Diseases of the colon and rectum
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Obstetric trauma and excessive defecatory straining with perineal descent may lead to pudendal neuropathy with bilateral increase in pudendal nerve terminal motor latencies (PNTML). We have frequently observed unilateral prolongation of PNTML. Diagnostic and therapeutic implications of unilateral pudendal neuropathy are discussed. ⋯ A significant number of patients with pelvic floor disorders have only unilateral pudendal neuropathy. Patients with unilaterally prolonged PNTML should be considered to have pudendal neuropathy, despite normal value for mean PNTML. This fact may be relevant in planning surgical treatment and in predicting prognosis of patients with sphincter injuries.
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Two hundred fifty-eight consecutive nonsedated colonoscopies were prospectively evaluated over an 18-month period. The cecum was intubated in 250 cases (97 percent). Polypectomies or biopsies were performed in 77 cases (31 percent). Indications for colonoscopy included history of polyps (32 percent), hematochezia (28 percent), family history of colon cancer (16 percent), prior history of colon cancer (9 percent), change in bowel habits (12 percent), abnormal flexible sigmoidoscopy (6 percent), and inflammatory bowel disease (3 percent). ⋯ Several series have studied nonsedated endoscopic upper and lower gastrointestinal evaluations. None, however, have evaluated patient comfort and satisfaction. In our prospective series of 258 consecutive nonsedated colonoscopies, we found the procedure to be safe, effective, and well accepted.