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A simple and fast procedure has been developed for the direct determination of sucrose in beet root samples through attenuated total reflectance Fourier transform infrared absorbance measurements (ATR-FTIR) at 1056 cm(-1) with a baseline established between 1187 and 887 cm(-1). The method only requires a previous crushing or liquefaction of samples and it is free from matrix effects and from the interference of minoritary sugars and fermentation molecules. Aqueous solutions of sucrose can be used as standards and recovery values from 101 to 103% were found for spiked concentration levels from 3.5 to 10.5% (w/w). The limit of detection provided by this method corresponds to 0.15% (w/w) of sucrose and the standard deviation of three independent analysis of a sample containing 9.30% (w/w) was 0.03% (w/w).

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A new procedure has been developed for the FT-IR determination of caffeine in roasted coffee samples. The method involves wetting the coffee samples with a 0.25 M aqueous NH3 solution, extracting the caffeine with CHCl3, and measuring absorbance at 1,659 cm(-1) using a baseline established between 1,900 and 830 cm(-1). The procedure proposed is fast, only requiring a total extraction time of 16 min for each sample, and provides a drastic reduction of the organic solvent consumed, from the 200 mL diethyl ether and 50 mL CHCl3, required for each sample by the reference chromatographic UV-spectrometric determination to only 5 mL CHCl3. The method provides a limit of detection of the order of 3 mg L(-1) caffeine and a relative standard deviation of 0.4% for 3 independent analyses of a sample containing 18.6%mg/g caffeine. The accuracy of the FT-IR procedure was evaluated from recovery experiments on spiked samples providing values from 94.4 to 100.1% and from the comparison of results found for a series of commercial samples, by both FT-IR and the official reference procedure.

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A fully automated procedure is proposed for the Fourier transform infrared (FTIR) determination of nicotine in tobacco. The method is based on the on-line extraction of nicotine with CHCl3. Samples, weighed inside empty extraction cartridges, were humidified with NH3 and the cartridges were installed in a flow manifold in which they were extracted with 2 ml CHCl3 for 2 min, then 400 microliters of the extract were introduced into a micro-flow cell using a carrier of CHCl3 and the IR spectrum was registered continuously. The absorbance, in the wavenumber range 1334-1300 cm-1, was measured, obtaining a peak as a function of time. The area of this peak was interpolated on a calibration line established from standard solutions of nicotine in chloroform treated in the same way as samples. The method provided a limit of detection of 0.1 mg ml-1 nicotine, an RSD lower than 2% and a sampling frequency of the whole procedure of 6 h-1. Results obtained for natural samples of cut tobacco and cigar compared well with those obtained by a batch FTIR procedure, involving an off-line extraction with a total time of 16 min. However, for yellow tobacco cigarette, an on-line extraction time of 10 min was required to obtain a good recovery of nicotine.

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PURPOSE: Functional results of total colectomy (TC) and ileorectal anastomosis for colonic inertia are often impaired by postoperative obstruction and diarrhea. In order to avoid these postoperative complications, we propose a subtotal colectomy (STC) preserving the ileo-caecal junction. METHODS: Since 1989, 18 consecutive patients (17 F, 1 M; mean age: 54 years) with intractable constipation underwent TC (n = 6) or STC with caecorectal anastomosis (Deloyers Procedure) (n = 12). Mean preoperative bowel frequency was two movements every month. Colonic inertia was defined as diffuse marker delay during transit study without obstructed defecation on manometry or digitalised rectography. Rectocele (n = 10), rectal (n = 5) and genital prolapse (n = 6) were treated in the same operative time. RESULTS: Postoperative course was uneventful after STC but bowel obstruction, requiring laparotomy, occurred in 3 patients (50%) after TC: enterolysis (n = 2), bowel resection (n = 2). Mean postoperative day stool frequency of TC (4.2 +/- 1.2) was higher than STC (1.2 +/- 0.1). Half of patients after TC needed anti-diarrheal treatment and diet, 33% had rectal evacuation difficulties despite liquid stools, 17% had episodic incontinence, 66% had persistent abdominal pain. Compared to TC, the functional results of STC were significantly better: regular normal transit return without diet or treatment in 75% of cases, 25% had rectal emptying difficulties easily treated by mild laxatives, only 17% had persistent abdominal pain. Postoperative obstruction, diarrhea or fecal incontinence never occurred after STC. CONCLUSION: Compared to TC, STC with Deloyers procedure seems to reduce significantly the postoperative incidence of bowel obstruction, diarrhea and abdominal pain. Expected regular transit return after STC needs a careful selection of patients and simultaneous treatment of ano-rectal and pelvic floor abnormalities frequently associated with colonic inertia.

