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At least 1,009 records · Page 56Linked to original sources
PubMed1999

A novel colon pouch and its comparison with a straight coloanal and colon J-pouch--anal anastomosis: preliminary results in pigs.

BACKGROUND: Early functional results after complete rectal resection and straight coloanal anastomosis are often characterized by frequent bowel movements, urgency, and varying degrees of stool incontinence. The formation of a colon reservoir improves early and long-term function. We evaluated the feasibility of a novel, modified design of a colon pouch--anal anastomosis in pigs and compared the results with those of pigs with straight coloanal anastomosis and colon J-pouch. METHODS: Complete rectal resection followed by either a straight coloanal anastomosis, a colon J-pouch, or a novel design of a colon pouch was performed in equal numbers in 15 pigs. By transversely closing a longitudinal colotomy, the new, technically simpler pouch is formed. Functional results were assessed during a period of 6 weeks. RESULTS: All 15 procedures were successful. The novel colon pouch required less surgical time than the colon J-pouch, and the formation of the pouches did not reduce tissue perfusion as assessed by laser Doppler flowmetry. The mean volume of the novel colon pouch was significantly smaller than the volume of the colon J-pouch. All the pigs with the novel colon pouch had normal stool frequency and consistency during a period of 6 weeks. In the group with straight coloanal anastomosis, two pigs had increased frequency of defecation, one pig showed signs of urgency and perianal dermatitis, and three had substantially reduced stool consistency. Of the four pigs with colon J-pouch, three had signs of impaired pouch evacuation and two had reduced stool frequency. CONCLUSIONS: The novel colon pouch is feasible in pigs and technically simpler than the colon J-pouch. These preliminary results indicate that the smaller capacity of this pouch seems sufficient for normal defecation. Its short-term functional results were better than those after reconstruction with a colon J-pouch or a straight coloanal anastomosis.

Anal Canal↗
PubMed2004

Colonic pacing: a therapeutic option for the treatment of constipation due to total colonic inertia.

HYPOTHESIS: The treatment of constipation caused by total colonic inertia is problematic and its results are unsatisfactory. We speculated that colonic pacing would initiate electric activity in the inertial colon and effect rectal evacuation. METHODS: Nine patients with constipation due to total colonic inertia (age range, 39-52 years; 7 women, 2 men) were enrolled in the study. One pacing electrode was applied to each of the 4 potential colonic pacemaker sites, and 2 to 3 temporary recording electrodes were applied distally. A stimulator was embedded subcutaneously in the inguinal area. Home pacing was practiced after patients were trained; the recording electrodes were removed before home pacing was started. RESULTS: Colonic pacing evoked electric waves, which effected defecation in 6 of the 9 patients. Three of these 6 patients had spontaneous defecation after a few months of pacing, and their electrodes and stimulators were removed. In the other 3 of these 6 patients, the pacemakers are still in place and continue to effect rectal evacuation. Colonic pacing did not produce rectal evacuation in 3 patients and is believed to have failed because of an advanced stage of colonic inertia. CONCLUSION: Colonic pacing induced rectal evacuation in 66.6% of the patients with total colonic inertia. No complications were encountered. We suggest that colonic pacing be considered as a new therapeutic option in the treatment of total colonic inertia.

Adult↗
PubMed1999

Seed handling in chimpanzees (Pan troglodytes) and redtail monkeys (Cercopithecus ascanius): implications for understanding hominoid and cercopithecine fruit-processing strategies and seed dispersal.

Primates are confronted with an array of constraints in feeding on fruit, including the removal of adhesive, energy-rich pulp from seeds. In this paper, I discuss how primates meet this challenge and present data on the fruit-processing and seed-handling behavior of chimpanzees and redtail monkeys in Kibale National Park, Uganda. These data are then related to these species' services as seed dispersers. Particular attention was paid to the methods by which primates removed pulp from seeds, the density of seed clumps that they deposited (by spitting, dropping, or defecating) to the forest floor, and the distance seeds were moved from parent trees. Distance and density differences in chimpanzee and redtail seed dispersal resulted from distinct fruit-processing and seed-handling methods. It was observed, in general, that redtail monkeys engaged in fine oral processing and were seed spitters: most seeds were dispersed in close proximity to parent trees (84% of spat seeds < 10 m of parent tree), and deposited singly (100% seeds spat singly). In contrast, chimpanzees were coarse fruit processors and seed swallowers: seeds were defecated in denser clumps (e.g., a mean of 149 large seeds/dung sample and hundreds of small seeds/dung sample), far from parent trees. I evaluate the factors that shape patterns of fruit processing in hominoids and cercopithecines, and argue that the observed seed handling differences can be attributed to differences in digestive retention times, oral anatomy, and alternative mechanisms by which to avoid the cost of seed ballast.

