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Biomedical subjects

Ahmed Shafik

Publications and source records attributed to Ahmed Shafik.

At least 109 records · Page 6Linked to original sources
PubMed2003

Colonic pacing in patients with constipation due to colonic inertia.

BACKGROUND: The colon exhibits electrical activity in the form of pacesetter potentials (PPs) and action potentials (APs); no activity is recorded in total colonic inertia (TCI). Electrical activity mediates colonic motility. We have elsewhere demonstrated that 4 pacemakers initiate colonic electric activity. We investigated the hypothesis that the absence of electric activity in TCI is due to non-functioning pacemakers and that their stimulation produces colonic motility and defecation. MATERIAL/METHODS: 19 patients with TCI were divided into 2 groups: a study group of 11 patients (age 42.6 +/- 6.8 years; 7 women) and a control group of 8 patients (age 41.4 +/- 6.3 years, 5 women). 7 healthy volunteers (age 40.9 +/- 6.1 years, 5 women) were also studied. Pacing electrodes were endoscopically hooked to colonic mucosa: one stimulating and 2 or 3 recording. Stimulating electrodes were applied to the 4 potential pacemaker sites located at the cecal pole, the cecocolonic junction, the mid-transverse colon, and the colosigmoid junction. Electrical activity was recorded before and during electrical stimulation. RESULTS: Colonic pacing of healthy volunteers caused a significant increase in the frequency, amplitude and conduction velocity of basal electric waves. Colonic pacing in the study group produced PPs and APs, which varied between colonic segments. No waves were recorded from the control group in which the pacemakers were not activated. CONCLUSIONS: Colonic pacing produces electrical activity in patients with TCI. This method can be applied for the treatment of constipation in these patients.

Action Potentials↗
PubMed2002

Study of the pelvic floor muscles in vaginismus: a concept of pathogenesis.

BACKGROUND: Neither the cause of vaginismus nor the muscles involved are precisely identified. AIM: To define the involved muscles and their role in the pathogenesis of vaginismus. METHODS: The EMG activity of the levator ani (LA), puborectalis (PR) and bulbocavernosus (BC) muscles was studied in seven female patients (age (years): 25.6(mean)+/-1.2(S.D.)) and seven healthy volunteers who matched the patients in age. Recordings were performed at rest and during induction of vaginismus by a vaginal dilator. MAIN RESULTS: Upon approximating the vaginal dilator to the vaginal introitus or introducing it into the vagina of the healthy volunteers, the EMG activity of the LA, PR and BC muscles showed no significant difference from the basal activity. In the patients, the basal EMG activity of the examined muscles was significantly higher than that of the healthy volunteers (P<0.05). Upon vaginismus induction, the muscles showed a significant increase of the EMG activity (P<0.01). The latency recorded a mean of 14.2+/-2.3, 13.9+/-2.3 and 14.1+/-2.2ms (P>0.05) in the LA, PR and BC muscles, respectively. The muscle response was momentary lasting a mean of 31.2+/-5.7s. It was reproducible provided an off-time of a mean of 13.2+/-2.3s was observed. CONCLUSION: The pelvic floor muscles of vaginismus patients exhibited increased EMG activity at rest and on vaginismus induction; the cause is unknown. The concept of a disordered sacral reflex arc is put forward but needs further studies to be verified.

Adult↗
PubMed2002

The motor efficacy of the artificial colonic pacemaker in colonic inertia patients.

We have recently demonstrated that the colon possesses at least 4 pacemakers which presumably generate electric waves and that colonic pacing evokes electric activity in colonic inertia. We tested the hypothesis that electric waves produced by artificial colonic pacing in colonic inertia patients may initiate colonic motilitiy and effect evacuation. 17 patients with constipation due to total colonic inertia were divided into 2 groups: 10 (age 45.6 ( 6.3 years, 7 women) in the study group and 7 (age 43.7 ( 5.8 years, 5 women) as controls. 7 healthy volunteers were included in the study. Colonic pacing was tested at 2 sites of pacemakers: mid-transverse colon and colosigmoid junction. A stimulating electrode was hooked to the colonic mucosa at the pacemaker site and 2-3 recording electrodes distally to it. Healthy volunteers showed resting electric waves in the form of pacesetter and action potentials which increased significantly on colonic pacing. Inertia patients exhibited no basal electric activity. Colonic pacing in the study group evoked electric waves and caused expulsion of small volume balloon. Balloon distension at pacemaker site produced mass movement of balloon, while away from pacemaker site step-wise movement. In conclusion, colonic pacing evoked electric waves in colonic inertia patients and effected balloon expulsion. We postulate that the pacemaker generates electric waves which spread along pacemaker branches that are composed of interstitial cells of Cajal and nerve fibers of the enteric nervous plexus and effect colonic mass contraction. Ex-pacemaker stimulation presumably leads to local activation of interstitial cells of Cajal and segmental step-wise contraction.

