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Biomedical subjects

G Devroede

Publications and source records attributed to G Devroede.

At least 37 records · Page 2Linked to original sources
PubMed1993

Effects of trimebutine on colonic function in patients with chronic idiopathic constipation: evidence for the need of a physiologic rather than clinical selection.

A double-blind crossover study on the effects of trimebutine on large bowel function was performed in 24 consecutive patients complaining of chronic idiopathic constipation. Their stool frequency, colonic transit time, and colonic electrical activity were measured. They were divided into a group of constipated patients with "normal" transit time (less than 40 hours) (n = 12) and another group of constipated patients with "delayed" transit time (more than 40 hours) (n = 12). The patients received trimebutine (200 mg/day per os) for one month and a placebo for another month, at random, with a washout period in between. Results show that stool frequency increased (P < 0.001) in all patients as soon as they entered the study; there was no difference between trimebutine and placebo. Colonic transit time was significantly reduced (P < 0.05) with trimebutine in patients with delayed transit time (from 105 +/- 19 hours to 60 +/- 11 hours; mean +/- SE), while it did not change with placebo (from 103 +/- 17 hours to 95 +/- 10 hours). It was slightly but not significantly increased in patients with normal transit time following trimebutine therapy. Electrical activity was not influenced by trimebutine or placebo in constipated patients with normal transit time, either before or after a meal. The number of propagating bursts during the postprandial period was significantly (P < 0.05) increased in patients with delayed transit (from 2.1 +/- 0.3 bursts/hour to 3.5 +/- 0.6 bursts/hour after trimebutine); it was decreased but not significantly with placebo (from 2.6 +/- 0.8 bursts/hour to 1.6 +/- 0.6 bursts/hour) in the same group of patients. Thus, stool frequency in patients with chronic idiopathic constipation was influenced mainly by a placebo effect. Colonic transit time was reduced by trimebutine, but this was found only in patients with delayed colonic transit; myoelectric propagating bursts were increased, and this probably explains the improvement. In conclusion, trimebutine may be of value in the treatment of patients with chronic idiopathic constipation, provided that a careful pathophysiologic evaluation reveals that they have a colonic transit time that exceeds the normal range. In addition, this study provides some argument for selecting patients with functional motor disorders of the large intestine to be entered into a research protocol or to be treated not on the basis of what they complain about--the symptom--but on the basis of some kind of measurement of dysfunction--a corresponding sign.

Action Potentials↗
PubMed1993

Use of play with clay to treat children with intractable encopresis.

We used play with modeling clay to treat six children, aged 4 to 12 years, with a history of intractable constipation with encopresis for a mean of 5.4 (2 to 8) years, refractory to treatment; biofeedback therapy had not been tried. Clay was chosen because, as a brown, messy material, it was a metaphor for feces and could let the child express either his disgust or aggressivity, or let him build symbolic structures. No interpretation was made during treatment. Four children had no symptoms during 2 months of therapy and no relapse during 1 year of follow-up, one child improved significantly, and one child failed to respond but withdrew from treatment after only three sessions. Modeling clay may be a cheap and effective treatment modality for refractory constipation with encopresis.

Aluminum Silicates↗
PubMed1992

What is the meaning of colorectal transit time measurement?

This study was done to understand the different available methods used to calculate colorectal transit times. A single abdominal radiograph is taken following six successive daily ingestions of the same number of identical radiopaque markers. This method correlates well (P less than 0.001) with that using a single ingestion of markers with daily x-ray films until total expulsion. In techniques used to measure colorectal transit time with multiple ingestion of markers, the number of days of ingestion depends on the kinetics of marker defecation. This was found to differ markedly in various groups of control subjects and constipated patients (P less than 0.001) and can be used to obtain reliable data, even in subjects with severe constipation. When they ingest 20 markers, constipated patients are found to retain eight or more markers three days after ingestion, and taking a plain film of the abdomen on that day is sufficient to make a diagnosis of constipation. Transit time studies are reproducible from month to month in patients with an irritable bowel syndrome. Control subjects who claim that their bowel habits are not modified by stress have shorter transit times, similar in both sexes, than those who say they are (P less than 0.001). This may explain why a large percentage of constipated patients have been found by most authors to have "normal" colorectal transit times. The choice of control subjects is thus a key element in studies of functional bowel motor disorders. Stool frequency and consistency, in health, correlate only to rectosigmoid transit time.

Adult↗
PubMed1992

Idiopathic ulcerative proctitis may be the initial manifestation of Crohn's disease.

