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PubMed1986

Restorative proctocolectomy and ileal reservoir.

The operation consisting of abdominal colectomy, proximal proctectomy, distal mucosal proctectomy, and ileal pouch-anal anastomosis eliminates colorectal mucosal disease, restores transanal defecation, and avoids the need for a permanent abdominal stoma and the wearing of an external appliance. During the 4-year period from January 1981 through December 1984, 369 such operations were done at the Mayo Clinic for either ulcerative colitis (in 336 patients) or polyposis coli (in 33 patients). None of the patients died in the immediate postoperative period. Follow-up data for the initial 188 patients showed the following complications: anastomotic stricture in 12%, pelvic sepsis in 11%, obstruction of the small intestine in 9%, and reservoir ileitis in 7%. A permanent stoma had to be established in 5% of patients. All patients could defecate spontaneously, and 95% had satisfactory continence for stools and gas. This operation seems safe and effective and provides a quality of life superior to that seen after the conventional Brooke ileostomy.

Adult↗
PubMed2001

Abdominal sacrocolpopexy and anatomy and function of the posterior compartment.

OBJECTIVE: To assess the effect of abdominal sacrocolpopexy with obliteration of the pouch of Douglas on anatomy and function of the posterior compartment. METHODS: We prospectively studied 33 consecutive women with pelvic organ prolapse who had abdominal sacrocolpopexies [expanded polytetrafluoroethylene (Gore-Tex)] with pouch of Douglas obliterations and posterior extensions of mesh, using a standardized questionnaire, urodynamic studies, pelvic floor fluoroscopies, and vaginal-rectal examinations (Baden-Walker classification). Concomitant colpoperineorrhaphy was done if rectoceles remained at rectovaginal examination at the end of sacrocolpopexy. The goal was to correct rectoceles transabdominally. RESULTS: Thirty-one women returned for follow-up investigations after 12--48 months (mean 26 months). Mean age was 61 years (range 41--77 years). There was no recurrence of vaginal vault prolapse, enterocele, or anterior rectal wall prolapse. Among 28 preoperative rectoceles, 16 recurred (57%) and one occurred de novo. Defecation problems (outlet constipation) were present in 21 women (64%) preoperatively and persisted or were altered in 12 (57%) after sacrocolpopexy. Grade of rectocele was associated significantly with symptoms of outlet constipation preoperatively, but not postoperatively (P =.002). CONCLUSION: Abdominal sacrocolpopexy with obliteration of the pouch of Douglas and posterior extension of the mesh was effective for vaginal vault prolapse, enterocele, and anterior rectal wall procidentia, but not concomitant rectocele. Twenty-eight percent of women described altered defecation with stool stopping higher in the rectosigmoid colon ("high outlet constipation"), which might have been caused by denervation during rectal mobilization.

Adult↗
PubMed2003

Evaluation of the fascial technique for surgical repair of isolated posterior vaginal wall prolapse.

OBJECTIVE: To study the anatomic and functional efficacy and assess long-term success of the fascial technique in the repair of rectocele. METHODS: Forty-two women with symptomatic posterior vaginal wall prolapse of at least stage II underwent a surgical repair using the technique of reconstruction of the rectovaginal septum. These women were evaluated at 6 weeks and 18 months postoperatively for anatomic improvement in the grade of their rectocele and a functional improvement in their vaginal, bowel, and sexual symptoms. RESULTS: Ninety-five percent (40 of 42) were assessed at 6 weeks and 78.5% (33 of 42) attended follow-up at 18 months. Preoperative symptoms included 1) vaginal protrusion (78%); 2) defecation symptoms (76%), which included fecal incontinence alone in 9.5%, evacuation difficulties in 57%, and both fecal incontinence and evacuation difficulties in 9.5%; and 3) sexual dysfunction (33%). At 6-week follow-up there was resolution of vaginal protrusion in 87.5%, and bowel symptoms in 87%. At 18 months there was anatomic cure in 92%, improvement in defecation in 81%, and improvement of sexual dysfunction in 35%. No major complications were seen. CONCLUSION: This technique is effective in providing relatively long anatomic cure of the rectocele and resolution of its symptoms.

