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Biomedical subjects

M M Schuster

Publications and source records attributed to M M Schuster.

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

[Psychosomatic aspects of irritable bowel syndrome. Specificity of clinical symptoms, psychopathological features and motor activity of the rectosigmoid].

The clinical symptoms of patients with the irritable bowel syndrome (ICS) frequently do not differ according to present findings from those of patients with lactose malabsorption. To test this observation further in a gastroenterological out-patient clinic, the authors compared the clinical symptoms, psychological features and motor activity in the rectosigmoid in 20 patients with ICS and 21 with lactose malabsorption. It was found that the intestinal symptoms, intestinal motor activity and psychopathology of patients with ICS was nonspecific and occurred equally frequently as those in the malabsorption patients. This casts doubt on the view that psychological factors play a role in the pathogenesis of ICS.

Colon, Sigmoid↗
PubMed1988

Symptoms of psychologic distress associated with irritable bowel syndrome. Comparison of community and medical clinic samples.

Women with symptoms indicative of irritable bowel syndrome who had not consulted a physician were compared with female patients at a gastroenterology clinic to investigate whether self-selection for treatment accounts for psychologic abnormalities in clinic patients' with irritable bowel syndrome. Two sets of diagnostic criteria were compared: restrictive criteria based on the work of Manning and conventional criteria (abdominal pain plus altered bowel habits). Lactose malabsorbers were included as a control group because they have medically explained bowel symptoms similar to those that define irritable bowel syndrome. Thus they control for the causative effects of chronic bowel symptoms on psychologic distress. Women who met restrictive criteria for irritable bowel syndrome but had not consulted a physician had no more symptoms of psychologic distress on the Hopkins Symptom Checklist than asymptomatic controls. However, medical clinic patients with both irritable bowel syndrome and lactose malabsorption had significantly more psychologic symptoms than asymptomatic controls or nonconsulters with the same diagnoses. Individuals who met only the conventional criteria for irritable bowel syndrome reported more psychologic distress than controls, whether or not they consulted a physician. These results suggest that (a) symptoms of psychologic distress are unrelated to irritable bowel syndrome but influence which patients consult a doctor and (b) conventional diagnostic criteria identify more psychologically distressed individuals than do restrictive criteria.

Adolescent↗
PubMed1988

Behavioral treatment of intractable chest pain in a patient with vigorous achalasia.

Chest pain is a major symptom of patients diagnosed with esophageal motility abnormalities. Motility disorders of the esophagus are also associated with elevated scores on measures of somatic anxiety and depression. In spite of this relationship between psychological characteristics and esophageal motility disturbances, few attempts have been made to treat complaints of chest pain in patients with esophageal motility disorders using psychological methods. This report describes the successful use of a behavioral pain management program for the treatment of persistent chest pain in a patient diagnosed with vigorous achalasia who was previously treated with pneumatic dilatation and a long Heller myotomy. This is the first report on the use of psychotherapy in treating chest pain associated with vigorous achalasia, and suggests that, in the etiology and treatment of chest pain in patients with esophageal motility disturbances, psychological influences may be more important than has generally been recognized. No long-term relationship between esophageal motility disturbances and complaints of chest pain was found.

Adult↗
PubMed1987

Pattern-recognition program for analysis of colon myoelectric and pressure data.

A pattern-recognition program was developed which emulates visual scoring of colonic myoelectric and pressure recordings. It smoothes digitized data with a moving average filter, computes difference scores between successive groups of three data points, and uses the signs of these difference scores to detect the beginning and end of waves. Adjacent waves are merged if their means are closer than 1.67 times the sum of their standard deviations, and amplitude and duration criteria are used to exclude nonsignificant waves. When compared to four experienced human scorers on randomly selected records, the program agreed as well with the human scorers as they agreed with each other, and it approached the level of agreement of these observers with themselves when they were asked to rescore the same records blindly four to six weeks later. Human scorers agreed with themselves on 36-71% of myoelectric slow waves and on 42-88% of pressure waves, compared to 100% test-retest reliability for the pattern-recognition program. Frequency histograms of the duration of waves detected by the pattern-recognition program differed from the spectra generated by the fast Fourier transform (FFT) method. This pattern-recognition program provides an alternative to spectral analysis for the reliable and objective quantification of colonic myoelectric slow waves and pressure waves.

Algorithms↗
PubMed1987

Anorectal physiology and pathophysiology.

The anatomy and physiology of the external anal sphincter, puborectalis muscle, internal anal sphincter, and rectum are described. Measurement techniques are reviewed emphasizing those which can be carried out by the gastroenterologist in independent office practice, and the range of normal values for each test is given. A protocol for diagnostic evaluation of anorectal disorders is recommended which includes testing for rectal prolapse and for descent of the perineum by having the patient strain while seated on a commode chair, evaluating the external and internal anal sphincters by recording EMG with an anal plug, or recording pressures with a perfused catheter or balloon probe, using a rectal balloon to evaluate the maximum tolerable volume of rectal distension and the minimum (threshold) volume of a bolus injection which can be subjectively perceived, and arranging with a radiologist to perform a proctogram--a radiograph of the rectum and anal canal during rest and when the patient strains to defecate--in order to evaluate the anorectal angle (puborectalis muscle) and to detect rectocele and intussusception. These objective tests should be supplemented by a careful clinical history and physical examination.

