Clinical and manometric evaluation of anorectal function following low anterior resection with low anastomotic line using an EEA stapler for rectal cancer

Anorectal function was evaluated in eight patients who had low anterior resection of the rectum with a low anastomotic line, using an EEA stapler, with determination of function based on periodic manometric studies and clinical symptoms. Immediately following surgery all patients suffered from frequent bowel actions and soiling. These symptoms improved with time and most patients could enjoy almost normal daily life by the sixth postoperative month. One month after surgery, anal canal resting pressure and maximum squeeze pressure were significantly reduced and rectoanal inhibitory reflex was absent; neither showed a distinct tendency to improve thereafter. Rectal sensation and reservoir capacity, which also were seriously impaired, recovered satisfactorily by the time of the six-month examination. This suggests that an improvement of clinical symptoms following this operation is dependent upon the recovery of reservoir capacity and sensation of the neorectum, and that this operative procedure is a functionally acceptable option for low rectal cancer.

Regional difference in intestinal adaptation after total colectomy as judged by the changes of mucosal Na-K ATPase, cyclic AMP, and transmural potential difference

Intestinal adaptation and its regional difference after total colectomy were investigated in dogs by measuring mucosal Na-K ATPase, cyclic AMP, and transmural electric potential difference (PD). Twenty-four weeks after the total proctocolectomy, Na-K ATPase activity and PD increased significantly in all intestinal sites, whereas cyclic AMP showed no significant changes. The regional difference in the remaining intestine was examined in the jejunum, ileum, and interposed jejunum (neorectum). Na-K ATPase activity showed no significant regional difference, but the largest increase was found to occur in the ileum. PD also increased markedly in the ileum and there was significant difference between the ileum and other intestinal sites. These facts suggest that the increased active ion transport mediated by mucosal Na-K ATPase and transmural PD in the ileum is closely related to the intestinal adaptation occurring after total colectomy and indicates a greater potential of the ileum for adaptive compensation than either jejunum or neorectum.

Mobility of the cervical spine after anterior interbody fusion for spondylotic myelopathy-a radiographic study

To study the influence of anterior body fusion on the adjacent vertebral discs, the radiographs of 101 patients with cervical spondylotic myelopathy (CSM) were analysed, and cervical mobility and intersegmental mobility were determined. Single level fusions were carried out in 29 patients, double level fusions in 45 patients and triple level fusions in 27 patients. Cervical mobility after surgery was inversely proportional to the number of fused discs. Angles were reduced by fusion in proportion to the number of fused discs. The compensatory increase in motion at the disc adjacent to the fusion was slight, and the number of fused discs had little influence on the compensatory increase in motion. Regarding cervical motion, extension and flexion were limited to the same extent in single level fusions, flexion was more limited in double level fusions and limitation of extension was much larger in triple level fusions. Seven patients underwent a second operation after a double level fusion, and one patient underwent a second operation after a single level fusion. In all five patients whose radiographs before the second operation were available, flexion was adequately limited, but extension was not limited at all. These results suggest that the failure to limit extension is responsible for the recurrence of CSM.

A possible role for calmodulin in Ca2+-induced swelling of mitochondria

Ca2+-induced mitochondrial swelling was inhibited by a low concentration of calmodulin antagonists. Two affinities of Ca2+ to mitochondrial swelling were observed: high (2-5 microM) and low (more than 100 microM) systems. The high-affinity change was inhibited by micromolar level of trifluoperazine and W-7, but not by W-5. The possible mechanism of this inhibition and the role of CaM in mitochondria are discussed.

No evidence for gamma-interferon mediated haematopoietic inhibition by T cells in aplastic anaemia: an observation in the course of immunosuppressive therapy

Two patients with aplastic anaemia were treated with immunosuppressive agents and peripheral blood T cells were cryopreserved serially. Inhibitory activity of T cells to autologous CFU-E, gamma-IFN production by T cells and T cell subpopulations were assayed after remission. Inhibitory activity to autologous CFU-E was not correlated with the numbers or ratios of T cell subpopulations. gamma-IFN production by T cells were within the normal range when inhibitory activity was found. In addition, gamma-IFN production increased after haematopoietic recovery. These findings suggest that gamma-IFN is not a soluble mediator of T cell-mediated haematopoietic inhibition in aplastic anaemia.

Intravenous gammaglobulin therapy for thromboneutropenic neonates of mothers with systemic lupus erythematosus

i.v. IgG therapy was used to treat thromboneutropenia in 2 male neonates of mothers with SLE. The mothers of both neonates were thrombocytopenic but not neutropenic during the last 3 months of their pregnancies. Anti-platelet and anti-neutrophil IgG directed against platelets and neutrophils from the neonates were detected in the sera of both mothers. The platelet and neutrophil counts increased significantly with i.v. IgG therapy in both neonates. i.v. IgG therapy is a safe and effective regimen for passive immune thromboneutropenia.

