[Post-surgical or traumatic anal incontinences. Prospective study in 40 patients explorated by endorectal ultrasonography and electromyography]. / Incontinences anales post-chirurgicales ou traumatiques. Etude prospective de 40 malades explorés par échographie endorectale et électromyographie.

OBJECTIVES: Anal endosonography is used to assess anal canal structure and external anal sphincter. The purpose of this study was to compare findings at anal endosonography with electromyographic tests in patients with faecal incontinence. METHODS: Fourty patients (31 women; median age: 47 years) were referred for exploration of the anal sphincter: 15 patients had previous anal surgery, 16 patients had obstetrical trauma, 3 patients had accidental trauma, 6 women had obstetrical trauma and previous anal surgery. RESULTS: Anal endosonography demonstrated an external sphincter defect in 19 patients (partial n = 4, complete n = 15); 18 of these patients had an electromyographic study: an external sphincter defect was demonstrated by mapping in 15 cases; 3 partial defects were not found. Eight patients had associated pudendal nerve terminal motor latency delayed due to neuropathic impairment of pudendal nerve. Surgery was performed in 12 patients; external sphincter lesion was confirmed in all cases. CONCLUSIONS: Anal endosonography and electromyography mapping easily recognize external sphincter disruption with high concordance. Partial defects are better diagnosed by anal endosonography. A study of pudendal nerve terminal motor latency is useful in the exploration of faecal incontinence because pudendal neuropathy occurs frequently in association with a sphincter defect.

[Exclusive elemental enteral diet in cortico-resistant and cortico-dependent forms of Crohn's disease]. / L'alimentation entérale élémentaire exclusive dans les formes corticorésistantes et corticodépendantes de la maladie de Crohn.

The aim of this study was to investigate the value of elemental diet in steroid-resistant and steroid-dependent Crohn's disease. Elemental diet (Vivonex HN, 39.4 +/- 9.2 kcal/kg/d) was delivered through a nasogastric tube at a constant rate. Twenty therapeutic periods lasting from 20 to 74 days (median, 32 days) were undertaken in 18 patients. Elemental diet was well tolerated. Mean values of hemoglobin, serum albumin, and serum transferrin increased significantly through the therapeutic period; body weight and anthropometric data did not change significantly. The short-term response to elemental diet was excellent in 11 cases, demonstrated by achievement of clinical remission and steroid withdrawal; six patients had an incomplete remission and remained slightly active or had to be maintained under low dose steroids; three patients did not respond to therapy and had to be operated upon. During the follow-up (6-30 months), 8 patients out of 17 had a relapse. Relapse was controlled by medical therapy in 5 cases and led to surgery in the 3 other cases. We conclude that elemental diet, as total parenteral nutrition, is an effective therapy of steroid-resistant and steroid-dependent Crohn's disease. However, elemental diet does not prevent relapse.

[Ogilvie's syndrome and non-mechanical obstructions]. / Syndrome d'Ogilvie et occlusions non mécaniques.

Ogilvie's syndrome and chronic intestinal pseudo-obstructions are two aspects of non-mechanical obstruction. The syndrome consists of acute colonic obstruction due to multiple causes and is characterized by passive dilatation of the colon without downstream obstacle. Treatment is primarily medical, except in cases with complications such as perforation by symptomatic treatment and, sometimes, by decompression colonoscopy. The most severe complication is perforation of the colon which may require colonic excision. Chronic intestinal pseudo-obstruction is characterized by chronic disorders mostly due to abnormalities of nervous plexuses and smooth muscle of the small and large bowels. It occurs in children and surgical abstention may lead to repeated but unfortunately ineffective operations. The only treatment recognized is digestive tract bypass combined with total parenteral feeding.

[Rubber band ligation. Ambulatory treatment of hemorroids (author's transl)]. / La ligature élastique. Procédé de traitement médical ambulatoire des hémorroïdes.

The rubber ligation, ambulatory treatment of hemorroids due to J. Barron, consists in the strangulation of hemorroidal packs by an elastric ring, assuring the destruction by ischemic necrosis. Widely spread in France since 1968, the treatment forms the subject of a retrospective enquiry among 30 french proctologists, after ten years of experiment. It bears on 1074 patients and 4122 ligatures. The prolapsus disappeared in 60% of the cases and disminished in 32%. The hemorragies have stopped in 69% and these results go on beyond four years in 87% of the cases. Less heterogenous statistics and more precise indications would improve these results which, however, confirm the efficience of the treatment.

[A study on the use of ginkor in proctology (author's transl)]. / Expérimentation du ginkor en proctologie.

A total of 37 ambulatory patients with proctological conditions were treated with Ginkor as preparatory therapy before instrumental treatment (sclerosants or elastic ligatures). Greater importance was attached to its hemostatic activity; always objective though sometimes transitory, than to the improvement in various painful functional syndromes. Changes in hemorrhoidal morphology were not included in the assessment, as they demonstrate very little in the course of general treatment, except in bouts of acute inflammation and more particularly when oedema and thrombis occur. After treatment, the functional syndrome (heaviness, tenesmus) which was present in 29 patients was absent in 9 cases, reduced in 13, and unchanged in 7. Pruritus ani, which was present in 14 patients, was absent in 4 cases, reduced in 5, unchanged in 4, and impossible to evaluate in 1 case. Rectorrhagia disappeared in 12 out of 20 cases, was reduced in 4 cases, and persisted in 4 others. Overall, there were 12 very satisfactory results, 13 incomplete results, 3 moderate results, and 9 cases where no effect was noted.

[Local surgical treatment of anal-perineal lesions in Crohn's disease. Retrospective study of 68 cases]. / Le traitement chirurgical local des lésions ano-périnéales de la maladie de Crohn. Etude rétrospective de 68 observations.

Sixty eight cases of ano-perineal lesions (APL) were studied. Lesions were classified into primary (19) and secondary (49) after Hughes. The course of primary APL was favourable (15 cases, 78 p. cent) when proximal CD was controlled, with 4 proctectomies being required when the latter was not the case. Suppurative secondary APL (48) were treated surgically either for an acute abscess (22) or for a chronic fistula (low: 14; high: 12). The treatment of fistulas involved: opening in 10 cases (4 recurrences, 5 failures) or slow fistulotomy with elastic in 17 cases (9 recurrences, 4 failures). Genital fistulas (9 cases) were studied separately: 3 recto-vaginal fistulas resulted in a permanent bypass and 6 ano-vulval fistulas healed or were tolerated. When proximal CD was controlled medically, proctological treatment alone resulted in the healing or quiescence of APL in 17/24 cases. In the group of patients undergoing intestinal resection with restoration of continuity, 10/25 recurred, with the appearance of worsening of an APL in 9 of them. Fifteen had no recurrence, with the appearance or worsening of an APL in 3 of them. In total, 13 patients (19 p. cent) underwent proctectomy, including 6 from the outset. Five had a stroma which was left open and 46 (72 p. cent) a functional anus. Local surgical treatment improved the comfort of patients without any increased risk regarding sphincter function, but the long term benefits of the active treatment of chronic fistulas remain to be proven.