Of 213 patients with proctitis of all etiologies seen between 1977 and 1987, we studied an original cohort of 96 patients with idiopathic ulcerative proctitis (mean follow-up of 62 months). The diagnosis was made according to strict inclusion criteria, and all cases with any initial feature suggestive of Crohn's disease were excluded. Follow-up showed that 13 patients (13.6%) eventually progressed to Crohn's disease, usually within the first 3 years of the initial diagnosis of idiopathic ulcerative proctitis. Their clinical, endoscopic and histological features at initial presentation were indistinguishable from those in whom the diagnosis remained that of idiopathic ulcerative proctitis. In nine of 13 of these patients (70.0%), the clinical course was characterized by a more protracted course and a poorer response to standard treatment. Such features were not found in those in whom the diagnosis of idiopathic ulcerative proctitis was maintained. Clinicians should be aware that Crohn's disease may present initially as apparent idiopathic ulcerative proctitis.

Adolescent↗
PubMed1992

Constipation--a sign of a disease to be treated surgically, or a symptom to be deciphered as nonverbal communication?

Constipation is not a sign but a symptom, which is not measurable scientifically. It has emotional components and must be dealt with in a holistic manner. The scientific approach aims only at the physiological derangement and serves to place the complaint in a more objective perspective. An algorithm can be constructed to select treatment including surgery, but there is no gold standard at present because the natural history of the symptoms is unknown. Most physicians confuse normality with epidemiology, neglecting in the process the evolution of mankind in terms of behavior. Constipation now means less than five stools per week, while it used to mean three. Thus, all complaints should be addressed. As for surgery, it should be performed in few, high select patients with no dysfunction other than that in the colon and in conjunction with a fully normal thorough psychological evaluation.

Adult↗
PubMed1991

The classification of digestive problems into "organic" and "functional" should not be abandoned: a surgical point of view.

To avoid the two pitfalls of medicine, it is essential to maintain the distinction between "functional disorders" and "organic diseases." Medicalization consists in forgetting the suffering of a patient and focusing on a sick organ. This is incorrect scientifically, because it dismisses the complexity of science by deleting many variables at work, and of course it is a very inhumane way to practice medicine. Conversely, psychiatrization runs the risk of rationalization by forgetting the reality of the body. Functional disorders can be observed and the abnormalities measured by various objective ways; a positive finding does not imply there is a lesion, because many psychophysiological links have been demonstrated. Moreover, secondary gains lead some patients either to lie or submit to unnecessary surgery.

Digestive System Diseases↗
PubMed1989

The reliability of routine pathologic diagnosis of colorectal adenocarcinoma.

The diagnosis of colorectal adenocarcinoma is generally considered as being reliable. However, the reproducibility of the classification of specific histologic patterns and the interrater agreement on the gradings have not been firmly established. A panel of three independent expert pathologists reviewed histologic sections from 128 patients selected among 1848 with colorectal cancer, diagnosed in 11 hospitals of the same region. The panel agreed with 92.6% of the original diagnoses of colorectal adenocarcinoma. As for agreement between panel members, the kappa value was 0.78 for the diagnosis of adenocarcinoma and 0.62 for confirmation of colorectal origin. The intraclass correlation coefficient for tumor differentiation features was 0.75. The proportion of villous and adenomatous components also generated good agreement. However, the grading of mucin secretion showed poor agreement (intraclass correlation coefficient = 0.44). Results confirm the reliability of routine pathological diagnosis and also demonstrate the reproducibility of basic diagnostic categories and pathognomonic features. Thus, to obtain reliable information from medical records for epidemiologic and clinical studies, data should be limited to well-defined diagnostic and histopathologic categories.

Adenocarcinoma↗
PubMed1989

Idiopathic constipation by colonic dysfunction. Relationship with personality and anxiety.

The personality of two groups of constipated women (by delayed colonic transit or by colonic inertia) was compared to that of two control groups of arthritic patients (rheumatoid or degenerative disease) with the Minnesota Multiphasic Personality Inventory (MMPI). All subjects suffered from chronic pain. Constipated women were found to have significantly higher scores on the hypochondria, hysteria, control, and low back pain scales and a lower score on the masculinity-femininity scale. Discriminant analysis permitted us to sort out constipated from arthritic patients in 83% of the cases, on the basis of only the personality data. In women with constipation by delayed colonic transit, multiple regression analysis demonstrated a close link (r = 0.90; P less than 0.001) between transit time in the ascending colon and levels of anxiety. It is concluded that women with constipation of colonic origin have a different pattern of personality than arthritic women and that severe constipation may play the role of a defense mechanism, where psychophysiologic responses to life stresses replace normal emotional reactions.

Adolescent↗
PubMed1989

Morphology and rheology of the rectum in patients with chronic idiopathic constipation.

