Endocrine cells in atresic chick embryo intestine: histochemical and immunohistochemical study.

Intestinal motility disorders are an important problem in the postoperative management of patients with intestinal atresia. Intestinal motility could be initiated by luminal factors that activate intrinsic and extrinsic primary afferent nerves involved in the peristaltic reflex. Endocrine cells act as a key point, because they transfer information regarding the intestinal contents and intraluminal pressure to nerve fibers lying in close proximity to the basolateral surface of the epithelium. In chick embryo, experimental intestinal atresia is associated with disorders in the development of the enteric nervous system, related to the severity of intestinal dilation. Our aim was to investigate the distribution pattern of endocrine cells in the developing endocrine system of chick embryo small intestine with experimentally-induced atresia on day 12 and on day 16. Changes in enteroendocrine population were examined in gut specimens (excised proximal and distal to the atresia) from experimental embryos 19 days old and in control sham-operated chick embryos at the same age. Sections from proximal and distal bowel and control bowel were stained with Grimelius silver stain, a valuable histochemical method for detecting the argyrophil and argentophilic cells, and with an immunohistochemical procedure for detecting serotonin and neurotensin immunoreactive cells. In chick embryo proximal bowel, intestinal dilation differed in the various embryos. We found significantly higher enteroendocrine cell counts in proximal bowel than in distal and control bowel. The differences depended on the precociousness of surgery and the severity of dilation. Considering the major contribution of enteroendocrine cells to the peristaltic reflex, our data may help to explain the pathogenesis of motility disorders related to intestinal atresia.

Endocrine cells in atresic chick embryo intestine: histochemical and immunohistochemical study.

Intestinal motility disorders are an important problem in the postoperative management of patients with intestinal atresia. Intestinal motility could be initiated by luminal factors that activate intrinsic and extrinsic primary afferent nerves involved in the peristaltic reflex. Endocrine cells act as a key point, because they transfer information regarding the intestinal contents and intraluminal pressure to nerve fibers lying in close proximity to the basolateral surface of the epithelium. In chick embryo, experimental intestinal atresia is associated with disorders in the development of the enteric nervous system, related to the severity of intestinal dilation. Our aim was to investigate the distribution pattern of endocrine cells in the developing endocrine system of chick embryo small intestine with experimentally-induced atresia on day 12 and on day 16. Changes in enteroendocrine population were examined in gut specimens (excised proximal and distal to the atresia) from experimental embryos 19 days old and in control sham-operated chick embryos at the same age. Sections from proximal and distal bowel and control bowel were stained with Grimelius silver stain, a valuable histochemical method for detecting the argyrophil and argentophilic cells, and with an immunohistochemical procedure for detecting serotonin and neurotensin immunoreactive cells. In chick embryo proximal bowel, intestinal dilation differed in the various embryos. We found significantly higher enteroendocrine cell counts in proximal bowel than in distal and control bowel. The differences depended on the precociousness of surgery and the severity of dilation. Considering the major contribution of enteroendocrine cells to the peristaltic reflex, our data may help to explain the pathogenesis of motility disorders related to intestinal atresia.

Active enlargement of the abdominal cavity--a new method for earlier closure of giant omphalocele and gastroschisis.

The authors present their own modification of surgical staged repair of large abdominal wall defects (AWD). 21 newborns with gastroschisis (GSCH) and 8 with omphalocele (OC) are presented. In all patients the protruding viscera were placed in a prosthetic sac with a semi-permeable lining. The sac was suspended using a system with active external traction with a force amounting to 30 - 40 % of the baby's weight. All babies tolerated the applied method well. A progressive stretching of the abdominal wall and enlargement of the abdominal cavity enabled the defect to be closed between the second and sixth postoperative day. In comparison to the classic method, the presented modification of staged repair of AWD makes an earlier reduction of the viscera into the abdomen possible and does not seem to be associated with a higher risk of mechanical or infectious complications.

Nervous system development in normal and atresic chick embryo intestine: an immunohistochemical study.