Adult↗
PubMed2003

Fearfulness and sex in F2 Roman rats: males display more fear though both sexes share the same fearfulness traits.

The pattern of sex differences in a large sample (about 400 for each sex) of F2-generation rats, derived from inbred Roman high- and low-avoidance strains differing in fearfulness and brain functioning, was investigated. We obtained measures from responses to a battery of novel/threatening tests [open field (OF), plus maze (PM), hole board (HB), activity (A), and acoustic startle reflex (ASR)] as well as learned fear paradigms [classical fear conditioning (CFC) and shuttlebox avoidance conditioning (SAC)]. The results showed that almost all behaviors assessed fit with a pattern of unidirectional sex effects characterized by male rats as being more fearful than females: males defecated more than females in the OF, PM, HB, ASR, and CFC; ambulated less in the OF, PM, A, and SAC; showed more self-grooming in PM and HB; explored the open arms of the PM and the holes of the HB less; displayed enhanced ASR; and showed poorer performance in the SAC task. We applied two factor analyses to each sex showing that, in general, they shared a common three-factor structure: a Learned Fear Factor comprising SAC and CFC responding, a Fear of Heights/Open Spaces Factor with the highest loadings for open arm behavior in the PM, and an Emotional Reactivity Factor, mainly grouping defecations, ambulation, and self-grooming. These results indicate that the essential components of fearful behavior are similar for both sexes in an inbred but genetically heterogeneous population.

Animals↗
PubMed1999

Inbred Roman high- and low-avoidance rats: differences in anxiety, novelty-seeking, and shuttlebox behaviors.

In the present study, male inbred animals (from the 10th generation of an inbreeding program that has been carried out in parallel to that of the outbred Roman high- and low-avoidance rat lines), were compared for emotionality in different testing situations, exploratory behavior in the holeboard and two-way, active-avoidance acquisition. Compared to the inbred Roman high-avoidance (RHA-I/Verh) rats, inbred Roman low-avoidance (RLA-I-Verh) rats showed higher emotionality in the open field (reduced distance travelled and number of rearings, and increased self-grooming behavior), in the elevated plus-maze test (increased number of total and open-arm entries, reduced distance travelled in the open arms, and increased self-grooming behavior), and during the habituation period in the shuttle box (decreased number of crossings, increased self-grooming behavior and defecations). Results from the hyponeophagia test were not conclusive, probably due to the test-dependent hyperactivity shown by RHA-I/Verh rats. In the holeboard apparatus, RHA-I/Verh rats explored more than RLA-I/Verh rats, especially when novel objects were located beneath the holes. Finally, RHA-I/Verh animals rapidly acquired active, two-way (shuttlebox) avoidance, whereas RLA-I/Verh animals required four 50-trial sessions to achieve an assymptotic level of 30-40% avoidance. Thus, the behavioral patterns of the Roman inbred strains were very similar to those previously reported for the RHA/Verh outbred lines. Differences in locomotor activity, exploratory, and self-grooming behavior were actually greater between the inbred strains than between the outbred lines. Differences in defecation, however, although still significant, were not so pronounced as those noted previously at this laboratory with the outbred lines.

Animals↗
PubMed1985

Neophobia in spontaneous hypertensive (SHR) and normotensive control (WKY) rats.

Latency of approaching a novel object (white-colored cube) placed in an unfamiliar open field, duration of object exploration, ambulation, rearing, grooming, and defecation were investigated in spontaneous hypertensive rats (SHR), their genetic normotensive controls (WKY), and standard Laboratory rats of Wistar origin (Tif:RAIf). The parameters measured were taken as indices of fear due to novelty (neophobia). Remarkable differences in behavior of all three strains were observed. By comparison to RAIf and WKY rats, SHR showed decreased neophobia as reflected in the significantly shorter latency of approaching the object and enhanced ambulation and rearing activity in the open field. By comparison to RAIf rats SHR also showed reduced grooming and defecation. WKY rats distinguished themselves from both SHR and RAIf by almost total absence of all responses in this test situation. This behavioral suppression was antagonized by 7.5 mg/kg ip of chlordiazepoxide. The results of this study further support the notion that, by comparison to standard laboratory rats, both SHR and WKY rats show possible genetically determined, altered behaviors which are diametrically opposite to each other.

