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  • 1
    Electronic Resource
    Electronic Resource
    Unilateral pudendal neuropathy (1996)
    Springer
    Diseases of the colon & rectum 39 (1996), S. 249-251 
    Details
    ISSN: 1530-0358
    Keywords: Pudendal neuropathy ; Pelvic floor ; Fecal incontinence ; Computerized anal manometry ; Pudendal nerve terminal motor latency
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Obstetric trauma and excessive defecatory straining with perineal descent may lead to pudendal neuropathy with bilateral increase in pudendal nerve terminal motor latencies (PNTML). We have frequently observed unilateral prolongation of PNTML. Diagnostic and therapeutic implications of unilateral pudendal neuropathy are discussed. METHODS: Records of 174 patients referred to pelvic floor laboratory for anorectal manometry and PNTML testing were reviewed. Computerized anal manometry was performed using dynamic pressure analysis, and PNTML was determined using a pudendal (St. Mark's) electrode. RESULTS: No response was elicited from pudendal nerves to electric stimulation from both sides in 14 patients (8 percent) and from one side in 24 patients (13.8 percent). Bilateral PNTML determination was possible in only 136 patients (78 percent), of whom 83 patients (61 percent) had no evidence of neuropathy, revealing normal PNTML on both sides. Of 53 patients (39 percent) with delayed conduction in pudendal nerves, in 15 patients (28 percent), PNTML was abnormally prolonged on both sides, with an abnormal mean value for PNTML. In the remaining 38 patients (72 percent), PNTML was abnormal on one side: in 27 patients with an abnormal mean PNTML and in 11 patients with a normal mean PNTML. CONCLUSIONS: A significant number of patients with pelvic floor disorders have only unilateral pudendal neuropathy. Patients with unilaterally prolonged PNTML should be considered to have pudendal neuropathy, despite normal value for mean PNTML. This fact may be relevant in planning surgical treatment and in predicting prognosis of patients with sphincter injuries.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02049459
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  • 2
    Electronic Resource
    Electronic Resource
    Unilateral pudendal neuropathy (1996)
    Springer
    Diseases of the colon & rectum 39 (1996), S. 686-689 
    Details
    ISSN: 1530-0358
    Keywords: Unilateral pudendal neuropathy ; Anal manometry ; Fecal incontinence
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Our purpose was to study the effect of unilateral pudendal neuropathy on the results of anal sphincter repair. METHOD: Fifteen female patients who underwent external sphincter repair for fecal incontinence were studied. In all instances, incontinence was the result of obstetric delivery injury. Anal manometry and neurophysiologic investigations to document sphincter defects and pudendal neuropathy were performed in all patients. Sphincter repair was performed using an overlapping suture technique. RESULTS: All patients had anterior sphincter defects. Seven patients (47 percent) had pudendal neuropathy: six (85 percent) had unilateral neuropathy, and one (15 percent) had bilateral neuropathy. Six patients (40 percent) had excellent results; three (20 percent) had good results; four (27 percent) were improved; two (13 percent) experienced no improvement after sphincter repair. All patients with excellent results had normal pudendal nerve terminal motor latency on both sides. Of the three patients with good results, one patient had unilateral pudendal neuropathy. The patients in the remaining two groups (improved and failed) had unilateral (six patients) or bilateral (one patient) pudendal neuropathy. CONCLUSION: We conclude that both pudendal nerves must be intact to achieve normal continence after sphincter repair. Patients with unilateral pudendal neuropathy are more likely to have poor than to have good postoperative function.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02056951
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  • 3
    Electronic Resource
    Electronic Resource
    Can manometric parameters predict response to biofeedback therapy in fecal incontinence? (1995)
    Springer
    Diseases of the colon & rectum 38 (1995), S. 1021-1025 
    Details
    ISSN: 1530-0358
    Keywords: Biofeedback therapy ; Fecal incontinence ; Obstetric trauma ; Anal canal ; High-pressure zone ; Cross-sectional asymmetry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02133972
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  • 4
    Electronic Resource
    Electronic Resource
    Distal rectoanal excitatory reflex: A reliable index of pudendal neuropathy? (1995)
    Springer
    Diseases of the colon & rectum 38 (1995), S. 916-920 
    Details
    ISSN: 1530-0358
