididymovasostomy performed for obstructive azoospermia (mean age 40.6 +/- 4.8 years), 9 with bilaterally absent vasa deferentia (mean age 36.6 +/- 7.4 years), 20 after vasectomy (mean age 44.3 +/- 7.9 years), and 18 after vasectomy reversal (mean age 58.6 +/- 6.8 years). Silver-silver chloride electrodes were applied to the posterior aspect of the upper part of the scrotum and a reference electrode was applied to the lower limb. The intravascular pressure was also measured in 18 subjects during vasectomy reversal operation. Normal EVG manifested as regular slow waves or pacesetter potentials (PPs) which had the same frequency, amplitude, and regular rhythm when the test was repeated in the individual subject. Mean frequency was 6.6 +/- 1.5 cycles/min, amplitude was 0.6 +/- 0.1 mV, and velocity was 5.6 +/- 1.1 cm/s. PPs were followed randomly by action potentials (APs). The EVG in obstructive azoospermia exhibited bradyvasa, i.e., diminished PP frequency, amplitude, and velocity, in 14 patients and a "silent" EVG in 8 patients. Eight of the 10 patients in whom azoospermia persisted after epididymovasostomy had a silent EVG, and the remaining 2 patients whose semen character normalized after the operation revealed normal EVG. A silent EVG was also recorded by the 9 patients with absent vasa deferentia. In vasectomized subjects, PPs from the proximal vasal segment exhibited an irregular rhythm (vasoarrhythmia). During vasectomy reversal, the proximal vasal segment exhibited vasoarrhythmia and high pressure (p < .05) and the distal segment showed a silent EVG and normal pressure (p > .05). EVG performed postvasectomy reversal by 1-6 years showed a normal pattern in 7 subjects who have impregnated their wives and vasoarrhythmic EVG in 11 who could not produce pregnancy. In conclusion, EVG could be characterized for normal and pathologic vasa deferentia. Electrovasography is a simple, noninvasive, and nonradiologic technique that might be used as a diagnostic tool in the investigation of VD disorders and infertility.

Adult↗
PubMedDate not supplied

Effect of different types of textiles on male sexual activity.

The effect of different types of textile underpants on sexual activity was studied in 50 men. All the subjects were potent and sexually active. They were divided into 5 equal groups: 4 test and 1 control. Each of the 4 test groups were dressed in one type of textile underpants made of either 100% polyester, 50/50% polyester/cotton mix, 100% cotton, or 100% wool. Sexual behavior was assessed before and after 6 and 12 months of wearing the pants, and 6 months after their removal. Behavioral response was rated as potent if the subject's penis became erect, entered the vagina, and ejaculated. The rate of potent intromission (I) to mounts (M) (I/M ratio) was determined. The electrostatic potentials (EP) generated on the penis and scrotum were measured by an electrostatic kilovoltmeter. The I/M ratio at 6 and 12 months of wearing the polyester and polyester/cotton mix pants was significantly reduced compared to the pretest levels and the controls (p < .001). The reduction was more manifest in the pure polyester than in the polyester/cotton mix group, and at the 12-month than at the 6-month examination. The I/M ratio of the cotton and wool groups showed insignificant changes during the study period. Six months after removal of the underpants, the I/M ratio had returned to the pretest levels in the two groups that had worn polyester-containing pants. The polyester-containing pants generated EP, which may induce electrostatic fields in the intrapenile structures and could explain the diminished sexual activity. The cotton and wool textiles did not generate EP. Thus, polyester underpants could have an injurious effect on human sexual activity.

Animals↗
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Pelvic floor muscles and sphincters during erection and ejaculation.

