Botulinium toxin, as bridge to transanal pullthrough in neonate with Hirschsprungs disease.

AIMS AND OBJECTIVES: The aim of this study is to find easier way of home care while obviating the colostomy before single stage pull through operation. MATERIALS AND METHODS: From August 2005 to December 2006, eight cases of neonatal Hirschsprung disease were treated. Mean age 4.5 (2-6) day/old with absent anorectal inhibitory reflex, rectosigmiod disease in Barium enema, positive Acetylcholine esterase (Ache) staining, good response to rectal washout. They underwent botulinium toxin injection (5 unit /kg/quadrant) in four quadrant intrasphincteric. They were followed until pull through operation in 8-10 weeks post injection. RESULTS: Four of 8 (50%) cases only needed rectal washout for three to five days post injection until pull through operation, two had decrease in number of rectal washouts /day and the remaining two underwent colostomy five days post injection because of no response. CONCLUSION: Botulinium toxin injection can help in palliative care in patients with Hirschsprung disease who are waiting for colostomy or definitive pullthrough. It gives an option of eaiser home care for these patients.

Ischaemic preconditioning of the liver before transplantation.

PURPOSE: Assessment of the effect of a short ischaemic time prior to liver transplantation on the liver graft. METHODS: White X Landrace pigs (N=10) were subjected to liver transplantation. Before being removed from the donor animal, the livers were randomised into two groups: group 1--pre-procurement ischaemia (15 minutes' temporary arrest of portal venous and hepatic arterial inflow to the liver, followed by reperfusion of these vessels for a period of 15 minutes); group 2--no prior inflow occlusion (control group). In group 1 a spleno-jugular bypass was established to prevent venous congestion, portal venous hypertension, intestinal oedema and bacterial translocation. The livers were perfused with Eurocollins solution (4 degrees C), after which they were stored on ice for a period of 3 hours' cold ischaemic time. Hepatocellular injury was assessed according to liver cell function tests (aspartate aminotransferase, AST), biochemical indicators of reperfusion injury (malondialdehyde) and histopathology. RESULTS: There was a significant rise of AST in both groups 1 hour after transplantation (from 51 +/- 27 IU/l to 357 +/- 152 IU/l in group 1 and from 29 +/- 10 IU/l to 359 +/- 198 IU/l in group 2). AST levels were marginally lower in group 1 at 2 and 4 hours after transplantation. There was also a rise in malondialdehyde levels in both groups at 5, 20, 40 and 60 minutes after transplantation. Levels of malondialdehyde were lower in the primed group at 5, 20 and 40 minutes, while the levels at 60 minutes after transplantation were comparable. Histological changes, as measured by vacuolisation, neutrophil infiltration and hepatic cell necrosis, were less in livers transplanted after ischaemic preconditioning, although the difference was not significant. CONCLUSIONS: Ischaemic preconditioning of the donor liver seems to decrease hepatocellular damage, reperfusion injury and histological changes in the liver after transplantation. Further studies with larger numbers are indicated.

Urethral reconstruction using autologous and everted vein graft: an experimental study.

Urethral reconstruction is one of the problematic issues in pediatric surgery. To evaluate the efficacy of vein graft for urethral reconstruction in rabbits, about 3 cm of distal urethra was excised under microscopic magnification. In groups A, B, and D, the urethra was replaced with the internal jugular vein. In group B, before performing anastomosis, vein grafts were everted. In group C (control group) after removing the urethra, a catheter was inserted without substituting the urethra and then fixed. Groups A, B, and C were kept for 3 months. Group D was divided into five subgroups each consists of two rabbits, which were killed at days 7, 10, 14, 22, and 30 for evolutionary histopathological studies. Gross evaluation, retrograde urethrography, and histopathological studies were also performed in other groups. Retrograde urethrography and gross evaluation revealed no sign of stricture and fistula formation in six and eight rabbits in groups A and B, respectively. However, those complications were observed in all the rabbits in group C. The grafted part of the neourethra was epithelialized with uroepithelium in all rabbits in group A (vein graft) and group B (everted vein graft) but only partial epithelialization was observed in three rabbits of group C. Severe fibrosis with stricture formation was developed in six rabbits in the control group. In group D, epithelialization gradually replaced necrosis and inflammation, within 1 month. This study showed that vein, everted or not, can be used as a substitute for urethra. It also suggests that new epithelialization might be formed from ingrowing of the uroepithelium from the proximal part.