Animals↗
PubMed2002

Variability factors in the expression of stress-induced behavioural sensitisation.

Altered behavioural and physiological responsivity following a short session of foot shocks in the rat has proven to be a stable and clinically relevant model of stress-induced sensitisation. However, a number of key factors influencing effect size or direction have not previously been reported. Rats underwent a single, 15-min session of foot shocks and were exposed to a variety of novel stressful challenges 1 or 2 weeks later. Sensitised behavioural responses (increased immobility) in preshocked rats remained present over 3 days of repeated exposure to noise stress. In mild novel challenges (open field, empty cage), behavioural sensitisation and defecation was most clearly expressed at the beginning of the dark phase (evening). Higher-arousal challenges (prod, noise) caused increased behavioural inhibition in preshocked rats at all three time points (morning, afternoon, evening). Female preshocked rats showed a different pattern of behavioural and defecation sensitisation than preshocked males. The robustness of the model makes it suitable for further investigations into the mechanisms and vulnerability factors involved in the long-term consequences of stress.

Acoustic Stimulation↗
PubMed1989

Hippocampal nicotinic cholinergic mechanisms mediate spontaneous alternation and fear during ontogenesis but not later in the rat.

Spontaneous alternation was examined in young rats following microinjections of antinicotinic agents into one of the 4 hippocampal sites: anterodorsal, or posteroventral dentate gyrus, hippocampal gyrus, or entorhinal cortex. In control and saline-injected animals, the alternation rate was shown to grow suddenly from 40 to 80% between days 15 and 17 (the adult level being 85-90%), to regress partly (to 55%) between days 20 and 30, and return to a near-adult level (75%) by day 40. Meanwhile fear responses to environment (defecation and vocalization) emerged between days 20 and 25, increased to a maximum until day 30, and returned to the typically low adult level by day 40. Injections of mecamylamine (5, 20 micrograms) or hexamethonium (5, 20 micrograms) into any of the 4 sites significantly reduced the rate of alternation from as early as day 10 on, but were no longer effective from day 30 on; on the other hand, they did not alter the level of defecation, but had a tendency to lower the level of vocalization on day 30 only. These results indicate that hippocampal nicotinic cholinergic mechanisms play a role in spontaneous alternation and appear to be involved in the control of one fear reaction (vocalization) until day 30.

Aging↗
PubMed2001

Vaginal vault suspension by abdominal sacral colpopexy for prolapse: a follow up study of 40 patients.

OBJECTIVES: Vaginal vault prolapse is a rare event after hysterectomy. Vaginal repair often results in a narrowed and shortened vagina with diminished function. Abdominal sacral colpopexy attaches the vaginal apex to the sacral promontory and restores the physiological position of the vagina. The objective of the study was to evaluate follow up results of the abdominal sacral colpopexy in 40 patients by a questionnaire and a gynaecologic examination. METHODS: We performed a cohort study. Between 1992 and 1998, 45 consecutive patients with a vaginal vault prolapse treated with an abdominal sacral colposcopy were included. RESULTS: Forty patients were included in the study. No serious complications occurred during surgery. Two patients per- or postoperative hemorrhage required blood transfusion. In two patients, one with a concomittant hysterectomy, the Gore-tex graft infected within 3 months after the operation. If vaginal 'protrusion' was the only preoperative complaint, in 93% (13/14) of the cases, surgery resulted in a condition without any complaint, related to the vaginal prolapse. If initially a combination of complaints (vaginal protrusion, urinary incontinence, defecation problems, sexual dysfunction) was the reason for surgery, only ten of 27 (37%) patients were symptom-free at follow up (P=0.002, Yates corrected). In the whole group 34 (85%) patients noticed before the operation a feeling of vaginal protrusion. At follow-up, 23 patients (56%) had no symptoms at all that could be related to the vaginal prolapse. Problems concerning defecation, like constipation were present before surgery in eight patients. In six of them, these complaints were resolved after surgery. However, in five patients de novo constipation developed after surgery. There were no cases of de novo urinary incontinence. At gynaecological examination in three patients, the vaginal vault prolapse recurred within the follow-up period, accounting for a success rate of 93%. In ten more patients a moderate enterorectocele developed or persisted. No reoperations were performed for that reason. CONCLUSIONS: Abdominal sacral colpopexy is a safe and efficacious treatment of the posthysterectomy vaginal vault prolapse. To prevent the persistence or development of an enterorectocele, a culdoplasty according to Halban or McCall might possibly be helpful. Peritonisation of the graft seems not to be necessary. The use of banked collagen tissue as graft material is promising and needs further investigation.

