Reversion to normal defecation after combined excision operation and end colostomy for rectal cancer.
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Colostomy↗
Biomedical subjects
A Shafik
Publications and source records attributed to A Shafik.
Non-surgical repair of rectovaginal fistulae.
Twelve women with recurrent rectovaginal fistulae (RVF) were treated by electrocauterization (EC). Ten fistulae were obstetric and two followed car accidents; they were located in the lower (4 patients), mid (6 patients) and upper (2 patients) third of the vagina. Under anesthesia, a cauterization probe was introduced into the fistulous track and an electric current was switched on for 30-60 s at a frequency of 20,000 cycles/s and a power of 30 W. Two patients required two sessions but all fistulae healed without recurrence (mean follow-up 24 months). No complications were encountered.
Adult↗
Pectinatoplasty: a technique for treatment of sensory fecal incontinence.
Nineteen patients (12 boys, 7 girls; mean age, 6.2 +/- 1.6 SD years) had fecal incontinence owing to absence of the ectodermal lining of the lower rectal neck. Physical examination findings were normal. The anal mucosa extended to the anal verge and was insensitive; there was no ectodermal lining or pectinate line in the lower rectal neck. The 19 patients were selected from a group of 62 patients with anorectal agenesis who had undergone an abdominoanal pull-through operation. The criterion for inclusion in the study was normal anorectal physiology. "Pectinatoplasty" was carried out with the patient under local anesthesia. Two 1.5- x 1.5-cm cutaneous flaps from each of the 5 and 12 o'clock positions of the perianal skin were advanced into the lower rectal neck at the site of an excised mucosal patch of similar size. The patients were discharged on the day of operation. Sixteen patients became continent. Two patients did not improve because of dislocation of the cutaneous flaps outside the anal orifice, as a result of suturing under tension; they became continent after regrafting, using two lateral flaps placed at the 3 and 9 o'clock positions. One patient had anal stenosis and was subjected to dilatation. Pectinatoplasty proved successful in restoring fecal continence in patients who lacked ectodermal anal lining. The procedure is simple, easy, and can be performed on an outpatient basis.
Child↗
Electroureterogram: human study of the electromechanical activity of the ureter.
OBJECTIVES: To study the electromechanical activity of the normal ureter in 5 men and 4 women (mean age 39.4 +/- 10.8 years) scheduled for rectopexy due to rectal prolapse. The results of urinary tract investigations were normal. METHODS: During anesthesia for rectopexy, rectal mobilization necessitates ureteral exposure for protective reasons. One electrode was applied to each of the upper, middle, and lower third of the right ureter, and signals were registered for 30 minutes. Simultaneous recording of intraureteral pressure was performed. RESULTS: Slow waves, or pacesetter potentials (PPs), were recorded from the three electrodes. Identical readings for frequency, amplitude, and velocity of conduction were obtained from the three electrodes in the same ureter. Action potentials (APs) followed the PPs and were inconsistent and were associated with an intraureteral pressure increase (P < 0.001). No pressure elevation occurred with PPs. CONCLUSIONS: In contrast to PPs, APs seem to have a role in ureteral mechanical activity and might initiate ureteral peristalsis. The function of the PPs is unknown; they might pace the APs in terms of direction and frequency. The present study could characterize an electroureterographic pattern for the normal ureter. It is suggested that this pattern is changed in the various ureteral pathologic conditions and, thus, the electroureterogram be considered a useful investigative tool in ureteral disorders. However, the procedure in its present from is not applicable to clinical practice. Nevertheless, the present study might be of significance in explaining the mechanisms of ureteral motility and urinary bolus transport.
Adult↗
Study of the intramural oviduct response to tubal and uterine distension: identification of tubo-uterine sphincter and reflex.
