Effects of herbal medicine Dai-Kenchu-to on anorectal function in children with severe constipation

AIM

We administered the herbal medicine Dai-Kenchu-To (DKT) to children with severe chronic constipation or with severe constipation after surgery for anorectal malformations. We then objectively assessed the effect of DKT on anorectal function by manometric study in addition to using a clinical scoring system.

PATIENTS AND METHODS

Ten children with severe chronic constipation and 5 children with severe constipation after surgery for anorectal malformations were assessed. These 15 children received 0.3 g/kg/day of DKT for periods ranging from 3 months to 1 year. We objectively assessed their bowel function, sphincter function and rectal reservoir function by anorectal manometry and clinical scoring.

RESULTS

In 10 children with severe chronic constipation, the clinical score after administration of DKT (7.2 +/- 0.8) improved significantly compared with that before administration of DKT (4.6 +/- 2.9) (p < 0.02). The threshold sensation volume and the maximum tolerable volume after administration of DKT significantly (p < 0.05; p < 0.01) decreased (128 +/- 63 ml vs. 69 +/- 18 ml; 229 +/- 99 ml vs. 144 +/- 47 ml), and rectal compliance after administration of DKT also significantly (p < 0.05) decreased (12.4 +/- 10.9 ml/cmH(2)O vs. 4.7 +/- 3.9 ml/cmH(2)O).

CONCLUSION

The present study demonstrated that DKT had a favorable clinical effect on severe constipation in children, and anorectal manometry showed an improvement in their rectal reservoir functions. It appears that the results were secondary to DKT-stimulated peristalsis of the intestine, which promoted regular bowel habits.

Morphology of the enteric nervous system in the hindgut of an infant with cloacal exstrophy

The authors describe the morphology of the enteric nervous system in the hindgut of an infant with cloacal exstrophy. Cloacal exstrophy was diagnosed at 32 weeks' gestation using prenatal ultrasonography. The baby was delivered at 34 weeks' gestation and underwent a separation of the cecum from bladder halves, reapproximation of hemibladders, closure of the omphalocele and pubic symphysis, and a distal colostomy. Intestinal wall specimens were obtained at colostomy from the distal end of the rudimentary hindgut. Serial frozen sections were prepared for histochemical acetylcholinesterase staining. Histological investigations demonstrated a strikingly crowded, immature enteric ganglia and prominent bundles of wandering cholinergic nerves. These findings suggest the unique pathology of the enteric nervous system development in cloacal exstrophy, in which the rudimentary hindgut behaves as a blind alley of the migratory pathway for neural crest-derived cells during embryogenesis. Histological examinations of the hindgut enteric nervous system in cloacal exstrophy may be beneficial for evaluating the postnatal development of the distal colon which might be utilized for a pull-through procedure.

A clinical analysis of prognostic parameters of survival in children with congenital diaphragmatic hernia

BACKGROUND

Congenital diaphragmatic hernia (CDH) still has a high mortality because of accompanying lung hypoplasia and persistent pulmonary hypertension. Although prognostic parameters based on perinatal measurements have been proposed, our ability to accurately predict the surgical results remains insufficient.

METHODS

We treated 55 infants with CDH from 1981 to 2004. Among them, 46 patients presented respiratory distress within the first 24 hours of life. Results of surgical treatment in the 46 infants were retrospectively correlated with gender, birth weight, gestational age at diagnosis, laterality, cardiac anomalies, diaphragmatic defect area, contents of herniated viscera, and the great vessel diameters measured by echocardiography.

RESULTS

Out of 46 CDH neonates, 27 (58.7 %) survived and 19 (41.3 %) died aged 3 to 17 days. Non survivors had a significantly larger diaphragmatic defect and more frequent liver herniation. Out of possible predictive parameters studied, an index of the main pulmonary artery (cross-sectional area/diaphragmatic defect area ratio) most closely correlated with the surgical outcomes.

CONCLUSIONS

The postoperative prognosis of CDH infants does not depend only on pulmonary hypoplasia, but also on other factors including the magnitude of abdominal visceral herniation. In this series of patients, the most reliable prognostic predictor was a clinical index reflecting the degree of both pulmonary hypoplasia and diaphragmatic maldevelopment.

A bleeding tendency as the first symptom of a choledochal cyst

We report an 8-month-old male presenting with gingival hemorrhages and nasal bleeding as the first symptom of a choledochal cyst (CC). On physical examination, there was a large cystic mass in the right upper abdominal quadrant. Laboratory studies on admission revealed moderate liver dysfunction and a bleeding tendency due to vitamin K deficiency. After administration of 5 mg vitamin K the bleeding tendency disappeared. At laparotomy, a large CC 5 cm in diameter was found and the liver showed moderate cholestasis. The sudden onset of a bleeding tendency in infants with congenital liver or biliary-tract disease may suggest not only biliary atresia, but also CC.

