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At least 1,369 records · Page 76Linked to original sources
PubMed1990

Benzodiazepine anti-conflict effects in Maudsley reactive (MR/Har) and non-reactive (MNRA/Har) rats.

The Maudsley Reactive (MR/Har) and Non-Reactive (MNRA/Har) rat strains, bred originally by Broadhurst for differences in Open Field Defecation, also differ in their control (i.e., non-drug) behavior in the Conditioned Suppression of Drinking (CSD) conflict procedure, a second "model" behavior for the study of anxiety and/or emotionality in rats. The present studies compared the effects of diazepam and alprazolam on CSD behavior in these two strains of rats. In daily 10-min sessions, water-deprived rats were trained to drink from a tube that was occasionally electrified (0.2-0.5 mA), electrification being signaled by a tone. Both diazepam and alprazolam increased punished responding in a dose-related manner. The per cent increase in punished responding (for diazepam only) was comparable in the two strains; however, both statistical and empirical approaches indicated that the magnitude of the anti-conflict effect of benzodiazepines in MNRA/Har versus MR/Har rats was not related to differences in baseline (i.e., non-drug) punished responding. Based on the absolute change in shocks received, rats of the MNRA/Har strain exhibited a significantly greater anti-conflict effect following diazepam or alprazolam treatment than did rats of the MR/Har strain. These findings further the hypothesis that the behavioral differences exhibited by Maudsley MR/Har and MNRA/Har rat strains may constitute a genetically-based "animal model" for the study of emotionality and/or anxiety.

Alprazolam↗
PubMed1984

The endorectal ileal pouch-anal anastomosis. Current clinical results.

One hundred thirteen patients with either chronic ulcerative colitis (108 patients) or familial polyposis coli (five patients) received an ileal J pouch-anal anastomosis after sphincter-saving proctocolectomy. There were no postoperative deaths. Leaks (radiologic and/or clinical) from the pouch or ileoanal anastomosis occurred in 14 per cent of patients. Small-bowel obstruction, requiring operative correction, occurred in 7 per cent and 3 per cent, respectively, of patients after either proctocolectomy or closure of the loop ileostomy. All 66 patients whose diverting ileostomy had been closed for at least three months could defecate spontaneously and their mean (+/- SE) stool frequency per 24 hours was 9.0 +/- 1 at one month and 5.9 +/- at 12 months. Major fecal incontinence was observed in 3 per cent of patients, and two patients eventually required a permanent ileostomy. The ileal J pouch-anal anastomosis has become our procedure of choice in selected patients who require proctocolectomy.

Adolescent↗
PubMed1985

The spastic pelvic floor syndrome. A cause of constipation.

In 12 patients with constipation, it was detected by defecography that, during straining, the anorectal angle did not increase, but remained at 90 degrees. These patients were unable to excrete barium. Since the anorectal angle is a measure of activity of the pelvic floor musculature, a dysfunction of this muscle was suspected. In order to determine whether this abnormality represented a true functional disorder or just a voluntary contraction of the pelvic floor muscles due to embarrassment, we performed electromyographic, manometric, and transit time studies in these patients. The electromyographic studies confirmed the persistent contraction during defecation straining. Both manometry and electromyography revealed normal muscle function at rest and during squeezing. Colonic transit time studies demonstrated rectal retention in nine of 12 patients, indicating outlet obstruction. Persistent contraction of the pelvic floor muscles, for which we propose the name "spastic pelvic floor syndrome," represents a functional disorder of normal pelvic floor muscles, causing a functional outlet obstruction.

Adult↗
PubMed1987

Physiology of ileoanal anastomosis with ileal reservoir for ulcerative colitis and adenomatosis coli.