The effect of tubal and uterine distension on the intramural portion of the oviduct (IMO) was studied in 11 women (mean age 31.1 years). The IMO length was determined and the pressure response of the IMO to distension of the anaesthetized oviduct and uterus was examined. A 1.2 cm long high pressure zone (32.2 +/- 6.9 cm H2O) was identified in the IMO. An IMO pressure drop occurred upon oviduct distension with 2 ml of CO2 (P < 0.01); distension with greater volumes induced the same pressure drop (not significant). The IMO pressure increased with 10 ml uterine distension (P < 0.05); distension with greater volumes did not induce further pressure rises (not significant). Distension of each of the anaesthetized oviduct, uterus and IMO separately effected no IMO pressure response. A 'tubo-uterine' physiological sphincter is postulated at the high pressure zone of the IMO. It relaxes or contracts upon tubal or uterine distension respectively. The sphincter response to tubal or uterine distension is suggested to occur by a reflex action through a 'tubo-uterine' reflex, as shown by reproducible results and sphincteric non-response upon anaesthetization of the two arms of the reflex.
Adult↗
Electrovasography in normal and vasectomized men before and after vasectomy reversal.
The electrical pattern of the vas deferens, or electrovasogram (EVG), was studied in 22 healthy volunteers, 20 vasectomy subjects and 18 individuals after vasectomy reversal. Their mean ages were 38.8 +/- 7.3, 44.3 +/- 7.9 and 58.6 +/- 6.6 years, respectively. Two electrodes were applied to the posterior aspect of the upper part of the scrotum. During the operation of vasectomy reversal, an electrode was applied directly to each of the two vasal segments before and immediately after vasovasostomy. The electrical activity and intravasal pressure were measured. In normal subjects, slow waves or pacesetter potentials (PP) were recorded. They had identical frequency and a regular rhythm from the two electrodes and were consistent in the individual subject on all test days. PP were followed randomly by bursts of action potentials (AP). In vasectomized subjects, PP from the proximal vasal segment exhibited an irregular rhythm (vasoarrhythmia). During operation for vasectomy reversal, the proximal vasal segment recorded vasoarrhythmia whereas the distal segment revealed a silent EVG. Intravasal pressure was normal (p > 0.05) in the distal segment but high (p < 0.05) in the proximal segment. EVG performed 1-6 years after vasectomy reversal showed a normal pattern in four subjects and diminished frequency and amplitude in three. These seven subjects had impregnated their wives and had an obstructive interval of < 3 years. The 11 subjects who did not produce a pregnancy had a vasoarrhythmic EVG and an obstructive interval of > 3 years. In conclusion, an EVG could be identified for normal subjects. Vasectomy resulted in a vasoarrhythmic EVG pattern which proved to be correctable by vasectomy reversal if the obstructive interval was short.
Action Potentials↗
Study of the arterial pattern of the rectum and its clinical application.
The purpose of this communication was to study rectal arterial supply in order to characterize its various patterns and use them to help avoid rectal ischemic complications and, in addition, to explain some of the unknown rectal pathologic conditions. Thirty-two cadavers were studied. The pelvic organs were eviscerated. The rectal arteries were examined by direct dissection in 12 specimens and after injecting the inferior mesenteric artery with barium sulfate in 20 specimens. The superior rectal artery (SRA) and vein were found to be enclosed in a fibrous sheath which was connected to the posterior rectal surface by an anterior mesorectum containing the "transverse rectal branches', and to the sacrum by an avascular posterior mesorectum. Small lymph nodes were scattered alongside the anterior mesorectum. The SRA gave rise to 4 branches: transverse rectal, descending rectal, rectosigmoid and terminal. The transverse rectal arteries arose from the SRA in 24 specimens and from the descending rectal artery in 8. They were distributed to the upper half of the rectum. The rectosigmoid artery was distributed to the descending limb of the sigmoid colon and rectosigmoid junction. We found 2 terminal branches in 21/32 cadavers and 3 in 11/32. They communicated in the lower half of the rectum. The inferior rectal arteries were present in all the dissected cadavers while the middle rectal arteries could be identified in only 50% of the cadavers. Two arterial patterns were recognized: annular in the upper rectal half provided by the transverse rectal arteries and plexiform in the lower half supplied by the SRA terminal branches.
Adolescent↗
Electro-oviductogram: a study of the electromechanical activity of the canine oviduct.
