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Effect of esophageal ligation on the development of fetal rabbit intestinal lactase
ABSTRACTS
573
FROM POSTER SESSIONS
Maltase
Lactase DW
21
Favored -
23
Runt
Favored
Runt
-
0.01 2 0.001
-
3.12 2 0.20*
2.36 -t0.60*
0.007 + 0.01
25
10.1 2 1.2*
6.61 2 0.74*t
8.16 IT1.3
6.94 2 1.49
27
15.2 zk1.7*
11.1 k 1.3"
4.1 + 1.5
3.57 * 0.91
29
24.9 * 2.2
21.2 + 2.4
7.6 t 0.23
7.1 + 0.45
31
28.2 _t2.0
23.3 r 2.9
8.7 f 0.91*
6.7 r 0.77'
*P < .05(ttest).
tP <
.05(ANOVA)
protein content. Results were analyzed by student’s unpaired t test and ANOVA and reported in UE/gram protein 2 SEM. Lactase activity appeared in the mid third trimester, peaking in the early neonatal period, with decline to adult levels. Of interest, activity was markedly increased in pregnant compared to nonpregnant adults (P < .Ol, ANOVA. t test). Maltase appeared in the early third trimester with a gradual rise to adult levels. Finally, sucrase remained at trace levels until the midneonatal period reaching adult levels at the time of weaning. Of note, lactase and maltase activity were consistently higher in the favored fetal rabbits compared to the runts demonstrating significance as listed in the table. Decreased neonatal levels remained, though not reaching statistical significance, until “catch-up” growth occurred at approximately 2 weeks of age. This report provides the first description of differential small intestinal disaccharidase development between normal and growth retarded fetuses in this naturally occurring model of IUGR. Effect of Esophageal Ligation on the Development of Fetal Rabbit Intestinal Lactase Terry L. Buchmiller, Jeffety Gregg, Francisco Rivera, Jared S. Diamond. Eric W. Fonkalsntd, UCLA School of Medicine, Los Angeles, CA To investigate the effect of normal fetal swallowing and the ingestion of amniotic fluid on the development of the small intestinal disaccharidases, 13 pregnant New Zealand White rabbits underwent operation on day 24 of a normal 31-day gestation. The right ovarian fetus in the bicornuate uterus underwent esophageal ligation (EL) while the contralateral left fetus underwent cervical exploration only, and served as the control (C). Rabbits were sacrificed on gestational day 31, somatic measurements obtained, and the midjejunum removed for determination of disaccharidase activity and protein content. There was one maternal death with 9 of 12 fetal pairs surviving (75%). Results are reported as mean 2 SE, analyzed by Student’s t test (2-tail) with P < .OSbeing considered significant. Fetal weight was decreased in EL (48.6 g t 2.7) versus C (51.42 g t 3.2) (P = .0651). Small intestinal length decreased in EL (49.2 cm 4 2.0) versus C (54.9 ? 1.1) (P = .0132). Midjejunal protein content (mg/mL homogenate) was also decreased slightly in EL (9.61 2 .85) versus C (11.5 ? .91) (P = .1404). Sucrase activity was not detectable in either group. Lactase activity in jejunal mucosa was not effected when expressed as units of enzyme per ml homogenate (EL = ,345 -t .031r C = .361 f ,038; P = .705) and units of enzyme per mg protein (EL = 3.75 2 .405 v C = 3.32 2 ,452; P = .4556). Previous studies have demonstrated the depressed somatic growth, small intestinal length, and decreased mucosal nutrient transport in rabbit fetuses after EL. The present study demonstrates that the brush border disaccharidase, lactase, develops independently of the normal fetal swallowing mechanism with the
concommitant ingestion of amniotic fluid. Implications for infants with intestinal atresias are under investigation. Endoscopic Variceal Ligation in Children F.M. Karrer, R.J. Hall, J.R. Lilly, G.V. Stiegmann, Department of Surgery, The Children’s Hospital, Universily of Colorado School of Medicine, Denver, CO
Contemporary therapy for variceal hemorrhage is by obliteration of varices with endosclerosis (ES) or more recently with endoscopic variceal ligation (EVL). Using an elastic band ligature device attached to a standard flexible endoscope, EVL results in mechanical strangulation of varices. This study assessed the effectiveness and safety of EVL in children. During a 5-year period, 77 EVL procedures were done in 18 consecutive patients with esophageal varices (10 had previous ES). Mean age at the start of therapy was 9.6 years (range 18 months to 19 years). Etiology of esophageal variceal hemorrhage was biliary atresia (9) portal vein thrombosis (7) cystic fibrosis (1) and chronic active hepatitis (1). Treatment was aimed at obliteration of varices in the distal 5 cm of esophagus and the interval between EVL sessions was gradually extended. Treatment was assessed by survival, incidence of rebleeding, subsequent