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Biomedical subjects

J Christiansen

Publications and source records attributed to J Christiansen.

At least 73 records · Page 4Linked to original sources
PubMed1998

Modern surgical treatment of anal incontinence.

New surgical treatment modalities have been developed for patients with anal incontinence resulting from extensive sphincter destruction and in whom standard sphincter repair has failed. These new modalities include the transposition of striated skeletal muscles combined with implantation of neurostimulators, artificial sphincters based on the same principle as artificial urinary sphincters, and direct sacral nerve stimulation. In a few reported series muscle transposition in combination with neurostimulation has given a satisfactory continence in 50-70% of the patients. The same is true for the smaller series published on artificial anal sphincters, whereas the results of sacral nerve stimulation have thus far been reported in only a few patients. The selection of patients and the performance of these procedures should be limited to few specialist centres.

Anal Canal↗
PubMed1998

Interobserver agreement in defecography--an international study.

BACKGROUND: Defecography is considered to be an essential investigation in the evaluation of functional anorectal disorders, but the agreement between observers from different clinical centers has never been evaluated. METHODS: 14 defecographic studies were selected aimed to cover the most relevant defecographic findings responsible for disordered defecation. Eight studies were considered unequivocal, but six were thought to be controversial. All were sent to the ten participants in Europe and the US (five proctosurgeons, three radiologists, two gastroenterologists). They evaluated the studies using a previously agreed upon questionnaire. Interobserver agreement was quantified by kappa statistics and by the proportions of positive and negative agreement as compared to chance agreement, respectively. RESULTS: Overall, only the completeness of rectal emptying and the presence of a rectocele achieved acceptable kappa values above 0.4. When restricting the evaluation to the studies considered to be unequivocal, agreement improved considerably and was moderate to good for all items describing the images (kappa 0.43-0.63). However, whether proctosurgery should be performed and whether defecography contributed to the management of the particular patient remained controversial with very low kappa. CONCLUSIONS: It is doubtful whether defecography contributes substantially to the management of patients with disordered defecation.

Anus Diseases↗
PubMed1997

Distinct repression of translation by wortmannin and rapamycin.

The role of phosphatidylinositol 3-kinase and FK506-binding protein rapamycin-associated protein (FRAP) in translational control has been examined by treating RD-rhabdomyosarcoma cells with wortmannin and rapamycin and studying the effects on cell-growth, translation initiation, and protein synthesis. Whereas wortmannin and rapamycin exhibit subtle effects on global translation, examination of individual mRNAs in sucrose gradients and of individual proteins in two-dimensional polyacrylamide gels reveals that wortmannin and rapamycin exhibit distinct effects on the translation of individual mRNAs. Wortmannin represses the synthesis of a third of cellular proteins, whereas rapamycin affects a subset of these proteins. Since ribosomal protein S6 was rapidly dephosphorylated following wortmannin and rapamycin treatment, and the phosphorylation status of the eukaryotic initiation factor 4E was unchanged, our data imply that the p70 signalling pathway has at least one branch-point upstream of FRAP leading to an additional route of translational control.

Androstadienes↗
PubMed1997

Viscous fluid expulsion in the evaluation of the constipated patient.

PURPOSE: The aim of this study was to evaluate a viscous fluid expulsion test as a method for quantifying rectal outlet obstruction. METHODS: We examined the ability of 30 severely constipated patients and 40 healthy control subjects to expel a viscous fluid simulating feces. RESULTS: Constipated patients with defecographic rectal retention expelled a significant lower viscous fluid volume compared with controls (P < 0.0001). Considering the viscous fluid expulsion test to be positive if the patient expelled less than 160 ml of fluid (lower 95 percent confidence value in healthy controls) and using the presence of defecographic rectal outlet obstruction as a reference, the predictive value of a negative viscous fluid expulsion test was 100 percent, the predictive value of a positive test was 67 percent, and sensitivity and specificity was 100 percent and 82 percent, respectively. The viscous fluid test identified symptomatic outlet obstruction in almost twice as many patients as did defecography. Some patients, however are-despite their obstructive symptoms-able to evacuate their rectum when examined in the laboratory. CONCLUSION: The viscous fluid expulsion test is a simple, reproducible, nonionizing, and low-cost method of quantifying rectal outlet obstruction. A positive test result should lead to a defecography, whereas a negative test result renders defecography dispensable and spares the patient from pelvic radiation.

