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At least 469 records · Page 26Linked to original sources
PubMed1992

Anal endosonography: relationship with anal manometry and neurophysiologic tests.

Thirty-seven patients were referred for evaluation of anal function; their clinical diagnoses were traumatic fecal incontinence (13), idiopathic (pudendal neuropathy) fecal incontinence (7), fecal soiling (9), and other (8). In all patients, anal endosonography (sphincter defects and internal sphincter thickness [IST]) and anal manometry (maximal basal pressure [MBP] and maximal squeeze pressure [MSP]) were performed. In 18 patients, neurophysiologic tests (EMG-maximal contraction pattern [MCP], single-fiber EMG [fiber density; FD], and pudendal nerve terminal motor latency [PNTML]) were also performed. Endosonography demonstrated in seven patients both an internal and external sphincter defect (Group 1), in seven patients an internal sphincter defect and in one patient an external sphincter defect (Group 2), and in 22 patients no sphincter defect (Group 3). There was a significant difference among these three groups for MBP and MCP, the lowest being in Group 1. Between the patients with traumatic fecal incontinence and idiopathic fecal incontinence, no differences in IST, MBP, MSP, MCP, FD, and PNTML were found. In two patients with a suspected obstetric trauma, there was an unexpected additional severe pudendal neuropathy. In one patient with a suspected obstetric trauma, no damage of the anal sphincters could be demonstrated. In one patient with suspected idiopathic fecal incontinence, there was an additional, unsuspected defect of the internal sphincter. There was concordance between endosonography and EMG in the mapping of the external sphincter. Clinical diagnoses can be misleading in differentiating between traumatic and idiopathic fecal incontinence; anal endosonography provides unsuspected and additional information about the sphincters; PNTML can reveal unsuspected neuropathy in traumatic fecal incontinence. Therefore, the combination of endosonography and PNTML is promising in selecting patients for surgery.

Adolescent↗
PubMed1989

Age and sex and anorectal manometry in incontinence.

Although the prevalence of fecal incontinence is greater in women compared with men and in elderly subjects compared with younger subjects, data regarding the influence of age and sex on anorectal performance in continent and incontinent patients are conflicting. The authors, therefore, investigated age- and gender-related changes in anal resting and squeeze pressure as well as in sphincter relaxation after rectal balloon distention in 75 patients with fecal incontinence of different pathogenesis and in 99 continent patients by multichannel anorectal manometry. As a group, incontinent patients usually exhibit lower pressure profiles than do continent patients regardless of age and gender; however, both the resting pressure of the internal anal sphincter and the voluntary contractile pressure of the external anal sphincter are decreased with age, and both are lowered in women compared with men. Sphincter relaxation and perception of gastrointestinal events are not altered in incontinent patients, and they are not different between men and women or between elderly and younger patients.

Adult↗
PubMed1987

Radiopaque markers transit and anorectal manometry in 16 patients with multiple sclerosis and urinary bladder dysfunction.

Fecal incontinence and/or constipation are frequent complaints in multiple sclerosis associated with urinary bladder dysfunction, incontinence, and/or retention. Total and segmental colonic transit were studied by determination of radiopaque markers, and anorectal function by anorectal manometry, in 16 multiple sclerosis patients clinically defined (with urinary bladder dysfunction shown by urodynamic examination). Fifteen multiple sclerosis patients had constipation and 14 had increased colonic transit time; ten multiple sclerosis patients had fecal incontinence and five had spontaneous rectal contractions. It is suggested that increased colonic transit and anorectal dysfunction were secondary to neurologic disorders just as urinary bladder dysfunction is due to neurologic disorders in multiple sclerosis.

Adult↗
PubMed1996

Endoscopic manometry of the sphincter of Oddi and pancreatic duct in patients with chronic pancreatitis.

