- Email: [email protected]
Anorectal physiology and pathophysiology
INTERNATIONAL ABSTRACTS
nutrition. The accumulation of arrested metaphases over a two-hour period was determined in a dose-response study. Increasing doses of URO-EGF progressively raised the two-hour collection of metaphases and intestinal weights. Intravenous infusion of URO-EGF was also effective in restoring cell proliferation when it was infused after the intestine had become hypoproliferative. URO-EGF administered through an intragastric cannula thrice daily had no significant effect on intestinal weight or crypt cell production rate or metaphase collection. It is proposed that one of the in vivo actions of URO-EGF is the maintenance of gastrointestinal growth and that this occurs through a systemic rather than a luminal mechanism.-Prem Puri Absorptive and Motor Function of Orthotopically Vascularized Segmental Ileal Autografts. A.R. Dennison, J. Collins, R.M. Wat-
kins, et al. Br J Surg 74:187-191, (March), 1987. One hundred centimeters of terminal ileum were successfully autografted in 18 of 24 dogs. Initially the graft was isolated with stomas at each end. Myoelectric activity was normal two days after transplantation, while transit time and contractility recovered within ten days. Mucosal morphology and absorption of most substances recovered by ten days, but oleic acid absorption was impaired for 4 weeks. In ten dogs the autograft was mobilized and normal intestinal continuity restored. Two to 3 months later all the nontransplanted small intestine was removed leaving only the autografted segment in continuity between the duodenum and the 2 cm of ileum proximal to the ileocecal valve. These dogs all survived until killed at 7 months. Their weight stabilized at 90% of preoperative levels. Diarrhea persisted for 3 to 4 weeks and then improved. Stools remained loose. The authors have demonstrated that animals can be adequately nourished with an autograft of 25% of their small intestine and suggest that segmental ileal allograft be investigated as a method of treating short bowel syndrome.--N.P. Madden Effects of Parenteral and Enteral Nutrition on Postnatal Development of the Small Intestine and Pancreas in the Rabbit. D.G. Gall,
M. Chung, E. V. O'Loughlin, et al. Biol Neonate 51:286-296, (May), 1987. Although total parenteral nutrition (TPN) is used frequently in young infants, little information is available regarding its effect on postnatal development of the gut. The effect of TPN and intragastric (IG) alimentation on ontogeny of the small intestine was examined in infant rabbits starting at ten to 12 days. Animals were killed at 17 to 19 days. Body weight, organ weight, and weight of segments of proximal, mid, and distal small intestine were measured. Intestinal mucosa was scraped, weighed, and homogenized for estimation of protein, DNA, and disaccharidases. Na + transport was examined in short-circuited jejunum. Weight gain was similar in controls, shamtreated, and TPN animals, but was significantly reduced in IG animals. TPN induced precocious development of sucrase and maltase activity and glucose-stimulated Na + transport, despite causing a significant decrease in mucosal weight and DNA and pancreatic amylase. IG alimentation also induced precocious development of sucrase, maltase, and glucose-stimulated Na § transport. Thus, TPN, despite producing mucosal atrophy and decreased pancreatic exocrine development, stimulates accelerated postnatal maturation of the small intestine.--Prem Puri Anoractal Physiology and Pathophysiology. W.E. Whitehead and
M.M. Schuster. Am J Gastroent 82:487-496, (June), 1987. This is a review of normal and abnormal anorectal physiology with particular emphasis on simple means of determining the functions of the various components of continence. Although the techniques
285
described are used in adults, the same principles can be applied to infants and children in evaluating incontinence and/or results from various pull-through procedures. The authors describe evaluating the external and internal anal sphincters by recording EMGs, or recording pressures with a perfused catheter or balloon probe. They also illustrate and describe the value of a proctogram.--Richard R. Ricketts Anorectal Malformations. Multicenter Study: 2503 Cases. P.
Vaysse and S. Yazbeck. Chir P&tiatr 27:250-273, (Decmeber), 1986. The 1986 French Symposium was dedicated to anorectal malformations. A total of 2,503 patients were analysed over a t6-year period (1970 to 1986). Overall continence was 46% in high malformations (HM), 67% in intermediate malformations (IM), and 76% in low malformations (LM). Acquisition of continence before 5 years was reported in 35% of the HM, 80% in IM, and 87% in LM. There was no significant variation between male and female except when IM and HM were evaluated together. Here, continence was better in the female group. Study of operative technique and relation to continence showed a better prognosis when rectum rather than colon was used and when a perineal approach was performed. Mortality was higher with a neonatal correction. Continence and cosmetic appearance seemed better when the surgical procedure was performed in the first 2 to 3 months of life. It is, however, difficult to evaluate the conclusions of such an extensive series from so many different centers.--Jean-Michel Guys Surgical procedure for High Imperforate Anus. P. Mollard, D.
