[New surgical procedures for the treatment of anal incontinence].
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Anal Canal↗
Biomedical subjects
J Christiansen
Publications and source records attributed to J Christiansen.
Ambulatory manometric recording of anorectal activity.
PURPOSE: Ambulatory anorectal manometry is usually analyzed by computer analysis only. An in-depth analysis with visual assessment of the recordings combined with computer analysis is presented. METHODS: Recordings of 20 to 24 hours in length were performed on ten healthy subjects. Spontaneous anal canal relaxations were analyzed and related to changes in rectal pressure and any reported rectal sensation. Pressure variations in the anorectum, including the rectal motor complex, were studied. RESULTS: In the awake subject the frequency of anal canal relaxations was 14.5 to 18.7/hour, and the frequency was 4.3/hour while asleep. They can be divided into two different subtypes. The amplitude of the pressure fall was 26 to 29 mm Hg, but diminished during sleep to 19 mm Hg. The duration of each relaxation was 16 to 19 seconds. Passage of flatus and the sensation of flatus in the rectum occurs 1.5 and 1.2 times per hour, respectively, usually with simultaneous anal canal relaxation. The frequency of rectal motor complexes in the midrectum was 0.4/hour and in the lower rectum was 0.7/hour; the duration was 10.3 and 5.8 minutes, respectively, with no nocturnal variation. The complexes could not be related to anorectal events. CONCLUSIONS: The study provides supplementary knowledge of anorectal physiology, particularly of anal canal relaxation, and proposes a more detailed method for evaluation of data obtained by ambulatory anorectal manometry.
Adult↗
Anal sphincter repair in patients with obstetric trauma: age affects outcome.
PURPOSE: This study was designed to determine whether advancing age affects the outcome of anal sphincter repair in patients with obstetric trauma and fecal incontinence. METHODS: Anal sphincter repair was performed on 24 patients younger than 40 (median age, 30) years and on 14 patients older than 40 (median age, 57) years. All patients had previous obstetric trauma. RESULTS: Twenty patients younger than 40 years (83 percent; 95 percent confidence interval, 63-95 percent) became continent, or incontinent to flatus only, after anal sphincter repair, whereas four patients had unchanged incontinence. Among patients older than 40 years, six patients (43 percent; 95 percent confidence interval, 18-71 percent) became continent, whereas eight patients remained incontinent (40 percent difference in functional outcome between younger and older patients; 95 percent confidence interval, 10-70 percent). CONCLUSION: Older females have a poorer outcome of anal sphincter repair for obstetric trauma compared with younger females.
Adult↗
Safety and efficacy of dynamic muscle plasty for anal incontinence: lessons from a prospective, multicenter trial.
BACKGROUND & AIMS: Dynamic muscle plasty has been advocated as therapy for refractory fecal incontinence and for anorectal reconstruction to avoid colostomy after abdominoperineal resection. This study evaluates the results of a multicenter experience with dynamic muscle plasty in the treatment of fecal incontinence and total anal reconstruction. METHODS: One hundred thirty-nine patients were enrolled at 12 centers between June 1992 and November 1994 and followed up through June 1996. Intramuscular leads and neurostimulators were implanted to stimulate transposed gracilis or gluteus muscle. Success was defined as 70% reduction in solid stool incontinence for patients with baseline incontinence and zero incontinence to solid stool for patients with baseline stomas and for patients undergoing total anal reconstruction. RESULTS: Overall, 85 of 128 graciloplasty patients (66%) achieved and maintained a successful outcome over the follow-up period. By etiology, these proportions were 71%, 50%, and 66% for patients with acquired fecal incontinence, congenital incontinence, and total anal reconstruction, respectively. One third of graciloplasty patients experienced a major wound complication, with therapy failing in 41%. Experienced centers had better outcomes and lower complication rates than inexperienced centers. Of the 11 gluteoplasty patients, 5 (45%) achieved and maintained a successful outcome. CONCLUSIONS: Dynamic graciloplasty may be an effective procedure for patients with refractory, end-stage fecal incontinence as well as for patients who require anorectal excision for low-lying malignancy. However, the procedure has significant morbidity that can lead to functional failure. Outcome after dynamic graciloplasty appears to correlate with surgical experience. In contrast to graciloplasty, the use of dynamic gluteoplasty should be limited to investigational purposes.
Adolescent↗
Dapsone hypersensitivity syndrome in a patient with cutaneous lupus erythematosus.
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Aged↗
Long-term results of artificial anal sphincter implantation for severe anal incontinence.