Action Potentials↗
PubMed2002

Parasympathetic extrinsic reflex: role in defecation mechanism.

The rectum has an intrinsic nervous mechanism represented by the enteric nervous plexus (ENP) and an extrinsic one mediated by the parasympathetic nerves. Rectal distension evokes the rectoanal inhibitory reflex, which acts through the ENP and is considered the main mechanism responsible for defecation. However, the role of the parasympathetic innervation compared to the role of the intrinsic mechanism of the defecation act has so far not been sufficiently addressed in the literature. The current study investigated this point. Twelve dogs were anesthetized. The anal and rectal pressures were recorded during rectal balloon distension with normal saline in 10 ml increments until the balloon was expelled to the exterior. The test was repeated after ENP block with a (phentolamine) and b (propranolol) adrenoceptor blocking agents and then after rectal denervation by bilateral pelvic ganglionectomy. The rectal balloon was expelled to the exterior at rectal balloon distension with 30 to 40 ml. After separate administration of phentolamine and propranolol, it was dispelled at a distending volume of 50 to 60 ml, and after rectal denervation at a volume of 80 to 90 ml. The results were reproducible. The balloon expulsion test suggests that the intrinsic defecation reflex is weaker than the extrinsic one for inducing defecation, although the two reflexes appear to be complementary. The difference between them in inducing defecation might be significant to our understanding the defecation act in the neurogenic rectum, a point that needs further study.

Adrenergic alpha-Antagonists↗
PubMed2002

Electrophysiologic identification of the location of the colonic pacemakers. A human study.

Colonic inertia, total or segmental, is a known cause of constipation, yet its etiology is poorly understood and its treatment not satisfactory. Although the colonic electric activity has been studied by many investigators, the colonic pacemakers that are assumed to generate the electric waves, are scarcely addressed and their location, to our knowledge, has not been determined. The current communication investigates the possible sites of the colonic pacemakers, aiming at a better understanding of the mechanism of colonic motility and its disorders, notably colonic inertia. The tests were performed during the repair of huge incisional hernia in 12 subjects (mean age 37.7 +/- 10.2 years, 7 women). Monopolar silver-silver chloride electrodes were applied to the terminal ileum (TI) and cecum (C), and to the ascending (AC), transverse (TC), descending (DC) and sigmoid colon (SC); they were fixed by electrode gel to the ileal and colonic serosa. The electric activity of each of the TI, C, AC, TC, DC and SC was recorded. Electric waves in the form of slow waves or pacesetter potentials and action potentials were recorded from the TI and colon. Differences in the frequency, amplitude and conduction velocity of the waves occurred between the TI and the various segments of the colon. The change in the wave variables between the TI and C occurred at the ileocecal junction, between the C and AC at the cecocolonic junction, the AC and TC at the mid third of the TC and the DC and SC at the colosigmoid junction. The colonic electric waves are suggested to be generated by at least 4 pacemakers, which are presumably located at the ileocecal junction, the cecocolonic junction, the mid third of TC and at the colosigmoid junction. The electric waves appear to be responsible for conducting the colonic motor activity. We postulate that disordered colonic pacemakers may produce segmental or total colonic inertia, a proposition that needs further investigation.

Action Potentials↗
PubMed2002

On the mechanism of colonic motility: the electric activation theory of colonic contraction.

PURPOSE: A previous study has demonstrated that the longitudinal muscle possesses electric activity, while the circular does not (A. Shafik and A. A. Shafik, 2000, Front. Biosci. 5, b5). In the current study, we investigated the mechanism of action of the two colonic muscle coats in the motility of the gut. METHODS: Fourteen patients (43.8 years, 10 men) with left colon or rectal cancer were scheduled to have transverse colostomy as a part of their operation. The electric activity of the ascending colon was recorded by three electrodes applied to each of the circular and the longitudinal (taenia coli) muscle coats. Simultaneously, the colonic pressure was recorded before and after colonic distension. The test was repeated after longitudinal muscle anesthetization. RESULTS: Electric waves in the form of pacesetter (PPs) and action (APs) potentials were recorded from the longitudinal but not the circular muscle fibers. APs were associated with an intracolonic pressure rise. Colonic distension produced significant increase in the PPs and APs recorded from the longitudinal muscle with appearance of similar electric activity from the circular muscle. Electric activity and colonic pressure increased upon increase in the colonic distension until the balloon in the proximal part of the ascending colon moved to the transverse colon in one mass contraction. Ten minutes after longitudinal muscle anesthetization, no electric activity was recorded from the longitudinal and circular muscles upon colonic distension. CONCLUSIONS: The electric waves appear to be transmitted from the longitudinal to the circular muscle upon colonic distension. The giant migrating contractions of the colon that move the food bolus from the cecum to the transverse colon are suggested to be a function of the longitudinal muscle electric activation with gut lumen modulation by the circular fibers.

