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1. Inhibitory non-adrenergic, non-cholinergic (NANC) responses were studied in isolated strips from the rabbit internal anal sphincter. 2. In the presence of atropine and guanethidine, transmural field stimulation induced frequency-dependent relaxations that reached a plateau at frequencies > or = 4 Hz. 3. These relaxations were inhibited by apamin (10(-6) M) and by N omega-nitro-L-arginine (L-NOARG, 10(-4) M). With these two substances in combination, relaxations were still seen in response to field stimulation, but only at frequencies > 2 Hz. 4. In the presence of both apamin (10(-6) M) and L-NOARG (10(-4) M), responses at high frequencies consisted of a fast relaxation followed by a slow return to prestimulus tension level. alpha-Chrymotrypsin hastens the return of tension to prestimulus level after high frequency stimulation. 5. Zinc-protoporphyrin IX, an inhibitor of haeme oxygenase, had a significant inhibitory effect on relaxations induced by transmural field stimulation. It was found, however, that responses to sodium nitroprusside and to isoprenaline (both 10(-9)-10(-4) M) were reduced comparably, indicating that the effect of zinc-protoporphyrin IX was unspecific. 6. It is concluded that pharmacological analysis allows identification of at least three distinguishable components of the inhibitory NANC innervation of the rabbit internal anal sphincter. The study does not allow conclusions about the role of carbon monoxide, a recently proposed mediator of NANC responses in opossum internal anal sphincter.

To evaluate the prognostic influence of blood transfusion in cancer patients, transfusion data were reviewed on 468 radically operated patients (260 Dukes' B and 208 Dukes' C) with carcinoma of the rectum and the rectosigmoid. Data on whole blood and packed red blood cell transfusions were recorded together with a number of clinical, pathological and histochemical characteristics. The endpoint used was death with cancer. All patients were followed for 2-7 years or until time of death. Univariate statistical methods revealed a highly significant trend towards worsened prognosis with increasing volume of transfusion blood. However, this effect was insignificant when multivariate statistical methods were employed: patients receiving whole blood or packed red blood cell transfusions did no worse than expected from their clinico-pathological characteristics. It is concluded that in this series the observed association between transfusion status and prognosis is adequately explained by a multivariate prognostic model including well-established prognostic factors.

Autologous splenic tissue was implanted in 14 patients undergoing splenectomy for traumatic rupture or peroperatively arising lesion of the spleen. To demonstrate function of the implanted splenic tissue, spleen scintigraphy using 99mTc-labelled heat-damaged autologous erythrocytes, and percentage measurement of vacuolated erythrocytes in peripheral blood were performed one and three months after the splenectomy. The spleen scans were positive in eight patients after one month and in 12 patients after three months, demonstrating splenic phagocytic function. The numbers of vacuolated erythrocytes also indicated some restoration of the pitting function due to the implanted splenic tissue. No alterations were seen in serum immunoglobulins, but a moderate thrombocytosis still persisted after three months. The clinical significance of implantation of autologous splenic tissue is discussed.

Urinary albumin and beta 2-microglobulin excretion and creatinine clearance were measured during 8 weeks' conventional cimetidine treatment in 13 ulcer patients without signs of renal disease. No changes were found in albumin or in beta 2-microglobulin excretion, indicating no changes in glomerular permeability and tubular reabsorption of proteins in the kidney. Creatinine clearance fell about 28 ml/min (26%) during cimetidine treatment but normalized after termination of medication. Concomitantly, serum creatinine increased by 22% during treatment and fell again after termination of treatment. The mechanism behind the changes in renal handling of creatinine during cimetidine was not clarified in the present study. It is concluded that the conventional 8 weeks' cimetidine treatment seems safe from the renal point of view, at least in patients without signs of renal disease.

Two methods of autologous splenic implantation, with sliced or with minced splenic tissue, were compared in six pigs. The two procedures were carried out simultaneously in each pig and the splenic remnants were surgically removed three months later. These remnants were histomorphometrically quantified by point counting. Statistical analysis showed the mincing procedure to be significantly superior, since 33% of the originally implanted tissue remained, in contrast to 21% of sliced, implanted tissue. At microscopy the tissue remaining after both procedures was in all cases indistinguishable from normal pig spleen. No necrotic splenic tissue was found. The authors conclude that minced tissue and omental pouch technique are preferable for autologous splenic implantation.

During a period of one year data were obtained concerning life events, non-specific psychological symptoms, individual social history and ulcer history in consecutive cases of patients about to undergo elective surgical treatment for duodenal ulcer. At a one-year follow-up, a blind clinical evaluation was performed, and information concerning the patients' assessment of outcome was obtained. Those patients who at the one-year follow-up stated no improvement due to the operation could be predicted to some extent from postoperative complications, partly from a long ulcer history. The patients who stated that the result did not come up to their expectations were predicted from older age, and from certain symptoms, especially severe headache. It is suggested that it is relevant to apply the patients' assessment of outcome for the purpose of evaluation, supplementing the clinical assessment of the more biomedical aspects of outcome.

The results of different types of treatment for early cancer in 158 out of 1,300 patients with rectal and sigmoid cancer were evaluated in a prospective study from 1979 to 1984. Radical surgery was performed in 121 patients (mean age 66 years) with cancer Dukes' A (median diameter 3 cm), while 37 patients (mean age 71) with smaller cancers (median 2 cm) had polypectomy or local excision. Post-operative complications were significantly more frequent in the first group. No patients in any of the two groups with carcinoma in pedunculated adenomas or within the upper half of the submucosa or above 9 cm from the anal verge had recurrent cancer. CEA-measurements had no prognostic value. No difference was found in crude or cancer-related death between the two groups. The overall results support the use of local treatment in elderly patients with complicating disease, having small cancers, not penetrating the tunica muscularis externa of the rectosigmoid wall.