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Gallbladder contractility in neonates: Effects of parenteral and enteral feeding
996
hospitalization consisted of parenteral corticosteroids and parenteral alimentation in all patients, and topical enemas, intravenous antibiotics, intravenous albumin, and packed red blood cell transfusions as needed. The patients were categorized as having severe ulcerative colitis if they had toxic megacolon for any four of the following five criteria: (1) grossly bloody stools more than five times per day, (2) tachycardia, (3) anemia with a hemoglobin less than 75% of normal for age, (4) albumin 53.0 g/dL, and (5) oral temperature of lOOoF on the first hospital day. Only one patient required surgery during the initial hospitalization. Ninety-one percent of the patients (n = 10) treated with medical therapy and nutritional therapy for more than 14 days went into clinical remission. Only one of these patients ultimately required surgery, and 60% have remained in clinical remission for up to 83 months posthospitalization (mean follow-up period, 49.5 months), Thirty percent suffer from mild to moderate colitis. The results of this study do not support the recommendation of colectomy for refractive severe ulcerative colitis if remission is not noted within 2 weeks of hospitalization.-??&& R. Rick&& Antineutrophil Cytopiasmic Antibody Correlates With Chronic Pouchitis After lleal Pouch-Anal Anastomosis. WT. Sundbom, CJ. Landers, WV. Trernaine, et al. Am .I Gastroenterol 90:740-747, (May), 1995. Antineutrophil cytoplasmic antibodies with a perinuclear staining pattern (pANCA) are present in 45% to 86% of patients with ulcerative colitis. The presence of pANCA is unrelated to disease activity, extent of disease involvement, duration of ulcerative colitis, or previous proctocolectomy. Pouchitis after abdominal colectomy with ileal pouch-anal anastomosis can occur in two forms: (1) acute pouch&is (either a single event or intermittent treatmentresponsive events with pouchitis-free intervals not requiring suppressive therapy), or (2) chronic pouchitis (either a treatmentresponsive form that requires ongoing suppressive therapy or a treatment-resistant form that does not respond to medical therapy). The frequency of chronic pouchitis alone is approximately 5% (15% of all pouchitis). Pouchitis is strongly associated with the diagnosis of ulcerative colitis and is significantly less common in patients with pull-through procedures for familial polyposis. Four patient populations were studied: (I) pull-through for ulcerative colitis with chronic pouchitis (n = 19), (2) pull-through for ulcerative colitis without pouchitis (n = 18), (3) pull-through for familial polyposis without pouchitis (n = 5), and (4) Brooke ileostomy for ulcerative colitis (n = 10). The pANCA levels and titers for each of these patient populations was assessed. The frequency of pANCA in patients with chronic pouchitis (100%) was significantly greater than in patients with colitis without pouchitis (50%), or in patients with familial polyposis without pouchitis (O%), or in patients with colitis with an ileostomy (70%). The finding that pANCA occur more frequentIy in patients with chronic pouchitis raises the possibility that this antibody may mark a genetically distinct subset of ulcerative colitis patients. The authors suggest that further studies are needed to determine whether the presence of pANCA before pull-through for ulcerative colitis will be predictive for later development of chronic pouchitis.-&&urd R. Ricketts Rehbein’s Anterior Resection in Hirschsprung’s Disease, Using a Circular Stapler. i? Wester, 1 Hoehner, und L. Ozlen. Eur J Pediatr Surg 5:358-362, (December), 1995. The results of 30 patients with Hirschsprung’s disease, operated on by Rehbein’s anterior resection, are presented. In 26 children the anastomosis was established with a circular stapler, and in four it was handmade. When a stapler was used, technical problems necessitated reinforcing sutures in four patients. The level of
INTERNATIONAL
ABSTRACTS
anastomosis was significantly lower in the children in whom a stapler had been used. Early postoperative complications included the following: 3.3% mortality, 6.7% enterocolitis, 3.3% anastomotic leakage, 3.3% early ileus, and 10.0% wound infection. Three
patients required reoperation
because of postoperative
anasto-
motic stricture (10.0%). During follow-up, two children (7.4%) reported constipation with regular requirement for enemas, and two (7.4%) reported daily encopresis. In the authors’ opinion, the use of a stapler allows a lower anastomosis. Also, the anastomosis is wider and more elastic, and the technique is easier to perform.Thomas A. Angerpointner
