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  • 1
    Electronic Resource
    Electronic Resource
    Morphology of dynamic graciloplasty compared with the anal sphincter (1993)
    Springer
    Diseases of the colon & rectum 36 (1993), S. 559-563 
    Details
    ISSN: 1530-0358
    Keywords: Fecal incontinence ; Dynamic graciloplasty ; Fast, slow-twitch skeletal muscle ; Electrical stimulation ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Dynamic graciloplasty for fecal incontinence includes gracilis muscle transposition around the anal canal as a new sphincter and subsequent electrical stimulation. The aim of electrical stimulation is to transform the gracilis fast-twitch, “fatigue-prone” fibers into slow-twitch, “fatigue-resistant” fibers to achieve a sustained tonic contraction. The latter is considered essential for sphincter function. Therefore, the following features of transposed gracilis muscle morphology were studied in nine patients before and after electrical stimulation: 1) the percentage of Type I fibers, 2) the lesser diameter of these fibers, and 3) the positive collagen staining area. Furthermore, the external anal sphincter and gracilis muscle histology was investigated in six autopsy cases. The mean percentage of Type I, slow-twitch, fatigue-resistant fibers in transposed gracilis muscle increased from 46 percent before electrical stimulation to 64 percent (P 〈0.01, paired Student's t-test) after electrical stimulation. The mean lesser diameter of these fibers did not change significantly (from 32 to 29 μm), and the mean percentage of collagen increased from 4 percent before electrical stimulation to 7 percent (P 〈0.01) afterward. The external sphincter in cadavers demonstrated a predominance of Type I fibers (80 percent) with a lesser diameter of 23 μ m and a high percentage (12 percent) of collagen. Gracilis muscle histology was uniform at six different sample sites in these cadaver dissections. We conclude that electrical stimulation induces histologic changes in transposed gracilis muscle, allowing this muscle to function as an external anal sphincter.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02049862
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Feasibility of stoma continence, using electrically stimulated rectus abdominis muscle in pigs (1993)
    Springer
    Diseases of the colon & rectum 36 (1993), S. 247-253 
    Details
    ISSN: 1530-0358
    Keywords: Stoma ; Fecal incontinence ; Fast-twitch and slow-twitch muscle fibers ; Electrical stimulation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To develop surgical techniques to obtain stoma continence with a muscular sphincter, the anatomy (especially innervation and vascularization patterns) of the human abdominal wall muscles was studied in three cadaver dissections. It was found that transposed rectus abdominis muscle might be positioned as a new sphincter (sphincteroplasty). Next, the feasibility was assessed in six pigs, and the rectus muscle was positioned as a sphincter around a Thiry Vella loop. The use of three different surgical procedures has been assessed: 1) a muscular ring of the proximal rectus was constructed and partly denervated the muscle; 2) the distal end of the Thiry Vella loop was pulled through the middle of the rectus muscle, thereby also introducing partial muscle denervation; and 3) a sling was constructed using the distal muscle part. In four of these six pigs, identical procedures were performed also at the left side. These new sphincters were electrically stimulated (with implanted stimulation devices) to study the feasibility of prolonged sphincter contraction independent of will. Stimulation with a frequency of 25 Hz was used at the right and 2 Hz was used at the left sphincters. It was found that electrical stimulation with a frequency of 25 Hz as well as 2 Hz increased the percentage of Type I (relatively fatigue-resistant) muscle fibers significantly from 42 to 65 percent (n = 6) in the right and from 50 to 67 percent (n = 4) in the left rectus muscle into innervated muscle areas of the sphincters. This increase is considered essential for sustained sphincter function. Stoma continence was not achieved because constructing muscular rings (as a sphincter) caused partial atrophy. Construction of a sling using the distal part of the rectus did not cause substantial atrophy, but continence was not achieved because the dorsal side of the Thiry Vella loop was not completely covered with muscle fibers.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02053505
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
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