A physiologic and metabolic assessment was carried out on eight patients six months after total proctocolectomy with ileal reservoir for ulcerative colitis and familial adenomatosis coli. All patients were continent and able to defecate spontaneously, stool frequency ranging from two to five per 24 hours. Anal sphincter resting pressures (35 +/- 14 mmHg) and squeeze pressures (88 +/- 24.2 mmHg) were similar to those of a healthy population, with the exception of one patient's complaint of nocturnal mucous leakage per anus. Biopsies of the ileal mucosa of the reservoirs showed a mild inflammation in seven patients; in one a subtotal villous atrophy (plus glandular pattern) was found. Anthropometric measurements, lymphocyte counts, hemoglobin, albumin, transferrin, iron, B12, and folate were normal in all. In the majority of patients there was no evidence of bacterial overgrowth. Vitamin B12 absorption was reduced slightly in only one patient. Lipid absorption (as judged by the 14C-Triolein breath test) was abnormal in three patients. Fecal clearance of alpha 1 antitrypsin as protein losses index was abnormal in three patients. Bile acid malabsorption was the most important ileal dysfunction observed in the patients.

Adenomatous Polyposis Coli↗
PubMed1985

Bowel function in an urban black African population.

Despite a low daily dietary fiber intake, an urbanized black African population in southern Africa has a low incidence of those diseases associated with fiber deficiency. Stool weights, defecation frequencies, and transit times in this group are much closer to those of westernized whites than to rural blacks.

Adult↗
PubMed2006

Constipation in children.

Constipation is a common problem throughout the world. It occurs in about 10-20% of adults in Western Countries and 0.3% to 28% of children worldwide. Most childhood constipation results from intentional withholding of stool following a painful experience with defecation. Thus, an extensive evaluation is often not necessary in a child presenting with constipation. Treatment should include education, evacuation of the rectum with oral or rectal laxatives if an impaction is present, laxatives to ensure soft stools and behavior modification.

Behavior Therapy↗
PubMed1999

Sigmoidofiberscopic incision plus balloon dilatation for anastomotic cicatricial stricture after anterior resection of the rectum.

We describe the procedure and examine the therapeutic efficacy of a combination of sigmoidofiberscopic incision plus balloon dilatation for tubular stricture by thick, long scar tissue at the colorectal anastomosis after anterior resection for rectal cancer. Balloon dilatation alone does not always relieve the strictures, although this method is the usual therapy for this condition. Five patients were identified in whom the stricture was not improved with balloon dilatation alone. Of these five patients, three complained of difficulty defecating, a feeling of incomplete evacuation, residual feces, and lower abdominal fullness. The remaining two patients, who had transverse colostomy to treat major leakage at the anastomosis, showed no symptoms. All five patients underwent the combination therapy described below. Two or three small radial incisions were made in the scar of the stricture with electrocautery under fiberscopic vision. Then the strictural scar was split and loosened bluntly along the incisions over a 15- to 20-minute period with a balloon dilator. This procedure was performed once or twice at a 2-week interval. In all five patients the stricture was improved according to objective criteria. There was also an improvement in the subjective symptoms suffered by three patients. The improvements were maintained over observation periods of 9 to 15 months. No complications were observed. Sigmoidofiberscopic incision plus balloon dilatation is an effective, safe therapy for cicatricial strictures after anterior resection for rectal cancer when the strictures have failed to improve following balloon dilatation alone.

Abdominal Pain↗
PubMed2004

[Anal sphincter replacement].

Presently, deep rectal carcinoma is usually treated by deep anterior rectal resection and colonal anastomosis. Abdominoperineal resection is needed only for the very few patients whose tumors infiltrate the pelvic base or sphincter musculature. This means the loss of normal anal function and thus of normal defecation. Many patients find the idea of a stoma unacceptable. In our experience, the construction of a functional neoanus after abdominoperineal rectal resection is a suitable option for patients in good general health and who are highly motivated.

Anal Canal↗
PubMed2004

[Functional anatomy of rectum and anus].

The anatomical structures of the rectum and anus are a functional unit designed to maintain continence mechanism. A pure anatomical description often fails to delineate this critical functional interaction. The topographic anatomy of the anorectum must be combined with an understanding of the mechanisms of anal continence and defecation, which can be transferred to clinical and especially surgical practice. The feedback-controlled reflex system of continence must be understood; it hinges on a complex interaction between the somatic and autonomic nervous systems.

