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PURPOSE: The purpose of this study was to review our results in patients undergoing treatment with 4 percent formalin for radiation-induced injury to the rectum. METHODS: A retrospective review of office charts was performed, identifying all patients undergoing formalin treatment. Patient gender, initial malignancy, prior treatments, response to treatment with formalin, complications, and length of follow-up were reviewed. All patients had flexible endoscopy to assess for proximal sources of bleeding. The indication for treatment was a symptomatic patient with endoscopic evidence of radiation injury. A cotton pledget was used for direct application of 4 percent formalin to the affected area via a rigid proctoscope or anoscope. The treatment was repeated if blanching did not occur or if bleeding continued. Patients were followed up at three-week to four-week intervals and treatment was repeated based on the above indications. Treatments were continued until cessation of bleeding occurred or, when treatment failed, operative treatment was required. RESULTS: Thirty-six patients were identified. Three were lost to follow-up. Symptoms included bleeding in all but one patient, who presented with an ulcer. There were 33 (26 male) patients. Seventeen (51.5 percent) patients had prior treatment. The number of formalin treatments ranged from 1 to 13, with a mean of 3.4. The follow-up ranged from 1 to 60 months, with a mean of 18 months. Twenty-nine (88 percent) patients had improvement or cessation of symptoms. Four (12 percent) patients failed treatment. Two patients were noted to have full-thickness ulcers and both failed formalin treatment. No complications were noted related to formalin treatment. CONCLUSION: We conclude that formalin therapy is a safe and effective form of treatment that can be performed in the office with minimal discomfort and no complications. It can be performed multiple times until results are achieved. Formalin therapy may be useful as a first-line treatment for chronic radiation proctitis, however, a prospective controlled trial comparing modalities is required to prove this to be true.

Cerebral ischaemia results in significant brain damage, but the molecular mechanisms associated with ischaemia-induced brain injury are not well defined. We have adopted an improved differential-display method to search for new ischaemia-related genes. Among the different cDNAs isolated following transient forebrain ischaemia in rat, PH3.3 was selected for further studies. The search for homologies revealed that it is the rat homologue to human zinc finger motif 1 (ZFM1), also called mammalian splicing factor 1 (SF1). With Northern blot, PH3.3 hybridized with three mRNA species of 2.3, 2.9 and 3.6 kb, significantly increased at 6 h and 5 days after the ischaemic insult. These findings were extended also to another animal model. In situ hybridization in ischaemic gerbils showed that PH3.3 mRNA was induced in the dentate gyrus as early as 4 h post-ischaemia. Expression peaked at 2 days in the whole hippocampus and cortex, and then progressively decreased towards sham levels. By day 4, expression had disappeared almost entirely from the cells in the CA1 region of the hippocampus, concomitant with the degeneration of pyramidal neurons. Interestingly, ZFM1/SF1 has been recently identified as activated following p53-induced apoptosis. Several lines of evidence suggest that p53 may play two roles in the post-ischaemic brain. The primary role of p53 is to activate DNA repair processes, but if repair fails, apoptosis will be initiated. Thus, ZFM1/SF1 may represent a relevant link between p53 and the neuroprotective/neurodegenerative processes which follow cerebral ischaemia.

In Regenerative Medicine one or more regenerative factors can be applied inside a cartilagine or bone defect to obtain a more rapid and complete healing. Bone Marrow Cells (BMC) added to Platelet-Rich Plasma (PRP) contain stromal cells which can differentiate in osteoclasts and osteoblasts and can be able to form osteogenic tissue and to repair bone defects secondary to degenerative processes.

