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Biomedical subjects

D C Bartolo

Publications and source records attributed to D C Bartolo.

At least 91 records · Page 5Linked to original sources
PubMed1986

New method for assessment of anal sensation in various anorectal disorders.

A new technique for quantifying anal sensation utilizing mucosal electrosensitivity is described and has been tested in 97 patients. Normal subjects (n = 20) have a sensory threshold varying from 2 to 7.3 mA being most acute in the region of the anal valves. Sensory awareness also extends into the upper anal canal. Patients with neuropathic incontinence (n = 17) have a sensory deficit (P less than 0.002) whilst patients with haemorrhoids (n = 28) have less sensitive mucosa displaced into the upper anal canal (P less than 0.0001). Patients with acute fissure-in-ano (n = 10) have lower thresholds of sensation at the site of the fissure and slow transit constipation patients (n = 22) have normal anal sensation. The technique is reproducible and should prove useful in the investigation of anorectal disorders.

Adult↗
PubMed1986

Diagnosis and surgical management of intractable constipation.

Seventy-four patients with intractable constipation, of whom thirty-three had slow and forty-one normal intestinal transit, were investigated to determine the aetiology of their disorder and plan treatment. Patients with slow transit had a greater incidence of abdominal pain and distension (P less than 0.001) and only 9 per cent had a normal call to stool compared with 71 per cent of those with normal transit (P less than 0.001). Internal and sphincter function as assessed by sphincter pressures, length and the recto-anal inhibitory reflex did not reveal any difference between the groups and normal controls; similarly anal sensation and rectal compliance were normal. However, those with normal transit had a higher threshold of rectal sensation than controls (P less than 0.05). Slow transit patients failed to show a postprandial increase in rectosigmoid motility compared with controls (P less than 0.05). Whilst the majority failed to inhibit the external sphincter on bearing down, half of those with normal transit produced either partial or complete inhibition. Both groups were able to increase the anorectal angle on straining. Twenty-two normal transit patients had abnormal perineal descent compared with controls (P less than 0.0005). Patients with perineal descent exhibited abnormal rectal morphology. Rectal intussusception was observed in 13 of 35 evacuation proctograms. On the basis of the data presented, we could not justify internal sphincterotomy of puborectalis division. Our policy in severe slow transit constipation was to offer colectomy and ileorectal anastomosis. In five out of seven to date, a successful result has been achieved. Eight patients with rectal intussusception have undergone an abdominal rectopexy with significant improvement in three. In our hands, the evacuation proctogram and transit studies were the most useful preoperative investigations.

Anal Canal↗
PubMed1986

Flap-valve theory of anorectal continence.

The most important component of continence is considered to be the puborectalis muscle which is reputed to function by creating a flap-valve mechanism in which the anterior rectal wall occludes the upper and canal. To elucidate this, anal and rectal pressures were measured simultaneously together with external anal sphincter and puborectalis electromyogram and synchronously superimposed on an image intensifier displaying the rectum outlined by barium. We studied 13 subjects at rest, and during a Valsalva manoeuvre. There was a significant rise in rectal and sphincter pressures (P less than 0.005) and external sphincter and puborectalis EMG (P less than 0.005). In a further 13 patients Valsalva manoeuvres were performed during proctography alone. In all subjects the anterior rectal wall was always clearly separated from the upper sphincter despite a maximal effort and a rectum filled with sufficient liquid to produce a desire to defaecate. These findings question the flap-valve theory of continence and suggest the puborectalis functions by sphincteric occlusion of the anal canal.

Adult↗
PubMed1986

The relationship between perineal descent and denervation of the puborectalis in continent patients.

