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To determine whether dilated bowel proximal to obstruction associated with duodenal atresia and stenosis is related to feeding problems after a surgical correction of obstruction, the authors reviewed retrospectively the degree of bowel dilatation and disturbed transit as well as other clinical features in 18 duodenal atresia and 12 duodenal stenosis patients. A multivariate analysis was conducted to determine the possible correlation among them. The authors also evaluated the physiological function of the dilated bowel in duodenal atresia and stenosis patients (n = 8) by manometry of dilated bowel. The results were as follows. (1) In multivariate analysis, using the degree of disturbed transit as a dependent variable and using other clinical features as independent variables, the presence of postoperative complication and the existence of bowel dilatation 2 weeks after the operation were risk factors for disturbed transit. (2) One or two episodes of phase 3 were found in six of eight measured patients during the recorded period. The most distinctive manometric finding was the low contraction amplitude of both phase 2 and phase 3. These results indicate that dilated bowel was related to disturbed transit during the postoperative period, and that the low contraction amplitude of the dilated bowel was the main pathophysiological feature. The tapering or plication of dilated bowel might be indicated in patients with a markedly dilated bowel.

We report an 11-year-old girl with acute disseminated encephalomyelitis (ADEM) who developed respiratory failure and coma despite the use of corticosteroid and intravenous immunoglobulin. We performed plasmapheresis four times, which improved her level of consciousness, hyperesthesia, external ophthalmoplegia and muscle weakness, and led to the normalization of brain and spinal cord MRI. Plasmapheresis might be an effective treatment in cases of fulminant ADEM.

To investigate the role of corticosteroids in the initial treatment of Kawasaki disease (KD).Between September 2000 and March 2005, we randomly assigned 178 KD patients from 12 hospitals to either an intravenous immunoglobulin (IVIG) group (n = 88; 1 g/kg for 2 consecutive days) or an IVIG plus corticosteroid (IVIG+PSL) group (n = 90). The primary endpoint was coronary artery abnormality (CAA) before a 1-month echocardiographic assessment. Secondary endpoints included duration of fever, time to normalization of serum C-reactive protein (CRP), and initial treatment failure requiring additional therapy. Analyses were based on intention to treat.Baseline characteristics of groups were similar. Fewer IVIG+PSL patients than IVIG patients had a CAA before 1 month (2.2% vs 11.4%; P = .017). The duration of fever was shorter (P.001) and CRP decreased more rapidly in the IVIG+PSL group than in the IVIG group (P = .001). Moreover, initial treatment failure was less frequent (5.6% vs 18.2%; P = .010) in the IVIG+PSL group. All patients assigned to the IVIG+PSL group completed treatment without major side effects.A combination of corticosteroids and IVIG improved clinical course and coronary artery outcome without causing untoward effects in children with acute KD.

A girl born after 36 weeks' gestation had emesis 15 hours after birth. She required total parenteral nutrition (TPN) because of persistent gastric retention. When milk was given, the volume of gastric aspirate 3 hours after feeding often was greater than the volume given. Domperidon and erythromycin were ineffective. Upper gastrointestinal series showed slow gastric emptying but no abnormalities in the stomach. No stenosis or obstruction below pylorus was found. Endoscopy showed normal gastric mucosa. Manometry showed normal antroduodenal motility patterns. Transpyloric feeding, which started at age 73 days, was successful and enabled cessation of the TPN. Laparotomy at 119 days of age showed partial absence of the muscle and serosal layer in the anterior wall of the gastric body (1 x 4 cm). The mucosal layer was intact and partly adhered to the peritoneum and the left lobe of the liver. The defect was surgically corrected by plicating the place. The postoperative course was excellent, and oral feeding was fully established within 2 weeks. Although the cause of the partial muscle defect in the case is unclear, this case suggests that this rare condition can cause severe chronic gastric retention.