Computed tomography (CT) was used in place of contrast enemas as the initial imaging study to evaluate patients with the clinical diagnosis of acute sigmoid diverticulitis. This report attempts to clarify the role of CT in the management of acute sigmoid diverticulitis by reviewing its usefulness in the diagnosis and treatment of 59 patients. CT established that three patients (5 percent) were hospitalized with an incorrect clinical diagnosis. Thirty-seven patients (62.7 percent) were identified as having uncomplicated acute diverticulitis. These patients were all treated successfully with nonsurgical therapies and were discharged in an average of 6.8 days. In the remaining 19 patients (32.2 percent), CT revealed complicated acute diverticulitis by identifying abscess, fistula, peritonitis, or obstruction. Eleven of these 19 patients required urgent surgery or CT-guided percutaneous drainage of an abscess. The four patients whose abscesses were drained percutaneously responded favorably and underwent an elective single-stage resection. The average hospital stay for patients with complicated diverticulitis was 13.6 days. Computed tomography is a useful aid in the initial management of patients with acute diverticulitis. It is a noninvasive test that recognizes and stratifies patients according to the severity of their disease. It has the further advantage of providing information about extracolonic pathology and anatomic variation useful for surgical planning. Additionally, early CT-guided needle drainage allowed downstaging of complicated diverticulitis, avoided emergent surgery, and permitted single-stage elective surgical resection.

Results Our patient, boy, 19 years old, 63.5 kg (50°centile), 161 cm, (3°centile), is affected by JIA, diagnosed at the age of 7 years. Since he presented many acute phases of illness, though on therapy with immunosuppressant (methotrexate 10 mg/m2/week), steroid and NSAID, in 2001 we introduced an anti-TNF drug (etanercept 0.5 mg/kg/twice a week) while reducing progressively steroid dose. However the patient showed still numerous articular acute phases. We decided to associate thalidomide (100 mg/ die). After two months, the boy showed an improvement of the articular symptoms. After six months JIA was in remission. After 16 months of thalidomide therapy, he presented electrophysiological PN, without clinical signs;we decided to stop the thalidomide therapy. Now, after 3 years of thalidomide suspension, no acute phases of JIA were observed and an electrophysiological improvement of PN was confirmed.

JIA is a chronic disease that can involve many different joints including TMJ. TMJ involvement leads to: chewing function alteration due to synovial membrane thickening, masticator muscle weakness and facial pain; craniofacial growth disturbance (micrognathia or facial asymmetry). The aim of our study is to evaluate the TMJ in people affected by JIA for early diagnosis of TMJ arthritis. Our series included 51 consecutive patients with JIA, 16 males and 35 females (age range 4 – 19 years), that were evaluated through a rheumatologic and dentist examination. Clinically suspected cases were studied with Magnetic Resonance Imaging (MRI). Our results showed that 19/51 patients (37%) (age range 9 – 19 years) had TMJ alterations, 10/19 (19,6%) concerning the left one while 7/19 (13,7%) the right one. Only 2/19 (4%) had a bilateral involvement. TMJ arthritis can severely affect the growth of mandibular, it can be asymptomatic in the majority of cases but it is present in about 50% of children with JIA. MRI is useful to evidence the assessment of disease activity with precious informations about its evolution. Besides, this imaging technique allows to eliminate X-rays exposure and, in according to its high definition, can show early joints alterations also in apparently asymptomatic children. In our patients, MRI was the gold standard for an early diagnosis showing that 37% of cases had TMJ involvement.

Results When Enbrel plus Methotrexate was started she got into remission. After one year of this therapy, she presented uveitis in both eyes, so oral steroids were started again. She obtained only partial ocular improvement, even when she received Infliximab associated with Methotrexate. Meantime she underwent cataract surgery with visus reduction. After one year, Infliximab was suspended because of an adverse reaction (dyspnea and rash) and Adalimumab (0.7 mg/kg subcutaneous/14 days) associated with Methotrexate was started, with no side effects. Fourteen months later there are no flare for uveitis and/or arthritis. Following SUN criteria [1] we demonstrated ocular clinical improvement, not withstanding the presence of signs of cataract and glaucoma.