It has been suggested that perineal descent causes puborectalis neuropathy. To elucidate this, perineal descent was measured on standard proctograms and prolongation of mean motor unit potential duration was used as the index of denervation of the external sphincter and puborectalis in 9 male and 18 female patients with perineal descent and obstructed defaecation. The findings were compared with 21 normal controls. There was no significant perineal descent below the pubococcygeal line at rest but both males and females had abnormal descent of the anorectal angle on straining and a similar degree of external sphincter neuropathy. Females, however, exhibited a significant degree of puborectalis denervation compared with controls (p less than 0.001) and with male patients (p less than 0.001). Thus external sphincter denervation was associated with perineal descent in both sexes whereas other causes, of which obstetric trauma is a possibility, must be implicated in the puborectalis neuropathy of the females studied.

Adult↗
PubMed1986

Techniques in evacuation proctography in the diagnosis of intractable constipation and related disorders.

A technique of evacuation proctography using a simple barium and air mixture is described. The study can be easily combined with a barium enema examination. A series of 35 patients with intractable constipation have been studied and compared with 7 controls. Most of the abnormalities seen using more elaborate methods of defaecography were identified. Variants of rectal intussusception were found in 16 patients. Other diagnoses included rectocele, mucosal and full rectal prolapse, accentuation of puborectalis impression and solitary rectal ulcer. The technique should prove useful in the management of patients with disorders of defaecation.

Air↗
PubMed1985

What is the best way of measuring perineal descent? A comparison of radiographic and clinical methods.

The 'perineometer' underestimated movement of the pelvic floor by nearly 60 per cent in 21 patients tested; mean descent was 1.2 cm, compared with a radiographic mean descent of 2.9 cm (P less than 0.001). Since the instrument measures movement of the anal verge, not the pelvic floor, no account is taken of anal canal shortening. Radiographic methods are still necessary for the reliable identification of abnormal descent.

Adult↗
PubMed1985

Evacuation proctography in obstructed defaecation and rectal intussusception.

The symptoms of obstructed defaecation may present as a number of different syndromes including descending perineum, solitary rectal ulcer, irritable bowel and mucosal or complete rectal prolapse. In order to clarify the pathophysiology of obstructed defaecation we carried out dynamic and static radiological investigations together with manometric and electrophysiological measurements in ten patients with severe, intractable obstructed defaecation. Results were compared with a total of 35 control subjects. There were no significant differences in sphincter pressures or the recto-anal inhibitory reflex between patients and controls. Mean motor unit potential duration was prolonged in patients compared with controls (P less than 0.02) in the puborectalis and external sphincter indicative of neuropathic changes. X-ray measurements of the anorectal angle and perineal descent at rest showed no differences. However, obstructed defaecation patients had a greater increase in anorectal angle on straining (P less than 0.02) and significantly more descent on straining (P less than 0.002). Fast film sequence evacuation proctography showed that the anal canal was occluded by anterior rectal wall in four patients and five patients had variants of recto-rectal intussusception without overt rectal prolapse, which explained the obstructive symptoms. This information should allow the surgeon to follow a rational treatment programme based on the anatomical abnormality.

Adult↗
PubMed1984

Spleen size in chronic renal failure.

To investigate the cause of clinically detectable splenomegaly, which is common in patients receiving regular haemodialysis, splenic volume was assessed by isotopic scanning using intravenously injected technetium-99m microspheres in 34 controls and 149 patients with chronic renal failure. Of the patients, 16 had never received dialysis, 10 were undergoing continuous peritoneal dialysis, 94 were undergoing regular haemodialysis, and 29 had undergone successful renal transplantation more than nine months previously. Mean splenic volume was increased only in the patients who were receiving haemodialysis. Splenic enlargement was probably not due to iron overload as it occurred in all patients who had received haemodialysis, 14 of whom had not received intravenous iron. No patient had had hepatitis. Splenic enlargement was probably related to the process of haemodialysis itself and may have been due either to red cell damage produced by haemodialysis or to an immunological reaction induced by a component of haemodialysis, possibly ethylene oxide.

Female↗
PubMed1984

Differences in anal function in patients with incontinence to solids and in patients with incontinence to liquids.