CONCLUSION: Endoscopic manometry in patients with chronic pancreatitis has demonstrated some manometric abnormalities in the sphincter of Oddi, but these abnormalities have no significant role in the pathogenesis of chronic pancreatitis. BACKGROUND: The study was undertaken to determine whether the sphincter of Oddi dysfunction plays a significant role in the pathogenesis of chronic pancreatitis. METHODS: Manometric investigation was performed in 32 patients with chronic pancreatitis. Twenty-three of them had alcohol-induced chronic pancreatitis, seven had biliary pancreatitis, and two patients had annular pancreas with chronic pancreatitis. Fifteen of them had dilated main pancreatic duct. Twenty-one cholecystectomized patients with no abnormality of the pancreas and biliary system served as controls. RESULTS: This study showed no significant difference in the mean pressures in the pancreatic duct, sphincter of Oddi (basal and phasic), and frequency of the sphincter of Oddi phasic contractions when comparing patients and controls. Sphincter of Oddi basal pressure (26-44 mmHg) was markedly increased in seven patients, whereas three patients (two of them had increased sphincter of Oddi basal pressure) had increased pancreatic duct pressure (20-24 mmHg). Increased numbers of retrograde contractions were found in seven patients.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2005

Effect of modified Sinisan on anorectal manometry of the constipation predominant type of irritable bowel syndrome.

OBJECTIVE: To explore the mechanism in patients with irritable bowel syndrome (IBS) of the constipation predominant type and observe the therapeutic effects of Sinisan (SNS). METHODS: Forty-seven IBS patients with the constipation predominant type were randomly divided into the treated group (n = 24) and the control group (n = 23). Another group of 22 healthy subjects was set up for healthy control. The treated group was treated with modified SNS, and the control group was treated with Cisapride, the therapeutic course for both groups was 8 weeks. The changes of symptom scoring and anorectal manometry (the anorectal resting pressure, anal tract systolic pressure, anal tract diastolic pressure, rectal threshold feeling, maximal tolerance volume of rectum, and rectum compliance) of these two groups were recorded respectively and compared with each other. RESULTS: Compared with the healthy control group, the rectal threshold feeling, maximal tolerance volume of rectum and rectal compliance of the treated groups got reduced significantly before treatment (P < 0.05). After treatment, the symptom scoring, rectal threshold feeling and maximal tolerance volume of rectum were improved in both groups (P < 0.05), and the improvement of the treated group was more significant than that of the control group (P < 0.01). The total effective rate and recurrence rate of the treated group were superior to those of the control group significantly (P < 0.05, P < 0.01). CONCLUSION: SNS has good effect on IBS of the constipation predominant type.

Adult↗
PubMed2001

A computerized vector manometry and MRI study in children following posterior sagittal anorectoplasty.

The study was designed to evaluate computerized eight-channel vector manometry (8CVM) and pelvic floor magnetic resonance imaging (MRI) as methods to assess the anal sphincter following posterior sagittal anorectoplasty (PSARP) for anorectal malformations, in particular the functional capacity of the sphincter structures in correlation with postoperative MRI findings. Seventeen children had been operated upon for a rectovesical, -urethral, or -vaginal fistula including one female cloacal malformation; 4 had a secondary PSARP. Mean follow-up was 5.57 years. Continence was evaluated with a modified Kelly score. A CVM technique with an eight-channel perfusion catheter was used. In addition to software-supported data, the manometric parameters included a score-system assessing three different pressure zones of the anal canal qualitatively on the three-dimensional image of the anal sphincter profile. The same procedure was performed on sagittal, oblique axial, and oblique coronal MRI. Furthermore, the thickness of the sphincter muscle was assessed at the level of the maximal mean segmental pressure. All children had decreased absolute vector-volumetry values at rest and on squeezing. Correlation with the clinical score was poor. Correlation of the manometric score with the clinical course was similar to the correlation of MRI score with clinical course (R = 0.425; P = 0.1). Thirteen children demonstrated normal or increased sphincter length; 5 of these had a decreased high-pressure zone (HPZ). The position of the anorectum in the sphincter muscles could be evaluated by the vector-volumetry image as anatomic in 11 cases, nearly correctly positioned in 4, and ectopic in 1 child. MRI detected 2 cases of malposition, 10 anatomic, and 4 nearly-anatomic findings. Correlation of the manometric score with the MRI score and the thickness of the sphincter muscle at the HPZ was significantly high (R = 0.801; P < 0.0001). 8CVM is thus highly sufficient in illustrating the function of the sphincter musculature seen on pelvic floor MRI. Both methods only moderately reflect clinical follow-up, since continence depends on more than sphincter ability.

Anal Canal↗
PubMed2003

Pharyngoesophageal manometry with an original balloon sensor probe for the study of oropharyngeal dysphagia.

