[Consensus on the use of small bowel manometry. Intestinal motility can be measured by 24-hour monitoring].
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A possible mechanism for pain in alcohol-induced chronic pancreatitis is increased pancreatic duct pressure. A study has been done to compare sphincter of Oddi and pancreatic duct pressures in normal controls and patients with alcohol-induced chronic pancreatitis who had recently had pain or who were pain-free. Pressures were measured in the sphincter of Oddi in 10 controls and 33 patients, in the pancreatic duct in six controls and 15 patients, and in the common bile duct in four controls and five patients during station pull-through at the time of an endoscopic retrograde cholangiopancreatogram. There was no significant difference in the mean pressures in the pancreatic duct, sphincter of Oddi (basal and phasic), and frequency of papillary contraction when comparing patients with alcoholic pancreatitis and controls. There was also no difference between patients with or without pain and patients with or without strictures. This study has not confirmed the hypothesis that increased pancreatic duct pressures may be incriminated as a possible mechanism of pain in alcoholic-induced chronic pancreatitis.
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BACKGROUND: In earlier studies, erythromycin stimulated but octreotide inhibited gastric antral contractions, as each drug induced phase 3-like episodes. METHODS: To assess the effect of erythromycin pretreatment on octreotide-induced changes in antroduodenal motility, 16 patients were studied (mean age, 8.7 +/- 1.5 years, 8 male): 6 with severe gastroesophageal reflux, 4 with cyclic vomiting, 3 with gastroparesis, 2 with chronic intestinal pseudo-obstruction, and 1 with Crohn's disease and unexplained nausea and vomiting. After recording fasting antroduodenal motility for 3 hours, 1 mg/kg intravenous erythromycin was administered over 30 minutes. Sixty minutes after the erythromycin infusion, 0.5 microg/kg subcutaneous octreotide was administered, followed 1 hour later by a meal. RESULTS: Phase 3 occurred spontaneously in 10 patients and after erythromycin in 12 patients. When administered after erythromycin, octreotide immediately induced phase 3s contractions in 15 patients, beginning in the antrum. In 7 children, some of the octreotide-induced phase 3s did not propagate. After the meal, antral contractions continued in all patients. The fed pattern was replaced in 14 patients by alternating phase 3 and phase 1 activities. CONCLUSIONS: Pretreatment with erythromycin prevented octreotide-induced inhibition of antral contractions. Inhibition of antral contractions by octreotide may be mediated through either a direct or indirect suppression of motilin release, because antral contractions persist after pretreatment with the motilin receptor agonist erythromycin.
OBJECTIVE: The anatomy of the anal canal, the anorectal junction and the lower rectum was studied with 3-D ultrasound. METHOD: Seventeen women with normal bowel transit, without rectocele (group 1) and 17 female patients with a large anterior rectocele (group 2) were examined with a B&K Medical Rawk. Mean age was 44.5 and 51.6 years respectively. In group 1, one (5.8%) patient was nuliparous, five (29.4%) had a caesarian section, 11 (64.7%) had a vaginal delivery while in group 2, two (11.7%) patients were nuliparous, four (23.5%) had a caesarian section and 11 (64.7%) had a vaginal delivery. Images were reconstructed in midline longitudinal (ML) and transverse (T) planes. The external (EAS) and internal (IAS) anal sphincters were measured in both projections. RESULTS: In the ML plane, the EAS length was longer in group 1 (1.94 cm vs 1.61 cm, P < 0.05), the gap length was shorter (1.54 cm vs 1.0 cm P < 0.01) and the wall thickness was shorter in group 2 (0.40 cm vs 0.50 cm P < 0.01). The IAS (0.18 cm vs 0.23 cm P < 0.01) and EAS thickness (0.68 cm vs 0.77 cm, P < 0.05) (left lateral of the posterior quadrant) was greater in group 2. In group 1, the anterior upper anal canal wall in normal females was an extension of the rectal wall and the circular muscle was thicker in the mid-anal canal to form the IAS. In group 2, however, the wall layers were not identified and the IAS was found to be more distal. The differences were not statistically significant in the anal canal resting and squeeze pressures in the two groups. CONCLUSION: Obstetric trauma does not seem to play any role in rectocele pathogenesis because the anal sphincter muscles are anatomically and functionally normal and rectocele is also present in nuliparous and in women with caesarian sections. It seems that it is associated with the absence of EAS and thinner IAS in the anterior upper anal canal. Herniation starts at the upper anal canal extending to the lower rectum in high or large rectoceles and maybe produced by rectal intussusception because of excessive and prolonged straining during defecation. In fact, the denomination 'rectocele' should be changed to 'anorectocele'.
