Act Of Defecation Research Articles

Signet ring-cell colorectal adenocarcinoma: review and clinical case

Colorectal cancer is one of the most common malignancies in the general population and has many histological subtypes. Signet-ring cell adenocarcinoma is a rather rare variant of this pathology. It is characterized by molecular genetic and morphological features that are absent in classical adenocarcinomas, which causes some nuances in the clinical course and approach to therapy of this type of tumor. In our clinical case, a 68-year-old patient went to a general practitioner with complaints of abdominal pain, changes in the act of defecation, and according to the primary physical and instrumental examination, he was diagnosed with chronic distal colitis, and later he was prescribed anti-inflammatory therapy. However, six months later, the patient went to the doctor again with complaints of worsening condition and symptoms, after examination, he was diagnosed with adenocarcinoma of the sigmoid colon, but due to low adherence to treatment, as well as late diagnosis, the patient died within six months. Surgical treatment of the patient was limited to resection of the sigmoid colon due to peritoneal adhesions. In the postoperative period, the development of fibrinous-purulent peritonitis and increasing cardiovascular failure were clinically noted. At autopsy, the histological variant of the lesion was changed to the signet-ring cell form with metastasis to the liver and greater omentum. Death occurred from disseminated intravascular coagulation syndrome with the development of acute renal failure and centrilobular necrosis of the liver. Clinical observation emphasizes the importance of introducing modern molecular diagnostic methods into wide practice.

Удосконалення комплексного підходу до лікування функціональних закрепів у дітей

Functional constipation in children has become a serious medical issue that needs to be addressed immediately. They can significantly limit children’s physical activity and social integration, which emphasizes the importance of providing them with effective care. Purpose - to analyze and improve the results of the complex use of a lactulose-based drug and prophylactic phytocylinders with a lipophilic complex of rose hips and chamomile extract in the treatment of functional constipation in children. Materials and methods. We examined 78 children with constipation over the past 3 years. They were divided into two groups. The first group included 36 (46.2%) patients, the second - 42 (53.8%). Patients of the first group received standard treatment according to the protocols of the Ministry of Health of Ukraine, patients of the second group received similar treatment and additionally lactulose in the form of syrup and a preparation based on prophylactic phytocylinders with a lipophilic complex of rose hips and chamomile extract during the course of treatment daily in the form of rectal suppositories. Results. Most patients were female (60.2%), had average physical development parameters. The duration of constipation ranged from 1 to 3 months, and stool retention - from 3 to 5 days. At the beginning of the observation, there were complaints of changes in the shape and consistency of stools, painful defecation, flatulence, periodic abdominal pain, strong straining during defecation, fear or anxiety in children before the act of defecation. An analysis of anamnestic data showed that in one third of patients, constipation was observed during the transition from breastfeeding to artificial feeding. Conclusions. The analysis of the addition to the complex of treatment of functional constipation, in addition to lactulose, of preparations based on prophylactic phytocylinders with a lipophilic complex of rose hips and chamomile extract is a safe and quite effective method of correcting these disorders in young children, as evidenced by the results obtained. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Comparative study between stapled and open hemorrhoidectomy results with one-year follow-up

Background Hemorrhoids are one of the most prevalent diseases of mankind, affecting 4%–36% of the general population. Most patients are asymptomatic. Anal bleeding during the act of defecation is the most common presenting symptom. Many techniques were described for treatment, including stapled hemorrhoidectomy and conventional (open) ones. Objective The objective is to compare the effectiveness, short-term outcomes, and postoperative complications of stapled hemorrhoidopexy against open hemorrhoidectomy in the treatment of symptomatic primary piles. Methods A total of 76 patients were operated on at Al-Azhar University Hospital. They were divided into two equal groups: the stapled group (operated using a proximate PPH hemorrhoidal stapler of 33 mm) and the open group. All patients were followed for 1 year. Preoperative complaints, operative time and blood loss, postoperative pain, complications, and resumption of daily activities were recorded for both groups. Results Intraoperative blood loss and duration of operation were less in the stapler group. Postoperative bleeding, postoperative pain, and discomfort were less in the stapler group, with a significant difference from the open group. Healing and resumption of daily activities were faster in the stapler group. Regarding early recurrence, it happened in two cases in the stapler group and in the open group as well. There are no differences between both groups regarding urine retention. Anal incontinence did not happen in both groups. Mild anal stenosis occurred in one case in every group and occurred late. Conclusion Stapled hemorrhoidectomy is a promising procedure with less pain, a shorter duration of hospital stay, and a faster resumption of daily activity than open hemorrhoidectomy. However, long-term follow-up for many years is still needed to define the recurrence rate in stapled hemorrhoidectomy.