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The authors studied erythrocyte aggregation in 62 patients suffering from hemorrhoidal disease, distributed on the basis of proctoscopy findings between three groups (recent uncomplicated congestive attack, recent thrombosed hemorrhoid, stage IIb or III chronic prolapse). This hemorheological parameter is a sensitive marker of circulatory stasis. Values measured were compared with those obtained in 21 healthy subjects. Erythrocyte aggregation index was significantly higher in patients than in controls (31.6 +/- 6.8 versus 27.7 +/- 4.4) (p < 0.05). This difference was due essentially to increased values in patients with acute hemorrhoid problems. A parallel increase in blood fibrinogen was found in these same patients. Hemorheological changes could predispose to worsening of venous stasis in the hemorrhoidal circulation and participate in the onset or spread of thrombotic processes.

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In line with the literature, the authors consider that solitary ulcer of the rectum, either isolated, multiple or histological, like suspended proctitis, inverted hamartomatous polyp, deep cystic colitis, is a complication of rectal prolapse, which usually shares the same clinical symptoms. Solitary ulcer of the rectum is generally discovered on proctoscopy and is due to the strain exerted on the rectal mucosa by 2 opposing forces:violent effort of defecation against an anal and/or perineal obstruction. The reduction of these pressure and counterpressure forces with age and progressive alteration of the pelvic floor accounts for the progression of acute lesions towards chronic or attenuated lesions or even complete resolution. The therapeutic strategy should therefore decrease trauma by facilitating defecation by a combination of hygiene and dietary advice and biofeedback retraining, and surgical reduction of the anal obstruction and prolapse and correction of any perineal insufficiency.

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The difficulties for evaluation of the perineal descent have always been linked to the choice of references and mostly with the incertitude of the measurement of length on the radiographic film. This present study was carried out to evaluate the perineal descent on the choice of an angular measurement: the posterior rectal inclination. The dynamic digitalized rectography was used to investigate the pelvic floor status of 134 women: 115 patients complaining of idiopathic constipation, and 19 healthy volunteers. Results have shown 3 populations with an increasing graduation of perineal impairment and led to propose a radiologic classification of pelvic floor impairment: stage I, or solid perineum, stage II, or descending perineum and stage III or descended perineum. This study has brought up that the first sign of a pelvic floor abnormality may be increased descent during straining, only later followed by perineal descent at rest. The relationship linking abnormal perineal descent and excessive opening of the ano-rectal angle suggested logically that fecal incontinence may be the end complication of the Descending Perineum Syndrom.