OBJECTIVE: To evaluate the long-term results of implantation of an artificial anal sphincter (AAS) for severe anal incontinence. SUMMARY BACKGROUND DATA: Implantation of an AAS is one of the options for treatment of anal incontinence when standard operations have failed. It is the only surgical option for treatment of anal incontinence in patients with neurologic disease that affects the pelvic floor and the muscles of the lower limb. METHODS: Seventeen patients underwent implantation of an AAS before 1993. These patients have been followed and their continence status evaluated. RESULTS: Two patients died of unrelated causes within the first 3 years after surgery, and in three patients the AAS was explanted because of infection. During the follow-up period, four patients had the AAS removed because of malfunction, and eight patients had a functioning AAS > or =5 years after the primary implantation. Five of these patients had revisional procedures, mainly because of technical problems in the early part of the study, when a urinary sphincter or slightly modified urinary sphincter was used. Continence at follow-up was good in four patients and acceptable in three, whereas one patient still had occasional leakage of solid stool. One patient had rectal emptying problems, which she managed by enema. CONCLUSIONS: An AAS based on the same principles as the artificial urinary sphincter seems to be a valid alternative in selected patients when standard surgical procedures have failed or are unsuitable. Approximately half of the patients have an adequate long-term result. Infectious complications still present a problem, whereas mechanical problems are less frequent with the modification of the device now available.
Adult↗
A family of insulin-like growth factor II mRNA-binding proteins represses translation in late development.
Insulin-like growth factor II (IGF-II) is a major fetal growth factor. The IGF-II gene generates multiple mRNAs with different 5' untranslated regions (5' UTRs) that are translated in a differential manner during development. We have identified a human family of three IGF-II mRNA-binding proteins (IMPs) that exhibit multiple attachments to the 5' UTR from the translationally regulated IGF-II leader 3 mRNA but are unable to bind to the 5' UTR from the constitutively translated IGF-II leader 4 mRNA. IMPs contain the unique combination of two RNA recognition motifs and four hnRNP K homology domains and are homologous to the Xenopus Vera and chicken zipcode-binding proteins. IMP localizes to subcytoplasmic domains in a growth-dependent and cell-specific manner and causes a dose-dependent translational repression of IGF-II leader 3 -luciferase mRNA. Mouse IMPs are produced in a burst at embryonic day 12.5 followed by a decline towards birth, and, similar to IGF-II, IMPs are especially expressed in developing epithelia, muscle, and placenta in both mouse and human embryos. The results imply that cytoplasmic 5' UTR-binding proteins control IGF-II biosynthesis during late mammalian development.
3T3 Cells↗
The C-terminal carboxy group of T7 RNA polymerase ensures efficient magnesium ion-dependent catalysis.
DNA and RNA polymerases use divalent metal ions for catalysis. Crystal structures of several polymerases reveal that two acidic residues are involved in coordinating two metal ions at the catalytic centre. Bacteriophage RNA polymerases contain a highly conserved C-terminus with the carboxylate positioned near the active site. We examined whether theC-terminal carboxy group of T7 RNA polymerase is important for magnesium ion-dependent catalysis. Introduction of a methyl ester or decarboxylation of the C-terminal carboxy group was achieved with an intein-based protein expression system and an elongation rate assay was developed to test the effects of the modifications. The results show that enzymes with a modified C-terminal carboxy group exhibit a magnesium ion-dependent decrease in catalytic activity.
Bacteriophage T7↗
Catalytic and biophysical properties of a nitrogenase Apo-MoFe protein produced by a nifB-deletion mutant of Azotobacter vinelandii.
A Zn-immobilized metal-affinity chromatography technique was used to purify a poly-histidine-tagged, FeMo-cofactorless MoFe protein (apo-MoFe protein) from a nifB-deletion mutant of Azotobacter vinelandii. Apo-MoFe protein prepared in this way was obtained in sufficient concentrations for detailed catalytic, kinetic, and spectroscopic analyses. Metal analysis and electron paramagnetic resonance spectroscopy (EPR) were used to show that the apo-MoFe protein does not contain FeMo-cofactor. The EPR of the as-isolated apo-MoFe protein is featureless except for a minor S = 1/2 signal probably arising from the presence of either a damaged P cluster or a P cluster precursor. The apo-MoFe protein has an alpha2beta2 subunit composition and can be activated to 80% of the theoretical MoFe protein value by the addition of isolated FeMo-cofactor. Oxidation of the as-isolated apo-MoFe protein by indigodisulfonate was used to elicit the parallel mode EPR signal indicative of the two-electron oxidized form of the P cluster (P2+). The midpoint potential of the PN/P2+ redox couple for the apo-MoFe protein was shown to be shifted by -63 mV when compared to the same redox couple for the intact MoFe protein. Although the apo-MoFe protein is not able to catalyze the reduction of substrates under turnover conditions, it does support the hydrolysis of MgATP at 60% of the rate supported by the MoFe protein when incubated in the presence of Fe protein. The ability of the apo-MoFe protein to specifically interact with the Fe protein was also shown by stopped-flow techniques and by formation of an apo-MoFe protein-Fe protein complex. Finally, the two-electron oxidized form of the apo-MoFe protein could be reduced to the one-electron oxidized form (P1+) in a reaction that required Fe protein and MgATP. These results are interpreted to indicate that the apo-MoFe protein produced in a nifB-deficient genetic background [corrected] contains intact P clusters and P cluster polypeptide environments. Small changes in the electronic properties of P clusters contained within the apo-MoFe protein are most likely caused by slight perturbations in their polypeptide environments.