PURPOSE: Technetium-99m-labeled red blood cell scintigraphy, commonly used in the evaluation of acute lower gastrointestinal hemorrhage, often fails to demonstrate a source of bleeding. It would be helpful to characterize a subset of patients more likely to have a positive scan. This study was undertaken to determine whether hemodynamic instability can predict tagged red blood cell scan positivity. METHODS: The records of 50 consecutive patients who underwent tagged red blood cell scanning for the evaluation of acute lower gastrointestinal bleeding were reviewed retrospectively. RESULTS: Patients presenting with a heart rate >100 beats per minute or a systolic blood pressure

Lysyl oxidase (LOX), a copper-dependent amine oxidase, has been implicated in tumor suppression and cell growth regulation. The chromosomal locus of LOX, 5q23, is affected by loss of heterozygosity (LOH) in colon cancer, suggesting that the LOX gene could be affected by LOH and consequently, loss or reduction of LOX function contribute to the tumorigenic process. Identification of microsatellite markers within the LOX locus has allowed us to map the LOX gene within the 5q23.1 region. Analysis of this locus and flanking loci in matched tumor and blood DNA samples from a panel of colorectal cancer patients, demonstrated that 38% (16/42) of informative samples were affected by LOH or allelic imbalance. Furthermore, 75% (6/8) of these tumor samples were shown to have significantly reduced LOX mRNA levels. Similar reduction in LOX levels were detected in a panel of matched normal colon and colon tumor samples. Tumor samples demonstrating LOH by RFLP, were subject to mutational analysis, including RT-PCR, exonic deletion detection by PCR, cDNA and genomic DNA sequencing, and were found to have a spectrum of alterations and mutations affecting the LOX gene. These results confirm that loss or reduction of LOX function during tumor development is a direct consequence of somatic mutations and is associated with colon tumor pathogenesis. © 2001 Wiley-Liss, Inc.

Background Interleukin (IL)-1 and metalloproteinases (MMP) are thought to play a crucial role in the cartilage degradation of osteoarthritis (OA). Recently it has been proposed that CRP may be useful index of OA activity and severity. Objectives We studied the relationships between synovial fluid (SF) IL-1b, MMP1 and MMP3, and serum levels of CRP in patients with OA of the knee (KOA) to investigate the role of CRP in KOA. Methods In the SF from 25 patients with KOA (Altman criteria, Kellgren and Lawrence score of 2 or greater on X-ray plan films) we determined the levels of IL-1b, MMP-1 and MMP-3 (ELISA), along with WBC number. In the same patients serum concentration of CRP was analysed by ultrasensitive rate nephelometry. No patients were taking NSAIDs or other antirheumatic drugs. Results In SF, MMP1 was correlated with MMP3 (r = 0.61, p = 0.0009), and MMP3 with IL-1b (r = 0.67, p = 0.0002). In turn, serum CRP was correlated with MMP3 (r = 0.76, p Conclusion The correlations found between serum CRP and SF levels of substances believed to be crucial in OA cartilage degradation, such as MMPs and IL-1, confirm the role of marker of disease severity recently proposed for this acute phase protein.

NW-1015 is a novel Na+ and Ca2+ channel blocker with broad spectrum anticonvulsant activity and an excellent safety margin. As the compound also shows sigma-1 receptor ligand properties it was deemed important to determine whether it possesses anticonvulsant properties in primates without causing behavioral and EEG abnormalities. Thus, the effects of NW-1015 on limbic electrically-induced afterdischarge (AD) were evaluated in four cynomolgus monkeys, and its activity compared to a single effective dose of phenytoin (PHT). The four male cynomolgus monkeys were chronically implanted for EEG recordings, from cortex and limbic structures. AD was induced in limbic areas by electrical stimulation. The effects of NW-1015 on the duration and the behavioral component of the AD were randomly tested at doses from 25 to 75 mg/kg and compared with the effects of PHT 50 mg/kg. Similarly to PHT, 50 mg/kg of NW-1015 significantly shortened the EEG AD and almost abolished AD elicited behavioral seizure. Only the behavioral effects of AD were reduced after administration of 25 mg/kg p.o. NW-1015 did not cause EEG or interictal behavioral alterations at doses up to 75 mg/kg p.o. These data further confirm the broad-spectrum anticonvulsant activity and a good safety profile of NW-1015 even in a primate model of complex partial seizures and suggest that its affinity for sigma-1 receptors is behaviorally irrelevant.

