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Biomedical subjects

J S Varma

Publications and source records attributed to J S Varma.

At least 55 records · Page 3Linked to original sources
PubMed1988

Neurophysiological dysfunction in young women with intractable constipation.

Fifteen women with intractable chronic idiopathic constipation dating from adolescence were investigated by anorectal manometry, neurophysiological evaluation of the conus medullaris and external anal sphincter. Comparison was made with 25 asymptomatic female control subjects. Urological disturbances were common amongst the constipated, in five of whom incidental lumbosacral spinal dysraphism was found. No differences in sphincter pressures or the rectosphincteric reflex were demonstrable between the two groups. Rectal defecatory sensation was blunted and the compliance was increased in the constipated group. The latency of the pudendo-anal reflex was significantly prolonged in idiopathic constipation, two women having an absent reflex (greater than 100 ms). Mean motor unit potential duration of the external anal sphincter was not significantly prolonged in the eight constipated women tested. A central neurogenic deficit is postulated in some women with this disorder.

Adult↗
PubMed1987

Late results of mucosal proctectomy and colo-anal sleeve anastomosis for chronic irradiation rectal injury.

Ten patients with severe chronic irradiation injury to the rectum were treated by mucosal proctectomy and colo-anal sleeve anastomosis. The indications were: recurrent rectal bleeding (five), stricture (three), fistula (one) and intractable pain (one). Overall follow-up has ranged from 8 to 77 months (mean 40 months). In the present survivors (n = 7) the follow-up ranges from 18 to 77 months (mean 52 months). Six patients have been followed up for more than 3 years and four for more than 5 years. There was no operative mortality. Three anastomotic strictures occurred but the protecting stoma could be closed in all but one patient. Continence was acceptable although urgency and frequency of defaecation were troublesome symptoms. The operation is recommended for life-threatening, haemorrhagic chronic irradiation injury to the rectum.

Adult↗
PubMed1987

Mucosal proctectomy and colo-anal anastomosis for distal ulcerative proctocolitis.

Four patients with long-standing symptomatic ulcerative colitis confined to the left colon and rectum were treated by resection, mucosal proctectomy and colo-anal sleeve anastomosis. There was no operative mortality or anastomotic leakage. Follow-up has ranged from 12 to 66 months (mean 52 months). Loose bowel motions with urgency and frequency of defaecation were troublesome postoperative symptoms. Recurrence of the colitis in the neorectum with extension into the proximal colon occurred in all patients within 3 to 11 months (mean 6 months) of operation. This necessitated total proctocolectomy with ileostomy in three patients (mean 18 months postoperatively). In the fourth patient the recurrence is medically controlled without a stoma more than 5 years after operation. This operation is unsuitable for the treatment of segmental ulcerative proctocolitis.

Adult↗
PubMed1986

Anorectal function following colo-anal sleeve anastomosis for chronic radiation injury to the rectum.

Anorectal manometry and electrophysiological studies of the pelvic floor were performed in eight patients who had undergone anterior resection of the rectum with mucosal proctectomy and colo-anal sleeve anastomosis for radiation rectal injury. There is a severe reduction in the compliance of the neorectum and in the maximal tolerable volume. Maximum basal anal canal pressure and physiological sphincter length are also significantly reduced although the 'squeeze' pressure of the external anal sphincter and the latency of the pudendo-anal reflex were unaffected. Four patients had an absent rectosphincteric reflex, four patients involuntarily expelled the test balloon at the maximal tolerable volume during a proctometrogram and four patients demonstrated increased EMG activity of the pelvic floor on straining and on rectal distension. These abnormalities help to explain many of the patients' symptoms. Histological abnormalities of the myenteric plexus were a prominent feature in all the excised specimens and may be responsible for some of the functional abnormalities.

Aged↗
PubMed1986

Differential effects of sacral anterior root stimulation on anal sphincter and colorectal motility in spinally injured man.

The motility responses of the sigmoid colon, rectum and external anal sphincter to sequential electrical stimulation of the anterior sacral roots (S2, S3 and S4) were studied in five patients with traumatic spinal cord injury. Identical and reproducible results were obtained. S2 stimulation provoked isolated low-pressure colorectal contractions. S3 stimulation initiated high-pressure colorectal motor activity which appeared peristaltic and was enhanced with repetitive stimuli. This response appeared to be frequency-dependent. S4 stimulation increased colonic and rectal tone. External sphincter activity was stimulated in increasing order from S2 to S4. These observations directly elucidate the central control of colorectal motility and may have implications in the treatment of severe constipation following spinal injury.

Adult↗
PubMed1986

Reproducibility of the proctometrogram.

The reproducibility of a method of measuring rectal distensibility by continuous controlled fluid inflation with a balloon has been evaluated in 15 patients. The volume at sensation threshold, constant sensation and maximal tolerance, the pressures at these volumes and rectal compliance were measured. The mean coefficients of variation of the seven variables measured ranged from 4.7%-7.9%. The expected correlation between rectal compliance and maximal tolerable volume was confirmed (r = 0.85, p less than 0.001). The high reproducibility makes this investigation reliable for use in clinical practice and research.

