scholarly journals Anal sphincter dysfunction in multiple sclerosis: an observation manometric study

Open Medicine ◽  
2016 ◽  
Vol 11 (1) ◽  
pp. 509-517 ◽  
Author(s):  
Silvia Marola ◽  
Alessia Ferrarese ◽  
Enrico Gibin ◽  
Marco Capobianco ◽  
Antonio Bertolotto ◽  
...  

AbstractConstipation, obstructed defecation, and fecal incontinence are frequent complaints in multiple sclerosis. The literature on the pathophysiological mechanisms underlying these disorders is scant. Using anorectal manometry, we compared the anorectal function in patients with and without multiple sclerosis.136 patients referred from our Center for Multiple Sclerosis to the Coloproctology Outpatient Clinic, between January 2005 and December 2011, were enrolled. The patients were divided into four groups: multiple sclerosis patients with constipation (group A); multiple sclerosis patients with fecal incontinence (group B); non-multiple sclerosis patients with constipation (group C); non-multiple sclerosis patients with fecal incontinence (group D). Anorectal manometry was performed to measure: resting anal pressure; maximum squeeze pressure; rectoanal inhibitory reflex; filling pressure and urge pressure. The difference between resting anal pressure before and after maximum squeeze maneuvers was defined as the change in resting anal pressure calculated for each patient.ResultsGroup A patients were noted to have greater sphincter hypotonia at rest and during contraction compared with those in group C (p=0.02); the rectal sensitivity threshold was lower in group B than in group D patients (p=0.02). No voluntary postcontraction sphincter relaxation was observed in either group A or group B patients (p=0.891 and p=0.939, respectively).ConclusionsThe decrease in the difference in resting anal pressure before and after maximum squeeze maneuvers suggests post-contraction sphincter spasticity, indicating impaired pelvic floor coordination in multiple sclerosis patients. A knowledge of manometric alterations in such patients may be clinically relevant in the selection of patients for appropriate treatments and for planning targeted rehabilitation therapy.

2007 ◽  
Vol 13 (9) ◽  
pp. 1138-1145 ◽  
Author(s):  
T. Kümpfel ◽  
M. Schwan ◽  
Th. Pollmächer ◽  
A. Yassouridis ◽  
M. Uhr ◽  
...  

During initiation of interferon-beta (IFN-β) therapy, many multiple sclerosis (MS) patients experience systemic side effects which may depend on the time point of IFN-β injection. We investigated the time course of plasma hormone-, cytokine- and cytokine-receptor concentrations after the first injection of IFN-β either at 8.00 a.m. (group A) or at 6.00 p.m. (group B) and quantified clinical side effects within the first 9 h in 16 medication free patients with relapsing-remitting MS. This investigation was repeated after 6-month IFN-β therapy. Plasma ACTH and cortisol concentrations followed their physiological rhythms, with lower levels in the evening compared to the morning, but raised earlier and stronger in group B after IFN-β administration. IFN-β injection in the evening led to a prompter increase of plasma IL-6 concentrations and temperature during the first hours and correlated to more intense clinical side effects compared to group A. Plasma IL-10 concentrations increased more in group A compared to group B, but sTNF-RI and sTNF-RII concentrations raised 7 h after IFN-β injection only in group B. Acute effects on plasma hormone and cytokine concentrations adapted after 6-month IFN-β treatment, while diurnal variations were still present. Baseline sTNF-RII concentrations were elevated after 6-month IFN-β therapy only in group A. Our results show that time point of IFN-β injection has differential effects on acute changes of plasma hormone and cytokine concentrations and is related to systemic side effects. This may have implications on the tolerability and effectiveness of IFN-β therapy. Multiple Sclerosis 2007; 13: 1138—1145. http://msj.sagepub.com


2014 ◽  
Vol 42 (4) ◽  
Author(s):  
Maria Angelica Zoppi ◽  
Ambra Iuculano ◽  
Giovanni Monni

