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  • 1
    Electronic Resource
    Electronic Resource
    Anal sphincter repair improves anorectal function and endosonographic image (1996)
    Springer
    Diseases of the colon & rectum 39 (1996), S. 878-885 
    Details
    ISSN: 1530-0358
    Keywords: Anus ; Anal endosonography ; Anal manometry ; Fecal incontinence ; Sphincteroplasty ; Sphincter repair ; Anal ultrasound ; Soiling
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: This study investigated the effect of anal sphincter repair on fecal continence in relation to anal endosonography and anal manometry. METHODS: Eighteen patients (7 male, 11 female) with anal sphincter defects and complaints of fecal incontinence (5), soiling (= liquid discharge; 3), or both (10) were studied before and after sphincter repair with endosonography and anal manometry. Complaints were the result of obstetric trauma (7), surgical trauma (7), both (3), and other trauma (1). Five patients had previous surgery. Preoperative endosonography showed a defect of both sphincters in nine patients, a defect of the external anal sphincter in five patients, and a defect of the internal anal sphincter in four patients. An overlapping sphincter repair was performed. RESULTS: Postoperatively and subjectively (S; patient's view), 13 (72 percent) patients became continent or improved; in 5 (28 percent) patients the complaints were unaltered. Objectively (O) (incontinence or soiling frequency), these figures were 12 (67 percent) and 6 (33 percent). Postoperative endosonographic images improved in 14 (78 percent) patients; defects of the sphincters (almost) disappeared (4) or were smaller (10). In the other four patients, images were unchanged. In two patients, overlapping of the muscle was clearly visible with anal endosonography. Clinical result (subjective (S) and objective (O)) of sphincter repair correlated with changes in anal endosonography (S,r=0.64,P 〈0.004; O,r=0.51,P=0.03) and anal manometry (S,r=0.54,P=0.038; O,r=0.44,P=0.09 (not significant)) and not with pudendal nerve latency. CONCLUSION: In 78 percent of our patients, endosonographic sphincter defect had diminished or disappeared after sphincter repair. There was a good correlation between clinical effect of sphincter repair and changes with anal endosonography and anal manometry. Postoperative persistent incontinence is attributable to remaining sphincter defects. Anal endosonography should be performed as a routine procedure in patients with fecal incontinence or soiling, also after failed surgery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02053986
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  • 2
    Electronic Resource
    Electronic Resource
    Computed tomography and granulocyte scintigraphy in active inflammatory bowel disease (1996)
    Springer
    Digestive diseases and sciences 41 (1996), S. 641-650 
    Details
    ISSN: 1573-2568
    Keywords: Crohn's disease ; ulcerative colitis ; computed tomography ; granulocyte scintigraphy ; inflammatory bowel disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The accuracy of computed tomography (CT) and [99mTc]HMPAO granulocyte scintigraphy (GS) for detection of bowel localization, inflammatory activity, and complications in acute inflammatory bowel disease (IBD) was prospectively studied in 32 patients. Of each bowel segment, findings on CT and GS were scored by one blinded observer. Findings on operation or endoscopy served as the gold standard. In Crohn's disease (CD, 17 patients), CT detected bowel pathology (sensitivity 71%, specificity 98%), abscesses (sensitivity and specificity 100%), and fistulas (sensitivity 80%, specificity 100%). In CD, GS had a sensitivity of 79% and a specificity of 98% for detection of inflammatory activity. The detection of complications with GS was poor. Segmental inflammatory activity correlated with endoscopy-operative findings for CT (r=0.86,P〈0.0001) and GS (r=0.86,P〈0.0001). In ulcerative colitis (UC, 15 patients), GS predicted proximal extension of bowel involvement better than CT. In CD, CT is superior to GS for localization of both active and fibrostenotic bowel disease, and in detection of abscesses and fistulas. In UC, GS showed proximal extension more accurately than CT.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02213118
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  • 3
    Electronic Resource
    Electronic Resource
    Unsuspected sphincter defects shown by anal endosonography after anorectal surgery (1995)
    Springer
    Diseases of the colon & rectum 38 (1995), S. 249-253 
    Details
    ISSN: 1530-0358
    Keywords: Anus ; Ultrasonography ; Manometry ; Fecal incontinence ; Surgery ; Hemorrhoids ; Fistula ; Fissure-in-ano
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Anorectal surgery can lead to fecal soiling and incontinence. Whether surgery changes the anatomy and causes symptoms is unknown. Anatomic changes can be visualized by anal endosonography. METHODS: We studied 50 patients after hemorrhoidectomy (24), fistulectomy (18), and internal sphincterotomy (8). Symptoms were assessed, and anal endosonography, anal manometry, mucosal electrosensitivity, and neurophysiologic tests were performed. RESULTS: In 23 (46 percent) patients, a defect of the anal sphincter was found (13 patients had an internal sphincter defect, 1 had an external sphincter defect, and 9 had a combined sphincter defect), 3 after hemorrhoidectomy, 13 after fistulectomy, and 7 after internal sphincterotomy. Seven patients had symptoms, and they all had a sphincter defect. In the other 16 of 23 patients (70 percent), the sphincter defect did not produce symptoms. An internal sphincter defect lowered maximum basal pressure and shortened sphincter length. CONCLUSION: Anal endosonography can reveal sphincter defects after anorectal surgery. Seventy percent of the patients in this group had no complaints; therefore, defects were unsuspected. This has clinical implications in the evaluation of patients with fecal incontinence.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02055596
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Anal sensitivity test: What does it measure and do we need it? (1997)
    Springer
    Diseases of the colon & rectum 40 (1997), S. 811-816 
    Details
    ISSN: 1530-0358