The purpose of this communication was to study the electromechanical activity of the oviduct aiming at the characterization of a normal 'electro-oviductogram' (EOG). The oviduct of 14 bitches was exposed and 3 monopolar silver-silver chloride electrodes were sutured to the duct serosa. The oviduct pressure was also measured. Direction of propagation of the electric activity was assessed by duct myotomies. Slow waves or pacesetter potentials (PPs) were recorded from the 3 electrodes of each dog. They were identical from the 3 electrodes, had a regular rhythm and were reproducible. The PPs were followed by bursts of action potentials (APs) which were associated with increased oviduct pressure. PPs and APs were recorded from electrodes proximal but not distal to the oviduct myotomy, indicating that they were propagated from the fimbrial end of the oviduct towards the uterus. A 'pacemaker' initiating these waves might exist at this fimbrial end. The increased oviduct pressure associated with APs might point to a contractile activity that may be responsible for initiating the oviduct peristaltic activity. In conclusion, the current study could characterize an EOG for the normal canine oviduct. It is suggested that, after further studies, the EOG may be included as an investigative tool in the diagnosis of oviduct disorders.
Animals↗
Pudendal canal decompression for the treatment of fecal incontinence in complete rectal prolapse.
Our recent studies have attributed fecal incontinence (FI) when it is associated with complete rectal prolapse (CRP) to pudendal neuropathy caused by pudendal canal syndrome (PCS). Herein we present the results of pudendal canal decompression (PCD), performed for the treatment of FI in 21 patients whose CRP was corrected by Ivalon sponge rectopexy 5.2 years before presentation. Thirteen patients had partial and eight complete FI. Examination revealed perianal hypoesthesia, diminished rectal neck pressure, reduced electromyographic (EMG) activity of both the external anal sphincter (EAS) and levator ani (LA) muscle, as well as prolonged pudendal nerve terminal motor latency (PNTML). PCD was performed with a mean follow up of 14.8 months. Postoperatively, seven (53.8%) of the patients with partial FI showed full fecal control with normalization or improvement of the perianal hypoesthesia, rectal neck pressure, EMG of EAS and LA, as well as PNTML. The remaining six patients were failures. Five (62.5%) of the eight patients with complete FI showed full fecal control, two partial improvement, and one failure. The degree of response of FI to PCD seems to be related to the degree of pudendal nerve damage. Nonimprovement may be due to irreversible pudendal nerve damage or incomplete PCD. In conclusion, PCD is effective in the treatment of FI associated with CRP, provided it is performed before complete nerve damage occurs.
Adult↗
Study of the electromechanical activity of the uterus. Experimental study.
The uterine electromechanical activity was studied in 12 mongrel bitches. The uterus was exposed under general anesthesia, and 2 electrodes were sutured to its serosa. The electric activity was recorded for 30 minutes/day for 10 days. Simultaneous electric and mechanical activity (registered by a 4 F catheter connected to a pressure transducer) was also studied without and with uterine distension by a balloon. The electric activity was further recorded after performing uterine annular myotomy proximal and distal to the electrodes and between them. Pacesetter potentials (PPs) were registered from the 2 electrodes, having identical frequency and regular rhythm by the 2 electrodes, and were consistent in the individual dog on all test days. Action potentials (APs) followed PPs randomly and were associated with increase in uterine pressure. Balloon distension of the uterus effected increased PP and AP frequency. Annular uterine myotomy led to PP and AP disappearance distally but not proximally to myotomy. In conclusion, the study demonstrates that the uterus possesses electric activity represented by PPs which spread caudally. APs seem to be contractile waves. Recording of the electromechanical activity of the uterus may be of diagnostic significance in uterine disorders.
Action Potentials↗
Surgical anatomy of the pudendal nerve and its clinical implications.
