New classification of histochemical staining patterns of acetylcholinesterase activity in rectal suction biopsy in Hirschsprung's disease.

Several previous studies have introduced classifications of Acetylcholinesterase (AChE) histochemical staining patterns in rectal suction biopsy performed in patients with Hirschsprung's disease. However, we introduce a new classification that is less complicated but shows the same age dependence as seen in previous studies. 135 rectal suction biopsies were submitted to histochemical staining for AChE activity and 88 specimens showed increased AChE activity. Therefore, we retrospectively analysed these 88 cases and could establish three patterns. Pattern I, presence of thick nerve trunks or coarse nerve fibers only in the muscularis mucosae and submucosa. This pattern was mainly seen in children aged 6 months or below. Pattern II, presence of abundant nerve fibers in all three layers of mucosa. This pattern was predominantly seen in children over 6 months of age. Pattern III, not predominant in any age group, showed positive nerve fibers in all three layers but, in one or more layers, the nerve fibers were sparse. Upon comparison with previous studies, we could observe the same age-pattern relationship. Thus, we propose this method of classification as a new tool to classify AChE histochemical staining patterns.

Modification of the acetylcholinesterase (AchE) staining method in Hirschsprung's disease.

Demonstration of the increasing activity of acetylcholinesterase (AChE) in a segment of the colon has proved to be the most accurate diagnostic tool to diagnose Hirschsprung's disease. Two methods of histochemical assessment were tried to establish the most appropriate and effective method for this study within the limitation of available equipment. Lake's method was chosen and was modified as the standard histochemical examination.

Postoperative elective ventilation in babies with "marked anastomotic tension" after repair of esophageal atresia.

The repair of esophageal atresia, preserving the patient's own esophagus is the surgical procedure of choice. In "long-gap" type or in "tension anastomosis" cases, anastomotic complications were known to be higher than in usual cases. From this report, postoperative elective ventilation for 5 days together with neck flexion position reduced such complications with minimal subsequent complications related to the mechanical ventilation.

One layer continuous anastomosis of the alimentary tract with absorbable polydioxanone suture.

A prospective study using absorbable Polydioxanone (PDS) suture material in a one layer continuous technique for gastrointestinal anastomosis was conducted. There were 40 anastomoses constructed in 39 children and 61 anastomoses in 49 adults which were classified as "non-complicated anastomoses" without any clinical evidence of leakage or any other complications attributable to the anastomotic technique or to the suture materials. There were other 20 anastomoses created in 20 patients with malnutrition or those receiving chemotherapy and/or radiation or where there was tension at the anastomosis which were classified as "complicated anastomosis". Anastomotic leakage was observed in one patient (5%). The starvation period was 3.16 +/- 0.9 days compared to 3.46 +/- 1.0 days in the two layer technique "control" group. The rate of complications and the function of the GI tract in both non-complicated and complicated anastomoses after one layer continuous Polydioxanone anastomotic completion was not significantly different from those using conventional two layer anastomosis. The technique for one layer continuous suture is simple, easy and takes less time than the conventional method. This technique also theoretically provides better postoperative condition in which bowel anatomy and physiology can return to normal earlier, causing minimal tissue trauma, and less narrowing of the lumen although the evidence cannot be supported by this study. The Polydioxanone suture material is biodegraded by specific time, and hence allows normal growth of the anastomosed bowel; it is therefore suitable for both children and adults.

Intestinal obstruction due to phytobezoars.

Seven adults and four children with phytobezoar obstruction to the small bowel were reported. All adult patients had undergone previous laparotomies, six of which were gastric operations. Phytobezoar obstruction was not suspected in any of the adult patients and surgery was necessary to relieve the obstruction. Abnormal gastric function may predispose phytobezoars, and surgeons should be aware of the possibility in patients with previous gastric surgery. The children had been previously healthy, but all had a history of eating an excessive amount of fruit or seeds before the onset of symptoms. The obstruction was found to be incomplete and could be relieved by conservative treatment, including the use of colonic washouts. In children with intestinal obstruction a good dietary history should lead to the correct diagnosis so that surgery may be avoided.