Study of the Rectal Electric Activity of the Uninhibited Rectal Detrusor (Overactive Rectum): A New Concept of Pathogenesis

Abstract

Background/Objective: One of the causes of fecal incontinence is uninhibited rectal detrusor syndrome (URDS). Patients with this condition either perceived the first rectal sensation after the onset of involuntary rectal contraction or not at all. We investigated the hypothesis that the abnormal rectal contractility in URDS may be caused by deranged rectal electric activity.

Methods: Twenty-five patients with URD (14 women and 11 men; age, 44.7 ± 10.3 years) and 10 healthy volunteers (6 women and 4 men; age, 42.8 ± 8.7 years) were studied. URDS was diagnosed by rectometry and provocative test. A transcutaneous EMG was performed with one electrode placed lateral to each sacroiliac joint and the third one midway between the greater trochanter and the ischial tuberosity. Two 20- minute recording sessions were performed for each subject.

Results: Slow waves (SWs) with regular rhythm and similar parameters (frequency, amplitude, conduction velocity) from the 3 electrodes were recorded from the healthy volunteers. They showed a significant increase in the parameters on saline filling of the rectum. The SWs of patients with URDS exhibited a “dysrhythmic” pattern with irregular parameters, which were different in the 3 electrodes and inconsistent during recording. They showed areas of tachyrhythmia, bradyrhythmia, and arrhythmia. On provoking rectal overactivity, the SWs showed an increased dysrhythmic activity.

Conclusions: The patients with URD exhibited a “dysrhythmic” electric pattern with areas of variable electric activity. The tachyrhythmic areas seem to initiate the urgency and fecal incontinence of URDS. It is suggested that a disordered rectosigmoid pacemaker causes the dysrhythmic waves.     

A role for vesicular glutamate transporter 1 in synaptic vesicle clustering and mobility

Synaptic vesicles (SVs) from excitatory synapses carry vesicular glutamate transporters (VGLUTs) that fill the vesicles with neurotransmitter. Although the essential function of VGLUTs as glutamate transporters has been well established, the evidence for additional cell‐biological functions is more controversial. Both VGLUT1 and VGLUT2 disruptions in mice result in a reduced number of SVs away from release sites, flattening of SVs, and the appearance of tubular structures. Therefore, we analysed the morphology, biochemical composition and trafficking of SVs at synapses of VGLUT1^?/? mice in order to test for a function of VGLUTs in the formation or clustering of SVs. Analyses with high‐pressure freezing immobilisation and electron tomography pointed to a role of VGLUT1 transport function in the tonicity of excitatory SVs, explaining the aldehyde‐induced flattening of SVs observed in VGLUT1^?/? synapses. We confirmed the steep reduction in the number of SVs previously observed in VGLUT1^?/? presynaptic terminals, but did not observe accumulation of endocytotic intermediates. Furthermore, SV proteins of adult VGLUT1^?/? mouse brain tissue were expressed at normal levels in all subcellular fractions, suggesting that they were not displaced to another organelle. We thus assessed the mobility of the recently documented superpool of SVs. Synaptobrevin2–enhanced green fluorescent protein time lapse experiments revealed an oversized superpool of SVs in VGLUT1^?/? neurons. Our results support the idea that, beyond glutamate loading, VGLUT1 enhances the tonicity of excitatory SVs and stabilises SVs at presynaptic terminals.     

Incorporation of extruded coils into the third nerve in association with third nerve palsy

The extrusion of the coil complex outside of the aneurysmal dome is thought to be an important mechanism by which the aneurysm neck and fundus recanalize, but the migration of the coil loops and their incorporation inside vital nervous structures has not been clearly described. We reviewed the medical literature on coil extrusion and migration and report a rare case of third nerve palsy due to direct damage caused by coil loop migration that resolved after surgery. A 25-year-old woman presented with subarachnoid hemorrhage and painful left third nerve palsy. The angiogram revealed a supraclinoid internal carotid aneurysm incorporating the origin of the left posterior communicating artery. Her aneurysm was coiled. The 8 month follow-up angiogram revealed a major recurrence of her aneurysm. It was decided to surgically clip the aneurysm. At surgery, coil loops were found in the subarachnoid space and embedded into the third nerve. At 1 month follow-up she had recovered well, and only had very subtle diplopia upon fatigue. Coil extrusion is a fairly common phenomenon that should be suspected in instances of major aneurysmal recurrence. Surgical treatment is recommended, and special care should be taken when mobilizing the extruded coil mass.     

New-generation oral anticoagulants for the prevention of stroke: Implications for neurosurgery

A new generation of oral anticoagulants, namely direct thrombin inhibitors and factor X_a inhibitors, have recently been approved for clinical use in patients with atrial fibrillation. These novel families of drugs have been shown to have favorable efficacy and safety profiles in multiple clinical settings, particularly in the prevention of atrial fibrillation-related stroke, and are likely to become part of everyday practice, making a crossover to neurosurgical patients inevitable. Concern has risen regarding the complexity of managing intracranial and intraspinal hemorrhages related to these drugs. This review aims to provide an update on the most recent advances in oral anticoagulant drug therapy from a neurosurgeon’s perspective. We discuss current evidence for the use of these novel agents, their limitations, existing methods of drug-level monitoring, and controversies related to anticoagulation reversal. We also discuss specific topics such as anticoagulation resumption after intracranial or intraspinal bleeding, perioperative anticoagulant administration, and the possibility of combination with tissue plasminogen activator in the setting of acute ischemic stroke. A special focus is given to the incidence of intracranial and intraspinal hemorrhage associated with each drug.     