The pelvic floor muscles (puborectalis [PR], levator ani [LA]) and external anal (EAS) and urethral sphincters (EUS) were studied during erection and ejaculation in 12 mongrel dogs. The animals were anesthetized and the response of PR, LA, EAS, and EUS to electroejaculation (EE) was evaluated. Penile tumescence and rigidity as well as increase of the EMG activity of the aforementioned muscles and sphincters occurred. The rigidity and EMG activity increased as the voltage and current of EE continued to increase until ejaculation occurred at a mean voltage of 11.1 +/- 1.2 V and current of 122.4 +/- 14.4 mA. The increased PR activity might express the prostatic secretions into the posterior urethra. LA contraction seems to elevate the prostate and partially straightens the prostato-membraneous urethral kink that might occur during erection. The EAS and EUS contractions are believed to abort the urge to defecate or urinate and prevent leak of feces, flatus, or urine during coitus. The rhythmic EUS contraction at ejaculation might act as a "suction ejection pump," sucking the genital fluid into the posterior urethra while being relaxed and ejecting it into the bulbous urethra upon contraction.

Animals↗
PubMedDate not supplied

Hollow and fenestrated penile prosthesis: a new implant for treatment of impotence.

Penile implants are used for erectile dysfunction (ED). Their main disadvantage is that the cavernous tissue is destroyed and replaced by fibrous so that implant replacement is difficult and the penis loses its erectile function permanently. This paper describes a novel prosthesis which is hollow and fenestrated to preserve, as much as possible, the cavernous tissue. The fenestrated implant was used in 18 men with ED, while the solid Small-Carrion implants were used in 14 impotent men who matched the 18 men in age and cause of impotence and acted as controls. Routine erectile function tests suggested that the ED was neurogenic. The fenestrated prosthesis was a hollow semisolid silicone rod with multiple openings (2-3 mm in diameter) along its whole length. The mean follow up of the patients was 43 +/- 12 SD months. No complications were encountered. Vaginal penetration was successful in the fenestrated and Small-Carrion implant groups. A total of 14/18 patients of the fenestrated prosthesis group experienced spontaneous erections upon sexual arousal, while none of the Small-Carrion prosthesis group did. During the sexual act the penis became tumescent in the patients of the former group but not in those of the latter. It is suggested that the residual cavernous tissue after insertion of the hollow fenestrated implant regenerates through the fenestrae into the implant lumen. This might explain the spontaneous erections upon sexual arousal and the tumescence during the sexual act, but this hypothesis remains to be proved histologically.

Adult↗
PubMedDate not supplied

The mechanism of ejaculation: the glans-vasal and urethromuscular reflexes.

To assist in the understanding of the pathogenesis of the various ejaculatory disorders, 9 healthy male volunteers (mean age 30.4 +/- 4.8 years) were studied. The EMG response of the bulbocavernosus (BCM) and ischiocavernosus (ICM) muscles and the external urethral sphincter (EUS) to ejaculation induced by glans penis (GP) vibration was recorded. The test was repeated with individual anesthetization of the GP, BCM, ICM, and EUS. During ejaculation, the BCM, ICM, and EUS showed a significant increase in the motor unit action potentials. The contractions were rhythmic with a mean duration of the contractile episode of 0.8 s and the noncontractile episode of 0.72 s, and with a total muscle activity of 4.2 s. GP vibration after anesthetization of the GP produced no ejaculation or increased EMG activity of the BCM, ICM, and EUS, GP vibration after individual anesthetization of the BCM or the EUS produced semen emission but no ejection, and GP vibration after ICM anesthetization produced ejaculation (emission and ejection). The results suggest that the ejaculatory mechanism consists of two reflexes: the glans-vasal and urethromuscular. The former seems to bring the semen to the posterior urethra (the emission stage of ejaculation) and the urethromuscular reflex ejects it to the exterior (ejection stage of ejaculation). A dysfunction of these two reflexes would seem to induce ejaculatory disorders, a point that needs further study.

Action Potentials↗
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Esophago-sphincter inhibitory reflex: role in the deglutition mechanism and esophageal achalasia.