Action Potentials↗
PubMed2002

Electrourethrogram: study of the electric activity of the urethra and its clinical significance.

PURPOSE: Apart from the urethral sphincters, the electric activity of the urethra has not been fully addressed in the literature. We investigated the hypothesis that also the non-sphincteric part of the urethra possesses electric activity which may have clinical significance. MATERIALS AND METHODS: Urethral electric activity was studied in 24 healthy volunteers (mean age 40.6 +/- 13.6 years, 14 women). Two electrodes in women and three in men were applied to the urethral mucosa distal to the striated urethral sphincter. A manometric catheter was placed into the penile urethra in men and distal to the striated sphincter in women. RESULTS: Monophasic negatively deflected slow waves were recorded. Their frequency, amplitude and conduction velocity were identical in the electrodes of the individual subject and were reproducible. The slow waves were followed or superimposed by fast activity spikes or action potentials which occurred randomly and were associated with urethral pressure rise. The pattern of electric activity was stable in the same subject on all test sessions. CONCLUSIONS: A normal electrourethrogram could be identified. It consisted of slow waves and action potentials. The waves had a regular rhythm. The action potentials appear to have a motor activity and are suggested to clear the urethra of the residual urine and secretions that may exist in the urethra after micturition. The clinical significance and diagnostic role of the electrourethrogram need to be further investigated.

Action Potentials↗
PubMed2002

Study of the motile activity of the colon in rectal inertia constipation.

BACKGROUND: We have recently demonstrated that rectal distension effected left colonic contraction, which probably acts to feed the rectum with fecal matter each time the rectum distends and evacuates its contents. This effect was postulated to occur through the recto-colic reflex. As the colonic status in rectal inertia constipation was scarcely addressed in the literature, we investigated this point. METHODS: The response of the colonic pressure to rectal balloon distension in increments of 10 mL of water was studied in 38 patients with rectal inertia constipation (IC) (age 42.6 +/- 14.3 years, 29 women) and 12 healthy volunteers (40.9 +/- 12.2 years, nine women). The rectal and colonic pressures were measured by saline-perfused tubes connected to a pneumohydraulic infusion system. The rectum was distended by a condom applied to the end of a 10-F catheter. RESULTS: The rectal and left colonic resting pressures were significantly lower in the patients than in the controls (P < 0.5, P < 0.05, respectively). In the healthy volunteers, rectal distension up to first rectal sensation produced no significant rectal or colonic pressure changes (P > 0.05, P > 0.05). At urge, rectal and left colonic pressures increased significantly (P < 0.001, P < 0.001, respectively), but there were no changes in the right colonic pressure (P > 0.05). The colonic response lasted as long as the rectum was distended. In IC, patients did not perceive the first rectal or urge sensation up to a rectal balloon filling of 300 mL; there was no rectal or colonic pressure response (P > 0.05, P > 0.05). CONCLUSION: In normal subjects, left colonic contraction on rectal distension probably acts to feed the rectum with fecal material. In IC, the low left colonic resting pressure assumedly points to left colonic hypotonia which appears to aggravate the constipation produced by the inertic rectum. Furthermore, non-response of the left colon to rectal distension probably impedes rectal feeding with fecal matter and enhances constipation.

Adult↗
PubMed2002

Role of the longitudinal smooth muscle coat in the ileal motile activity: evidence of ileo-ileal inhibitory reflex.

