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  • 1
    Electronic Resource
    Electronic Resource
    The pharmacology of the internal anal sphincter and new treatments of ano-rectal disorders (2001)
    Oxford UK : Blackwell Science Ltd
    Alimentary pharmacology & therapeutics 15 (2001), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Surgical options for faecal incontinence in the presence of intact sphincters are limited. Furthermore, in patients with fissures, lateral sphincterotomy reduces anal sphincter hypertonia but there has been concern about complications. A greater understanding of the basic pharmacology of the internal anal sphincter has led to the development of novel treatments for both these disorders. A Medline review was undertaken for internal anal sphincter pharmacology, anal fissures and faecal incontinence. This review is based on these articles and those found by further cross-referencing.  Nitric oxide released from non-adrenergic non-cholinergic nerves is the main inhibitory agent in the internal anal sphincter. Relaxations are also mediated through β-adrenoceptors and muscarinic receptors. Stimulation of α-receptors results in contraction. Calcium and its entry through L-type calcium channels is important for the maintenance of tone. Nitric oxide donors produce reductions in resting anal tone and heal fissures but are associated with side-effects. Muscarinic agents and calcium channel antagonists show promise as low side-effect alternatives. Botulinum toxin appears more efficacious than other agents in healing fissures. To date, α-receptor agonists have been disappointing at improving incontinence.Further understanding of the pharmacology of the internal anal sphincter may permit the development of new agents to selectively target the tissue with greater efficacy and fewer side-effects.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2036.2001.00995.x
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  • 2
    Electronic Resource
    Electronic Resource
    Abnormal contractile properties of rectal smooth muscle in chronic ulcerative colitis (2000)
    Oxford UK : Blackwell Science Ltd
    Alimentary pharmacology & therapeutics 14 (2000), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Patients with ulcerative colitis have abnormal rectal motility.〈section xml:id="abs1-2"〉〈title type="main"〉Aim:To compare the contractile properties of rectal smooth muscle from patients with ulcerative colitis and controls.〈section xml:id="abs1-3"〉〈title type="main"〉Methods:Rectal smooth muscle strips from patients undergoing resection for ulcerative colitis or cancer (control) were mounted in an organ bath. The effects of carbachol (receptor–mediated) and potassium (causes membrane depolarization) were studied. Acetylcholinesterase histochemistry was performed and nerve counts compared.〈section xml:id="abs1-4"〉〈title type="main"〉Results:Ulcerative colitis (n=41) and control (n=34) strips contracted in response to potassium and carbachol. Mean (S.E.M.) maximum response to potassium in the control and ulcerative colitis groups was 1.07 (0.06) g/mg and 1.02 (0.09) g/mg tissue, respectively (P=N.S.). EC50s (concentrations required to give 50% of maximal response) were 75 (1) mM and 73 (1) mM, respectively (P=N.S.). Although maximum responses to carbachol were similar, 2.12 (0.12) g/mg and 1.95 (0.12) g/mg tissue (P=N.S.), ulcerative colitis strips exhibited an increased sensitivity to carbachol, EC50s: 5.05 × 10–6  (0.55 × 10–6) M vs. 8.36 × 10–6 (0.88 × 10–6) M, P=0.002). There was no significant difference in nerve counts between the tissues, as assessed by staining for acetylcholinesterase.〈section xml:id="abs1-5"〉〈title type="main"〉Conclusions:Ulcerative colitis tissue has an increased sensitivity to carbachol and this is not due to denervation; it may result from increased calcium release from intracellular stores since contraction due to membrane depolarization is not altered. Modulation of this pathway could potentially be used to alter rectal motility in patients with ulcerative colitis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2036.2000.00819.x
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  • 3
    Electronic Resource
    Electronic Resource
    Distribution of nitric oxide synthase containing neurons in the rectal myenteric plexus and anal canal (1994)
    Springer
    Diseases of the colon & rectum 37 (1994), S. 350-357 
    Details
    ISSN: 1530-0358
    Keywords: Rectoanal inhibitory reflex ; Nonadrenergic noncholinergic neurotransmission ; Enteric inhibitory nerves ; Nitric oxide