Quinolinic acid (QUIN) is an endogenous neurotoxin which originates from the kynurenine pathway of tryptophan metabolism. An increase of brain QUIN level occurs in several degenerative and inflammatory disorders, but the cellular source of QUIN is still a matter of controversy. In the present study, the gerbil model of transient global ischemia was used to investigate the time course and the cellular localization of QUIN immunoreactivity. Neurodegeneration was evident in the subiculum and in the CA1 area of the hippocampus 4, 7 and 14 days after ischemia. QUIN positive cells, with microglia-like morphology, appeared in the subiculum and in the CA1, 4 days after ischemia. At 7 days post-ischemia they extended to the whole CA1, disappearing at 14 days. Neither neurodegeneration nor QUIN positive cells could be detected in ischemic gerbils sacrificed at 1 and 2 days after ischemia and in sham-operated animals. These findings suggest that microglia-like cells infiltrating the degenerating areas of the hippocampus represent the major source of QUIN following transient ischemia in the gerbil. Thus, in situ production of QUIN in vulnerable brain regions may contribute to the pathophysiological mechanisms of delayed brain injury.

In Regenerative Medicine one or more regenerative factors can be applied inside a cartilagine or bone defect to obtain a more rapid and complete healing. Bone Marrow Cells (BMC) added to Platelet-Rich Plasma (PRP) contain stromal cells which can differentiate in osteoclasts and osteoblasts and can be able to form osteogenic tissue and to repair bone defects secondary to degenerative processes.

Background In Regenerative Medicine one or more regenerative factors can be applied inside a cartilagine or bone defect to obtain a more rapid and complete healing. Bone Marrow Cells (BMC) added to Platelet-Rich Plasma (PRP) contain stromal cells which can differentiate in osteoclasts and osteoblasts and can be able to form osteogenic tissue and to repair bone defects secondary to degenerative processes. Methods We report on a 15-year and 8 month-old boy, followed at our Department, affected by JIA since he was 2 years old. He presented a systemic form, evolved into a polyarticular form, treated with steroids and immunosuppressor drugs. The patient had a good response to treatment with Enbrel, which he is still taking. In January 2009, he presented right hip pain and functional limitation. In July 2009 he underwent MRI of the hip joints which showed osteonecrosis in chondral/subchondral regions at the superior-external convexity of the right femoral head. We recommended deambulation with crutches and no weight bearing. Because of the persistence of joint symptoms, in July 2010 we implanted BMC plus PRP in the osteonecrotic region with improvement of pain and mobilization. In October 2010, he presented left hip pain. MRI showed focal osteonecrosis in subchodral region of left femoral head convexity. For this reason, we made a second BMC plus PRP implantation in the left hip. The last MRI, made on January 2012, showed any changes concerning the morphology of femoral heads and subchondral erosions but our patient autonomous walks, without joint pain and with improved ankle movements, since January 2011; he keeps on Enbrel and NSAIDs. Conclusions To the best of our knowledge, there are no literature data on the use of BMC plus PRP in pediatric patients affected by JIA. Considering the obvious limitations of our single case report, we observed a good short-term outcome. Therefore, follow-up is essential to check if BMC plus PRP implantation represents only a palliative care to delay surgical treatment or if it is a valid alternative to traditional orthopedic surgery. References Gothard D et al. In search of the skeletal stem cell: isolation and separation strategies at the macro/micro scale for skeletal regeneration. Lab Chip. 2011 Apr 7; 11(7): 1206-20. Epub 2011 Feb 25. Nauth A et al. Growth factors: beyond bone morphogenetic proteins. J Orthop Trauma. 2010 Sep; 24 (9): 543-6. Calori GM et al. Bone morphogenetic proteins and tissue engineering: future directions. Injury. 2009 Dec; 40 Suppl 3: S67-76. Disclosure of Interest None Declared

Quinolinic acid (QUIN) and kynurenic acid (KYNA) are two metabolites of the L-tryptophan degradation belonging to the kynurenine pathway and showing opposite effects on the brain. KYNA is a neuroprotectant and acts as an antagonist on the ionotropic excitatory amino acid receptors. In particular KYNA has an high affinity to the glycine site associated to the N-Methyl-D-Aspartate (NMDA) receptor complex (Foster et al., 1984; Kessler et al., 1989). On the contrary, QUIN is a neurotoxin and the observation that QUIN is a potent NMDA receptor agonist as well as a potent lipid peroxidant in brain homogenates has suggested the involvement of this metabolite in many neurodegenerative disorders (Schwarcz et al., 1983; Rios and Santamaria, 1991).