BACKGROUND: All gut movements are claimed to be activated essentially by the concentric contraction of the circular muscle, moving the chyme aborally. The role of the longitudinal smooth muscle of the small intestine in gut motility is poorly understood; this point was investigated in the current study. METHODS: The abdomens of 14 crossbreed dogs (eight dogs, six bitches) were opened. A segment of the small intestine was distended by a balloon in increments of 2 mL of saline, and the pressure and electrical activity were recorded proximally and distally to the balloon. The gut wall around the balloon was anesthetized and the test was repeated. The longitudinal muscle coat of the small intestine segment was then excised, and the pressure response and electrical activity were recorded on ileal distension. RESULTS: Two milliliter ileal distension produced pressure decrease (P < 0.05) proximally and distally to the balloon and caused balloon movement. Four, 6 and 8 mL distension effected similar pressure response, while 10 mL showed no response. Electrical waves were recorded from the three electrodes applied to the ileal segment. Upon ileal distension, electrical activity increased over the distended area, with no activity proximally and distally to it. Balloon distension of the anesthetized ileal segment produced no pressure response or electrical activity. After longitudinal myectomy, no electrical activity was recorded at rest or upon ileal distension, and the balloon did not move. CONCLUSION: Ileal distension initiated circular muscle contraction only in the presence of the overlying longitudinal muscle, which appears to transmit the electrical activity to the circular muscle upon ileal distension. Ileal contraction is suggested to initiate ileal hypotonia in the proximal and distal ileal segments mediated through an 'ileo-ileal inhibitory reflex' that leads to aboral progress of the proximally and distally located chyme.

Animals↗
PubMed2002

Electrophysiological study of the rectosigmoid canal: evidence of a rectosigmoid sphincter.

Previous studies strongly suggest the presence of a sphincter at the rectosigmoid junction, an area with a mean length of 2.8 cm in adults, called the rectosigmoid canal (RSC). To find supporting evidence of a sphincteric function for the RSC, two recording electrodes were applied to each of the sigmoid colon (SC), RSC and rectum (R) in 11 subjects during operative repair of huge incisional hernias. The RSC, SC and R were individually stimulated by a further electrode and their pressures monitored by a three-channel microtip catheter. The variables of the slow waves or pacesetter potentials, recorded at rest from the RSC and R, were significantly higher than those of the SC. While the frequency and conduction velocity of pacesetter potentials of the RSC and R were similar, the potential pacesetter amplitude of the RSC was significantly higher. The increase of the electrical activity and pressure upon electrostimulation was significantly greater in the RSC than that of the SC or R. Electrostimulation led to an increase in pressure of all three areas, the RSC increase being significantly the greatest. The greater increase of the electrical activity and pressure of the rectosigmoid canal upon electrostimulation, compared to that of the SC or R, strongly supports the presence of a rectosigmoid sphincter.

Adult↗
PubMed2002

Effect of mercury vapour exposure on urinary excretion of calcium, zinc and copper: relationship to alterations in functional and structural integrity of the kidney.

BACKGROUND: The kidney has a remarkable capacity to concentrate mercury (Hg) and as such is a primary target organ when exposure to Hg occurs, and it is also an organ for Hg excretion. OBJECTIVE: The present work aims to investigate the effect of occupational Hg vapour exposure on the urinary excretion of calcium (Ca), zinc (Zn) and copper (Cu), and the possible association of this excretion to work duration as well as renal alterations. METHODS: 83 non-smoker participants (36 referents, age: 35.6 +/- 9.5 years; 27 Hg vapour-exposed workers with < or = 10 years work duration, age: 33.0 +/- 5.1 years; and 20 Hg vapour-exposed workers with > or = 11 years work duration, age: 39.50 +/- 8.50 years) were included in the present study. Urinary levels of microalbumin (U-Malb) and retinol-binding protein (U-RBP) as well as cytosolic glutathione S-transferase activity (U-GST) were measured to assess the glomerular and proximal tubular reabsorption functions as well as structural integrity of proximal tubules; respectively. In addition, blood Hg (B-Hg), serum levels of Hg (S-Hg) and Ca (S-Ca), and urinary levels of Hg (U-Hg), Ca (U-Ca), Zn (U-Zn), Cu (U-Cu) and creatinine (U-cr) were estimated. RESULTS: In comparison to referents, all investigated parameters showed significant increase (except S-Ca and U-Zn/U-Cu ratio that significantly decreased among the workers as one group, S-Ca and U-Zn/U-Cu ratio that significantly and nonsignificantly decreased; respectively among workers with < or = 10 years work duration, S-Ca and U-Zn/U-Cu ratio that significantly decreased among workers with > or = 11 years work duration). In addition, B-Hg was nonsignificantly increased and S-Ca was significantly decreased; also, both U-Hg and U-Zn/U-Cu were nonsignificantly decreased among workers with > or = 11 years work duration in comparison to those with < or = 10 years work duration. Also, each of U-Hg, U-Ca, U-Zn and U-Cu was related to one another, while each of U-Ca, U-Zn and U-Cu was related to each of U-Malb, U-RBP and U-GST (except U-Zn was not related to U-GST). CONCLUSION: Hg vapour exposure leads to renal alterations which may parallel the change in proteinuria and enzymuria as well as the increased loss in urine of each of Ca, Zn and Cu. The urinary assessment of these metals may be used as a good indicator for renal dysfunction.

Adult↗