RESUMEN
Eleven paraplegic patients with complete traumatic spinal cord injuries (SCI) [according to American Spinal Injury Association (ASIA) criteria] at different levels (Th3-L3) were investigated during non-painful stimulation of the distal rectum and anal canal, using event related functional magnetic resonance imaging. Although a complete lesion was clinically diagnosed in all, four of them experienced reproducible sensations during anal and/or rectal stimulation. In six patients, individual data analysis revealed significant activation in the right secondary somatosensory cortex SII, the posterior cingular gyrus, the prefrontal cortex, and the left posterior cerebellar lobe during either anal or rectal stimulation or both. A Region of interest analysis using a data mask from healthy controls confirmed that SCI patients demonstrate cortical activation in areas similar to those activated in healthy volunteers, but to a less extensive degree. This supports the notion that the diagnosis of complete spinal cord transsection by ASIA criteria alone may be insufficient for assessment of 'completeness' of cord lesions, and that visceral sensitivity testing may be required in addition.
Asunto(s)
Canal Anal/fisiología , Corteza Cerebral/fisiología , Imagen por Resonancia Magnética/métodos , Recto/fisiología , Sensación/fisiología , Traumatismos de la Médula Espinal/fisiopatología , Adolescente , Adulto , Mapeo Encefálico/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estimulación Física/métodos , Traumatismos de la Médula Espinal/diagnósticoRESUMEN
This document contains the guidelines of the German Societies of Neurogastroenterology and Motility, Gastroenterology (committee for proctology), Abdominal Surgery (coloproctology working group), and Coloproctology for anorectal manometry in adults. Recommendations are given about technical notes, study preparation (equipment; patient), technique for performing manometry and data analysis, reproducibility, and indications. Minimum standards for anorectal manometry are measurement of resting and squeeze pressure, testing of rectoanal inhibitory reflex, determination of rectal sensation (first perception and urge), and calculation of rectal compliance. Anorectal manometry is indicated in patients with fecal incontinence and constipation in the context of a structured programme.
Asunto(s)
Canal Anal , Estreñimiento/diagnóstico , Incontinencia Fecal/diagnóstico , Manometría/métodos , Manometría/normas , Pautas de la Práctica en Medicina/normas , Recto , Alemania , Humanos , Manometría/instrumentación , Guías de Práctica Clínica como AsuntoRESUMEN
Passenger well-being is influenced by cabin environmental conditions which interact with individual passenger characteristics like age and health conditions. Cabin environment is composed of different aspects, some of which have a direct influence on gastrointestinal functions and may directly generate nausea, such as cabin pressure, oxygen saturation, and motion or vibration. For example, it has been shown that available cabin pressure during normal flight altitude can significantly inhibit gastric emptying and induce dyspepsia-like symptoms when associated with a fibre-rich meal. Other aspects of the cabin environment such as space and variability of seating, air quality, and noise, also have been shown to modulate (reduce or increase) discomfort and nausea during flights. Individual passenger characteristics and health status also have been demonstrated to increase vulnerability to adverse health outcomes and discomfort.
Asunto(s)
Contaminación del Aire Interior/efectos adversos , Aeronaves , Mareo por Movimiento/etiología , Viaje , Presión del Aire , Dióxido de Carbono/análisis , Humanos , Humedad/efectos adversos , Náusea/etiología , Ruido del Transporte/efectos adversos , Oxígeno/sangre , Trombosis de la Vena , Ventilación , Vómitos/etiologíaRESUMEN
Assessment of the neuronal control of the external anal sphincter (EAS) has long been restricted to investigating patients with defecation disorders by invasive tools such as needle electromyography (EMG), while less invasive techniques have been regarded as non-suitable for diagnostic purposes. Multichannel surface EMG by means of electrode arrays applied to anal sphincter muscle records and identifies individual motor unit action potentials, their place of origin along the circumference, their repetitive firing frequency, and their progression along the muscle fibres at different levels within the anal canal. These data shed doubts on conventional knowledge about the anatomy of the EAS muscle, and confirms new concepts of anatomical differences between gender. This may eventually be transferred to a new understanding of the role of symmetry and asymmetry of pelvic floor innervation and its role in the pathogenesis of fecal incontinence.
Asunto(s)
Canal Anal/anatomía & histología , Canal Anal/fisiología , Electromiografía , Adulto , Electromiografía/instrumentación , Electromiografía/métodos , Incontinencia Fecal/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Músculo Liso/anatomía & histología , Músculo Liso/fisiologíaRESUMEN
OBJECTIVES: The objective of this work was to investigate the distribution of the innervation zones of the motor units that make up the external anal sphincter (EAS) in healthy males and females. METHODS: A cylindrical probe carrying a circumferential array of 16 electrodes was used to detect the generation, propagation and extinction of individual motor unit action potentials (MUAPs) at 1, 2, and 3 cm depth from the orifice of the anal canal during maximal voluntary contractions of the EAS. Fifteen healthy males and 37 healthy nulliparous females were investigated. RESULTS: IZs could be detected in all males and in 34 out of 37 females. In the males, the IZs are scattered in the right and left hemisphincter at each of the three levels and their distribution is not affected by depth. In the females, the distribution is also concentrated in the right and left hemisphincter at depth 1 cm but is more uniform at depth 2 cm and more concentrated in the dorsal and ventral regions at depth 3 cm. ANOVA shows a statistically significant dependence of the IZ distribution on depth only in females and not in males. CONCLUSIONS: It is concluded that (a) IZs of the EAS can indeed be detected with a circumferential array placed at different depths along the anal canal; (b) large individual variability is observed, and (c) IZs show similar distribution at the three depth levels in males and different distributions in females.
Asunto(s)
Canal Anal/inervación , Adulto , Canal Anal/anatomía & histología , Análisis de Varianza , Electromiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores SexualesRESUMEN
UNLABELLED: The increased prevalence of urinary and fecal incontinence is one of the most important factors in the loss of independence and mobility in the elderly population. It is also one of the major reasons for elderly people to give up their household and move into a nursing home. Anorectal biofeedback therapy is a very effective treatment for fecal incontinence. However, due to the increased immobility of elderly people, ambulatory biofeedback training programs which require the participants to leave their homes and travel to the next available outpatient clinic on a regular basis, especially when depending on public transportation, may prove particularly difficult for elderly, incontinent subjects. Supervised home biofeedback training programs may offer an alternative for those patients, who are motivated enough and not mentally impaired. Two different age groups of women (between 49 and 63; and between 65 and 78 years old) suffering from fecal incontinence due to external anal sphincter impairment, received a supervised home biofeedback program, after extensive anorectal diagnostics including manometry. The program focused on improving voluntary sphincter contraction. After an average of 9 months, anorectal manometry was repeated, and anal resting and squeeze pressure as well as minimal rectal perception threshold were determined. There was no effect on anal resting pressure and rectal perception. However, anal maximum squeeze pressure as well as squeeze pressure over 10 s was substantially increased with no difference between the age groups. CONCLUSION: Supervised home biofeedback for sphincter insufficiency was effective in improving the voluntary contraction of the anorectum in both age groups. Therefore, biofeedback home training programs may offer an alternative to ambulatory programs for those individuals, who are not mobile enough to regularly attend an outpatient clinic.