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Biomedical subjects

G Devroede

Publications and source records attributed to G Devroede.

52 records · Page 3Linked to original sources
PubMed1976

Manometric assessment of continence after surgery for imperforate anus.

Of 49 children with imperforate anus, 23 underwent an abdominoperineal procedure for a high and seven for a low maliformation, 17 had a perineoplasty for a low and two for a high malformation. In each subject, rectal and anal sphincteric resting pressures were studied at least 1 yr after surgery. Of 30 subjects who had undergone an abdominoperineal procedure, eight were continent in contrast to 15 out of 19 patients who had had a perineoplasty (p less than 0.001). In patients who had undergone an abdominoperineal procedure, the rectal motility was of the colonic type, with waves of higher amplitude and lower frequency (p less than 0.01) than in the normal rectum in 23 cases and in most of these, peristalsis was recorded down to the anal margin. Incontinence was most frequently associated with abnormally short anal resistance, low anal pressure, reduced sensibility, weak voluntary contraction and absence of rectoanal inhibitory reflex. In the group of patients who underwent perineoplasty, continence was associated with normal mechanical parameters and normal physiologic behavior of the anal sphincter.

Adolescent↗
PubMed1976

Relationship between viscoelastic properties of the rectum and anal pressure in man.

Viscoelastic properties of the rectal wall and anal sphincter pressure were studied simultaneously in 25 normal children. During rectal distension for 60 s, with varying volumes of air, the rectal pressure varied as the sum of two exponential functions of the time plus an asymptotic constant. A rectoanal inhibitory reflex was elicited during these distensions. The exponential decrease of the rectal pressure corresponded exactly to the return of the upper anal canal pressure to the resting value in some subjects. In others, the upper anal canal remained relaxed as long as the rectal ampulla was distended, except with smaller volumes. The results obtained may be explained by an analogical rheological linear model.

Anal Canal↗
PubMed1976

Intraluminal pressures during perfusion of the human colon in situ.

Nine healthy human volunteers underwent colonic perfusion and recording of the intraluminal pressure simultaneously in the right, transverse, and left colon. Isotonic saline was infused into the caecum at various flow rates from 10 to 30 ml per min. During colonic perfusions, pressure waves were simple and distorted only by respiratory artifacts. Their amplitude was large (10 to 44 cm of H2O), of long duration (8 to 68 sec), and of low frequency (0.2 to 1.8 wave per min). The frequency of the waves was very stable and this stability was uninfluenced by the site of recording and the rate of perfusion. A pressure wave in the right colon was always followed within 3 sec by a wave in the transverse and left colon. The frequency and amplitude of the waves increased in all subjects and at all rates of perfusion from right to left colon (P less than 0.001). The wave frequency increased with the perfusion flow rate (P less than 0.001). The relationship between the perfusion flow rate and the waves amplitude was curvilinear (P less than 0.01). It is concluded that in the human colon perfused in situ there is a gradient of motility preventing aboral propulsion. This study suggests that during perfusion, liquids are trapped in the right colon. Data on transport of water and electrolytes, obtained from whole colon perfusion, may in fact reflect events occurring in the proximal part of the large bowel.

Adolescent↗
PubMed1976

Computer-aided diagnosis of gastroenterologic diseases in Sherbrooke: preliminary report.

To assess the diagnostic accuracy of a computer-aided-diagnosis system when implemented in different parts of the world, an automated system, which had established its reliability in Leeds, England, was transferred to Sherbrooke, Quebec. In this preliminary study two retrospective series, comprising 104 patients with acute abdominal pain and 101 patients with dyspepsia, were drawn from the files of the Centre Hospitalier Universitaire in Sherbrooke. The history and physical-examination sheet was analyzed, coded and tested against the Leeds data base on a WANG 2200 computer, and the results were compared with the final Sherbrooke pathologic diagnosis. Overall the computer made a correct diagnosis in 78.8% of cases of acute abdominal pain and 70% of cases of dyspepsia. Computer diagnoses of appendicitis were correct in 97% of cases and the system recognized 91% of the actual appendicitis cases. Similar figures for cholecystitis were 91% and for peptic ulcer, 87%. However, the "pick-up" rate by the computer of pancreatitis was only 25%. It is concluded that geographical differences in disease presentation will probably not impair the validity of the computer method used in this study. A comparison of various diagnostic methods and levels of competence will await a prospective trial of this method.

Abdomen↗
PubMed1976

The genesis of bowel sounds: influence of viscus and gastrointestinal content.

