J. F. W. Haffner

Surgical Treatment of Ulcerative Colitis in Children

. Twenty-four children below the age of 16 were operated on for ulcerative colitis at Rikshospitalet during the 20-year period 1960-79. Fifteen were treated primarily with colectomy and ileo-rectal anastomosis (IRA), nine with proctocolectomy and ileostomy (PCI). There were twice as many boys as girls in both groups, an equal age distribution (median 13 1/2 years for IRA, 14 1/2 for PCI), and identical median duration of disease (3 1/2 years). Twenty-three of the 24 patients were below the expected weight and/or height for their age, 6 in each group were more than 2 SD. below. Six patients with IRA had been treated with steroids, compared with 5 with PCI. Six patients with IRA had normal rectal mucosa, 2 mild, five moderate and one severe proctitis. One had a rectal stricture. Two of the patients with IRA required immediate reoperation, and one subsequently died because of leakage at the anastomosis and septicaemia. One further patient, who required immediate proctectomy because of bleeding, also died of septicaemia. Six other IRA patients have required proctectomy later because of proctitis. One has died of rectal carcinoma. Five IRA patients are alive with intact rectum, but 2 require treatment for proctitis. None of the patients with PCI are dead, one has required an external revision of the ileostomy, otherwise the primary treatment has been completely successful. None have stomal, urinary or sexual dysfunction. It is concluded that colectomy with IRA gives poorer results than proctocolectomy with ileostomy in children, just as it does in adults. The results of PCI are so good that the present paediatric prejudice against surgical treatment seems quite unjustified.

Excitatory Adrenergic Receptors in the Human Stomach and Pylorus

The responses to cholinergic and adrenergic drugs in human muscle strips from stomach and pylorus have been studied in vitro. Acetylcholine and carbacholine induced contractions in all preparations tested. The responses were blocked by atropine. The response to adrenaline and noradrenaline elicited contractions in some preparations; in others biphasic responses or inhibition was obtained. Reversal of the response was also produced in some preparations by increasing the dose. The studies indicate excitatory adrenergic α-receptors in addition to inhibitory α- and β-receptors.

Serotonin–A Possible Transmitter for the Gastric Adaptive Relaxation

Serotonin, or 5-hydroxytryptamine (5-HT), relaxes upper guinea pig stomach, and its possible role as a transmitter in the vagally induced upper gastric adaptive relaxation has been discussed. Such a transmitter is expected to act via other mechanisms than crude muscle depression. To test whether the relaxation response to serotonin is compatible with a putative role as transmitter in gastric adaptive relaxation, we wanted to evaluate whether serotonin acts by crude muscle depression and whether it selectively inhibits histamine or prostaglandin F2 alpha (PGF2 alpha). The study shows that 5-HT, in addition to its relaxatory effect on fundic spontaneous activity, selectively inhibits histamine, whereas PGF2 alpha is not inhibited. It is then concluded that the relaxatory effect of 5-HT is provided through other mechanisms than crude muscle depression and that selective inhibition of intramural agonists, like histamine, is a possible effect mechanism.

Blood Flow of the Hyperplastic and Neoplastic Human Prostate Measured by Hydrogen Polarography

Twenty-seven recordings of prostatic blood flow were made in 24 patients, using the hydrogen polaro-graphy method. The blood flow varied from 14.5 to 46.9 ml/100 g/min. In 12 patients with benign hyperplasia the mean prostatic blood flow was 26.7. In 6 patients with clinically manifest carcinoma, and in 4 patients with unsuspected carcinoma, the corresponding values were 23.2 and 32.1 ml/100 g/min. The blood flow was not significantly different in the three groups. Treatment with stilboestrol did not change the blood flow significantly.Periurethral tissue had a mean flow of 37.5 ml/100 g/ min, which is significantly higher than that of prostatic tissue.It is concluded that hydrogen polarography can be used to measure prostatic blood flow, but it appears to be of no diagnostic value in distinguishing between prostatic carcinoma and benign hyperplasia.

The effect of ranitidine on oesophageal motility.

Ranitidine is used to treat symptomatic oesophageal reflux; its effect is probably to a great extent due to reduced gastric secretion. Whether it also affects oesophageal motility is a matter of controversy. In a randomized double-blind study oesophageal motility was recorded in 21 healthy individuals after 3 doses of 150 mg ranitidine or placebo given over 36 h. Ranitidine increased the pressure in the lower oesophageal sphincter from 14 to 18 mmHg (p = 0.05) but otherwise did not influence oesophageal motility.