Anal Canal↗
PubMed2003

On the pathogenesis of rectocele: the concept of the rectovaginal pressure gradient.

Coughing or straining evokes reflex bulbocavernosus (BCM) and puborectalis (PRM) muscle contraction, which apparently transforms the vagina into a closed high-pressure cavity. This elevated vaginal pressure counteracts the increased intra-abdominal pressure and the tendency of the uterus to prolapse, and also supports the rectovaginal septum against the high straining-induced intrarectal pressure and possible consequent rectocele (posterior vaginal prolapse) formation. We investigated the hypothesis that a weak BCM and PRM share in the genesis of rectocele by changing the rectovaginal pressure gradient. Twenty-three women with rectocele (mean age 43.2+/-6.6 years) and 12 healthy women volunteers (mean age 41.6+/-6.2 years) were studied. The response of the intrarectal (intra-abdominal) and intravaginal pressure, as well as the EMG activity of the BCM and PRM to straining or coughing, was recorded. In the healthy volunteers the rectal and vaginal pressures showed a significant increase on coughing or straining, with no significant difference between the rectal or vaginal pressures. Also, the BCM and PRM EMG activity exhibited a significant increase. Rectocele patients showed a significantly low resting vaginal pressure. The increase in rectal and vaginal pressure, as well as of the EMG activity of the BCM and PRM on straining or coughing, was significantly lower and the latency of the EMG response was significantly longer than those of the healthy volunteers. A difference in the rectovaginal pressure gradient showing a significant increase in the rectal against the vaginal pressure, particularly on coughing or straining, is suggested to be the basic factor in the genesis of rectocele. This pressure difference appears to be caused by diminished BCM and PRM contractile activity. A disrupted rectovaginal septum is not a prerequisite for rectocele formation, as the septum appears normal in obstructed defecation despite the common occurrence of rectocele. A histopathologic study of the septum in rectocele seems necessary.

Adult↗
PubMed2004

Predictive value of prolapse symptoms: a large database study.

We sought to describe the relationship between patient symptoms and pelvic organ prolapse (POP) and report the sensitivity, specificity, and positive and negative predictive value of these POP symptoms. Two urologists and four urogynecologists developed a standardized pelvic floor questionnaire based on face validation for use at three female pelvic floor disorder clinics. Specific questions related to prolapse included questions on urinary splinting, digital assistance for defecation, and a bulge per vagina. Prolapse was assessed with the standardized Pelvic Organ Prolapse Quantitative (POP-Q) terminology. The analysis included 1912 women. Urinary splinting was uncommon (< 10%) when Ba < 0, but ranged between 23 and 36% for stage III and IV Ba prolapse. Digital assistance was equally common in stage II Bp prolapse (21-38%) and stage III-IV Bp prolapse (26-29%). Only 6-11% of women with stage 0 or I POP reported symptoms of bulge, but with stage II it increased to 77%. Urinary splinting is 97% specific for anterior prolapse. The report of a bulge has an 81% positive predictive value and a 76% negative predictive value. Very few patients without anterior prolapse will report urinary splinting. Digital assistance for fecal evacuation is no more common with massive posterior prolapse than with moderate posterior prolapse. Patient report of a bulge is a valuable screening tool for POP and should prompt a careful exam.

Adolescent↗
PubMed2002

Abdominal versus vaginal approach for the management of genital prolapse and coexisting stress incontinence.