Adolescent↗
PubMed1997

Pudendal nerve function during pregnancy and after delivery.

The aim of the study was to assess pudendal nerve function serially during pregnancy and after delivery. Twenty-eight women participated at 14, 30 and 36 weeks of pregnancy and 12 weeks postpartum. A prospective study of pudendal nerve terminal motor latency during pregnancy and after delivery was carried out. Results showed that pudendal nerve terminal motor latency did not increase significantly during pregnancy but increased significantly after delivery.

Adult↗
PubMed1997

Reliability of pudendal nerve terminal motor latency.

AIM: To evaluate reliability of Pudendal Nerve Terminal Motor Latency (PNTML). METHODS: Forty healthy subjects, 24 women and 16 men, and eight female patients were included. Four patients had idiopathic faecal incontinence and 4 an anal sphincter rupture after child-birth. PNTML measurement was performed by two observers with the patient in left lateral and supine position. Examinations were repeated on another day to evaluate intraindividual reproducibility. RESULTS: Interobserver reproducibility was 92%-116% for PNTML. Degree of agreement for PNTML between left lateral and supine position was 86%-111%. Intra-individual reproducibility in the supine and left lateral positions was 89%-109% and 88%-113% respectively. Normal values for mean PNTML were higher in women compared with men, 1.91 msec (2 SD, 0.52 msec) and 1.74 msec (2 SD, 0.33 msec) respectively, t = 2.44, 37 DF, P < 0.01. CONCLUSIONS: Reliability of PNTML in terms of interobserver and intraindividual reproducibility was high. Women had higher normal values for PNTML than men.

Adult↗
PubMed1997

Vaginal pudendal nerve stimulation: a new technique for assessment of pudendal nerve terminal motor latency.

BACKGROUND: To evaluate vaginal stimulation of the pudendal nerve, a new method for investigation of pudendal nerve terminal motor latency (PNTML) and to assess the reproducibility of the method. METHODS: Thirteen healthy women and 11 female patients, median age 31 years (range 21-53 years), participated in the study. Ten patients had sustained an anal sphincter rupture and one had idiopathic anal incontinence. Pudendal nerve terminal motor latency was measured after vaginal stimulation of the pudendal nerve with motor response from the pelvic floor and rectal stimulation with motor response from the anal sphincter using the St. Marks pudendal electrode. The women were stimulated by two observers both vaginally and by the rectum. RESULTS: Vaginal PNTML for observer 1 was 2.06 msec (0.50 msec, 2 s.d.) and 2.04 msec (0.55 msec, 2 s.d.) for observer 2, while rectal PNTML was 1.99 msec (0.56 msec, 2 s.d.) and 1.97 msec (0.54 msec, 2 s.d.) respectively. The difference between vaginal and rectal PNTML was 0.065 msec for observer 1 (p = 0.106) and 0.070 msec for observer 2 (p < 0.05). Degree of agreement between vaginal and rectal PNTML was 80%-116% for observer 1 and 84%-12% for observer 2 (100% represent total agreement between measurements). Interobserver reproducibility for vaginal PNTML was 90%-109% and 86%-113% for rectal PNTML. CONCLUSION: In clinical practice vaginal PNTML may replace rectal PNTML in women. Reproducibility is in the same range as for rectal PNTML.

Adult↗
PubMed1997

Delivery and pudendal nerve function.