Гетеротопія слизової оболонки шлунка в прямій кишці: опис клінічного випадку

Heterotopic gastric mucosa is rare in the paediatric population, but it can pose a diagnostic challenge. This pathology can occur in any part of the digestive tract, from the oropharynx to the anorectal area. Most cases are observed in the esophagus, duodenum and hepatobiliary system, but the presence of this tissue in the rectum is extremely rare. Purpose - conduct a clinical description of a rare pathology in children in order to pay the doctors` attention to the need for comprehensive diagnosis of patients with hematochezia. Clinical case. We present a clinical case of a child with heterotopia of the gastric mucosa into the rectum. Symptoms included hematochezia and anal pain during the act of defecation, general weakness, and decreased appetite. These manifestations were observed for two years with periods of exacerbations and remissions on the background of conservative treatment. The final diagnosis was made on the basis of a biopsy of nodular formations of the rectum, detected by colonoscopy. Conclusions. Given the negative impact of the disease manifestations on the patient's quality of life and the potential risk of malignant transformation, the possibility of heterotopic gastric mucosa in the rectum with indeterminate bleeding from the lower gastrointestinal tract should be considered and a complete examination, including biopsy, should be performed. Once the diagnosis is confirmed, radical surgical removal is recommended. Initial conservative treatment with proton pump inhibitors provides only short-term relief and is accompanied by periods of exacerbation and remission. The final treatment is always surgical or endoscopic excision of the heterotopic mucosa. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Epidemiological investigation and Factors affecting the Gastrointestinal parasitism in Cattle at selected areas of kotalipara upazila of Gopalganj district in Bangladesh

The investigation of the GI parasite’s epidemiology and associated risk factors in cattle was the study’s main goal. A total of 211 fecal samples from 92 bulls and 119 cows were collected from Pinjuri and Hiron unions of Kotalipara upazila of Gopalganj district from February, 2023 to April, 2023. Fecal samples were collected directly from the ground when the animals were found in the act of defecation or immediately after defecation. On the day of collection, the samples were evaluated at the BAPARD Laboratory using conventional coprological methods. A pretested questionnaire was utilised to capture the essential animal data during sample collection. The cattle were separated into three age groups, including 0 to 1 year, 1 to 2 years, and 2 years; various sex groups, including male and female; different health status groups, including poor and normal; and different breeds, including indigenous non-descriptive and crossbred. The total incidence of gastrointestinal parasitism was 45.49% (n=96/211), with Toxocara spp. (19.90%), Strongyloides spp. (3.79%), and Haemonchus spp. being the most frequently found parasites. and Bunostomum spp. (8.06%), Paramphistomum spp. (10.43%), Paramphistomum spp. and Fasciola sp. (1.42%) and Moniezia spp. (1.89%). The parasitic prevalence load was higher in crossbred (50.36%) than non-descriptive indigenous breed (36.48%). In another instance, female cattle (47.05%) slightly outnumber male cattle (43.47%). The parasitic load was higher in young (≥1 year) comparatively growing (<1 to ≥2 year) and adult (< 2 years) cattle. In this study areas, prevalence of gastrointestinal parasite shows slightly higher in Hiron union (45.87%) comparatively Pinjuri union (45.09%). So, the study indicates high percentage of infection found in crossbred, female and young animals.

