Slow transit chronic constipation (Arbuthnot Lane's disease). An immunohistochemical study of neuropeptide-containing nerves in resected specimens from the large bowel.

Seven patients (6 women, 1 man) with severe idiopathic chronic constipation, who underwent surgery with subtotal colectomy and ileorectal anastomosis, were investigated for the occurrence and density of nerve fibres, immunoreactive to different neuropeptides in the mucosa, submucosa, ganglia and smooth muscle in fresh specimens from the colon ascendens, the colon transversum and the colon descendens-sigmoideum. The following substances were studied: enkephalin, substance P, somatostatin, neuropeptide Y, vasoactive intestinal polypeptide, calcitonin gene-related peptide, bombesin, motilin, tyrosine hydroxylase, dynorphin and galanin. Nerve fibres immunoreactive to CGRP occurred in large numbers in the myenteric ganglia of the patients with severe idiopathic chronic constipation, whereas in the myenteric ganglia of the control cases they only occurred in low numbers.

A combined electromyographic and cineradiologic investigation in patients with defecation disorders.

Records from 20 patients on whom defecography and electromyography were performed simultaneously because of defecation disorders were analyzed. According to the electromyographic investigation, the patients could be divided into three main groups: 1) normal sphincter reaction; 2) paradoxical sphincter reaction; and 3) combined reaction. Group A was characterized by a marked reduction of muscular activity during emptying and a pronounced closing reflex after emptying.

Slow transit of the colon associated with severe constipation after the Ripstein operation. A clinical and physiologic study.

Eighteen patients with severe constipation after undergoing the Ripstein operation for rectal prolapse (n = 11) or internal rectal procidentia (n = 7) were studied with defecography, anorectal manometry, electromyography of the external anal sphincter and the puborectalis muscle, colonic transit time, and blood tests. Thirteen patients had slow-transit constipation. None showed a completely normal pattern in the parameters studied.

Voluntary relaxation of the external anal sphincter.

In this study five volunteers with special training in anal sphincter exercise (Scandinavian Yoga School) managed voluntarily to reduce anal pressure. The mean reduction of anal pressure was 20 mm Hg. In one of the subjects, this was shown by manometry during low spinal anesthesia and electromyography to be caused by relaxation of the external anal sphincter.