The goal of our study was to verify the clinical applicability of an original balloon sensor probe for the manofluorographic study of oropharyngeal dysphagia. A prototype apparatus for manofluorography was developed and a standard perfused probe for esophageal manometry was modified by applying fluid-filled floppy balloons 0.5-, 1-, and 2.5-cm long. A group of healthy volunteers and a group of patients affected by oropharyngeal dysphagia underwent manofluorography. Statistically significant differences were calculated between the groups with regard to the upper esophageal sphincter (UES) basal and postrelaxation contraction pressures (p<0.05, Student's t test, 2.5- vs. 1-cm-long balloon sensors). In the group of patients versus the group of healthy volunteers, statistically significant differences were calculated with regard to pharyngeal intrabolus pressure, UES residual and UES postrelaxation contraction pressures, and mean diameter of the UES during maximal opening (p<0.05, Student's t test). A strong negative correlation (r=-0.92, p=0.001; r=-0.93, p=0.006 linear regression analysis) was observed between intrabolus pressure and UES diameter during maximum opening in the group of patients. The balloon probe demonstrated its reliability and clinical adequacy for the study of swallowing disorders.

Adult↗
PubMed1998

Endoscopic manometry of the sphincter of Oddi in patients with Lemmel's syndrome.

Endoscopic manometry was performed to evaluate the motor activity of the sphincter of Oddi (OS) in six patients with Lemmel's syndrome, four of whom had acute cholangitis and two of whom had acute pancreatitis. As controls, 24 patients undergoing cholecystectomy without juxtapapillary duodenal diverticula (JPD) for cholelithiasis or cholesterol polyps in the gallbladder were also studied. The OS basal pressure and contraction pressure values were 12.4 +/- 5.1 mmHg and 103.4 +/- 24.3 mmHg, respectively, in the patients with Lemmel's syndrome, and 19.5 +/- 5.1 mmHg and 136.8 +/- 28.2 mmHg, respectively, in the control patients. These differences between the groups were statistically significant; however, the wave frequency was not significantly different between the groups. The mean percentages of antegrade, simultaneous, and retrograde sequences were 37.5% +/- 11.3%, 19.9% +/- 8.7%, and 43.4% +/- 11.7%, respectively, in the patients with Lemmel's syndrome, and 66.5% +/- 11.0%, 20.2% +/- 4.7%, and 14.3% +/- 9.2%, respectively, in the controls. The differences between the groups were significant (P < 0.01) for the antegrade and retrograde sequences. These findings indicate that dysfunction of the OS in patients with Lemmel's syndrome could be important in the development of hepatocholangiopancreatic disease caused by duodenobiliary and duodenopancreatic reflux.

Acute Disease↗
PubMed2005

Anorectal manometry: are fatigue rate and fatigue rate index of any clinical importance?

BACKGROUND: Loss of voluntary contraction of the external anal sphincter is thought to be a factor in fecal incontinence. During anal manometry, computerized systems produce several parameters including fatigue rate (FR), which is the basis for calculating the fatigue rate index (FRI). Our aim was to evaluate FR and FRI and their clinical importance in patients suffering from fecal incontinence or severe constipation. MATERIALS AND METHODS: All patients scheduled for an anal physiology work-up were included in the study. FR was determined by a computer program and FRI was calculated manually with the following equation: FRI (minutes) = [squeeze pressure (mm Hg) - resting pressure (mmHg)] / - FR (mmHg/min). FR and FRI were compared in patients suffering from fecal incontinence (group I) and severe constipation (group II). Furthermore, subgroups (<50 and > or = 50 years of age) were compared. Lastly, a possible relation between length of the high-pressure zone (HPZ) and FR and FRI was assessed. RESULTS: Between January 2000 and December 2004, 131 patients (96 with fecal incontinence, 35 with constipation) were studied. Both FR and FRI were similar between groups I and II; no significant differences were found when younger and older patients were compared within the same group. We also did not find any relation between HPZ length and either FR or FRI. CONCLUSIONS: FR and FRI do not seem to be helpful in routine colorectal practice for evaluating the strength of the external anal sphincter.

Adult↗
PubMed2005

Is sphincter of Oddi manometry a risk factor for pancreatitis? A different view.

