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Achieving anal relaxation: The key to continence for encopretic children
ABSTRACTS
October1990
Pneumatic Dilation of the Lover Esophageal SphincteroftheOpossur:APrel~~~Report. G. Gossett, N. Izima, D. Pieper, J.A. Rinaldo, Departments of Medicine and Physiology, Jr, Southfield, Michigan Providence Hospital, Pneumatic dilation (PD) is largely empirical. An animal model would be useful to test its effect on the lower esophageal sphincter (LES). HETFIOD: Ten adult opossums had LES pressures measured with 4 sensors placed at the same Pressure level equidistant around the tube. profiles were done by continuous pull through Five animals had PD the LES at .33 mm/set. with a 12 mm OD and 5 with a 20 mm OD balloon were done at 12 psi for 2 min. Pull throughs before PD (C), immediately after PD (PD-0) and 10 min later (PD-10).
FzlmJLTs: Balloon 12 20
4052:l 4422.0
Pressure (mm Hg) PD-0 PD-10 2922.3 (48): (56) 1120.5 (60) 26+2.3 (60)* (60)
Mean + SE (n pull throughs); * p < 0.01 vs C for same balloon diameter CONCMSIONS: 1. Pressure in the LES of this 2. This model animal can be lowered by PD. makes it possible to observe the effect of changes in technique on reduction of LES pressure.
ACHIEVING ANAL RELPXATION: 'RIE KEY To CCNI'INEKE FDR ECJZOPRETIC CHILDREN. Allan J. Rosenberg, M.D.. M.P.H., and Tanya Whitehead, R.A., The University of Kansas MedicalCenter, Kansas City, Kansas.
We believe that contraction rather than relaxation of the anal canal during attenpts at defecation can lead to functional anal outlet obstruction with encopresis. 'IV.enty-nineencopretic children, 22 boys and 7 girls betweentheages 5and17,enrolledinabiofeedbackbowel Fecal accidents ranged fmm one to training program. ltrelve children were having no bawel threeperday. rnxrementsin the toilet. Biofeedback training utilized a visual display generated frunan intra-analmtoteach relaxation and contraction of the anal sphincter. The patients were praised for appropriately turning the display lights on and off. Between training sessions, children practiced anal sphincter contractions and relaxations. Initial EMG contraction strength averaged 10 uv for all patients. Twenty-two of the 29 children could not ccmpletely relax the anal sphincter. Three children dropped out. Of the 26 children continuing in the program, there wre 21 non-relaxers. After 6 mnths, 17 of 21 were able to completely relax the anal sphincter to ow. Thirteen were ccnpletely continent, 2 were having less than one accident perweek and 2 were having 2 accidents per week. Five children who carpletely relaxed initially continued to relax: all but one retarded child became carpletely continent. Five of the children were non-carpliant. After training the m contraction strength remined unchanged. our study darPnstrates that biofeedback with a sirrple intra-anal visual display RXi device can train encopretic children to relax the anal sphincter and achieve fecal continence.
OF PAPERS
1229
PRESSURE: A CCMPARISON OF TECHNIQUES. M.D., M.P.H., and Tanya Whitehead, R-A., The University of Kansas Medical Medical Center, Kansas City, Kansas. ANT&
Allan
SPHINCTER
J. Rosenberg,
The microtipped pressure transducer and water catheter perfusion system are techniques used to lreasure anal nt for sphincter pressure. We ccqared pressure measurerre these two methods. Fifty-four children, ages 4 to 17, 21 myelodysplastic and 33 neurologically intact children underwent -rectal rnananetq (ARM) using both systems. Both procedures were done using a station pull through technique. The microtipped pressure transducer uses an ultra miniature s&conductor gauge of three sensors radially placed three centimeters apart outer diameter 2.5 mn. Ths water infusion technique is performed with 4.8 mn outer diameter three 1-n catheter. Water is infused at 0.5 ml/min. at 15 psi. A rmlti channel direct writing physiograph records all the mzaswnts. -ison for each method was perfonnsd for anal pressure barrier (APB) and the maximalanalsqueeze (MAS) in rmHg. APB onlywas recorded for the myelcdysplastic children. Each patient's pressure represents the average of all recording sites for three pull throughs. The average APB for the microtipped transducer was 38 mMg for myelodysplastic children and 49 infusion system, mMg for no-1 children. Forthewater the APB averaged 44 m!Hg for myelodysplastic and 58 tig for normals. The APB average for all patients was 45 tig for microtipped transducer and 52 mMg for water. Ths microtippedMAS averaged 41 mrHg and 38 mxHg for water MAS. The APBwas higher for thewater infused system. Although there is reliability within each system, it may be necessaq to appreciate possible differences between systers before comparing results.