FEATURES OF THE CLINICAL COURSE AND COMPLEX TREATMENT OF HEMORRHOIDS IN CHILDREN

The aim: to analyze the current state of the issue of hemorrhoid disease in children of different age on the basisof first-hand experience.Materials and methods: author conducted examinations in 71 children with hemorrhoids: general clinical,laboratory, rectal finger, anoscopy, rectoscopy and additional research complexes. There were 56 (78,8%) boys and15 (21,2%) girls.Results and discussion: The features of the cause of the disease, clinical manifestation, course, localization havebeen studied and tactical treatment approaches in the age aspect have been developed. In infants, a common cause ofhemorrhoids were: a two-stage act of defecation with increased diarrheal syndrome; in children of early and preschoolage, periodic and prolonged potty sitting and congenital inferiority of the venous network of the small pelvis in schoolage children played an important role. The frequency of occurrence is more marked in preschool age – 71.7%. Theexternal form of hemorrhoids was revealed – in 90% and combined – in 10% of sick children. Frequent localizationof hemorrhoids occurred in children at 4 o'clock (35%) and 7 o'clock (30%).Comprehensive treatment of hemorrhoids in children was carried out: conservative - in 34 (83%) and surgical - in7 (17%) patients. In infancy and early age, the complex of conservative treatment included: treatment of the mainprimary disease (ChD, diarrheal syndrome, pathology of the colon, etc.) and local treatment; in preschool children- the use of medical enemas and rectal suppositories, ointments and the use of SCL, LL and school and older age- treatment of ChD. Indications for the operation were: the presence of large varicose nodes that violate the act ofdefecation, inflammation, prolapse, infringement and constantly falling out nodes and causing pain. In children, moregentle surgical methods are used. Surgical treatment is more susceptible to school age. There were no complicationsin the postoperative period.Conclusions. 1. Persistent constipation is a common cause of hemorrhoids in children; increased diarrhea, atwo-stage act of defecation, tension in sports, tense cough and urination are also causes of hemorrhoids.2. The clinical features of the course of hemorrhoids in children 1-3 years old is the transient nature of the coursein 70% of cases.3. Hemorrhoids are often found in children of preschool age, with the absence of pain and bleeding.4. The most frequent (65%) localization is 4 and 7 on the clock face.5. In children under 3 years of age with hemorrhoids, only conservative treatment is an effective method. Surgicaltreatment is more susceptible to school age.6. Indications for hemorrhoid surgery in children are: the presence of large varicose nodes that violate the act ofdefecation, inflammation, prolapse, infringement, as well as easily or constantly falling out nodes and causing pain.

Associations of clinical features of functional bowel disorders with gut microbiota characteristics in adolescents: A pilot study

Background. Obesity is a multifactorial disease that is one of the important public health problems in the 21st century. Functional bowel disorders in obese children and adolescents are one of the most common pathologies of the digestive tract. The aim: to characterize the bacteriological composition of the colon microbiota in obese adolescents and identify its associations with the clinical manifestations of functional bowel disorders.Materials and methods. The study included 20 adolescents aged 11–17 years. Stool consistency was assessed using the Bristol Stool Scale. The study of biological material was carried out using standard bacteriological methods. To assess the strength of the relationship between the nominal variables, Cramer’s V test was used.Results. It has been shown that in adolescents with obesity and functional bowel disorders, there is a decrease in the number of representatives of bifidoflora, an increase in the microbial density of Escherichia coli with altered enzymatic properties and an excessive growth of potentially pathogenic enterobacteria. In obese adolescents with functional bowel disorders, abdominal pain associated with the act of defecation is associated with the presence of enterobacteria and E. coli with altered enzymatic properties. Rare bowel movements are associated with an increased abundance of Enterococcus spp. and the presence of opportunistic Enterobacteriaceae microorganisms. Frequent bowel movements are associated with the presence of E. coli with altered enzymatic properties and Clostridium spp. In the presence of loose stool, Clostridium spp. is present; unstable stool (alternation of hard and liquid stools in one patient) is associated with a decrease in the number of lactobacilli and E. coli with normal enzymatic properties, the appearance of E. coli with altered enzymatic properties, opportunistic microorganisms of Enterobacteriaceae family and Clostridium spp. Conclusion. The relationship between the clinical symptoms of functional bowel disorders and changes in the composition of the gut microbiota in obese adolescents may be a justification for conducting in-depth studies aimed at finding early predictors of functional bowel diseases associated with obesity in the adult cohort.