    Keywords: Anal sensitivity ; Mucosal electrosensitivity ; Anal manometry ; Anal endosonography ; pudendal nerve terminal motor latency ; Fecal incontinence
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: This study was undertaken to determine the anal sensitivity in controls and in different patient groups and to establish factors that determine anal sensitivity. METHODS: Anorectal function tests were performed in 387 patients with different anorectal diseases. Anal sensitivity was measured in 36 controls. Anal sensitivity was measured by means of mucosal electrosensitivity (MES) using a catheter with two electrodes placed in the anal canal. A constant current (square wave stimuli 100 μsec, pulses per second) was increased stepwise from 1 to 20 mAmp until the threshold sensation was reached. Other tests used were anal manometry (maximum basal pressure, maximum squeeze pressure, rectal compliance (maximum rectal volume and pressure), endosonography (submucosal thickness), defects and thickness of internal and external sphincter), electromyography (maximum contraction pattern, Grade 1 (solitary contractions) to Grade 4 (interference pattern)), and pudendal nerve terminal motor latency. Multiple regression analysis was performed. It was postulated that age, local conditions (anal scars, anal fissures, hemorrhoids, mucosal prolapse, proctitis, sphincter thickness and defects, and submucosal thickness), and neurologic factors could influence anal sensitivity. RESULTS: Controls had an MES of 3.4±1.7. MES was significantly increased compared with controls in patients with fecal incontinence, soiling, hemorrhoids, mucosal prolapse, constipation, anal scars, anal surgery, and sphincter defects; patients with fecal incontinence had the highest MES (6.7±4.3;P 〈0.0001). Patients with anal fissures and proctitis showed no differences compared with controls. MES correlated significantly with age (R =0.29), maximum basal pressure (R =−0.29), maximum squeeze pressure (R =−0.32), submucosal thickness (R =0.19), maximum contraction pattern (R =−0.39), single-fiber electromyography (R =0.39), and maximum rectal volume and pressure (0.14). Multiple regression analysis showed that age, internal sphincter defects, and submucosal thickness significantly influenced anal sensitivity, but explained only 10 percent of the variance. CONCLUSION: Anal sensitivity is diminished in all patients with anorectal diseases except for anal fissures and proctitis. There are correlations with other anorectal function tests. Anal sensitivity is determined for 10 percent by age, internal sphincter defects, and thickness of the submucosa. Anal sensitivity measurement, therefore, has limited clinical value and should be used in conjunction with other tests in a research setting.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02055438
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  • 5
    Electronic Resource
    Electronic Resource
    Rectal compliance as a routine measurement (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 1732-1738 
    Details
    ISSN: 1530-0358
    Keywords: Rectal compliance ; Rectal capacity ; Rectal visceral sensitivity ; Proctitis ; Pouchitis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: The clinical impact of rectal compliance and sensitivity measurement is not clear. The aim of this study was to measure the rectal compliance in different patient groups compared with controls and to establish the clinical effect of rectal compliance. METHODS: Anorectal function tests were performed in 974 consecutive patients (284 men). Normal values were obtained from 24 controls. Rectal compliance measurement was performed by filling a latex rectal balloon with water at a rate of 60 ml per minute. Volume and intraballoon pressure were measured. Volume and pressure at three sensitivity thresholds were recorded for analysis: first sensation, urge, and maximal toleration. At maximal toleration, the rectal compliance (volume/pressure) was calculated. Proctoscopy, anal manometry, anal mucosal sensitivity, and anal endosonography were also performed as part of our anorectal function tests. RESULTS: No effect of age or gender was observed in either controls or patients. Patients with fecal incontinence had a higher volume at first sensation and a higher pressure at maximal toleration (P=0.03), the presence of a sphincter defect or low or normal anal pressures made no difference. Patients with constipation had a larger volume at first sensation and urge (P〈0.0001 andP〈0.01). Patients with a rectocele had a larger volume at first sensation (P=0.004). Patients with rectal prolapse did not differ from controls; after rectopexy, rectal compliance decreased (P〈0.0003). Patients with inflammatory bowel disease had a lower rectal compliance, most pronounced in active proctitis (P=0.003). Patients with ileoanal pouches also had a lower compliance (P〈0.0001). In the 17 patients where a maximal toleration volume〈60 ml was found, 11 had complaints of fecal incontinence, and 6 had a stoma. In 31 patients a maximal toleration volume between 60 and 100 ml was found; 12 patients had complaints of fecal incontinence, and 6 had a stoma. Proctitis or pouchitis was the main cause for a small compliance. All 29 patients who had a maximal toleration volume〉500 ml had complaints of constipation. No correlation between rectal and anal mucosal sensitivity was found. CONCLUSION: Rectal compliance measurement with a latex balloon is easily feasible. In this series of 974 patients, some patient groups showed an abnormal rectal visceral sensitivity and compliance, but there was an overlap with controls. Rectal compliance measurement gave a good clinical impression about the contribution of the rectum to the anorectal problem. Patients with proctitis and pouchitis had the smallest rectal compliance. A maximal toleration volume〈60 ml always led to fecal incontinence, and stomas should be considered for such patients. A maximal toleration volume〉500 ml was only seen in constipated patients, and therapy should be given to prevent further damage to the pelvic floor. Values close to or within the normal range rule out the rectum as an important factor in the anorectal problem of the patient.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02236859
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