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We report our experience on 61 anal canal epidermoid carcinoma bearing patients. The patients are divided into three therapeutic groups: a) 14 patients treated with combined surgery and preoperative radiotherapy (37.8 Gy in 18 fractions and 21 days); b) 28 patients treated with 60Co and electrontherapy (total tumor dose of 60 to 65 Gy); c) 19 patients treated with external cobaltherapy (30 Gy/10 fractions/12 or 15 days) followed 1 to 2 months later by interstitial brachytherapy with Iridium 192 (20 Gy). Local control was observed in 41 out of 61 patients (67.2%). Out of the six patients who underwent salvage abdomino-perineal resection, five were locally cured at 5 years. The overall 5-year survival is 78.6%; the corrected 5-year survival is 88.8%. Analysis of prognosis factors shows a direct relation between local control survival and the loco-regional extension. The 5-year survival was 90.9% in the first therapeutic group, 90.9% in the second group, and 94.7% in the third group. The 5-year survival rates according to the stage and to treatment were as follows: Stage T1 N0 100% in the 1st therapeutic group, 85.7% in the 2nd group, 100% in the 3rd group; for Stage T2 N0 80% in the 1st group, 90.9% in the 2nd group, 90% in the 3rd group; for Stage T3 N0 83.3% in the 1st group, 85.7% in the 2nd group, and 66.6% in the 3rd group. The rates of sphincter preservation were 85.7% in the 2nd group and 94.7% in the 3rd group. These results show the incidence of loco-regional extension on the prognosis and the usefulness of conservative treatments.

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Rectopexy associated with anterior prolepsectomy was performed for 22 patients (19 females, 3 males), with solitary rectal ulcer syndrome (SRUS) surrounding internal rectal prolapse. The different lesions of SRUS were distributed among 3 main groups (G) according to the macroscopic appearance: G1: solitary ulcer (n = 7); G2: ulcerated proctitis (n = 7); G3: muco-hemorroidal prolapse (n = 3). A significant difference (P less than 0.05) was observed between each group, concerning mean age (G1: 34 years, G2 = 49, G3: 65) and the degree of perineal descent, which was more important in G3 and G2. Posterior intersphincteric rectopexy was performed for 6 patients in G3, with descending perineum and faecal incontinence, treated in the same time by perineoplasty (Parks). Abdominal rectopexy, mainly by the antero-posterior technique (Nicholls), was performed for the other patients (n = 6). Large anterior prolapsectomy reaching the top of the mucosal prolapse (4-7 cm), allowing ulcer resection in 3 cases, was combined with rectopexy. Associated operations were: sphincterotomy (n = 8) for narrow fibrous anal canal, sigmoidectomy (n = 4) for dolichocolon. Mean healing time for the solitary ulcer group (G1) was 2 months, 1 month for lesion of G2 and G3. Failures concerned 1 solitary ulcer after abdominal rectopexy and 1 ulcerative proctitis after rectopexy without prolapsectomy. Anorectal pain (81%), rectal bleeding (76%), faecal incontinence (27%), straining (81%), were cured or improved in 80% of cases. These results tend to confirm the efficacy of rectopexy, specially using the antero-posterior technique, for the treatment of SUSR with internal rectal prolapse. Nevertheless, rectopexy seems to be insufficient to correct the mucosal component of internal rectal prolapse, bearing the ulcerated lesion which needs to be treated by associated anterior prolapsectomy. Similarly all functional or organic disorders involving the perineum, anal canal or colon leading to anorectal dysfunction must also be considered to ensure complete treatment.

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We report the results of a procedure aimed at correcting the disorders of rectal and perineal tone responsible for the descending perineum syndrome (DPS). The procedure, carried out by the perineal approach, combines a posterior intersphincteric sacro-rectopexy, an anterior perineoplasty via a pre-anal levator myorraphie, a posterior perineoplasty using a post anal repair technique and a mucosal resection aimed at freeing the anal canal. 22 F and 1 M, mean age 68 years, with DPS were operated on. Digitised rectography demonstrated pathological perineal descent (greater than 3 cm) in all cases and posterior rectal angulation at rest of more than 25 degrees (normal less than 10 degrees) confirming an important deterioration in perineal tone. Results after a mean follow up of 12 months (6 to 30 months) were excellent, with objective improvement in rectal bleeding, pain, mucosal prolapse and anal incontinence. In spite of an almost constant return to normal in the number of stools and their facility of evacuation improvement in the dyschesic syndrome (78% of patients) was subjectively variable. Improvement was judged to be very good in 34%, good in 33%, fair in 11%. Healing of mucosal lesions: solitary ulcer (n = 2), rectal inflammation (n = 2), ulcerated mucosal prolapse (n = 3) occurred in all cases within 1 month. Post operative rectography demonstrated a significant decrease in posterior rectal angulation and ano-coccygeal distance confirming the efficacy of the anatomical correction. No serious complications, in particular, infections, were noted under appropriate prophylactic antibiotic cover (Piperacillin) continued up to D5.(ABSTRACT TRUNCATED AT 250 WORDS)