To evaluate whether there is a relationship between the viscoelastic properties of the rectum and its surface, barium enema and rectal accommodation studies were performed under standard conditions in 46 subjects (25 adults, 21 children) with chronic idiopathic constipation. In adults, a significant correlation was found between rectal surface at barium enema and the minimum radius of rectal distention with a balloon necessary to higher wall tension changes (r = 0.68; P less than 0.01). In both adults (r = 0.48; P less than 0.05) and children (r = 0.57; P less than 0.01), negative correlations were found between the surface of the rectum and its elasticity. It is concluded that rectal accommodation studies produce data comparable to those of radiologic examinations and may therefore be used repetitively, and without fear of radiation, as follow-up studies on constipated patients.

Adult↗
PubMed1989

[Sigmoid motility stimulated by luminal distention. Changes in the motility response in constipation by the slowing down of left colonic transit].

The aim of our study was to develop a new technique of sigmoid manometry using standardized luminal distensions and to compare patterns of colonic motility following distension in normal subjects and in constipated patients. Eight subjects without colonic disturbances and 8 constipated patients with delayed transit time of the left colon as shown by radiopaque markers were investigated. Sigmoid motor activity was recorded by measuring pressure in a distending latex balloon placed at 25 cm from the anus. Inflations were maintained during 250 s and separated by 60 s recovery periods of deflation. Volumes of air (V) were increased until the patient reported abdominal pain (VMT). For each distension level, the resistance to distension of the bowel wall evaluated by the baseline adaptative pressure (P) and the contractile activity (A) quantified by planimetry of the active contractile activity (A) quantified by planimetry of the active contraction waves superimposed to P were assessed. In normal subjects, VMT was 147 +/- 9 ml. P increased linearly with V (p less than 0.03) up to 4,336 +/- 876 Pa. A increased with V until VMT/2 reached the maximum of 389 +/- 72 Pa*; for higher volumes A decreased significantly with to 166 +/- 46 Pa for VMT. Reference to controls, the constipated patients had a decreased VMT (61 +/- 4 ml). P increase at VMT (5,084 +/- 753 Pa) and A maximal value (387 +/- 176 Pa) were not different.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Megarectum.

Evaluation of the rectum by barium enema does not correlate well with rectometrographic studies and is not predictive of bowel function. The purpose of the present study was to describe clinical and functional data in patients with chronic idiopathic constipation, where a megarectum was diagnosed by a rectometrogram. Among 355 patients who underwent rectal elasticity studies, 35 were found to have a megarectum (maximum tolerable volume above 320 ml in women and 440 in men) for which no specific etiology was recognized. They, and a group of 11 healthy controls who were not sensitive to stress, underwent studies of stool frequency, colonic transit time of radiopaque markers, rectal elasticity, and anorectal pressures and reflexes. The elasticity coefficient of the rectal wall was decreased in patients as compared to controls (P less than 0.01). Seven patients had onset of symptoms at birth, with maximum tolerable volume in the rectum between 460 and 900 ml, and all were incontinent for feces. Studies of colonic transit times demonstrated normal function in the right and left colon, but there was rectosigmoid stagnation (transit time of 122 +/- 17 hr vs 8 +/- 2 in stress-free controls; X +/- SE; P less than 0.001). In the other 28 patients (late-onset megarectum), in contrast to the congenital group, there was a marked female preponderance, and their recorded stool frequency (4 +/- 0.7/week) was greater than the recalled frequency (1.4 +/- 0.2/week; P less than 0.001). Only half suffered from fecal incontinence. They did not have a greater rectal capacity when colonic transit times were prolonged (455 +/- 27 ml) than when normal (422 +/- 27). Rectal pressure was similar at the level of conscious sensation of filling, regardless of rectal capacity, suggesting a motor, rather than a sensory, abnormality. The amplitude of the rectoanal inhibitory reflex was decreased (P less than 0.001) as compared to controls, sometimes mimicking the findings of Hirschsprung's disease, but increasing rectal distension always induced a relaxation of the internal anal sphincter. The notion of a megarectum, which tolerates large amounts of fluid without sensation, lacks elasticity, and is accompanied by an abnormal rectoanal inhibitory reflex, provides an explanation for one of the mechanisms of constipation by outlet obstruction.

Adult↗
PubMed1988

Effects of rest, stress, and food on myoelectric spiking activity of left and sigmoid colon in humans.

