Hemorrhoidectomy in the patient with multiple or circumferential hemorrhoids

A technique is presented that allows complete removal of hemorrhoids even when large hemorrhoids exist between the classic three major hemorrhoidal location. Since the anorectal mucosa overlying these “interval” hemorrhoids is preserved, there is no increased tendency for stricture formation to occur.     

功能性便秘患者肛门直肠动力学的临床研究

目的观察功能性便秘(functional constipation,FC)患者的肛门直肠动力学改变.方法采用灌注式测压装置测定20例FC患者和15例健康人的肛门直肠压力、直肠对容量刺激的最低敏感量、最大耐受量及直肠顺应性.结果 FC患者的直肠、肛门内外括约肌静息压力、内括约肌主动收缩压、模拟排便时直肠收缩压、内外括约肌净减压与对照组比较无显著性差异.FC组肛门-直肠屏障压高于对照组.FC组直肠对容量刺激的最大耐受量及顺应性均高于对照组.结论功能性便秘患者存在肛门直肠动力学异常,这种异常可能是导致便秘的原因.     

Anal pressure waves in patients with irritable bowel syndrome

PURPOSE: Many data suggest in irritable bowel syndrome a generalized smooth-muscle disorder, but data are scant concerning anal waves in patients with irritable bowel syndrome. The aim of the present study was first to propose a new method of anal pressure-wave analysis and second to apply this method to patients with irritable bowel syndrome. METHODS: Spectral analysis was used in 20 healthy controls and 60 patients with irritable bowel syndrome to investigate anal pressure waves at rest during a standard anorectal test and during a maintained 12-ml anal distention. RESULTS: Adaptation of the anal canal to maintained distention was similar in the two groups of subjects. Using a cluster analysis, three groups of anal waves were defined (in cycles per minute): ultra slow waves (0.9–3.3), slow waves (3.8–16.4), and simple waves (16.9–23). In the resting state only simple waves were found less prevalent in patients with irritable bowel syndrome. During maintained distention, ultra slow waves increase in both groups, but slow waves increase in patients with irritable bowel syndrome and simple waves decrease in controls. CONCLUSIONS: Characterization of anal pressure waves is a simple procedure that is easy to perform in outpatients. Anal pressure waves of patients with irritable bowel syndrome have altered organization and respond differently to distention as compared with controls.Published in part as an abstract inGastroenterology 1998;114:G3030A.     

功能性便秘动力学改变与情志因素的相关性

目的:分析功能性便秘(functional constipation,FC)肛肠动力学与患者生活质量及情志因素相关性.方法:患者进行肛肠动力学指标观察分析,采用生命质量调查问卷、精神心理状态评定量表问卷调查,进行动力学指标和情志因素相关性分析.结果:患者组生活质量所有8个维度的评分均低于健康对照组,存在明显的焦虑、抑郁情绪.焦虑、抑郁积分与生活质量负相关;肛肠动力学和精神心理因素相关(P<0.05),肛管缩榨压及其持续时间与抑郁自评量表(selfrating depression scale,SDS)、焦虑自评量表(selfrating anxiety scale,SAS)呈负相关;初始感觉阈值、排便感觉阈值和最大耐受容量与SAS、SDS呈正相关.结论:便秘显著损害患者的生存质量,易合并有焦虑、抑郁等情志因素的异常.焦虑、抑郁和生存质量相关,肛肠动力学和精神心理因素相关.     

慢性特发性便秘患者肛门直肠动力学及精神心理因素的研究

目的：研究慢性性发性便秘（CIC）患者的肛门直肠动力学及其力学及其心理的变化。方法肛门直肠测压法检测28例CIC患者肛门直肠动力学的变化,同时进行心理测试,并与24名健康者进行对照观察。结果：CIC患者年龄偏大（P＜0．05）;肛门括约肌静息压,最大缩榨压降低（P＜0．05,P＜0．005）,肛管高压带长度增加（P＜0．005）;引起直肠肛门抑制反射的最小松驰容量（MVR）增加（P＜0．005）,肛门括约肌松驰率下降（P＜0．025）;直肠内部容量刺激的排便阈值和最大耐受量均明显增加（P＜0．005,P＜0．005）;CIC患者焦虑、抑郁精神心理异常倾向的出现率明显高于对照组（P＜0．05,P＜0．01）。结论：CIC患者存在肛门直肠动力学及精神心理因素的异常。     

Anorectal pressure gradient in patients with anal incontinence

Anorectal pressures in patients with fecal incontinence have been investigated. With anal manometry, 34 percent of patients with fecal incontinence had maximal resting pressure and 39 percent had maximal squeeze pressure within the normal range. When a pressure gradient was calculated as the pressure difference between maximal resting pressure and rectal pressuring during filling of a rectal balloon, patients with fecal incontinence could be better distinguished from controls: 20 percent of patients with fecal incontinence had values within the normal range when the rectal pressure at the earliest defecation urge was used (P <0.05), and 12 percent had values within the normal range when the rectal pressure at maximal tolerable volume was used (P <0.01). Anorectal pressure gradient measurements seem to distinguish patients with fecal incontinence from controls better than maximal resting pressure or maximal squeeze pressure alone.     