V. A. Bogoroditsky. - About the conduct of childbirth according to the Indian method. - (Channel. Tamb. Med. General, 1894, 1-12. Tambov, 1895, p. 157).

The author calls the Indian method the method of delivery on his heels, on his knees, in general with the position of the body close to vertical. This method was practiced exclusively by the ancients, and now it is widespread among wild and uncultured peoples. The position of a woman in labor with this method, according to the author, is the most natural, because the act of childbirth by self-awareness approaches the act of defecation, the anatomical structure of the birth canal in an upright position favors the rapid passage of the fetus and less pressure of the presenting part on the perineum. The author adopted this method with success, and in the sense of speed and ease of childbirth and in the sense of preserving the integrity of the perineum, in 5 primiparous, of which one was 20 years old, the rest 30-40 years.

SURGICAL TREATMENT OF PATIENTS WITH CHRONIC HEMORRHOIDS

Symmary. About 300 surgical treatments for hemorrhoids are known now. The most common method in the world remains the Milligan-Morgan operation and its numerous modifications. These surgical interventions are essential in the choice of surgical treatment for chronic hemorrhoids. However, both open and closed hemorrhoidectomy have their disadvantages.
 Purpose. To study the effectiveness of various surgical treatments for patients with chronic hemorrhoids using a laser coagulator.
 Materials and methods. We conducted a clinical examination and treatment of 140 patients with chronic grade III-IV hemorrhoids by Goligher. All patients were presentably divided into three groups. The first group included 60 patients who had classic open hemorrhoidectomy - the Milligan-Morgan operation. The second group included 40 patients in whom had surgical treatment with a laser coagulator - laser open hemorrhoidectomy. The third group consisted of 40 patients who underwent laser open hemorrhoidectomy, supplemented with laser transcutaneous submucosal mucopexia.
 Results and discussion. Analyzing the indicators of pain in different groups of patients at different postoperative period, we found that on the first postoperative day the classic Milligan-Morgan surgery, the was most uncomfortable procedure (the first group of patients). Among the patients in the second and third groups there were no people who rated pain above 7 points. In the first group, the median period of first defecation was in 5.0 days. As for in patients of the second group, the first defecation was observed in terms of the 3-5 days with a median of 4.0 days. A similar indicator was observed in patients of the third group. Patients in the second and third groups did not indicate severe pain during the first act of defecation. The anal hematoma was found only in patients of the first group (p<0.01). Anal infiltration occurred in 12.5±5.23 % in the third group (p<0.01). Infections of wounds were not found in any group.
 Conclusion. Laser open hemorrhoidectomy is an effective method of surgical treatment of patients with chronic hemorrhoids. However, like the classic open hemorrhoidectomy Milligan-Morgan, it allows to eliminate only pathological substrate (cavernous bodies). To prevent recurrence of the disease, it should be supplemented with laser transcutaneous submucosal mucopexia. Analysis of cases of early postoperative complications showed that the classic Milligan-Morgan hemorrhoidectomy, compared with intraoperative laser coagulation, had a significantly higher frequency (p<0.001).

A simple novel concept to conservatively manage refractory spasm in acute fissure-in-ano: Defecation put on-hold temporarily (DePOT).

