PURPOSE:Sacral nerve stimulation has proven to be a promising treatment for fecal incontinence when conventional treatment modalities have *** have been several hypotheses concerning the mode of action of sacral nerve...
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PURPOSE:Sacral nerve stimulation has proven to be a promising treatment for fecal incontinence when conventional treatment modalities have *** have been several hypotheses concerning the mode of action of sacral nerve stimulation,but the mechanism is still *** study was designed to evaluate the results of rectal volume tolerability,rectal pressure-volume curves,and anal pressures before and six months after permanent sacral nerve stimulation and to investigate the mode of action of sacral nerve ***:Twenty-nine patients with incontinence(male/female ratio = 6/23;median age,58(range,29-79) years) underwent implantation of a permanent sacral electrode and neurostimulator after a positive percutaneous nerve evaluation *** incontinence score,rectal distention with thresholds for “ first sensation,” “ desire to defecate,” and “ maximal tolerable volume,” rectal pressure-volume curves,anal resting pressure,and maximum squeeze pressure were evaluated at baseline and at six months ***:Median Wexner incontinence score decreased from 16(range,6-20) to 4(range,0-12;P < 0.0001) .Median “ first sensation” increased from 43(range,16-230) ml to 62(range,4-186) ml(P = 0.1) ,median “ desire to defecate” from 70(range,30-443) ml to 98(range,30-327) ml(P = 0.011) ,and median “ maximal tolerable volume” from 130(range,68-667) ml to 166(range,74-578) ml(P = 0.031) .Rectal pressure-volume curves showed a significant increase in rectal capacity(P < 0.0001) .The anal resting pressure increased significantly from 31(range,0-109) cm H2O to 38(range,0-111) cm H2O(P = 0.045) .No significant increase in maximum squeeze pressure was ***:For patients with fecal incontinence successfully treated with sacral nerve stimulation,there was a significant increase in rectal volume tolerability and rectal capacity.A significant increase in anal resting pressure,but not in maximum squeeze pressure,was *** suggest that sacral nerve
Intravenous immunoglobulin (IVIg) treatment improves mus- cle strength in Lambert-Eaton myasthenic syndrome (LEMS), butits specific mod e of action is unknown. We have delineated its mode of action on neuromuscular b ...
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Intravenous immunoglobulin (IVIg) treatment improves mus- cle strength in Lambert-Eaton myasthenic syndrome (LEMS), butits specific mod e of action is unknown. We have delineated its mode of action on neuromuscular b locking properties of LEMS IgG. The effect of sera and purified IgG from six pat ients with LEMS on evoked quantal release was investigated after direct applicat ion to the motor nerve terminal by the perfused macro-patch-clamp electrode in mouse hemidiaphragms. The effect of LEMS IgG was analyzed alone and after coinc ubation with different concentrations of IVIg or its Fab fragments. All LEMS ser a and purified LEMS IgG fractions taken before IVIg treatment inhibited evoked q uantal release in a dose-dependent manner. When LEMS IgG was coincubated with a therapeutic IVIg preparation, presynaptic inhibitory activity of LEMS IgG was d iminished in a dose-dependent fashion. Monovalent Fab fragments were as effecti ve in neutralizing the activity of LEMS IgG as whole IVIg. These direct neutrali zing effects of IVIg may explain its therapeutic efficacy.
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