Compensation of the rectum muscle dysfunction

The possibility of compensating for the inborn pathology of the obturative apparatus of the rectum has been examined. An adequate experimental model of encopresis and a method of transplantological compensation of this pathological state have been developed.     

Compensation of muscle dysfunction of the rectum

The possibility of compensating for the inborn pathology of the obturative apparatus of the rectum has been examined. An adequate experimental model of encopresis and a method of transplantological compensation for this pathological state have been developed.     

Surgical anatomy of the gracilis muscle of the thigh

As demonstrates the investigation of 100 preparations, the main vascular-nervous "hilus" of the muscle is situated on the superior third of its lateral part. They contain the transversal branch of the medial artery, circumflexing the femoral bone with the accompanying vein, having the same name, and the anterior branch of the obturative nerve (92 preparations), or muscle branch of the femoral nerve (8 preparations). The muscle has a well developed network of intrasystemic and intersystemic anastomoses. Beginning from the first period of childhood, for sphincter plasticity either the whole muscle, or a graft, cut out from its lateral part, can be used.     

Adaptive thermoregulatory reactions of the rabbit fetus at the end of the intrauterine development

The data of permanent simultaneous registration of electrocardiogram, rectal & brown adipose tissue temperatures of the rabbit foetus have been obtained in chronic experiments. The haemodynamic shift in intensity of maternal-placental and foeto-placental blood flow (by female trental injection) led to a decrease in the foetus rectal temperature (0.33 +/- 0.09 degree C in intact foetus and 0.58 +/- 0.27 degree C in retarded foetus, p < 0.05). Both foetuses reacted by rectal temperature decrease (0.65 +/- 0.28 & 0.68 +/- 0.31 degree C, respectively) during immobilisation (by foetus arduan injection). Thus in both series of experimental cooling of foetus, brown fat activation was similar in intact foetus (approximately 53%), but did not change in growth retardation foetus--as a result of its tissue functional immaturity, probably.     

Study of the mechanism of rectal motility: the 'mass squeeze contraction'

The motor physiology of the rectum has remained largely obscure, especially concerning the mechanism of rectal motility. In the current communication we tested the possibility of characterizing the mechanism of rectal motility during filling and evacuation through the study of the rectal electric activity in 16 healthy volunteers (mean age 43.6 +/- 10.8 years; 11 men). Two monopolar silver-silver chloride electrodes were introduced per annum and fixed to the rectal mucosa by suction. The rectum was distended in 10 ml increments of water by means of a balloon-ended catheter inserted into the rectum. The rectal pressure was measured by one catheter placed above and a second one below the rectal balloon, and the 2 catheters were connected to 2 strain gauge pressure transducers. Regular triphasic slow waves or pacesetter potentials (PPs) were recorded from the 2 electrodes at rest. PPs were superimposed or followed randomly by action potentials (APs). APs but not PPs were coupled with elevated rectal pressure. Rectal distension with 10 ml of water caused no significant changes of the rectal pressure or EMG activity. Distension with a mean volume of 27.3 +/- 4.7 ml effected a significant increase (p < 0.05) of the rectal electromechanical activity proximally to the balloon and a decrease distally (p < 0.05) to it. With progressive increase of the rectal distension, the electromechanical activity continued to increase proximally and to decrease distally to the balloon, until, at a mean distending volume of 76.3 +/- 3.7 ml, the balloon was dispelled to the exterior. In conclusion, the identification of the modality of rectal motility during defecation was feasible by recording the rectal electromechanical activity. The rectal contraction is suggested to occur in a 'mass squeeze manner' which squeezes the rectal contents aborally into the anal canal. The recognition of the rectal motor modality appears to be important for the understanding of rectal motility disorders. However, further studies are required to confirm these findings.     

Transport of methyl eugenol-derived sex pheromonal components in the male fruit fly, Bactrocera dorsalis