Randomized, Prospective Trial Comparing 0.25 Percent Glycerin Trinitrate Ointment and Anal Cryothermal Dilators Only with 0.25 Percent Glycerin Trinitrate Ointment and Only with Anal Cryothermal Dilators in the Treatment of Chronic Anal Fissure: A Two-Year Follow-Up

Purpose The objective of this study was to compare the efficacy of 0.25 percent glycerin trinitrate ointment in association with cryothermal anal dilators with 0.25 percent glycerin trinitrate ointment only and cryothermal anal dilators only. Methods A total of 48 patients suffering from chronic anal fissure were enrolled in this prospective, randomized study between January 2002 and December 2003: Group A, 16 patients were treated with 0.25 percent glycerin trinitrate ointment and also used cryothermal anal dilators; Group B, 16 patients were treated with 0.25 percent glycerin trinitrate ointment only; Group C, 16 patients were treated with cryothermal anal dilator use only. All patients in each group followed the specified treatment protocol for six weeks. Results After seven weeks of treatment, the symptoms complained of were resolved in 15 patients (93.7 percent) in Group A, 12 patients (75 percent) in Group B, and 12 patients (78 percent) in Group C. After two years of follow-up, 14 patients (87.5 percent) in Group A, 9 patients (56.2 percent) in Group B, and 10 patients (62.5 percent) in Group C presented no recurrence of symptoms. No patient in any group reported serious side effects of the treatment proposed, and treatment did not have to be withdrawn in any of the randomized patients. No episodes of anal incontinence of gas or feces were recorded in the patients who had used the anal dilators. Conclusions The combined treatment for chronic anal fissure proved to be efficacious, safe, and with statistically significant better results than the other treatments analyzed. Presented at the Central European Congress of Coloproctology, Graz, Austria, May 11 to 13, 2006. Reprints are not available.     

肠易激综合征便秘型和功能性便秘结、直肠肛门动力学研究

目的 研究肠易激综合征(IBS)便秘型和功能性便秘患者结肠、直肠动力,直肠感觉功能.方法 对IBS便秘型患者52例和功能性便秘患者48例进行肛门直肠测压检查,并做结肠传输试验.同时选择正常健康人作对照组.结果 IBS便秘型组和功能性便秘组与对照组间直肠静息压、肛管静息压和肛门括约肌最大缩榨压比较均未见明显差异.IBS便秘型组初感阈值及排便阈值(75.00±34.04 ml,117.31±37.60 ml)较正常对照(97.14±20.54 ml,138.57±19.94 ml)明显降低.功能性便秘组排便阈值及最大耐受阈值(187.92 ±68.62 ml,252.5±93.40ml)较正常对照组(138.57±19.94 ml,181.43±18.34 ml)明显升高.IBS便秘型组各项感觉阈值较功能性便秘组均明显降低.功能性便秘组较IBS便秘型组患者结肠传输试验符合出口梗阻的比例高,但无统计学差异.结论 IBS便秘型直肠感觉过敏,功能性便秘直肠感觉迟钝.     

Individual prediction of response to pneumatic dilation in patients with achalasia

During nine years, 157 consecutive patients with achalasia have been dilated in our unit. First, the long-term effect of dilation on clinical status was evaluated. The probability of being in clinical remission eight years after first dilation was 51%. The pressure of the LES measured after dilation was highly predictive of the long-term clinical evolution. Second, a predictive model of the individual response to pneumatic dilation was developed and simplified. Therapy was effective in 80% of the patients, after one to four dilations. Younger age was the only factor significantly associated with ineffective therapy. Depending on the prognosis of the outcome calculated with the predictive model, patients were classified in groups of risk that showed a different rate of ineffective therapy. In the simplified model, age 20 years, male gender, esophageal body diameter 3 cm, esophageal body basal pressure >15 mm Hg, and pressure of the lower esophageal sphincter >30 mm Hg were predictors of a poor response to dilation. We conclude that pneumatic dilation is an effective therapy for achalasia. A predictive model was useful to classify the patients in groups with a different risk for ineffective dilation. A simplification of this model could be used to predict the response to dilation.     