ABDOMEN Gallbladder Contractility in Neonates: Effects of Parenteral and Enteral Feeding. G. Jawaheer, A. Pierro, D.A. Lloyd, et al. Arch Dis Child 72:F200-F202, (May), 1995. The size of the gallbladder was measured in 30 newborn infants, 18 of whom had been fed parenterally and 12 enterally. The gallbladder size was measured using real-time ultrasonography. The gallbladder was found to be significantly larger in parenterally fed infants than in enterally fed infants. In the latter, a 50% reduction in gallbladder volume was observed 15 minutes after starting a feeding. The study gives insight into the effects of intravenous feeding on biliary flow and function.-D.M Burge Choledochal Cysts: Lessons From a 20-Year Experience. M.D. Stringer, A. Dhawan, M. Davenpoi?, etal. Arch Dis Child 73:528-531, (December), 1995. The clinical features and outcome after surgery for 78 children with choledochal cysts referred to a supraregional center are presented. Six (8%) cases presented as an antenatally diagnosed ultrasound anomaly. The remaining 72 children presented postnatally with jaundice (60%) and/or abdominal pain owing to pancreatitis (18%). Rarer presentations included perforation (n = 4), abdominal distension caused by ascites, liver failure, variceal bleeding, and cholangitis. In approximately 20% of cases, symptoms had been present for more than 1 year before the correct diagnosis was established. Common reasons for the delay included misdiagnosis as hepatitis, noninvestigation of abdominal pain, and failure to interpret ultrasound anomalies. Sixty-nine (91%) of the 76 children with type I or IV cysts underwent radical extrahepatic cyst excision and hepaticojejunostomy, 10 after having had incomplete excisional surgery elsewhere. Five children had biliary bypass alone because cyst excision was believed to be dangerous, and one child had transplantation. One child died without surgical intervention of end-stage liver failure. There was one other postoperative death, again related to liver failure. In both cases, referral for definitive treatment had been markedly delayed. Early complications occurred in 12% after primary cyst excision. Although later follow-up was relatively short (mean, 4 years), biochemical liver function was normal in virtually all.-Mark Duvenpoti lntraperitoneal Sodium Carboxymethylcellulose tion Prevents Reformation of Peritoneal Adhesions Surgical Lysis. S.H. Wurster, V? Boner, A. Maybeny, Res 59:97-102, (July), 1995.
AdministraFollowing et al. J Surg
Sodium carboxymethylcellulose (SCMC) has been shown to prevent peritoneal adhesion formation in various mammalian species without evidence of toxicity. SCMC is a high-molecular-weight polysaccharide. The proposed mechanism of action by which SCMC prevents adhesion formation is the creation of a “flotation bath” that prevents direct contact of traumatized visceral surfaces during the critical period of mesothelial regeneration. This study evalu-
hospitalization consisted of parenteral corticosteroids and parenteral alimentation in all patients, and topical enemas, intravenous antibiotics, intravenous albumin, and packed red blood cell transfusions as needed. The patients were categorized as having severe ulcerative colitis if they had toxic megacolon for any four of the following five criteria: (1) grossly bloody stools more than five times per day, (2) tachycardia, (3) anemia with a hemoglobin less than 75% of normal for age, (4) albumin 53.0 g/dL, and (5) oral temperature of lOOoF on the first hospital day. Only one patient required surgery during the initial hospitalization. Ninety-one percent of the patients (n = 10) treated with medical therapy and nutritional therapy for more than 14 days went into clinical remission. Only one of these patients ultimately required surgery, and 60% have remained in clinical remission for up to 83 months posthospitalization (mean follow-up period, 49.5 months), Thirty percent suffer from mild to moderate colitis. The results of this study do not support the recommendation of colectomy for refractive severe ulcerative colitis if remission is not noted within 2 weeks of hospitalization.-??&& R. Rick&& Antineutrophil Cytopiasmic Antibody Correlates With Chronic Pouchitis After lleal Pouch-Anal Anastomosis. WT. Sundbom, CJ. Landers, WV. Trernaine, et al. Am .I Gastroenterol 90:740-747, (May), 1995. Antineutrophil cytoplasmic antibodies with a perinuclear staining pattern (pANCA) are present in 45% to 86% of patients with ulcerative colitis. The presence of pANCA is unrelated to disease activity, extent of disease involvement, duration of ulcerative colitis, or previous proctocolectomy. Pouchitis after abdominal colectomy with ileal pouch-anal anastomosis can occur in two forms: (1) acute pouch&is (either a single event or intermittent treatmentresponsive events with pouchitis-free intervals not requiring suppressive therapy), or (2) chronic pouchitis (either a treatmentresponsive form that requires ongoing suppressive therapy or a treatment-resistant form that does not respond to medical therapy). The frequency of chronic pouchitis alone is approximately 5% (15% of all pouchitis). Pouchitis is strongly associated with the diagnosis of ulcerative colitis and is significantly less common in patients with pull-through procedures for familial polyposis. Four patient populations were studied: (I) pull-through for ulcerative colitis with chronic pouchitis (n = 19), (2) pull-through for ulcerative colitis without pouchitis (n = 18), (3) pull-through for familial polyposis without pouchitis (n = 5), and (4) Brooke ileostomy for ulcerative colitis (n = 10). The pANCA levels and titers for each of these patient populations was assessed. The frequency of pANCA in patients with chronic pouchitis (100%) was significantly greater than in patients with colitis without pouchitis (50%), or in patients with familial polyposis without pouchitis (O%), or in patients with colitis with an ileostomy (70%). The finding that pANCA occur more frequentIy in patients with chronic pouchitis raises the possibility that this antibody may mark a genetically distinct subset of ulcerative colitis patients. The authors suggest that further studies are needed to determine whether the presence of pANCA before pull-through for ulcerative colitis will be predictive for later development of chronic pouchitis.-&&urd R. Ricketts Rehbein’s Anterior Resection in Hirschsprung’s Disease, Using a Circular Stapler. i? Wester, 1 Hoehner, und L. Ozlen. Eur J Pediatr Surg 5:358-362, (December), 1995. The results of 30 patients with Hirschsprung’s disease, operated on by Rehbein’s anterior resection, are presented. In 26 children the anastomosis was established with a circular stapler, and in four it was handmade. When a stapler was used, technical problems necessitated reinforcing sutures in four patients. The level of
INTERNATIONAL
ABSTRACTS
anastomosis was significantly lower in the children in whom a stapler had been used. Early postoperative complications included the following: 3.3% mortality, 6.7% enterocolitis, 3.3% anastomotic leakage, 3.3% early ileus, and 10.0% wound infection. Three
patients required reoperation
because of postoperative
anasto-
motic stricture (10.0%). During follow-up, two children (7.4%) reported constipation with regular requirement for enemas, and two (7.4%) reported daily encopresis. In the authors’ opinion, the use of a stapler allows a lower anastomosis. Also, the anastomosis is wider and more elastic, and the technique is easier to perform.Thomas A. Angerpointner
ABDOMEN Gallbladder Contractility in Neonates: Effects of Parenteral and Enteral Feeding. G. Jawaheer, A. Pierro, D.A. Lloyd, et al. Arch Dis Child 72:F200-F202, (May), 1995. The size of the gallbladder was measured in 30 newborn infants, 18 of whom had been fed parenterally and 12 enterally. The gallbladder size was measured using real-time ultrasonography. The gallbladder was found to be significantly larger in parenterally fed infants than in enterally fed infants. In the latter, a 50% reduction in gallbladder volume was observed 15 minutes after starting a feeding. The study gives insight into the effects of intravenous feeding on biliary flow and function.-D.M Burge Choledochal Cysts: Lessons From a 20-Year Experience. M.D. Stringer, A. Dhawan, M. Davenpoi?, etal. Arch Dis Child 73:528-531, (December), 1995. The clinical features and outcome after surgery for 78 children with choledochal cysts referred to a supraregional center are presented. Six (8%) cases presented as an antenatally diagnosed ultrasound anomaly. The remaining 72 children presented postnatally with jaundice (60%) and/or abdominal pain owing to pancreatitis (18%). Rarer presentations included perforation (n = 4), abdominal distension caused by ascites, liver failure, variceal bleeding, and cholangitis. In approximately 20% of cases, symptoms had been present for more than 1 year before the correct diagnosis was established. Common reasons for the delay included misdiagnosis as hepatitis, noninvestigation of abdominal pain, and failure to interpret ultrasound anomalies. Sixty-nine (91%) of the 76 children with type I or IV cysts underwent radical extrahepatic cyst excision and hepaticojejunostomy, 10 after having had incomplete excisional surgery elsewhere. Five children had biliary bypass alone because cyst excision was believed to be dangerous, and one child had transplantation. One child died without surgical intervention of end-stage liver failure. There was one other postoperative death, again related to liver failure. In both cases, referral for definitive treatment had been markedly delayed. Early complications occurred in 12% after primary cyst excision. Although later follow-up was relatively short (mean, 4 years), biochemical liver function was normal in virtually all.-Mark Duvenpoti lntraperitoneal Sodium Carboxymethylcellulose tion Prevents Reformation of Peritoneal Adhesions Surgical Lysis. S.H. Wurster, V? Boner, A. Maybeny, Res 59:97-102, (July), 1995.
AdministraFollowing et al. J Surg
Sodium carboxymethylcellulose (SCMC) has been shown to prevent peritoneal adhesion formation in various mammalian species without evidence of toxicity. SCMC is a high-molecular-weight polysaccharide. The proposed mechanism of action by which SCMC prevents adhesion formation is the creation of a “flotation bath” that prevents direct contact of traumatized visceral surfaces during the critical period of mesothelial regeneration. This study evalu-