Intestinal motility disorders are a common complication after surgery for neonatal intestinal atresia. Although intestinal atresia causes alterations in the enteric nervous system, especially in its inner structures (nervous fibers in the mucosa, submucous and deep muscular plexuses), how these alterations develop is unclear. The chick model is a useful research tool for investigating the ontogenesis of the enteric nervous system and the pathogenesis of congenital bowel diseases. More information is needed on the overlap between the developing enteric nervous system and intestinal atresia. Because vasoactive intestinal polypeptide and substance P are typical intestinal neuropeptides, and vasoactive intestinal polypeptide acts as a modulator in neurodevelopment and an inhibitor of smooth muscle cell proliferation, our aim in this study was to investigate the distribution of their immunoreactivity in the developing enteric nervous system of normal and experimental chick models. We studied gut specimens excised from normal chick embryos (aged 12-20 days) and experimental chick embryos (aged 15-20 days) that underwent surgical intervention on day 12 to induce intestinal atresia (atresic embryos) or simply to grasp the bowel loop (sham-operated embryos). In normal chick embryos we showed vasoactive intestinal polypeptide and substance P immunoreactivity from day 12 in the submucous and myenteric plexuses. The distribution of peptide immunoreactivity differed markedly in atresic and normal or sham-operated gut embryos. These differences especially affected the inner structures of the enteric nervous system of specimens proximal to atresia and were related to the severity of dilation. Because nerve structures in the gut wall mucosa and submucous and deep muscular plexuses play a role in motility control and stretch sensation in the intestinal wall, our findings in the chick embryo may help to explain how gut motility disorders develop after surgery for neonatal intestinal atresia.

Nitrofen-induced congenital diaphragmatic hernia in rat embryo: what model?

PURPOSE: The aim of this study was to investigate the natural history of congenital diaphragmatic hernia (CDH) in rat embryos with special attention to the pathomorphologic changes of diaphragm, liver, intestines, and lungs at various stages of embryonic development. METHODS: Pregnant Sprague-Dawley rats were given, via a gavage tube, 100 mg nitrofen (Wako Chemicals, Neuss, Germany) on day 10.5 of gestation. Fetuses were harvested by laparotomy on day 15.5, 16.5, 18, and 21. Anatomic study of the diaphragm, herniated viscera, and lungs was performed under stereoscope with special attention to the diaphragmatic defect. RESULTS: CDH occurred in 44 embryos on right, in 10 on the left, and in 34 bilateral. In the youngest embryos, the small defect was located in the dorsomedial portion of the diaphragm very close to the aortic hiatus. During pregnancy, the defect enlarged progressively to occupy more than half of the affected hemidiaphragm on day 21. In all animals, regardless of their age and side of the defect, the liver was found inside the chest. The intrathoracic mass was formed by ingrown hepatic tissue originating from the dorsal surface of the intraabdominal liver. It appeared as an accessory liver lobe. The amount of intrathoracic liver increased rapidly. From around day 18, the thoracic portion of liver, when examined in sagittal plane, was bent forward and assumed an uncinate shape. The stomach and small bowel loops were displaced into the chest in the oldest examined fetuses. The first sign of reduction of size of the lung was seen in 16, 5-day old embryos, and at further stages of embryonic development the lung growth impairment strictly paralleled the ingrowth of the liver. The natural history of the right and left CDH were very similar. In fetuses with bilateral CDH, asymmetry regarding size of the defect and volume of intrathoracic hepatic mass was noted with larger defects on the left side in more than 60% of animals. CONCLUSIONS: Pathogenesis of nitrofen-induced diaphragmatic defect in the rat embryo and CDH in the human fetus seem to differ significantly. Nitrofen induces a complex malformation of the embryonic diaphragm and the liver. CDH in rat embryo bears more resemblance to a model of space-occupying lesion than to human CDH. The induction of localized hepatic proliferation may be a result of disturbance of as yet unknown regulatory interaction between hepatic and mesenchymal diaphragmatic cells.

Natural history of experimental intestinal atresia: morphologic and ultrastructural study.

PURPOSE: The aim of this study was to evaluate a natural history of congenital intestinal atresia (IA) in the chick embryo and to assess the type and nature of changes in the intestine at various developmental stages. METHODS: Chick embryos underwent operative induction of IA on the 12th day of incubation. The procedure consisted of electrocoagulation of the mesenteric vessels supplying a 7- to 8-mm intestinal segment. The embryos were subjected to macroscopic examination, histologic and ultrastructural studies of the preatretic and postatretic bowel using the light microscope, scanning, and transmission electron microscopes. All investigations were performed in an experimental group (operated embryos), in a control group, and in a sham-operated group on the 15th, 17th, 19th, and 21st day of incubation. RESULTS: The original technique of an iatrogenic "vascular event" proved to be effective because IA developed in 96% of embryos surviving the procedure. The affected portion of the bowel underwent progressive necrosis, and signs of bowel obstruction could be observed 48 hours after operation. Cord atresia (type II) developed in 81% of embryos. Histologic investigations showed progressive thinning of mucosa, flattening of mucosal folds, and epithelial detachment within the intestine proximal to atresia. There was only mild hypertrophy of the muscular layers. All these pathomorphologic changes were of rapidly progressive nature until the 17th day of incubation. Later, the rate of distension of preatretic bowel and histologic changes were less. Ultrastructural investigation of the proximal bowel showed progressive flattening of the enterocytes associated with their apical bulging, widening of the intercellular spaces, and microvilli atrophy. Surprisingly, at days 19 and 21 of incubation, signs of induction of adaptive mechanisms with partial restoration of near-normal microvilli pattern were observed. CONCLUSIONS: Study of natural history of experimental IA indicates that histologic and ultrastructural lesions of the bowel are of dynamic nature and are not only the effect of pathologic intraluminal pressure.