Anal Canal↗
PubMed1986

Dermatoglyphic (fingerprint) evidence for a congenital syndrome of early onset constipation and abdominal pain.

Chronic idiopathic constipation and abdominal pain are the most common gastrointestinal symptoms but their cause is rarely determined; therefore, they usually are called functional. To determine if congenital factors play a role in these disorders, we examined dermatoglyphic (fingerprint) patterns, a congenital marker, in 155 consecutive patients with gastrointestinal complaints. Sixty-four percent of patients with constipation and abdominal pain before age 10 yr had one or more digital arches, compared with 10% of patients without constipation and abdominal pain (p less than 0.001). Seventy percent of constipated patients with arches had the onset of symptoms before age 10 yr compared with 23% of constipated patients without arches (p less than 0.001) and 14% of patients with symptoms other than constipation (p less than 0.001). Compared with an age- and sex-matched sample of patients without arches, patients with arches had a higher prevalence of constipation and abdominal pain before age 10 (p = 0.003), were more likely (p less than 0.001) to have chronic intestinal pseudoobstruction (an organic disorder), and were less likely (p = 0.013) to have irritable bowel syndrome (a functional disorder). Identification of a congenital marker, digital arches, associated with early onset constipation and abdominal pain may help to differentiate a congenital organic syndrome from functional disorders such as the irritable bowel syndrome.

Abdomen↗
PubMed1986

Surgical treatment of Hirschsprung's disease in adults.

A series of eight adult patients with lifelong refractory constipation are presented. All were proved to have Hirschsprung's disease. In some of the patients, the diagnosis was initially determined in childhood. However, the other patients were not found to have this hereditary disorder of the motor function of the colon and rectum until adulthood. The lengths of the terminal aganglionic segments were quite variable, ranging from 2 to more than 25 centimeters. Rectal myectomy alone or in combination with anterior resection proved to be curative and obviated the need for extensive pelvic dissection which otherwise would be hazardous in male patients.

Adolescent↗
PubMed1985

Habit training as treatment of encopresis secondary to chronic constipation.

Fifty-eight encopretic children were placed on a habit training regimen consisting of initial disimpaction followed by attempts to defecate after a specific meal, and use of enemas contingent on failure to defecate for 2 successive days. All patients had gross incontinence of long duration. After an average of less than four visits in 5 months, 83% had an excellent outcome, 60% were completely continent, and 23% had only staining. Patients not achieving continence averaged a 90% decrease in frequency of incontinence. The mean frequency of incontinent episodes decreased from 13.2 to 0.52 per week, while appropriate bowel movements increased from 3.8 to 5.9 per week. At follow-up (average of 3 years), 61% of 43 patients contacted had excellent outcomes, 51% were continent, and 10% had only staining. Patients still incontinent at follow-up averaged 89% fewer episodes than they had prior to treatment. These findings show habit training to be a rapidly effective and long-lasting treatment for encopresis secondary to chronic constipation.

Adolescent↗
PubMed1984

Metronidazole therapy for Crohn's disease and associated fistulae.

Because of reports suggesting the efficacy of metronidazole therapy in the healing of perianal fistulae in Crohn's disease, the effect of metronidazole on symptoms of Crohn's disease and associated perianal fistulae were evaluated in eight consecutive patients. The criterion for entry into the study was the presence of resistant fistulae in patients with Crohn's disease. The duration of intestinal Crohn's ranged from 1/2-30 years and fistulae from 1-14 years. All patients had ileocolitis or pancolitis. Two had enteroenteric fistulae in addition to perianal fistulae. All had had previous surgery, half for fistulae and half for intestinal complications, usually obstruction. All had been on Prednisone. All but one had received multiple other drugs including Azathioprine, Azulfidine, antibiotics, and rectal steroids. Patients were placed on metronidazole 1000 to 1500 mg/day orally in divided doses. The number of draining fistulae was reduced 20-fold and the number of detectable fistulous openings by 50%. All patients had relief of fistula-associated pain; general Crohn's disease symptoms improved as well. Complete resolution of all symptoms occurred in half the patients. All patients experienced side effects, six had numbness of toes and five had metallic taste. Resolution of side effects occurred on discontinuation of metronidazole after 1-3 wk off the drug in all except one patient. All patients noted continued improvement in Crohn's symptoms during 6 months of follow-up after cessation of their therapy. Other side effects that have been reported with metronidazole therapy were not seen in our patients.

Adult↗