status of esophageal varices and complications. Each patient had from 1 to 8 EVL sessions (mean, 4) and at each session 1 to 3 varices were banded. There were no deaths. Four children rebled in the interval between sessions. In 8 children, varices have been completely eradicated. Eight patients are still in treatment, and one had successful liver transplantation. Complications included: a single patient with cervical esophageal injury [early in the series from use of an “overtube” (no longer used)], and three patients with transient fevers. In conclusions: (1) EVL is effective in controllingvariceal hemorrhage in children; (2) the complication rate is low after modification of the adult technique; and (3) EVL is an acceptable alternative to ES and without its potential complications of esophageal stricture. motility disturbance, and gastroesophageal reflux. The Diaphragm in Acute Gastric Volvulus R.C. McIntyre, Jr. J.R. Lilly, R.J. Hall, F.M. Katrer. Department of Surgery, The ChildrenS Hospital, Unk~ersin, of Colorado School of Medicine, Denver, CO
Acute gastric volvulus (AGV) occurred in eight infants and one older child over the past 19 years, the largest single series from one institution. All nine patients had a left diaphragmatic anomaly. There were seven examples of eventration and single examples of giant hiatal hernia and Bochdalek hernia. Eight patients presented with vomiting and one with respiratory distress. AGV was mesenteroxial in seven patients and organoaxial in two. Treatment consisted of repair of the diaphragmatic anomaly and gastric fixation in seven patients, gastric fixation in one patient, and nonoperative management in one. The latter resulted in gastric necrosis and the only death in the series. In 77 previously reported cases, only 53% had an associated diaphragm anomaly. Gastric fixation was not performed in 55%. and four recurrences were reported. We conclude that (1) AGV should be suspected in any infant presenting with unexplained vomiting in association with a left diaphragm anomaly, and (2) gastric fixation should be routine adjunctive operative therapy. The Button Gastrostomy as a Primary Procedure Robert S. Sawin, David Tapper, Departments of Surgery, Children% Hospital & Medical Center and University of Washington, Seattle, WA
The gastrostomy button was developed as a replacement for an already established, matured gastrostomy. The convenience of the
573
FROM POSTER SESSIONS
Maltase
Lactase DW
21
Favored -
23
Runt
Favored
Runt
-
0.01 2 0.001
-
3.12 2 0.20*
2.36 -t0.60*
0.007 + 0.01
25
10.1 2 1.2*
6.61 2 0.74*t
8.16 IT1.3
6.94 2 1.49
27
15.2 zk1.7*
11.1 k 1.3"
4.1 + 1.5
3.57 * 0.91
29
24.9 * 2.2
21.2 + 2.4
7.6 t 0.23
7.1 + 0.45
31
28.2 _t2.0
23.3 r 2.9
8.7 f 0.91*
6.7 r 0.77'
*P < .05(ttest).
tP <
.05(ANOVA)
protein content. Results were analyzed by student’s unpaired t test and ANOVA and reported in UE/gram protein 2 SEM. Lactase activity appeared in the mid third trimester, peaking in the early neonatal period, with decline to adult levels. Of interest, activity was markedly increased in pregnant compared to nonpregnant adults (P < .Ol, ANOVA. t test). Maltase appeared in the early third trimester with a gradual rise to adult levels. Finally, sucrase remained at trace levels until the midneonatal period reaching adult levels at the time of weaning. Of note, lactase and maltase activity were consistently higher in the favored fetal rabbits compared to the runts demonstrating significance as listed in the table. Decreased neonatal levels remained, though not reaching statistical significance, until “catch-up” growth occurred at approximately 2 weeks of age. This report provides the first description of differential small intestinal disaccharidase development between normal and growth retarded fetuses in this naturally occurring model of IUGR. Effect of Esophageal Ligation on the Development of Fetal Rabbit Intestinal Lactase Terry L. Buchmiller, Jeffety Gregg, Francisco Rivera, Jared S. Diamond. Eric W. Fonkalsntd, UCLA School of Medicine, Los Angeles, CA To investigate the effect of normal fetal swallowing and the ingestion of amniotic fluid on the development of the small intestinal disaccharidases, 13 pregnant New Zealand White rabbits underwent operation on day 24 of a normal 31-day gestation. The right ovarian fetus in the bicornuate uterus underwent esophageal ligation (EL) while the contralateral left fetus underwent cervical exploration only, and served as the control (C). Rabbits were sacrificed on gestational day 31, somatic measurements obtained, and the midjejunum removed for determination of disaccharidase activity and protein content. There was one maternal death with 9 of 12 fetal pairs surviving (75%). Results are reported as mean 2 SE, analyzed by Student’s t test (2-tail) with P < .OSbeing considered significant. Fetal weight was decreased in EL (48.6 g t 2.7) versus C (51.42 g t 3.2) (P = .0651). Small intestinal length decreased in EL (49.2 cm 4 2.0) versus C (54.9 ? 