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The Finapres (Ohmeda, Madison, U.S.A.) is a non-invasive device which continuously measures the arterial blood pressure in a finger and produces a real-time display of the arterial pressure wave. It consists of a finger cuff with an infra-red transmission plethysmograph, a servo control box and a monitor unit. The device was compared with intra-arterial pressure monitoring in twenty patients during induction of anaesthesia for elective neurosurgical procedures. The differences between the two methods were considerable, ranging from -40 mmHg to +26 mmHg for mean pressure. While the Finapres has potential as a non-invasive continuous blood pressure monitor, the current model Finapres, as supplied, displays too great a variability for it to be used as an alternative to intra-arterial pressure monitoring.
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643 ano-rectal electromanometric investigations were carried out in 438 children with different ano-rectal diseases including myelomeningocele, Hirschsprung's disease, anal atresia and chronic constipation, as well as in healthy premature, new-born and older infants. The reliability of the recorded physiological and pathological parameters was found to be significant in 87,2%. Electromanometry is shown to be an important new method of assessing ano-rectal continence.
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Servoplethysmomanometry (Penáz method) is based on the principle of "vascular unloading" or "arterial volume clamp". It permits continuous recording of the arterial pressure pulse in a finger. We evaluated such a device (Finapres) intraoperatively in cardiac surgical patients and compared the results with those obtained using simultaneous intra-arterial pressure recording. METHODS. Intravenous anesthesia was employed in a total of 31 patients. Invasive pressure monitoring was carried out in the radial artery. The cuff of the Finapres was wrapped around the 3rd finger, either on the same side as the radial cannula (group I, n = 15) or on the contralateral side (group II, n = 16). Quantitative comparison was accomplished for the paired values obtained by the two methods by calculating linear regression equations and correlation coefficients (r), as well as for the differences between the paired values (means, SD, frequency distributions). RESULTS. In group I (ipsilateral recording), r was 0.74 for systolic (SAP), 0.52 for diastolic (DAP), and 0.77 for mean (MAP) pressure. The means +/- SD of the differences (mm Hg) were -1.6 +/- 16.6 (SAP), 4.6 +/- 11.5 (DAP), and 0.2 +/- 11.3 (MAP). In group II (contralateral recording), r was found to be 0.86 (SAP), 0.72 (DAP), and 0.82 (MAP). The mean differences were -2.7 +/- 13.1 (SAP), 4.7 +/- 9.8 (DAP), and -2.6 +/- 10.9 mm Hg (MAP). Prior to cardiopulmonary bypass (CPB) the results of the two methods corresponded to a higher degree than after CPB; during CPB the MAP values correlated poorly in the two groups (r = 0.62). DISCUSSION. The results obtained may be interpreted to mean that the Finapres will enable us to monitor arterial blood pressure continuously with satisfactory reliability when the cuff design has been improved.
New ideas and inspirations for future human investigations have emerged from the experience obtained in this study. These investigations ought to be performed for both scientific and clinical reasons. It is the author's opinion that the ETM method is extremely useful and valuable. The author intends to continue the human investigations if proper conditions are available. The ETM equipment can also be further improved for scientific and special clinical investigations. For normal clinical practice a more "simplified" ETM equipment should be developed. Clinical investigations concerning the diagnosis of brain stem disorders and the selection of noise susceptible persons will be two of the primary clinical tasks.
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