外痔剥离术联合铜离子电化学治疗术和后正中位肛门内括约肌部分离断术治疗老年患者混合痔的疗效分析

目的 探讨外痔剥离术联合铜离子电化学治疗术和后正中位肛门内括约肌部分离断术治疗老年患者Ⅲ、Ⅳ度混合痔的临床疗效。方法 选择2019年11月—2020年3月黄石市中医医院肛肠科收治的100例老年患者,随机分为对照组和观察组,每组50例。对照组采用外痔剥离术联合铜离子电化学治疗术治疗,观察组在对照组的基础上,联合后正中位肛门内括约肌部分离断术治疗。观察比较2组疗效、肛管动力学指标（肛管静息压、肛管最大收缩压）、手术相关指标（手术时间、术中出血量、术后12h VAS疼痛评分、术后住院时间以及创面愈合时间）以及术后复发率。结果 观察组总有效率明显高于对照组（P<0.05）;术后1个月,2组肛管动力学指标均显著低于术前（P<0.05）,且观察组明显低于对照组;2组手术时间及术中出血量差异均无统计学意义（P> 0.05）;观察组术后12h疼痛VAS评分、术后住院时间、创面愈合时间和术后复发率均明显低于（短于）对照组（P<0.05）。结论 外痔剥离术联合铜离子电化学治疗术和后正中位肛门内括约肌部分离断术治疗老年患者Ⅲ、Ⅳ度混合痔的疗效肯定,可有效改善肛管功能及手术相关指标,降...     

Anorectal function and morphology in patients with sporadic proctalgia fugax

PURPOSE: The pathophysiology of sporadic proctalgia fugax remains unknown. This study investigates whether patients with this syndrome exhibit alterations in anal function and morphology. METHODS: Eighteen patients with sporadic proctalgia fugax and 18 sex-matched and age-matched healthy controls were studied. Manometric studies investigated anal resting and squeeze pressures, the rectoanal inhibitory reflex, rectal compliance, and smooth muscle response to edrophonium chloride administration. External and internal sphincter thickness was measured endosonographically. RESULTS: Patients had slightly higher (P=0.0291) anal resting pressures (65.5±11.4 mmHg) than controls (56±9.9 mmHg). However, anal squeeze pressure, sphincter relaxation during rectal distention, and rectal compliance were similar in both groups, and no alterations were detected in external and internal anal sphincter thickness. Edrophonium chloride administration was followed by sharp postrelaxation contractions in two patients, whereas anal function remained unaltered in controls. Acute episodes of proctalgia, which occurred in two patients while under study, were associated with a rise in anal resting tone and an increase in slow wave amplitude. CONCLUSIONS: In the resting state, patients with proctalgia fugax have normal anorectal function and morphology. However, they may exhibit a motor abnormality of the anal smooth muscle during an acute attack.Supported by Grant Ec 105/1-2 from the Deutsche Forschungsgemeinschaft.     

Topical phenylephrine increases anal canal resting pressure in patients with faecal incontinence

INTRODUCTION: The internal anal sphincter receives a stimulatory alpha(1) adrenergic innervation. Use of an adrenergic agonist may therefore have a role in treating patients with faecal incontinence. METHODS: Ten patients (seven females, median age 66 years) with passive faecal incontinence related to weak internal anal sphincter were studied. All patients had intact anal sphincters as assessed by endoanal ultrasound. Phenylephrine gel was applied in a double blind manner in concentrations of 0%, 10%, 20%, 30%, and 40% (Slaco Pharma (UK) Ltd, Watford, UK) on separate days. Maximum resting anal pressure (MRP), anodermal blood flow, blood pressure, and pulse rate were measured before, and one and two hours after application. RESULTS: All concentrations of phenylephrine gel increased median MRP (43, 48, 54, 65, and 70 cm H(2)O, for placebo, 10% (p=0.122), 20% (p=0.170), 30% (p=0.002), and 40% (p=0.004), respectively at one hour; comparisons with placebo). This was sustained at two hours. There was a clear dose-response relationship at one hour. Higher concentrations raised median MRP to within the normal range (> 60 cm H(2)O). At two hours, all concentrations greater than 20% increased the pressure to a similar degree, suggesting that the exact concentration may be important for the initial effect but given a certain threshold is less important after a period of time. Toxicity was rare. Two patients experienced transient perianal burning which settled within a few minutes. There was no significant effect on anodermal blood flow, blood pressure, or pulse rate. CONCLUSION: This study has demonstrated the feasibility of using topical phenylephrine to raise resting anal tone in patients with faecal incontinence. Randomised controlled trials are required to assess the efficacy of this agent.     