A study of the surgical anatomy of the pudendal nerve (PN) was performed in 13 female and 7 male cadavers. The knowledge of the precise anatomy and anomalies of this important nerve would help in better localization of the nerve and its roots and branches for neurostimulation or for pudendal canal decompression in pudendal canal syndrome. Two routes were used in the dissection: gluteal and perineal. The PN was identified and its course was followed from its roots to its termination. The PN was composed of three roots derived from the 2nd, 3rd, and 4th anterior sacral rami (S 2,3,4). The roots received a contribution from S 1 in five cadavers and from S 5 in one. The three roots formed two cords. The first root continued as the upper cord while the second and third root fused together producing the lower cord. The PN was formed by union of the two cords a short distance proximal to the sacrospinous ligament, and then crossed the back of the ligament. In no specimen did the nerve cross the ischial spine. The inferior rectal nerve arose from the PN in the pudendal canal in 18 cadavers. In two cases it came out proximal to the canal; this would spare the two subjects the anorectal manifestations of the pudendal canal syndrome. As the PN crossed the back of the sacrospinous ligament, it gave origin to a branch that supplied the levator ani muscle. This branch was only found in male cadavers and we call it "accessory rectal nerve"; the levator ani muscle in such cadavers was doubly innervated on its perineal aspect.
Adult↗
Inferior rectal nerve stimulation for anal sphincteric control: experimental study.
The effect of inferior rectal nerve (IRN) stimulation on sphincteric control of the rectal neck was studied in eight dogs. With the dog under anesthesia, the IRN was exposed through para-anal incision, and a bipolar electrode was applied to it. Response of the rectal and rectal neck pressures as well as external and sphincter (EAS) EMG activity to IRN stimulation was determined. IRN stimulation resulted in increase in both the rectal neck pressure (P < 0.01) and the EMG activity of EAS (P < 0.01). Response increased with increasing stimulation frequency up to 50 Hz, above which no more response occurred. Rectal pressure showed no change (P > 0.05). Both the latency and the duration of response decreased with increased stimulation. The response was resumed after an off-time of twice the stimulation phase. Long-term activation has not been associated with an impairment of nerve responsiveness or with electrode migration or break. To conclude, a stimulus of 50 Hz evokes the most adequate EAS contraction and RN pressure elevation. Chronic electrostimulation of the perineal nerve may restore EAS tone.
Action Potentials↗
Perianal injection of autologous fat for treatment of sphincteric incontinence.
PURPOSE: The aim of this study was to evaluate the results of treatment of partial fecal incontinence with perianal injection of autologous fat. METHODS: The study comprised 14 patients with partial fecal incontinence (9 women and 5 men). Ages ranged from 38 to 62 years. Fifty to 60 ml of fat were harvested from the abdominal wall and injected submucosally into the rectal neck at 3 and 9 o'clock positions. Mean follow-up was 18.6 months. RESULTS: All patients were continent during the first two to three postinjection months. At the sixth month, patients were divided into three scores. Score 1 (complete continence) comprised three patients who are now continent for 9, 11, and 14 months postinjection, with normalization of their rectal neck pressure. Seven patients with Score 2 were incontinent to flatus and were reinjected; they are now continent (Score 1) for a mean of 13.8 months and have normal rectal neck pressure. Four patients had Score 3 (no improvement), of whom two became continent after the second injection and two after the third. They are now continent (Score 1) 6 to 16 months postinjection. Factors that contributed to failure comprised injection of unwashed fat or wrong positioning of the needle. There was no fat migration or embolism. CONCLUSION: Perianal fat injection is effective in treatment of partial fecal incontinence. The technique is simple, easy, cost-effective, and performed on an outpatient basis.
Adipose Tissue↗
Vagino-levator reflex: description of a reflex and its role in sexual performance.
A new reflex, termed the 'vagino-levator reflex', was studied in 17 healthy women (mean age 36.6 years). The vagina was distended with up to 300 ml air in a condom tied to a catheter, and the levator ani response was determined by means of needle electrode introduced into the muscle. The test was repeated after anesthetizing the vagina and the levator muscle, respectively. The levator EMG activity rose when the vagina was distended; the amplitude and duration of activity increased in parallel with vaginal distension. The levator response did not occur after successive repetition of vaginal distension due probably to levator muscle fatigue; nor did it occur after anesthetizing the vagina or the levator muscle. The mean latency of the reflex was 39.5 ms. The vagino-levator reflex seems to play a role in the sexual act. Levator contraction upon penile thrusting leads to genital responses that could facilitate sexual performance. These responses comprise widening of the vaginal introitus, vaginal elongation and ballooning of the upper vagina as well as uterine elevation. Vagino-levator reflex dysfunction may result in disorders of sexual act.