The effect of esophageal distension on the lower esophageal sphincter (LES) in 14 normal volunteers and 6 esophageal achalasia (EA) patients was studied. A balloon-tipped catheter was introduced into the LES and a second one into the esophagus. The pressure response of LES to balloon distension of the esophagus and pharyngoesophageal sphincter (PES) was recorded. In normal subjects, esophageal distension caused significant decrease of LES pressure; this reflex action was reproducible and was called "esophagosphincter inhibitory reflex" (ESIR). PES distension caused insignificant LES pressure changes (p > .05). Distension of the anesthetized esophagus or PES did not evoke LES pressure response. The ESIR was nonfatigable. In EA patients, the resting LES pressure was significantly higher than normal (p < .01). Upon esophageal distension, the LES pressure increased, while no response occurred with PES distension. There was paradox ESIR in EA with a resulting esophago-sphincter dyssynergia. To conclude, the ESIR seems to be of significance in esophageal motility disorders and may be incorporated as investigative tool in such conditions.

Adult↗
PubMedDate not supplied

Electrovesicogram in the neurogenic bladder.

The vesical electric activity was studied by electrovesicogram (EVG) in 24 patients with spinal cord injury: 15 with upper (UMNL) and 9 with lower (LMNL) motor neuron lesion. Mean age was 48.3 years; 16 were men and 8 were women. Eight healthy volunteers acted as controls. Transcutaneous recording was done with both a full and empty urinary bladder. three electrodes were applied supra-pubically and one reference electrode was applied to the lower limb. The normal volunteers recorded regular triphasic pacesetter potentials (PPs), which were reproducible in the individual subject. The electrovesicographic pattern was similar in the full and empty bladder, except that the PPs of the latter had a lower amplitude. the patients with UMNL showed "dysrhythmic" pattern with irregular rhythm, amplitude, and frequency in both the full and empty urinary bladder. Patients with LMNL exhibited "silent" EVG. The results indicate that electrovesicography could be used as an investigative tool that may help in the diagnosis of such conditions. The technique is simple, easy, noninvasive, and without complications.

Adult↗
PubMedDate not supplied

Electro-ureterogram: canine study of the electromechanical activity of the ureter.

The purpose of this investigation was to study the electromechanical activity of the ureter aiming at characterizing an "electro-ureterogram" that might be of diagnostic significance. Eighteen mongrel dogs were used in this study. Under anesthesia the ureter was exposed and three electrodes (monopolar, silver-silver chloride, 0.8 mm in diameter) were sutured to the ureteric adventitia, 2-3 cm apart. The intraureteric pressure was measured by a scalp vein needle inserted into the ureteric lumen and connected to a pressure transducer. The ureteric electric activity and pressure were recorded 30 min daily for 15 days. The electric activity was also registered after having performed ureteric myotomy in 12 out of 18 dogs. Monophasic negatively deflected slow waves or pacesetter potentials were recorded. Their frequency, amplitude, and velocity were identical in the three electrodes and reproducible. The pacesetter potentials were followed by fast activity spikes or action potentials that occurred randomly and were inconsistent. The action potentials were associated with ureteric pressure increase. After ureteric myotomy, both the pacesetter potentials and action potentials were recorded proximally to the myotomy but not distally to it, indicating a caudal spread of the waves. In conclusion, a normal electro-ureterogram could be characterized. It might show changes in various pathologic conditions of the ureter and could thus be included as an investigative tool in the diagnosis of ureteric diseases.

Action Potentials↗
PubMedDate not supplied

Cholecysto-sphincter inhibitory reflex: identification of a reflex and its role in bile flow in a canine model.

To study the effect of gallbladder (GB) distension on the sphincter of Oddi (SO), 9 mongrel dogs (mean weight 15.3+/-3.6 kg) were studied. Under anesthesia, the abdomen was opened and the GB and SO were exposed. A balloon-tipped catheter was introduced into the GB and a manometric catheter into the common bile duct so that its fluoroscopically controlled tip lay within the SO. The pressure response of the GB and SO to GB distension by the balloon without and with selective anesthetization of the GB and SO was recorded. The test was repeated in four vagotomized dogs. GB distension effected pressure rise within the GB and pressure drop within the SO. The GB pressure increased progressively as the distending volume increased, while the SO pressure drop was not affected. Selective anesthetization of the GB or the SO produced no SO pressure changes upon GB distension. The SO pressure response to GB distension after vagotomy was similar to that before vagotomy. The SO relaxation on GB contraction, being reproducible and abolished by selective anesthetization of either the SO or the GB, postulates a reflex relationship that we call the cholecysto-sphincter inhibitory reflex. This reflex seems to regulate the bile flow from the GB to the duodenum through the SO.

