RESUMO
AIM: Rectal hypercontractility can lead to faecal incontinence (FI). Botulinum toxin (BT) has been used successfully for the treatment of bladder overactivity. This study aimed to evaluate the therapeutic value of intrarectal injections of BT in inhibiting colorectal contractions and relieving FI in patients suffering from FI as a result of overactive rectal contractions. METHOD: A prospective open study was carried out in Rouen University Hospital. Six patients (four men and two women) with severe FI related to overactive rectal contractions underwent intrarectal submucosal injections of BT placed in three rows of 10, 1-ml injections (50 U/1 ml; Dysport(®)) starting 1 cm above the dentate line and repeated twice, at intervals of 5 cm proximally. The end-points included improvement in the FI score, in faecal incontinence quality of life (FIQL) and of manometric abnormality. RESULTS: All patients reported improvement in the FI score [18.2±1.1 at baseline vs 9.0±1.7 at 3 months (P=0.04)] and in FIQL. Rectal contractile activity was reduced. The frequency of contractions remained unaffected (28.1±6.6/h; P=0.46 vs baseline). High-amplitude contractions of >50 cmH(2)O were significantly decreased in all patients (16.6±3.9 vs 6.6±4.1/h; P=0.03). CONCLUSION: Patients with an 'overactive rectum' are a heterogeneous group, with varying causes of dysfunction. The dose of BT used was arbitrarily selected. Nevertheless, the study introduces a further therapeutic option in the treatment of FI caused by rectal overactivity.
Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Incontinência Fecal/tratamento farmacológico , Fármacos Neuromusculares/uso terapêutico , Reto/fisiopatologia , Adulto , Idoso , Incontinência Fecal/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Sigmoidoscopia , Resultado do TratamentoRESUMO
Pelvic floor abnormalities often impact significantly the quality of life and result in a variety of symptoms, including chronic pelvic pain, fecal incontinence, and obstructed constipation. Fluoroscopic defecography and MR defecography enable identification of rectocele, rectal prolapse, enterocele, sigmoidocele with high prevalence in female patients with obstructed constipation, fecal incontinence, and chronic pelvic pain. In this manuscript, we describe the techniques and indications of the two techniques of defecography. We discuss the abnormalities of the posterior pelvic floor compartment at the origin of constipation, incontinence, chronic pelvic pain. Finally we compare the data obtained by clinical examination and defecography, remembering that 50% of enterocele and 100% of sigmoidocele are missed at clinical examination.
Assuntos
Constipação Intestinal/etiologia , Defecografia/métodos , Incontinência Fecal/etiologia , Diafragma da Pelve/anormalidades , Diafragma da Pelve/cirurgia , Dor Pélvica/etiologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Qualidade de Vida , RetoceleRESUMO
BACKGROUND: Pyloric pressure and compliance have never been investigated in health nor gastroparesis. AIM: We hypothesised that pyloric pressure and/or compliance may be altered in gastroparesis. METHODS: Fasting pyloric pressure and compliance were investigated in 21 healthy volunteers (HV), 27 gastroparetic patients (GP) and 5 patients who had undergone oesophagectomy without pyloroplasty as positive controls. Under videofluoroscopic control, pyloric compliance and pressure were measured by the EndoFLIP technique. Gastric emptying half time (T1/2 ) using (13) C-octanoic acid breath test, as well as symptoms and quality of life (GIQLI score) were also monitored. RESULTS: Mean fasting pyloric compliance was measured at 25.2 ± 2.4 mm²/mmHg in HV, and was lower both in GP (16.9 ± 2.1 mm²/mmHg; P < 0.05) and patients with oesophagectomy (10.9 ± 2.9 mm²/mmHg; P < 0.05). By contrast, fasting pyloric pressure was not different among groups. Fasting pyloric compliance and pressure correlated with T1/2 in GP (R = -0.43; P = 0.04). Fasting pyloric compliance, but not pressure, correlated with symptoms and GIQLI score. Pyloric dilation in 10 GP with low fasting pyloric compliance (<10 mm²/mmHg) increased compliance from 7.4 ± 0.4 to 20.1 ± 4.9 mm²/mmHg (P < 0.01) and improved the GIQLI score from 72.5 ± 5.5 to 89.3 ± 6.1 (P = 0.04). CONCLUSION: This prospective study assessed pyloric compliance for the first time, and showed that fasting pyloric compliance is decreased in gastroparetic patients and is associated with T1/2 , symptoms and quality of life. This suggests that pyloric compliance may be a new relevant metric in gastroparetic patients, and may be useful to target patients for pyloric dilation or botulinum toxin injection.