Patients who undergo surgery because of genital prolapse and coexisting stress incontinence can be treated by a combination of surgical procedures via a unified route. We performed a retrospective study among 47 patients to compare micturition, defecation and prolapse symptoms after surgery, as well as duration of hospital stay and complication rate between patients who underwent a unified vaginal or abdominal surgical correction. All patients were treated between January 1995 and December 1997 in the University Medical Center Utrecht or St Antonius Hospital Nieuwegein, The Netherlands. Abdominal surgery was associated with a higher prevalence of difficulty in bladder emptying (relative risk (RR) 2.3 (95% CI 1.4-8.4)), fecal incontinence (RR 3.4, CI 1.1-10.7) and soiling (OR 2.8, CI 1.2-6.2), as well as with a longer postoperative hospital stay (8.6 vs 7.3 days) and a higher complication rate (25.0% vs. 11.4%) than vaginal surgery. These results suggest that a unified vaginal surgical correction of genital prolapse and coexisting stress incontinence appears to be preferable to a unified abdominal surgical correction.

Aged↗
PubMed2001

Amygdala, hippocampus, and unconditioned fear.

Embedded within contemporary views of emotional learning is a well-founded agreement that the amygdala plays a pivotal role in the formation and consolidation of aversive memories formed during fear conditioning. However, it is important to determine whether observed deficits are reflective of a memory impairment or whether they are simply attributable to a deficit in the performance of unconditioned fear responses such as freezing. Within the neurobiology of learning and memory literature, there is an ongoing debate concerning the potential role of the amygdala in the performance of unconditioned fear responses. A view put forth by Vazdarjanova and McGaugh (1998) suggests that the amygdala is not required for the formation and consolidation of the aversive memories formed during fear conditioning, but is essential in the performance of unconditioned fear responses. Data provided by Maren (1999) counter this view by positing that the amygdala is not required for the performance of fear responses, but its role is of a mnemonic nature in the conditioning of fear to neutral cues. To clarify the amygdala's participation in these two processes, a useful approach would involve a situation where animals with amygdala damage were examined for their unconditioned fear responses in reaction to footshock as well as the conditioning of these reactions to previously neutral cues paired with the aversive event. We have previously reported that rats with amygdala or hippocampal damage are impaired in discriminative fear conditioning to context. In the present experiment, we report the initial unconditioned fear responses to footshock by these same animals as well as the conditioned responses during testing. In both groups, the fear responses assessed (freezing, urination, defecation, and locomotion) were not impaired and did not differ from those expressed by the sham animals. The impairment of discriminative fear conditioning to context, in combination with the present experiment, represents a dissociation where damage to specific memory structures (amygdala or hippocampus) debilitates the mnemonic processes involved in fear conditioning, but not the performance of the fear responses per se.

Amygdala↗
PubMed2001

Colonic J-pouch function at six months versus straight coloanal anastomosis at two years: randomized controlled trial.

The colonic J-pouch (pouch group) functions better than the straight coloanal anastomosis (straight group) immediately after ultra-low anterior resection, but there are few studies with long-term follow-up. This randomized controlled study compared functional outcome, anal manometry, and rectal barostat assessment of these two groups over a 2-year period. Forty-two consecutive patients were recruited, of which 19 of the straight group [17 men with a mean age of 62.1 +/- 2.3 (SEM) year] and 16 of the pouch group (11 men with a mean age of 61.3 +/- 3.2 year) completed the study. Four died from metastases and two emigrated; there was no surgical morbidity or local recurrence. At 6 months the Pouch patients had significantly less frequent stools (32.9 +/- 2.8 vs. 49 +/- 1.4/week; p < 0.05) and less soiling at passing flatus (38% vs. 73.7%; p < 0.05). At 2 years both groups had improved with no longer any differences in stool frequency (7.3 +/- 0.4 vs. 8 +/- 0.2/week) and soiling at passing flatus (38% vs. 53%). Defecation problems remained minimal in both groups. Anal squeeze pressures were significantly impaired in both groups up to 2 years (p < 0.05). The rectal maximum tolerable volume and compliance were not different between groups. Rectal sensory testing on the barostat phasic program showed impairment at 6 months and recovery at 2 years, suggesting that postoperative recovery of residual afferent sympathetic nerves may play a role in functional recovery. In conclusion, stool frequency and incontinence were less in the Pouch patients at 6 months; but after adaptation at 2 years the straight group patients yielded similar results. Nonetheless, this functional advantage can be given to patients with minimal added effort or complications by using the colonic J-pouch.

