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Biomedical subjects

D E Neal

Publications and source records attributed to D E Neal.

244 records · Page 14Linked to original sources
PubMed1985

The role of the ileal conduit in the development of upper tract dilatation.

The purpose of this study was to clarify the role of the conduit in the development of upper tract dilatation after ileal conduit urinary diversion. Twenty-seven patients with a normal upper tract were compared with 17 who had developed upper tract dilatation. Patients were studied by means of a technique to measure pressure and flow under "steady-state" conditions. Pressure activity was classified into two types. Type I pressure activity (frequency 6.2 +/- 3/min; amplitude 4.7 +/- 3 cm H2O) resulted in to-and-fro movement of contrast and the escape into the appliance of small volumes of contrast. In controls, most of the output from the conduit occurred during type I activity (73 +/- 14%). Type III/IV pressure activity resulted in vigorous aboral peristalsis and occurred infrequently in controls (frequency 5 +/- 4/h). In patients with upper tract dilatation, in contrast, type III/IV peristaltic activity occurred frequently (frequency 37 +/- 30/h; P less than 0.001: amplitude 72 +/- 34 cm H2O) and was responsible for most of the output (70 +/- 17%; P less than 0.001). The findings support the hypothesis that high pressure activity in the conduit is an important factor in the aetiology of upper tract dilatation, and they are compatible with the presence in such patients of functionally important obstructions of the distal conduit.

Dilatation, Pathologic↗
PubMed1984

The effect of resection of the distal ileum on gastric emptying, small bowel transit and absorption after proctocolectomy.

Patients who had undergone proctocolectomy and ileostomy for ulcerative colitis have been studied. One group (contrast group) had undergone resection of only small amounts of terminal ileum (median = 4 cm), the other group of patients (study group) had undergone resection of greater lengths of small bowel (median = 60 cm). Gastric emptying and transit of a standard meal through the small bowel were estimated, whilst the amounts of fat, nitrogen, glucose, sodium and potassium excreted by the ileostomy were simultaneously determined. Significantly greater amounts of fat, nitrogen, sodium, potassium and water were excreted by patients who had undergone resection compared with contrast patients (P less than 0.01). The rate of gastric emptying was not increased in patients who had undergone ileal resection compared with contrast patients but small bowel transit within 4 hours of ingestion of the meal was significantly faster. A significant correlation between transit times and excretion of fat was also noted in patients (P less than 0.02). Thus, quite modest ileal resection in addition to proctocolectomy leads to rapid small bowel transit and marked malabsorption of nutrients as well as water and electrolytes.

Adolescent↗
PubMed1984

The effects on pelvic visceral function of anal sphincter ablating and anal sphincter preserving operations for cancer of the lower part of the rectum and for benign colo-rectal disease.

The effects on pelvic visceral function of radical operations for carcinoma of the lower part of the rectum and of operations for inflammatory bowel disease have been determined by studying bladder, sexual and rectal function. Denervation of the bladder was diagnosed in 15% of patients who had undergone sphincter-saving resection of the rectum for carcinoma and in 19% of patients who had undergone abdominoperineal excision of the rectum. In the remaining patients, temporary, less severe, degrees of impairment of bladder function were noted. Abnormalities of function were found on urodynamic testing of patients with denervation of the bladder which explained, in part, the propensity of such patients to develop incontinence of urine. Partial recovery of function was noted in the long term in patients with denervation of the bladder and evidence consistent with regeneration of autonomic nerves was obtained on histological examination of biopsies from the bladders of such patients. In patients who had undergone conventional proctectomy for inflammatory bowel disease, impairment of bladder and sexual function was observed. In contrast, no evidence of damage to pelvic autonomic nerves was found in patients who underwent selective mucosal proctectomy. Mucosal proctectomy and ileo-anal anastomosis in patients with ulcerative colitis did impair ano-rectal reflex function; nevertheless, most patients were continent. Patients in whom, in addition to mucosal proctectomy and ileo-anal anastomosis, a pelvic ileal reservoir had been constructed had better rectal function than patients who lacked such a reservoir.

Aged↗
PubMed1982

The long term effects of proctectomy on bladder function in patients with inflammatory bowel disease.

The effect on bladder function of protectomy for colitis or Crohn's disease was studied by means of a questionnaire and by pressure/flow cystometry. Thirty-seven patients who had undergone protectomy for inflammatory bowel disease were compared with 34 control patients who had undergone bowel resection without protectomy. Symptoms of urinary dysfunction were found to be significantly more common in patients after protectomy than in controls (P less than 0.05). Straining at micturition (P less than 0.05) and a sensation of incomplete emptying of the bladder (P less than 0.02), in particular, were significantly more common after protectomy. Evidence of denervation of the bladder, as shown by the finding of capacious bladders with poor detrusor function, was found in 6 patients after protectomy but in none of the controls (P less than 0.05). The residual volume of urine in the bladder after micturition was significantly greater in patients after protectomy than in controls (P less than 0.02). Thus, the bladder is at risk of denervation in the course of protectomy for inflammatory bowel disease even when dissection is kept close to the rectum.