Adult↗
PubMed2003

An estimation of Toxocara canis prevalence in dogs, environmental egg contamination and risk of human infection in the Marche region of Italy.

The human risk of infection with larvae of Toxocara canis was estimated in people from the Marche region of Italy. This region includes both urban and rural areas and its inhabitants frequently keep dogs for company, hunting, as guardians or shepherds. T. canis infection was diagnosed in 33.6% out of 295 dogs examined. Nearly half of the dogs (48.4%) living in rural areas were found T. canis positive, compared to about one-quarter of the dogs (26.2%) from urban areas. Analysis by provenance and role revealed the highest infection rate in rural hunting dogs (64.7%) and the lowest in urban companion dogs (22.1%). According to questionnaire data, the peridomestic environment, i.e. gardens and dog pens, is the most important defecation site in both rural and urban areas. Since over 40% of the dogs who defecate in dog pens are infected and 24% of urban and 47% of rural dogs who leave their droppings in the house surroundings harbour the parasite, it is clear that these environments may constitute sites of zoonotic risk. Our analysis of soil samples from 60 farms confirmed the high contamination level, revealing positive soil samples in more than half of the farms. Substantial egg contamination was also found in urban areas, as 3/6 parks examined were Toxocara spp. positive. Finally, our serological findings indicate that human infection actually occurs in the area: 7 out of 428 adults examined (1.6%) had very high levels of antibodies to T. canis antigen, suggesting a previous contact with the Larva migrans of the nematode.

Animals↗
PubMed2003

Epidemiology of Toxocara canis in the dog population from two areas of different socioeconomic status, Greater Buenos Aires, Argentina.

Toxocara canis infection in dogs is a public health problem in most countries, although it has been poorly documented in many of them. The main objective of the present work was to investigate the epidemiology of infection in the canine populations from two areas of Buenos Aires of different socioeconomic status and urban conditions: a middle-income neighbourhood (MIN) and a low-income neighbourhood (LIN). This study evaluated the prevalence of infection in dogs by parasitological and serological techniques in both areas, and described the relationship between the infection and different epidemiological variables for each neighbourhood. A cross-sectional study was carried out after a house-to-house census was completed. During August 1999, a sample of households was selected at random (nMIN=53 and nPA=52). In each house, one dog was randomly chosen for the collection of fresh faeces and blood. The dog owners were interviewed utilising a questionnaire about dogs on sex, recent anthelmintic treatment, degree of confinement, control by the dog's owner (whether the dog goes out of the house accompanied or not, leashed or unleashed), defecation site, defecation substratum and number of dogs in the house. The diagnostic techniques were concentration-sedimentation formalin/ether method and ELISA test. The parasitological prevalences in dogs were 9% (5/53) in MIN and 19% (10/52) in LIN, and serological prevalences were 22% (2/9) in MIN and 40% (15/37) in LIN. In MIN, the patent infection of males was significantly higher than that of females. In LIN, puppies less than 1 year old were the most prevalent age class. Our serological results showed that the positivity of adult dogs was more frequent in LIN than in MIN. The density of puppies with patent infection was seven times higher in LIN than in MIN, when combining coprological analysis and the estimated age structure obtained by the census.

Animals↗
PubMed2004

Effect of an oral bulking agent and a rectal laxative administered alone or in combination for the treatment of constipation.

