Shigeru Fujisaki

The role of nitric oxide (NO) in the human internal anal sphincter

Purpose. Nitric oxide (NO) has recently been shown to be a neurotransmitter in nonadrenergic noncholinergic (NANC) inhibitory nerves in the human gut. To clarify the physiological significance of NO in the human internal anal sphincter (IAS), we investigated enteric nervous responses in normal IAS muscle strips above the dentate line, obtained from patients with rectal cancer. Methods. Normal IAS muscle strips above the dentate line, obtained from ten patients who underwent rectal amputation for low rectal cancers were used. The subjects consisted of eight men and two women, aged from 46–72 years (mean age, 54.2 years). A mechanographic technique was used to evaluate in-vitro IAS muscle responses to electrical field stimulation (EFS) of adrenergic and cholinergic nerves before and after treatment with various autonomic nerve blockers, NG-nitro-l-arginine (l-NNA) and l-arginine. Results. Excitatory nerves were mainly involved in the regulation of enteric nerve responses to EFS in the baseline condition of the study, and NANC inhibitory nerves acted on the normal IAS. l-NNA concentration-dependently inhibited the relaxation in response to EFS in the human IAS, and this inhibitory effect in the IAS was reversed by l-arginine. Conclusions. These findings suggest that NANC inhibitory nerves play important roles in regulating relaxation of the human IAS, and that NO plays an important role as a neurotransmitter in NANC inhibitory nerves of the human IAS.

Studies on Omental Implantation with or without Postoperative Complications for Perforated Duodenal Ulcer.

十二指腸潰瘍穿孔術後 (大網充填閉鎖術) 症例20例を術後合併症の無 (A群), 有 (B群) から2群に分け (それぞれ10例), 入院時臨床的特徴を検討した. 呼吸器合併症が最も多く, 手術直接死亡例 (直死例) はDICであった. 60歳以上症例はB群がA群より多い傾向 (p<0.1) を示し, 直死例2例はともに60歳以上であった. 発症から手術までは, A群では全例10時間以内で, B群の直死例はいずれも72時間以上であった. B群がA群より有意にCRPは高値, 総蛋白量は低値 (それぞれ, p<0.01) で, 直死例は, CRPは高値, 総蛋白量は低値であった. 肝機能と胸部X線検査上の異常はB群がA群より多い傾向を示し (p<0.1), 直死例1例に異常を認めた. 腹水中細菌陽性率はB群がA群より高率であり, Candida albicansとKlebsiella pneumoniaeが最も多く, 直死例ではいずれもKlebsiella pneumoniaeが認められた.

Anorectal Manometric Studies in Patients with Symptomatic and Asymptomatic Rectocele.

排便障害 (残便感, 便秘, 排便困難, 会陰部重圧感など) の有無により, rectocele例 (全例女性;有症状38例, 無症状16例) の病態生理学的相違があるかどうかの解明を目的に, 直腸肛門内圧検査法を用いて, 排便異常のない女性 (16例) を対照に比較検討した. その結果, 排便障害の有無に関係なく, 内・外肛門括約筋機能 (対照に比較して, 肛門管最大静止圧と肛門管最大随意収縮圧は明らかに低値), 直腸貯留能 (対照に比較して, 直腸最大耐容量は低値, コンプライアンスは明らかに低値), 直腸感覚能 (直腸最小知覚量と直腸最小耐容量は高値) などの低下を認めた. そして, 直腸内圧は対照より明らかに高値を示した. すなわち, rectocele例では, 排便障害の有無に関係なく, 直腸壁の弾性能低下に高い直腸内圧が存在していることが判明した. これらのことは, rectoceleの成因に関与している可能性を示唆するものと思われた.