Simultaneous transient erythroblastopenia and agranulocytosis: IgG-mediated inhibition of erythrogranulopoiesis

We report a case of simultaneous transient erythroblastopenia and agranulocytosis recovering spontaneously. In vitro study using autologous bone marrow cells after recovery demonstrated IgG-mediated inhibition of both erythropoiesis and granulopoiesis but not megakaryopoiesis. The inhibitory activity disappeared shortly after remission. These findings suggest that IgG-mediated inhibition of hematopoiesis may be pathogenetic for transient bone marrow failure of the patient.

[A case of posttraumatic vascular abnormality similar to dural arteriovenous malformation]

A case of posttraumatic vascular abnormality similar to dural arteriovenous malformation is reported. A 21-year-old man was injured in the traffic accident and admitted to our hospital with comatose state. Bilateral carotid angiograms revealed no abnormal findings. Then, he was treated conservatively as a diagnosis of cerebral contusion. Nine years after the initial admission, he was fallen into comatose state suddenly and admitted to a local hospital. On the next day, he was transferred to our hospital. Neurological examination disclosed comatose state, right oculomotor palsy, and left hemiparesis. CT scan showed a crescent shaped high density area in the right subdural space, right temporal intracerebral high density area, and left frontal low density area, suggesting right acute subdural hematoma, right temporal intracerebral hematoma, and left frontal old cerebral contusion respectively. Right carotid angiogram revealed an abnormal vascularity in the right middle fossa, which was fed by the middle meningeal artery and drained into the superior sagittal sinus and the transverse sinus. Surgical treatment was performed immediately. Following the evacuation of intracerebral hematoma, the abnormal vascular mass suggesting a nidus of arteriovenous malformation was removed totally, that was attached to the dura mater. Pathological specimen showed large veins and arteries with thrombus, however, no characteristic feature of arteriovenous malformation. Then, this was thought to be an arteriovenous fistula between the branches of middle meningeal artery and the veins of fibroglial scar following by the cerebral contusion.(ABSTRACT TRUNCATED AT 250 WORDS)

[Familial occurrence of intracerebral cavernous angioma]

A case of familial occurrence of intracerebral cavernous angioma is reported. The patients were a mother and her eldest son, a 48-year-old woman and a 28-year-old man, respectively. The mother, a hypovascular mass in the right frontal lobe was excised surgically, and in the son a well demarcated mass in the left temporal lobe was extirpated. Pathological examination in each case revealed cavernous angioma. Familial occurrence of intracerebral cavernous angioma is extremely rare. In the literature, 8 cases of familial occurrence have been reported, including our case, and in three out of the 8 cases the lesions were histologically confirmed. To our knowledge, this is the first case in Japan in which the diagnosis was established by surgical specimen. Of 17 cases in 8 family lines, multiple occurrence was observed in 7 cases. The clinical manifestations of the disease appear mostly in a form of adult epilepsy or intracerebral hematoma, and rarely sudden death associated with intracerebral hematoma. At present, CT scanning is widely used for diagnosis of the disease, and the lesions are surgically curable if they are located at the accessible sites. Although there has been no evidence of genetic basis, it is interesting that there is familial occurrence. From this point of view, we should carefully check the family tree of such patients.

Anorectal function after high sacrectomy with bilateral resection of S2-S5 nerves. Report of a case

A 19-year-old man underwent resection at the S1-S2 interspace with sacrifice of bilateral sacral nerves below S2 for a sacral tumor. The postoperative anorectal function was evaluated periodically for one year using manometry and subjective findings. The rectoanal inhibitory reflex was intact, whereas a disturbance of anorectal sensation, a loss of anal squeeze pressure, a decrease of anal canal resting pressure, urinary incontinence, and impotency were apparent. These findings suggest that sacrifice of bilateral sacral nerves below S2 leads to a feeble anal canal basal tone with the rectoanal inhibitory reflex, and that a significant impairment of anorectal function is inevitable.

Ileal adenomas in familial polyposis coli. Differences before and after colectomy

We treated two patients with familial polyposis coli (FPC) who were found to have multiple adenomas in the ileostomy stoma, five and seven years after colectomy, respectively. These adenomas were dense and 3 to 10 mm in diameter. The adjacent ileal mucosa showed a colonic metaplasia. Ileal adenomas detected using intraoperative intestinal endoscopy at the time of colectomy were less than 2 mm in diameter and sparse in density. These findings suggest that ileal adenomas occurring after colectomy for FPC tend to increase in size and number and to resemble colonic adenomas.