Assuntos
Dilatação/métodos , Jejum/fisiologia , Esvaziamento Gástrico/fisiologia , Gastroparesia/fisiopatologia , Piloro/fisiopatologia , Adulto , Testes Respiratórios , Caprilatos/análise , Esofagectomia , Feminino , Gastroparesia/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de VidaRESUMO
We report four cases of difficult defaecation and/or faecal incontinence revealing a neurologic disease. These anorectal symptoms were associated with urinary disorders, but urinary symptoms always appeared several years after anorectal complaints. Clinical neurologic examination immediately led us to suspect a neurologic aetiology in two patients with the following signs: perineal hypoesthesia, absence of voluntary anal contraction and anal reflexes in one subject (final diagnosis: L1 neurinoma), and in the other a weakness in both thighs with absent tendon reflexes in the four limbs (final diagnosis: amiodarone neuropathy). In the two other patients with multiple cerebral infarction or multiple system atrophy, the neurologic aetiology was suspected on the absence of anal voluntary contraction contrasting with a normal perineal anatomy, but the final diagnosis was made only two years later when orthostatic arterial hypotension occurred.
Assuntos
Constipação Intestinal/etiologia , Incontinência Fecal/etiologia , Doenças do Sistema Nervoso/fisiopatologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The aim of this study was to determine whether the colonic motor profile of seven patients with constipation secondary to antidepressants differed from the motility of seven patients with idiopathic constipation and seven healthy volunteers. All constipated patients had very severe constipation. Colonic manometric recordings were performed for 24 h. The number of high amplitude propagating contractions (HAPC) was lower in the two groups of constipated patients than in controls. No HAPC were observed in 5/7 patients with constipation secondary to antidepressants and in 1/7 patients with idiopathic constipation. The overall area under the curve (AUC) in the left colon was lower in the two constipated patient groups than in controls. AUC increased after a 1000-kcal standard meal given at noon in controls but not in the two groups of constipated patients. In conclusion, in patients with constipation secondary to antidepressants, the overall AUC was as poor as in patients with idiopathic constipation, and no colonic response to eating was observed. Moreover, the number of HAPC was more markedly decreased in patients with constipation secondary to antidepressants than in patients with idiopathic constipation.
Assuntos
Antidepressivos/efeitos adversos , Constipação Intestinal/induzido quimicamente , Transtorno Depressivo/tratamento farmacológico , Motilidade Gastrointestinal/efeitos dos fármacos , Adulto , Amitriptilina/efeitos adversos , Amitriptilina/farmacologia , Amitriptilina/uso terapêutico , Antidepressivos/farmacologia , Antidepressivos/uso terapêutico , Transtornos de Ansiedade/complicações , Catárticos/uso terapêutico , Antagonistas Colinérgicos/efeitos adversos , Antagonistas Colinérgicos/farmacologia , Antagonistas Colinérgicos/uso terapêutico , Clomipramina/efeitos adversos , Clomipramina/farmacologia , Clomipramina/uso terapêutico , Colo/efeitos dos fármacos , Colo/fisiopatologia , Colonoscopia , Constipação Intestinal/tratamento farmacológico , Constipação Intestinal/fisiopatologia , Transtorno Depressivo/complicações , Ingestão de Alimentos , Impacção Fecal/induzido quimicamente , Impacção Fecal/tratamento farmacológico , Impacção Fecal/fisiopatologia , Feminino , Humanos , Masculino , Manometria , Maprotilina/efeitos adversos , Maprotilina/farmacologia , Maprotilina/uso terapêutico , Pessoa de Meia-Idade , Transtornos do Humor/complicações , Contração Muscular , Paroxetina/efeitos adversos , Paroxetina/farmacologia , Paroxetina/uso terapêutico , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Inibidores Seletivos de Recaptação de Serotonina/farmacologia , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Tiazepinas/efeitos adversos , Tiazepinas/farmacologia , Tiazepinas/uso terapêutico , Viloxazina/efeitos adversos , Viloxazina/farmacologia , Viloxazina/uso terapêuticoRESUMO
OBJECTIVE: To evaluate the manometric and clinical efficacies of electrostimulation to treat anal incontinence. PATIENTS AND METHODS: Thirty-three women suffering from anal incontinence self-administered anal electrostimulation twice daily for 15-min intervals for 4 months. RESULTS: After 4 months, the incontinence score decreased from 10.4+/-0.5 to 7.1+/-0.8 (P<0.001) but all patients except two remained incontinent The decrease in the incontinence score was more marked in patients receiving medical treatment for an associated bowel disorder, than in patients treated by electrostimulation alone. Anal resting pressures and the amplitude of voluntary anal contractions did not increase after 4 months. CONCLUSION: Electrostimulation decreased the incontinence score but all patients except two remained incontinent after 4 months, suggesting that electrostimulation is not a clinically effective treatment of anal incontinence.