Manometric radiological and neurophysiological measurements of the anal sphincter were carried out in 19 female patients who were incontinent to liquid faeces only, 15 female patients who exhibited incontinence to solid and liquid faeces and 18 normal female controls. Both groups of patients had abnormally obtuse anorectal angulation and perineal descent, a weak and easily inhibited sphincter tone and similar degrees of neuropathy during electromyography. However, patients who were incontinent to solids and liquids exhibited lower squeeze pressures during standard manometry and lower peak pressures during saline infusion than patients who were only incontinent to liquids. These findings suggest that it is the additional weakness of the external sphincter that renders patients incontinent to solids as well as liquids.

Adult↗
PubMed1983

Differences in anorectal manometry between patients with haemorrhoids and patients with descending perineum syndrome: implications for management.

Anorectal manometry was carried out at rest, during balloon distension of the rectum and during rectal infusion of saline in 19 patients with haemorrhoids, 30 patients with descending perineum syndrome and 21 controls. Basal and squeeze pressures were significantly higher in patients with haemorrhoids than patients with the descending perineum syndrome. A lower rectal volume was required to inhibit internal sphincter tone in patients with descending perineum syndrome compared with control subjects or patients with haemorrhoids. During rectal infusion of saline basal and peak anal pressures in patients with the descending perineum syndrome were lower than in haemorrhoid patients. Peak rectal pressure was abnormally high in both groups. These differences in anorectal function suggest that despite a similar presentation, the two conditions have a different pathogenesis. Moreover, inappropriate anal sphincter stretch or mucosal excision in patients with descending perineum syndrome may lead to severe incontinence.

Anal Canal↗
PubMed1983

The cutaneo-anal reflex: a useful index of neuropathy?

Recent studies have suggested that the latency of the cutaneo-anal reflex is prolonged in idiopathic faecal incontinence, suggesting neuropathic damage to the external anal sphincter. Electrical responses were recorded from the external anal sphincter following stimulation of the ipsilateral and contralateral perianal skin in normal subjects and patients with idiopathic faecal incontinence. Ipsilateral stimulation gave rise to shorter latencies of the earliest responses to stimulation compared with contralateral stimulation (P less than 0.001). When care was taken to compare results obtained by stimulating the skin on corresponding sides of the sphincter, the latency of both the early and late components of the cutaneo-anal reflex in incontinent patients was not significantly different from that in control subjects. The durations of the motor unit potentials, obtained by conventional electromyography, were prolonged in incontinent patients, indicating that they have external sphincter neuropathy. The data support the suggestion that external sphincter neuropathy in idiopathic faecal incontinence is due to a stretch injury to the pudendal nerve, and indicate that measurement of the latency of the cutaneo-anal reflex may be an inadequate means of demonstrating nerve damage in patients with idiopathic faecal incontinence.

Action Potentials↗
PubMed1983

The role of partial denervation of the puborectalis in idiopathic faecal incontinence.

Recent studies have suggested that patients with idiopathic faecal incontinence have neuropathic damage to the external and sphincter and pelvic floor musculature, though no direct assessment of puborectalis function has been made in intact man. Obstetric trauma and chronic straining at stool are thought to be possible causes for damage to the puborectalis nerve supply. In this study the motor unit potential duration in the external sphincter and puborectalis was measured by conventional electromyography in incontinent patients and two groups of continent patients who strained at stool. Our results confirm that incontinent patients had significant neuropathic damage to the puborectalis and the external sphincter compared with controls. Patients with the descending perineum syndrome, who were continent, showed partial denervation of the external sphincter and puborectalis, though the degree of abnormality in puborectalis was less than that in incontinent patients. Finally, patients with constipation showed neurogenic abnormalities in the external anal sphincter but not in the puborectalis. The findings suggest that partial denervation of the external sphincter can occur independently of partial denervation of the puborectalis in patients who strain at stool but if severe changes are present in both muscles, the patient is likely to be incontinent.

Action Potentials↗
PubMed1983

The use of conventional electromyography to assess external sphincter neuropathy in man.