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Following the demonstration that a novel neurotransmitter, nitric oxide (NO), is released during neurogenic relaxation of the internal anal sphincter in vitro,it has been suggested that NO could mediate the rectoanal inhibitory reflex in vivo.The aim of this study was to establish whether the distribution of NO-producing nerves in the anorectum is consistent with this proposed role. METHODS: NO is synthesized in neurons which contain the enzyme nitric oxide synthase and their presence in the anorectum was determined in tissue obtained from nine abdominoperineal and three anterior resection specimens in patients undergoing surgery for rectal carcinoma. Cryostat sections were stained for nitric oxide synthase immunoreactivity, pan-neuronal/axonal immunoreactivity, and NADPH diaphorase activity. RESULTS: Nitric oxide synthase immunoreactivity is present in a subpopulation of neurons in rectal myenteric ganglia which also contain NADPH diaphorase activity. Use of the latter histochemical technique enabled the structure and distribution of nitric oxide synthase containing neurons to be determined in whole-mount preparations. Individual neurons have Dogiel type 1 morphology and are present throughout the rectal myenteric plexus. In the distal rectum, positively stained axons enter shunt fascicles which descend into the anal canal, where they ramify into and throughout the internal anal sphincter. Within the sphincter, positively stained nerves lie in close proximity to smooth muscle cells. CONCLUSION: These results are consistent with the hypothesis that NO is the neurotransmitter that mediates the rectoanal inhibitory reflex.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02053596
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  • 4
    Electronic Resource
    Electronic Resource
    Improvement of anal sensation with preservation of the anal transition zone after ileoanal anastomosis for ulcerative colitis (1990)
    Springer
    Diseases of the colon & rectum 33 (1990), S. 414-418 
    Details
    ISSN: 1530-0358
    Keywords: Restorative proctocolectomy ; Ileoanal anastomosis ; Anal transition zone ; Continence ; Discrimination ; Sensation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract One of the most important considerations in restorative proctocolectomy for ulcerative colitis is postoperative continence. Preservation of the anal transition zone has been associated with improved results after this procedure in the pediatric age group. This study was carried out to determine the effect of preservation of the amal transition zone in adult patients undergoing restorative proctocolectomy, comparing a group of patients with the anal transition zone preserved with a group of patients with the anal transition zone removed. Physiologic testing demonstrated improved sensation in those patients with a preserved anal transition zone. Functional results were not significantly improved, although there was a trend toward improved continence and discrimination in those with the anal transition zone preserved. Although the results are early and are not conclusive from the clinical standpoint, they are certainly encouraging and may justify continued use of this technique.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02156269
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  • 5
    Electronic Resource
    Electronic Resource
    The relationship between perineal descent and denervation of the puborectalis in continent patients (1986)
    Springer
    International journal of colorectal disease 1 (1986), S. 91-95 
    Details
    ISSN: 1432-1262
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract It has been suggested that perineal descent causes puborectalis neuropathy. To elucidate this, perineal descent was measured on standard proctograms and prolongation of mean motor unit potential duration was used as the index of denervation of the external sphincter and puborectalis in 9 male and 18 female patients with perineal descent and obstructed defaecation. The findings were compared with 21 normal controls. There was no significant perineal descent below the pubococcygeal line at rest but both males and females had abnormal descent of the anorectal angle on straining and a similar degree of external sphincter neuropathy. Females, however, exhibited a significant degree of puborectalis denervation compared with controls (p〈0.001) and with male patients (p〈0.001). Thus external sphincter denervation was associated with perineal descent in both sexes whereas other causes, of which obstetric trauma is a possibility, must be implicated in the puborectalis neuropathy of the females studied.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01648413
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  • 6
    Electronic Resource
    Electronic Resource
    Endosonography of the rectum (1986)
    Springer
    International journal of colorectal disease 1 (1986), S. 201-202 
    Details
    ISSN: 1432-1262
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01648336
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  • 7
    Electronic Resource
    Electronic Resource
    Endorectal sonography: laboratory and clinical experience in Bristol (1986)
    Springer
    International journal of colorectal disease 1 (1986), S. 212-215 
    Details
    ISSN: 1432-1262
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The normal echographic pattern produced by the colon and rectum has been investigated in vitro. Five basic ultrasonic layers or interfaces have clearly been identified; a first echogenic layer produced by the mucosa, then an echopoor layer representing the mucosa and muscularis mucosae, an echogenic layer which was submucosa, echopoor layer which was muscularis propria and an echogenic layer which was either pararectal fat or serosa. The effectiveness of endoluminal ultrasound (ELU) in the pre-operative staging of rectal cancer has been assessed in a group of 67 patients who were also, where possible, graded by digital examination and in some cases computer aided tomography (CT) (33 patients). Digital examination had an overall accuracy of 50% and could predict invasion beyond or confinement to the rectal with an accuracy of 64%. ELU is a highly accurate method for staging local invasion and when compared to post-operative histopathology had an overall correlation coefficient of 0.88 (p〈 0.001) (Rank Spearman). Our overall accuracy was 91 % and it could predict invasion beyond the muscularis propria with a sensitivity of 96%, specificity of 94% and positive predictive value of 98%. In the cohort studied by both radiological techniques ELU was more accurate than CT where overall accuracy was 79%, sensitivity was 84%, specificity was 63% and the positive predictive value was 88%.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01648339