Nocturnal pulse rate and symptomatic response in patients with obstructive sleep apnoea treated with continuous positive airway pressure for one year

Background

Obstructive sleep apnoea (OSA) is the most common form of sleep-disordered breathing and a known risk factor for cardiovascular disease. We hypothesised that in patients with OSA the characteristics of nocturnal pulse rate (PR) are associated with changes in blood pressure and daytime sleepiness, following commencement of continuous positive airway pressure (CPAP) therapy.

Methods

Pulse oximetry data, demographics, daytime sleepiness and blood pressure were recorded at baseline and at one year follow up. Patients with OSA were grouped according to positive and negative changes in the PR (ΔPR) response during the first night of pulse oximetry before commencement of CPAP.

Results

A total of 115 patients (58 with OSA and 57 matched subjects without OSA) were identified and included in the analysis. The scale of improvement in daytime sleepiness could be predicted by a negative or positive ΔPR, as recorded in the initial screening pulse oximetry [ΔESS –5.8 (5.1) vs. –0.8 (7.2) points, P<0.05]. A negative correlation was observed between mean nocturnal PR and changes in systolic blood pressure (SBP) after one year of CPAP treatment (r=–0.42, P<0.05).

Conclusions

Mean nocturnal PR prior to CPAP initiation was associated with changes in SBP at one year follow up. A descending nocturnal PR in patients with OSA, prior to CPAP initiation, might help to identify a symptomatic response from long term CPAP treatment.     

老年高血压患者脉压与左房构型改变的相关研究

目的:探讨老年高血压患者脉压(PP)与左房构型改变的相关关系。方法:测定63例老年高血压患者的血压,计算PP;用超声心电图仪测量左房内径(LAD),左房内径指数(LADI),左室重量指数(LVMI)等。将PP≥60mmHg的患者33例列为A组,PP<60mmHg的患者列为B组。结果:A组中LAD、LADI显著大于B组(P<0.01);LADI与SBP、PP、LVMI呈密切正相关(r分别为0.58、0.52、0.51,P分别为<0.001、<0.01、<0.01)。结论:老年高血压患者PP与左房构型改变密切相关。     

Provocation of transient lower esophageal sphincter relaxations by meals in patients with symptomatic gastroesophageal reflux

The effect of a meal on the rate of transient lower esophageal sphinter (LES) relaxations and patterns of gastroesophageal reflux was investigated in 49 patients referred for evaluation of gastroesophageal reflux. Esophageal motility and pH were recorded concurrently before and after a standard meal. In the patients with symptomatic reflux, the meal induced a four-to sevenfold increase in the gastroesophageal reflux through two mechanisms: a four-to fivefold increase in the rate of transient LES relaxations and an increase in the proportion of transient LES relaxations accompanied by reflux from 47% to 68^. Overall the rate of reflux episodes that occurred by mechanisms other than transient LES relaxation did not increase significantly. An exception to these findings were those in six patients with chronically absent basal LES pressure in whom transient LES relaxations could not be scored. In these patients, reflux increased postprandially through mechanisms other than transient LES relaxation. These findings confirm the pivotal importance of transient LES relaxations in the pathogenesis of gastroesophageal reflux.     

高血压伴鼾症患者夜间低氧血症与动态血压关系的研究

目的:探讨高血压伴鼾症患者夜间低氧血症与动态血压变化的关系。方法:对95例高血压伴鼾症患者进行夜间持续经皮血氧饱和度监测,次日行24小时动态血压监测。根据夜间最低血氧饱和度(LSaO2)结果,将患者分为高血压合并低氧血症(EHL)组(51例)及单纯高血压(EH)组(44例),进行两组的一般状况及24小时动态血压各指标对比分析,并进一步行LSaO2、体重指数(BMI)、年龄(Age)与24小时动态血压各指标相关性分析。结果:95例患者中杓型组33例,占34.7%;非杓型组62例,占65.3%。EHL组24hSBP、24hHR、dSBP、dHR、nSBP、nHR、偶测SBP(cSBP)、偶测DBP(cDBP)与EH组相比有显著差异(P<0.05);低氧血症组中84.3%患者动态血压昼夜节律消失。EHL组与EH组血压昼夜节律异常者存在显著性差异(P<0.001)。结论:高血压伴OSAS者血压增高的程度以及血压昼夜节律异常与夜间低氧血症密切相关。     