Adenocarcinoma↗
PubMedDate not supplied

Expandable metallic stent treatment for malignant colorectal strictures.

Four patients were treated by placement of an expandable metallic stent (two Gianturco Z-stents, two Ultraflex stents) for malignant colorectal strictures. All four patients were able to defecate after stent placement. Stent migration was recognized in one patient. Two patients suffered from tenesmus after stent placement.

Aged↗
PubMed2004

Bowel function after urinary diversion.

Removal of bowel segments for the purposes of urinary diversion may have a significant effect on bowel function. The remaining bowel may not be able to fulfill its normal role, resulting in not only malabsorption syndromes, but also dysfunctional defecation. Provided, however, care is taken in selecting patients and the bowel segments for such procedures and follow-up is vigilant, complications should be minimal. There appears to be a significant risk of developing symptoms of increased bowel frequency following urinary diversion and reconstruction. Patients need to be counselled regarding this prior to surgery, however, further data needs to be collected to accurately quantify the risk and the effect it has on quality of life.

Defecation↗
PubMed2004

Three digestive movements in Hydra regulated by the diffuse nerve net in the body column.

The mammalian digestive tract undergoes various digestive movements such as peristalsis and segmentation movement. How those digestive movements and the underlying mechanisms appeared in evolution remains unraveled. A widely accepted view has been that, early in evolution, the digestive process was static based upon diffusion, and later it became dynamic involving digestive movements. Here, we report digestive movements which occur in Hydra, a member of the phylum Cnidaria. We find that the body column of Hydra undergoes a series of movements when fed with Artemia. Comparison of the movements to those in mammals showed similarities in appearance to esophageal reflex, segmentation movement, and defecation reflex. When nerve cells were eliminated, polyps showed only a weak segmentation movement, demonstrating that the diffuse nerve net in the body column of Hydra primarily regulates the movements just as the netlike enteric nervous system does in mammals. Elimination of both secretory gland cells and nerve cells resulted in the complete loss of movement, suggesting that the gland cells are involved in the weak movement. Overall, these observations suggest that the digestive process in Hydra is dynamic and that the diffuse nerve net regulates the digestive movements as a primitive form of enteric nervous system.

Animals↗
PubMed1998

Anorectal function and endopelvic dissection in patients with repaired imperforate anus.

Fifty-eight patients with anorectal malformations were closely followed up for postoperative anorectal function. Constipation was noted shortly after anorectoplasty in 10 of 28 low anomalies (35.7%) treated with limited sagittal anorectoplasty (LSARP), in 18 of 25 high or intermediate anomalies (72.0%) treated with posterior sagittal anorectoplasty (PSARP), but in none of 5 high or intermediate anomalies treated with Rehbein's mucosa-stripping endorectal pull-through and anterior sagittal perineal anorectoplasty (R-ASAP). The constipation resolved mostly within 1-2 years after repair under conservative management, but persisted beyond 2 years after repair in 3/25 children with LSARP and 10/25 with PSARP. Anal soiling was noted in 1/23 (4.3%) LSARP and 6/22 (27.3%) PSARP patients, but normal anorectal function was attained in 20/23 LSARP (86.9%) and 11/12 PSARP patients (50.0%) by the time of toilet training. Manometric studies disclosed that the resting rectal pressure (RRP) was lower and the anorectal pressure gradient (ARPG) higher in the constipated than the non-constipated children, while the RRP was higher and the ARPG lower in the soiled than the non-soiled patients. The ARPG after R-ASPA was close to that of non-constipated and in between that of the constipated and soiled patients. The rectoanal sphincter inhibitory reflex was not related to defecation status or surgical procedures, but showed a tendency toward positive conversion with time or after exclusion of esctatic terminal bowel in the severely constipated. It is concluded that anorectal function in patients with repaired imperforate anus seems to be more affected by the extent of endopelvic dissection than by preservation of the terminal bowel or sphincter muscles.

Anal Canal↗