Studies suggest a causal relationship between sphincter of Oddi manometry (SOM) and acute pancreatitis, presumably due to water instillation in the ductal system. In this article, critical analysis of the existing studies attributes the high risk of acute pancreatitis with SOM to "association due to confounding" rather than to "causation." This conclusion is based on two pieces of evidence: The first is lack of biologic plausibility: Biologic evidence is lacking to support the hypothesis that water instillation during SOM can induce acute pancreatitis. The second is confounding evidence: Manometric studies show considerable variation in the risk of post-procedure pancreatitis (4% to 30%), which suggests that other important factors besides SOM influence the adverse outcome. These studies did not control for other variables, which are well known to predispose to pancreatitis and therefore may act as confounding factors. Two studies that assessed the independent role of SOM in causation of acute pancreatitis showed that SOM is not an independent predictor of acute pancreatitis. It is the underlying disorder sphincter of Oddi dysfunction, and not the "SOM" procedure, that predisposes patients to post-procedure acute pancreatitis.

Acute Disease↗
PubMed1983

Esophageal manometry in systemic amyloidosis. A study of 30 patients.

The motility of the esophagus was studied by esophageal manometry in 24 patients with primary amyloidosis and six with secondary amyloidosis. Resting lower esophageal sphincter pressure was decreased in 12 patients with primary amyloidosis and two with secondary amyloidosis; 12 of these 14 patients complained of heartburn. Abnormalities in the motility of the body of the esophagus were found in nine patients with primary amyloidosis and one with secondary amyloidosis. No abnormality of the upper esophageal sphincter was demonstrated in any of the 30 patients. Six of the nine patients with primary amyloidosis exhibiting the most marked esophageal motor dysfunction had striking evidence of peripheral and/or autonomic nervous system involvement. No consistent pattern of motility disorder was observed in either group. The manometric abnormalities observed are consistent with a random deposition of amyloid in the esophagus involving a myopathic and/or neuropathic component.

Adult↗
PubMed1988

Comparison of intraocular pressure measurements with the Oculab Tono-Pen vs manometry in humans shortly after death.

We compared the Oculab Tono-Pen, a miniaturized Mackay-Marg tonometer, with a Statham membrane manometer in six humans (12 eyes), three to six hours after death. The intraocular pressure was changed in 5- to 10-mm Hg steps in a range between 0 and 60 mm Hg by an infusion system. The correlation coefficient of the relation of Tono-Pen readings vs manometrically determined intraocular pressures was .99. Compared to the manometer, the Tono-Pen gave a small underestimation of intraocular pressure above 17 mm Hg or overestimation below 17 mm Hg. The maximal deviation of the Tono-Pen readings from the manometer readings was 2.5 mm Hg. In our experience the correspondence between Tono-Pen and manometer readings was superior to the correspondence between the readings obtained with the original Mackay-Marg tonometer and manometry.

Aged↗
PubMed1975

Evaluation of the Nissen antireflux procedure by esophageal manometry and twenty-four hour pH monitoring.

Fifteen normal volunteers without symptoms of gastroesophageal reflux and sixteen patients with symptoms of gastroesophageal reflux unresponsive to medical management and having endoscopic esophagitis had esophageal manometry and twenty-four hour pH monitoring of the distal esophagus. The symptomatic patients underwent a Nissen antireflux procedure and were restudied at four months. After surgery, patients had less reflux, a higher sphincteric pressure, and an equal amount of sphincter within the abdomen as did asymptomatic control subjects.

Deglutition Disorders↗
PubMed1975

Renal artery stenosis: a complication of needle puncture for manometry. Case of subintimal dissection with spontaneous resolution.

After aortorenal bypass for renovascular hypertension secondary to atherosclerosis of the renal artery of a solitary left kidney a high-grade stenosing lesion developed distal to the site of insertion of a Dacron graft. In the immediate postoperative period the blood pressure was restored to normal, but one week later hypertension recurred. An arteriogram disclosed an area of stenosis 1 cm distal to the site of insertion of the graft in the renal artery. During the next year, serial arteriograms were made, renal function remained normal, and hypertension gradually abated. One year after the discovery of the postbypass stenosis, an arteriogram showed disappearance of the constricting lesion. The postoperative stenosis was, in all probability, caused by subintimal dissection secondary to needle puncture for strain gauge manometry.

