A. Infantino

Striated anal sphincter electromyography in idiopathic fecal incontinence

PURPOSE: This study was designed to determine the importance of innervation of striated anal sphincters, one of the most important structures in idiopathic fecal incontinence. METHODS: Forty-three idiopathic, fecally incontinent patients (40 women and 3 men; mean age, 57.2±11 (range, 33–77) years) underwent anorectal manometry and sphincteric electromyography. On the basis of electromyographic findings, patients were subdivided into three groups: Group A consisted of 21 patients with normal electromyography; Group B consisted of 14 patients with moderate denervation; Group C consisted of 8 patients with severe denervation. Manometric results from the patients were compared with those from 15 healthy subjects (8 women and 7 men; mean age, 35±12 (range, 15–55) years). RESULTS: Incontinent patients had a shorter anal canal (P=0.005), and anal canal pressure was lower at rest (P<0.001), at contraction (P<0.001), and at coughing (P<0.001); rectal distention and rectal compliance were reduced (maximum tolerated volume,P<0.003; compliance at 200 ml,P=0.03; at 250,P<0.005; at 300 ml,P=0.03). No statistically significant differences were found between the manometric results of the three different groups of patients. A statistically significant linear correlation was reached by comparing the clinical severity of fecal incontinence with age (P=0.02) and some other manometric parameters: the pressure of the anal canal at rest (P<0.001) and at contraction (P<0.01); rectal compliance at 50 ml (P=0.03), 100 ml (P=0.004), and 150 ml (P=0.004). CONCLUSION: Clinical severity of fecal incontinence is correlated with some manometric parameters. Severity of denervation of the anal striated sphincters does not appear to influence severity of fecal incontinence.

Role of proctography in severe constipation

As referred to in the literature, patients complaining of constipation may have a spastic or, in the case of chronic straining, weak pelvic floor. Twenty-two severely constipated patients who did not improve after a high fiber diet were submitted to whole gut transit time (TT), proctographic, and anorectal manometric studies. A control group consisting of five subjects for TT, five subjects for proctogram, and ten subjects for manometry was also studied. Transit time was delayed (P< 0.001) in all patients. Manometry in the constipated group showed a high rectal threshold (64.1vs.17.1 ml of air,P< 0.01), but no other significant difference. Proctograms in 10 of 22 patients (Group A) showed no differences in the anorectal angle (ARA) and in its distance from the pubococcygeal line (DLPC) in respect to the control group; 12 of 22 patients (Group B) had a paradoxical closure of the ARA at straining in respect to resting position (101.2†vs.120.1†), and a higher DLPC than Group A and the control group in all positions studied. There was no difference in TT for rectal stasis of radiopaque markers between the two pathologic groups. Patients in Group B were older than patients in Group A (55.3vs.42.9 years,P<0.05). In conclusion, proctograms showed alterations of the pelvic floor, but there was no correlation between proctographic data and rectal or colonic stasis of the radiopaque markers, or clinic severity of constipation, but a correlation between ages did exist.

Failure of secretin to exert an ameliorative effect on acute reflux pancreatitis in the rat

SummaryThis study was undertaken to evaluate the possible ameliorative effect of secretin on acute reflux pancreatitis in the rat. Thirty days after the performance of a gastrojejunal anstomosis, in all rats (36 Sprague-Dawley, mean weight 250 g) acute pancreatitis was induced by creating a closed duodenal loop for 12h. In the subsequent 12h group A (14 rats) received continuous intra-arterial infusion of secretin (5 CU/kg/h); group B (22 rats) received equal volumes of saline solution. Serum amylase and pancreatic histology were evaluated. In group B a mild form of pancreatitis was observed, since the mean values of haemorrhage, necrosis and steatonecrosis, indices of severe disease, were found to be low. Group A presented similar results. No difference was documented between the two groups for both the histological findings and serum amylase. We can conclude that despite the reported protective and ameliorative effects of secretin in cerulein-induced acute pancreatitis in the rat, our data do not support a similar action of secretin in the closed duodenal loop model.

Protective Effect of Reduced Glutathione on Acute Reflux Pancreatitis in the Rat

The possible beneficial effect of reduced glutathione infusion on acute reflux pancreatitis was investigated in five groups of rats (8 each). In groups A, A’ and B, B’ acute pancreatitis was induced b

Biliary hyperpressure in rat extrahepatic cholestasis alters horseradish peroxidase biliary excretion.

1. The authors investigated the effect of two extrahepatic cholestasis models (one by bile duct ligation and the other by choledocho‐jugular fistula) on the hepatic clearance of horseradish peroxidase in male Sprague‐Dawley rats divided into four groups.

Acute reflux pancreatitis in rats: A comparison between two experimental models

SummaryThis study was undertaken in order to compare the reliability of two acute reflux pancreatitis models in rats, one performed by positioning a silicon tube in the duodenum and the other by creating a gastro-jejunal anastomosis. In two groups (A= 10 and B= 10 rats) a silicon tube was positioned in the duodenum; in the remaining two groups (C=12 and D=6 rats) a latero-lateral antecolic anisoperistaltic gastrojejunal anastomosis was performed 30 days before surgery. A closed duodenal loop was created for 12 hours in groups A and C but not in B and D. Rats in both groups A and C developed acute pancreatic inflammation of a mild degree. Sham operated rats with silicon tube placement had higher histological damage scores than those with gastro-jejunal anastomosis. The difference found between the two groups of rats which under-went gastro-jejunal anastomosis was more marked than that between the two groups which had silicon tube placement. It was concluded that the creation of a gastro-jejunal anastomosis is probably the safer procedure to allow gastro-intestinal flow in acute reflux pancreatitis in rats.