[High risk Wilms' tumor in children. Clinico-pathological correlation based on 320 patients registered in the Polish Paediatric Solid Tumor Study Group]. / Nerczak plodowy u dzieci z Wysokim ryzykiem zlosliwosci. Korelacje kliniczno-patologiczne u 320 dzieci zarejestrowanych w Polskiej Pediatrycznej Grupie ds. Leczenia Guzów Litych.

The records of 320 patients treated for Wilms' tumour in the first Wilms' Tumour Study (01-92 schedule) were reviewed and 42 children (13,86%) with unfavourable histology (UH) tumours were identified. There were 18 boys and 24 girls. Diffuse anaplasia was found in 26 patients (61,9%), focal anaplasia in 10 children (23,8%), CCSK and MRT were diagnosed in 3 patients each (7,1%). Clinical stages were: CS I - 5 (11,9%) patients, CS II N(-) - 7 (16,7%), CS II N(+) - 9 (21,4%), CS III - 15 (35,7%), CS IV - 5 (11,9%) and CS V - 1 patient (2,4%). Local and metastatic relapses of the disease occurred in 18 patients (43%). Seven of the 42 patients died, in 2 cases due to complications and in 5 from progression of the disease.

Paraoesophageal hernia in children: familial occurrence and review of the literature.

Paraoesophageal hernia (PH) in children is a rare entity, and most reported cases refer to adult patients. Its etiology is not precisely known, but the hypothesis of its congenital origin is widely accepted. Similarly to other congenital diaphragmatic defects, PH follows a sporadic pattern of incidence in most cases. Familial occurrence of sliding hiatal herniae has been reported in more than 20 cases, but only one family with two members affected by PH was described in the literature. We present two pairs of siblings with the paraoesophageal type of hiatus hernia and discuss the clinical presentation of this anomaly in children.

[Early and late complications of the use of life-cath type catheters in children with malignancies requiring urgent surgical intervention]. / Wczesne i pózne powiklania stosowania cewników typu life-cath u dzieci z choroba nowotworowa, wymagajace pilnej interwencji chirurgicznej.

Permanent access to the centrally positioned veins is necessary for the treatment of children with malignancy. The Broviac-Hickman's catheters and venous port system fulfill this require. Since January 1992 to February 1998, 276 intravenous life-cath devices were installed. In 7 patients life-threatening complications after catheter implantation occurred, which demanded urgent surgical intervention. The complications appeared in both early and late periods after catheter insertion. Pneumothorax (three children), bleeding to the mediastinum (one patient), fragmentation, disconnection and migration of a separate part of catheter into the right heart (two patients) were observed. The way of treatment and its results were described.

[Concurrent goiter and vitiligo in a 13-year old boy]. / Wspólwystepowanie wola koloidowego oraz bielactwa nabytego u 13-letniego chlopca.

The coincidence of goitre and vitiligo in 13-year-old boy is reported. Skin changes appeared two years before the thyroid disease was diagnosed. Immunological investigation revealed the presence of anti-thyroid antibodies, which may suggest an autoaggressive etiology of both disorders.

[Tutoplast-Dura and Zenoderm-Corium implant--materials for tissue replacement. Experimental studies]. / Tutoplast-dura i Zenoderm-Corium implant--materialy do zaopatrywania ubytków tkanek. Badania doswiadczalne.

The results of experimental studies with the use of two biostatic materials: solvent-preserved human dura mater (Tutoplast-Dura--Pfrimmer-Vigo) and lyophilized porcine dermis (Zenoderm-Corium implant--Ethicon) as prosthesis of deficient, abdominal wall tissue are submitted. The studies were performed on an animal model and consisted on the evaluation of mechanical and biological qualities of the investigated materials as well as their surgical handiness and tissue tolerability. The application of knitted polyester net as a reinforcing agent for both materials was also estimated. Process of incorporation of the prosthetic material was investigated macroscopical at 3, 6 and 12 weeks after the implantation. The experimental trials revealed the usefulness of Tutoplast-Dura and Zenoderm-Corium implant in reconstructive surgery in account of their good biocompatibility and adequate, mechanical properties. It was stated that Tutoplast-Dura was characterized by remarkably better surgical handiness in comparison to Zenoderm-Corium implant. Additional mechanical reinforcement with polyester net was not necessary.