OBJECTIVE: To assess the impact of mode of delivery and the occurrence of pelvic instability upon the pudendal nerve function and relate the pudendal nerve function to the occurrence of anal and urinary incontinence. METHODS: One hundred and forty-six pregnant women were examined during pregnancy and 12 weeks post partum with measurement of pudendal nerve terminal motor latency (PNTML), the difference between the two measurements was defined as delta PNTML. Anal and urinary continence status, details of delivery and the occurrence of pelvic instability were recorded prospectively. RESULTS: Pudendal nerve terminal motor latency increased from 1.7 msec in primiparae and 1.8 msec in multiparae during pregnancy to 2.0 msec (p < 0.001) and 2.1 (p < 0.001) respectively after delivery. The increase was significantly higher after the use of vacuum extraction (p < 0.04). Multivariate analysis showed that delta PNTML was associated with age, the presence of pelvic instability and the use of vacuum extraction. Whereas delta PNTML was not associated with factors such as infant's head circumference and weight, parity, cesarean section, pudendal block, epidural analgesia and second stage of labor. Only four women had anal incontinence after delivery. Twenty-five women with urinary incontinence had a significantly higher mean PNTML (2.20 msec) than 121 continent women (2.01 msec). CONCLUSION: Pudendal nerve terminal motor latency increases in both primiparous and multiparous women after delivery. In 10% of the women the increase resulted in a pathologic PNTML value > 2.4 msec. The delta PNTML was significantly associated with age, the occurrence of pelvic instability and the use of vacuum extraction. The group of women with urinary incontinence had a significant increased PNTML.

Adult↗
PubMed1997

Promoting changes in clinical practice. Treatment time and outcome studies in a Danish public child dental health clinic.

This paper examines the characteristics of the process of innovation as applied to provision of dental health to children. The data are from a demonstration project conducted in a Danish public child dental health clinic to evaluate the appropriateness and effectiveness of an individualized and alternative, mainly non-operative caries treatment strategy that was implemented in 1987. The aim of the strategy was to avoid operative intervention and sealants, and was based on three principles: caries is a localized disease; intensive training in home-based treatment, and individualized risk assessments and controls in conjunction with professional plaque removal. The major influence on the innovation process appeared to be personal education of the personnel, active participation in research, and feedback from clinical observations. In 1992 an additional feedback measure was introduced addressing the question: how much time does the individual child spend on treatment during one year? Mean total treatment time varied from 12 min 1- to 4-yr-olds to 44-58 min for 7- to 17-yr-olds. About 60% of the total treatment time was used on non-operative caries treatment (diagnosis, risk assessment, plaque removal, toothbrushing training) and about 25% on operative caries treatment for 3- to 17-yr-olds. The 1-2-yr-olds required only non-operative treatment. The new treatment strategy reduced operative procedures by 60%. The paper introduces an easily applicable measure of treatment outcome in terms of teeth that have not been restored or sealed as a result of regular professional treatment or care. The main conclusion drawn is that the dominant moving forces in the innovation process were professional responsibility and self-adjustment by a constant learning process involving clinical feedback measures in conjunction with modern understanding of caries as a localized disease caused by local evolution of microbial cariogenic biofilms.

Adolescent↗
PubMed1997

Pinch grafting of leg ulcers. A retrospective study of 412 treated ulcers in 146 patients.

In a retrospective study of 412 leg ulcers in 146 patients treated with pinch grafting, with a mean duration of follow-up of 32 months (range 2-84), the overall healing rate was 38%. The healing rate was best in the vasculitic ulcers (56%), followed by venous ulcers (38%), arteriosclerotic ulcers (33%), mixed ulcers (33%) and "other ulcers" (20%). In the series as a whole, the mean duration of ulcer problems was 8 years, and that of the 412 ulcers treated 2.5 years; the mean recurrence rate was 28%, and the mean remission time 12.5 months. In the ulcers that were still healed at close of the study (comprising 27% (112/412) of the series), the remission time was > or = 26.6 months. Thus we consider pinch grafting to be a successful complement to conservative therapy in most types of ulcers.

