Another use of the laser: a new treatment for open-angle glaucoma.
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Biomedical subjects
Publications and source records attributed to M M Henry.
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We have studied 20 patients with the descending perineum syndrome, half of whom were incontinent of faeces. Objective criteria were established in 103 control subjects for determining the relationship of the perineum to the bony pelvis. The anal reflex latency was increased in the 10 patients in whom perineal descent was associated with faecal incontinence, but not in the 10 without incontinence. However, there was hypertrophy of the muscle fibers in external anal sphincter muscle biopsies in all the patients. Thus, abnormal degrees of perineal descent are associated with changes in the external anal sphincter muscle, consistent with damage to its nerve supply.
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We have recorded the latency of the anal reflex, using a simple electrophysiological method, in 22 patients with anorectal incontinence and in 33 control subjects without anorectal disease. The mean latency in the control subjects was 8.3 ms (range 5-11.3 ms). In the patients with faecal incontinence the mean latency of the anal reflex was 13.0 ms (range 6.5-22.0 ms). The reflex latency was within the normal range in only three incontinent patients. These findings support our concept, based on histological examination of the external anal sphincter musculature, that a major cause of this syndrome is denervation of these muscles due to damage to the innervation of the external anal sphincter and puborectalis muscles.
The records of 74 patients who had loop colostomies closed at Addenbrooke's Hospital between 1970 and 1975 were studied retrospectively. One death from a pulmonary embolus occurred and the incidence of fistula from the site of closure was found to be 5.4 per cent. A number of differing factors were assessed. Closure 6 weeks after the colostomy's formation and preoperative antibiotic (antimicrobial) bowel preparation appeared to be factors associated with a favourable outcome. On the other hand, an initial operation for carcinoma and closure less than 6 weeks after the colostomy's formation were factors related to a less favourable outcome.
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An apparent increase in incidence of chronic cystic maculopathy following cataract surgery in our patients prompted an analysis of changes in surgical procedure. The important change was in the increased amount and duration of exposure to the operating lights. Previous animal research by various authors suggested to us the precipitating factor was a photic maculopathy. Various methods of avoiding excessive exposure of the patient's eye to the operating lights are discussed.
A case is described of heterotopic brain tissue with simultaneous occurrence of melanotic neuroectodermal tumor in the oropharynx of a 6-week-old infant. The melanotic neuroectodermal tumor was embedded within the heterotopic glial tissue. This coexistence leads us to speculate that a defect causing a pinching-off of both neural crest cap and medullary epithelium of neural tube might have taken place at, or before, the 25-30 somite stage. The displaced embryonic structures subsequently differentiated into glial tissue, choroid plexus, and melanotic neuroectodermal tumor. This observation may be interpreted as further support in favor of a neural crest origin of juvenile melanotic neuroectodermal tumor.
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