Alkylation↗
Quantifying biosynthetic human growth hormone in Escherichia coli with capillary electrophoresis under hydrophobic conditions.
A method has been developed which is able to quantitate the content of precursor biosynthetic human growth hormone (Pre-bhGH) in the cytosol of E. coli cells containing the gene for human growth hormone (hGH). The method uses hydrophobic C18 coated capillaries with native biosynthetic human growth hormone (bhGH) as an internal standard. This allows for highly robust and precise determinations as well as the evaluation of the presence of deamidated forms in the cytosol samples. Furthermore, by modifying the running buffer with zwitterionic surfactants and an organic modifier, it is possible to detect a related form with a three sulfur atom Cys-Cys bridge (trisulfide Pre-bhGH). Thus, a strong tool for monitoring the effect of fermentation conditions on the biosynthesis of bhGH is obtained.
Amino Acid Sequence↗
Evidence for coupled electron and proton transfer in the [8Fe-7S] cluster of nitrogenase.
Substrate reduction by nitrogenase requires electron transfer from a [4Fe-4S] cluster in the iron (Fe) protein component to an FeMo cofactor in the molybdenum-iron (MoFe) protein component in a reaction that is coupled to MgATP hydrolysis and component protein association and dissociation. An [8Fe-7S] (or P-) cluster in the MoFe protein has been proposed as an intermediate electron-transfer site, although how this cluster functions in electron-transfer remains unclear. In the present work, it is demonstrated that one redox couple of the P-cluster (P2+/1+) undergoes coupled electron and proton transfer, whereas a more reduced couple (P1+/N) does not involve a coupled proton transfer. Redox titrations of the MoFe protein P-cluster were performed, and the midpoint potential of the P2+/1+ couple (Em2) was found to be pH dependent, ranging from -224 mV at pH 6.0 to -348 mV at pH 8.5. A plot of Em2 versus the pH for this redox couple was linear and revealed a change of -53 mV/pH unit, indicating a single protonation event associated with reduction. From this plot, it was concluded that p is <6.0 and p is >8.5 in a proton-modified Nernst equation. In contrast, the midpoint potential for the P1+/N couple (Em1) was found to be -290 mV and was invariant over the pH range 6.0-8.5. These results indicate that the protonated species does not influence either the P1+ or the PN oxidation states. In addition, at physiological pH values, electron transfer is coupled to proton transfer for the P2+/1+ couple. The P-clusters are unique among [Fe-S] clusters in that they appear to be ligated to the protein through a serinate-gammaO ligand (betaSer188) and a peptide bond amide-N ligand (alphaCys88), in addition to cysteinate-S ligands. Elimination of the serinate ligand by replacement with a glycine was found to shift the Em values for both P-cluster couples by greater than +60 mV, however the pH dependence of Em2 was unchanged. These results rule out Ser188 as the protonated ligand responsible for the pH dependence of Em2. The implications of these results in understanding the nitrogenase electron-transfer mechanism are discussed.
Amino Acid Substitution↗
[Does colonic J-pouch after low anterior resection of rectal cancer give a better functional result?].
Low anterior resection (LAR) with mesorectal excision for adenocarcinoma of the rectum leads to low colorectal or coloanal anastomosis, and often poor functional results. Increased stool frequency and urge are common after the operation, and some have anal incontinence. Construction of a neo-rectum, in the form of a colonic J-pouch improves the functional results to some extent. Patients with a colonic J-pouch have significantly lower stool frequency and perhaps also fewer symptoms of urge and incontinence than patients with a straight coloanal anastomosis. If part of the rectum is preserved, the benefit of a pouch is doubtful. The overall quality of life after the operation in patients with a J-pouch is not different from quality of life in patients with a straight coloanal anastomosis. Patients with a pouch may have trouble emptying the reservoir, this is less pronounced if the pouch is shortened to 5 cm. It is not proved with certainty that patients with a colonic J-pouch have fewer anastomotic leakages than patients with a straight coloanal anastomosis. It is concluded that with an anastomotic height below 5 cm a pouch apparently improves the functional results after LAR for adenocarcinoma of the rectum, while the benefit of a pouch above this anastomotic height is doubtful.
