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  • 1
    ISSN: 1573-2568
    Keywords: constipation ; rectal prolapse ; rectopexy ; intestinal motility ; manometry ; evacuation proctography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The pathophysiology of constipation after rectopexy remains unclear: acquired anorectal dysfunction or preoperative colonic state are, by turns, the supposed culprit. The aim of this prospective study was to characterize the colorectal motility abnormalities encountered after such a surgical procedure. Twelve patients (10 females, 2 males, aged 50.5±5.2 years) complaining of severe constipation or its worsening after orr rectopexy (OR) for rectal prolapse were studied. Each underwent detailed interrogation as to their symptoms, left colonic manometry (basal and postprandial motor indexes and their caudad gradients in the sigmoid), anorectal manometry, evacuation proctography, and colonic transit time with radiopaque markers. Results were compared to those obtained in two control groups: 10 healthy volunteers (HV) and 12 patients complaining of a rectal prolapse (RP) observed consecutively during the same period of evaluation (June 90 to December 91). Before surgery, the OR and RP groups were similar with respect to mean age, sex ratio, weekly stool frequency, subjective dyschezia and manual anal supplies, constipation symptoms, and anal incontinence. OR patients differed significantly from the RP group in having a lower weekly stool frequency (2.5±2.2 vs 5.2±3.7,P〈0.01) and a higher prevalence of abdominal pain (7 vs 1 patients,P〈0.05). Above the rectopexy, global (135.9±38 vs 51±30.5 hr,P〈0.01) and left (61.6±10 vs 18.2 hr,P〈0.01) colonic transit times were significantly higher in OR patients; moreover, the basal motor index gradient was negative in all but one case (−94.1±101 vs 177.3±131,P〈0.01). The OR patients differed from HV by their prolonged segmental transit time in the right colon (24.2±14 vs 9.9±8.2 hr,P〈0.01) and the negative values of the postprandial colonic motor index (−191±281 mm Hg/min vs 39.8±72 mm Hg/min,P〈0.05). No postprandial peristaltic rush was observed in the OR group. Below the rectopexy, the segmental transit time in the rectosigmoid, the qualitative and quantitative rectal emptying during evacuation proctography, and the anal and rectal manometric values were not, for the most part, different between the groups. In conclusion constipation following surgical procedure of rectal prolapse seems to be related in this study to acquired sigmoid motility disturbances above the rectopexy rather than to anorectal emptying.
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  • 2
    ISSN: 1573-2568
    Keywords: Crohn's disease ; isotope scanning ; colonoscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The aim of this study was to determine whether the sensitivity of indium-111 (111In) scanning in the assessment of the activity and extent of Crohn's disease correlates with the severity of intestinal lesions as measured by the newly validated Crohn's disease endoscopic index of severity (CDEIS). Nineteen patients with active (CDAI〉200) colonic (N=11) or ileocolonic (N=8) Crohn's disease were assessed by colonoscopy and indium scanning. The intestine was divided into five segments in both studies (rectum, sigmoid and left colon, transverse colon, right colon, and ileum). Seventy of the 86 intestinal segments seen at colonoscopy presented macroscopic lesions of Crohn's disease. On third-hour scintigrams111In uptake was observed in 52 segments, 51 of which were found to be abnormal at colonoscopy. Predictive positive and negative values of scanning with respect to disease extent assessment were equal to 98% and 44%, respectively. Complete agreement between endoscopic and scintigraphic findings was observed in only six of the 19 patients (32%). Segmental endoscopic indexes of severity (SEIS) were significantly (P〈0.001) lower in false negative (7.9±4.2) (mean ±sd) than in true positive (18.0±9.7) segments as defined by scintigraphy. SEIS values above which111In uptake was constantly observed did not differ in the different disease locations. When comparing macroscopically abnormal intestinal segments according to their111In uptake grade, the corresponding mean SEIS values increased significantly as the grade increased. Scintigraphic activity, as assessed by the fall in splenic activity, was equal to 23±11% (N=19). It correlated significantly with CDEIS (r=0.63,P〈0.005), but even more so when the highest SEIS of each patient had been taken into account (r=0.75,P〈0.0005). In conclusion, when considering disease extent and activity, scanning results correlate well with the endoscopic severity of intestinal lesions in active Crohn's disease. Nevertheless, minor endoscopic lesions can be missed by111In scanning.
