SUMMARY Forty seven healthy young volunteers underwent defecographic examination to determine the range of normal findings. Normality was shown to encompass radiological features often considered pathological. These features included broad ranges of anorectal angle and pelvic floor descent which overlap with reported pathological states. Furthermore, the formation of rectocoeles during defecation was a very common finding in women. Finally, a subgroup of the volunteers had marginal anorectal function. The marginal anorectal function and certain radiological findings such as rectocoeles or intussusceptions may predispose to later problems, or contribute to clinical problems when combined with other factors such as dietary fibre deficiency. The radiological findings raise a number of questions with respect to different aspects of the functioning of the continence and defecation mechanisms.There has recently been increased interest in the investigation of problems of defecation and pelvic floor dysfunction using defecography (evacuation proctography). This procedure was first described by Burhenne in 1964' and April, 1986. Volunteers were recruited from the student population of the University of Toronto through advertisement at the Student Placement Offices. The recruiting advertisements explained only that the study was gastroenterological in nature and respondents were fully briefed when they applied. The respondents were excluded from the study if older than 35 years of age or there was a history of faecal incontinence, difficulties in defecation or past history of anorectal surgery. Forty eight subjects completed the study (23 women, 21 (1.6) (SD) yr; 25 men, 26 (4-8) yr). All the women were nulliparous.All subjects completed detailed questionnaires related to gastrointestinal and somatic symptoms, health habits and beliefs, affective status, and cognitive function. These details are not reported in this paper except as relates to the subjective report of bowel function.
Sickle cell disease results from the presence of abnormal beta globin chains within hemoglobin and may be manifested in anemia, vaso-occlusion, and superimposed infection. The gene that causes sickle cell disease is particularly prevalent in populations of African origin; approximately 8% of African Americans and 40% of the members of some African tribes carry the gene for hemoglobin S. Over time, the disease produces various musculoskeletal abnormalities as a result of chronic anemia; these include marrow hyperplasia, reversion of yellow marrow to red marrow, and, occasionally, extramedullary hematopoiesis. Familiarity with the imaging features of sickle cell disease is important for the diagnosis and management of complications. Ischemia and infarction are common complications that may have long-term effects on the growth of bone; these conditions have characteristic radiographic appearances. Infection may be more difficult to identify. Both infection and infarction may occur in muscle and soft tissue alone, without involving bone. However, osteomyelitis must be diagnosed early and treated immediately to prevent bone destruction and deformity; therefore, care must be taken to achieve an accurate diagnosis by identifying or excluding bone involvement. The clinical and radiographic features of acute osteomyelitis may be particularly difficult to distinguish from those of bone infarction. In that context, magnetic resonance (MR) imaging may be useful. At MR imaging, findings of cortical defects, adjacent fluid collections in soft tissue, and bone marrow enhancement are suggestive of infection.
We have performed coeliac plexus block by standard percutaneous technique for disabling pain in 36 patients (13 with cancer and 23 with chronic pancreatitis). Eleven of the 13 cancer patients had complete pain relief initially and 7 remained pain free at the time of death. By contrast, only 12 of the 23 patients with pancreatitis had complete pain relief, 6 had partial relief and there was no effect in 5. The mean pain-free period in the chronic pancreatitis patients was only 2 months, and the longest 4 months. Benefit was least in patients with previous pancreatic surgery and repeat blocks were unhelpful. Transient postural hypotension occurred in most patients; two had nerve root pain and one developed persistent weakness and anaesthesia of the left leg, with bladder disturbance. These results warrant the continuing use of coeliac plexus block in pancreatic cancer, but rarely in chronic pancreatitis.
The widespread success of laparoscopic cholecystectomy has led to the development of a wide range of laparoscopic surgical procedures. Procedures for treating rectal prolapse (Procidentia) may constitute some of the best applications for colorectal laparoscopic techniques. A technique of laparoscopic rectopexy performed using the endo-stapler is described. Twenty-nine consecutive patients have undergone laparoscopic rectopexy. The median age was 71 years (52-89), and male:female ratio was 27:2. One procedure had to be converted to open due to ventilatory difficulties. The mean operative time was 95 minutes (50-190). The mean hospital stay was 5 days (4-15). There was no mortality in this series. Morbidity included incisional hernia through a port hole (n = 1), extraperitoneal haematoma (n = 1), and urinary tract infection with retention (n = 1). In conclusion, laparoscopic abdominal rectopexy is a safe and effective technique in the management of rectal prolapse.
Objective-To study the disturbed anorectal physiology associated with constipation in multiple sclerosis.
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