Animals↗
PubMed1998

Variation in seed handling by two species of forest monkeys in Rwanda.

We examined temporal variability in the handling and dispersal of seeds by two sympatric species of monkeys, the arboreal blue monkey (Cercopithecus mitis doggetti) and the more terrestrial mountain monkey (C.l'hoesti). Ten months of data on phenological patterns and foraging behavior, including details of seed handling based on scan sampling data, were combined with dung sample data to examine patterns of seed handling. The systematic scan sampling observations showed that blue monkeys and mountain monkeys alternated between acting predominately as seed droppers, seed predators, and seed defecators depending on fruit resource availability. All the mountain monkey dung samples examined contained intact seeds, and 94% of the blue monkey dung samples contained intact seeds. Both monkey species defecated a greater number of seeds per dung sample and larger-sized seeds than found elsewhere for Cercopithecus monkeys. We found a mean of 2.33 and 6.43 seeds > 2 mm in blue and mountain monkey dung samples, respectively. The mountain monkeys dispersed relatively higher numbers of seeds and frequented open, disturbed forest, suggesting that terrestrial forest monkeys have been overlooked as potentially important seed dispersal agents. The variability in the ways seeds were handled was dependent on the array of available food resources and may suggest that the monkeys exert weak selective pressures on fruit traits.

Animals↗
PubMed1998

Diurnal variation on the excretion patterns of fecal steroids in common marmoset (Callithrix jacchus) females.

The use of fecal steroid analysis to assess gonadal and adrenal function in primates has rapidly increased in recent years due to the ability to collect feces from nonhuman primates living in wild conditions. These techniques offer an exciting new potential for enhancing our knowledge of the endocrine status of free-living animals. Prior to using these techniques under field conditions, it is important to determine the diurnal variation of fecal excreted steroids for assessing possible time limitations on fecal collections. The following study investigates the diurnal frequency of defecation and patterns of steroid levels excreted in feces from four female common marmosets, Callithrix jacchus, living in a family group. These females represented three reproductive conditions: early pregnancy, ovarian cycling, and noncycling (postpubertal). Cortisol, estradiol, and progesterone were extracted and analyzed by enzyme immunoassay. Diurnal variations in steroid levels were found by ANOVA for cortisol and progesterone but not for estradiol. Significantly higher levels of cortisol were found in the afternoon, while the reverse was found for progesterone. All females showed the same pattern of steroid level change, except for cortisol in the pregnant female. Since all females defecated within the first hour after they awoke in the morning, this time was determined to be the most effective time to collect feces. The consistency of our findings reinforces the usefulness of this approach for studying reproductive and adrenocortical function in marmosets and also indicates that fecal collection should be limited to either morning or afternoon collections.

Adrenal Cortex↗
PubMed1979

Long-term effects of preweaning taurine injections in rats: interactions with strain and gender.

A comparison was made of MR, MNR, and RCA strains that had been injected with either 62.5 mg/kg of taurine or comparable volumes of physiological saline between postnatal Days 8 and 20 and later tested at 100 days of age in an open field and 1-way shock avoidance situations. Taurine-injected rats displayed significant elevation in defecation score in the open field. In addition a significant Treatment X Strain interaction was due to the larger defecation numbers displayed by the taurine-injected MR rats relative to the saline-injected MR rats.

Animals↗
PubMed1991

Behavioral comparisons of the Tsukuba emotional strains of rats (Rattus norvegicus) in three types of novel situations.