ULTRASTRUCTURE AND ORGANIZATION OF INTERSTITIAL CELLS OF CzlsAL IN HUMAN SMALL INTESTINE. J.J.Rumessen and L.Thuneberg.
Anatomy Dept. C, univ. Copenhagen, Panum Instituttet, DK-2200 Copenhagen N, De-k. Previous morphological and electrophysiological studies support the hypothesis that interstitial cells of Cajal (ICC) have important regulatory (pacemaker-) functions in the gut (1). - We have studied ICC associated with Auerbach's plexus in human small intestine by light and electron microscopy of resected tissue. ICC resembled modified smooth muscle cells. They had a moderate number of caveolae and dense bodies, an incomplete basal lamina, a very well developed smooth endoplasmic retiCUlUm, and abundant intermediate (10 nm) filaments. Thick (myosin) filaments were not seen. Fibroblast-like cells were distinguished by their lack of caveolae and dense bodies, the relative scarcity of smooth cisternae and intermediate filaments, but abundance of granular endoplasmic reticulum. ICC were arranged in cellular networks, the parallel processes of 2-7 cells forming bundles, with fibroblast-like cells interspersed in the bundles. ICC bundles were innervated by nerve elements of Auerbach's plexus and extended into both layers of smooth muscle, between muscle cells and into septa. ICC bundles were closely associated with elastin fibers. The organization revealed in this study strongly supports the concept of ICC as regulatory cells also in human small intestine. The characteristic structure and organization of ICC may provide a basis for further morphological, electrophysiological, and pathological studies of ICC in human small intestine. 1. Thuneberg, L. 1n: Handbook of physiology Sect. 6, Vol. 1, Part 1, 1989: 349-386.
(Wood, J.D., ed.)
October1990
Pneumatic Dilation of the Lover Esophageal SphincteroftheOpossur:APrel~~~Report. G. Gossett, N. Izima, D. Pieper, J.A. Rinaldo, Departments of Medicine and Physiology, Jr, Southfield, Michigan Providence Hospital, Pneumatic dilation (PD) is largely empirical. An animal model would be useful to test its effect on the lower esophageal sphincter (LES). HETFIOD: Ten adult opossums had LES pressures measured with 4 sensors placed at the same Pressure level equidistant around the tube. profiles were done by continuous pull through Five animals had PD the LES at .33 mm/set. with a 12 mm OD and 5 with a 20 mm OD balloon were done at 12 psi for 2 min. Pull throughs before PD (C), immediately after PD (PD-0) and 10 min later (PD-10).
FzlmJLTs: Balloon 12 20
4052:l 4422.0
Pressure (mm Hg) PD-0 PD-10 2922.3 (48): (56) 1120.5 (60) 26+2.3 (60)* (60)
Mean + SE (n pull throughs); * p < 0.01 vs C for same balloon diameter CONCMSIONS: 1. Pressure in the LES of this 2. This model animal can be lowered by PD. makes it possible to observe the effect of changes in technique on reduction of LES pressure.
ACHIEVING ANAL RELPXATION: 'RIE KEY To CCNI'INEKE FDR ECJZOPRETIC CHILDREN. Allan J. Rosenberg, M.D.. M.P.H., and Tanya Whitehead, R.A., The University of Kansas MedicalCenter, Kansas City, Kansas.