The great variability which is known to affect colonic motility may partly be the result of changes in physiological conditions. In order to test this hypothesis, 40 subjects were sequentially put in conditions of vigilance, rest, stress, and feeding while colonic motility was monitored. The myoelectric spiking activity of the left colon was recorded with a 50-cm-long silastic tube equipped with four bipolar ring electrodes (located 10 cm apart) introduced into the left colon by flexible sigmoidoscopy. Tracings were performed while the subjects were kept awake (by conversation) for 1 hr, put at rest (quiet) for another 1 hr, submitted to a stress (by alternatively immersing and removing one hand from 2-4 degrees C cold water) for 20 min, and finally recorded for 2 hr after a 800-kcal meal. In 18 other subjects, the sequences of vigilance and rest were randomized. The results showed that colonic spiking activity was made of sporadic bursts that are known to be associated with intraluminal propulsion and of stationary bursts that probably play no role in colonic peristalsis. The duration of sporadic spiking activity was respectively 13.6 +/- 1.2 min/hr (mean +/- SEM) during the period of vigilance, 5.4 +/- 0.6 min/hr during the period of rest (P less than 0.001), 14.3 +/- 1.0 min/hr during the period of stress (NS), and 16.8 +/- 1.2 min/hr after a meal (P less than 0.05). The duration of stationary spiking activity did not change significantly throughout the four periods, respectively, 6.6 +/- 4.9, 4.4 +/- 3.7 (NS), 5.2 +/- 3.9 (NS), and 3.3 +/- 2.8 min/hr (NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Relationship between parietal blood flow studies in the left colon and the rectum in dogs. Colonic pressure and blood flow.

An animal model was proposed to clarify the difference in occurrence of enterocolitis in congenital aganglionosis. When gaseous distention of the colon was localized to the rectosigmoid area, enterocolitis never occurred. On the contrary, when it involved the left colon, enterocolitis occurred in 13 of 15 patients. Intestinal blood flow rates were simultaneously measured in the left colon and rectum of six dogs by using labeled microspheres and expressed in function of the intraluminal pressure. Results show that for elevated values of intraluminal pressure, blood flow was significantly lower in the left colon than in the rectum. These results may explain why ischemia and necrosis occurred more frequently in the left colon than in the rectum.

Animals↗
PubMed1988

Colonic hamartomas in tuberous sclerosis.

Twelve patients, 5 from the same family, diagnosed consecutively to suffer from tuberous sclerosis were investigated for gastrointestinal polyps. Six patients had no clinical neurologic involvement. Nine had colonic polyps: in 5 patients, these were hamartomas, in 3 patients adenomatous polyps, and the ninth patient had hamartomas and adenomatous and villoglandular polyps. Hamartomatous polyps were identical to those found in the Peutz-Jeghers syndrome. However, in 1 patient they included neural structures and in another there were angiomatous and adipous structures in addition to colitis cystica profunda. Two patients with hamartomatous polyps had normal intelligence and no clinical neurologic symptoms. The evaluation of one kindred revealed the association of hamartomatous polyps of the colon with forme fruste of tuberous sclerosis in different members, but none had the typical disease. Tuberous sclerosis should thus be considered in the differential diagnosis of hamartomatous colonic polyps. Conversely, colonic endoscopy may be a useful adjunctive test in the diagnosis of tuberous sclerosis, particularly in the incomplete varieties of disease.

Adolescent↗
PubMed1988

[Vasopressin and colonic motility].

Vasopressin (VS) has been reported to stimulate colonic peristalsis in different therapeutic conditions. In order to determine the mechanisms involved in this effect, colonic function was studied with three different techniques staying: a) the transit time of radioopaque markers through the colon was measured in 7 healthy subjects after VS IM (0.3 U/kg of weight). A marked propulsive effect was observed. One hour after injection, 64.7 +/- 16.2 p. 100 of the markers (m +/- sem) had left the right colon vs 9.1 +/- 4.6 p. 100 after injection of NaCl (p less than 0.01) and 70.5 +/- 10.8 p. 100 of the markers emptied from the left colon vs 4.3 +/- 4.5 p. 100 after NaCl (p less than 0.01); b) an electromyographic study was carried out in 6 other healthy subjects with an intraluminal device equipped with contact electrodes, introduced into the left colon by colonoscopy. The injection of VS was followed by an increase in the number of the propagating electrical spike bursts that are known to correlate well with the propulsion of the colonic intraluminal contents. The number of bursts was 2.7 +/- 0.6 bursts/30 min after NaCl and 5.2 +/- 1.4 bursts/30 min after VS (p less than 0.02); c) finally, the outflow of ileostomies and colostomies was measured in respectively 3 and 8 subjects over one h after IM 0.3 U/kg of VS. A considerable increase in the outflow of intestinal fluids was observed: output from the colostomies was 10 +/- 10 ml/h after NaCl and 250 +/- 39 ml/h after VS (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