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Anorectal function after anterior resection may be impaired as a result of reduced luminal capacity in the pelvis. The aim of this study was to evaluate the colonic J pouch neorectum by means of ambulatory manometry. Twelve patients with a colonic pouch following anterior resection and seven healthy controls were studied for a median of 6 (range 6–24) h using a probe with two pouch-rectal and two anal canal transducers. Records were interpreted by visual inspection. Pressure values and wave frequencies were determined by software analysis. Pouches had been functioning for a median of 32 (range 11–55) months. All patients with a pouch had an acceptable stool frequency. Seven of 12 patients complained of incomplete evacuation. Resting anal canal pressure (73 versus 100 cmH2O), pouch-rectal pressure (29 versus 15cmH2O) and anal canal pouch-rectal pressure gradients (60 versus 85 cmH2O) were similar in patients and controls. The frequency of slow-wave activity in patients with a pouch was significantly lower than that in controls (7 versus 16 cycles per min, P =0.001). Coordination between the colonic J pouch and the anal canal, in the form of sampling episodes, was observed in more than half of the patients with a functioning pouch. Large isolated contractions (pressure greater than 30cmH2O and lasting longer than 20 s) and rhythmic contractions were the most frequent pattern of pouch motility.

PURPOSE: The aim of this study was to determine whether a colonic J-pouch has similar properties to that of a normal rectum, including recovery of rectoanal coordination. METHODS: Ten patients with colonic J-pouch-anal anastomosis (anastomotic distance from anal verge, 3–5 (range, 2.0–4.5) cm for low rectal cancer (7 men; mean age, 64.7 (range, 44–76) years) were studied clinically and in the anorectal physiology laboratory at least one year after operation. Results were compared with a series of ten matched patients who underwent high anterior resection for upper rectal carcinoma (anastomotic height, 12.7 (range, 9.5–16) cm). RESULTS: Although results seemed to be slightly better in the group with the rectum preserved, no statistical differences could be found either in functional outcome or anorectal physiology. One-half of the patients with colonic J-pouch (neorectum) had a positive rectoanal inhibitory reflex. CONCLUSION: Addition of a colon pouch neorectum would appear to improve function to the level of those patients with a high anastomosis and “normal” rectum.

Classically, clinical assessment of faecal incontinence is supported by anal manometry and electromyography. Recently, anal endosonography has appeared to be the ideal method evaluating anatomically both the internal and external anal sphincter. In this paper, our experience in evaluating faecal incontinence by anal endosonography is presented.34 patients (26 female, 4 male; mean age, 40) complaining of faecal incontinence were analysed by traditional anorectal physiologic tests as well as by anal endosonography. Previously, patients were clinically grouped in: group 1, post-delivery, 18 cases; group 2, post-surgery, 6 cases; group 3, "idiopathic", 10 cases.Results of anal physiologic test showed significant differences between group 1 and the rest of patients. All patients complaining of post-surgery incontinence were found to have sphincter disruptions. 2 out of 10 patients from group 3 presented unsuspected lesions. Nearly 40% of women with post-delivery incontinence had normal anal muscles.Anal endosonography is a imaging technique that permits fully vision of the sphincters. It showed to be a great help in cases of faecal incontinence particularly in the decision-making of surgical approach.

One principal aim in follow-up after curative surgery for colorectal cancer is to identify recurrent disease at an early and possibly treatable stage. The major problem for patients with rectal carcinoma is local recurrence, which occurs in 3–30 per cent of cases and carries a 5-year survival rate of less than 5 per cent. Since 1989, in addition to digital and sigmoidoscopic examination, endorectal ultrasonography has routinely been used in the follow-up of patients with rectal cancer. Sixty-six patients (40 men) who had undergone attempted radical surgery for mid- and lower-third rectal cancer were included in the study. The mean age was 68 (range 43–87) years. A total of 190 scans were performed, with a mean of 3 (range 1–9) for each patient. Thirteen (20 per cent) of the 66 patients developed local recurrence; in all cases this was suggested by rectal ultrasonography. Digital examination and rigid sigmoidoscopy failed to detect recurrence in three patients. Four detected recurrences were treated radically; the remaining patients received radiotherapy, palliative transanal resection or laser management because of advanced age or refusal to undergo surgery. Six patients were alive a mean of 21 (range 4–50) months after recurrence. Of these six patients, four were free from disease (three had undergone salvage surgery and one radiotherapy). Postoperative rectal ultrasonography can detect some local recurrences at an early treatable stage. The method is more accurate than digital examination and sigmoidoscopy, and should be used as part of a regular follow-up programme.

The aim of this study was to evaluate the health state of a random group of subjects occupationally exposed to polyvinyl chloride. The emphasis was put on the hepatic functional tests in comparison with acetaminophen pharmacokinetics. Forty two males were assigned to two groups: the control group free from occupational exposure and the group exposed to polyvinyl chloride. The latter one was divided into two subgroups according to the length of exposure. The following examinations were carried out in all subjects: subjective and physical examinations, basic laboratory and functional hepatic tests, radioisotope examinations of the liver and spleen, and acetaminophen pharmacokinetics was analysed as well. Acetaminophen was administered intragastrically in a single dose of 1.0 g. Blood was collected within 24 hrs after drug administration. The method of Routh et al. was used for determination of paracetamol concentration. A two-compartment open model for extravascular administration was used for calculation of pharmacokinetic parameters. The results suggest that polyvinyl chloride leads to an accelerated acetaminophen biotransformation, regardless of the length of occupational exposure. There was no correlation between changes in paracetamol metabolism and standard functional hepatic tests. The acetaminophen test can be useful in detecting alterations in the activity of hepatic microsomal enzymes, a symptom of early occupational exposure to chemical compounds with potential hepatoxic properties.