This study was undertaken to try to solve the controversy about the influence of gastrointestinal contents on the genesis of bowel sounds, and to probe the respective importance of the various abdominal viscera. Eleven healthy volunteers were intubated by mouth with a multiple-lumen tube. Bowel sounds were recorded for 10 min when the tube was in the stomach, the upper jejunum, and the cecum, while it was left intact in situ, or perfused with isotonic saline (15 ml per min), or with an equal (7.5 ml per min of each) mixture of isotonic saline and air. Using a previously developed method, a computer analysis was made of the recording without any human intervention during the treatment of data. An analysis of variance demonstrated that the effect of perfusion varied according to site, with 46% of counted sounds while the tube was in the stomach, 32% in the jejunum, and 22% in the colon (P less than 0.05). There were two types of sounds: some exceeded in amplitude a preset threshold, and thus were picked up by the computer, but their average absolute value for 20 msec remained inferior to another preset threshold. Their number was kept in memory (NS--sounds having an amplitude exceeding a threshold S1, expressed in number per 10 min). A second type of sounds also exceeded the present threshold but their average absolute value for 20 msec also exceeded another preset threshold. Their number (NE--sounds having an amplitude exceeding the thershold S1 but having also a 20-msec average amplitude above another threshold S2, expressed in number per 10 min) was also memorized. The latter group was composed of two types of sounds: some had a limited spectrum of low frequency (100 Hz) and were of high amplitude and short (congruent to 5 msec) duration (NE1); some others had a higher and more dispersed frequency centered around 300 Hz (NE2). Fifty per cent of high energy (NE) sounds appeared while the tube was in the stomach, 30% in the colon, and 20% in the jejunum (P less than 0.005). Short and high amplitude sounds (NE1) were counted more often (43%) when it was in the colon than in the stomach (38%) and the jejunum (19%) (P less than 0.025), and this was confirmed (P less than 0.005) by a study of the ratio of NE1/NE. On the contrary, higher frequency sounds (NE2) were present more often when the tube was in the stomach (59%) than in the jejunum (24%) and in the colon (17%) (P less than 0.005). There was no influence of the presence of the unperfused tube on the genesis of bowel sounds in different sites (P greater than 0.05). In the stomach and the colon perfusion of the air/saline mixture increased the number of sounds (P less than 0.025) and all types of sounds in the stomach (P less than 0.025), whereas in the jejunum it was the perfusion of saline which increased them (P less than 0.025). It is concluded that the stomach is the most active site of production of bowel sounds, followed by the colon and then the small bowel, that sounds differ in different sites, and that all this is influenced by viscus content.

Cecum↗
PubMed1975

Crohn's disease of the vulva.

Three patients with Crohn's disease primarily involving the large intestine had unusual abscesses of the vulvar area. At biopsy, the abscesses had classic features of the primary disease and were clearly separated from the intestinal tract. There was no fistula in the anal canal, and the perineum between the vulvar abscess and the anus was normal. One of the patients also had an early lesion of Crohn's disease in the sigmoid. The lesion appeared as a small erythematous spot without ulceration. Biopsy revealed a typical granuloma under an intact mucosa. It is concluded that Crohn's disease is not confined to the gastrointestinal tract, and that early lesions of the disease within the gastrointestinal tract are submucosal rather than mucosal.

Abscess↗
PubMedDate not supplied

Changes in the rectal mucosa induced by hypertonic enemas.

The aspect of the rectal mucosa after administration of hypertonic enemas is occasionally confused with the macroscopic appearance of quiescent ulcerative colitis. Criteria for a diagnosis of enema reaction were derived from a retrospective series and tested prospectively on 11 healthy volunteers. Photographs and biopsies were obtained before and after administration of a sodium phosphate hypertonic enema. Three observers evaluated blindly the "before" and "after" macroscopic and microscopic pictures, graded the features, and made an overall diagnosis. In random studies, two observers mistakenly classified a macroscopic picture, but all correct histologic diagnoses of "before" and "after" biopsies. In decreasing order of discriminating power, the following features of an enema reaction were found to be useful: separation and mucous depletion of the glands (no observer variation), increase in mucosal fragility in 91 per cent of cases (82--100 per cent), edema of the lamina propria in 88 per cent (73--100 per cent), straightening of the basal membrane in 82 per cent (73--91 per cent) and an increase in extruded mucus in 70 per cent (18--100 per cent). In 39 per cent of cases (36--45 per cent), erythrocytes appeared focally in the lamina propria. The effects of hypertonic enemas can be recognized on biopsy.

Adult↗