We believe that contraction rather than relaxation of the anal canal during attenpts at defecation can lead to functional anal outlet obstruction with encopresis. 'IV.enty-nineencopretic children, 22 boys and 7 girls betweentheages 5and17,enrolledinabiofeedbackbowel Fecal accidents ranged fmm one to training program. ltrelve children were having no bawel threeperday. rnxrementsin the toilet. Biofeedback training utilized a visual display generated frunan intra-analmtoteach relaxation and contraction of the anal sphincter. The patients were praised for appropriately turning the display lights on and off. Between training sessions, children practiced anal sphincter contractions and relaxations. Initial EMG contraction strength averaged 10 uv for all patients. Twenty-two of the 29 children could not ccmpletely relax the anal sphincter. Three children dropped out. Of the 26 children continuing in the program, there wre 21 non-relaxers. After 6 mnths, 17 of 21 were able to completely relax the anal sphincter to ow. Thirteen were ccnpletely continent, 2 were having less than one accident perweek and 2 were having 2 accidents per week. Five children who carpletely relaxed initially continued to relax: all but one retarded child became carpletely continent. Five of the children were non-carpliant. After training the m contraction strength remined unchanged. our study darPnstrates that biofeedback with a sirrple intra-anal visual display RXi device can train encopretic children to relax the anal sphincter and achieve fecal continence.
OF PAPERS
1229
PRESSURE: A CCMPARISON OF TECHNIQUES. M.D., M.P.H., and Tanya Whitehead, R-A., The University of Kansas Medical Medical Center, Kansas City, Kansas. ANT&
Allan
SPHINCTER
J. Rosenberg,
The microtipped pressure transducer and water catheter perfusion system are techniques used to lreasure anal nt for sphincter pressure. We ccqared pressure measurerre these two methods. Fifty-four children, ages 4 to 17, 21 myelodysplastic and 33 neurologically intact children underwent -rectal rnananetq (ARM) using both systems. Both procedures were done using a station pull through technique. The microtipped pressure transducer uses an ultra miniature s&conductor gauge of three sensors radially placed three centimeters apart outer diameter 2.5 mn. Ths water infusion technique is performed with 4.8 mn outer diameter three 1-n catheter. Water is infused at 0.5 ml/min. at 15 psi. A rmlti channel direct writing physiograph records all the mzaswnts. -ison for each method was perfonnsd for anal pressure barrier (APB) and the maximalanalsqueeze (MAS) in rmHg. APB onlywas recorded for the myelcdysplastic children. Each patient's pressure represents the average of all recording sites for three pull throughs. The average APB for the microtipped transducer was 38 mMg for myelodysplastic children and 49 infusion system, mMg for no-1 children. Forthewater the APB averaged 44 m!Hg for myelodysplastic and 58 tig for normals. The APB average for all patients was 45 tig for microtipped transducer and 52 mMg for water. Ths microtippedMAS averaged 41 mrHg and 38 mxHg for water MAS. The APBwas higher for thewater infused system. Although there is reliability within each system, it may be necessaq to appreciate possible differences between systers before comparing results.
ULTRASTRUCTURE AND ORGANIZATION OF INTERSTITIAL CELLS OF CzlsAL IN HUMAN SMALL INTESTINE. J.J.Rumessen and L.Thuneberg.
Anatomy Dept. C, univ. Copenhagen, Panum Instituttet, DK-2200 Copenhagen N, De-k. Previous morphological and electrophysiological studies support the hypothesis that interstitial cells of Cajal (ICC) have important regulatory (pacemaker-) functions in the gut (1). - We have studied ICC associated with Auerbach's plexus in human small intestine by light and electron microscopy of resected tissue. ICC resembled modified smooth muscle cells. They had a moderate number of caveolae and dense bodies, an incomplete basal lamina, a very well developed smooth endoplasmic retiCUlUm, and abundant intermediate (10 nm) filaments. Thick (myosin) filaments were not seen. Fibroblast-like cells were distinguished by their lack of caveolae and dense bodies, the relative scarcity of smooth cisternae and intermediate filaments, but abundance of granular endoplasmic reticulum. ICC were arranged in cellular networks, the parallel processes of 2-7 cells forming bundles, with fibroblast-like cells interspersed in the bundles. ICC bundles were innervated by nerve elements of Auerbach's plexus and extended into both layers of smooth muscle, between muscle cells and into septa. ICC bundles were closely associated with elastin fibers. The organization revealed in this study strongly supports the concept of ICC as regulatory cells also in human small intestine. The characteristic structure and organization of ICC may provide a basis for further morphological, electrophysiological, and pathological studies of ICC in human small intestine. 1. Thuneberg, L. 1n: Handbook of physiology Sect. 6, Vol. 1, Part 1, 1989: 349-386.
(Wood, J.D., ed.)