Assuntos
Terapia por Estimulação Elétrica , Incontinência Fecal/terapia , Canal Anal , Feminino , Seguimentos , HumanosRESUMO
OBJECTIVE: To determine (1) whether patients complaining of straining at stool have pelvic floor descent and anal abnormalities similar to those of patients with anal incontinence and (2) whether these patients are prone to develop anal incontinence. METHODS: To answer the first question we used defecography to study perineal floor position at rest, during maximal contraction of the anal sphincter and during straining, and we performed anorectal manometry in 46 women with straining at stool but without anal incontinence at the beginning of the study, and in 46 women with idiopathic anal incontinence, matched for age. To answer the second question, we performed a 5-year follow-up study to determine whether anal incontinence had developed in those women with straining at stool. RESULTS: Perineal floor position at rest, during maximal contraction of the sphincter and during straining, resting pressure in the upper part of the anal canal, maximal amplitude and duration of the voluntary contraction were similar in the 46 women with straining at stool and the 46 women with idiopathic anal incontinence. In the follow-up study, 24 of the 46 women with straining at stool were contacted. The incidence of anal incontinence after 5 years was higher among these 24 women than in a control group of 20 women (13 out of 24 versus three out of 20, for women with straining at stool versus controls respectively; P < 0.01). The 13 patients with straining at stool who became incontinent had, at the initial investigation, a lower maximal amplitude of voluntary contraction, greater perineal descent at rest and less elevation of the pelvic floor during maximal contraction of the anal sphincter than the other women (P < 0.05). CONCLUSION: Women with chronic straining at stool have perineal descent at rest and during straining similar to that of incontinent women. Women with chronic straining are also prone to develop anal incontinence, suggesting that perineal descent at defecography in women with straining at stool may predict future anal incontinence.
Assuntos
Defecação , Incontinência Fecal/diagnóstico por imagem , Períneo/diagnóstico por imagem , Idoso , Canal Anal/fisiopatologia , Incontinência Fecal/diagnóstico , Incontinência Fecal/fisiopatologia , Feminino , Humanos , Manometria , Pessoa de Meia-Idade , Períneo/fisiopatologia , Valor Preditivo dos Testes , Radiografia , Reto/fisiopatologiaRESUMO
This study compared the effects of cimetidine, ranitidine, and antacids on oesophageal pH levels. Forty-five patients were confirmed as having a gastro-oesophageal acid reflux by 3-hour postprandial metered pH measurements. The 45 patients were randomly placed into three treatment groups; one group received cimetidine 1 g/day, the second received ranitidine 300 mg/day, and the third received 60 ml/day of an antacid. The patients were retested under treatment (3-hour postprandial metered pH and prolonged 20-hour metered pH). The 3-hour postprandial metered pH was then compared to the pretreatment tests. The 20-hour postprandial metered pH test was compared with the results from 43 control (untreated) subjects with gastro-oesophageal acid refluxes. The 3-hour postprandial comparison showed a significant decrease in acid reflux with all three treatment drugs. The 20-hour measurement demonstrated a significant decrease with all three drugs in the number of acid reflux incidences compared to the untreated control patients; the ranitidine group had a significant decrease in the percentage of time with acid pH. No significant differences appeared in the comparison of the records of the 45 treated patients except for the percentage of time below pH 2 for 20 hours which was significantly lower for ranitidine. All three treatments were effective with a clear advantage in favour of ranitidine.
