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Biomedical subjects

R Stien

Publications and source records attributed to R Stien.

At least 19 recordsLinked to original sources
PubMed1994

Needle EMG registration of striated urethral wall and pelvic floor muscle activity patterns during cough, Valsalva, abdominal, hip adductor, and gluteal muscle contractions in nulliparous healthy females.

The aim of the present study was to describe co-activity patterns of the striated urethral wall muscle and the pelvic floor muscles (PFM) during contraction of outer pelvic muscles. Six healthy nulliparous physical education students, mean age 19.5 years (19-21) participated in the study. Concentric needle EMG and a Dantec amplifier were used for registrations. EMG activity was continuously recorded with the participants lying in a supine position. EMG was recorded during relaxation, contraction of the PFM, valsalva maneuver, coughing, hip adductor contraction, gluteal muscle contraction, backward tilting of the pelvis, and sit-ups. The procedure was performed with the needle in the striated muscle of the anterior wall of the urethra and then repeated with the needle set lateral to the urethra in the PFM. The results showed that the striated urethral wall muscle was contracted synergistically during PFM, hip adductor, and gluteal muscle contraction, but not during abdominal contraction. Both hip adduction, gluteal muscle, and abdominal muscle contraction gave synergistic contraction of the PFM. Thus the urethral wall striated muscle and the PFM react differently during abdominal contraction.

Adult↗
PubMed1994

The importance of anal endosonography in the evaluation of idiopathic fecal incontinence.

PURPOSE: The aim of the study was to evaluate the use of anal endosonography in idiopathic incontinence. METHODS: In 29 patients and 26 normal controls, the relationship between sonography images and physiologic parameters was studied. RESULTS: External anal sphincter function, measured as fiber density by single-fiber electromyography (P = 0.0001) and pudendal nerve terminal motor latency (P = 0.04), was significantly impaired in patients with idiopathic incontinence compared with controls. Both the external and internal and sphincter could be identified by anal endosonography, and the thickness directly measured. The thickness of the external anal sphincter was significantly negatively correlated to muscle fiber density (r = -0.65, P = 0.002) and to pudendal nerve distal conduction velocity (r = -0.74, P = 0.008). The thickness of the internal anal sphincter was significantly correlated to resting pressure (r = -0.67, P = 0.0001). CONCLUSION: The ratio between the thickness of the external and internal sphincter muscles measured on the sonography screen was significantly reduced in patients with neurogenic incontinence compared with controls (P < 0.01).

Adult↗
PubMed1994

Anal endosonography and physiology in adolescents with corrected low anorectal anomalies.

Sixteen patients aged 12 to 16 years (mean, 14.9) with corrected low anorectal anomalies, and eight age-matched controls were studied. Eight patients were totally continent, six had staining, and two had fecal soiling. Half the patients had trouble with constipation. The grade of incontinence was related to significantly reduced resting and squeeze pressure in the anal canal. Girls had significantly worse results than boys. The anal sphincter muscle complex was visualized by anal endosonography, and images of the external anal sphincter corresponded to the results of the surface electromyography. In addition, anal endosonography provided a detailed picture of all perianal structures including the internal anal sphincter. Anal endosonography supplements other imaging techniques for assessing the perianal structures in patients who have an accessible anal canal.

Adolescent↗
PubMed1994

Clinical and urodynamic assessment of nulliparous young women with and without stress incontinence symptoms: a case-control study.

OBJECTIVE: To assess the prevalence of stress urinary incontinence symptoms in young, nulliparous, physically fit women, evaluate their clinical and urodynamic characteristic, and compare them to a matched asymptomatic control group. METHODS: All first-year physical education students (N = 37) were asked to participate in a four-step study on urinary incontinence. The study included an interview, a clinical examination (incorporating an assessment of pelvic floor muscle strength), ambulatory urodynamics during exercise, and a needle electromyographic assessment of pelvic floor muscles and the striated urethral wall muscle with simultaneous urethral and bladder-pressure measurements. RESULTS: Thirteen (38%) subjects reported stress urinary incontinence symptoms. Eight of the 13 reported the condition to be a social or hygienic problem; six experienced leakage more than once a week. The mean quantity of leakage of the symptomatic women during ambulatory urodynamics was 12 g (range 0-43). No uninhibited detrusor contractions were detected during leakage episodes. Six of seven subjects with symptoms were found to have urodynamic evidence of urethral sphincteric incompetence. There were no differences between the symptomatic and the control group in body mass index, percent body fat, pelvic floor muscle strength, menstrual cycle, and electromyographic patterns. Four of seven women in the symptomatic group had benign hypermobility joint syndrome, whereas there were none in the control group. CONCLUSION: Physically fit nulliparous women have a high prevalence of stress incontinence symptoms and evidence of urethral sphincteric incompetence.

Adolescent↗
PubMed1993

Sperm quality assessed by flow cytometry and accessory sex gland function in spinal cord injured men after repeated vibration-induced ejaculation.