Adenocarcinoma↗
[Anal and urinary incontinence after obstetric anal sphincter rupture].
The aim of the study was to assess the long term impact of obstetric anal sphincter rupture on the frequency of anal and urinary incontinence, and identify factors to predict patients at risk. In 94 consecutive women who had sustained an obstetric anal sphincter rupture, anal manometry, anal sphincter electromyography and pudendal nerve terminal motor latency at three months post partum was performed. A questionnaire regarding incontinence was sent between two to four years post partum. Forty-two percent of responders had anal incontinence, 32% had urinary and anal incontinence. Overall, 56% of the women had incontinence symptoms. The occurrence of anal incontinence was associated with pudendal nerve terminal motor latencies > 2.0 milliseconds and the occurrence of urinary incontinence was associated with the degree of rupture, the use of vacuum extraction and previous presence of urinary incontinence. Thirty-eight percent of the women with incontinence wanted treatment, but only a few had sought medical advice.
Adult↗
Anorectal pressure gradient and rectal compliance in fecal incontinence.
To study whether anorectal pressure gradients discriminated better than standard anal manometry between patients with fecal incontinence and subjects with normal anal function, anorectal pressure gradients were measured during rectal compliance measurements in 36 patients with fecal incontinence and in 22 control subjects. Anal and rectal pressures were measured simultaneously during the rectal compliance measurements. With standard anal manometry, 75% of patients with fecal incontinence had maximal resting pressure within the normal range, and 39% had maximum squeeze pressure within the normal range. Anorectal pressure gradients did not discriminate better between fecal incontinence and normal anal function, since, depending on the parameters used, 61%-100% of the incontinent patients had anorectal pressure gradients within the normal range. Patients with fecal incontinence had lower rectal volumes than controls at constant defecation urge (median 138 ml and 181 ml, P < 0.05) and at maximal tolerable volume (median 185 ml and 217 ml, P < 0.05). We conclude that measurements of anorectal pressure gradients offer no advantage over standard anal manometry when comparing patients with fecal incontinence to controls. Patients with fecal incontinence have a lower rectal volume tolerability than control subjects with normal anal function.
Anal Canal↗
Dynamic graciloplasty for severe anal incontinence.
BACKGROUND: The surgical options for the treatment of anal incontinence where standard procedures have failed include transposition of striated muscles, primarily gracilis and gluteus maximus, and implantation of artificial sphincters. Due to a high proportion of fatigue-prone fibres in striated muscles, the results of transposition without stimulation have been disappointing. This study presents the results of stimulated graciloplasty in 13 patients with severe anal incontinence in whom other surgical procedures had failed. METHODS: The gracilis muscle was transposed around the anal canal according to a previously described technique. Eight weeks later the intramuscular electrodes were implanted into the gracilis at the site of the nerve entry and a neurostimulator was placed in a subcutaneous pocket in the abdominal wall. The patients were followed from 7 to 27 months. RESULTS: Six patients obtained satisfactory continence and five showed marked improvement. Two patients were considered failures. Rectal evacuation problems occurred in three patients, in one so severe that the patient, in spite of satisfactory continence, considered the treatment a failure. CONCLUSION: Dynamic graciloplasty is a viable option in carefully selected patients with severe anal incontinence where other methods have failed.
Adolescent↗
Chronic idiopathic anal pain.
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Anus Diseases↗
Improving leaping ability in elite rhythmic gymnasts.
PURPOSE: The purpose of this study was to improve the leaping ability of athletes in rhythmic gymnastics, a high leap demanding sport, using a controlled course of jump training. METHODS: Six elite athletes underwent a course of leap training including pool training and Pilates' Method of Body Conditioning using spring controlled resistance to muscular exertion. Baseline data was obtained on a force plate that measured reaction time, leap height, and explosive power on each athlete before initiating training. RESULTS: After 1 month of training, leap height improved 16.2%, ground reaction time improved 50%, and explosive power improved 220%. With continued maintenance training, no decrease in effect was noted; however, no significant improvement occurred after the first month of training. At 1 yr with discontinuation of the leaping protocol but continued training within the sport, the initial gains were likewise maintained. No injuries occurred during participation in the leaping protocol. CONCLUSIONS: Elite rhythmic gymnasts can safely improve their leaping ability significantly through an intense course of jump training. Continued training with the leaping protocol does not appear to further enhance the benefit; however, the gains appear to be maintained at 4 months and 1 yr post training with or without additional training with the leaping protocol.
Adolescent↗