1.1) (P = .0132). Midjejunal protein content (mg/mL homogenate) was also decreased slightly in EL (9.61 2 .85) versus C (11.5 ? .91) (P = .1404). Sucrase activity was not detectable in either group. Lactase activity in jejunal mucosa was not effected when expressed as units of enzyme per ml homogenate (EL = ,345 -t .031r C = .361 f ,038; P = .705) and units of enzyme per mg protein (EL = 3.75 2 .405 v C = 3.32 2 ,452; P = .4556). Previous studies have demonstrated the depressed somatic growth, small intestinal length, and decreased mucosal nutrient transport in rabbit fetuses after EL. The present study demonstrates that the brush border disaccharidase, lactase, develops independently of the normal fetal swallowing mechanism with the
concommitant ingestion of amniotic fluid. Implications for infants with intestinal atresias are under investigation. Endoscopic Variceal Ligation in Children F.M. Karrer, R.J. Hall, J.R. Lilly, G.V. Stiegmann, Department of Surgery, The Children’s Hospital, Universily of Colorado School of Medicine, Denver, CO
Contemporary therapy for variceal hemorrhage is by obliteration of varices with endosclerosis (ES) or more recently with endoscopic variceal ligation (EVL). Using an elastic band ligature device attached to a standard flexible endoscope, EVL results in mechanical strangulation of varices. This study assessed the effectiveness and safety of EVL in children. During a 5-year period, 77 EVL procedures were done in 18 consecutive patients with esophageal varices (10 had previous ES). Mean age at the start of therapy was 9.6 years (range 18 months to 19 years). Etiology of esophageal variceal hemorrhage was biliary atresia (9) portal vein thrombosis (7) cystic fibrosis (1) and chronic active hepatitis (1). Treatment was aimed at obliteration of varices in the distal 5 cm of esophagus and the interval between EVL sessions was gradually extended. Treatment was assessed by survival, incidence of rebleeding, subsequent status of esophageal varices and complications. Each patient had from 1 to 8 EVL sessions (mean, 4) and at each session 1 to 3 varices were banded. There were no deaths. Four children rebled in the interval between sessions. In 8 children, varices have been completely eradicated. Eight patients are still in treatment, and one had successful liver transplantation. Complications included: a single patient with cervical esophageal injury [early in the series from use of an “overtube” (no longer used)], and three patients with transient fevers. In conclusions: (1) EVL is effective in controllingvariceal hemorrhage in children; (2) the complication rate is low after modification of the adult technique; and (3) EVL is an acceptable alternative to ES and without its potential complications of esophageal stricture. motility disturbance, and gastroesophageal reflux. The Diaphragm in Acute Gastric Volvulus R.C. McIntyre, Jr. J.R. Lilly, R.J. Hall, F.M. Katrer. Department of Surgery, The ChildrenS Hospital, Unk~ersin, of Colorado School of Medicine, Denver, CO
Acute gastric volvulus (AGV) occurred in eight infants and one older child over the past 19 years, the largest single series from one institution. All nine patients had a left diaphragmatic anomaly. There were seven examples of eventration and single examples of giant hiatal hernia and Bochdalek hernia. Eight patients presented with vomiting and one with respiratory distress. AGV was mesenteroxial in seven patients and organoaxial in two. Treatment consisted of repair of the diaphragmatic anomaly and gastric fixation in seven patients, gastric fixation in one patient, and nonoperative management in one. The latter resulted in gastric necrosis and the only death in the series. In 77 previously reported cases, only 53% had an associated diaphragm anomaly. Gastric fixation was not performed in 55%. and four recurrences were reported. We conclude that (1) AGV should be suspected in any infant presenting with unexplained vomiting in association with a left diaphragm anomaly, and (2) gastric fixation should be routine adjunctive operative therapy. The Button Gastrostomy as a Primary Procedure Robert S. Sawin, David Tapper, Departments of Surgery, Children% Hospital & Medical Center and University of Washington, Seattle, WA
The gastrostomy button was developed as a replacement for an already established, matured gastrostomy. The convenience of the