Dear Editor The article by Soltany et al. was very informative and highlighted that the botulinum injection was effective in about 85% patients.[1] However, few patients (about 15–20%) would not respond to the botulinum injection and their anal spasm would not be relieved. In these patients, the surgery would be required just to alleviate the pain.[23] It is important to consider that severe spasm and pain in acute fissure-in-ano is primarily aggravated by the act of defecation.[45] The patients suffering from fissures are usually constipated and the shearing force of the hard stools aggravates the spasm.[45] Moreover, the 'narrowed’ anal outlet due to spasm further increases the impact of this shearing force[Figure 1].Figure 1: Overview of the DePOT (defecation is put on-hold temporarily) conceptTherefore, if the defecation is put on-hold temporarily (DePOT) for a week, then it would not only provide immediate pain relief but would also lead to an earlier and faster resolution of the underlying disease (by removing the aggravating factor- defecation process). Thus, it would help to avoid surgery in many, if not all, such patients. It has to be ensured that while implementing DePOT, the daily requirements of protein, minerals, vitamins, water and fats are taken care of. This is done by liquid diet having zero fiber plus full nutrition [oral rehydration solution (ORS), vitamin supplementation and protein (whey) supplementation (50–60 grams/day)]. Once these nutritional needs of the patient are taken care of, then it is not difficult for the patient to sustain on the liquid diet for a week and even longer, as required. An enema is given on the first day to evacuate the rectum. Otherwise, there is risk of hardening of residual stools already present in the rectum, which could create difficulty on resumption of normal diet later. DePOT was also prescribed for seven days to four patients of acute fissure-in-ano with refractory spasm in whom conservative management was not working (26-year/male, 23-year/female, 34-year/female, 29-year/male). All patients except the third patient, had immediate pain relief and the acute spasm improved progressively over next 7–10 days. The third patient had to stop DePOT after 3 days as she developed an intersphincteric abscess and was operated for the same. The ethical approval was taken from Indus Hospital Ethical Committee via reference no. Indus hospital/EC/02-12. The DePOT regimen is very useful to primary care physicians. The patients suffering from refractory acute fissure-in-ano (not responding to the conservative management) usually require surgery and need to be referred to a surgeon.[23] But, with the DePOT regimen, such patients can be easily managed by primary care physicians. To summarize the key points, - The DePOT regimen puts defecation process on hold for a week by zero fiber, full nutrition, liquid diet - It is a simple, economical, safe and easily reproducible concept - DePOT is a new concept which provides immediate relief and helps prevent surgery in acute thrombosed hemorrhoids and acute fissure with refractory spasm (conditions which get aggravated by defecation and often require surgery). This simple logical concept is proposed so that prospective randomized controlled studies can corroborate the efficacy of this regimen. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Pulmonary embolism associated with the act of defecation. “The bed pan syndrome”

Pulmonary embolism associated with the act of defecation. “The bed pan syndrome”

Turtle Shell Impression in a Coprolite from South Carolina, USA

ABSTRACTCoprolites (fossilized feces) can preserve a wide range of biogenic components. A mold of a hatchling turtle partial shell (carapace) referable to Taphrosphys sulcatus is here identified within a coprolite from Clapp Creek in Kingstree, Williamsburg County, South Carolina, USA. The specimen is the first-known coprolite to preserve a vertebrate body impression. The small size of the turtle shell coupled with the fact that it shows signs of breakage indicates that the turtle was ingested and that the impression was made while the feces were still within the body of the predator. The detailed impression could only have survived the act of defecation if the section of bony carapace was voided concurrently and remained bonded with the feces until the latter lithified. Exceptionally, the surface texture of the scutes is preserved, including its finely pitted embryonic texture and a narrow perimeter of hatchling scute texture. The very small size of the shell represented by the impression makes it a suitable size for swallowing by any one of several large predators known from this locality. The coprolite was collected from a lag deposit containing a temporally mixed vertebrate assemblage (Cretaceous, Paleocene and Plio-Pleistocene). The genus Taphrosphys is known from both sides of the Cretaceous–Paleogene (K–Pg) boundary so, based on the size of the coprolite and the locally-known predators, the juvenile turtle could have been ingested by a mosasaur, a crocodylian, or a theropod dinosaur. Unlike mosasaurs and theropod dinosaurs, crocodylian stomachs have extremely high acid content that almost always dissolves bone. Therefore, the likely predator of this turtle was a mosasaur or a (non-avian or avian) theropod dinosaur.

RULE "THE OPPOSITE HAND" AS THE BASIS FOR THE PREVENTION OF DEVELOPING INTRAFAMILY FOCUS OF H. PYLORI INFECTION

We have analyzed the results of a comprehensive study which involved 587 patients with chronic nonatrophic gastritis. It was established that all patients suffered from chronic non-atrophic gastritis of varying degrees of activity and varying degrees of severity. When analyzing the history data, it was found that the leading right hand was in 584 (99,5 %), and the left one in 3 (0,5 %) patients, and all patients would take the toilet paper by the leading hand after the act of defecation; at the time of the survey the bathroom in the house number 205 (34,9 %) patients was combined, and in 382 (65,1 %) it was separate; the рatients in 100% of cases noted pathology of the gastrointestinal tract at least in one of their close relatives. Given that the presence of separate toilets formed 13 zones of the "storage" of inactive forms of HP infection, and in the combined one there were 9 of them, the patients and all members of their families were urged to follow the rule of "the other hand" (the paper should be taken by the opposite to the leading hand after a bowel movement and do not touch any places until it is washed with soap) and control yourself 3-4 days to produce a conditioned reflex and band –" drives "1 times a week while cleaning the facilities to process a disinfectant containing chlorine ("Domestos ", weak solution of normal brightness).

