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Biomedical subjects

F Penninckx

Publications and source records attributed to F Penninckx.

At least 127 records · Page 7Linked to original sources
PubMed1973

Pharmacological characteristics of the non-striated anorectal musculature in cats.

The isolated internal anal sphincter from cats shows a myogenic spontaneous rhythmic activity. Basal tension and frequency of contraction waves from internal anal sphincter strips are inhibited by muscarinic and beta-adrenergic receptors and excited by alpha-adrenergic receptors. Isoprenaline in high doses had an alpha-adrenoceptor-stimulating activity in strips from the internal sphincter. The inhibitory muscarinic receptors may be the final effectors in the anorectal reflex. The relaxing effect of acetylcholine on the internal sphincter was sometimes preceded by a temporary contraction due to the interaction of intermingled longitudinal muscle fibres. Rectal circular muscle strips contain excitatory muscarinic receptors and inhibitory alpha- and beta-adrenergic receptors. The same can be said of the strips from the longitudinal muscle layer at the anal canal and at the rectum.

Acetylcholine↗
PubMed1970

A study in vivo of adrenergic receptors in the rectum and in the internal and sphincter of the cat.

THE SMOOTH MUSCLE SPHINCTERIC ACTIVITY OF THE ANUS IN CATS IS BASED ON TWO DISTINCT MECHANISMS: a typical anal component, characterized by anal slow pressure waves not related to spike potentials in the internal anal sphincter, and an intestinal-like pressure component related to spiking activity in the internal sphincter. Anal slow pressure waves are influenced by the activity of alpha excitatory receptors within the internal sphincter, whereas no conclusive data are available concerning the action of adrenergic beta receptors on this pressure component. Intestinal-like pressure waves and the correlated spiking activity in the internal anal sphincter are influenced by alpha and beta inhibitory adrenergic receptors. The rectal wall of the cat contains alpha and beta adrenergic receptors producing relaxation.

Adrenergic alpha-Agonists↗
PubMedDate not supplied

Fecal incontinence: indications for repairing the anal sphincter.

Incontinent patients should be comprehensively investigated by objective tests, especially manometry, continence tests, and electromyography. Manometry can be used to predict the functional outcome and to calibrate the sphincter repair. Pure anatomical defects of the anal and pelvic musculature deserve surgical correction with or without overlapping the muscle ends. If the repair is delayed it should be done after a 3 month interval. A protective colostomy has to be performed in complex cases and in cases with septic complications. Before closing the colostomy, the ano-rectal function should be assessed. Acceptable continence can be restored in the majority of the patients, the outcome depending on the extent of local defects and the severity of concomitant pelvic floor neuropathy. Skeletal muscle transposition remains an esoteric approach to be used only in selected patients; the implantation of a neuromuscular stimulator seems to be warranted. In the presence of important functional deficits, sphincter repair may create a situation where additional conservative measures become more effective. A post-anal repair may be considered 3-12 months after rectopexy or sphincter repair. Incontinence based on pure functional defects is initially treated conservatively. A post-anal repair may improve the situation in two thirds of the patients but fails to help those who need it most. Failure seems to be related to a continuing neuropathic process. A peri-anal prosthetic band implant may be a valuable alternative in such patients. A sigmoidostomy is a measure of last resort. The prevention of fecal incontinence is most important and concerns surgeons, obstetricians, and physicians.

Anus Diseases↗
PubMedDate not supplied

Survival of rectal cancer patients in Belgium 1997-98 and the potential benefit of a national project.

BACKGROUND: PROCARE, a Belgian multidisciplinary project on rectal cancer (RC), will be launched in 2006. Guidelines have been developed, but remain to be implemented. AIM: A population-based study on RC treatment and outcome in Belgium and comparison with recent international benchmarks in order to better define targets that should be reached. PATIENTS AND METHODS: Anonymous data of 3079 patients with rectal cancer registered in the National Cancer Registry in 1997 and 1998 were analysed. Observed (OS) and relative survival (RS) were compared with figures from nationwide projects and multi-centre studies. RESULTS: The 5-yr OS and RS were 46.6% and 58.5%, respectively. For patients with stage I-III tumours 5-yr OS was 57.1% and 5-yr RS 70.1%. Adjuvant or neo-adjuvant treatment was given in 54.8% stage II-III patients who were < 70 years old. There were marked differences between the provinces in the use of radiotherapy for stage II-III patients and in 5-yr RS for all stages. In stage IV, the median OS was 13 months and the 2-yr OS was 28%. Comparison with recent multi-centre trials indicates significant potential benefits from the PROCARE project: an absolute increase of the 5-yr OS by 10 to 20% after chemoradiotherapy and TME in stage II-III patients 75 years old or less, a 7-month increase of the median OS and an absolute 15% increase of the 2-yr OS in unresectable stage IV patients with combined chemotherapy. CONCLUSION: Significant improvement seems to be achievable. Implementation of the PROCARE guidelines with quality assurance through prospective registration in a specific database, however, is a crucial prerequisite for credible audit of performance and feedback to individual teams.

Adolescent↗
PubMedDate not supplied

Computed tomography in paraprosthetic sigmoid fistula.

A patient with a paraprosthetic-sigmoid fistula following complicated aortic abdominal surgery is reported. Computed tomography confirmed the diagnosis by demonstrating inflammatory tissue around the left limb of the prosthesis in close contact with the sigmoid.

Aged↗
PubMedDate not supplied

Valvular colonic sphincter substitutes. An experimental study in dogs.