Adult↗
PubMed1982

Histological appearances of the nerves of the bladder in patients with denervation of the bladder after excision of the rectum.

Two groups of patients who developed denervation of the bladder after excision of the rectum for carcinoma have been studied by histological examination of bladder biopsies. The groups were compared with a group of control patients of a similar age. One group with denervation of the bladder was studied soon after (7 weeks) and the other group in the long term (10 months) after operation. Bladder biopsies were stained for acetylcholinesterase, catecholamines and connective tissue. Tissue was also processed for electron microscopy. In control patients, the ratio of cholinesterase positive nerves to the number of smooth muscle nuclei (24:100) was significantly greater than in patients with denervation of the bladder studied soon after operation (2.5: 100; P less than 0.01). Appearances consistent with degenerate nerve terminals were observed on electron microscopy in these patients. No increase in the density of adrenergic nerves was observed in either group of patients with denervation of the bladder. In the long term, a greater density of cholinergic innervation was noted compared with patients studied soon after operation (P less than 0.05). In addition, nerve terminals, similar in appearance to those of control patients, were observed on electron microscopy. The findings in patients with denervation of the bladder studied in the long term after operation are consistent with partial regeneration of autonomic nerves. They suggest that, whilst histological examination of bladder biopsies may be useful soon after excision of the rectum, they may be less sensitive in the long term.

Adrenergic Fibers↗
PubMed1981

The value of preserving the anal sphincter in operations for ulcerative colitis and polyposis: a review of 22 mucosal proctectomies.

Ulcerative colitis and polyposis are both diseases of the mucosa. They can be cured by colectomy combined with selective mucosal proctectomy, without sacrifice of teh anal sphincters or damage to bladder or sexual function. Terminal ileum, either as a straight tube or in the form of a pouch, is drawn down through the denuded tube of anorectal muscle and anastomosed to the mid-anal canal. A temporary defunctioning ileostomy is always used. Caecum has also been used as a neorectum after mucosal proctectomy, but without long term success. Twenty-two patients, 20 with ulcerative colitis and 2 with polyposis, have been treated by mucosal proctectomy in the past 4 years, with no mortality. The caeco-anal procedure proved a failure because of recurrence of colitis, although the early functional results were good. After ileo-anal anastomosis, continence was perfect by day, but 2 patients had occasional lapses at night. The disadvantage of straight ileo-anal anastomosis is frequency of bowel action (6-9 times a day), even with codeine medication, although the patients considered the operation a success. Some form of pelvic reservoir is therefore desirable and our early experience with the triplicated ileal pouch is encouraging.

Adolescent↗
PubMed1981

A prospective study of bladder function before and after sphincter-saving resections for low carcinoma of the rectum.

The effects of sphincter-saving resections for carcinoma of the rectum on bladder function were studied prospectively. Twenty-seven patients, each acting as his or her own control, were studied before, shortly after and 9 months after operation by means of pressure/flow filling and voiding cystometry. After operation there was a significant and lasting increase in the residual volume of urine and a temporary decrease in the compliance of the bladder. There was a statistically significant decrease in detrusor contraction pressure after operation, which persisted throughout the period of study. This was probably due to partial denervation of the bladder. Four patients had signs of total or almost total denervation of the bladder. There was a significant correlation between proximity of the tumour to the anal verge and risk of damage to the nerve supply to the bladder. Thus sphincter-saving resections of the rectum for carcinoma are associated with a significant risk of bladder denervation. Many of the "minor" symptoms of bladder dysfunction which develop after this procedure are due to partial denervation of the bladder.

Aged↗
PubMedDate not supplied

Unilateral testicular microlithiasis associated with a seminoma.

Unilateral testicular microlithiasis is an uncommon entity that is important because of its association with malignancy. We describe a case in which the initial clinical presentation was that of metastatic cervical lymphadenopathy. Subsequent sonographic examination of the testes revealed right testicular microlithiasis and a small, hypoechoic, ill-defined mass, which proved to be a seminoma. Since testicular microlithiasis is highly associated with testicular malignancy, it cannot be considered a benign condition. Sonographic follow-up examinations are warranted in patients with testicular microlithiasis to detect the possible development of malignancy.

Adult↗