Males of Bactrocera dorsalis (Diptera: Tephritidae) are attracted strongly to and feed compulsively on methyl eugenol (1,2-dimethoxy- 4 -(2-propenyl)benzene), a highly potent male attractant. Pharmacophagy of methyl eugenol results in the production of phenylpropanoids 2-allyl-4,5-dimethoxyphenol and (E)-coniferyl alcohol that are sequestered and stored in the rectal gland prior to release as sex pheromonal components during mating at dusk. While these pheromonal components have also been detected in the hemolymph and crop of methyl eugenol-fed males, there is currently little information on the transport of these compounds from the crop to rectal gland in male B. dorsalis. Therefore, using physiological techniques such as parabiosis, rectal gland transplantation and hemolymph transfusion coupled with gas chromatography-mass spectrometry (GC-MS) analyses, we were able to ascertain and confirm the role of the hemolymph in the transport of these sex pheromonal components from the crop to the rectal gland. Further, the temporal profile of these methyl eugenol-derived bioactive compounds in the hemolymph also shows an increase with time post-methyl eugenol-feeding, i.e., 2-allyl-4,5-dimethoxyphenol attaining maximum amounts 15 min after ME consumption and decreasing thereafter, while for (E)-coniferyl alcohol-the increase and decrease are more gradual. These results further demonstrate the ability of insect hemolymph to transport many diverse forms of bioactive molecules including attractant-derived sex pheromonal components.     

Use of cephalosporins for the prevention of mixed infection during surgical treatment of rectal cancer

Cephalosporin antibiotics such as cephaloridine, cephazolin and cephalothin++ were used during operations for rectum cancer. The antibiotics were administered intravenously and immediately into the superior rectal artery. It provided high levels of the antibiotics in blood and discharge of the small pelvis cavity and prevented development of infectious complications during the postoperative period.     

Anatomo-surgical bases of the sphincteroplasty technic using a musculus adductor magnus femoris flap on a nutritive pedicle

In 100 preparations it has been stated that with reference to the operation of sphincteroplasty, the main vascular-nervous fasciculus should be considered the one, which composition includes posterior branches of the obturative arteries, veins and nerve. The intramuscular course of the arterial and nervous branches coincides. For sphincteroplasty it is possible to use one type of transplants cut out of the posterior part of the muscle.     

Mercury toxicity in the shark (Squalus acanthias) rectal gland: apical CFTR chloride channels are inhibited by mercuric chloride

In the shark rectal gland, basolateral membrane proteins have been suggested as targets for mercury. To examine the membrane polarity of mercury toxicity, we performed experiments in three preparations: isolated perfused rectal glands, primary monolayer cultures of rectal gland epithelial cells, and Xenopus oocytes expressing the shark cystic fibrosis transmembrane conductance regulator (CFTR) chloride channel. In perfused rectal glands we observed: (1) a dose-dependent inhibition by mercury of forskolin/3-isobutyl-1-methylxanthine (IBMX)-stimulated chloride secretion; (2) inhibition was maximal when mercury was added before stimulation with forskolin/IBMX; (3) dithiothrietol (DTT) and glutathione (GSH) completely prevented inhibition of chloride secretion. Short-circuit current (Isc) measurements in monolayers of rectal gland epithelial cells were performed to examine the membrane polarity of this effect. Mercuric chloride inhibited Isc more potently when applied to the solution bathing the apical vs. the basolateral membrane (23 +/- 5% and 68 +/- 5% inhibition at 1 and 10 microM HgCl2 in the apical solution vs. 2 +/- 0.9% and 14 +/- 5% in the basolateral solution). This inhibition was prevented by pre-treatment with apical DTT or GSH; however, only the permeant reducing agent DTT reversed mercury inhibition when added after exposure. When the shark rectal gland CFTR channel was expressed in Xenopus oocytes and chloride conductance was measured by two-electrode voltage clamping, we found that 1 microM HgCl2 inhibited forskolin/IBMX conductance by 69.2 +/- 2.0%. We conclude that in the shark rectal gland, mercury inhibits chloride secretion by interacting with the apical membrane and that CFTR is the likely site of this action.     

Rectal sensorimotor dysfunction in women with fecal incontinence

The rate and pattern of rectal distension affect rectal distensibility, perception, and anal relaxation in health. Because rectal urgency is a prominent symptom in fecal incontinence (FI), we assessed rectal distensibility, contractions, perception, and anal pressures during rectal distention in 21 healthy, asymptomatic women (age 61 +/- 2 yr, mean +/- SE) and 51 women with FI (60 +/- 2 yr). Rectal staircases (0-32 mmHg, 4-mm steps) and ramp distensions [0-200 ml at 25, 50, and 100 ml/min with a phase of sustained distension (SD), lasting 1 min, between inflation and deflation]. The rectum was stiffer during rapid than slow ramp distention. This effect was more prominent at a lower volume (50 ml) and was also more pronounced in older subjects and in FI. A rectal contractile response was observed not only during inflation but also during SD and during deflation. During inflation, this contractile response was rate dependent in controls but not in FI. During staircase but not ramp distentions, the threshold for the desire to defecate was lower in FI. During ramp distentions, the duration of perception was significantly longer in FI. The rate of distention did not affect rectal perception (i.e., sensory thresholds or duration of perception) during ramp distentions. Baseline anal pressures and the magnitude of anal relaxation during rectal distention were also reduced in FI. In addition to reduced rectal capacity and compliance, women with FI had an exaggerated rate-dependent reduction in rectal distensibility, lower sensory thresholds, and more prolonged perception, indicative of rectoanal dysfunctions.     