When injected into the brain of experimental animals, quinolinic acid (QUIN) and kynurenic acid (KYNA) act as a neurotoxin and neuroprotectant, respectively, and these effects are mediated by excitatory amino acid (EAA) receptors (Stone, 1993). Since their identification in the mammalian brain, QUIN and KYNA have therefore been proposed to play roles as endogenous modulators of EAA receptors. Both compounds are metabolites of the kynurenine pathway in the periphery and in the brain, and a large number of studies have been performed to examine their source, metabolism and disposition in the central nervous system in physiological and pathological conditions (see Stone, 1993, for review). In particular, an increased formation of QUIN was observed in several models of nerve cell damage, such as excitotoxin lesions (Speciale et al., 1987), spinal cord trauma (Popovich et al., 1994) and global ischemia (Heyes and Nowak, 1990; Saito et al., 1993), and in humans infected with the HIV virus (Heyes et al., 1991). This enhancement of QUIN production was suggested to contribute to the loss of neurological function. On the other hand, KYNA was found to be likely involved in cerebral self-defence (Schwarcz et al., 1992). This is supported both by occurrence of cell death following the pharmacologically induced decrease in brain KYNA (McMaster et al., 1991) and by the increase in cerebral KYNA production following acute excitotoxic (Schwarcz et al., this volume) or convulsive (Wu and Schwarcz, 1994; Baran et al., 1995) insults.

We have previously shown that the administration of a thromboxane A2 (TXA2) synthase inhibitor (FCE 22178) reduced the progression of glomerular lesions and protein-uria in MNS rats, an inbred strain which develops an age-related nephrotic syndrome. In the present study we investigated the effect of FCE 22178 on the plasma lipoproteins of MNS rats at 28 weeks of age (with mild proteinuria andmoderate dyslipoproteinemia) and at 48 weeks of age (with heavy proteinuria and severe dyslipoproteinemia). Drug treatment reduced proteinuria (by 70% and 36% at 28 and 48 weeks of age, respectively) plasma cholesterol (by 36% and 27% at 28 and 48 weeks of age, respectively) and prevented the decrease of plasma albumin observed in untreated rats (C-MNS) 48 weeks old. In treated rats (T-MNS), the decrease of proteinuria was positively correlated with that of plasma cholesterol. FCE 22178 reduced the elevation in plasma HDL1 (by 17.4%) and HDL2 levels (by 30%), a key feature of nephrotic dyslipoproteinemia in the rat. From 28 to 48 weeks of age plasma apo A-I and apo E increased 217% and 128%, respectively, in C-MNS rats and 191% and 121%, respectively, in T-MNS rats. A significant increase of apo A-I/apo E ratio was found in C-MNS rats from 28 (2.28±0.36) to 48 weeks of age (3.84±0.9) but not in T-MNS rats. FCE 22178 altered the lipid composition of VLDL and HDL2 by reducing the content of cholesteryl esters and increasing that of free cholesterol and phospholipids. These findings suggest that the beneficial effect of FCE 22178 on the dyslipoproteinemia of nephrotic MNS rats is secondary to the amelioration in kidney function and to the reduction of proteinuria produced by this drug. (Aging Clin. Exp. Res. 6; 381–390, 1994)