Tsukuba High- and Low-Emotional rats (THE and TLE), Wistar-Imamichi/Iar rats (control group for the Tsukuba Emotional rats), and F344/DuCrj rats were tested in three types of novel situations: the open field, a runway devised as a type of open field with a shelter, and an I-maze devised as a narrow runway with shelters and covers to remove rats' freezing behavior against predatory attack. The TLE was the most active, and the THE the least active in the three tests. While the F344 was inactive in the runway and the I-maze, this strain was as active as the Wistar-Imamichi in the open field. While the THE and F344 defecated frequently, the TLE never defecated.

Animals↗
PubMed1979

Behavior in chimeric mice combining differently behaving strains.

A/J and C57BL/6J mice behave differently in tests for alcohol preference, open-field activity, defecation in the open field, cricket attacking, and rope climbing. Chimeric mice, i.e., mice containing both A/J cells and C57BL/6J cells, were constructed and tested for these behaviors. Patterns of behavior among A/J in equilibrium with C57BL/6J chimeras are such as to suggest that none of these behavior differences is controlled by a single cell or clone and that the same cell population that gives rise to the strain difference in alcohol preference also gives rise to the differences in open-field activity and defecation, while separate cell populations control cricket killing and rope climbing.

Alcohol Drinking↗
PubMed1982

Does uncomplicated diverticular disease produce symptoms?

A questionnaire dealing with bowel symptoms was administered to 97 outpatients referred for air-contrast barium enema. Subsequently, the barium enema was interpreted by a radiologist who did not know the results of the questionnaire. Forty-nine had normal x-rays, and 27 had uncomplicated diverticular disease. Weight loss, rectal bleeding, abdominal pain, and pain at night were as common in those with a normal examination as in those with diverticula. Symptoms of colon dysfunction included abdominal pain relieved by defecation, altered stool frequency and consistency with pain onset, abdominal distension, feeling of incomplete evacuation after defecation, and mucus in the stool. These were equally prevalent in both groups. Therefore, no symptoms could be ascribed to the presence of diverticula.

Abdomen↗
PubMed1976

Circadian rhythm of colonic motility in the cat.

Since circadian patterns of colonic motility are largely unknown the electrical activity of the colon musculature was recorded in 6 unanesthetized cats during day and night. All parts of the colon exhibited 6 patterns of electrical activity: spikes, oscillations, omnipresent regular slow waves, and three composite patterns, i.e. a minute-rhythmic activity, activity complexes of 1 to 18 minute duration and a nyctohemeral pattern. The circadian rhythm was different between the proximal and distal colon resulting in activity gradients. These were directed in an aborad direction from 7 to 9 a.m. and from 9 p.m. to midnight. Most of the defecations of the 6 cats occured in the late evening until 1 a.m. Spike activity of the distal colon predominated from 3 to 4 a.m. and from 11 a.m. to 5 p.m. It is concluded that a circadian rhythm exists in the motility of the cat colon. Differences in the activity between the proximal and the distal colon and resulting activity gradients may offer an explanation for the influences of the time of day on the timing of defecations.

Animals↗
PubMed1996

Bowel function survey after segmental colorectal resections.

PURPOSE: Long-term bowel function after right hemicolectomy (RHC), extended right hemicolectomy (ERHC), left hemicolectomy (LHC), sigmoid colectomy (SC), and anterior resection (AR) was evaluated. METHOD: Three hundred fifteen patients (52.3 percent) replied to a questionnaire on stool frequency, fecal continence, and defecation problems. All patients had undergone surgery at least one year before questionnaire was sent to them. Patients with anastomotic leaks and recurrences were excluded. RESULTS: Stool frequency was one to two bowel movements per day in 78 percent of patients after RHC, 75 percent after ERHC, 57.6 percent after LHC, 64.3 percent after SC, and only 44.8 percent after AR (P = 0.01). Continence affected lifestyle in 32 percent of patients after AR, but affected only up to 11.5 percent of patients who had had more proximal resections (P = 0.001). Defecation problems occurred in less than 15.4 percent after RHC, ERHC, and LHC but were encountered more frequently after SC (25 percent) and AR (28.4 percent; P = 0.009). CONCLUSIONS: Problems with postoperative bowel function were appreciably more common after SC and AR.

Colectomy↗
PubMed1993

Parameters of anorectal and colonic motility in health and in severe constipation.