The danger of an inadequate water intake during prolonged exercise A novel concept re-visited

To prevent thermal injuries during distance running, the American College of Sports Medicine proposes that between 0.83 and 1.65 l of water should be ingested each hour during prolonged exercise. Yet such high rates of fluid intake have been reported to cause water intoxication. To establish the freely-chosen rates of fluid intake during prolonged competitive exercise, we measured fluid intake during, body weight before and after, and rectal temperature after competition in a total of 102 runners and 91 canoeists competing in events lasting from 170-340 min. Fluid intakes during competition ranged from 0.29-0.62 l.h-1; rates of water loss ranged from 0.69-1.27 l.h-1 in the runners; values were lower in the canoeists. Mean post-race rectal temperatures ranged from 38.0-39.0 degrees C. There was no relationship between the degree of dehydration and post-race rectal temperature. We conclude that hyperthermia is uncommon in prolonged competitive events held in mild environmental conditions, and that exercise intensity, not the level of dehydration, is probably the most important factor determining the postexercise rectal temperature. During prolonged exercise in mild environmental conditions, a fluid intake of 0.5 l.h-1 will prevent significant dehydration in the majority of athletes.     

Bisphosphonates and the risk of atrial fibrillation

Osteoporosis is a growing problem in an ageing society. It affects women of post-menopausal age, as well as elderly subjects of both sexes, often with dysfunction of the cardiovascular system or with an increased risk of circulation disorders. It has been found that the mortality rate of subjects with osteoporosis is comparable to that of patients suffering from such diseases as obturative pulmonary disease or myocardial ischaemia. Bisphosphonates are the most thoroughly studied group of drugs prescribed for the treatment of osteoporosis. Their administration is, however, associated with a risk of adverse symptoms, which can occur as gastro-intestinal tract disturbances, muscular-osseous pains, mandible necrosis, atypical fractures and other symptoms. Recently, there has been discussion about an increased risk of atrial fibrillation in bisphosphonate-using female patients. This paper focuses on this particular problem, while summing up the actual status of knowledge regarding possible associations of bisphosphonates with cardiac rhythm disturbances.     

Bisphosphonates and the risk of atrial fibrillation

Osteoporosis is a growing problem in an ageing society. It affects women of post-menopausal age, as well as elderly subjects of both sexes, often with dysfunction of the cardiovascular system or with an increased risk of circulation disorders. It has been found that the mortality rate of subjects with osteoporosis is comparable to that of patients suffering from such diseases as obturative pulmonary disease or myocardial ischaemia. Bisphosphonates are the most thoroughly studied group of drugs prescribed for the treatment of osteoporosis. Their administration is, however, associated with a risk of adverse symptoms, which can occur as gastro-intestinal tract disturbances, muscular-osseous pains, mandible necrosis, atypical fractures and other symptoms. Recently, there has been discussion about an increased risk of atrial fibrillation in bisphosphonate-using female patients. This paper focuses on this particular problem, while summing up the actual status of knowledge regarding possible associations of bisphosphonates with cardiac rhythm disturbances.     

Rectal temperature, distal sweat rate, and forearm blood flow following mild exercise at two phases of the circadian cycle

Changes in rectal temperature during mild exercise in the middle of the rising (11:00 h) and falling (23:00 h) phases of the circadian rhythm of resting core temperature have been compared. Seven healthy males were studied at rest, while exercising on a cycle ergometer (60 min at 80 W), and during the first 30 min of recovery. Rectal temperature, forearm blood flow, and forearm sweat rate were measured at 1 min intervals throughout. During exercise, there were significant time-of-day differences in the profiles of all three variables, and in the thresholds for increases in forearm blood flow and sweating. Forearm blood flow and sweat rate were recruited more rapidly and to a greater extent with evening exercise, and rectal temperature rose less. Analysis of covariance, with rectal temperature as the covariate, indicated the associations between it and forearm blood flow or sweating were significantly different (p<0.05) between the two times of day. There were also significant (p<0.05) time-of-day effects for forearm blood flow and sweating that were independent of rectal temperature. During recovery, rectal temperature fell more quickly in the late evening than late morning. Forearm blood flow and sweating also showed time-of-day differences, but these did not co-vary with rectal temperature. Control of rectal temperature during exercise and recovery appears to be more effective in the late evening than late morning, and differences in forearm blood flow and sweating, as well as factors independent of these two variables, contribute to this difference. The results support our "heat-gain/heat-loss modes" hypothesis.     