Assuntos
Antiácidos/uso terapêutico , Cimetidina/uso terapêutico , Refluxo Gastroesofágico/tratamento farmacológico , Ranitidina/uso terapêutico , Adulto , Idoso , Hidróxido de Alumínio/uso terapêutico , Esôfago/fisiopatologia , Feminino , Refluxo Gastroesofágico/fisiopatologia , Humanos , Concentração de Íons de Hidrogênio , Hidróxido de Magnésio/uso terapêutico , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Distribuição Aleatória , Simeticone/uso terapêuticoRESUMO
Two patients with acute colectasia, and acute urinary retention following pregnancy (case n. 1) and Klebsiellae septicemia (case n. 2) requiring endoscopic exsufflation in both cases, were seen. At onset, both patients had esophageal and anorectal manometric abnormalities with right colonic transit delay, and in case n. 2 urodynamic perturbation. Several months later, abnormalities disappeared in case 1, but remained unchanged in case 2. Jejunal manometry performed in case 2 showed decreased interdigestive complex frequency. These data suggest that: 1) acute colectasia may be major expression of digestive and urinary motility disorders, 2) acute colectasia can be the first symptom of a chronic disease, suggesting the usefulness of manometric studies in these patients, once the acute episode is over.
Assuntos
Pseudo-Obstrução do Colo/complicações , Sistema Digestório/fisiopatologia , Motilidade Gastrointestinal , Pseudo-Obstrução Intestinal/complicações , Doenças da Bexiga Urinária/fisiopatologia , Bexiga Urinária/fisiopatologia , Adulto , Doenças do Sistema Digestório/complicações , Doenças do Sistema Digestório/fisiopatologia , Esôfago/fisiopatologia , Feminino , Humanos , Doenças da Bexiga Urinária/complicações , UrodinâmicaRESUMO
The aim of this study was to evaluate clinical symptoms, disease past-history, and parameters of anorectal manometry, defecography, and radiopaque pellet transit time in anal incontinence by multivariate analysis. We studied 76 patients, 68 women and 8 men, who complained of anal incontinence, excluding that due to obstetrical lesions. All patients were asked to complete a standard questionnaire. Results indicated that: a) hemorrhoidectomy, hysterectomy, and cholecystectomy appeared to play a role, b) daily incontinence for air or liquid stools is more frequent after hemorrhoidectomy, c) decreased resting pressure of the upper part of the anal canal was observed mainly after hysterectomy, d) decreased resting pressure of the upper part of the anal canal could be a factor of poor prognosis after treatment, e) anal incontinence in men was secondary to traumatic lesions of the anal sphincter in 7 of 8 cases.
Assuntos
Incontinência Fecal/fisiopatologia , Trânsito Gastrointestinal/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colecistectomia/efeitos adversos , Incontinência Fecal/diagnóstico por imagem , Incontinência Fecal/etiologia , Feminino , Humanos , Histerectomia/efeitos adversos , Masculino , Manometria , Pessoa de Meia-Idade , Complicações Pós-Operatórias , RadiografiaRESUMO
Gastric emptying, gastric secretion and esophageal pH were studied prospectively in 32 patients who had either a Lortat-Jacob type operation (n = 7) or a fundoplication with a 360 degrees (n = 4), 270 degrees (n = 5) or 180 degrees (n = 16) gastric fundic wrap. The goal was to determine the effects of various antireflux mechanisms on these functions as well as to try to explain abnormal postoperative esophageal pH scoring indexes. Esophageal pH was recorded during the 3 h period following a standard meal. Acid reflux was expressed using a scoring index taking into account the duration and magnitude of pH fall. Preoperatively, all patients had an abnormal pH scoring index. Postoperatively, the pH scoring index remained increased in 7 patients (group A) and returned to normal values in 25 (group B). Clinical data, esophageal pH parameters and gastric acid secretion measured preoperatively were not significantly different in the two groups of patients. Preoperative gastric emptying for liquids was shorter in group A than in group B patients (p less than 0.05). Postoperative gastric emptying of radiopaque markers was not different in the two groups of patients. Postoperative resting pressure of the lower esophageal sphincter was always less than 10 cm H2O in group A and more than 10 cm H2O in group B patients. Changes in lower esophageal pressure after surgery were higher in group B than in group A patients (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Refluxo Gastroesofágico/cirurgia , Adulto , Idoso , Esôfago/fisiopatologia , Feminino , Ácido Gástrico/metabolismo , Esvaziamento Gástrico , Humanos , Concentração de Íons de Hidrogênio , Masculino , Manometria , Métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Período Pós-Operatório , Estudos ProspectivosRESUMO
