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Biomedical subjects

P Arhan

Publications and source records attributed to P Arhan.

15 recordsLinked to original sources
PubMed1992

Ureterorectal diversion with rectal augmentation. Morphological and manometric study in the dog.

Uretersigmoidostomy in the adult has progressively been abandoned because of its high complication rate (both metabolic and functional). We have studied the feasibility of a new model of ureterorectal diversion in 12 Beagle dogs, with the aim of increasing rectal capacity and decreasing rectal pressure. A segment of the ileum was isolated and opened along its antimesenteric border to obtain a patch into which the right ureter was implanted, the left ureter being left intact to allow comparison of the kidneys postoperatively. The patch was then sutured to the edges of a large anterior rectotomy. Modifications of rectal physiology were studied by recording the rectal pressure after distension by a latex balloon both preoperatively and 3 months postoperatively, so that it was possible to evaluate the elasticity of the rectal wall. Radiographic studies and examination of autopsy specimens after 3 months yielded the impression of a reservoir added to the rectal space. Intrarectal pressure was significantly decreased (50% of the preoperative value) for a given distension volume following rectal augmentation (P less than 0.01). The elasticity of the rectal wall was not modified but the capacity of the reservoir was increased. The ureteroileal implantation was patent in two of the five evaluable dogs out of seven implantations performed. In these cases, signs of pyelonephritis were found in the right kidneys. In the remaining cases the implantation became obstructed for reasons mainly related to canine anatomy and experimental conditions. These technical difficulties in the dog make it impossible to assess the quality of this reimplantation technique in this model.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

What is the meaning of colorectal transit time measurement?

This study was done to understand the different available methods used to calculate colorectal transit times. A single abdominal radiograph is taken following six successive daily ingestions of the same number of identical radiopaque markers. This method correlates well (P less than 0.001) with that using a single ingestion of markers with daily x-ray films until total expulsion. In techniques used to measure colorectal transit time with multiple ingestion of markers, the number of days of ingestion depends on the kinetics of marker defecation. This was found to differ markedly in various groups of control subjects and constipated patients (P less than 0.001) and can be used to obtain reliable data, even in subjects with severe constipation. When they ingest 20 markers, constipated patients are found to retain eight or more markers three days after ingestion, and taking a plain film of the abdomen on that day is sufficient to make a diagnosis of constipation. Transit time studies are reproducible from month to month in patients with an irritable bowel syndrome. Control subjects who claim that their bowel habits are not modified by stress have shorter transit times, similar in both sexes, than those who say they are (P less than 0.001). This may explain why a large percentage of constipated patients have been found by most authors to have "normal" colorectal transit times. The choice of control subjects is thus a key element in studies of functional bowel motor disorders. Stool frequency and consistency, in health, correlate only to rectosigmoid transit time.

Adult↗
PubMed1991

Achalasia of the esophagus in childhood. Surgical treatment in 35 cases, with special reference to familial cases and glucocorticoid deficiency association.

Achalasia of the esophagus is a relatively rare problem in children, but it may be the cause of severe lung disease, growth retardation and respiratory death in young infants. Surgical esophago-cardio-myotomy remains the treatment of choice, and this article details 25 years of experience with 35 children with achalasia of the esophagus and their late post-operative follow-up. The occurrence of achalasia in the first six months of life, the existence of a familial factor, the prevalent possible association with genetic diseases (familial dysautonomia, glucocorticoid insufficiency, Rozycki syndrome) suggest that achalasia in childhood may in certain cases represent a congenital problem, somewhat different from the adult form, which is considered to be an acquired disease.

Child↗
PubMed1979

[Constipation in the infant (author's transl)].

The authors studied 102 cases of constipation in children. 76 of them went through a protocol of investigations : clinical, psychological, radiological and manometric. The authors suggest that so-called functional constipation is more often organic than is commonly thought.

Adolescent↗
PubMed1979

Traumatic constipation.

In 4 patients, trauma to the lumbosacral area produced abnormalities similar to those seen after resection of the nervi erigentes. Mechanisms of the resulting constipation and fecal incontinence for liquid stools included a prolonged transit time through the entire colon, a low rectal pressure, spasticity of the anal canal, and abnormal anal reflexes. Previous trauma to the lower spine must be considered in the differential diagnosis of chronic constipation.