PURPOSE: This study was designed to assess the results of a minimally invasive surgical procedure for the correction of complete rectal prolapse in a poor surgical risk group. METHODS: Over a ten-year period, 40 patients underwent 41 Delorme operations when advanced age and/or poor overall health mitigated against an abdominal approach. Mean age was 82 (range, 30–100) years. Eighty-eight percent were females. Surgery was performed in the prone jackknife position utilizing intravenous sedation and local anesthesia. RESULTS: Follow-up ranges from 1 year to 2 years (mean, 47 months). There have been 9 recurrences in 8 patients (22 percent). Mean time to recurrence was 13 months (range, 1 month to 6 years). One death occurred in an 81-year-old patient within 24 hours of surgery from cardiopulmonary arrest. Minor complications occurred in 25 percent of patients. CONCLUSION: Satisfactory prolapse repair was safely performed in 78 percent of this high-risk group. Pitfalls in performing this procedure relate primarily to associated perineal and colonic conditions. Most prominent among these conditions are weak or absent anal sphincter tone, perineal descent, and previous sphincter injury. Extensive diverticular disease may prohibit effective and complete proximal mucosectomy. An inadequate mucosectomy sets the stage for early recurrence of prolapse.

Uveitis in JIA can be severe and immunosoppressive therapies may not be sufficient. Anti-TNF-alfa agents (Infliximab, Adalimumab) have been proposed. The percentage of success is different among series and no controlled trials have been published yet. Abatacept, a selective T-cell co-stimulation modulator, has been shown to be a valid alternative to anti-TNF-alfa agents in patients with refractory uveitis (Angels-Han S.2008; Zulian 2010).

PURPOSE: Controversy exists over the appropriate preoperative evaluation of colorectal cancer patients. Most surgeons agree that basic laboratory studies are indicated. Computerized tomography of the abdomen and pelvis has been used in our practice to augment the preoperative evaluation of these patients. METHODS: One hundred fifty-eight consecutive patients with primary colorectal carcinoma underwent computerized tomography (CT) of the abdomen as part of their preoperative evaluation. Their medical records were retrospectively reviewed. RESULTS: In 88 patients, 120 findings present on CT were otherwise unknown. Of these, 35 percent were clinically significant in that they allowed the surgeon to alter the proposed operative procedure or added additional technical information for consideration preoperatively. Findings include liver metastasis (26), atrophic kidney (3), and abdominal wall or contiguous organ invasion (11). In addition, two other solid organ carcinomas were detected. In the remaining 70 patients, CT contributed no additional pertinent information about the patient prior to this initial operative procedure. CONCLUSIONS: CT aids in the preoperative evaluation of individuals with colorectal carcinoma. It provides important clinical information that is useful to the surgeon planning the procedure. Additionally, CT permits the patient and his family to be aware of their overall status and to subsequent treatment options. Computerized tomography eliminates the need for preoperative intravenous pyelogram, improves the preoperative staging for metastatic disease, and provides a baseline for comparison during the postoperative follow-up period should recurrence be suspected or adjuvant therapy be planned.

Psoriatic arthritis (PsA) is an inflammatory joint disease in which environmental factors, particularly trauma and infections, are thought to play an important role. The authors describe the case of a patient with a mild and long-untreated form of PsA which was severely exacerbated by Salmonella typhimurium infection. This case confirms the importance of infectious agents in the occurrence and course of PsA.

Each year we treat several patients with an anterior perineal sinus tract. They do not conform to commonly encountered perineal problems such as pilonidal disease, epidermal cysts, hidradenitis, fistulous abscess, or inflammatory bowel disease. In an effort to improve understanding of the problem and its clinical significance, we reviewed our practice records for the period from 1968 through 1988. Fifty-six patients underwent surgery for an anterior perineal sinus tract. In 31 patients, the clinical and pathologic condition defied classical diagnostic categorization. We have termed these lesions “anterior perineal sinuses.” Their clinical characteristics, treatment, and pathologic assessment form the body of this report. Male predominance (87 percent) and midlife presentation (average age, 44 years) characterized this group. Local symptoms were present from several weeks to several years prior to treatment. Local anesthesia (74 percent) and limited surgery (100 percent) resulted in complete healing in all patients (average, 7 weeks). A 15 percent recurrence rate was noted. The pathologic evaluation demonstrated acute and chronic dermal and subcutaneous inflammation. The etiology of this process remains uncertain. Its predominance along the median raphe suggests a congenital midline inclusion disorder.