Multiple factors contribute to the production of esophagitis in gastroesophageal reflux (GER), but the respective roles of esophageal (i. e. lower esophageal sphincter (LES) tone, peristalsis) and gastric factors (i. e. acid secretion and gastric emptying) are not well known. The aim of this work was to study the frequency and the severity of esophageal and gastric abnormalities observed in the same patients and to correlate these findings with the degree of esophagitis. Thirty-three consecutive patients with GER proven by esophageal pH recording (3-hr postprandial pH-test) were classified according to the presence (group A, n = 18) or absence (group B, n = 15) of severe esophagitis (i. e. erosions, ulcerations, or stenosis) at endoscopy. LES basal tone and esophageal peristalsis were studied by manometry. Gastric acid secretion and emptying of liquids were measured by intragastric titration coupled with the dye dilution technique. Results obtained in GER patients were compared with those found in twenty-three normal subjects. Hypotonia of LES (i. e. LES tone less than 7 cm H2O) was more frequent in group A (72 p. 100) than in group B patients (30 p. 100, p less than 0.05). Magnitude of esophageal peristaltic waves was lower in group A than in group B (p less than 0.10). When compared to values found in normal subjects, gastric emptying and acid secretion were not significantly different both in presence and in absence of esophagitis. There was no linear correlation between esophageal pH parameters and acid secretion values or gastric emptying rates.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Esofagite Péptica/fisiopatologia , Esôfago/fisiopatologia , Ácido Gástrico/metabolismo , Esvaziamento Gástrico , Adulto , Idoso , Endoscopia , Feminino , Humanos , Concentração de Íons de Hidrogênio , Masculino , Manometria , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Our aim was to assess the efficacy of photodynamic therapy in inoperable patients with small esophageal carcinoma. Eleven patients were treated for squamous cell carcinomas ranging in size from 1 to 3 cm2. Hematoporphyrin (between 3 and 5 mg/kg) was injected intravenously and then the tumor irradiated at endoscopy 72 hours later with a dye laser (630 nm) at an energy of 250 joules/cm2. Complete destruction of the lesion was obtained in 6 cases with negative biopsies at 1 month. In all 6 patients, no recurrence was seen after a median follow-up of 4 months (range: 2-38). Partial destruction of the tumor was obtained in 4 cases while treatment was a complete failure in the last patient. Two instances of mild cutaneous photosensitization occurred. Two patients treated for recurrence after radiotherapy, died of esophageal perforation directly related to the procedure. Photodynamic therapy appears to be a possible effective treatment for esophageal squamous cell carcinoma in inoperable patients when other curative treatment modalities are not possible.
Assuntos
Carcinoma de Células Escamosas/tratamento farmacológico , Neoplasias Esofágicas/tratamento farmacológico , Fotorradiação com Hematoporfirina/métodos , Terapia a Laser , Idoso , Carcinoma de Células Escamosas/mortalidade , Neoplasias Esofágicas/mortalidade , Seguimentos , Fotorradiação com Hematoporfirina/efeitos adversos , Fotorradiação com Hematoporfirina/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos ProspectivosAssuntos
Neoplasias do Sistema Digestório/terapia , Gastrostomia/instrumentação , Doenças do Sistema Nervoso/terapia , Neoplasias Otorrinolaringológicas/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Endoscopia Gastrointestinal , Feminino , Gastrostomia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Forty-two patients complaining of constipation with abnormal anorectal motility were studied: 20 children and 6 adult females had a decreased rectoanal inhibitory reflex (RAIR) amplitude and 16 adult females had anal hypertonia and ultra slow waves (USW). Biofeedback training was used to condition the patients to relax the anal sphincter during the desire to defecate. After two to eight (mean, 4) training sessions, the authors observed simultaneously a normal RAIR amplitude and recovery from constipation for at least six months in 15 children and five females with decreased RAIR amplitude. Nine of the adult females with hypertonia and USW were able to suppress USW but did not recover from constipation. The data suggest that biofeedback training could be useful in some groups of constipated patients.