Conventional electromyography was used to measure motor unit potential duration in the external anal sphincter in normal subjects and patients with idiopathic faecal incontinence. The results revealed a direct correlation between age and mean motor unit potential duration in control subjects, but no differences between age-matched male and female subjects. Patients with faecal incontinence exhibited prolongation of mean motor unit potential duration compared with matched controls. This technique provided useful quantitative data on reinnervation within the anal sphincter, complementing the results of single fibre electromyography.

Action Potentials↗
PubMed1983

Treatment of thyroid carcinoma in 107 cases.

One hundred and seven patients with thyroid carcinoma were treated. Thirty-one per cent of the tumours were papillary, 27% were follicular, 28% anaplastic, 4% medullary, and 10% were lymphomas. In the differentiated group of tumours, lobectomy followed by suppressive doses of thyroxine was the commonest surgical treatment. This series confirms that in the absence of extrathyroid dissemination, lobectomy is a safe and effective treatment.

Adenocarcinoma↗
PubMed1983

Use of anorectal manometry during rectal infusion of saline to investigate sphincter function in incontinent patients.

Anal and rectal pressures and external sphincter electromyogram were recorded continuously during rectal infusion of 1.5 L saline in 18 normal subjects and 37 patients who complained of diarrhea and fecal incontinence. All subjects exhibited a pattern of regular fluctuations in anorectal pressure and electromyogram. All except 1 of the normal subjects were able to retain 1500 ml saline without leakage, and their pressure record comprised simultaneous rectal contractions, internal sphincter relaxations, and external sphincter contractions. None of the incontinent patients were able to retain 1500 ml saline without leakages, and leakages always coincided with the peaks of rectal pressure. Two manometric patterns were observed. Fifty-nine percent of incontinent patients exhibited a pattern of contractions of similar profile occurring throughout the anorectum. This finding was associated with low basal sphincter pressures, an easily inhibited anal sphincter tone, an obtuse anorectal angle, and a funnel-shaped configuration to the anal canal. These results suggested that, in this group, the internal sphincter was weak and easily inhibited so that the whole anorectum behaved as one fluid-filled compartment recording contractions of the external sphincter. The remaining 41% of incontinent patients exhibited a normal pattern of anorectal pressure fluctuations and had normal maximum basal pressures, although maximum squeeze pressures, rectoanal inhibitory reflex, and anorectal angles were abnormal. Peak rectal pressures were abnormally high in this group during saline infusion, suggesting that abnormally strong rectal contractions may play a role in the incontinence in this group.

Adult↗
PubMed1983

Differences in anal sphincter function and clinical presentation in patients with pelvic floor descent.

Perineal descent is found in patients with idiopathic fecal incontinence and patients with the descending perineum syndrome, who have little or no incontinence but present with a symptom pattern that suggests obstructed defecation. To investigate why patients with perineal descent present in different ways, manometric, radiologic, and neurophysiologic studies were performed in 53 patients with radiologically proven perineal descent and 34 control subjects. Thirty-two patients exhibited incontinence to rectally infused saline, while 21 patients presented with obstructed defecation but exhibited no incontinence. Both patient groups exhibited similar degrees of perineal descent on straining and increases in the motor unit potential duration of the external anal sphincter, indicative of neuropathic damage. Both groups had an abnormal rectoanal inhibitory reflex and an abnormal anorectal angle, though the latter was more obtuse in idiopathic fecal incontinence. However, although patients with incontinence had lower maximum basal and maximum squeeze sphincter pressures than normal, these values were normal in patients with obstructed defecation. Our findings suggest that perineal descent and neuropathy are not necessarily associated with incontinence as long as sphincter pressures remain normal.

Action Potentials↗
PubMed1980

Treatment of infiltrating bladder carcinoma.

One hundred and seventy-five patients with invasive bladder tumours are reviewed. The overall crude survival rate was 30% at 3 years and 23% at 5 years. The 5-year survival rates for T2 and T3 tumours treated by radical radiotherapy were 38% and 28% respectively. Multiple urinary symptoms, obstruction, a large tumour, and poor differentiation were particularly unfavourable features.

Adult↗