    Keywords: Pudendal neuropathy ; Fecal incontinence ; Manometry ; Rectoanal excitatory reflex ; Pudendal nerve terminal motor latency ; Electromyography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Denervation of the extrinsic anal sphincter and pudendal neuropathy are confirmed by electrophysiologic or electromyographic testing, techniques that may not be available universally and require special equipment and training. A simple manometric test that is easy to perform and complements existing studies was performed to confirm pudendal neuropathy. METHODS: Fourteen patients with excessive defecatory straining and 30 patients with idiopathic fecal incontinence were studied by electrophysiology and balloon reflex manometry. Pudendal nerve terminal motor latency (PNTML) and rectoanal excitatory reflex were evaluated for abnormalities. Results were compared with 20 controls who had no anorectal complaints and who had similar testing performed. RESULTS: In controls, PNTML was normal in all but one person. Rectoanal excitatory reflex could be elicited in all controls with either 20 or 40 ml of air. Four different types of balloon reflex responses were observed in patient groups: diminutive excitation, delayed excitation, excitation at high volume of distention only, and absent excitation. Ten patients with fecal incontinence had normal PNTML but abnormal distal excitatory reflex, 5 patients had abnormal PNTML but normal distal excitatory reflex, and 15 patients had both PNTML and excitatory reflex that were abnormal. In patients with excessive defecatory straining, results of both tests were abnormal in six patients, and eight patients had abnormal excitatory reflex but normal PNTML. CONCLUSION: Pudendal neuropathy may result in abnormalities of excitatory reflex morphology or other characteristics. Abnormal distal excitatory reflex may complement electrophysiologic findings or may serve as a suitable alternative to confirm pudendal neuropathy in centers where facilities for formal testing are not available.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02049725
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  • 5
    Electronic Resource
    Electronic Resource
    Biofeedback training is useful in fecal incontinence but disappointing in constipation (1994)
    Springer
    Diseases of the colon & rectum 37 (1994), S. 1271-1276 
    Details
    ISSN: 1530-0358
    Keywords: Biofeedback ; Fecal incontinence ; Nonrelaxing puborectalis ; Constipation ; Manometry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract BACKGROUND: Successful biofeedback therapy has been reported in the treatment of fecal incontinence and constipation. It is uncertain which groups of incontinent patients benefit from biofeedback, and our impression has been that biofeedback is more successful for incontinence than for constipation. PURPOSE: This study was designed to review the results of biofeedback therapy at the Lahey Clinic. METHODS: Biofeedback was performed using an eightchannel, water-perfused manometry system. Patients saw anal canal pressures as a color bar graph on a computer screen. Assessment after biofeedback was by manometry and by telephone interview with an independent researcher. RESULTS: Fifteen patients (13 women and 2 men) with incontinence underwent a mean of three (range, 1–7) biofeedback sessions. The cause was obstetric (four patients), postsurgical (five patients), and idiopathic (six patients). Complete resolution of symptoms was reported in four patients, considerable improvement in four patients, and some improvement in three patients. Manometry showed a mean increase of 15.3 (range, −3–30) mmHg in resting pressure and 35.7 (range, 13–57) mmHg in squeezing pressure after biofeedback. A successful outcome could not be predicted on the basis of cause, severity of incontinence, or initial manometry. Twelve patients (10 women and 2 men) with constipation underwent a mean of three (range, 1–14) biofeedback sessions. Each had manometric evidence of paradoxic nonrelaxing external sphincter or puborectalis muscle confirmed by defography or electromyography. All patients could be taught to relax their sphincter in response to bearing down. Despite this, only one patient reported resolution of symptoms, three patients had reduced straining, and three patients had some gain in insight. CONCLUSIONS: Biofeedback helped 73 percent of patients with fecal incontinence, and its use should be considered regardless of the cause or severity of incontinence or of results on initial manometry. In contrast, biofeedback directed at correcting paradoxic external sphincter contraction has been disappointing.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02257795
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  • 6
    Electronic Resource
    Electronic Resource
    Dietary retinoids and carotenoids in rodent models of mammary tumorigenesis (1997)
    Springer
    Breast cancer research and treatment 46 (1997), S. 181-189 
    Details
    ISSN: 1573-7217
    Keywords: breast cancer ; carcinogenesis ; carotenoids ; chemoprevention ; differentiation ; in vivo ; retinoids