Assuntos
Biorretroalimentação Psicológica , Constipação Intestinal/terapia , Adolescente , Adulto , Canal Anal/fisiopatologia , Criança , Constipação Intestinal/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reto/fisiopatologia , Reflexo/fisiologiaRESUMO
The aim of this work was to analyze clinical symptoms in light of anorectal manometry results. We compared the frequency of clinical symptoms in relation with the presence or absence of functional anomalies. Using this methodology, the following relationships may be suggested: the need to wear a pad, with a decreased resting pressure at the upper part of the anal canal; the inability to delay rectal evacuation, with decreased anal voluntary contraction; interference of incontinence with social activities, with decreased duration of anal voluntary contraction; urinary symptoms, with an increased threshold volume of rectal distention needed to elicit the rectoanal inhibitory reflex; and complete rectal prolapse, with reduced length of the anal canal.
Assuntos
Canal Anal/fisiopatologia , Incontinência Fecal/fisiopatologia , Reto/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Incontinência Fecal/psicologia , Incontinência Fecal/reabilitação , Humanos , Tampões Absorventes para a Incontinência Urinária , Relações Interpessoais , Masculino , Manometria , Pessoa de Meia-IdadeRESUMO
Six patients with complete transection of the spinal cord and six healthy volunteers were examined by using anorectal manometry together with electromyographic (EMG) recording of the external anal sphincter composed of striated muscle. Anal pressure and EMG activity of the external anal sphincter were continuously recorded at rest and during gradual rectal distention (10, 20, 30, 40, and 50 ml) by means of an air-filled balloon eliciting a rectoanal inhibitory reflex (RAIR) at the upper part, and an inflation reflex (IR) at the lower part of the anal canal. All patients and controls had a RAIR for each rectal distention volume. A relationship between the duration of the RAIR and the rectal distention volume was present in controls only. In controls the IR was present for each rectal distention volume, whereas it was present in only one patient for a 40-ml volume. During the resting period, all controls showed continuous tonic EMG activity of the external anal sphincter, but after 30 minutes all the patients showed a decrease and ultimately in five cases a disappearance of the tonic EMG activity of the external anal sphincter. In spinal patients, the presence or absence of EMG activity of the external anal sphincter did not modify the anal canal pressure. These results indicate that: 1) the tonic EMG activity of the external anal sphincter seems to be under the control of supraspinal structures, because in spinal patients it disappears in the absence of sensitive inputs toward the spinal cord; 2) the absence of EMG activity at rest indicates that the external anal sphincter is not implicated in the RAIR disturbances observed in spinal patients; 3) the IR is not a spinal reflex but is under voluntary control, because it is not present in spinal humans; 4) in spinal humans the tonic EMG activity of the external anal sphincter does not play a role in the maintenance of the anal pressure at rest.
Assuntos
Canal Anal/fisiopatologia , Reto/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologia , Adolescente , Adulto , Eletromiografia , Feminino , Humanos , Masculino , Manometria , Pressão , Reflexo Anormal , Análise de RegressãoRESUMO
The aim of this study was to assess the reliability of cortical evoked potentials after electrical stimulation of the anal canal. Cortical evoked potentials were recorded on 243 patients presenting with perineal pain (28 patients), impotence (55 patients), anal incontinence (52 patients), urinary continence (30 patients), constipation (49 patients), and on 29 neurological patients, by stimulating the external anal sphincter and penis (or clitoris). The inter- and intra-observer reproducibility was studied by coding recordings interpreted by three different observers on two separate occasions. The influence of recording characteristics and clinical data were assessed. To study operator dependence, five operators investigated the patients. Only one of them was well trained in this technique. The interpretation of the coded curves by the observers was poorly reproducible in about 15% of cases, depending on time between the two readings and the quality of recordings. The interpretation of cerebral responses after anal stimulation were observer-dependent and influenced by the knowledge of clinical data. This was also observed with cortical evoked potentials after electrical stimulation of the penis or clitoris, but to a lesser extent. The cerebral evoked potentials method was also operator-dependent, mainly after anal stimulation. When a study of cortical evoked potentials by perineal stimulation is needed in clinical practice, it seems logical to prefer cortical evoked potentials by penile or clitoral stimulation as they seem easier to obtain than those evoked by anal stimulation if the investigators are not well trained for the performance of electrophysiological studies as the former are much less operator- and observer-dependent.