Herbert J. Kaufmann

Anal Sphincter Pressure Characteristics

Summary A simple method for recording pressures in the anal sphincter during distention at rest and during voluntary contraction is presented. The resting sphincter resists distention until a resting yield pressure is reached, after which further distention of the sphincter produces no further pressure rise. Maximal sphincter pressure is reached by voluntary contraction only after the recording balloon has been distended to the volume needed to reach the resting yield pressure. The ability of the sphincter to resist distention appears to be the mechanism for maintaining continence at rest; however, contraction of the voluntary component of the anal sphincter can forcibly close the sphincter when distended and thereby maintain continence. Of 48 subjects studied, all 14 with incontinence were found to have normal resting yield pressures, but maximal sphincter pressures varied depending upon the cause of incontinence. Most patients with incontinence had low maximal sphincter pressure, but incontinence was not invariable with low maximal sphincter pressure. It is possible to differentiate patients with incontinence as the result of abnormalities of the voluntary component of the anal sphincter from those patients with incontinence of other cause.

Esophageal Manometry in Scleroderma

Esophageal manometry was performed in 21 cases of scleroderma, including a number of patients with mild diseases. Previous reports have emphasized aperistalsis in the lower esophagus as the most characteristic feature but it was found that weakness of contraction was the most common feature. This was often coupled with aperistalsis. Abnormalities of the lower sphincter were common, as was absence of an end-expiratory gastroesophageal gradient. Multiple peaking of responses and segmental weakness were also seen.Most of the abnormalities seen are non-specific. Scleroderma can only be diagnosed manometrically when very marked changes coupled with a negative Mecholyl test are present.

Estrogens and gastric secretion.

Summary The gastric secretory response in patients and monkeys was studied before, during, and after treatment with estrogens. No significant decrease in acid or pepsin secretion could be demonstrated, although a suggestion of a decrease in acid secretion was noted. This does not, by itself, explain the alleged benefits of estrogens on the course of peptic disease and neither does it explain some of the well recognized sex differences in peptic disease and acid secretion.

Intestinal epithelial enzyme abnormalities induced by 5-fluorouracil: Translocation of NADPH2-dehydrogenase

SummaryGraded doses of 5-fluorouracil were administered to mice. Histochemical studies for dehydrogenases, alkaline and acid phosphatase, and nonspecific esterases were performed. As small- and large-bowel tissue became more severely damaged, the enzyme activity was generally decreased. In the colon, but not in the small bowel, NADPH2D was noted to translocate from a diffuse normal pattern to a luminal border pattern. This was also observed in 1 patient treated with 5-FU.

Chylous ascites and intestinal muscular hypertrophy occurring in the course of celiac sprue.

SummaryChylous ascites developed in the course of celiac sprue and disappeared on treatment. Its presence was probably related to the mesenteric nodal hyperplasia which is known to occur in celiac sprue. Muscular hypertrophy of the intestinal wall was found and may be related to the motility disorders of celiac sprue. Its improvement appears to parallel mucosal improvement.

Prevention of 5-FU Induced NADPH-D Translocation in Colonic Epithelium by Antibiotics and the Effect on the Intestinal Bacterial Flora

One hundred and thirty-two mice were studied for the effects of 5-FU, neomycin, and penicillin on the histology and histochemical localization of dehydrogenases in colonic epithelium. These effects were correlated with the aerobic and anaerobic enteric bacterial flora. 5-FU induces a luminal distribution of NADPH-D in colonic epithelium. Both neomycin and penicillin prevent this translocation. It was not observed in control animals or with the NADH-D reaction. Neomycin and penicillin both had definite effects on the mouse colonic flora, but these effects were not similar and the reason they prevent this translocation is not clear, although it appeared to be related to an alteration in the aerobic coliform bacterial flora.