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In this review of the scientific literature the relationship between retinoids, carotenoids, and mammary carcinogenesis is examined. Several retinoids have shown promise as chemopreventive agents against chemically induced mammary carcinogenesis in mice and especially in rats. The most promising retinoids are retinyl acetate (RA) and N-(4-hydroxyphenyl)retinamide (4-HPR, fenretinide). In rats, dietary administration of these retinoids reduced tumor incidence and multiplicity, and increased the latency of DMBA or MNU-induced mammary cancers. In mice, 4-HPR reduced the number of hyperplastic alveolar nodules and the number of tumors in MTV- and MTV+ mice, respectively. Among retinoids, 4-HPR is at present the most promising analogue, due to its ability to concentrate in the mammary gland. The combination of 4-HPR with tamoxifen not only is more effective in suppressing breast cancer than either agent alone, but also inhibits the appearance of subsequent cancers following the surgical removal of the first tumor. These studies suggest that retinoids, like tamoxifen, may be applicable to the prevention of contralateral breast cancer in women who underwent breast cancer surgery. It is also becoming evident that differentiation therapy and chemoprevention can become attractive alternative approaches to intensive cytotoxic chemotherapy. The role of carotenoids in the prevention of mammary carcinogenesis, however, is ambiguous. Poor absorption and low levels of carotenoids that reach the target tissues complicate interpretation of data in rodent models of mammary carcinogenesis. Very few animal studies are presently available in which purified carotenoids were found effective against mammary carcinogenesis. These results do not justify undertaking clinical evaluation of individual carotenoids against breast cancer at this time.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1005995925246
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  • 7
    Electronic Resource
    Electronic Resource
    Intermediate endpoint biomarkers for chemoprevention (1992)
    New York, N.Y. : Wiley-Blackwell
    Journal of Cellular Biochemistry 50 (1992), S. 93-110 
    Details
    ISSN: 0730-2312
    Keywords: bladder cancer ; chemoprevention ; F-actin ; G-actin ; intermediate biomarker ; intermediate endpoint biomarker ; Life and Medical Sciences ; Cell & Developmental Biology
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Biology , Chemistry and Pharmacology , Medicine
    Notes: The understanding of intermediate endpoint biomarker expression in relation to the sequential events in bladder tumorigensesis establishes a useful approach for evaluating chemopreventive agents. Biomarkers may be genotypic or phenotypic and function as biomarkers of susceptibility, expouser, effect, or disease. This paper reviews serverla years or reserach on biomarkers and their use in monitoring chemoprevention therapy. In initial animal experimnets, mice were doesed with N-butyl-N-(4-hydroxybutyl) nitrosamine(OH-BBN) while co-administering N(4-hydroxyphenyl) retinamide (4-HPR). 4-HPR did not statistically reduce tumor incidence, but did affect tumor dfferentiation and consequently, nuclear size and DNA ploidy. These results suggest that nuclear size and ploidy may function as intermediate endpoint biomarkers of effect for oncogenesis and that epigenetic as well as genetic mechanisms may be primary in the oncogenic proces. Early biomarkers of effect which occur prior to genetic effects or chromosome aberration may portend a higher probability of being modulated by differentiating agents such as retinoids. In vitro studies demonstrated that RPMI-7666 cells cultured with a phorbol ester tumor promoter (12O-tetradecanoyl-phorbol-13-acetate) could be redifferentiatee with 13-cis-retinoic acid and dimethyl sulfoxide (DMSO). F-Actin, A cytoskeltal biomerker with a presumed function in the epigenetic mechanisms of carcinogenesis, could also be normalized in HL-60 cells treated with 4-HPR or DMSO.A clinical evaluation of F-actin in patients whith varying degrees of risk confirmed the value of F-actin as a differentiating biomarker useful for bladder cancer risk assessment. The clarification of when the photypic changes of F-acting occur in biomerker useful for bladder cancer risk assessment. The clarification of when the phenotypic changes of F-actin occur in the oncogenic process was achieved when a variety of biochemical changes were mapped in the patients with bladder cancer. There stuides confirmed that G-acting, a reciprocal form of F-actin, is increased relatively early in bladder cancer oncogenesis when multiple biomarkers are quantiated in the field, adjacent area, and the tumor. Comparison of each individual biomarker's expression from field, adjacent to tumor, and tumor, and subsequent cluster analysis of these biomarkers, indicated that the possible sequences of phenotypic expression of biomarkers in bladder cancer oncogenesis is from G-actin, to p300 antigen, to epidermal growth factor receptor (EGFR), to p185, (neu oncogene product), to DNA aneuploidy and family, finally, to visual morphology. To date, a bettery of three biomarkers, G-actin, M344, and DNA, with routine cytology has been used to monitor eleven patients receiving Bacillus Calmette-Guerin(BCG) immunotherapy and eight patients clinically free of bladder cancer (negative cytology and biopsy) who were treated with differentiation agent, DMSO. These results indicate that G-actin may be useful biomarker for evaluating the efficacy of chemopreventive agents. © 1992 Wiley-Liss, Inc.