The endothelium-derived peptide, endothelin, has been shown to exert powerful constrictor activity in both isolated and in situ coronary arteries. Recent in vitro data on isolated cardiac myocytes suggest that the substance might also possess electrophysiologic properties. We investigated the possibility that endothelin (ET-1) may exert proarrhythmic effects when infused selectively in the coronary circulation of open-chest-anesthetized dogs. Animals were instrumented for the measurement of left anterior descending (LAD) or left circumflex (LCX) coronary artery blood flow, left systolic ventricular pressure (LSVP), dP/dtmax, mean arterial pressure (MAP), and epicardial electrocardiogram (ECG; three leads). Data were recorded during infusion (2 min) of saline (n = 5) or increasing doses of endothelin (5-80 pmol/kg) given selectively in either the LCX (n = 10) or the LAD (n = 10). When infused into the LCX, endothelin produced a dose-dependent decrease in flow (40 +/- 23% at 80 pmol/kg, mean +/- SD, p less than 0.01) with a concomitant increase in coronary resistance and a decrease in dP/dtmax and MAP. ECG changes typical of myocardial ischemia paralleled the decrease in flow and culminated in ventricular fibrillation at the highest dose (80% of dogs). Endothelin caused similar hemodynamic effects when infused in the LAD, but fatal arrhythmias occurred for lower doses and for little or no change in coronary blood flow. Thirty percent of the animals died at 10 and 60% died at 20 pmol/kg, doses that induced only a moderate decrease (8 +/- 7 and 21 +/- 12%, respectively) in LAD total blood flow. Ventricular tachycardia always preceded ventricular fibrillation and death.(ABSTRACT TRUNCATED AT 250 WORDS)

Anorectal fistulas associated with Crohn's disease are difficult to manage, particularly when the rectum is diseased. Significant morbidity has been associated with both medical and surgical therapy. Although conventional therapy is acceptable in the management of simple fistulas in Crohn's disease, these approaches often exacerbate rather than ameliorate problems in patients with complex fistulas. The authors report ten cases of complex fistulas in patients with Crohn's disease managed with their technique of long-term, indwelling setons. These setons are placed through the fistula tract and tied loosely to maintain the patency of the fistula without cutting through the sphincters. At the time of insertion, although abscesses are incised and drained, no attempt is made to divide the superficial tissues or sphincter overlying the fistulous tract. The patients ranged in age from 23 to 81 years and had a history of Crohn's disease for 1 to 20 years. All cases resulted in excellent palliation. No patient required a proximal colostomy. These patients have been followed for four months to seven years. Despite severe proctitis in six of these patients at the initial operation, no patient has required a proctectomy. The authors believe this technique achieves adequate palliation and should be employed as the procedure of choice in patients with complex anal fistulas associated with Crohn's disease.

A method for low transection of the rectum within a narrow pelvis is described using the new GIA 90 autosuture instrument.

Electrosurgery is a useful tool. Some basic knowledge of the terms, waveforms and circuits allows more intelligent use. Let us all use the same terms so that we may understand the work of others and share our experiences. Learn about your own particular apparatus and its capability. Practice on a piece of meat if necessary. Be aware of the potential complications reported in the literature, and how they may be prevented.

A retrospective study was done comparing the rates of local recurrence in cancer of the rectum treated by low anterior resection using the stapling device or hand-sewn. It was found that there was no increase in recurrences when the stapler was used, even though lower lesions were treated.

Presented is the authors' experience with 182 patients treated primarily by the one-stage primary resection or two-stage resection. (Hartmann operation). One hundred thirty five patients undergoing primary resection had an associated mortality rate of 2.2 per cent. Of 44 patients operated upon using the Hartmann operation for complicated diverticulitis (obstruction, perforation, abscess formation, or fistula formation) the mortality rate was 4.5 per cent. Primary resection in an elective setting is associated with the lowest mortality and morbidity; however, marked inflammation, obstruction and/or peritonitis preclude primary anastomosis. In the urgent setting the staged operation is associated with acceptable morbidity and mortality.

Injury to the ureters is a serious complication of colonic and rectal surgery. The experience of the authors with routine use of ureteral catheters to minimize this complication is reviewed. It was found that there are minimal complications associated with their use. Injuries to the ureters were not completely avoided. However, unrecognized injuries (except ischemia) did not occur.