Arteriosclerosis↗
PubMed1984

Pancreas divisum and its association with choledochal sphincter stenosis. Diagnosis by endoscopic retrograde cholangiopancreatography and endoscopic biliary manometry.

Choledochal sphincter stenosis was demonstrated in 37 of 90 patients with pancreas divisum. In 21 of the patients, stenosis was diagnosed during ERCP by endoscopic calibration of the choledochal sphincter, delayed drainage of contrast material from the bile duct, or a dilated common duct with or without elevation of the serum alkaline phosphatase level. In 12 patients, stenosis was diagnosed during endoscopic manometry with the demonstration of elevated basal choledochal sphincter pressures. Stenosis was initially diagnosed during surgery in four patients. Common duct diameters were normal in all patients who had not had cholecystectomy. Choledochal sphincter stenosis was confirmed in all patients who subsequently underwent sphincteroplasty. The surgical approach to patients with pancreas divisum and intractable obstructive pain should include sphincteroplasty of both the major and minor sphincters rather than the minor sphincter alone.

Adolescent↗
PubMed1992

Esophageal manometry and 24-hour pH monitoring in the diagnosis of pulmonary aspiration secondary to gastroesophageal reflux.

Twenty-three consecutive patients who had persistent respiratory symptoms of unexplained etiology were evaluated to determine the presence of gastroesophageal reflux (GER) and its relationship to their respiratory complaints. Lower esophageal sphincter (LES) and upper esophageal sphincter (UES) pressures and the characteristics of the peristaltic waves in the proximal and distal esophagus were determined. Esophageal acid exposure 5 cm and 20 cm above the LES was measured using a pH probe with two antimony sensors. Aspiration was diagnosed when respiratory symptoms occurred during or within 3 minutes after a reflux episode, recorded at both levels of the esophagus. Based on these criteria, 12 patients were considered nonaspirators (group A), and 11 were categorized as aspirators (group B). Aspirators had: (1) lower LES pressure (6.1 +/- 3.1 versus 12 +/- 4.8 mm Hg, p less than 0.01); (2) decreased amplitude of peristalsis in the proximal esophagus (34 +/- 16 versus 59 +/- 21 mm Hg, p less than 0.01) and distal esophagus (46 +/- 25 versus 91 +/- 28 mm Hg, p less than 0.01), and higher incidence of simultaneous, nonperistaltic waves (30% versus 4%); and (3) lower UES pressure (44 +/- 23 versus 74 +/- 38 mm Hg). Impaired peristalsis in aspirators caused a higher acid exposure (11.4% +/- 8.0% versus 1.0% +/- 0.7% of time pH less than 4, p less than 0.01) and delayed clearance (5.5 +/- 6.5 versus 0.7 +/- 0.4 min) in the proximal esophagus. Our study shows that, in patients with respiratory symptoms of unexplained etiology, esophageal manometry and 24-hour pH monitoring will identify a subgroup of true aspirators. These patients suffer from a panesophageal motor dysfunction that affects all three barriers to aspiration: the LES, the esophageal "pump mechanism," and the UES.

Adult↗
PubMed1993

Electrical stimulation of the sacral dermatomes in spinal cord injury: effect on rectal manometry and bowel emptying.

The impairment in defecation function that comes as a result of spinal cord injury may have a significant negative impact upon quality of life. Electrical stimulation (ES) of the somatic nervous system has been used to elicit autonomic reflexes in animals, before and after spinal cord transection. To determine whether ES might be used to promote bowel emptying, seven persons with recent spinal cord injury (SCI) and seven control subjects were studied. Electrical stimulation of the second sacral dermatome was applied during rectal manometry in both groups, and ES was added to the bowel programs of SCI patients. A significant rise in the number of rectal pressure spikes was noted in both groups after application of ES (p < .002, f = 6.34). There was no significant differences between the SCI and control groups when measuring the amplitude of spike waves in the colon. No significant change was noted in the time required for SCI patients to initiate a bowel movement, or in the time required to complete bowel emptying. Electrical stimulation of the sacral dermatomes can result in a change in the bowel activity of the recto-sigmoid colon. To date, no clinical effect on bowel emptying has been demonstrated.

Colon↗