PURPOSE: This study was designed to compare routine clinical examination and d efecography in the diagnosis of rectal intussusception in constipated patients a nd study relationships between rectal intussusception and...PURPOSE: This study was designed to compare routine clinical examination and d efecography in the diagnosis of rectal intussusception in constipated patients a nd study relationships between rectal intussusception and symptoms. METHODS: A t otal of 127 consecutive patients with functional constipation were examined in t he left-lateral position with rectal palpation and rectoscopy according to a pr otocol. An overall clinical judgment was made if the patient had intussusception , unclear finding, or no intussusception. Defecography was performed without kno wledge of the results of the clinical evaluation. Symptomduration varied between 0.5 to 60 (median, 10) years. All patients fulfilled a bowel questionnaire and all had a full physiologic workup. RESULTS: A diagnosis by digital examination ( P = 0.002) and by rectoscopy (P = 0.002) as well as the overall judgment (P = 0. 0002) was clearly related to a longer intussusception as measured by defecograph y. Five of six intraanal intussusceptions were correctly assessed by clinical examinat ion,whereas the correlation to defecographywas poor in the group with short intu ssusceptions. Neither clinical nor defecographic diagnosis of rectal intussuscep tion were related to the main symptoms of constipation but both were associated with a tendency toward lower anal resting pressures (P = 0.04 and P = 0.06) and an obtuse anorectal angle (during evacuation, P = 0.01 and P = 0.01). CONCLUSION S: There is no clear relationship between rectal intussusception and constipatio n. However, intussusception is related to sphincter function and may be of clini cal relevance. A normal clinical examination will exclude most long intussuscept ions, whereas a positive finding needs further evaluation with defecography.展开更多
Background. Pili annulati is an inherited hair shaft abnormality with a wide range of clinical expression. Objective. We have examined closely three kindreds to reveal levels and character of expression of the phenoty...Background. Pili annulati is an inherited hair shaft abnormality with a wide range of clinical expression. Objective. We have examined closely three kindreds to reveal levels and character of expression of the phenotype and supplement cu rrent literature on the threshold for detection and aspects of hair shaft fragil ity. Patients and methods. Eleven cases of pili annulati from three families wer e included in a clinical and morphological study. All cases were assessed clinic ally and by light and scanning electron microscopy (SEM) of hair shafts. In addi tion, transmission electron microscopy (TEM) (four patients) and amino acid anal ysis (three patients) were undertaken on clinically overt cases. Results. Examination by light microscopy with a fluid mountant w as more sensitive than clinical examination, increasing the detection rate by 12 0% . Microscopic examination revealed that the characteristic periodic bands be come less frequent distally in the hair shaft. Microscopic features of weatherin g were found in two cases, adding pili annulati to the list of structural hair s haft dystrophies that may weaken hair and dispose to weathering. Amino acid anal ysis of the hair of three patients with pili annulati showed elevated lysine and decreased cystine content compared to 12 normal controls, consistent with the r educed threshold for weathering. Conclusion. Careful light microscopy with fluid -mounted hair is needed to detect subjects mildly affected by pili annulati. E xpression of the phenotype varieswidely between individuals, between hairs andwi thin hairs of the same individual,where ageing of the hair diminishes detectable features.展开更多
文摘PURPOSE: This study was designed to compare routine clinical examination and d efecography in the diagnosis of rectal intussusception in constipated patients a nd study relationships between rectal intussusception and symptoms. METHODS: A t otal of 127 consecutive patients with functional constipation were examined in t he left-lateral position with rectal palpation and rectoscopy according to a pr otocol. An overall clinical judgment was made if the patient had intussusception , unclear finding, or no intussusception. Defecography was performed without kno wledge of the results of the clinical evaluation. Symptomduration varied between 0.5 to 60 (median, 10) years. All patients fulfilled a bowel questionnaire and all had a full physiologic workup. RESULTS: A diagnosis by digital examination ( P = 0.002) and by rectoscopy (P = 0.002) as well as the overall judgment (P = 0. 0002) was clearly related to a longer intussusception as measured by defecograph y. Five of six intraanal intussusceptions were correctly assessed by clinical examinat ion,whereas the correlation to defecographywas poor in the group with short intu ssusceptions. Neither clinical nor defecographic diagnosis of rectal intussuscep tion were related to the main symptoms of constipation but both were associated with a tendency toward lower anal resting pressures (P = 0.04 and P = 0.06) and an obtuse anorectal angle (during evacuation, P = 0.01 and P = 0.01). CONCLUSION S: There is no clear relationship between rectal intussusception and constipatio n. However, intussusception is related to sphincter function and may be of clini cal relevance. A normal clinical examination will exclude most long intussuscept ions, whereas a positive finding needs further evaluation with defecography.
文摘Background. Pili annulati is an inherited hair shaft abnormality with a wide range of clinical expression. Objective. We have examined closely three kindreds to reveal levels and character of expression of the phenotype and supplement cu rrent literature on the threshold for detection and aspects of hair shaft fragil ity. Patients and methods. Eleven cases of pili annulati from three families wer e included in a clinical and morphological study. All cases were assessed clinic ally and by light and scanning electron microscopy (SEM) of hair shafts. In addi tion, transmission electron microscopy (TEM) (four patients) and amino acid anal ysis (three patients) were undertaken on clinically overt cases. Results. Examination by light microscopy with a fluid mountant w as more sensitive than clinical examination, increasing the detection rate by 12 0% . Microscopic examination revealed that the characteristic periodic bands be come less frequent distally in the hair shaft. Microscopic features of weatherin g were found in two cases, adding pili annulati to the list of structural hair s haft dystrophies that may weaken hair and dispose to weathering. Amino acid anal ysis of the hair of three patients with pili annulati showed elevated lysine and decreased cystine content compared to 12 normal controls, consistent with the r educed threshold for weathering. Conclusion. Careful light microscopy with fluid -mounted hair is needed to detect subjects mildly affected by pili annulati. E xpression of the phenotype varieswidely between individuals, between hairs andwi thin hairs of the same individual,where ageing of the hair diminishes detectable features.