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  • 8
    Electronic Resource
    Electronic Resource
    Intestinal haemorrhage after strictureplasty for Crohn's disease (1996)
    Springer
    International journal of colorectal disease 11 (1996), S. 180-182 
    Details
    ISSN: 1432-1262
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé. Entre 1978 et 1995, 52 patients ont subi 241 stricturoplasties de l'intestin grêle au cours de 76 interventions dans un seul centre. L'évolution postopératoire a été compliquée d'une hémorragie intestinale chez 4 patients. Dans 3 cas, le saignement a été tari par des mesures conservatrices. Le 4e patient a nécessité une relaparotomie à 2 reprises pour contrôler le saignement provenant d'un foyer de Crohn duodénal et du lieu de la stricturoplastie jéjunale proximale. La stricturoplastie est une intervention chirurgicale relativement sûre qui ne se complique qu'avec une incidence basse d'un risque hémorragique postopératoire majeur.
    Notes: Abstract. Between 1978 and 1995, a total of 52 patients have undergone 241 small intestinal strictureplasties at 76 operations in one surgical unit. The post-operative course was complicated by intestinal haemorrhage in 4 patients. In 3, the bleeding settled with conservative management. The 4th patient required laparotomy on two occasions to control bleeding from duodenal Crohn's disease and the proximal jejunal strictureplasty site, respectively. Strictureplasty is a relatively safe operation, but has a low incidence of potentially life-threatening post-operative haemorrhage.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003840050039
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  • 9
    Electronic Resource
    Electronic Resource
    An analysis of rectal morphology in obstructed defaecation (1988)
    Springer
    International journal of colorectal disease 3 (1988), S. 17-22 
    Details
    ISSN: 1432-1262
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Obstructed defaecation in the descending perineum syndrome has been attributed to anterior mucosal prolapse. Manometric and radiological measurements together with evacuation proctograms in 49 patients with obstructed defaecation and normal whole gut transit times were carried out and compared in a total of 25 controls. Proctography delineated four groups: (I) puborectalis accentuation,n=11; (II) rectal intussusception,n=25; (III) anterior rectal wall prolapse,n=11; (IV) rectocele,n=2. The anorectal angle at rest, maximum basal sphincter pressures and the rectoanal inhibitory reflex did not differ between the groups and controls. Group III achieved a greater increase in anorectal angle on straining than controls. Groups II and III exhibited significant perineal descent below the pubococcygeal line whereas group I did not. In perineal descent intussusception was the commonest morphological abnormality associated with obstructed defaecation. Isolated anterior mucosal prolapse was not observed, making local treatment aimed at reducing its bulk questionable.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01649677
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  • 10
    Electronic Resource
    Electronic Resource
    The effect of fixation conditions on the ultrastructural appearance of gastrin cell granules in the rat gastric pyloric antrum (1977)
    Springer
    Cell & tissue research 176 (1977), S. 251-263 
    Details
    ISSN: 1432-0878
    Keywords: Gastrin cells ; Electron microscopy ; Fixation ; Granule maturation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine
    Notes: Summary The ultrastructural appearance of gastrin cell (G cell) granules was studied after different fixation procedures. When the pH of prefixation was varied there was greater preservation of the electron density of granule cores after acidic (pH 5.0 and 6.0) than after neutral or alkaline (pH 7.0 and 8.0) prefixation. Increasing duration of prefixation at pH 7.3 resulted in progressive loss of electron density of the granule core with swelling and occasional rupture of the limiting membrane. In tissues where most granules had been rendered electron lucent by fixation, those granules remaining dense cored were preferentially located close to the Golgi zone. These findings indicate that the electron density of G cell granules is profoundly affected by conditions of fixation, and that immature granules are more resistant to loss of core density than mature granules. They also suggest that the gastrin granule in vivo, like other polypeptide granules, may have a “solid”, osmotically inactive core.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00229466
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