Anorectal function and colonic transit was assessed in 17 severely constipated patients and 15 age-matched controls. The constipated patients were divided into those who had "immobile perineum" (perineal descent < or = 1.0 cm during attempted defecation) and those who had a normal descent (> 1.0 cm) of the perineum. When constipation was accompanied by an immobile perineum, patients had impaired balloon expulsion, impaired and delayed artificial stool expulsion, decreased straightening of the anorectal angle, decreased descent of the pelvic floor with defecation, and prolonged rectosigmoid colon transit compared with the patients with constipation who had a mobile perineum and with normal controls. The mobile-perineum group differed from controls only in colon transit times, having prolonged total colon transit. Anal sphincter resting pressures, immediate artificial stool expulsion, resting anorectal angles, and electromyography of the external anal sphincter and puborectalis did not differentiate the constipated patients from the controls. We concluded that descent of the perineum of < 1 cm was associated with impaired expulsion, an adynamic anorectal angle, and slowed distal colon transit. This simple sign of pelvic floor function distinguished constipated patients with disordered expulsion from constipated patients with normal pelvic floor function. These patients may respond poorly to surgery and conventional management and would therefore be candidates instead for pelvic floor retraining. Accurate characterization and appreciation of pelvic floor dysfunction in patients with severe chronic constipation may improve the selection for and results of surgical and nonsurgical intervention.

Adult↗
PubMed1992

Chronic constipation with encopresis persisting beyond 15 years of age.

Childhood constipation with encopresis is a common malady. Previous reports suggest that essentially all patients either respond to standard treatments or have spontaneous recovery before 16 years of age. In this paper, we describe the results of anorectal function studies and treatment outcome in four patients in whom constipation and encopresis persisted beyond 15 years of age. Abnormalities in the ability to defecate water-filled balloons, in external sphincter relaxation with straining, in rectal sensation and development of the urge to defecate, and in maximum anal resting pressure were seen in some or all of these patients. In addition, two patients had impaired voluntary squeeze strength. Two patients responded to standard therapy; a colostomy was needed in one; and one failed therapy and has become a recluse.

Adolescent↗
PubMed1991

Behavioral medicine treatment in chronic constipation with paradoxical anal sphincter contraction.

Nine women and five children with severe chronic constipation received behavioral medicine therapy. Before treatment, all patients had a paradoxical contraction of the external anal sphincter at defecation attempts as demonstrated with electromyography and/or anorectal manometry. An electromyographic biofeedback device connected to an anal probe was used for the training that was performed on a regular toilet seat during five 1-hour sessions. Thirteen of the patients improved considerably and could learn to defecate spontaneously, and the use of laxatives ceased or diminished. Simultaneously with improvement, the paradoxical anal contraction disappeared. The results remained after 6 months, although two of the patients had received booster sessions of biofeedback training during follow-up.

Adolescent↗
PubMed1996

Microchip implants on the anterior sacral roots in patients with spinal trauma: does it improve bowel function?

PURPOSE: This study evaluated the effect of anterior sacral roots stimulator implants on bowel function of patients with spinal cord trauma. METHOD: Eight patients with spinal cord injury and constipation had anterior sacral roots stimulator implants inserted for concomitant bladder dysfunction. Questionnaires on bowel function and anorectal manometry tests were given before and after insertion of the implants. RESULTS: Six patients achieved improvement in bowel function. Four of these patients could defecate spontaneously following stimulation. Two patients had no improvement in bowel function. Anorectal manometry studies showed a negative rectoanal pressure difference at the time of stimulation. All patients were unable to defecate during stimulation. Positive rectoanal pressure difference was recorded in the six patients who had improved bowel function. This may be attributable to the slower relaxation of the smooth rectal muscle compared with the easily fatigable striated external anal sphincter. CONCLUSION: Anterior sacral roots stimulator implants can improve bowel function in patients with spinal cord trauma.

Adult↗
PubMed1996

Clinical and physiologic effects of biofeedback in outlet obstruction constipation.

