Dynamic study of the rectal detrusor activity at defecation.

The dynamics of the rectal detrusor at defecation was studied in 29 normal and 10 constipated subjects. The rectal pressure was measured by a ureteral catheter with terminal side holes, while the intra-abdominal pressure was measured by a Foley catheter introduced into the urinary bladder. Simultaneous recording of fecal flow was performed by fecoflowmetry.

Levator-urethral reflex. A new reflex with clinical significance.

A preliminary study of a new reflex which I called "levator-urethral reflex" is presented. Twenty-three volunteers were studied. Two concentric needle electrodes were introduced: one in the levator ani muscle (stimulating electrode) and the other in the external urethral sphincter (recording electrode).

The scrotoscope. A new instrument for examining the scrotal contents.

A new instrument (the scrotoscope) is described. It was used in the diagnosis of questionable masses in the testis, epididymis and spermatic cord in 49 patients. Scrotal examination and testicular biopsy were performed in 31 infertile patients by means of the scrotoscope, together with pampiniform plexus venography in 1 patient and vasography in 2.

Testicular veins: anatomy and role in varicocelogenesis and other pathologic conditions.

The anatomy of the testicular veins of 42 male cadavers were studied to determine the extent of their role in varicocelogenesis and other pathologic conditions. The results of that study are presented.

Anal submucosal injection: a new route for drug administration in pelvic malignancies. III. Misonidazole distribution in serum, uterus and vagina: an experimental study.

The anal and oral administration routes were compared in 40 rats to study the distribution of misonidazole (MIS), a radiation sensitizer, in the serum, uterus and vagina. 14C-labelled MIS was administered in a dose of 0.2 ml water/100 g body weight containing 1 microCi MIS.

A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. XXIII. An injection technique for the treatment of idiopathic pruritus ani.

An injection technique for the treatment of idiopathic pruritus ani is presented. The technique was performed on 67 patients after failure of other methods to achieve permanent cure. The technique comprises injection of 5% solution of phenol in almond oil in the subcutaneous tissue of the rectal neck aiming at destruction of the "epithelial debris" which exists in this area and is considered the primary cause in idiopathic pruritus.

Inguinal pelviscopy. A new approach for examining the pelvic organs.

Inguinal pelviscopy is a new approach for examining structures in the extra- and intraperitoneal pelvic cavity. The total number of patients studied was 70. The method was used to visualize and take biopsies from masses in the presacral area (3 patients) and in the ovaries (8 patients).

Detrusor sphincter dyssynergia syndrome. A new syndrome and its treatment by external sphincter myotomy.

A new syndrome in which there was persistent external anal sphincter contraction on rectal distension is described in 18 patients. 12 were females and 6 males. Average age was 38.

Anal submucosal injection: a new route for drug administration in pelvic malignancies. V. Advanced prostatic cancer: results of methotrexate treatment using the anal route--preliminary study.

The present study compares the effectiveness of methotrexate injected per anum (group 1, 19 patients) versus that administered intravenously (group 2, 17 patients) in the treatment of advanced metastasizing prostatic carcinoma. The dose in both groups was 50 mg every 5 days for 5 consecutive doses. The course was repeated at 3-week intervals.

A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. The involuntary action of the external anal sphincter: histologic study.

The histologic changes in the external anal sphincter after internal anal sphincter excision were studied in 20 dogs. An external sphincter biopsy was taken before internal sphincterectomy and 2 weeks and monthly thereafter for 10 months. The excised material was studied microscopically after being stained with hematoxylin and eosin, Verhoeff-van Gieson and succinic dehydrogenase.

Anal submucosal injection: a new route for drug administration in pelvic malignancies. IV. Submucosal anal injection in the treatment of cancer of uterine cervix--preliminary study.

Seven patients with advanced cancer of the uterine cervix were treated by anal submucosal injection of methotrexate. Each course consists of five injections, one every 5 days; each injection contains 100 mg of methotrexate. The course was repeated at 3-week intervals and was given on an outpatient basis.

Experimental model of varicocele.

The purpose of this investigation was to create a varicocele model in animals and to study the subsequent alterations in testicular physiology. The study comprised 22 dogs divided into 2 groups: test and control. In the test group (17 dogs), excision of a longitudinal strip of the fasciomuscular tube of the spermatic cord was done on one side only.

Closed prostatic commissurotomy. An endoscopic technique for the treatment of benign prostatic hypertrophy.

Closed prostatic commissurotomy was performed in 27 patients with benign prostatic hypertrophy. The procedure was done under local anaesthesia. Through a 1-cm suprapubic incision, the retropubic space was insufflated with carbon dioxide or nitrous oxide and the endotherm introduced.