正常高值血压患者认知行为干预效果评价

目的探讨对正常高值血压患者进行认知行为干预的治疗效果。方法将2011年4月~2011年10月体检时发现正常高值血压患者60例作为对照组,将2011年11月~2012年4月体检时发现的60例正常高值血压患者作为干预组。对照组采用常规护理,干预组在常规护理的基础上通过电话进行为期1年的认知行为干预,内容包括改变患者生活习惯、鼓励患者低盐低脂饮食、禁烟限酒,适当增加运动等,并分别于第2年体检时通过问卷调查患者对正常高值血压治疗性生活方式相关知识的知晓率、生活方式改变等情况。同时收集两组患者干预前后的体检报告,内容包括:血压、空腹血糖、血脂、测量当日身高、体重等指标,评价两组患者认知行为干预的效果。结果通过1年系统的认知行为干预,与对照组比较,干预组正常高值血压治疗性生活方式相关知识知晓率较高(90%vs.73.3%,P0.05),同时高盐饮食(23.3%vs.46.7%,P0.05)、高脂饮食(13.3%vs.35.9%,P0.05)、吸烟人数(25.0 vs.48.3%,P0.05)、饮酒人数(30.0%vs.36.7%,P0.05)均减少,而坚持运动的人数增加(86.7%vs.50.0%),同时血脂、血糖也获得了改善,差异均有统计学意义(P0.05)。结论通过系统的认知行为干预可纠正正常高值血压人群不良生活方式,改善患者代谢水平。     

高血压患者24h动态血压的昼夜规律及变异性研究

目的 探讨原发性高血压（EH）患者血压昼夜规律及血压波动程度即变异性的临床意义.方法 回顾分析65例EH患者24 h动态血压（24 h ABPM）监测报告.将65例EH患者分为两组：一组为高血压伴左心室肥大（LVH）30例,另一组为高血压不伴左心室肥大35例.选择同期健康体检者30名为正常血压对照组.对下列参数进行分析：①24 h平均收缩压（24 h SBP）与舒张压（24 h DBP）;②白昼平均收缩压（dSBP）与舒张压（dDBP）;③夜间平均收缩压（nSBP）与舒张压（nDBP）;④24 h收缩压标准差（24 h SSD）与舒张压标准差（24 h DSD）;⑤白昼收缩压标准差（dSSD）与舒张压标准差（dDSD）;⑥夜间收缩压标准差（nSSD）和舒张压标准差（nDSD）;⑦夜间/白昼平均收缩压比值（nSBP/dSBP）与舒张压比值（nDBP/dDBP）.结果 高血压伴LVH组与正常对照组或高血压无LVH组比较,24 h各时间段的血压均值及血压变异性差异有统计学意义（P＜0.01）,血压昼夜（清醒/睡眠）规律性不明显,nSBP/dSBP比值显著高于对照组（P＜0.01）.高血压无LVH组与正常对照组比较,血压均值差异有统计学意义（P＜0.01）,血压大多有较明显昼夜（清醒/睡眠）变化规律,血压变异性比较除白昼收缩压变异性有明显差异外,其余差异无统计学意义.结论 高血压不合并靶器官损害时,血压的变异性不显著,有明显昼夜规律性;高血压合并靶器官损害时,血压的变异性增大,无明显昼夜规律性,nSBP/dSBP比值明显增高.利用这些指标可评估高血压患者是否有靶器官损害,以便更有效地控制血压,减少并发症.     

Office and ambulatory blood pressure control in hypertensive patients treated with different two-drug and three-drug combinations

There is scarce information regarding ambulatory blood pressure (BP) achieved in daily practice with a wide range of antihypertensive drug combinations. We looked for differences in office and ambulatory BP among major drug combinations of two and three antihypertensive agents from a different drugs class. A total of 17187 patients treated with six types of two-drug combinations and 9724 treated with six types of three-drug combinations from the Spanish ABPM Registry were analyzed. We compared achieved office and ambulatory BP, as well as office (< 140/90 mmHg) and ambulatory (24-hour BP < 130/80; day BP < 135/85, and night BP < 120/70 mmHg) BP control among groups. The combination of renin-angiotensin system (RAS) blockers with diuretics and the triple combination of RAS blockers with diuretics and calcium channel blockers (CCB) were associated with lower values of 24-hour, daytime and nighttime BP, as well as more pronounced nocturnal BP dip. Compared with such combinations (reference), other double combinations had lower rates of ambulatory BP control. Moreover, triple combinations containing alpha blockers also had lower rates of ambulatory BP control. We conclude that even with similar office BP control, differences exist among antihypertensive two-drug and three-drug combinations with respect to ambulatory BP control achieved during treatment, with RAS blockers/diuretics and RAS blockers/CCBs/diuretics obtaining better control rates. This can help physicians choose among drug combinations in order to obtain further ambulatory BP reductions.