PURPOSE: We report the results of biofeedback (BF) on patients with outlet obstruction defecation (OOC), including those with and without measurable paradoxical puborectalis contractions (PP). Clinical and anorectal physiologic parameters (ARP) were assessed one week before and after a standardized course of BF. METHODS: Sixty-two consecutive patients (24 men, 38 women; mean age, 48 (standard error of the mean, 2.3) years) were recruited. All had persistent constipation despite six weeks of dietary fiber supplements. Colonic inertia was excluded by transit marker studies. Defecating proctography excluded anatomic abnormalities causing outlet obstruction. Patients underwent four outpatient sessions of biofeedback, each session lasting one hour. RESULTS: After BF, 56 patients (90.3 percent) were subjectively improved. Frequency of spontaneous bowel movements were significantly increased (P = 0.003). Frequency of laxative-induced (P = 0.004) and enema-induced (P = 0.005) stools were reduced. Anal resting (P = 0.04) and squeeze (P = 0.002) pressures were increased. Number of patients with PP was reduced from 40 to 31 (P = 0.004). Presence of PP did not affect response to BF. There were no differences in ARP between the 56 patients who improved and the 6 who did not. There were no side effects or clinical regressions after a mean follow-up of 14.9 (standard error of the means, 0.9) months. CONCLUSIONS: BF effectively treated OOC in 90.3 percent, regardless of PP. Anal pressures were increased, and PP was decreased.

Biofeedback, Psychology↗
PubMed1994

Distension-stimulated propagated contractions in human colon.

To investigate the mechanisms for elicitation of peristaltic activity in the human colon, we studied the effect of balloon distension of the transverse, descending, and sigmoid colon and the rectum. Fifteen healthy subjects were studied by means of a colonoscopically positioned probe carrying a 5-cm latex balloon. After positioning of the probe, stepwise distension was performed for each colonic segment (transverse, descending, sigmoid, rectum), and the onset of large (> 50 mm Hg) and small (< 50 mm Hg) propagated waves was observed. Analysis of the tracings showed: (1) In 8/15 subjects (53.3%), balloon distension elicited propagated contractions, but these contractions were qualitatively different from the spontaneously occurring high-amplitude propagated contractions previously found to occur in association with defecation. Therefore, intraluminal distension is probably not the cause of defecation-associated high-amplitude propagated contractions. (2) Pain reports were poorly correlated with propagated contractions elicited by balloon distension, suggesting that these contractions are not the cause of the pain produced by balloon distension. (3) The transverse colon shows lower pressures, fewer pain reports, and fewer large propagated contractions in response to balloon distension as compared to the descending and the sigmoid colon.

Adult↗
PubMed1997

Total anorectal reconstruction with a double dynamic graciloplasty after abdominoperineal reconstruction for low rectal cancer.

PURPOSE: Total anorectal reconstruction with a double dynamic graciloplasty was performed after abdominoperineal reconstruction (APR) for low rectal cancer. In four patients an additional pouch was constructed to improve neorectal motility and capacity. The aim of this study was to evaluate the results in the first 20 patients and to report on the preliminary results of patients with an additional pouch. METHODS: Twenty patients with a mean age of 52 (range, 25-71) years and a rectal tumor at a mean of 3 (range, 0-5) cm from the anal verge were treated. In 14 patients the Miles resection, colon pull-through, and construction of a neosphincter were performed in one session. Six patients had the double graciloplasty at an average of 4.1 (range, 1.1-8.8) years after APR. In four patients a pouch was constructed with an isolated segment of distal ileum. RESULTS: After a mean follow-up of 24 (range, 1-60) months after APR, none of the patients developed local recurrence, whereas four patients developed distant metastasis. Fifteen of 20 patients were available for evaluation, and 5 patients were still in training. Of these 15 patients, 8 patients were continent (53 percent), 2 patients were incontinent, and in 5 patients the perineal stoma was converted to an abdominal stoma. Failures were attributable to necrosis of the colon stump (n = 2) and incontinence (n = 3). At 26 weeks mean resting pressure was 44 (standard deviation (SD), 28) mmHg, and mean pressure during stimulation was 90 (SD, 46) mmHg at a mean of 3.5 (SD, 1.2) volts at 52 weeks. Mean defecation frequency was three times per day (range, 1-5). Of the eight patients who were continent, six used daily enemas. Mean time to postpone defecation was 11 (range, 0-30) minutes. CONCLUSION: In experienced hands, the double dynamic graciloplasty is an oncologically safe procedure that can have an acceptable functional outcome in a well-selected group of patients. However, to improve the outcome, further modifications will be necessary. So far, the addition of a pouch has not resulted in improved outcome.

Adenocarcinoma↗