Anal submucosal injection: a new route for drug administration in pelvic malignancies. II. Methotrexate anal injection in the treatment of advanced bladder cancer. Preliminary study.

The clinical efficacy of submucosal anal injections of methotrexate in advanced bladder cancer is investigated. An experimental study on 20 mice has shown that methotrexate injected into the anal submucosa has no clinicopathological effect on the anorectum. The clinical study comprised 18 patients with advanced bladder cancer (13 with stage T3 and 5 with stage T4 disease) as a test group in whom methotrexate was injected into the anal submucosa and 8 (6 with stage T3 and 2 with stage T4 cancer) treated concurrently with intravenous methotrexate.

Pelvic organ venous communications. Anatomy and role in urogenital diseases; a new technique of cystovaginohysterography.

A study of the communicating veins between the venous plexuses of the pelvic organs was performed on 21 female cadavers. Thirteen cadavers were studied radiologically after being injected with barium sulfate and 8 were examined after injection of a plastic material. Two groups of communicating veins could be recognized: rectovaginal and vaginovesical; their anatomic features are described.

A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. XXXI. "Strainodynia": an etiopathologic study.

"Strainodynia" is the name I give to the excessive and exhaustive straining that may accompany defecation. Eighty-six patients with strainodynia were studied; the investigations comprised study of the stool character, proctoscopy, colonoscopy, barium enema, intestinal transit rate, EMG, manometry, and rectal biopsy. These patients were classified into 3 groups: band, diet, and levator strainodynia.

A concept of the anatomy of the anal sphincter mechanism and the physiology of defecation.

A review of the new concepts of the anatomy of the anal sphincter mechanism and the physiology of defecation is presented. The external sphincter is a triple-loop system; each loop can function as a separate sphincter through voluntary inhibition action and mechanical compression. Stress defecation resulting from internal sphincter damage is described.

Epididymal ligaments: anatomy and function.

Three ligaments are described in relation to the epididymis: superior and inferior epididymal, and vasal ligaments. The study was conducted on 38 cadavers and included direct dissection and histologic examination. The superior and inferior epididymal ligaments are triangular folds of the visceral tunica vaginalis, and extend from epididymis to testicle.

Prostatic commissurotomy. A simple technique for the treatment of benign prostatic hypertrophy.

Division of the anterior prostatic commissure and the bladder neck (but sparing the mucosa) achieves "urethral decompression". This simple technique for the treatment of benign prostatic hypertrophy was performed in 68 poor risk patients. The results were very satisfactory, especially in large prostates with lateral lobe enlargement.

Anal submucosal injection: a new route for drug administration in pelvic malignancies. Part I. Experimental study of misonidazole distribution in serum and tissues, with special reference to urinary bladder. Preliminary report.

The anal and oral administration routes were compared in 30 rats to study the distribution of misonidazole, a radiation sensitizer, in the serum and tissues with special reference to the urinary bladder. 14C-labelled misonidazole was administered in a dose of 0.2 ml water/100 gm body weight containing 1 mu Ci misonidazole.

A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. Reversion to normal defecation after combined excision operation and end colostomy for rectal cancer.

Twenty-one patients with combined excision operation for rectal cancer were subjected to electromyographic study of the levator ani muscle, the puborectalis muscle, and the external anal sphincter. Myoelectric activity of the puborectalis and levator ani muscles was detected in 12 patients, 6 of whom had normal activity of both muscles. Of the remaining six patients, there was reduced activity of the levator ani muscle in four and of the puborectalis muscle in all six.

Role of hemorrhoids in the pathogenesis of recurrent bacteriuria with a new approach for treatment.

A new approach for the pathogenesis and treatment of recurrent bacteriuria is presented. Ten patients with recurrent bacteriuria were studied. Episodes started 3-8 years prior to presentation.

A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. Treatment of hemorrhoids: report of a technique.

A technique for the treatment of hemorrhoids has been presented. It is based on a recent study in which the persistence of the anorectal band, a remnant of the anorectal sinus, and failure of rectal neck remodeling are considered responsible for the initiation of the hemorrhoid disease. The constricting effect of the anorectal band on the rectal neck results in elevation of its pressure, straining at defecation, and prolapse of the rectal mucosa.

Pelvic double-sphincter control complex. Theory of pelvic organ continence with clinical application.

A double-sphincter mechanism controlling the continence of pelvic organs is presented with a role-description of the involved pelvic musculature. The rectum and the urinary bladder identically have a detrusor with a neck related to a group of muscles which is responsible for its opening and closure. Whereas the levator ani and longitudinal muscle function to open the neck, the puborectalis and the internal sphincter are continent muscles.