Animals↗
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Sigmoidometry: a method assessing sigmoid colon function.

The purpose of this communication is to present a method that assesses the sigmoid colon (SC) volume, pressure and compliance both quantitatively and qualitatively. The response of the SC pressure to SC distension was recorded in 12 healthy volunteers. The SC was distended by means of a condom, which was applied to an 8 F tube and inflated with carbon dioxide at a rate of 150 ml/min. The SC pressure was measured by a saline-perfused 8 F tube and the intra-abdominal pressure by a catheter placed in the urinary bladder. A curve called 'sigmoidometrogram' could be recorded and assessed qualitatively and quantitatively. The curve had a 'tone limb' representing the SC pressure upon distension and an 'evacuation limb' representing the SC pressure during balloon expulsion. The former showed insignificant pressure elevation (P > 0.05) with increasing volumes of CO2 inflation. It exhibited minor fluctuations which paralleled those of the intra-abdominal pressure. The 'evacuation limb' described a curve with an ascending limb continuous with the tone limb and a descending one, which descended vertically to the base line. Quantitatively, the infused CO2 volume and intrasigmoid and intra-abdominal pressures could be determined from the curve at each of the distension and expulsion sensation. Consequently, the SC compliance could be calculated. A normal sigmoidometrogram seems to reflect the normality of the sigmoid wall structure, afferent axons and central sensory pathways. Alteration of any of the components of this pathway is expected to change the measurements of SC volumes, pressure, compliance and sensation; it would also disturb the morphometry of the curve.

Adult↗
PubMedDate not supplied

Effect of rectal distension on the small intestine with evidence of a recto-enteric reflex.

BACKGROUND/AIMS: To study the effect of rectal distension on jejunal and ileal motility aiming at the assessment of the possible role of rectal distension induced by constipation on the transport of the material in the gut. METHODOLOGY: The rectum of 16 healthy volunteers (mean age: 38.6 +/- 11.7 years, 10 men, and 6 women) was distended by a balloon filled with water in increments of 50 mL up to 200 mL and the response of the jejunal and ileal pressures was recorded. The test was repeated distending the anesthetized rectum 20 min and 3 hours after anesthetization. RESULTS: Rectal distension with 50 mL of water effected no jejunal or ileal pressure changes (P > 0.05). One hundred-mililitre (100-mL) rectal distension produced decrease of jejunal and ileal pressures (P < 0.05) which lasted as long as distension was maintained. Rectal distension with 150 and 200 mL caused jejunal and ileal pressure response similar to that of the 100 mL distension (P > 0.05). Distension of the anesthetized rectum effected no significant jejunal or ileal pressure changes. CONCLUSIONS: The results were reproducible in the individual subject. The decline of the intestinal pressure upon rectal distension postulates a reflex relationship between the 2 conditions. This reflex nature is evidenced by reproducibility and by its absence on distension of the anesthetized rectum. We termed this reflex relation: "recto-enteric reflex". It is suggested that under normal physiologic conditions the reflex inhibits the intestinal transit, thus giving the rectum time to evacuate itself. Continuous rectal distension, as occurs in inertia constipation, appears to effect enteric hypotonia, a hypothesis which requires further studies.

Adult↗
PubMedDate not supplied

Uninhibited sigmoid colon syndrome (sigmoid hyperreflexia): description of a new clinicopathological entity.