OBJECTIVES: The aim of the present study was to search for a synergetic action between psyllium and a defecation-inducing drug, Eductyl, for symptom relief in patients suffering from chronic constipation. METHODS: Twenty healthy volunteers and 20 patients complaining of chronic constipation were included in a randomized crossover study. The study was divided into four 2-weeks periods: pre-inclusion and three periods of treatment with psyllium, Eductyl, and Eductyl + psyllium respectively. Colonic transit time was determined at the end of each period of treatment. During each of the four periods, a self-administered questionnaire was used to assess symptoms of constipation. RESULTS: For constipated patients, treatment with Eductyl and Eductyl-psyllium improved clinical symptoms of constipation: increased stool frequency, resulted in fewer hard stools and less sensation of incomplete evacuation and less straining to defecate. The improvement was associated with a decrease in total and segmental colonic transit time. The Eductyl-psyllium combination did not exhibit any synergetic effect. CONCLUSION: Treatment with Eductyl alone is more efficient than with psyllium alone in providing symptom relief. Combination with psyllium is not synergetic.

Administration, Oral↗
PubMed1999

Different behavioral patterns related to alcohol use in rodents: a factor analysis.

To estimate genetic correlations among behavioral measures from explorative crossmaze, inescapable slip funnel, as well as from drinking tests, the data from five pairs of high/low alcohol drinking rat (AA/ANA, P/NP, HAD1/LAD1, HAD2/LAD2, HIGH-IPH/LOW-IPH) and from three pairs of mouse (B10.AKM/B10.A(4R), HD/LD, Small_Brain/ Large_Brain) lines were evaluated by the use of principal component analysis. The analysis yielded a two-factor solution explaining 71.8% of total variability. Both the factors had high positive loadings on alcohol drinking. The first factor had sufficient positive loadings on latency of crossmaze exploration and total time of slip funnel immobility, whereas, there was a negative loading on slip funnel avoidance. The second factor had positive loadings on efficacy of crossmaze exploration and slip funnel escape attempts, whereas there was a negative loading on slip funnel immobility. The number of defecations in the crossmaze, time in open arms of the elevated plus-maze, time immobile during the forced-swim test, as well as intake of a saccharin solution, additionally available for a lesser number of the lines, were studied for correlations with the factor scores. The first factor of "alcohol drive with timidity and meekness" exhibited positive relation to saccharin intake. Time in the open arms of the elevated plus-maze showed significant negative correlation with a latency of crossmaze exploration. The second factor of "alcohol drive with novelty seeking and persistence" showed a negative link to crossmaze defecations and forced-swim immobility.

Animals↗
PubMed2002

Gum chewing enhances early recovery from postoperative ileus after laparoscopic colectomy.

BACKGROUND: Postoperative ileus limits early hospital discharge for patients who have undergone laparoscopic procedures. Sham feeding has been reported to enhance bowel motility. Here, the effect of gum chewing is evaluated as a convenient method to enhance postoperative recovery from ileus after laparoscopic colectomy. STUDY DESIGN: A total of 19 patients who underwent elective laparoscopic colectomy for colorectal cancer participated in the study. Each patient was randomly assigned to one of two groups: a gum-chewing group (n = 10, mean age 58.6 years, range 50 to 71 years) or a control group (n = 9, mean age 60.6 years, range 45 to 80 years). The patients in the gum-chewing group chewed gum three times a day from the first postoperative AM until oral intake. The times of the first passage of flatus and defecation were recorded precisely. RESULTS: The first passage of flatus was seen, on average, on postoperative day 2.1 in the gum-chewing group and on day 3.2 in the control group (p < 0.01). The first defecation was 2.7 days sooner in the gum-chewing group (postoperative day 3.1) than in the control group (5.8 days; p< 0.01). All patients tolerated gum chewing on the first operative AM. The postoperative hospital stays for the gum-chewing and control groups were 13.5+/-3.0 days and 14.5+/-6.1 days, respectively. CONCLUSIONS: Gum chewing aids early recovery from postoperative ileus and is an inexpensive and physiologic method for stimulating bowel motility. Gum chewing should be added as an adjunct treatment in postoperative care because it might contribute to shorter hospital stays.

Aged↗
PubMedDate not supplied

The jejunal pouch as a rectal substitute after proctocolectomy.

