References: Laxative
Dis Colon Rectum. 1993 May;36(5):475-83.
Does perineal descent correlate with pudendal neuropathy?
Jorge JM, Wexner SD, Ehrenpreis ED, Nogueras JJ, Jagelman DG.
Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309.
A prospective study was undertaken to assess the potential correlation between increased perineal descent (IPD) and pudendal neuropathy (PN) in 213 consecutive patients. These 165 females and 48 males of a mean age of 62 (range, 18-87) years had constipation (n = 115), idiopathic fecal incontinence (n = 58), or chronic intractable rectal pain (n = 40). All 213 patients underwent cinedefecography (CD) and bilateral pudendal nerve terminal motor latency (PNTML) assessment. Perineal descent (PD) of more than the upper limit of normal of 3.0 cm during evacuation was considered increased. Pudendal neuropathy was diagnosed when PNTML exceeded the upper limit of normal of 2.2 milliseconds. Although 65 patients (31 percent) had PD, only 16 (25 percent) of these 65 patients had neuropathy. Moreover, PN was also found in 42 (28 percent) of 148 patients without IPD. Conversely, only 16 (28 percent) of the 58 patients who had PN also had IPD, and IPD was present in 49 (32 percent) of 155 patients without PN. The frequency of PN according to the degree of IPD was: 3.0 to 4.0 cm, 6 of 27 patients (22 percent); 4.1 to 5.0 cm, 4 of 15 (27 percent); 5.1 to 6.0 cm, 4 of 12 (25 percent); 6.1 to 7.0 cm, 2 of 8 (25 percent); and > 7.0 cm, 0 of 3 (0 percent). Linear regression analysis was undertaken to compare the relationships between measurements of PD at rest (R), push (P), and change (C = P-R) and values of PNTML. These values for all 213 patients were: R, r = 0.048; P, r = 0.031; and C, r = -0.050. The correlation coefficients were equally poor for all the individual subgroups analyzed, including the patient's sex or diagnosis. In summary, no correlation was found between PD and PNTML. The lack of a relationship was seen for the entire group as well as for those pa
J Adolesc Health. 1993 Jul;14(5):362-8.
Clinical characteristics of adolescent endometriosis.
Davis GD, Thillet E, Lindemann J.
Maricopa Medical Center, St. Joseph's Hospital and Medical Center, Arizona.
Our study objective was to describe the appearance, stage, and treatment of endometriosis in adolescents undergoing laparoscopic treatment of severe dysmenorrhea and endometriosis. We designed a retrospective analysis of adolescents with endometriosis whose primary symptom was severe dysmenorrhea. We studied patients in a private practice associated with a residency program. Forty-nine adolescents with histologically confirmed endometriosis underwent laparoscopy. Thirty-six of these patients (mean age, 16.6 +/- 1.4 years; range, 13-20 years) presented with severe dysmenorrhea in a non-emergency state and were refractory to prior therapy. All patients underwent laparoscopic surgery. We classified endometriosis implants as typical implants, red lesions, and occult lesions in thirty-six adolescents. We excised infiltrating lesions (defined as implants penetrating greater than 3-5 mm) and vaporized or coagulated superficial lesions (defined as surface implants or those penetrating < 3 mm). All adolescents underwent postsurgical ovulation suppression with a daily birth control pill. The need for reoperation at any time or the use of GnRH analogs, Danazol, or large doses of progestins served to indicate treatment failure. The presence or absence of red lesions was recorded in this group and compared to the presence or absence of such lesions in an older population of patients undergoing definitive therapy for endometriosis during the same time period. Our results showed that red lesions are the predominant implant type in adolescents. Adolescents with cyclic pain and those who complain of abdominal pain, nausea, constipation, and diarrhea, during menses had the largest proportion of red lesions.(ABSTRACT TRUNCATED AT 250 WORDS)
Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8399247&dopt=Abstract constipation laxative colon cleansing
Int J Colorectal Dis. 1993 Jul;8(2):66-70.
A regional audit of the investigation and treatment of colorectal and pelvic floor disorders (1984-1991).
Varma JS, Binnie NR, Kawimbe B, Papachrysostomou M, Smith AN.
University Department of Surgery, Western General Hospital, Edinburgh, UK.
The activities of a regional physiology unit established for the investigation of colorectal and pelvic floor physiology in health and disease in a clinically relevant setting has been audited and its evolution described over a period of eight years. Trends in surgical treatment of some of these disorders over the same period have also been documented in the Lothian Region. Although there has been little change in the number of patients investigated annually patterns of investigation appear to change. Sphincter manometry, proctometrography and somatosensory reflex measurements have remained the most frequently performed and useful investigations. Spinal stimulation studies increased transiently because of a collaborative investigation of bowel and bladder function in patients with spinal injuries. A considerable increase in surface EMG tests and dynamic proctography has occurred. These trends are thought to be related to interest in defining evacuation dysfunction of the rectum and related problems of the pelvic floor. Isotope proctography now rivals barium videoproctography; at the same time the use of manometric colonic motility studies has diminished. Anal ultrasonography has replaced sphincter mapping in the last year and is being applied to other aspects of anorectal pathology. The last 4 years have seen the introduction and increasing use of non-surgical therapeutic modalities for the treatment of faecal incontinence and constipation: reflex electronic sphincter stimulation, biofeedback and the use of a prokinetic agent to promote colonic motility. Concomitant changes in the surgery of constipation and reconstructive anorectal procedures have been observed. It is recommended that coloproctology units should
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