The control of defecation in humans: an evolutionary advantage?

Defecation is a physiological event present in every individual, consisting of the expulsion of fecal matter, and in normal conditions, mostly occurring in the morning or after meals provided the appropriate neuroanatomical circuits are intact [1, 2]. Due to the fact that it involves a very private sphere and is the object of cultural taboos, the act of defecation is rarely thought of, even by physicians, even though it involves complex anatomical, psychophysiological, and neurological relationships, disruption of which can lead to constipation or incontinence [3, 4]. In brief, actual defecation is the result of synchronized ileo-colo-recto-anal motility, with voluntary sphincteric relaxation allowing the expulsion of fecal matter [1, 2]. Semiliquid intestinal content arriving in the terminal ileum elicits powerful contractions that propels this content into the large bowel; here, a mix of segmental and propulsive activity progressively compacts the content and shifts it toward the rectum, where it is temporarily stored until the subject (alerted by defecation stimuli) decides it is convenient to defecate [1, 2]. The act of defecation, in a healthy individual, is under strict voluntary control; thus, the individual decides if and when (mostly depending on environmental/social events) it is opportune to defecate. We put forward the hypothesis, which is very difficult to prove, that this rigid control of defecation may have evolved not only due to social amenities but as an evolutionary advantage.

Internal carotid artery dissection triggered by the act of defecation

Background and purpose . Defecation can precipitate the onset of acute cardiovascular diseases.Case report. A 54 year-old woman presented 3 episodes of right brachiofacial weakness with left amaurosis after an intensive effort of defecation in a context of severe constipation. These neurological disorders were secondary to a left internal carotid artery dissection triggered by defecation.Conclusion . To the best of our knowledge, it’s the first description of an internal artery dissection induced by an effort of defecation.

A Rump Sexuality: The Recurrence of Defecating Horses in Beckett's Oeuvre

Through the examination of the recurrent sexualised image of horses' posteriors in the act of defecation in , , and this paper outlines a nexus of concepts clustering around this apparently aberrant sexual stimulus. Using Freud's case history of Little Hans and the suggested relationship between defecation and childbirth as an analogue, the paper argues that the image reveals not a horror at sexuality within Beckett's works, but a horror at reproductive sexuality which finds its fullest expression in the sterile world of

Endometriosis: an immune condition resembling Crohn’s disease?

1.1. Anorectal disease in pregnancy is both directly and indirectly affected by specific anopelvirectal changes of pregnancy prenatally, with delivery and with changes of involution postpartum.2.2. The relationship of the anorectum and the pelvirectum is shown both anatomically and physiologically to the pelvis and genital organs in the non-pregnant state, during pregnancy and postpartum. This particularly relates to knowledge gained recently of their levator ani components from the levator ani structurely and functionally, and particularly relates to the profuseness of blood supply to the anopelvirectum with its profuse collateral blood supply throughout the pelvis.3.3. It has been shown that the work of Courtney on the anatomy of the pelvic diaphragm and anorectal musculature, now applied both anatomically and physiologically, demonstrates that the anorectum cannot be considered as an organ distinctly anorectal, but should be considered as an organ both pelvirectal as well as anorectal and as part of the levator ani. The levator ani assumes a vital part in the act of defecation as well as of childbirth which is anopelvirectal. Here pelvirectally is the area where a profuse blood supply to the rectum occurs.4.4. Specific anorectal and pelvirectal changes in pregnancy are outlined.5.5. Accompanying mechanical, hormonal and secretory changes affecting the gastrointestinal tract and directly or indirectly affecting specific anopelvirectal changes are outlined.6.6. Hemorrhoids and pruritus of anorectal and perigenital type have a high incidence during pregnancy. Other anorectal diseases have a low incidence.7.7. A new concept of the etiology of hemorrhoids and a new classification thereof is given. This is based on our knowledge of the profuse collateral blood supply in the pelvis to the ano rectum and pelvirectum and is also based on known accepted facts of the etiology and classification of varicose veins elsewhere than the anorectum.8.8. Anorectal disease in pregnancy, other than cancer, ulcerative colitis and postpartum communicating fistulas, such as rectovaginal fistula, are discussed in detail and new concepts of their presence or absence in pregnancy and their management as related to pregnancy changes, and to the pregnancy itself, are considered in each instance.