Louis, T. Basset, et al. Chir P~diatr 27:277-281, (December), 1986. The essentials of the MoUard technique involve an abdominoperineal procedure with the patient in the lithotomy position. A rectangular anterior perineal incision is made approximately 1 and 2 cm lateral to the site of the new anus. This flap is reflected posteriorly and the dissection conducted upward along the bulbous and membranous urethera. All muscle fibers are gently retracted laterally and posteriorly as described in the first report (1978). The new aspect is the designing of a neoanus by tubularization of the cutaneous flap passed through the external sphincter and anastomosed to the bowel. Complications in 56 patients include anal stenosis (5), postoperative occlusions (4), distal necrosis of the colic pull-through (2), and urinary complications (7). A ten-year minimum follow-up was done in 25 patients. Three intermediate types are normally continent. Sixteen have good results with a normal social life. Five patients have occasional soiling. One is totally incontinent. The authors focus on the perineat approach, the creation of an anal canal with the cutaneous flap, and surgical correction at about 2 months of age.--Jean-Michel Guys Neonatal Surgical Treatment of High Anorectal Malformations W i t h o u t Diversion. D. Pellerin, C.N. Fekete, and T. Yandza. Chir P6diatr 27:274-276, (December), 1986.
In a series of 118 patients with high anorectal malformations over a 30-year period, 84 (77 boys, seven girls) were treated in the neonatal period without colostomy. Mean weight was 3,080 kg. In 63 patients a pull-through using Romualdi's technique was performed. Two patients were operated on using Stephen's approach. This series is taken from 740 children operated on from 1952 to 1982. The ages of these patients at operation are not given, nor the reason why only the late results of 84 are analyzed. Mortality was 27% (23 cases) before 1974. None have died since. Twenty-four patients presented postoperative complications: necrosis of the colic pull-through (2), recurrent rectourinary fistulae (5), colic perforations (2), urethral stenosis (4), and urethral diverticula (3). Mean follow-up is 12.7
nutrition. The accumulation of arrested metaphases over a two-hour period was determined in a dose-response study. Increasing doses of URO-EGF progressively raised the two-hour collection of metaphases and intestinal weights. Intravenous infusion of URO-EGF was also effective in restoring cell proliferation when it was infused after the intestine had become hypoproliferative. URO-EGF administered through an intragastric cannula thrice daily had no significant effect on intestinal weight or crypt cell production rate or metaphase collection. It is proposed that one of the in vivo actions of URO-EGF is the maintenance of gastrointestinal growth and that this occurs through a systemic rather than a luminal mechanism.-Prem Puri Absorptive and Motor Function of Orthotopically Vascularized Segmental Ileal Autografts. A.R. Dennison, J. Collins, R.M. Wat-
kins, et al. Br J Surg 74:187-191, (March), 1987. One hundred centimeters of terminal ileum were successfully autografted in 18 of 24 dogs. Initially the graft was isolated with stomas at each end. Myoelectric activity was normal two days after transplantation, while transit time and contractility recovered within ten days. Mucosal morphology and absorption of most substances recovered by ten days, but oleic acid absorption was impaired for 4 weeks. In ten dogs the autograft was mobilized and normal intestinal continuity restored. Two to 3 months later all the nontransplanted small intestine was removed leaving only the autografted segment in continuity between the duodenum and the 2 cm of ileum proximal to the ileocecal valve. These dogs all survived until killed at 7 months. Their weight stabilized at 90% of preoperative levels. Diarrhea persisted for 3 to 4 weeks and then improved. Stools remained loose. The authors have demonstrated that animals can be adequately nourished with an autograft of 25% of their small intestine and suggest that segmental ileal allograft be investigated as a method of treating short bowel syndrome.--N.P. Madden Effects of Parenteral and Enteral Nutrition on Postnatal Development of the Small Intestine and Pancreas in the Rabbit. D.G. Gall,