Evaluation of the effect of soybean milk and soybean milk peptide on bone metabolism in the rat model with ovariectomized osteoporosis

We have reported that soybean milk is an excellent source for increasing bone mineral density (BMD) and mechanical bone strength. However, it is not known what kind of components in soybean milk affect bone metabolism. Consequently, the purpose of this study is to find the effective components in soybean milk on bone metabolism. It might be some peptide in soybean milk. Therefore, in this study the soybean milk was separated into two different preparations according to molecular weight: a high-molecular-weight soybean milk, and a low-molecular-weight soybean milk. Then, the effect of the peptides in soybean milk on bone metabolism was examined. After producing the experimental osteoporotic model rats, they were divided into four groups. The BMD and the mechanical bone strength of the three experimental groups, whose diet contained a soybean milk, a high-molecular soybean milk, or a low-molecular soybean milk (soybean milk peptide) were significantly higher than those of the control group. Moreover, the intestinal Ca absorption for the three experimental groups was significantly increased. From these results, the peptides in the soybean milk are effective for the acceleration of the intestinal Ca absorption. It is possible to assume that the mechanism for increasing the BMD and the mechanical strength in the three experimental groups was due to increasing the intestinal Ca absorption by alimenting the soybean milk, the high-molecular soybean milk or the low-molecular soybean milk.

Sequence determination of unknown cyclic peptide antibiotics by fast atom bombardment mass spectrometry

The primary structures of unknown cyclic peptides produced by a Bacillus strain have been determined by fast atom bombardment (FAB) mass spectrometry, which has established the peptides as a new family of the iturin group antibiotics. FAB mass spectra of the intact peptides gave the immonium ions characteristic of constituent amino acids which made it possible to distinguish Asn from Asp and Glu from Gln. Collision-induced dissociation (CID) spectra of protonated molecules provided complete information on the connectivity of amino acid residues but did not reveal the direction of peptide bonding, while those obtained for fragment ions allowed us to make a discrimination between the correct sequence and its retro sequence. The amino acid sequences derived are c(Thr-Xaa-Asn-Tyr-Asn-Ser-Glu-Ser) (Xaa: C14 or C15 beta-amino acid) which are closely related to that of bacillomycin L. The structure is confirmed by the FAB mass spectra of the partial acid hydrolysate and the peptide mixture obtained from its single-step Edman degradation. Fragmentation processes involved in the CID spectra of the cyclic peptides are discussed based on the established amino acid sequence.

Heat-shock proteins and nucleolar hypertrophy in the liver of rat infused with methionine-free total parenteral nutrition

Infusing a methionine-free solution into rats for 7 days resulted in a marked enlargement of liver nucleoli. By the analysis of two-dimensional gel electrophoresis, a spot 'a' (76 kDa, pI 5.3) stained with Coomassie blue was observed to accumulate highly in liver cytosol from rat infused with methionine-free solution. Metabolically labeling experiments with [35S]methionine showed that 'a' was more heavily labeled in primary hepatocytes of rats infused with methionine-free solution than in those of control rat. To ascertain whether 'a' is one of stress proteins, primary hepatocyte cultures were incubated at 42 degrees C for 2 h. 'a' (76 kDa, pI 5.3) was slightly induced in control hepatocytes but not appreciably in hepatocytes from the treated rat. In contrast, two other spots 'b' (74 kDa, pI 5.6) and 'c' (74 kDa, pI 5.3) were highly induced at 42 degrees C in hepatocytes from control and treated rats. The antibody against the consensus sequence peptide of hsp70 family reacted with 'a' (76 kDa, pI 5.3) as well as 'b' and 'c'. Immunoblot analysis revealed that 'a' accumulates highly in hepatocytes of treated rats. These results indicate that infusion of methionine-free solution into rats induces one member of the hsp70 family in hepatocytes.

Alteration in the ribonucleic acids in rat liver induced by a methionine-free total parenteral nutrition solution

The effect of infusion of a methionine-free total parenteral nutrition solution for 7 d on ribonucleic acids in liver of rats were investigated. The control solution contained leucine, valine, isoleucine, lysine, phenylalanine, threonine, tryptophan, arginine, histidine, glycine, methionine, glucose and vitamins and minerals. Deprivation of a methionine is known to increase the activity of RNA polymerase I. Infusing the methionine-free solution resulted in the accumulation of RNA molecules larger than 28S in the liver nuclei and resulted in a higher rate of rRNA synthesis than in rats infused with the control solution. A methionine deficiency did not impede either the processing of 45S pre-rRNA or transport of 28S and 18S rRNA into cytoplasm. When rats were infused with the methionine-free solution for 7 d followed by the control solution for 2 d, the level of RNA in the nucleus as well as the rate of RNA polymerase I were similar to the levels in rats receiving the control solution for 9 d. There were no significant changes in the rate of DNA synthesis due to nutritional manipulations.