Three types of colonic sphincter substitutes were placed at an abdominal colostomy in dogs. Simple valve construction (8) was based on orthograde intussusception of the colon over 3.5 cm. In calibrated valves (6) the intraluminal pressure was increased by reducing the diameter of the overlying muscle coat. Reverse smooth muscle plasties (5) and simple colostomies (5) served as controls. Immediately after construction highest pressure (50 +/- 8.9 mm Hg) was obtained in calibrated valves. After 1 month the pressure dropped to 20 mm Hg, but remained stable thereafter. Although valvular constructions cannot maintain high pressure, they may be useful as substitutes for the internal anal sphincter by filling up the lumen so that the action of a surrounding striated muscle ring becomes more effective.

Animals↗
PubMedDate not supplied

Different gastritis features are linked to different gastric neoplasms.

OBJECTIVES: Helicobacter pylori infection induces gastritis, which may evolve to carcinoma or lymphoma. Whether duration of infection and inflammation pattern determine the outcome of the neoplastic process is not known. The aim of this study was to investigate the features of the gastritis associated with neoplasia. METHODS: Gastritis found in association with carcinoma (100 cases) and lymphoma (45 cases) were graded using the Sydney system. RESULTS: In particular in the antrum, gastric carcinomas, in particular of the intestinal type, were associated with a chronic (94%, n = 34/36) atrophic (92%, n = 33/36) gastritis and intestinal metaplasia (81%, n = 29/36). In diffuse type carcinomas inflammation was either absent or mild. An active (64%, n = 16/25), chronic gastritis (100%, n = 25/25) with lymphoid hyperplasia (72%, n = 18/25) was found in marginal zone cell lymphoma. CONCLUSIONS: Our study shows that the (pre)atrophic phases of inflammation are associated with gastric carcinomas. In contrast the active phase of inflammation, characterized by severe activity as well as severe chronicity, is found next to marginal zone cell lymphoma.

Adult↗
PubMedDate not supplied

The pathology of complex fistula in ano.

Anal fistulae do not heal spontaneously without surgery. Knowledge of anorectal anatomy and function, and diligent examination frequently requiring anaesthesia are prerequisites for adequate assessment, classification and treatment of the pathology. Fistulography, endoanal ultrasound and MRI of the anorectum may have additional diagnostic value with therapeutic impact in complex and recurrent fistulae. Parks' classification is most useful because it is the best guide for surgical therapy. In the modern treatment of trans- or suprasphincteric fistula in ano fast or slow division of any part of the striated perianal musculature is to be avoided in order to prevent anal incontinence.

Anal Canal↗
PubMedDate not supplied

Advancement flap plasty for the closure of anal and recto-vaginal fistulas in Crohn's disease.

The management of anal fistulas in patients with IBD continues to be extremely challenging and, indeed, somewhat frustrating. Despite a global closure rate of about 75%, all patients should be informed about the risk of infection, early failure, eventual temporary disfunctioning stoma and the possibility of late recurrence (about 15%). Closure of a RVF in Crohn's disease should not be considered an easy undertaking, especially in patients with several Crohn localisations. The technique can be adapted to the local situation. Construction of a temporary stoma is not mandatory. However, stoma construction seems to be beneficial when extensive perianal or recto-vaginal dissection including eventual tissue interposition is required. Advancement flaps are an attractive surgical alternative for the management of all anal transsphincteric fistulas, also in Crohn's disease, because sphincter architecture and function are well preserved. Improved medical treatment and the changed approach from conservative to reparative surgery may well have resulted in a decreased need or at least in a delay of the need for a proctectomy. Although the surgical principles of advancement flap techniques are sound, these techniques have not been used for many decades. Skills needed, problematic approach, suboptimal quality of local tissues have contributed to its selective use and to the absence of prospective randomised studies.

Crohn Disease↗
PubMedDate not supplied

Surgeon-related aspects of the treatment and outcome after radical resection for rectal cancer.

AIM: To summarise the magnitude and mechanisms of surgeon-related variability in the outcome after radical resection for rectal cancer and to present a solution and targets. METHODS: A review of the literature, consultation of the "Guidelines for the management of colorectal cancer" published by the Association of Coloproctology of Great-Britain and Ireland, and analysis of data from the database of the Belgian Ministry of Health, RIZIV-INAMI, on radical resection for rectal cancer in Belgium during the years 1995-1997. RESULTS: The proportion of abdominoperineal excision of the rectum (APER) varies between 23-58% in specialised centres and 43-57% general practice. In Belgium the APER rate for rectal cancer located between 4 and 16 cm above the anal verge is 50% with an overall in-hospital mortality of 3.5%; both APER rate and postoperative mortality are lower in university than in community hospitals. Most studies observe an effect of specialisation, reducing mortality with a factor of 2.5-3. The magnitude of surgeon-related variability in the oncological outcome has been well documented indicating that the impact of the surgeon-factor is considerably larger than that of adjuvant therapy. When comparing subspecialised with general surgeons, relative risk factors of 0.3-0.8 are reported for local recurrence rate, and 0.7-0.8 for disease free survival. CONCLUSION: Inter-surgeon variability is to be related with surgical skill and adequate implementation of recent diagnostic and therapeutic methods. Guidelines and centralisation are appropriate concepts, but do not guarantee improved quality of care. The targets are an APER rate of < 40% with an operative risk of < 2%, a local recurrence rate of < 10% and a disease free survival of > 70%. External audit is essential, but subspecialty training is a prerequisite and the surgeon is not the only factor to be audited.

Aged↗