Adult↗
PubMed1997

DNA ploidy analysis in breast carcinoma. Comparison of unfixed and fixed tissue analyzed by image and flow cytometry.

OBJECTIVE: To form a methodologic basis for DNA analysis of ductal carcinoma in situ (DCIS) and invasive carcinoma (IC) of the breast, including very small lesions, by comparison of flow cytometric (FCM) and image cytometric (ICM) methods for DNA quantitation. STUDY DESIGN: The material consisted of 41 DCIS lesions and 26 ICs. FCM DNA analysis of unfixed, frozen samples were compared to (1) FCM of formalin-fixed, paraffin-embedded tissue; (2) ICM of imprints; and (3) ICM of paraffin-embedded tissue sections. RESULTS: FCM of unfixed tissue showed higher DNA measurement precision and a higher number of DNA nondiploid clones as compared to the other three methods. For the classification of DNA diploid/nondiploid cases, high concordance rates were found between the methods. Discordant cases were predominantly DNA neardiploid by FCM of unfixed tissue but DNA diploid by the other methods. The reproducibility of the DNA index (DI) was best in the interval 1.2 < DI < or = 2.2; it was 74% for FCM of fixed tissue and 79% for ICM of imprints. Clones with DI > 3 were found almost exclusively by ICM of imprints. For ICM of tissue sections, DI could not be reliably estimated. By ICM, contrary to FCM, a combined DNA diploid and nondiploid pattern was found frequently. CONCLUSION: Each of the methods has its own advantages and limitations. If possible, FCM should be combined with ICM. FCM of unfixed tissue is superior to the other methods with respect to precise DI estimation. Alternatively, FCM of fixed tissue and ICM of imprints may both give a reliable estimate of DI. ICM of tissue sections can discriminate DNA diploid from nondiploid clones, except for neardiploid subpopulations, and permits the analysis of very small lesions.

Breast Neoplasms↗
PubMed1996

Intrinsic termination of T7 RNA polymerase mediated by either RNA or DNA.

Intrinsic termination of T7 RNA polymerase transcription occurs at different signals in vitro. One type of signal is similar to that mediating factor-independent termination of Escherichia coli RNA polymerase, whereas the other type does not involve RNA hairpin formation. By examining the termination behaviour of T7 RNA polymerase at the E.coli rrnB operon t1 terminator, at the T7-t(phi) terminator, at the human preproparathyroid hormone gene terminator on both single- and double-stranded templates, and in the presence of GTP or ITP during transcription, we show that the termination event can be mediated by either RNA or DNA structural features. Moreover, by using co-transcriptional probing with potassium permanganate, we present evidence for the presence of transcription-induced hyperreactive thymidines on the non-template strand in the DNA-mediated event, and a putative sequence motif is identified. We conclude that intrinsic termination of T7 RNA polymerase transcription in vitro can be mediated either by a hairpin in the nascent RNA or by a sequence motif including hyperreactive thymidines in the non-template DNA strand.

Bacteriophage T7↗
PubMed1996

A mammalian patched homolog is expressed in target tissues of sonic hedgehog and maps to a region associated with developmental abnormalities.

Drosophila patched is a segment polarity gene required for the correct patterning of larval segments and imaginal discs during fly development and has a close functional relationship with hedgehog. We have isolated a complete human PATCHED cDNA sequence, which encodes a putative protein of 1296 amino acids, and displays 39% identity and 60% similarity to the Drosophila PATCHED protein. Hydropathy analysis suggests that human PATCHED is an integral membrane protein with a pattern of hydrophobic and hydrophilic stretches nearly identical to that of Drosophila patched. In the developing mouse embryo, patched is initially detected within the ventral neural tube and later in the somites and limb buds. Expression in the limb buds is restricted to the posterior ectoderm surrounding the zone of polarizing activity. The results show that patched is expressed in target tissues of sonic hedgehog, a murine homolog of Drosophila hedgehog suggesting that patched/hedgehog interactions have been conserved during evolution. Human PATCHED maps to human chromosome 9q22.3, the candidate region for the nevoid basal cell carcinoma syndrome. Patched expression is compatible with the congenital defects observed in the nevoid basal cell carcinoma syndrome.

