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  • 1
    Electronic Resource
    Electronic Resource
    Slow-transit constipation (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 231-240 
    Details
    ISSN: 1530-0358
    Keywords: Constipation ; Colonic inertia ; Autonomic neuropathy ; Gastrointestinal motility ; Stomach ; Gallbladder motility
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract INTRODUCTION: Autonomic neuropathy is thought to play a role in the pathogenesis of slow-transit constipation, but other gastrointestinal organs may also be involved, even if they are symptom-free. We investigated whether motility in gastrointestinal organs other than the colon was impaired in patients with slow-transit constipation and whether the autonomic nervous system was involved. METHODS: Twenty-one consecutive patients (18 females; median age, 46 years) with severe chronic constipation (≤2 defecations/week and delayed colonic transit time) were studied. Autonomic neuropathy function was tested with esophageal manometry, gastric and gallbladder emptying (fasting and postprandial motility) by ultrasonography, orocecal transit time (H2-breath test), colonic transit time (radiopaque markers), and anorectal volumetric manometry. The integrity of the autonomic nervous system was assessed by a quantitative sweat-spot test for preganglionic and postganglionic fibers, tilt-table test, and Valsalva electrocardiogram R-R ratio. RESULTS: Esophageal manometry showed gastroesophageal reflux or absence of peristalsis in five of the seven patients examined. Gallbladder dysmotility (i.e., increased fasting, postprandial residual volume, or both) was observed in 6 of 14 (43 percent) patients. Gastric emptying was decreased in 13 of 17 (76 percent) patients. Orocecal transit time was delayed in 18 of 20 (90 percent) patients; median transit time was 160 (range, 90–200) minutes. Median colonic transit time was 97 (range, 64–140) hours. Anorectal function showed abnormal rectoanal inhibitory reflex and decreased rectal sensitivity in 11 of 19 (58 percent) patients. Signs of autonomic neuropathy of the sympathetic cholinergic system were found in 14 of 18 (78 percent) patients. Only one of nine patients had vagal abnormalities detected with the Valsalva test and four of five patients with a history of orthostatic hypotension had a positive tilt-table test. CONCLUSIONS: Slow-transit constipation may be associated with impaired function of other gastrointestinal organs. More than 70 percent of patients with slow-transit constipation present some degree of autonomic neuropathy. Severe constipation may be the main complaint in patients with a systemic disease involving several organs and possibly involving the autonomic nervous system. This should be considered in the management of such cases.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02237134
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  • 2
    Electronic Resource
    Electronic Resource
    Treatment of external anorectal mucosal prolapse with circular stapler (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 1102-1105 
    Details
    ISSN: 1530-0358
    Keywords: Rectal mucosal prolapse ; Stapler
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: The aim of this study was to demonstrate the feasibility, effectiveness, and reliability of a new technique for treating overt rectal mucosal prolapse using a stapler device. METHODS: Eighteen consecutive patients with overt rectal mucosal prolapse were selected for the study. Preoperative anal manometry and cinedefecography demonstrated no anal incontinence and the absence of full-thickness rectal prolapse. One or two purse strings were prepared 3 to 4 cm distally to the dentate line and tied on a 33 mm circular stapler introduced through the anus and then fired. RESULTS: The operation lasted an average of 15 minutes, and no local complications were recorded. Supplementary hemostatic sutures (2 to 6 stitches) were sometimes necessary. Seven patients did not require postoperative analgesia, whereas eight patients received one or two administrations of analgesics. Longer-lasting analgesic treatment (4 days) was necessary in only three patients. Sixteen patients were discharged after 48 hours, and only 1 after four days because of pulmonary infection. Patients resumed normal activities after a median period of three days. Median follow-up was 20 months. The prolapse was eliminated in all cases. No stricture was found at anal exploration, and no episodes of anal incontinence or bleeding were recorded. Postoperative manometry did not show significant changes compared with preoperative findings. CONCLUSIONS: This new surgical technique is safe, effective, and rapid, causing minimum or no postoperative pain and could be proposed to replace traditional surgery for this common condition.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02236713
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Glyceryl trinitrate for chronic anal fissure—Healing or headache? (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 174-179 
    Details
    ISSN: 1530-0358
    Keywords: Chronic anal fissure ; Glyceryl trinitrate ; Nitric oxide ; Randomized double-blind clinical trial
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Internal anal sphincterotomy for treating chronic anal fissure can irreversibly damage anal continence. Reversible chemical sphincterotomy may be achieved by anal application of glyceryl trinitrate ointment (nitric oxide donor), which has been reported to heal the majority of patients with anal fissure by inducing sphincter relaxation and improving anodermal blood flow. This trial aimed to further clarify the role of glyceryl trinitrate in the treatment of chronic anal fissure. METHODS: A total of 132 consecutive patients from nine centers were randomly assigned to receive 0.2 percent glyceryl trinitrate ointment or placebo twice daily for at least four weeks. The severity of pain and maximum anal resting pressure were measured before and after one week of treatment. Anodermal blood flow was measured before and after application of glyceryl trinitrate or placebo in ten patients. RESULTS: The study was completed by 119 patients (59 glyceryl trinitrate and 60 placebo), matched for gender, age, duration of symptoms, duration of treatment, site of fissure, previous attempts to treat, pain score, and maximum anal resting pressure. Twenty-nine patients (49.2 percent) healed after glyceryl trinitrate and 31 patients (51.7 percent) healed after placebo (P= not significant). Pain score fell significantly in both groups, in addition to maximum anal resting pressure. Anodermal blood flow improved significantly in seven patients receiving glyceryl trinitrate, but not in the three receiving placebo. Twenty-three patients (33.8 percent) experienced headache and 4 (5.9 percent), orthostatic hypotension after glyceryl trinitrate. CONCLUSION: This trial fails to demonstrate any superiority of topical 0.2 percent glyceryl trinitrate treatmentvs. a placebo, although the effects of glyceryl trinitrate on anodermal blood flow and sphincter pressure are confirmed. This finding, together with the high incidence of side-effects, should discourage the use of this treatment as a substitute for surgery in chronic anal fissure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02236977
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Structure of dipotassium 5,6-dihydrouracil-6,6-disulfonate monohydrate (1993)
    Springer
    Journal of chemical crystallography 23 (1993), S. 981-985 
    Details
    ISSN: 1572-8854
    Source: Springer Online Journal Archives 1860-2000
    Topics: Geosciences , Physics
    Notes: Abstract The title compound was synthesized and its crystal structure determined by single crystal X-ray diffraction techniques. It crystallizes in the monoclinic system witha=9.390(1),b=9.688(2),c=13.828(3)Å,β=110.16(2)°, space groupP21/c,Z=4. The structure was solved by direct methods and refined by full-matrix least-squares calculations toR=0.032 for 1968 reflections withI〉3σ(I) [MoKα radiation]. The six-membered ring of the 5,6-dihydrouracil-6,6-disulfonate dianion displays an approximate skew-boat conformation, but the ring puckering differs from that commonly observed in 5,6-dihydrouracil derivatives. The coordination to two crystallographically independent K+ ions which exhibit different coordination geometries links anions, cations and water molecules in an infinite three-dimensional network.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01185547
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    Paper (German National Licenses)
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