Adult↗
Response of the urethral and intracorporeal pressures to cavernosus muscle stimulation: role of the muscles in erection and ejaculation.
OBJECTIVES: The role of the bulbocavernosus (BC) and ischiocavernosus (IC) muscles in erection and ejaculation was studied. METHODS: The response of the urethral and intracorporeal pressure to cavernosus muscle stimulation was evaluated in 18 male volunteers (mean age, 36.6 years). A two-channel microtip catheter was placed in the prostatic and bulbous urethra. Muscle stimulation was done by two needle electrodes inserted into the BC and IC muscles. RESULTS: BC muscle stimulation caused an increase in the pressure of the bulbous urethra (P < 0.001) and corpus spongiosum (P < 0.01) and an insignificant change in the prostatic and pendulous urethral and corpus cavernosal pressures (difference not significant). IC muscle stimulation effected an increase in the corpus cavernosal pressure (P < 0.001) without changing the urethral pressure (difference not significant). CONCLUSIONS: The BC muscle contracts rhythmically at orgasm and this might help to eject the semen from the posterior to the anterior urethra. It is apparent that the muscle has minimal or no role in erection. IC muscle may have a role in erection by increasing the intracavernosal pressure. It seems that it has no role in ejaculation. BC may be considered the "muscle of ejaculation," and IC the "muscle of erection."
Adult↗
Electrovasogram: a canine study of the electromechanical activity of the vas deferens.
OBJECTIVES: To study the electric activity of the vas deferens (VD), or electrovasogram (EVG), in 14 mongrel dogs. METHODS: The VD was exposed in the spermatic cord and three electrodes were applied to it. Synchronous transcutaneous EVG was also recorded by another three electrodes. The electric activity and intravasal pressure (IVP) were determined at rest, during ejaculation, and after vasal myotomy. RESULTS: Slow waves or pacesetter potentials (PPs) were recorded regularly from all electrodes applied to the VD whether directly or transcutaneously. They had identical frequency and regular rhythm from all the electrodes and were consistent in the individual dog on all test days. Action potentials (APs) followed PPs randomly and were associated with an IVP increase, indicating a state of contractile activity. Just before ejaculation, the PPs and APs increased significantly (P < 0.05) and were associated with IVP rise (P < 0.01). During ejaculation, there was rhythmic increase of the PPs, APs, and IVP (P < 0.01 for frequency and amplitude, P < 0.05 for velocity of PPs and P < 0.001 for IVP) followed by a silent period and return to the resting activity (P > 0.05). After vasal myotomy, PPs and APs were recorded proximal but not distal to the cut. This suggests that the PPs and APs spread caudally from the proximal part of the VD that is believed to be the site of a pacemaker that triggers the PPs. The PPs seem to pace the vasal contractile activity in terms of direction and frequency. CONCLUSIONS: A normal EVG pattern was characterized for the VD, which may be deranged in the various vasal pathologic conditions. EVG may thus be proposed to be included as an investigative tool in the diagnosis of vasal disorders.
Animals↗
Electrorectogram study of the neuropathic rectum.
The rectal electrical activity was studied by electrorectogram (ERG) in 28 patients with spinal cord injury (SCI) (mean age 46.6 years, 18 men and 10 women) and nine healthy volunteers (controls). Nineteen patients had an upper motor neuron lesion (UMNL) and 9 a lower motor neuron lesion (LMNL). The ERG was recorded by a monopolar silver-silver chloride electrode applied to the rectal mucosa by suction. Simultaneous recording of the rectal and rectal neck pressures was performed. At least four recording sessions of 120 min each were done for every subject. No complications were encountered during the test. The ERG in normal subjects showed pacesetter potentials (PP) with a regular rhythm and constant frequency and were reproducible in the individual subject. PP were followed by action potentials (AP) which had an inconsistent frequency and were associated with increased rectal pressure. The ERG in UMNL patients exhibited 'dysrhythmia' with irregular frequency, amplitude and velocity. The AP did not show in any recording. LMNL patients had a 'silent' ERG. In conclusion, two patterns of ERG could be identified in SCI patients: dysrhythmic and silent. The cause of the disordered ERG could be due to derangement of the intrinsic rectal conducting system.
Adult↗