Functional aspects of ano-rectal vascularity

The blood supply of the ano-rectum has been studied in cadaveric specimens by angiographic methods. The vascular anastomosis between the middle rectal and superior rectal vessels was found to be demonstrable on one side only. There appears to be a midline paucity of vessels in both the posterior and anterior rectal walls, and this may be important in the aetiology of anastomotic dehiscence in low anterior resection.     

Circadian rhythms in bed rest: Monitoring core body temperature via heat-flux approach is superior to skin surface temperature

Continuous recordings of core body temperature (CBT) are a well-established approach in describing circadian rhythms. Given the discomfort of invasive CBT measurement techniques, the use of skin temperature recordings has been proposed as a surrogate. More recently, we proposed a heat-flux approach (the so-called Double Sensor) for monitoring CBT. Studies investigating the reliability of the heat-flux approach over a 24-hour period, as well as comparisons with skin temperature recordings, are however lacking. The first aim of the study was therefore to compare rectal, skin, and heat-flux temperature recordings for monitoring circadian rhythm. In addition, to assess the optimal placement of sensor probes, we also investigated the effect of different anatomical measurement sites, i.e. sensor probes positioned at the forehead vs. the sternum. Data were collected as part of the Berlin BedRest study (BBR2-2) under controlled, standardized, and thermoneutral conditions. 24-hours temperature data of seven healthy males were collected after 50 days of -6° head-down tilt bed-rest. Mean Pearson correlation coefficients indicated a high association between rectal and forehead temperature recordings (r > 0.80 for skin and Double Sensor). In contrast, only a poor to moderate relationship was observed for sensors positioned at the sternum (r = -0.02 and r = 0.52 for skin and Double Sensor, respectively). Cross-correlation analyses further confirmed the feasibility of the forehead as a preferred monitoring site. The phase difference between forehead Double Sensor and rectal recordings was not statistically different from zero (p = 0.313), and was significantly smaller than the phase difference between forehead skin and rectal temperatures (p = 0.016). These findings were substantiated by cosinor analyses, revealing significant differences for mesor, amplitude, and acrophase between rectal and forehead skin temperature recordings, but not between forehead Double Sensor and rectal temperature measurements. Finally, Bland-Altman analysis indicated narrower limits of agreement for rhythm parameters between rectal and Double Sensor measurements compared to between rectal and skin recordings, irrespective of the measurement site (i.e. forehead, sternum). Based on these data we conclude that (1) Double Sensor recordings are significantly superior to skin temperature measurements for non-invasively assessing the circadian rhythm of rectal temperature, and (2) temperature rhythms from the sternum are less reliable than from the forehead. We suggest that forehead Double Sensor recordings may provide a surrogate for rectal temperature in circadian rhythm research, where constant routine protocols are applied. Future studies will be needed to assess the sensor’s ecological validity outside the laboratory under changing environmental and physiological conditions.     

Attenuation of the colorectal tonic reflex in female patients with irritable bowel syndrome

Alterations in normal intestinointestinal reflexes may be important contributors to the pathophysiology of irritable bowel syndrome (IBS). Our aims were to compare the rectal tonic responses to colonic distension in female IBS patients with predominant constipation (IBS-C) and with predominant diarrhea (IBS-D) to those in healthy females, both fasting and postprandially. Using a dual barostat assembly, 2-min colonic phasic distensions were performed during fasting and postprandially. Rectal tone was recorded before, during, and after the phasic distension. Colonic compliance and colonic sensitivity in response to the distension were also evaluated fasting and postprandially. Eight IBS-C patients, 8 IBS-D patients, and 8 age- and sex-matched healthy subjects (group N) participated. The fasting increments in rectal tone in response to colonic distension in both IBS-C (rectal balloon volume change -4.6 +/- 6.1 ml) and IBS-D (-7.9 +/- 4.9 ml) were significantly reduced compared with group N (-34 +/- 9.7 ml, P = 0.01). Similar findings were observed postprandially (P = 0.02). When adjusted for the colonic compliance of individual subjects, the degree of attenuation in the rectal tonic response in IBS compared with group N was maintained (fasting P = 0.007; postprandial P = 0.03). When adjusted for colonic sensitivity there was a trend for the attenuation in the rectal tonic response in IBS patients compared with group N to be maintained (fasting P = 0.07, postprandial P = 0.08). IBS patients display a definite attenuation of the normal increase in rectal tone in response to colonic distension (colorectal reflex), fasting and postprandially. Alterations in colonic compliance and sensitivity in IBS are not likely to contribute to such attenuation.     