The long-acting local anesthetic, bupivacaine, was used in a series of 467 anorectal patients, both inpatients and outpatients. Bupivacaine was found to be safe and effective. Like other local anesthetics, it has none of the operative and postoperative complications frequently associated with general or spinal anesthetics. Its longer duration of action makes it extremely useful in anorectal operations on hospatilized and non-hospitalized patients. The potential hypertensive effects of using epinephrine in the local anesthetic solution appears to be negated by the calming, hypotensive effects of the intravenously administered sedatives in hospitalized patients.

Leukocyte migration inhibition assays were compared in patients with colo-rectal cancer treated by resection and by electrocoagulation. Patients treated by electrocoagulation had identical leukocyte migration inhibition assays before and after treatment. Patients treated by resection were less reactive after treatment, presumably because of peri-operative immunosuppression. This suggests that electrocoagulation may stimulate host immunity in the period immediately following surgery.

Several data support the involvement of serotonin (S-HT) in the pathogenesis of hypertension (Vanhoutte 1985). Therefore in recent years the selective antagonism of vascular serotonin receptors has been pursued as a target for a new class of antihypertensive agents. Ketanserin was the first serotonergic-receptor antagonist shown to be active in lowering blood pressure in man; however, it is now recognised that its concomitant Q!,-adrenoreceptor blocking activity contributes to its antihypertensive effect (De Cree et al. 1981; Fozard 1982). The aim of the present work is to describe the pharmacological profile of an ergoline derivative, FCE 24379 (l-[S( 1O-9)abeo-6-methyl-9, lO-didehydro-ergolin-8{j-methyl]dihydrouracyl), which is highly selective in antagonising vascular serotonergic receptors in isolated arterial vessels and also iowers blood pressure in spontaneously hypertensive rats (SHR).

The results obtained from 1,012 examinations in an on-going, cooperative study indicate that the overall yield provided by use of the flexible fiberoptic sigmoidoscope is 3.2 times greater than that of examinations with the rigid sigmoidoscope. More than twice (2.4 times) the number of polyps and more than three times the number of cancers were detected with the flexible fiberoptic sigmoidoscope. Experienced endoscopists can perform an examination with the flexible fiberoptic sigmoidoscope expeditiously in the office with minimal patient preparation, a high level of patient and physician acceptance, and relative safety when the usual mandatory colonoscopic precautions and guidelines are obeyed. The extraordinary advantages demonstrated by this study warrant wide clinical application of the flexible fiberoptic sigmoidoscope. We strongly recommend provision be made for appropriate training of physicians in the use of the instrument.

The levator syndrome is an entity characterized by pain high in the rectal area that can be elicited by pressure applied to the levator ani. The etiology, diagnosis, and treatment of this disorder are described. Its importance lies in its misdiagnosis or in the failure to diagnose.

A series of 490 consecutive patients with internal hemorrhoids is presented, in whom the chief treatment has been by the Barron ligating technic.

Ten cases of abdominoendorectal resection for cancer of the proximal and midportions of the rectum have been reported. This procedure differs from other sphinctersaving operations in that the distal 3.5 cm. of the rectum is preserved. The operation is indicated for lesions situated from 6 to 12 cm. internal to the anal canal where, for technical reasons, an anterior resection cannot be done. The morbidity rate is high but in this series it is probably due in some measure to circumstances such as advanced age, obesity, small pelves and factors responsible for poor risks. There appears to be a place for this technic in the management of cancer of the proximal and midportions of the rectum.

Two cases of massive hemorrhage from colonic diverticula are reported in which an eroded artery has been demonstrated as the source of bleeding. Eight previously reported cases have been reviewed.

Seventy-three patients with adenocarcinoma of the sigmoid, rectosigmoid and rectum were reviewed to determine the incidence of suture-line recurrence. Four patients (5.5 per cent) developed suture-line recurrence despite the use of a number of techniques to reduce this problem. All four recurrences were in patients who had Dukes' C lesions of the rectum. It would appear that such recurrences are not related to implantation factors alone.