In past studies, investigators have reported that the salivary glands respond to esophageal acidification by increased salivary secretion and termed this response the 'esophago-salivary response'. The existence, however, of such a reflex was but a speculation because the verification of its mechanism could not be traced in the literature. In the current study, the hypothesis that the salivary glands' response to esophageal acidification is a reflex was investigated.In 15 healthy volunteers (nine men, six women, age 32.3 +/- 4.2 years) the saliva of the four salivary glands was collected by intubation after individual esophageal perfusion with normal saline and 100 mmol HCl. The test was repeated after each of the lower esophagus and the salivary glands had been separately anesthetized. The latency was calculated.The mean basal volume of saliva was 62.7 +/- 6.4 mL/60 min. This volume did not show a significant change (P > 0.05) on esophageal saline instillation, whereas acid perfusion effected a significant increase (P < 0.01). The mean latency was 12.4 +/- 2.7 s. Esophageal acid perfusion after lower esophageal anesthetization did not produce a significant change in salivary volume; similar results were obtained on repetition of the test after anesthetization of salivary glands. When saline was used instead of lidocaine in the lower esophagus or salivary glands, the salivary glands' response was similar to that without saline perfusion.Esophageal acidification effected an increase of secreted saliva which clears the esophagus of the refluxed acid. Increased salivation on esophageal acidification is suggested to be a reflex and is mediated through the 'esophago-salivary' reflex. This reflex might be of diagnostic significance in the investigation of reflux esophagitis, a point that requires further study.

10.1111/j.1440-1746.2005.04005.x

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Citations (48)

Transfer mechanism and concentrating processes of certain radionuclides in the aquatic ecology of the Ismailia Canal

Mahmoud K. AL‐Omiri Y.A. Yousef M. M. Ishak W. E. Y. Abdelmalik Saeed Khalil

Water transfer

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Citations (2)

The Scrotal Fat

Urologia Journal (1978)

Ali A. Shafik Soophie Olfat

10.1177/039156037804500404

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Citations (1)

Dilatation and Closing Anal Reflexes

Cells Tissues Organs (1991)

Ali A. Shafik

The present communication describes new reflexes which are called ‘dilatation and closing anal reflexes’, and discusses their clinical significance. The study comprised 21 healthy volunteers and 15 incontinent patients (7 with partial fecal incontinence and 8 with urinary stress incontinence). The technique comprised the introduction into the rectal neck of a balloon-tipped catheter. The balloon was inflated with air in increments of 10 ml up to 50 ml and the EMG response of the external anal and urethral sphincters to balloon inflation and deflation was recorded. A new device called ‘switch inflation’ apparatus was used to inflate the balloon simultaneously with switching of the EMG apparatus.Rapid rectal neck inflation and deflation evoked external anal and urethral sphincter contraction. Slow and gradual inflation or deflation did not initiate the response. The anesthetized external anal sphincter did not respond to the stimulus, while the saline-infiltrated sphincter responded. The latency of the reflexes was recorded. In fecal incontinent patients, the external anal sphincter, on rapid rectal neck inflation or deflation, showed lower EMG activity and longer latency than in normal volunteers; the external urethral sphincter responded as in normal volunteers. In urinary stress incontinent patients, the external anal sphincter responded normally for both rectal neck inflation and deflation. The external urethral sphincter showed lower EMG activity and prolonged latency than normal on rectal neck inflation; it did not respond to deflation. The dilatation and closing reflexes seem to play a role in fecal and urinary continence as well as in fecal sampling. Detectable changes in latency or amplitude of the evoked response indicate a defect in the reflex pathway. The reflexes could thus be included as an investigative tool in the study of fecal and urinary disorders.

External anal sphincter

Fecal Incontinence

10.1159/000147205

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Citations (16)

Fecoflowmetry: a new parameter assessing rectal function.