Adolescent↗
PubMed1978

Viscoelastic properties of the rectal wall in Hirschsprung's disease.

Viscoelastic properties of the rectal wall were compared with Hirschsprung's disease. The elasticity of the rectal wall after accomodation to distension was found to be significantly greater (P less than 0.001) in patients, and the time taken by the rectum to accomodate was also found to be longer (P less than 0.001). The increased elasticity correlated well with severity of the illness, but none of the parameters correlated with length of aganglionic segment. Measuring elastic properties of the rectal wall may help to assess the severity of illness in patients with Hirschsprung's disease.

Adolescent↗
PubMed1978

Some parameters of large bowel motility in normal man.

This study presents normal values of bowel habits, colonic transit times of radioopaque markers, and anorectal pressure obtained from 114 normal subjects. Their stool frequency ranged from 3 to 11 per 7 days, whereas their diet contained an average of 14.4 g of crude fibers. Radioopaque markers progressed regularly along the large bowel and a range of transit times was established for its different segments. Manometric studies included measurements of anal pressure at rest, amplitude and duration of the rectoanal inhibitory reflex, anal inflation reflex, and amplitude of rectal contraction in response to rectal distension. Normal ranges were established. Amplitude, duration and magnitude (as measured by planimetry) of anal relaxation elicited by rectal distensions were related to rectal distending volume (P less than 0.001). The incidence of spontaneous variations of anal pressure at rest and of overshoot of pressure after the inhibitory reflex was also established. These data obtained on normal subjects may be compared to those obtained in patients with constipation in order to define the symptoms and to understand pathophysiological mechanisms. This has been done in a companion study.

Adolescent↗
PubMed1978

Mechanisms of idiopathic constipation: outlet obstruction.

Anorectal myectomy was performed in 62 patients suffering from symptoms attributed to ineffective colonic motility. Indications for surgery rested on the presence of one or more of the following three criteria: abnormally reduced stool frequency, prolonged transit of radioopaque markers, and abnormal anorectal manometry. One year after myectomy in the 50 patients with less than three stools per week the average number of stools per week increased from 1.2 to 4.2 (P less than 0.001). The remaining 12 patients, who had more than three stools per week, were completely relieved of their symptoms. In all cases with improved symptoms, myectomy acclerated the transit of radioopaque markers through the large bowel. Organic constipation amenable to surgical treatment is more frequent than previously thought. Idiopathic constipation may result from colonic inertia or outlet (anorectal) obstruction.

Adolescent↗
PubMed1976

Manometric assessment of continence after surgery for imperforate anus.

Of 49 children with imperforate anus, 23 underwent an abdominoperineal procedure for a high and seven for a low maliformation, 17 had a perineoplasty for a low and two for a high malformation. In each subject, rectal and anal sphincteric resting pressures were studied at least 1 yr after surgery. Of 30 subjects who had undergone an abdominoperineal procedure, eight were continent in contrast to 15 out of 19 patients who had had a perineoplasty (p less than 0.001). In patients who had undergone an abdominoperineal procedure, the rectal motility was of the colonic type, with waves of higher amplitude and lower frequency (p less than 0.01) than in the normal rectum in 23 cases and in most of these, peristalsis was recorded down to the anal margin. Incontinence was most frequently associated with abnormally short anal resistance, low anal pressure, reduced sensibility, weak voluntary contraction and absence of rectoanal inhibitory reflex. In the group of patients who underwent perineoplasty, continence was associated with normal mechanical parameters and normal physiologic behavior of the anal sphincter.

Adolescent↗
PubMed1976

Relationship between viscoelastic properties of the rectum and anal pressure in man.

Viscoelastic properties of the rectal wall and anal sphincter pressure were studied simultaneously in 25 normal children. During rectal distension for 60 s, with varying volumes of air, the rectal pressure varied as the sum of two exponential functions of the time plus an asymptotic constant. A rectoanal inhibitory reflex was elicited during these distensions. The exponential decrease of the rectal pressure corresponded exactly to the return of the upper anal canal pressure to the resting value in some subjects. In others, the upper anal canal remained relaxed as long as the rectal ampulla was distended, except with smaller volumes. The results obtained may be explained by an analogical rheological linear model.

Anal Canal↗