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Dis Colon Rectum. 1996 Jul;39(7):794-8.
Prospective comparative study of abnormal distal rectoanal excitatory reflex, pudendal nerve terminal motor latency, and single fiber density as markers of pudendal neuropathy.

Sangwan YP, Coller JA, Barrett RC, Murray JJ, Roberts PL, Schoetz DJ Jr.

Department of Colon and Rectal Surgery, Lahey Hitchcock Medical Center, Burlington, Massachusetts 01805, USA.

PURPOSE. This study was undertaken to determine the role of abnormal distal rectoanal excitatory reflex (RAER) as a marker of pudendal neuropathy and to compare results with pudendal nerve terminal motor latency (PNTML) and single fiber density (SFD) estimation. METHODS. Fifteen female patients (mean age, 47.1 (range, 20-70) years) referred to the pelvic floor laboratory with pelvic floor disorders (fecal incontinence, 13 patients; constipation, 2 patients) were evaluated prospectively with neurophysiologic tests and balloon reflex manometry for evidence of pudendal neuropathy. RESULTS. Pudendal nerve terminal motor latency provided evidence of pudendal neuropathy in ten patients (67 percent) and was normal in five patients (33 percent). Increased SFD confirmed denervation of the external anal sphincter in 12 patients (80 percent), being normal in 3 patients (20 percent). Distal RAER was abnormal in 13 patients (87 percent) and was normal in 2 patients (13 percent). In ten patients (67 percent), the three diagnostic modalities were in complete agreement, correctly identifying neuropathy in nine patients (60 percent) and excluding nerve damage in one patient (7 percent). Distal RAER was normal despite prolonged PNTML and increased SFD in one patient (7 percent). In two patients (13 percent), distal RAER was abnormal or absent despite normal PNTML and SFD. Pudendal nerve terminal motor latency was normal in the presence of abnormal distal RAER and increased SFD on electromyography in two patients (13 percent). CONCLUSIONS. Abnormal distal RAER compares favorably with current neurophysiologic tests us



Urology. 1996 Jun;47(6):905-7.
Laparoscopic creation of a continent cecal tube for antegrade colonic irrigation.

Cromie WJ, Goldfischer ER, Kim JH.

Department of Sugery, University of Chicago Pritzker School of Medicine, Illinois, USA.

OBJECTIVES; The antegrade continence enema (ACE) procedure has been used for the treatment of overflow fecal incontinence or constipation inpatients with spina bifida. The procedure requires an appendiceal reimplantation into the cecum with creation of a continent abdominal stoma for antegrade colonic washout. To preserve the appendix for potential use in urinary diversion, we developed two surgical techniques for tubularizing an antimesenteric cecal segment to use in place of the appendix. METHODS: The surgery was performed in 6 dogs. The first two procedures used an open surgical technique through a 10-cm midline laparotomy. The cecum was isolated, and a small cecotomy was made. A 10F red rubber catheter was introduced into the cecotomy, and a 4-cm length of cecum was tubularized along its antimesenteric border with a gastrointestinal anastomosis stapler over the catheter. A nipple was created at the base of the tube to enhance continence, and the tubular segment was brought through the lower abdominal wall to create a catheterizable stoma. After our success, four subsequent procedures were performed laparoscopically to create the same tubularized cecal segment. A 4-cm antimesenteric tubularized cecal segment with sufficient lumen to accommodate a 10F to 12F catheter was constructed using a laparoscopic gastrointestinal anastomosis stapler. Rather than creating a nipple at the base of the tubular segment, continence of the stoma was achieved by tunneling the cecal tube through a 2-cm lower quadrant subcutaneous tunnel. A flush stoma was then created and secured to the skin. RESULTS: Stoma viability was grossly confirmed in all 6 dogs during the postoperative period, with no incidence of bowel obstruction. Slight fecal leakage through the stoma was



Z Gastroenterol. 1996 May;34(5):273-8.
Functional diagnostic work-up in patients with irritable bowel syndrome.

Klauser AG, Voderholzer WA, Schindlbeck NE, Muller-Lissner SA.

Department of Gastroenterology, University of Munich, Germany.

The first aim of the study was to find a cause of symptoms in patients suffering from "irritable bowel syndrome" using diagnostic tests aimed at functional disorders of lower gut. A second aim was to test, whether the presence of irritable bowel syndrome (or, synonymously, absence of classic organic disease) can be predicted by specific symptoms. 134 consecutive patients (50 +/- 16 SD years, range 17 to 88, 94 women) presenting in our gastroenterological outpatient department with abdominal pain and altered bowel habits were included. A conventional diagnostic work-up aimed at classic organic diseases and, if negative, a functional diagnostic work-up aimed at gastrointestinal malfunction such as dietary fibre trial, functional proctoscopy, defecography, colonic transit of radiopaque markers, anorectal manometry, and lactose tolerance test were done. A classic organic disease was found in only 15 of 134 patients by conventional diagnostic tests. Functional diagnostic work-up yielded a diagnosis in 70 of the remaining 119 patients that else would have been labeled to suffer from IBS (25 slow transit constipation, 20 disordered defecation, nine low fibre intake, and nine lactose intolerance among them). When symptoms were evaluated with a standardized questionnaire, "constipation" and the "necessity of straining to open bowels" were very specific for functional bowel disorder (92% and 100%), but sensitivity of both symptoms was only about 60%. The so-called "Manning criteria" had a very low prevalence in our sample and so were not discriminatory. Since in more than half of the patients with "irritable bowel syndrome" a specific diagnosis can be reached, functional tests should be considered in such patients. T



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