AbstractWe investigated the umbilical vein volume flow (UVVF) at 11–14 weeks in monochorionic-diamniotic (MCDA) twins, focusing on the occurrence of complications. We considered 87 MCDA pregnancies. We used “E-flow” to detect the umbilical vein and measured the mean velocities and diameters of veins, also calculating the UVVF. Pregnancies were divided into four groups: a (twin-to-twin transfusion, TTTS); b (selective intrauterine growth restriction, sIUGR); c (discordance of fluid, DF); and d (with “normal” outcome). The main outcome of the study was the assessment of the difference of UVVF between twin 1 and twin 2 (larger and smaller twin). In eight of eight pairs of group a and seven of seven pairs of group b, the UVVF of fetuses 1 were significantly different than fetuses 2 (P<0.05). The UVVFs of fetuses 2 of group a were significantly lower in respect to the UVVFs of fetuses 2 of group d (P<0.05). We provide evidence of an important difference in UVVF in pairs that successively developed TTTS or sIUGR. The smaller fetuses of group a (TTTS) showed a lower venous return than fetuses 2 of group d (normal). First-trimester UVVF is lower in fetuses with a smaller crown-rump length in twin pairs at risk of TTTS or IUGR.


Author(s):  
Wang TL ◽  
◽  
Wu WJ ◽  
Gu JX ◽  
Hou XR ◽  
...  

Objective: To study the effect of liposomal curcumin combined with PDGFBB on tendon healing after tendon injury in rats and explore its mechanism. Methods Thirty-six rats were randomly divided into four groups: healthy control group (group A), liposomal curcumin group (group B), PDGF-BB group (group C) and combined application group (group D). The rats in each group were divided into groups according to the experimental group. At the 4th and 8th weeks after operation, the general morphology, histomorphology, biomechanics and other aspects of rat tendon were detected and statistically analyzed. Results: The degree of tendon adhesion in group B and D was significantly less than that in group A and C, and the difference was statistically significant. The biomechanical test showed that the tendons in group C and D had higher strength and could withstand greater stress than those in group A and B. Conclusion: Liposome curcumin combined with PDGF-BB can significantly reduce the degree of adhesion after tendon injury, increase the strength of tendon healing, and significantly promote tendon healing.


2020 ◽  
Author(s):  
Qin Yin ◽  
Jiao Xie ◽  
Jixian Zhang ◽  
Zhen Fu ◽  
Wangcai Zhu ◽  
...  

Abstract BackgroundSince the outbreak of coronavirus disease 2019 (COVID-19), some studies reported the clinical characteristics of COVID-19 patients in hospital. However, these studies did not investigate the clinical symptoms heterogeneity of COVID-19 patients in the outpatient. This study aimed to describe the heterogeneity of clinical characteristics of outpatient COVID-19 patients.MethodsCOVID-19 patients visiting the respiratory outpatient department of our hospital from January 1st to February 28st 2020 were retrospectively analyzed. Based on the complaints, the patients were classified into four groups including group A (patients without symptoms), group B (patients with fever), group C (patients with respiratory symptoms but without fever), and group D (patients with extra-respiratory symptoms but without fever). The difference of clinical characteristics, basic diseases, laboratory examination of outpatient, characteristics of chest CT imaging among all the groups were analyzed and compared.ResultsA total of 309 COVID-19 patients were included with 126 men and 183 women. The common symptoms included fatigue (59.87%, 95% CI: 54.17-65.38%), loss of appetite (51.13%, 95% CI: 45.41-56.83%), fever (50.81%, 95% CI: 45.09-56.51%), muscle soreness (41.42%, 95% CI:35.88-47.14%), and dry cough (35.28%, 95% CI:29.95-40.89%). The percentages of group A to group D were 2.91%, 50.81%, 18.12%, and 28.16%, respectively. The most common symptoms in Group D included fatigue, loss of appetite, muscle soreness. ConclusionThe heterogeneity of clinical symptoms for COVID-19 patients in the outpatient is significant. We should pay attention to patients without symptoms or those with only extra-respiratory symptoms, who are prone to missed diagnosis.


2010 ◽  
Vol 24 (3) ◽  
pp. 197-201 ◽  
Author(s):  
Huimin Chen ◽  
Xiaobo Li ◽  
Zhizheng Ge ◽  
Yunjie Gao ◽  
Xiaoyu Chen ◽  
...  

