James R. Newland

Comparison of techniques for growing small bowel neomucosa

Small bowel neomucosa has been grown on a variety of surfaces. The purpose of this study was to compare the rate of growth and function of neomucosa on colon serosa (CS) and abdominal wall muscle (AM) in New Zealand white rabbits. The terminal ileum was incised for 5 cm and patched with either adjacent CS (23 animals) or AM (19 animals) to create a 2 X 5-cm defect. Gross and histologic examinations of the specimens at 1, 2, 4, and 8 weeks revealed that the rate of growth was similar in both groups. There was minimal lateral ingrowth at 2 weeks, nearly complete coverage of the defects at 4 weeks, and complete coverage of the defect at 8 weeks in more than 85% of animals with mature villi and muscularis mucosae. The ileal diameter at the site of patching increased in both groups from 11.9 +/- 2.6 to 16.3 +/- 3.2 mm in the CS group and 11.3 +/- 2.5 to 15.1 +/- 1.8 mm in the AM group (P less than 0.01). Glucose uptake was similar in both groups being 65.4 +/- 24.1% of control in the CS group and 73.9 +/- 29.8% in the AM group. Brush border enzyme activity of sucrase, maltase, and lactase was similar to controls in the AM group but in the CS group activity of sucrase and maltase were significantly less than controls (P less than 0.01). Average body weight was increased postoperatively in both groups. There was one anastomotic leak in each group and two cases of partial intestinal obstruction in the abdominal wall group.(ABSTRACT TRUNCATED AT 250 WORDS)

Growth of intestinal neomucosa on prosthetic materials

The short bowel syndrome is a potential complication of the surgical management of diseases of the large and small intestine. Recently methods have been examined for expanding the small bowel absorptive area using prosthetic materials. We investigated the feasibility of growing intestinal mucosa on prosthetic patches and tubes. Ileal defects were patched with a 2 X 5-cm patch of either Dacron (n = 15), polyglycolic acid mesh (PGA) (n = 9), or polytetrafluroethylene (PTFE) (n = 5) prosthesis in New Zealand white male rabbits. Gross and microscopic analysis at 2, 4, and 8 weeks revealed that the serosal surface was covered with neomucosa by 4 weeks. Dacron and PTFE grafts were either minimally attached or extruded and PGA grafts had dissolved. At 8 weeks, none of the patches were present but with all three materials the resultant area of neomucosa was only 15% of the original defect. The neomucosa was functional as determined by glucose uptake and disaccharidase activity. Three centimeter Dacron tubes were interposed in the distal ileum of 10 rabbits and in a bypassed ileal segment in 11 rabbits. There was an 80% mortality within 2 weeks, and no evidence of neomucosal growth. Although prosthetic patches support the growth of functional neomucosa, there is a minimal increase in the final surface area. The type of prosthesis did not influence the outcome. The use of Dacron tubes is associated with high mortality and no neomucosal growth. The use of prosthetic materials is not likely to be useful in the clinical management of the short bowel syndrome.

Abdominal pregnancy: Magnetic resonance identification with ultrasonographic follow-up of placental involution

Abdominal pregnancy is a rare event and preoperative diagnosis may be difficult. Recently, sonographic examination and magnetic resonance imaging have proved helpful in the preoperative diagnosis in a patient who presented with advanced abdominal pregnancy after tubal sterilization. As well, ultrasound was of benefit in the follow-up of placental involution after delivery.

The effect of dietary fat on metastasis of the lewis lung carcinoma and the BALB/c mammary carcinoma

The effect of feeding mice diets high in beef tallow (high in saturated fat) or corn oil (high in polyunsaturated fat) on the production of lung metastases by the Lewis lung carcinoma and the BALB/c mammary tumor was determined. Diets were fed ad libitum, and the mice fed the high-fat (24.6%) diets consumed more calories and gained more weight than those fed the control (5%) diets. With the Lewis lung carcinoma, we found that both high-fat diets significantly increased the growth of the primary tumor in the footpad as well as the number of spontaneous metastases produced after the primary was removed; this was in comparison with results from the appropriate control diets. With the BALB/c mammary tumor, the high-fat beef tallow diet (but not the corn oil diet) significantly increased the number of lung metastases formed after tail vein injection. In addition, the group given the control corn oil diet had more metastases than the group given the control beef tallow diet. Overall, these studies showed that the consumption of high-fat/high-calorie diets increased metastasis compared to the consumption of high-fat/high-calorie diets increased metastasis compared to the consumption of low-fat diets. However, the results varied depending on the tumor model used and the type of fat.