PURPOSE: To present 10 patients who complained of passage of frequent loose stools which was found to be due to sigmoid colon hyperreflexia, a condition that, to our knowledge, has not been described before. PATIENTS AND METHODS: Ten patients (6 women, 4 men, mean age 46.6 years) complaining of frequent loose stools of 5-8 years' duration and 10 healthy volunteers (controls) matching the patients in age and gender, were included in the study. Colonoscopy, barium enema and intestinal transit studies were normal in all. The anorectal physiological studies comprised: recording of rectal, anal and intra-abdominal pressures, EMG of the external and internal anal sphincters and levator ani muscles, sigmoidometry and determination of the sigmoido-rectal junction reflex. RESULTS: Apart from sigmoidometry, all the aforementioned anorectal physiological studies were in accordance with those of the controls. Sigmoidometry showed that balloon expulsion occurred at a distending volume of 32.4 ml and a sigmoid colon pressure of 86.4 cmH2O in the patients, and of 86.2 ml and 98.6 cmH2O, respectively, in the controls. The tone limb exhibited major fluctuations (mean pressure rise 43.8 cmH2O) in the patients, while it was smooth or showed minor fluctuations (insignificant pressure changes) in the controls. CONCLUSIONS: The sigmoid colon contractions produced by small volumes of stools and the lack of proper storage necessary for water absorption from the stools, are suggested to explain the frequent loose stools in the studied patients and to be the result of sigmoid colon hyperreflexia.

Adult↗
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Study of the motile activity of the small intestine in constipated subjects.

BACKGROUND/AIMS: A recent study has demonstrated that rectal balloon distension effected inhibition of jejunal and ileal motility (Shafik, Hepatogastroenterology, 2000). It was hypothesized that rectal distension occurring in rectal inertia constipation might cause enteric hypotonia. This hypothesis was investigated. METHODOLOGY: Twenty-three patients with rectal inertia constipation (18 women, 5 men mean age 38.8 +/- 10.6 SD years) and 10 healthy volunteers (7 women, 3 men, mean age 37.2 +/- 9.8 SD years) were studied. The rectal, jejunal and ileal pressures were measured by means of saline-perfused tubes. The pressure response of rectum, jejunum and ileum to rectal balloon distension in increments of 50 mL of saline was recorded. RESULTS: The mean basal rectal, jejunal and ileal pressures measured in the patients with rectal inertia were significantly (P < 0.05) lower than those of the volunteers. Fifty-milliliter rectal balloon distension caused no rectal, jejunal or ileal pressure response in either the volunteers or patients. One hundred-milliliter distension effected in volunteers a rectal pressure elevation (P < 0.001) and a decline of jejunal (P < 0.05) and ileal (P < 0.05) pressures which were maintained as long as rectal distension was continued. In patients, no significant (P > 0.05) pressure changes were registered from the rectum, jejunum or ileum. Rectal distension with 150 and 200 mL caused balloon expulsion in the volunteers and in patients no significant rectal, jejunal or ileal pressure changes (P > 0.05). CONCLUSIONS: Rectal inertia was associated with reduced jejunal and ileal pressures, presumably indicating the presence of enteric hypotonia. The inertia-hypotonia relationship is proposed to be mediated through the recto-enteric reflex and transmitted by the enteric nervous plexus. The enteric hypotonia is suggested to prolong the intestinal transit, act as a contributing factor in the genesis of constipation and may explain some of its clinical manifestations.

Adult↗
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Fecoflowmetry: a new parameter assessing rectal function.

Fecoflowmetry is a new technique by which the fecal flow rate is studied through recorded curves representing the changes which occur in the rate against time. Fecal flow rate is the product of rectal detrusor action against outlet resistance. The technique was performed on 36 normal volunteers and 8 chronically constipated patients. A one liter water enema was given to the individual. On feeling the desire to defecate, he or she was placed on the commode of a fecoflowmeter and was asked to defecate. Defecation flow curves were obtained. Evaluation of the curve comprises reporting on the defecated volume, flow time, maximum and mean flow rates and the shape of the curve. The technique was developed to stimulate natural defecation. It provides quantitative and qualitative data concerning the act of defecation. It assesses all objective parameters in one test. The procedure is simple, non-invasive and constitutes a useful screening tool in defecation and rectal disorders.

Adolescent↗