R. Tomita

A role of nitric oxide in Hirschsprung's disease

Nitric oxide (NO) has recently been shown to be a neurotransmitter in the nonadrenergic noncholinergic (NANC) inhibitory nerves in the gastrointestinal tract. To clarify the significance of NO in Hirschsprungs disease (HD), enteric nerve responses in colonic tissue obtained from HD patients were investigated. Colonic tissue specimens were obtained from four patients with HD and from 11 patients without constipation who were used as controls. A mechanograph was used to evaluate in vitro colonic responses to electrical field stimulation (EFS) of the adrenergic and cholinergic nerves before and after treatment with various autonomic nerve blockers, and NG-nitro-L-arginine (L-NNA) and L-arginine with the following results: (1) NANC inhibitory nerves were found to act on normal human colon, but had no effect on aganglionic colon; (2) L-NNA concentration dependently inhibited the relaxation in response to EFS in the normal colon, but had no effect on aganglionic colon; and (3) this inhibitory effect was reversed by L-arginine in the normal colon, but had no effect on the aganglionic colon. Nitric oxide mediates the relaxation reaction of NANC inhibitory nerves in the human colon, but the effect of NO was absent in aganglionic colon. The loss of action by NO may be implicated in the impaired motility observed in aganglionic colon.

Electrophysiologic assessments in pudendal and sacral motor nerves after ileal J-pouch-anal anastomosis for patients with ulcerative colitis and adenomatosis coli

PURPOSE: To clarify neurologic function with respect to external anal sphincter and puborectalis muscles after J configuration ileal J-pouch-anal anastomosis for patients with ulcerative colitis and adenomatosis coli, we examined the terminal motor latency in the pudendal and sacral motor nerve (S2-4). METHODS: Latency of the response in the external anal sphincter muscle following digitally directed transrectal pudendal nerve stimulation (PNTML) and in the puborectalis muscle following transcutaneous magnetic stimulation of the cauda equina at the levels S2-4 (SMNLTSS) were measured in 12 patients with ileal J-pouchanal anastomosis; they were divided into a group with continence (7 cases) and a group with soiling (5 cases). Results were compared with data obtained from 12 patients before operation and 15 controls. RESULTS: Conduction delay of PNTML and SMNLTSS in patients with soiling was longest, followed by delay in those without any soiling, then delay in patients before operation, and then controls. In addition, significant differences were also noted between conduction delay of PNTML in controls and those who are incontinent and experience soiling(P< 0.05 andP< 0.01, respectively), and there were significant differences also noted between conduction delay of PNTML in patients before operation and those who are incontinent and experiencing soiling(P< 0.05 andP< 0.01, respectively). Conduction delay of PNTML and SMNLTSS were found in patients before operation rather than in controls. No significant differences were noted between conduction delay of PNTML and SMNLTSS in patients before operation and controls. Significant differences were also noted between conduction delay of PNTML and SMNLTSS in patients who are incontinent and experiencing soiling(P< 0.01, respectively). CONCLUSION: These findings support the hypothesis that soiling after this procedure may be partially caused by damage to pudendal and sacral motor nerves (S2-4).