We investigated the possible involvement of the upper alimentary tract in vincristine (VCR)- induced dysmotility. Gastric contractions were recorded by a strain-gauge force transducer in conscious rats. Rats were injected with various doses of VCR followed by continuous recording for 12 hr. Additionally, 3-hr recordings to study the later effects were performed one and three days after injection. Gastric motility was dose-dependently increased by VCR. Post- versus preinjection motility index (MI; area under contraction waves) ratios were 0.78 ± 0.12 for saline and 1.95 ± 0.21 for VCR at 0.75 mg/kg. This increase in MI was completely inhibited by atropine and hexamethonium. MI one day after injection of VCR (0.75 mg/kg) was significantly less than in control (0.32 ± 0.10 vs 0.92 ± 0.24, respectively). The decrease was reversed by acetylcholine. In conclusion, VCR first increased gastric motility, and this was followed by a gradual decrease in conscious rats. These alterations may involve a presynaptic cholinergic pathway.

Background: WslWs rat (Ws) has a mutation at the c-kit gene which has a critical role in the development of interstitial cells of Cajal (ICC). In the gastrointestinal tract of Ws ICCs are either absent or markedly reduced. In vitro studies using intestinal muscle strips showed that regularity of contractions is severely impaired in Ws. Interestingly, however, Ws rats can live and be fertile, while the WlWv mouse with a mutation at the c-kit gene can not survive. In the present study we recorded gastrointestinal mechanical contractions in vivo in Ws and control (wild type: (+1+» rats. Methods: Ws (8weeks old, approximately 250g, n=9) and control rats (Cont, n=8) were operated under nembuthal anesthesia. Miniature strain gauge force transducers developed specifically for in vivo rat motility studieswere sutured onto the serosal side of the gastric antrum and jejunum (5cmto 8cm distal to pylorus). In order to confirm the migration of intestinal phase 3s, two transducers were attached in proximal jejunum 5 em apart in Ws (n=2) and Cont (n=3). After 4 to 7 days recovery period and 24-36 h fasting, lead wires of transducers were connected to transducers and contractions were recorded in computer through an amplifier and an AID converter. Rats were free of any body restrictions. Results: (I) In Ws sporadic or short c1usters( 1 min) clusters of rhythmic contractions were the dominant pattern in Cont. Migration of those gastric clusters to the duodenum were not clearly observed. (2) In the duodenum and jejunum, MMC patterns were present in 4 out of II Ws and in 6 out of II Cont. The mean duration, interval, and frequency of contractions of phase 3 were 2.3+/-0.6 min, 28.7+1-8.7 min, 29.5+1-2.0 min'! and 4.5+1-0.9 min, 12.3+1-1.6 min, 34.3+1-2.2 min'! in Ws and Cont, respectively. (3) In phase 2 of small intestine, clusters of contractions with various length were the dominant contraction pattern in borh Ws and Cont. (4) Feeding immediately changes motility patterns both in Ws and in Cont. Conclusion: Unlike normal rats, clusters of rhythmic contractions are rare in the stomach of Ws. Although phase 3-like clustered contractions were present in the small intestine in Ws, they are quantitatively different from those in Cont.

Background: Developmental changes occur in the gastric mucosal defense mechanism. Experimental mucosal injuries produced by intragastric ethanol or HCl are greatest in newborn rats and decreased with age. Recovery of the mucosa from injury was faster in newborn rats than in older rats. In the present study, to determine if metabolism of prostaglandins is responsible for the physiological characteristics of the mucosal protective mechanisms in developing rats, we studied COX mRNA expression in rats of various age with/without acute mucosal injury by quantitative (kinetic) RT-PCR. The effect of age on endotoxin-induced mRNA expression was also investigated. Methods: Gastric mucosa was excised from male Wistar rats and separated from the muscle layer. mRNA was extracted and converted to cDNA using random primers. The number of copies of cDNA for COX I, COX2, and GAPDH(internal control) was measured using real-time PCR with Taqmann Probes. Mucosal injuries were produced by administrating 0.005 ml/kg of l50mM HCI-60% EtOH through nasogastric tube 60 min prior to the sacrifice. Results:COXl mRNA expression was lowest in l -week-old rats, and highest in 4-week-old rats. Mucosal injury did not increase COXI mRNA expression in any age group. Expression of COX2 mRNA was highest in l-week-old rats and then decreased with age. Mucosal injury increased COX2 mRNA in each age group, mostly in one week old rats (Table). There were no age-related changes in COX2 mRNA expression in response to lipopolysaccharide O,5,lOmg/kg,ip). Conclusion: The high level of COX2 mRNA expression in the gastric mucosa of l-week-old rats might be responsible for the physiological charateristics of gastric mucosal defense in this age group.