BACKGROUND: Regardless of surgical technique, patients who have undergone cholecystectomy appear to be predisposed to the development of bile reflux gastritis.OBJECTIVE: To assess the efficacy of rabeprazole and hydrotalcite in patients with bile reflux gastritis after cholecystectomy.METHODS: Postcholecystectomy patients with bile reflux gastritis confirmed by endoscopy and 24 h gastric bilirubin monitoring were randomly assigned to one of four eight-week treatments: observation (group A), rabeprazole alone (group B), hydrotalcite alone (group C) and rabeprazole in combination with hydrotalcite (group D). Endoscopy and 24 h gastric bilirubin monitoring were repeated in all patients after treatment. Dyspeptic symptoms of abdominal pain, bloating, heartburn, bitter taste, endoscopic and histological finding, and biliary reflux were evaluated before and after treatment.RESULTS: After administering medication, patient symptoms in groups B, C and D were relieved – most significantly in group D (P<0.05). There were no significant differences in endoscopic hyperemia and histological inflammation among the groups (P>0.05). However, histological activity, the number of reflux episodes and the number of reflux episodes lasting longer than 5 min were significantly decreased only in group D (P<0.05). The total per cent of bilirubin absorption (value of 0.14 units or greater) time was decreased in groups B, C and D, and most significantly in group D (P<0.05).CONCLUSION: Rabeprazole combined with hydrotalcite is an effective therapeutic option in the treatment of patients with bile reflux gastritis after cholecystectomy.


2016 ◽  
Vol 9 (2) ◽  
pp. 256 ◽  
Author(s):  
Hamidollah Afrasiabian ◽  
Mohammad Hadi Imanieh ◽  
Mohammad Ali Nejati ◽  
Alireza Salehi

<p><em>H. pylori</em><strong> </strong>infection is one of the most common infections in the world so that the aim of this study was to evaluate the antimicrobial <em>P. Atlantica Kurdica</em> gum in the eradication of <em>H. pylori</em>. This study is a randomized clinical trial; Patients with positive Urea Breath Test and symptoms of dyspepsia were entered. Patients were randomly divided into four groups. Group A: three drugs including 500 mg of Amoxicillin twice a day (bd), Clarithromycin 500 mg bd and Omeprazole 20 mg (bd) and Group B: Group A drugs plus the capsule containing 1 g of powdered <em>P. Atlantica Kurdica </em>gum (bd). In Group C: the capsule containing 1 g of powdered <em>P. Atlantica Kurdica</em> gum (bd) and Group D: this group took placebo-containing capsule (bd) for 14 days respectively. Dyspeptic symptoms before and after healing period and the UBT results two days before the start of treatment and 30 days after the completion were compared in 4 groups. Patients were not statistically significant difference from each other in the four groups regarding the demographic situation. Moreover, <em>H. pylori</em> eradication rate was 19/24 in Group A, 18/24 in Group B, 10/23 in Group C and 2/24 in Group D. Relieving symptoms of dyspepsia in Groups B and C were significantly higher than in Group D (P=0.025 and p=0.006 respectively). <em>P. Atlantica Kurdica</em> significantly led to the treatment of dyspepsia symptoms and <em>H. pylori</em> eradication.</p>


Author(s):  
J. Viswanath ◽  
Chakrapani Cheekavolu ◽  
S. Sankaraiah ◽  
Renu Dixit

Background: To evaluate the efficacy of Cissus quadrangularis Linn. or Zingiber officinalis Rosc. or in combination treatment of osteoarthritis which reduces joint pain, joint swelling and tenderness without risk of side effects.Methods: Total 60 patients were selected and divided into 3 groups (each group consist of 20 patients); data were collected before and after treatment of following groups: Group A-Cissus quadrangularis linn-5gm; Group B- Zingiber officinale rosc-5gm; Group C-Treatment of Cissus quadrangularis linn combined with Zingiber officinale rosc-5 gm/dose twice a day with luke warm water.Results: 60 % cases of joint pain were relieved at the end of the treatment in group B & C, in group A 50%, reduction in joint pain extremely significant in all groups A, B, C (p<0.0001). ‘C’ 80%, ‘A’ 15% and ‘B’5% reduction in symptom of Joint swelling and which is very significant in group A, and group B (p<0.001) and extremely significant in group C (p<0.0001). Symptom of tenderness ‘C’ 90%, ‘A’ 85%, and ‘B’ 10% cases were relived from the complaint. The difference in tenderness is statistically extremely significant when compared between groups (p<0.0001).Conclusions: Present study reveals that, significant reduction of joint pain, joint swelling and tenderness after treatment of Cissus quadrangularis Linn. or Zingiber officinalis Rosc. and extremely significant reduction of joint swelling and tenderness in combination therapy.