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We report the results of 30 antero-posterior rectopexies (APR) for rectal kinetic disorders with descending perineum syndrome. All patients were investigated by digital subtraction defecography and ano-rectal manometry. The associated surgical procedures were: sphincterotomy (n = 13) for outlet obstruction demonstrated by anal manometry or balloon expulsion test: hypertonic sphincter (n = 7), narrow fibrous sphincter (n = 6); 10 cases of prolapsectomy with extended anterior mucosectomy to reduce anterior rectal prolapse; 2 sigmoidectomy for dolichosigmoid. Best results (mean follow-up: 12 months, 3-26) were observed for ano-rectal or pelvic pain and rectal bleeding, which were cured in more than 80% of cases. Faecal incontinence (n = 5) was cured in all cases. Although normalisation of bowel movements and easier defecation were observed in 78% of cases, improvement in the dyschezic syndrome was differently perceived by the patients. Postoperative investigation demonstrated the probable cause of surgical failures (23%): impairment of rectal sensitivity (n = 2), anismus (n = 3), motor constipation (n = 4), with dolichosigmoid (n = 3). Severe perineal deficiency was also noted in 4 cases. Solitary ulcer (n = 6), anterior proctitis (n = 8), were cured within 2 months. Postoperative defecography showed correction of rectal intussusception without impairment of anterior rectal motility during defecation. These results confirm the efficacy of ARP for treatment of rectal intussusception or anterior rectocele. This functional rectopexy avoids the rectal "sling effect" of standard rectopexy which usually increases rectal dysfunction. Nevertheless, ARP alone seems to be insufficient when the associated functional or organic disorders implicated in rectal dysfunction are not also corrected, essentially outlet obstruction and dolichosigmoid.

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The aim of this study was to compare the prevalence and the size of hemorrhoids with the degree of portal hypertension; 101 patients with intrahepatic portal hypertension documented by measuring wedged and free hepatic venous pressures before performing transjugular liver biopsy and 67 patients free of liver disease were investigated by proctoscopy. Portal hypertension was associated with a higher prevalence of hemorrhoids (93 p. 100 vs 76 p. 100); there was no relation between portal pressure and the size of haemorrhoids; no relation was found between the size of hemorrhoids and the grade of esophageal varices.

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In a new statistic concerning 245 cases of primary ano-rectal neuralgia, it can be seen that the schematic classical classification derived from Thaysen, Theile, and Bensaude must be maintained (proctalgia fugax: 45 cases; coccygodynia: 44 cases; ano-rectal neuralgia: 95 cases), partially integrating unusual cases of pruritus ani. Among the 4 principle etiologies, while not underestimating the neuropsychical and intestinal factors (constipation, laxatives), the importance of two other factors must be underlined (the urogenital factor, and particularly, the role of menopause, and important pelvic operations (33 cases) often overestimated; rachidian factors: tendomyositis (Garrigues), pseudoradicular factor. The interest of this study is to show that besides these typical cases (81,7%), a number of atypical cases exist, which have often been under-estimated. These cases can be classified in intermediary (4%), associated (10%), alternating (3,3%) cases, in the course of which the different syndromes replace each other or seem superposed. It must be underlined that the notion of these primitive ano-rectal neuralgias must be inserted in the much larger class of perineal urinary, gynecological or bone and ligament neuralgias. The classification remains opened. An etiopathogenical treatment must be installed, that rejects all regional or surgical aggressive acts when not absolutely necessary, and underlines the importance of massage, internal (levator ani), or external (Maigne's technique, attentive and repeated sessions of rachidian massage).U

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