Electromyographic biofeedback can improve subjective and objective measures of fecal incontinence in the short term

Electromyographic biofeedback therapy has demonstrated subjective improvement in patients with fecal incontinence that is comparable to surgery. We assessed the efficacy of biofeedback therapy in a consecutive heterogeneous group of patients using both subjective and objective assessment criteria. These 28 patients with fecal incontinence were studied retrospectively. Patients were assessed using a qualityof-life questionnaire (QOL), the Vaizey and Wexner incontinence scoring systems, and anorectal manometry for efficacy of treatment, before and after biofeedback therapy. Eighty-six percent of patients completed the study. Median follow-up was 18 months. Eighty percent of patients demonstrated significant improvements in their Vaizey and Wexner scores (P < 0.001 and P < 0.001, respectively). The mean QOL score improved from 62 to 77 (P < 0.01). Significant improvements were also demonstrated in the mean resting pressure (P < 0.01), peak amplitude of squeeze (P < 0.01), and the duration of squeeze pressure (P < 0.05). The deferred 15-minute evacuation time also significantly increased (P < 0.001). This study reported significant short-term improvement in fecal incontinence with electromyographic biofeedback therapy using validated subjective and objective scoring systems. Similarly, this treatment also significantly improved anorectal manometric findings. Our data confirm the role of biofeedback therapy in the multimodality approach to patients with fecal incontinence. Presented at the Forty-Fourth Annual Meeting of The Society for Surgery of the Alimentary Tract, Orlando, Florida, May 19–21, 2003 (oral presentation).     

Review of a routine test of cardiac function before aortic aneurysm surgery

The majority of vascular surgeons employ tests of cardiac function prior to embarking on elective abdominal aortic aneurysm (AAA) repair. This study reviewed the value of measuring preoperative ventricular ejection fraction (VEF). The records of the 207 patients considered for elective AAA repair between 1994 and 2000 were reviewed. In patients who underwent surgery, morbidity and mortality data were retrieved from the vascular department database. These outcomes were correlated with the measured VEFs. In patients turned down for surgery, the reasons were determined from patients' notes, and the role that VEF played in the decision was evaluated. Low VEF did not correlate with postoperative cardiac morbidity or mortality. The range of VEF values in patients turned down for surgery was not significantly different from those who underwent AAA repair. VEF was pivotal in the decision not to operate in only one patient over the 6-year interval. This review found no evidence that routine measurement of VEF prior to elective AAA repair was valuable either in making the decision whether to operate or in predicting outcome and complications. Little or no information was added that could not be gained on simple clinical evaluation of cardiac function.     

P2X7 receptors stimulate AKT phosphorylation in astrocytes

1. Emerging evidence indicates that nucleotide receptors are widely expressed in the nervous system. Here, we present evidence that P2Y and P2X receptors, particularly the P2X(7) subtype, are coupled to the phosphoinositide 3-kinase (PI3K)/Akt pathway in astrocytes. 2. P2Y and P2X receptor agonists ATP, uridine 5'-triphosphate (UTP) and 2',3'-O-(4-benzoyl)-benzoyl ATP (BzATP) stimulated Akt phosphorylation in primary cultures of rat cortical astrocytes. BzATP induced Akt phosphorylation in a concentration- and time-dependent manner, similar to the effect of BzATP on Akt phosphorylation in 1321N1 astrocytoma cells stably transfected with the rat P2X(7) receptor. Activation was maximal at 5 - 10 min and was sustained for 60 min; the EC(50) for BzATP was approximately 50 microM. In rat cortical astrocytes, the positive effect of BzATP on Akt phosphorylation was independent of glutamate release. 3. The effect of BzATP on Akt phosphorylation in rat cortical astrocytes was significantly reduced by the P2X(7) receptor antagonist Brilliant Blue G and the P2X receptor antagonist iso-pyridoxal-5'-phosphate-6-azophenyl-2',4'-disulfonic acid, but was unaffected by trinitrophenyl-ATP, oxidized ATP, suramin and reactive blue 2. 4. Results with specific inhibitors of signal transduction pathways suggest that extracellular and intracellular calcium, PI3K and a Src family kinase are involved in the BzATP-induced Akt phosphorylation pathway. 5. In conclusion, our data indicate that stimulation of astrocytic P2X(7) receptors, as well as other P2 receptors, leads to Akt activation. Thus, signaling by nucleotide receptors in astrocytes may be important in several cellular downstream effects related to the Akt pathway, such as cell cycle and apoptosis regulation, protein synthesis, differentiation and glucose metabolism.