M. Chung, E. V. O'Loughlin, et al. Biol Neonate 51:286-296, (May), 1987. Although total parenteral nutrition (TPN) is used frequently in young infants, little information is available regarding its effect on postnatal development of the gut. The effect of TPN and intragastric (IG) alimentation on ontogeny of the small intestine was examined in infant rabbits starting at ten to 12 days. Animals were killed at 17 to 19 days. Body weight, organ weight, and weight of segments of proximal, mid, and distal small intestine were measured. Intestinal mucosa was scraped, weighed, and homogenized for estimation of protein, DNA, and disaccharidases. Na + transport was examined in short-circuited jejunum. Weight gain was similar in controls, shamtreated, and TPN animals, but was significantly reduced in IG animals. TPN induced precocious development of sucrase and maltase activity and glucose-stimulated Na + transport, despite causing a significant decrease in mucosal weight and DNA and pancreatic amylase. IG alimentation also induced precocious development of sucrase, maltase, and glucose-stimulated Na § transport. Thus, TPN, despite producing mucosal atrophy and decreased pancreatic exocrine development, stimulates accelerated postnatal maturation of the small intestine.--Prem Puri Anoractal Physiology and Pathophysiology. W.E. Whitehead and
M.M. Schuster. Am J Gastroent 82:487-496, (June), 1987. This is a review of normal and abnormal anorectal physiology with particular emphasis on simple means of determining the functions of the various components of continence. Although the techniques
285
described are used in adults, the same principles can be applied to infants and children in evaluating incontinence and/or results from various pull-through procedures. The authors describe evaluating the external and internal anal sphincters by recording EMGs, or recording pressures with a perfused catheter or balloon probe. They also illustrate and describe the value of a proctogram.--Richard R. Ricketts Anorectal Malformations. Multicenter Study: 2503 Cases. P.
Vaysse and S. Yazbeck. Chir P&tiatr 27:250-273, (Decmeber), 1986. The 1986 French Symposium was dedicated to anorectal malformations. A total of 2,503 patients were analysed over a t6-year period (1970 to 1986). Overall continence was 46% in high malformations (HM), 67% in intermediate malformations (IM), and 76% in low malformations (LM). Acquisition of continence before 5 years was reported in 35% of the HM, 80% in IM, and 87% in LM. There was no significant variation between male and female except when IM and HM were evaluated together. Here, continence was better in the female group. Study of operative technique and relation to continence showed a better prognosis when rectum rather than colon was used and when a perineal approach was performed. Mortality was higher with a neonatal correction. Continence and cosmetic appearance seemed better when the surgical procedure was performed in the first 2 to 3 months of life. It is, however, difficult to evaluate the conclusions of such an extensive series from so many different centers.--Jean-Michel Guys Surgical procedure for High Imperforate Anus. P. Mollard, D.
Louis, T. Basset, et al. Chir P~diatr 27:277-281, (December), 1986. The essentials of the MoUard technique involve an abdominoperineal procedure with the patient in the lithotomy position. A rectangular anterior perineal incision is made approximately 1 and 2 cm lateral to the site of the new anus. This flap is reflected posteriorly and the dissection conducted upward along the bulbous and membranous urethera. All muscle fibers are gently retracted laterally and posteriorly as described in the first report (1978). The new aspect is the designing of a neoanus by tubularization of the cutaneous flap passed through the external sphincter and anastomosed to the bowel. Complications in 56 patients include anal stenosis (5), postoperative occlusions (4), distal necrosis of the colic pull-through (2), and urinary complications (7). A ten-year minimum follow-up was done in 25 patients. Three intermediate types are normally continent. Sixteen have good results with a normal social life. Five patients have occasional soiling. One is totally incontinent. The authors focus on the perineat approach, the creation of an anal canal with the cutaneous flap, and surgical correction at about 2 months of age.--Jean-Michel Guys Neonatal Surgical Treatment of High Anorectal Malformations W i t h o u t Diversion. D. Pellerin, C.N. Fekete, and T. Yandza. Chir P6diatr 27:274-276, (December), 1986.
In a series of 118 patients with high anorectal malformations over a 30-year period, 84 (77 boys, seven girls) were treated in the neonatal period without colostomy. Mean weight was 3,080 kg. In 63 patients a pull-through using Romualdi's technique was performed. Two patients were operated on using Stephen's approach. This series is taken from 740 children operated on from 1952 to 1982. The ages of these patients at operation are not given, nor the reason why only the late results of 84 are analyzed. Mortality was 27% (23 cases) before 1974. None have died since. Twenty-four patients presented postoperative complications: necrosis of the colic pull-through (2), recurrent rectourinary fistulae (5), colic perforations (2), urethral stenosis (4), and urethral diverticula (3). Mean follow-up is 12.7