Our hypothesis was that a jejunal pouch used as a rectal substitute after proctocolectomy would slow enteric transit, delay defecation, and decrease stool frequency compared to an ileal pouch so used. Twelve dogs underwent proctocolectomy; six had a jejunal pouch-distal rectal anastomosis and six had an ileal pouch-distal rectal anastomosis. After recovery, postprandial mouth-to-anus transit was slower in jejunal pouch dogs (253 +/- 18 minutes [mean +/- SEM]) than in ileal pouch dogs (112 +/- 7.9 minutes; P <0.05). Moreover, jejunal pouch dogs passed only 4.1 +/- 0.3 stools during the 12 hours after eating, whereas ileal pouch dogs passed 6.3 +/- 0. 9 stools (P <0.05). The mean frequency of proximal ileal pacesetter potentials after feeding was less in jejunal pouch dogs (12 +/- 0.4 cycles/min) than in ileal pouch dogs (16 +/- 0.3 counts/min; P = 0. 01), and jejunal pouches had more action potentials (jejunal = 82% +/- 4.3% of pacesetter potentials had action potentials, ileal = 61% +/- 3.0%; P <0.05). In contrast, gastric emptying and pouch motility, emptying, mucosal integrity, and bacteriologic and histologic properties were similar in the two groups of dogs. We concluded that the jejunal pouch operation slowed enteric transit, delayed defecation, and decreased postprandial stooling compared to the ileal pouch operation.

Animals↗
PubMed2002

Irritable bowel syndrome.

Irritable bowel syndrome (IBS) is one of the most common diagnoses made in the primary care setting and is responsible for up to 40% of referrals to gastroenterologists. Approximately 70% of persons who meet the diagnostic criteria for IBS do not seek health care, and the remaining account for 12% of visits to primary care providers. IBS is a functional bowel disordered comprising abdominal pain associated with defecation or a change in bowel habit with features of disordered defecation and distension in the absence of any demonstrable abnormality. The diagnosis is based on clinical findings and the exclusion of other disorders. New pharmaceutical agents are available to treat the underlying disorder; however, the treatment of IBS still involves a comprehensive, multicomponent approach that includes medical management of dominant symptoms, dietary modifications, and, possibly, psychotherapy.

Antidepressive Agents↗
PubMedDate not supplied

Two cases of cauda equina syndrome following spinal-epidural anesthesia.

BACKGROUND AND OBJECTIVES: Cauda equina syndrome (CES) is a well-known complication of spinal and epidural anesthesia. Previous reports have implicated lidocaine, chloroprocaine, and procaine in its etiology, but not bupivacaine. METHODS: A 63-year-old man underwent transurethral resection of the prostrate for which he received bupivacaine with glucose intrathecally. Postoperative, he had difficulty in urination and defecation, and magnetic resonance imaging revealed spinal stenosis at the L1-L2 level. The second patient was a 70-year-old woman who underwent hip replacement surgery using a combined spinal-epidural technique. Postoperative, after 42 hours, when the epidural infusion of bupivacaine was stopped, the patient had difficulty in urination and defecation. No anatomical abnormality was found on magnetic resonance imaging. RESULTS: The two patients developed cauda equina syndrome following bupivacaine with glucose injected spinally, and bupivacaine without glucose injected in a combined spinal-epidural technique. CONCLUSIONS: This case report describes two cases of CES following the use of bupivacaine. The first patient had spinal stenosis which could explain this complication; however the explanation for CES in the second patient is uncertain and consequently speculative. We have discussed the possible contributing factors but believe that the etiology of CES in the second patient remains unknown.

Aged↗
PubMed1997

Labyrinth exploration, emotional reactivity, and conditioned fear in young Roman/Verh inbred rats.

An inbreeding program has been carried out with the Swiss sublines of Roman high- and low-avoidance rats since 1993. The present study reports the first experiments conducted with young animals of those inbred strains (RHA-I/Verh and RLA-I/Verh, respectively) from the sixth and seventh inbreeding generations. The results confirmed expected behavioral profiles. Compared to the RHA-I/Verh strain, RLA-I/Verh rats showed decreased entries into the illuminated central arena of an hexagonal tunnel maze, as well as decreased spontaneous locomotor activity and increased defecations, in two independent experiments. Young RLA-I/Verh females explored less than did their RHA-I/Verh counterparts during session 1 of a conditioned-fear experiment preceding shock administration, and in session 2 (conducted 24 h after the application of three footshocks), they showed greater conditioned behavioral inhibition (i.e., reduced amount of rearing), as well as higher defecation scores, than did RHA-I/Verh females.

Analysis of Variance↗