2020 ◽  
Vol 28 (5) ◽  
pp. 477-485
Author(s):  
Rekha Kaja ◽  
Anandh Vaiyapuri ◽  
Mohamed Sherif Sirajudeen ◽  
Hariraja Muthusamy ◽  
Radhakrishnan Unnikrishnan ◽  
...  

BACKGROUND: Flutter is a device used in removing excess lung secretions. The conventional flutter lacks a biofeedback component to facilitate optimal use by the patients. OBJECTIVE: The current research aims to compare the effects of biofeedback flutter devices with the conventional flutter in managing the symptoms of patients with chronic obstructive pulmonary diseases. METHODS: One hundred and sixty-eight participants were randomly allocated into four groups: Group A (conventional), Group B (visual biofeedback), Group C (auditory biofeedback) and Group D (visual and auditory biofeedback). All groups were treated five days for 20 minutes. Outcome measures included wet sputum weight [during intervention (T1) and 1 hour after intervention (T2)], oxygen saturation and dyspnea score (before and after intervention) on all days. RESULTS: The wet sputum expectorated (T2) by Group B was significantly higher than Group A (P< 0.001), Group C (P< 0.001) and Group D (P< 0.05). The dyspnea score for Group B (P< 0.05), Group C (P< 0.05) and Group D (P< 0.05) was significantly lower than Group A. The post-intervention oxygen saturation level was higher in Group D followed by Groups B, C and A. CONCLUSION: The use of biofeedback flutter is effective in the removal of secretion, reducing dyspnea and improving oxygen saturation when compared to conventional flutter.


2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Atsushi Yoshida ◽  
Takashi Sugiyama ◽  
Norimasa Sagawa

It was previously reported that the brachial-ankle pulse wave velocity (baPWV) is elevated in preeclamptic women. However, baPWV is strongly affected by blood pressure. Recently, a new index of vascular stiffness, the cardioankle vascular index (CAVI), was developed. CAVI is thought to be an index independent of blood pressure. We assessed CAVI in normotensive and hypertensive pregnant women. We studied a total of 109 Japanese women consisting of 23 nonpregnant healthy women (group A), 45 normotensive pregnant women (group B), 28 pregnant women complicated with established preeclampsia (group C), and 13 pregnant women with chronic hypertension (group D). The subject remained supine while the blood pressure, baPWV, and CAVI were recorded. No significant difference in baPWV was present between groups C and D, but the difference in CAVI was significantly high in group D. We believe that we can distinguish the vessel structural change between chronic hypertension and preeclampsia through simultaneous baPWV and CAVI measurements.


2010 ◽  
Vol 16 (4) ◽  
pp. 450-454 ◽  
Author(s):  
Roberta Lanzillo ◽  
Giuseppe Orefice ◽  
Mario Quarantelli ◽  
Carlo Rinaldi ◽  
Anna Prinster ◽  
...  

A large body of evidence suggests that, besides their cholesterol-lowering effect, statins exert anti-inflammatory action. Consequently, statins may have therapeutic potential in immune-mediated disorders such as multiple sclerosis. Our objectives were to determine safety, tolerability and efficacy of low-dose atorvastatin plus high-dose interferon beta-1a in multiple sclerosis patients responding poorly to interferon beta-1a alone. Relapsing—remitting multiple sclerosis patients, aged 18—50 years, with contrast-enhanced lesions or relapses while on therapy with interferon beta-1a 44 µg (three times weekly) for 12 months, were randomized to combination therapy (interferon + atorvastatin 20 mg per day; group A) or interferon alone (group B) for 24 months. Patients underwent blood analysis and clinical assessment with the Expanded Disability Status Scale every 3 months, and brain gadolinium-enhanced magnetic resonance imaging at screening, and 12 and 24 months thereafter. Primary outcome measure was contrast-enhanced lesion number. Secondary outcome measures were number of relapses, EDSS variation and safety laboratory data. Forty-five patients were randomized to group A ( n = 21) or B ( n = 24). At 24 months, group A had significantly fewer contrast-enhanced lesions versus baseline ( p = 0.007) and significantly fewer relapses versus the two pre-randomization years ( p < 0.001). At survival analysis, the risk for a 1-point EDSS increase was slightly higher in group B than in group A (p = 0.053). Low-dose atorvastatin may be beneficial, as add-on therapy, in poor responders to high-dose interferon beta-1a alone.


Sign in / Sign up

Export Citation Format

Share Document