PubMed (1992)

Ali A. Shafik K Abdel Moneim

Fecoflowmetry is a new technique by which the fecal flow rate is studied through recorded curves representing the changes which occur in the rate against time. Fecal flow rate is the product of rectal detrusor action against outlet resistance. The technique was performed on 36 normal volunteers and 8 chronically constipated patients. A one liter water enema was given to the individual. On feeling the desire to defecate, he or she was placed on the commode of a fecoflowmeter and was asked to defecate. Defecation flow curves were obtained. Evaluation of the curve comprises reporting on the defecated volume, flow time, maximum and mean flow rates and the shape of the curve. The technique was developed to stimulate natural defecation. It provides quantitative and qualitative data concerning the act of defecation. It assesses all objective parameters in one test. The procedure is simple, non-invasive and constitutes a useful screening tool in defecation and rectal disorders.

Enema

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A Novel Concept for the Surgical Anatomy of the Perineal Body

Diseases of the Colon & Rectum (2007)

Ahmed Shafik Olfat El Sibai Ali A. Shafik Ismail A. Shafik

Perineal body is considered by investigators as a fibromuscular structure that is the site of insertion of perineal muscles. We investigated the hypothesis that perineal body is the site across which perineal muscles pass uninterrupted from one side to the other.Perineal body was studied in 56 cadaveric specimens (46 adults, 10 neonatal deaths) by direct dissection with the help of magnifying loupe, fine surgical instruments, and bright light.Perineal body consisted of three layers: 1) superficial layer, which consisted of fleshy fibers of the external anal sphincter extending across perineal body to become the bulbospongiosus muscle; 2) tendinous extension of superficial transverse perineal muscle crossing perineal body to contralateral superficial transverse perineal muscle, with which it formed a criss-cross pattern; and 3) tendinous fibers of the deep transverse perineal muscle; the fibers crossing perineal body decussated in criss-cross pattern with the contralateral deep transverse perineal muscle. A relation of levator ani or puborectalis muscles to perineal body could not be identified.Perineal body (central perineal tendon) is not the site of insertion of perineal muscles but the site along which muscle fibers of these muscles and the external anal sphincter pass uninterrupted from one side to the other. Such a free passage from one muscle to the other seems to denote a "digastric pattern" for the perineal muscles. Perineal body is subjected to injury or continuous intra-abdominal pressure variations, which may eventually result in perineocele, enterocele, or sigmoidocele.

Levator ani

External anal sphincter

Cadaveric spasm

Anus

10.1007/s10350-007-9064-8

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Citations (69)

Lipectomy in the Treatment of Scrotal Lipomatosis

British Journal of Urology (1981)

Ali A. Shafik Soophie Olfat

Scrotal lipectomy was performed in 102 infertile patients with scrotal lipomatosis; suprapubic lipectomy was included in 22 patients who had redundant suprapubic fat. Improvement in semen quality was obtained in 64.7% and pregnancy occurred in 19.6%. Statistically, the improvement was significant in both the sperm count and motility of the total series and only in the sperm count in the cases which produced pregnancy. The technique is described and the factors to which the results may be attributed are discussed.

Semen quality

Semen Analysis

10.1111/j.1464-410x.1981.tb03129.x

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Citations (84)

On the pathogenesis of rectocele: the concept of the rectovaginal pressure gradient

International Urogynecology Journal (2003)

Ahmed Shafik Olfat El‐Sibai Ali A. Shafik Ismail Ahmed

Bulbocavernosus reflex

10.1007/s00192-003-1087-7

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A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. III. The longitudinal anal muscle: anatomy and role in anal sphincter mechanism.

PubMed (1976)

Ali A. Shafik

A study of the longitudinal anal muscle was performed in 16 cadaveric specimens. The study comprised dissection and microscopic examination. The bundles of the longitudinal were found arranged in three layers: medial, intermediate, and lateral; each has a different origin and is separated from the other by a fascial septum. Four fascial septa related to the longitudinal muscle could be identified. They split and decussate below the lower end of the longitudinal muscle to form the "central tendon." The central tendon lies between the base loop of the external anal sphincter and the longitudinal muscle. It gives rise to multiple small fibrous septa in different directions; those which penetrate the base loop split and decussate to form the corrugator ani cutis. A mechanism of action of the corrugator is presented. The role of the longitudinal muscle in the anal sphincter mechanism and during defecation is discussed. The muscle plays its major role during defecation. The part played by the muscle in anal fixation is considered. It helps to fix the anal canal to the side wall of the pelvis during defecation, thus preventing anal prolapse.

External anal sphincter

Obstructed defecation

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Citations (64)