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  • 3
    ISSN: 1530-0358
    Keywords: Anus ; Rectum ; Rectocele ; Anismus ; Constipation ; Defecography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Herniation of the anterior rectal wall into the lumen of the vagina (so called rectocele) may be encountered in patients who complain of constipation and emptying difficulties but it is difficult to ascertain whether this anatomic abnormality is an etiologic factor or a consequence of the dyschezia. PURPOSE: The aim of our study was to assess symptomatic, anatomic, and physiologic features encountered in women with a clearly defined rectocele in order to determine the predisposing factors, symptoms, functional associations, and effects on quantified rectal emptying. METHODS: Clinical, physiologic (manometry), and anatomic (evacuation proctography) assessments were carried out in 26 consecutive women (mean age, 47.6±12 years) with dyschezia and a large rectocele as evidenced by radiography and compared with a group of 26 consecutive women complaining of dyschezia without a significant rectocele (mean age, 42.6±14 years). Both groups were similar with respect to mean age, parity, laxative abuse, manual anal evacuation, fecal incontinence, urgency, and weekly stool frequency. RESULTS: Patients having a rectocele differed significantly from those without a rectocele in having frequent endovaginal digitation during defecation (7 vs. 1,P 〈 0.05), more frequent symptoms of urinary incontinence (14 vs. 3,P 〈0.001), and a surgical history of hysterectomy (9 vs. 2,P 〈 0.05). The rectocele group differed in having a delayed rectal emptying (55.5±38 vs. 30.3±23 seconds,P 〈0.005), a more frequent incomplete rectal emptying (23 vs. 11,P 〈0.0005), and was more often associated with a manometric anismus (16 vs. 6,P 〈0.01). During the straining effort, there was a correlation between the depth of the rectocele and the duration of rectal emptying (rs=0.3,P 〈0.05). In the group without manometric anismus, women with a rectocele (n=10) had a more incomplete rectal emptying than those without rectocele (8/10 vs. 8/19,P =0.05). CONCLUSION: Some of our results indicate that the rectocele itself could be a contributory factor in difficult evacuation. These results also exhibit the importance of other disorders, such as anismus, in the occurrence of dyschezia. Physiologic examination therefore should be made before considering surgical repair in any patient with rectocele and dyschezia.
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  • 4
    ISSN: 1530-0358
    Keywords: Anus ; Pelvirectal disorders ; Constipation ; Clinical examination ; Manometry ; Evacuation proctography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We prospectively evaluated 50 patients (38 females and 12 males; mean age, 44.7±15 years) who complained of defecatory difficulties to determine the accuracy of the clinical examination in diagnosing and quantifying pelvirectal abnormalities. Each parameter was then compared with the features of anorectal manometry and evacuation proctography performed by two independent observers. Global agreement between clinical diagnosis and the reference method (radiology for rectoceles, rectal intussusceptions, and abnormal perineal descent; manometry for anismus) was observed in 80 percent of cases. In rectoceles, anismus, and rectal intussusceptions especially, excellent negative predictive values were obtained (96, 96, and 80 percent, respectively). Clinical examination always diagnosed high-grade intussusceptions. Nevertheless, abnormal perineal descent was poorly evaluated in 20 patients. When compared with anal manometry, digital assessment was able to quantify resting and squeeze pressures and length of the anal canal with excellent correlation and good global agreement as well as predicting a short or hypotonic anal canal. Clinical assessment is usually sufficient and accurate in most pelvirectal disorders encountered in patients complaining of defecatory difficulties. Both anorectal manometry and evacuation proctography retain a definite but limited place in investigating pelvirectal disorders.
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  • 5
    ISSN: 1432-2056
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology
    Notes: Summary First- and multi-year sea ice are colonized by microalgae, whose biomass modifies the spectral distribution of underice downwelling irradiance. It is proposed that an index of algal biomass in the first-year ice may be derived from the ratio of underice irradiance at a wavelength where absorption by chlorophyll a is high to a wavelength where absorption by the photosynthetic pigments is low and transmission through the ice is high. In southeastern Hudson Bay (Canadian Arctic), the irradiance ratio (671∶540 nm) accounts for 55% of the variance in chlorophyll a, indicating that the in situ biomass of algae in first-year ice can be estimated from spectral measurements of underice downwelling irradiance.
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  • 6
    ISSN: 1476-4687
    Source: Nature Archives 1869 - 2009
    Topics: Biology , Chemistry and Pharmacology , Medicine , Natural Sciences in General , Physics
    Notes: [Auszug] From 26 July to 26 August 1994, the United States and Canada conducted an interdisciplinary expedition aboard USCGC Polar Sea and CCGS Louis S. St Laurent to study the role of the Arctic Ocean in global change and the potential effects of climate change on biological production in this region. ...
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  • 7
    ISSN: 1432-0509
    Keywords: Chronic pancreatitis ; Bleeding pseudocysts ; Pseudoaneurysms ; Gastrointestinal tract ; Diagnosis and treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Pseudoaneurysms and bleeding pseudocysts are rare but life-threatening complications of chronic pancreatitis. This report summarizes our experience in 8 cases collected from among 250 patients admitted for chronic pancreatitis. We describe the radiological findings of nine vascular lesions and especially emphasize the contribution of recent radiological imaging, ultrasound and computed tomography scanning in establishing the diagnosis of vascular complication. We also report a case of successful embolization of a splenic pseudoaneurysm that ruptured into the colon.
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