Is squatting a triggering factor for stroke in Indians?

Undocumented observations of ours suggested increased occurrence of strokes in the early hours of the morning and in the toilets where most Indians still squat. The present study has been designed to assess the validity of this observation and to identify the likely triggering factor in stroke onset in such situations. Part A of the study looked into stroke onset data of 100 consecutive CT-confirmed stroke patients specially in relation to time of day, place, posture and activity of the individual. Part B of the study included 67 healthy volunteers (age 24-49 years) whose supine and squatting blood pressure (BP) were measured and the differences noted. Part C of the study consisted of repeating the same procedure in 104 known hypertensives on treatment (age 28-60 years). Part A of the study revealed that most strokes (52%) occurred in the morning and at home (86%) and over a third (36%) while in toilets. Thirty-six per cent of the strokes occurred while the subjects squatted, mostly during the act of defecation. More than half of the haemorrhagic strokes occurred while the subjects were in squatting position. In normal healthy volunteers squatting produced a small (8.09 +/- 7.04 mmHg) but significant rise in systolic blood pressure (SBP) but not in diastolic blood pressure (DBP) (0.9 +/- 7.38 mmHg). In contrast, in treated hypertensives squatting produced a significantly higher rise in both SBP (14.49 +/- 11.63 mmHg) and DBP(9.10 +/- 9.19 mmHg). The relationship of the clinical observations regarding stroke onset with the BP changes noted on squatting in healthy as well as hypertensive subjects appears to be more than fortuitous. Squatting induced rise in BP appears to be an important triggering factor for stroke onset in subjects at risk in India.

Simultaneous defecography and peritoneography in defecation disorders.

A number of physiologic and radiologic investigations are used in investigating defecation disorders. Defecography is one important part of these investigations. However, a correct diagnosis of an enterocele is sometimes difficult despite use of contrast media in the rectum, vagina, and small bowel. This study was undertaken to ascertain if it was technically possible to perform simultaneous defecography and peritoneography in an effort to improve the diagnostic possibilities in patients with defecation disorders. Twelve patients with defecation disorders and an unexplained widening of the rectovaginal space at defecography were investigated. Contrast medium was introduced intraperitoneally, after which conventional defecography was performed. All investigations were carried out without complications and demonstrated the peritoneal outline in all patients. Simultaneous defecography and peritoneography differentiated between an enterocele and a pathologically deep pouch of Douglas--a peritoneocele. Three types of peritoneocele were visualized: vaginal peritoneocele, septal peritoneocele, and rectal peritoneocele with or without enterocele. Combinations of the three types were also found. Eight of the 12 patients had rectal intussusception or rectal prolapse. All of these eight patients had a rectal peritoneocele. Simultaneous defecography and peritoneography can be performed without technical difficulties or complications. Peritoneal outlines and pouches can, therefore, be studied directly during the act of defecation. An unexplained widening of the rectovaginal space at defecography can be clarified as a peritoneocele, with or without an enterocele. Peritoneocele can be of three different types: rectal, septal, or vaginal.

Defecography as Part of the Evaluation of Anorectal Dysfunction

Defecography is the evaluation of the anus and rectum during the act of defecation. We have devised a very simple method of performing this examination in conjunction with the Radiology Department. The entire procedure takes less than 15 minutes from start to finish. In our hospital, we have performed over 130 of these tests. A high level of patient cooperation has been noted in our experience. For the most part, the entire procedure from bowel preparation to final films is well tolerated.