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Gut. 1997 Aug;41(2):258-62.
Paradoxical sphincter contraction is rarely indicative of anismus.

Voderholzer WA, Neuhaus DA, Klauser AG, Tzavella K, Muller-Lissner SA, Schindlbeck NE.

Medizinische Klinik, Klinikum Innenstadt, University of Munich, Germany.

BACKGROUND: Anismus is thought to be a cause of chronic constipation by producing outlet obstruction. The underlying mechanism is paradoxical contraction of the anal sphincter or puborectalis muscle. However, paradoxical sphincter contraction (PSC) also occurs in healthy controls, so anismus may be diagnosed too often because it may be based on a non-specific finding related to untoward conditions during the anorectal examination. AIMS: To investigate the pathophysiological importance of PSC found at anorectal manometry in constipated patients and in patients with stool incontinence. METHODS: Digital rectal examination and anorectal manometry were performed in 102 chronically constipated patients, 102 patients with stool incontinence, and in 18 controls without anorectal disease. In 120 of the 222 subjects defaecography was also performed. Paradoxical sphincter contraction was defined as a sustained increase in sphincter pressure during straining. Anismus was assumed when PSC was present on anorectal manometry and digital rectal examination and the anorectal angle did not widen on defaecography. RESULTS: Manometric PSC occurred about twice as often in constipated patients as in incontinent patients (41.2% versus 25.5%, p < 0.017) and its prevalence was similar in incontinent patients and controls (25.5% versus 22.2%). Oroanal or rectosigmoid transit times in constipated patients with and without PSC did not differ significantly (total 64.6 (8.9) hours versus 54.2 (8.1) hours; rectosigmoid 14.9 (2.4) hours versus 13.8 (2.5) hours). CONCLUSIONS: Paradoxical sphincter contraction is a common finding in healthy controls as well as in patients with chronic constipation and stool incontinence. Hence, PSC is primarily a laboratory a

Aust N Z J Surg. 1997 Sep;67(9):607-10.
Colonic J-pouch as a neorectum: functional assessment.

Chew SB, Tindal DS.

Illawarra Area Health Service, Wollongong, New South Wales, Australia.

BACKGROUND: Sphincter-saving procedures are now commonly used for low rectal cancer but straight colo-anal anastomosis seemed to produce poor functional outcome. The present study was therefore carried out to compare and contrast the functional outcome of colonic J-pouch and straight colo-anal anastomosis. METHODS: The clinical and functional outcome of 17 patients having a colonic J-pouch-anal anastomosis and 10 patients having a straight colo-anal anastomosis were compared. They were compared in terms of age, sex, distal resection margin, Dukes stage, histological grade, morbidity/mortality and postoperative anal function. RESULTS: There was better bowel function in patients having J-pouch-anal anastomosis, especially in the early period after closure of the covering stoma. Bowel frequency in those patients who had a J-pouch anastomosis was much less compared to those patients in the straight colo-anal group in the 1st and possibly the 2nd year. There was a period of adaptation for the straight colo-anal group which led to a bowel frequency approaching that of the J-pouch group over 1-2 years. Differences in urgency, faecal continence, evacuation function, the use of drugs to slow bowel frequency and ability to discriminate between flatus and faeces were found to favour the J-pouch group in the first postoperative year. The difference between the two groups diminished after that because the straight group improved, especially by the end of the 2nd year. During the study period, there were no constipation problems in the J-pouch group, as noted in some other studies. This was probably associated with the 6-cm length chosen for the pouch. CONCLUSIONS: The use of colonic J-pouch resulted in a significant decrease in stool frequency and more satisfactory anal function for the first postoperative year. This dif

Br J Plast Surg. 1997 Sep;50(6):463-7.
Psychosocial adjustment of children and adults with port wine stains.

van der Horst CM, de Borgie CA, Knopper JL, Bossuyt PM.

Department of Plastic and Reconstructive Surgery, University of Amsterdam, The Netherlands.

OBJECTIVES: To assess the impact of a facial port wine stain (PWS) on behavioural problems in children and on health related quality of life in adults applying for laser treatment. DESIGN: A survey by questionnaire of patients with PWS not previously treated. OUTCOME MEASURES: Two standard general instruments and a more specific PWS questionnaire were used. Adolescents and adults (13-31 years) received a short version of the RAND Health Insurance Questionnaire from the Medical Outcome Study (MOS-24). Children's (4-12 years) parents received the Child Behaviour Checklist (CBCL). A specific PWS questionnaire was sent to both age groups. ANALYSIS: The results of the MOS-24 were compared with those of a reference population without chronic illness. Observed behaviour in children was compared with data from a Dutch reference group, from children with constipation and from another group of children with a PWS. RESULTS: 41 MOS-24 and 41 CBCL were returned (91% and 95% response rates, respectively). Adolescents and adults reported little effect on role and social functioning, but showed low scores for mental health, self-perceived health and vitality/health. Children's parents reported no clinically significant problem behaviour (T-score > 70). Adults experienced more negative psychosocial consequences of having a PWS than children (specific PWS questionnaire). CONCLUSIONS: Children with PWS do not show significant problem behaviour. Adolescents and adults reported less vitality/energy than was expected in this age group. Adolescents and adults showed statistically significant negative consequences of their PWS in social contacts compared to children (P < or = 0.01, Mann-Whitney).

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9326151&dopt=Abstract constipation laxative colon cleansing

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