Semen was obtained by vibration-induced ejaculation from 5 spinal injured men once a week for 5 consecutive weeks under standardised conditions. The site of the spinal lesions varied from C5 to Th10. Although in all subjects except one, the total sperm count in the first ejaculate was within normal limits, conventional criteria indicated a high degree of asthenoteratozoospermia in all cases. In subsequent ejaculates there was no major general improvement in motility, vitality or morphology. However, 2 individuals exhibited a marked increase in the proportion of motile sperm in the ejaculate over the next 3 weeks. Flow cytometry of the same sperm samples indicated a high degree of abnormal chromatin condensation and reduced binding of a fluorescent acrosomal marker in the first ejaculates. No improvement in these parameters could be detected with time. Assessment of accessory sex gland function using specific secretory markers indicated that compared to the normal population, the vesicular contribution was markedly reduced in 3 subjects and prostatic contribution in the 2 remaining subjects in the first and subsequent ejaculations. Ejaculate volumes were consistently low in all subjects during the observation period. In contrast, total epididymal secretion was comparable to normal ejaculates. Prostatic contributions to the ejaculate increased significantly over the first 4 weeks. In conclusion, regular vibration-induced ejaculation at weekly intervals could not improve sperm quality in paraplegic men to an acceptable degree for assisted fertilisation to be recommended. Although certain aspects of sperm quality, as judged by conventional criteria, were improved in some cases, flow cytometry revealed persistent chromatin and acrosomal abnormalities.

Adult↗
PubMed1990

Maximal electrical stimulation in the treatment of unstable detrusor and urge incontinence.

Ninety-one patients with unstable detrusor and urge incontinence were treated with maximal electrical stimulation. There were 17 dropouts. From the remaining 74 patients 51 were subjectively cured or significantly improved, this effect lasted for more than 6 weeks in 40. Objectively a significant decrease in frequency was found, also a significant increase in bladder volume. No effect on detrusor pressure at bladder contraction was noted.

Adult↗
PubMed1989

The effect of loperamide on bowel habits and anal sphincter function in patients with ileoanal anastomosis.

The effect of loperamide on stool frequency, volume, and weight and on the function of the internal (IAS) and the external (EAS) anal sphincter was investigated in 19 patients with straight ileoanal anastomosis. Nine patients had intact anal sphincter function (group I), and in the other 10 the function of the anal sphincters was impaired (group II). After 72 h without any medication, the patients were investigated on a standard diet on 2 consecutive days: the 1st day with placebo, and the 2nd day with loperamide (16 mg). Stool collection and anal sphincter manometry/electromyography (EMG) were done on both days. The median number of stools was reduced from 10 and 13.5 to 6 and 7 per 24 h (p less than 0.01), and the fecal weight reduced from 600 and 900 g to 400 and 500 g (p less than 0.01) from the placebo day to the loperamide day in groups I and II, respectively. The tone of the IAS was significantly increased by loperamide in group I but remained unchanged in group II patients. The EAS function, determined by EMG and pressure measurements, was not significantly changed in any group by loperamide.

Adult↗
PubMed1989

Anal sphincter function after colectomy, mucosal proctectomy, and ileoanal anastomosis.

Anal sphincter investigations were performed in 41 patients with straight ileoanal anastomosis and in 10 controls. In 20 patients (group I) the mucosal stripping had been performed from the abdominal side, leaving 1-2 cm of distal anal mucosa. In 21 patients (group II) the anal mucosa had been stripped from the perineal side as far as the dentate line. Continence was perfect in all patients in group I and poor in 6 of 17 patients in group II, when examined 12 months after the operation. Anal canal resting pressure was normal in group I. In group II the resting pressure was significantly decreased and correlated to continence function. The maximum anal canal squeeze pressure was the same in the two groups. The slope of the regression line between pressure rise and integrated electromyography proved to be a useful criterion of the external anal sphincter function and was significantly correlated to degree of incontinence. This variable was significantly smaller in group II patients than in group I and controls. Thus, function of the anal sphincters was normal after mucosal proctectomy performed from above with preservation of a mucosal brim. Dysfunction of the internal and external anal sphincter was found after perineal mucosal dissection and was correlated to continence function.

Adult↗
PubMed1989

Failed ileoanal anastomosis: correlations between clinical function and anal canal neurophysiologic and histologic examinations.

Ten patients with an ileoanal anastomosis had conversion to permanent ileostomy 13 (range, 6-29) months after the primary procedure. Causes for reoperation were incontinence in seven patients, unacceptable stool frequency without incontinence in two patients, and atypia in the mucosal remnant with perfect continence in one patient. Stool frequency, continence function, anal canal resting pressure, external anal sphincter (EAS) EMG/pressure relationship (in terms of slope, m), EAS fiber density (FD), and pressure in the distal ileum were registered, and the mucosa and the anal sphincter muscles were examined histologically. There were significant correlations between continence function and EAS changes in terms of both neurophysiologic tests (m and FD) and the histologic picture. The abnormalities in six incontinent patients were consistent with denervation of the EAS. The main reason for fecal leakage in one patient was the high amplitude of pressure waves in the distal ileum. Preservation of mucosal epithelium proximal to the dentate line per se did not seem essential to maintain continence.

Action Potentials↗
PubMed1987

The treatment of spasticity in multiple sclerosis: a double-blind clinical trial of a new anti-spastic drug tizanidine compared with baclofen.

The anti-spastic effect of a new drug, tizanidine, was compared with that of baclofen in a double-blind clinical trial; 40 seriously handicapped patients with multiple sclerosis (MS) were randomly allocated treatment with one or the other drug for a 6-week period. The antispastic effect was evaluated by clinical criteria. The optimal daily dose of both drugs varied considerably from patient to patient, and was on the average 23 mg for Tizanidin and 59 mg for baclofen. To the extent an antispastic effect was observed, the 2 drugs appeared to be equally effective when given at a 1:2 ratio (mg tizanidine: mg baclofen). Side effects of both drugs were sleepiness, muscular weakness and dry mouth. Tizanidine had a mild depressive effect on blood pressure. Sudden withdrawal of both drugs was accompanied by a transient relative increase of spasticity in approximately half the patients. There were no other changes suggesting physical or psychological dependence. The present study underscores that neither baclofen nor tizanidine are ideal antispastic drugs, and emphasize the need for further research.

Adult↗