Amino Acid Sequence↗
PubMed1996

Pudendal nerve recovery after a non-instrumented vaginal delivery.

The aim of the study was to investigate pudendal nerve function after a non-instrumented vaginal delivery. Seventeen primiparae women who had had a non-instrumented vaginal delivery were examined 3-5 days and 3 months after delivery. At both assessments pudendal nerve terminal motor latency (PNTML) was measured. The PNTML was found to decrease significantly from 2.64 ms in the first few days after delivery to 1.95 ms 3 months after delivery (P = 0.00009). PNTML decreased in all but one of the 17 women during the observation period. Immediately after delivery 9 women (53%) had a pathological high PNTML value, which was normalized 3 months later in all but 1. It was concluded that pudendal nerve function is often impaired immediately after a non-instrumented vaginal delivery, but recovers in most women over a 3-month period.

Adult↗
PubMed1996

Effect of octreotide on anal pressure and rectal compliance.

PURPOSE: The somatostatin analog, octreotide, has previously been found to influence rectal sensation and may also influence anal resting pressure. METHODS: We studied the effect of octreotide on anal resting pressure and rectal compliance in eight healthy patients. Octreotide was administered intravenously as a bolus injection in doses of 100 and 10 micrograms or as infusion of 250 micrograms/hour on separate days and compared with placebo. RESULTS: Within one minute after a bolus injection of 100 micrograms of octreotide, anal resting pressure increased from 56 +/- 12 to 96 +/- 16 cm H2O (P < 0.005). Octrotide had no effect on rectal sensitivity or compliance measurements. Octreotide counteracted rectoanal reflex by increasing anal pressure almost to the level found with an empty rectum. CONCLUSION: Somatostatin thus seems to contribute to the regulation of rectoanal reflex.

Adult↗
PubMed1996

Anal and urinary incontinence in women with obstetric anal sphincter rupture.

OBJECTIVE: To assess the long term impact of obstetric anal sphincter rupture on the frequency of anal and urinary incontinence and to identify factors to predict women at risk. DESIGN: An observational study. SETTINGS: Departments of Obstetrics and Gynaecology and of Surgery D, Glostrup County University Hospital, Denmark. PARTICIPANTS: Ninety-four consecutive women who had sustained an obstetric anal sphincter rupture. INTERVENTIONS: Assessment of history, anal manometry, anal sphincter electromyography and pudendal nerve terminal motor latency at three months postpartum A questionnaire regarding anal and urinary incontinence was sent two to four years postpartum. MAIN OUTCOME MEASURES: The frequency of anal and urinary incontinence and risk factors for the development of incontinence. RESULTS: Thirty of 72 women (42%) who responded had anal incontinence two to four years postpartum; 23 (32%) had urinary incontinence and 13 (18%) had both urinary and anal incontinence. Overall, 40 of 72 women (56%) had incontinence symptoms. The occurrence of anal incontinence was associated with pudendal nerve terminal motor latencies of more than 2.0 ms, and the occurrence of urinary incontinence was associated with the degree of rupture, the use of vacuum extraction and previous presence of urinary incontinence. Seventeen women had subsequently undergone a vaginal delivery in relation to which four (24%) had aggravation of anal incontinence, and three (18%) had aggravation of urinary incontinence. Of the women with incontinence, 38% wanted treatment but only a few had sought medical advice. CONCLUSIONS: Obstetric anal sphincter rupture is associated with a risk of approximately 50% for developing either anal or urinary incontinence or both. The prediction of women at risk is difficult. Information and routine follow up of all women with obstetric anal sphincter rupture is mandatory.

Adolescent↗