Experience with a program of faculty development.

The authors describe the faculty development program at the University of Nebraska Medical Center. Faculty needs were identified in instructional skill development, academic socialization and mentoring. Committees with campus-wide representation designed the instructional activities. Among the total 749 faculty, 59% attended at least one faculty development offering consisting of one and two-day institutes or two-hour luncheon workshops in the past five years. Evaluations ranked each event highly for quality, relevance, impact on teaching and usefulness. Experiences in creating a successful faculty development program at an academic medical center are reported. Success was measured by attendee numbers and increased participation of faculty in teaching and mentoring. Factors contributing to this success include generous financial support by leadership, broad-based planning and administrative support.

Uterine cervical and vaginal verrucous squamous cell carcinoma

Abstract A case of verrucous squamous cell carcinoma involving the cervix and vagina simultaneously is described. The tumor was aggressive locally, recurring after radical hysterectomy and total vaginectomy. It recurred again after local radiation of minimal disease. Treatment of verrucous squamous cell carcinoma is discussed.

Chemical induction of ovarian epithelial carcinoma in mice

Murine ovaries were treated with silk sutures saturated with a solution of 7,12-dimethylbenz(a)anthracene in beeswax. One of 35 animals developed an epithelial carcinoma. This tumor was not successfully transplanted into young animals.

Fentanyl intermittent bolus technique for anesthesia in infants and children undergoing cardiac surgery

The use of fentanyl by an incremental intravenous (IV) bolus technique was evaluated in eight pediatric patients (ages 4 months to 5 years, ASA III-IV) undergoing corrective surgery for congenital heart defects. Anesthesia was induced with 5 to 10 micrograms/kg of fentanyl. Additional boluses of comparable size were given intermittently thereafter, in order that a total dose of 100 micrograms/kg was achieved just before instituting cardiopulmonary bypass (CPB). Heart rate, systolic blood pressure, various measures of anesthetic depth, and plasma fentanyl levels measured by radioimmunoassay were compared at various points during anesthesia, surgery, and recovery. Decreases in heart rate were observed at the time of sternal incision and at 30 minutes thereafter, when doses of fentanyl were near-maximal. No changes from baseline in systolic blood pressure or in anesthetic depth occurred at any of the intervals studied. The plasma concentration of fentanyl was 30 +/- 8 ng/mL just after completion of the fentanyl administration, immediately before CPB. With onset of CPB, the fentanyl level fell to 13 +/- 9 ng/mL, a statistically significant difference from the baseline value. No further change occurred over the additional 231 +/- 74 minutes in the operating room. The fentanyl concentration was 10 +/- 4 ng/mL upon entry into the recovery room. It is concluded that administration of fentanyl in small, intermittent IV boluses, with dosing completed before the onset of CPB, produces satisfactory plasma levels, anesthesia, and hemodynamic stability in children undergoing corrective surgery for congenital cardiac defects.

Heterotopic liver of the jejunum: report of a case and a review

A case of heterotopic liver of the jejunum confirmed by electron microscopy in a 2-year-old girl is described. We review the literature regarding heterotopic liver and discuss its embryogenesis. We suggest that in our case, there was trapping of hepatocyte-destined mesenchyme prior to biliary tree development.

Blood coagulation: A review

Blood coagulation consists of several interrelated reactions involving platelets and blood vessels, the classical cascade, and the fibrinolytic system. There is a complex of inhibiting influences on each of these schemes, and there are interrelationships among these inhibitory influences.