    Additional Material: 7 Ill.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1002/jcb.240501320
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  • 8
    Electronic Resource
    Electronic Resource
    Chemoprevention of exprimental bladder cancerAcknowledgment: This work was supported in part by the National Cancer Institute, Contracts N01-CN-55448-06 and N01-CN-85097-02. (1992)
    New York, N.Y. : Wiley-Blackwell
    Journal of Cellular Biochemistry 50 (1992), S. 134-138 
    Details
    ISSN: 0730-2312
    Keywords: bladder cancer ; chemoprevention ; MNU ; model systems ; mouse ; OH-BBN ; rat ; retinoids ; Life and Medical Sciences ; Cell & Developmental Biology
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Biology , Chemistry and Pharmacology , Medicine
    Notes: The chemopreventive efficacy of several compounds was evaluated in the N-butyl-N-(4-hydroxybuty) introsamine (OH)-BBN)-induced urinary bladder cancer model using C57BL/6xDBA/2F1 (BDF) male mice. Compounds were administered in a defined semipurified diet (AIN-76-A) either as single agents orin combination. As single agents and at the doses emplyed, 2-α-difluoromethylornithine (DFMO), piroxicam, oltpraz, and sodium moybdate effectively inhibited the incidence of trasitional cell carcinoma (TCC). 4-Hydroxyphenyl retinamide (4-HPR) was ineffective. Body weight gain and survival was not affected by thedoses of agents used. Combinations of two agents which increased efficacy were 4-HPR+DFMO, DFMO+piroxicam, 4-HPR+oltipraz, and DFMO+oltiprz. Three-agent combinations which showed enhanced efficacy against TCC induction were 4-HPR+Namolybdate+DFMO, 4-HPR+DFMO+piroxicam, and 4-HPR+DFMO+oltipraz. Although the three-agent combinations were, for the most part, no more effective than the two-agent combinations at the doses employed, all combination regmens signicantly reduced bladder incidence even when single agent administration did not. © 1992 Wiley-Liss, Inc.
    Additional Material: 1 Tab.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1002/jcb.240501326
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  • 9
    Electronic Resource
    Electronic Resource
    Preclinical efficacy evaluation of potential chemopreventive agents in animal carcinogenesis models: Methods and results from the NCI chemoprevention drug development program (1994)
    New York, N.Y. : Wiley-Blackwell
    Journal of Cellular Biochemistry 56 (1994), S. 32-54 
    Details
    ISSN: 0730-2312
    Keywords: Animal models ; carcinogenesis ; chemoprevention ; drug development ; Life and Medical Sciences ; Cell & Developmental Biology
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Biology , Chemistry and Pharmacology , Medicine
    Notes: In the NCI, Chemoprevention Branch drug development program, potential chemopreventive agents are evaluated for efficacy against chemical carcinogen-induced tumors in animal models. This paper summarizes the results of 144 agents in 352 tests using various animal efficacy models. Of these results, 146 were positive, representing 85 different agents.The target organs selected for the animals model are representative of high-incidence human cancers. The assays include inhibition of tumors induced by MNU in hamster trachea, DEN in hamster lung, AOM in rat colon (including inhibition of AOM-induced aberrant crypts), MAM in mouse colon, DMBA and MNU in rat mammary glands, DMBA promoted by TPA in mouse skin, and OH-BBN in mouse bladder.The agents tested may be classified into various pharmacological and chemical structural categories that are relevant to their chemopreventive potential. These categories include antiestrogens, antiinflammatories (e. g., NSAIDs), antioxidants, arachidonic acid metabolism inhibitors, GST and GSH enhancers, ODC inhibitors, protein kinase C inhibitors, retinoids and carotenoids, organosulfur compounds, calcium compounds, vitamin D3 and analogs, and phenolic compounds (e. g., flavonoids). The various categories of compounds have different spectra of efficacy in animal models. In hamster lung, GSH-enhancing agents and antioidants appear to have high potential for inhibiting carcinogenesis. In the colon, NSAIDs and other antiinflammatory agents appear particularly promising. Likewise, NSAIDs are very active in mouse bladder. In rat mammary glands, retinoids and antiestrogens (as would be expected) are efficacious. Several of the chemicals evaluated also appear to be promising chemopreventive agents based on their activity in several of the animal models. Particularly, the ODC inhibitor DFMO was active in the colon, mammary glands, and bladder models, while the dithiolthione, oltipraz, was efficacious in all the models listed above (i. e., lung, colon, mammary glands, skin, and bladder). 1994 Wiley-Liss, Inc.This article is a US Government work and, as such, is in the public domain in the United States of America.
    Additional Material: 1 Tab.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1002/jcb.240560905
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