Adolescent↗
PubMed1986

Function of the anal sphincters after chronic radiation injury.

Anorectal manometry was done in 10 men with chronic radiation proctitis and symptoms of urgency, frequency, and occasional incontinence of faeces. They were compared with 10 asymptomatic age and sex-matched controls. The maximum resting anal canal pressure and the physiological sphincter length were significantly lower (p less than 0.01) in the irradiated group. The rectosphincteric reflex was absent in one patient and showed abnormalities of recovery in four others, who had received radiotherapy. The squeeze pressure of the external sphincter was not significantly different. These results indicate that dysfunction of the internal anal sphincter may contribute to patients' anorectal symptoms after pelvic radiotherapy. Histological evidence suggests that damage to the myenteric plexus is mainly responsible. The manometric function of the external sphincter remains relatively unaffected.

Aged↗
PubMed1986

Electrophysiological observations on the human pudendo-anal reflex.

A reproducible electrophysiological technique is described to determine the latency of reflex contraction of the external anal sphincter in response to stimulation of the dorsal genital nerve: the pudendo-anal reflex. This was studied in 38 asymptomatic control subjects and 20 women with neurogenic faecal incontinence, supplemented by determination of the mean motor unit potential duration (MUPD) of the external anal sphincter and anorectal manometry. The reflex latency in the control group was 38.5 +/- 5.8 (SD) ms and appeared to be independent of age or sex. Three patients with faecal incontinence had absent reflexes; the remainder showed significant prolongation of latency (56 +/- 12.2 SD ms) and diminution of amplitude. MUPD was prolonged in incontinence and showed significant correlation with the corresponding reflex latency determination (tau = 0.56, p less than 0.001). The latency of this polysynaptic spinal reflex hence provides a reliable index of neuropathy of the external anal sphincter.

Adult↗
PubMed1985

Correlation of clinical and manometric abnormalities of rectal function following chronic radiation injury.

Continuous fluid-inflation proctometrograms were performed in men with the symptoms of chronic radiation proctitis and in age and sex-matched control subjects (n = 10). Rectal volumes and compliance were measured. There was a significant reduction in the rectal volumes at sensory threshold, constant sensation and maximal tolerance and in rectal compliance (P less than 0.01). Comparable pressure measurements did not demonstrate significant differences. The maximum tolerable volume, symptomatic and sigmoidoscopic scoring correlated to rectal compliance (r = 0.77, -0.8, -0.73; P less than 0.01, less than 0.01, less than 0.02, respectively). Reduction in volume and compliance is often not obvious radiologically. Histological evidence suggests that smooth muscle hypertrophy and myenteric plexus damage are contributory.

Aged↗
PubMed1985

Acute chylous ascites with carcinoid of the pancreas.

Acute chylous ascites is of idiopathic origin in 50 per cent of cases, the remainder being accounted for by trauma and intestinal obstruction. It usually presents with acute abdominal pain. Neoplastic disease is much more common in chronic cases, and lymphomas comprise about half of these. Chronic chylous ascites usually presents without pain but with inanition and hypoproteinaemia. This report describes acute chylous ascites following trauma in a patient who was subsequently found to have a pancreatic carcinoid, the lymphangiographic findings being of particular interest.

Abdominal Injuries↗
PubMed1984

Anorectal profilometry with the microtransducer.

The reproducibility of anal sphincter manometry has been evaluated in 17 patients with a continuous pull-through technique using a miniature transducer mounted on a 2mm diameter Dacron catheter. Comparison was made with a conventional station pull-through technique using a 4mm diameter waterfilled microballoon connected to an external transducer. Parameters measured with the microtransducer (maximum resting pressure, squeeze pressure, functional sphincter length, area under high pressure zone, amplitude of rectosphincteric reflex) showed mean coefficients of variation from 3.2 to 5.7 per cent. Pressures measured with the microballoon were uniformly higher than those obtained with the microtransducer. The functional sphincter length was significantly shorter when measured with the microballoon (P less than 0.001). The microtransducer provides a highly accurate and reproducible method of anorectal profilometry that avoids many of the drawbacks associated with fluid-filled systems.

Anal Canal↗
PubMed1984

A randomized trial of 48 hours of prophylactic cefotaxime versus single dose in transurethral prostatic surgery.

A previous randomized trial from this department demonstrated that there was significant reduction in morbidity and post-operative bacteriuria when men undergoing transurethral prostatectomy were given a prophylactic perioperative regimen of 48 h of cefotaxime compared with a no treatment control group. In this paper we report the results of a new randomized trial to determine whether a single dose of cefotaxime given with the induction of anaesthesia would be of equal efficacy to the previous 48 h regimen. We also investigated the ward bacterial flora for cefotaxime resistance before and during the trial. The 48 h regimen was significantly superior to the single dose in terms of the number of men who developed post operative complications and there was also a small but significant reduction in post-operative hospital stay. Forty-eight hours of prophylaxis covers the normal time of post-operative urethral catheterization and this may explain our findings. There was no evidence of emergence of cefotaxime resistant strains.

Bacteriuria↗