Factors associated with early growth in Egyptian infants: implications for addressing the dual burden of malnutrition

Optimal nutrition is critical to the attainment of healthy growth, human capital and sustainable development. In Egypt, infants and young children face overlapping forms of malnutrition, including micronutrient deficiencies, stunting and overweight. Yet, in this setting, little is known about the factors associated with growth during the first year of life. A rise in stunting in Lower Egypt from 2005 to 2008 prompted this implementation research study, which followed a longitudinal cohort of infants from birth to 1 year of age within the context of a USAID‐funded maternal and child health integrated programme. We sought to determine if growth patterns and factors related to early growth differed in Lower and Upper Egypt, and examined the relationship between weight loss and subsequent stunting at 12 months of age. Growth patterns revealed that length‐for‐age z‐score (LAZ) decreased and weight‐for‐length z‐score (WLZ) increased from 6 to 12 months of age in both regions. One‐quarter of infants were stunted and nearly one‐third were overweight by 12 months of age in lower Egypt. Minimum dietary diversity was significantly associated with WLZ in Lower Egypt (β = 0.22, P < 0.05), but not in Upper Egypt. Diarrhoea, fever and programme exposure were not associated with any growth outcome. Weight loss during any period was associated with a twofold likelihood of stunting at 12 months in Lower Egypt, but not Upper Egypt. In countries, like Egypt, facing the nutrition transition, infant and young child nutrition programmes need to address both stunting and overweight through improving dietary quality and reducing reliance on energy‐dense foods.     

Immunomodulatory effect of gelatin-coated silver nanoparticles in mice: Ultrastructural evaluation

Silver nanoparticles (SNP) are used in many pharmaceutical, cosmetic, and industrial products already available in the market. Although they are considered relatively safe, many toxic and pathological alterations in different organs including immune organs were reported after SNP administration. In this study, 10-week-old male mice (n = 20) were divided into two groups. Ten mice received greenly synthesized gelatin-coated silver nanoparticles in a dose of 10 mg/kg body weight for five consecutive days while the other 10 received 0.5 ml of distilled water daily for 5 days and kept as control. At the sixth day, all mice were sacrificed; blood and tissue samples were collected and prepared for pathological analysis. Liver and kidney lesions were in the form of degenerative and inflammatory changes. Interestingly, the immune organs were drastically affected by SNP treatment. Severe hyperplasia of the Peyer’s patches was noticed in the intestines of intoxicated animals both in gross and microscopic examination. Spleen was enlarged and showed large number of megakaryocytes. The particles were encountered in membrane-bound phagosomes inside macrophages in different organs like lungs and spleen. Blood picture complied to morphological findings with an increase in monocytes and eosinophils accompanied by drop in the platelets count in the intoxicated animals.     

Rheumatoid arthritis patients with interstitial lung disease: Clinical,radiological and laboratory characteristics

BackgroundRheumatoid arthritis associated interstitial lung disease (RA-ILD) has a significant burden of morbidity and mortality.Aim of the workTo analyze clinical, radiological and laboratory characteristics of RA-ILD in an Egyptian cohort.Patients and methodsThe study included 160 RA patients. Detailed medical history, disease activity score (DAS28) and joint damage (Sharp score) were carefully recorded. Chest x-ray, high-resolution computed tomography (HRCT) and pulmonary function tests (PFTs) were done and patients were sub-grouped as RA-ILD (HRCT or PFTs abnormalities) and RA without ILD.ResultsPatients were 136 (85%) females and 24 (15%) males with a mean age of 37.8 ± 11.3 years and disease duration of 4.98 ± 5.53 years. 50% of patients had chest manifestations suggestive of ILD. 60% demonstrated abnormalities in PFT and 63.75% in HRCT. The most common HRCT findings were reticulation (66.6%) and ground glass appearance (64.7%), followed by bronchiectasis (50.9%) and honey combing (46%). usual interstitial pneumonia (UIP) was the most common HRCT subtype (49%). RA-ILD patients were significantly older (p < 0.001), had longer disease duration (p < 0.001), more frequent arthritis (p = 0.002), higher DAS28 (p < 0.001) and Sharp score (p < 0.001), significantly positive rheumatoid factor (RF) (p = 0.007) and anti-citrullinated protein antibody (ACPA) (p < 0.001).ConclusionA high frequency of ILD among Egyptian patients is recorded due to careful evaluation of respiratory symptoms and valuable assessment by PFTs and HRCT chest. UIP is the most common radiologic pattern of RA-ILD. RA patients with ILD are significantly older with longer disease duration, delayed age at onset, high disease activity with arthritis and positive RF and ACPA.