Anatomy and topography of the lymphatic vessels and regional lymph nodes of the rectum in newborn infants and children to 3 years of age

In 30 corpses of newborns and children up to 3 years of age, by means of the intratissue and direct injection of the modified Gerota's mass, certain increase in number and size of the superficial inguinal lymph vessels belonging to the superior-medial group, as well as the pararectal and superior rectal lymph nodes has been noted. The diameter of both afferent and efferent lymphatic vessels in the nodes mentioned in children of 1-3 years of age is greater than in the newborns. The number of the afferent vessels running towards these nodes in most cases, regardless the age, prevail over the efferent ones, and the diameter of the latter is greater than in the afferent vessels. The pararectal lymph nodes in 80% of cases are the nodes of the first step for the lymph flowing from the rectum, in 15% - the nodes of the first and second steps, simultaneously, and in 5% - of the third and fourth steps. The superior pararectal lymph nodes in 80% of cases are the nodes of the third and fourth steps, and in 20% of cases - those of the first and second steps for the lymph flowing from the rectum.     

Secretory diarrhea in villous adenoma of rectum: effect of treatment with somatostatin and indomethacin.

The effects of treatment with the synthetic long-acting somatostatin analogue SMS-201-995 were studied in a patient with a fluid and electrolyte secreting villous adenoma of the rectum. The effects of SMS-201-995 on rectal fluid volume and electrolyte loss, and local and general prostanoid production were compared with those of treatment with indomethacin. During treatment with the somatostatin analogue iso-osmolar rectal fluid production increased about 25%; the quantity of prostaglandin E2 in the rectal fluid rose almost 20-fold. Prostaglandin F2 alpha, 6-keto-prostaglandin F1 alpha and 13,14-dihydro-15-keto-prostaglandin F2 alpha output showed similar, though less impressive increments during somatostatin treatment. The somatostatin analogue did not affect urinary prostanoid excretion except for levels of 2,3-dinor-thromboxane B2, which doubled. With indomethacin treatment diurnal rectal fluid production dropped by about 50% and all prostanoids measured in urine and rectal fluid decreased below control values. It appears that the somatostatin analogue SMS-201-995 has a marked stimulatory effect on the in vivo prostanoid production by the villous adenoma. Perhaps this stimulation is not confined to the tumor only, but also affects thromboxane synthesis.     

Rectal temperature,distal sweat rate,and forearm blood flow following mild exercise at two phases of the circadian cycle

Changes in rectal temperature during mild exercise in the middle of the rising (11:00 h) and falling (23:00 h) phases of the circadian rhythm of resting core temperature have been compared. Seven healthy males were studied at rest, while exercising on a cycle ergometer (60 min at 80 W), and during the first 30 min of recovery. Rectal temperature, forearm blood flow, and forearm sweat rate were measured at 1 min intervals throughout. During exercise, there were significant time‐of‐day differences in the profiles of all three variables, and in the thresholds for increases in forearm blood flow and sweating. Forearm blood flow and sweat rate were recruited more rapidly and to a greater extent with evening exercise, and rectal temperature rose less. Analysis of covariance, with rectal temperature as the covariate, indicated the associations between it and forearm blood flow or sweating were significantly different (p<0.05) between the two times of day. There were also significant (p<0.05) time‐of‐day effects for forearm blood flow and sweating that were independent of rectal temperature. During recovery, rectal temperature fell more quickly in the late evening than late morning. Forearm blood flow and sweating also showed time‐of‐day differences, but these did not co‐vary with rectal temperature. Control of rectal temperature during exercise and recovery appears to be more effective in the late evening than late morning, and differences in forearm blood flow and sweating, as well as factors independent of these two variables, contribute to this difference. The results support our “heat‐gain/heat‐loss modes” hypothesis.