Nick Read » sphincter

A method for measuring the activity of the gastropyloroduodenal unit in man

admin — Sun, 01 Mar 2009 09:02:30 +0000

Dr John Dent from the University of Adelaide had invented the perfused sleeve catheter for measuring the pressures across a mobile sphincter. He incorporated this into a multilumen catheter assembly for recording the contractile activity in the stomach, pylorus and duodenum in human subjects. My experience with measuring transmucosal potential difference allowed this catheter to be positioned accurately at the gastroduodenal junction. On sabbatical to Adelaide and applying this method, we were able to define in detail the normal contractile activity across the pylorus under fed and fasted conditions, and in response to infusion of lipid into the duodenum.

Houghton, L.A., Heddle, R., Maddern, G.J., Read, N.W., Downton, J., Toouli, J., Dent, J. (1988) Motor activity of the gastric antum, pylorus and duodenum under fasted conditions and after a liquid meal. Gastroenterology 94: 1276-1284.
Houghton, L.A., Read, N.W., Heddle, R., Horowitz, N., Collins, P.J., Chatterton, B., Dent, J. (1988) The relationship between the motor activity of the antrum, pylorus and duodenum emptying of a solid-liquid mixed meal. Gastroenterology 94: 1285-1291.
Heddle, R., Dent, J., Read, N.W., Houghton, L.A., Toouli, J., Horowitz, M., Maddern, G.J. and Downton, J. (1988) Antropyloroduodenal motor responses to intraduodenal lipid infusion in healthy volunteers. Am. J. Physiol. 254: G671-G679.

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Haemorrhoids

admin — Sun, 01 Mar 2009 08:51:17 +0000

The anal cushions are composed or erectile tissue similar to that in the penis. This is developed to enormous size in some gibbons and mandrills, where it is a sexual signal, but in man it’s more modest function is to seal the anal canal and prevent seepage. We showed that haemorrhoids are associated with hypertension of the anal cushions probably caused by an imbalance of the autonomic control of the pre and post erectile sphincters. Does anybody know if Viagra causes haemorrhoids?

Gibbons, C.P., Trowbridge, E.A., Bannister, J.J. and Read, N.W. (1986). The role of the anal cushions in maintaining continence. Lancet. Apr 19;1(8486):886-8.
Sun, W.M., Read, N.W., Shorthouse, A.J. (1990) The hypertensive anal cushion as a causse of high anal canal pressures in patients with haemorrhoids. Brit. J. Surg. 77: 458-462.
Sun, W.M., Peck, R.J., Shorthouse, A.J., Read, N.W. (1992) Haemorrhoids are associated not with hypertrophy of the internal anal sphincter but with hypertension of the anal cushions. Br. J. Surg. 79: 592-594

Anorectal Function The anus is much cleverer than we like to think....
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Constipation; the thief of time!

admin — Sun, 01 Mar 2009 08:38:13 +0000

“Constipation is the thief of time, diarrhoea waits for no man!”
The literature suggested that idiopathic constipation, which mainly affected young women, could, like faecal incontinence, be caused by one of a number of possible defects. This was not true. Although our studies showed that a range of abnormalities, delays in colonic transit, a blunting or rectal sensitivity and propulsion, inhibition of internal sphincter relaxation and paradoxical contraction of the external sphincter, these all tended to co-exist. Moreover a blunting of spinal reflexes and a parallel inhibition of micturition suggested that it was the cerebral activation of the programme for evacuation that was at fault, even though there was no sign of stroke, tumor or any other neurological disease. This indicated a psychological inhibition and underlined the success of biofeedback and psychological therapies.

Read, N.W., Timms, J.M., Barfield, L.J., Bannister, J.J., Donnelly, T.C. and Read, M.G. (1986) Impairment of defaecation in young women with severe constipation. Gastroenterology 90: 53-60.
Bannister, J.J., Lawrence, W., Thomas, D.G., Smith, A.B.R., Read, N.W. (1988) Urological abnormalities in patients with slow transit constipation. Gut 29: 17-20.
Kerrigan, D., Sun, W.M., Lucas, M.J., Read, N.W. (1989) Idiopathic constipation is associated with impaired urethrovesical and sacral reflex function. Brit. J. Surg. 76: 748-751.
Read, N.W. (1992) Anismus; does biofeedback work after all? Lancet.

Faecal impaction in the elderly Dr Leila Abouzekry came from Egypt and was working in...
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Anorectal Function

admin — Sun, 01 Mar 2009 08:29:59 +0000

The anus is much cleverer than we like to think. Or maybe we don’t like to think about it at all, unless it fails or is too up tight. It is, in fact, two sphincters in one, the outer one under conscious control, the inner not. It is exquisitely sensitive, distinguishing accurately between gas, fluid and solid.
The control of defaecation, so essential for socialization, requires the coordination of colonic propulsion, anorectal sensation and relaxation of internal and external sphincters and the muscles of the pelvic floor.
Continence is protected by the response of the external sphincter and puborectalis muscles to rectal distension and increases in intra-abdominal pressure.
Over the course of nearly twenty years, we worked with colleagues in surgery to describe the function of the anal sphincter in health and disease and helped devise and perfect new procedures to treat disorders of anal sphincter mechanism.

Read, N.W. and Bannister, J.J. (1985). Anorectal manometry: Techniques, measurements in healthy subjects and patients with anorectal disease. In: Proctology and the Pelvic Floor. (Eds. M. Henry and M. Swash). Butterworths, Sevenoaks, pp.65-87.
Bannister, J.J., Davison, P., Timms, J.M., Gibbons, C.G., Read, N.W. (1987). Effect of the stool size and consistency on defaecation. Gut 28: 1246-1250.
Bannister, J.J., Gibbons, C., Read, N.W. (1987) Preservation of faecal continence during rises in intra-abdominal pressure. Is there a role for a flap valve in maintaining normal continence. Gut 28: 1242-1245.
Rao, S.S.C., Holdsworth, C.D., Read, N.W., Davison P.A., Bannister J.J. (1987) Anorectal sensitivity and reactivity in patients with ulcerative colitis. Gastroenterology 93: 1270-1275.
Read, N.W., Sun, W.M. (1988) Disorders of the anal sphincter. In: Functional Bowel Disease (Ed. W.J. Snape), Plenum Press.
Edwards, C.A., Baxter, J., Brown, S., Bannister, J.J., Read, N.W. (1989) Effect of bile acids on anorectal function in humans. Gut 30: 383-386.
Brown, S., Cann, P.A., Read, N.W. (1990) Effect of coffee on distal colon function. Gut 31: 450-453.
Sun, W.M., Prior, A., Daly, J., Cheam, K., Read, N.W., Grundy, D. (1990) Sensory and motor responses to rectal distension vary according to rate and pattern of balloon inflation. Gastroenterology 99: 1008-1015
Prior, A., Stanley, K., Smith, A.R.B., Read, N.W. (1992) Effect of hysterectomy on anorectal and ureathrovesical physiology. Gut 33: 264-267.
Sun WM. Katsinelos P, Horowitz M, Read NW. (1996) Disturbances in anorectal function in patients with diabetes mellitus and faecal incontinence. Euro. J. Gastro. Hep. 8 (l0): 1007-12.

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Haemorrhoids The anal cushions are composed or erectile tissue similar to...
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