Shoichi Kohatsu

Diverting ileostomy in the surgical management of Crohn's disease of the colon.

Abstract Diverting ileostomy has been performed in thirteen patients with Crohns disease of the colon with or without ileal involvement. Immediate and persistent relief of symptoms has occurred in all patients in three to twenty-four months (mean sixteen months) without evidence of recurrence. Radiologic as well as histologic findings have shown a return towards normal. Three patients have undergone restoration of intestinal continuity after two years. A mild recurrence developed in one patient which was controlled by corticosteroids whereas the other two remain well after two and thirty-six months. The results of diverting ileostomy have been unsuccessful in cases of chronic ulcerative colitis, further serving to illuminate fundamental differences in addition to clinical and histologic differences between these two inflammatory conditions. Further experience with this mode of therapy is justified.

Combined treatment of cancer of the esophagus

Abstract Forty patients with carcinoma of the thoracic esophagus were entered into a treatment plan utilizing megavoltage radiation therapy and excision of the entire thoracic esophagus. No patient with advanced primary disease or metastasis to the regional lymphatics benefited from this plan of treatment. Three patients are alive and without disease, nine, thirty-six, and sixty-two months after surgery, respectively.

Comparative anatomy of feline and canine gastric sling fibers. Analogy to human anatomy.

Investigation of the function of human sling fibers is not feasible with the use of technics currently available for animal experiments. Thus, this study examined the anatomy of the gastric sling fibers in 22 dogs and 16 cats to determine if either or both resemble that of the human. In both species, the gastric sling fibers hooked around the notch between the gastric fundus and distal esophagus, and traversed the stomach, anteriorly and posteriorly, parallel to the lesser curve, finally disappearing near the incisura angularis. A constrictor cardiac muscle was found at the upper limit of the sling fibers in both species. The muscularis propria of the distal esophagus of the dog was found to be striated. In contrast, smooth muscle was present in the distal esophagus of the cat. Furthermore, a vestibule, analogous to that described in man, was found in the cat but not in the dog. It has been postulated that the sling fibers play a role in the sphincteric mechanism of the distal esophagus. Our finding that the anatomy of the sling fibers and the distal esophagus in the cat resembles that of man suggests that it would be a more suitable model than that of the dog.

Use of indium-111-labeled autologous leukocytes in differentiating pancreatic abscess from pseudocyst☆

Pancreatic abscess is very difficult to diagnose and the differentiate from pancreatic pseudocyst based on clinical findings, laboratory studies and roentgenographic examinations. Eight patients diagnosed as having a pancreatic mass by ultrasonography or computed tomography also underwent indium-111-labeled autologous leukocyte scanning (10 scans) for suspected intraabdominal sepsis. This scan detects migration of labeled leukocytes into abscesses or areas of inflammation. Four patients had abscess and positive scans, and four patients had pseudocyst and negative scans. There was one false-positive scan in a patient with a recurrent pancreatic mass after drainage of an abscess. Since pancreatic abscess requires prompt drainage, and since it may be preferable to delay drainage of a pseudocyst, the differentiation of these two conditions is important. This test appears very effective in diagnosing pancreatic abscess and differentiating it from a pseudocyst.

Electrical, contractile, and radiographic studies of the stomach after proximal gastric vagotomy.

The effects of proximal gastric vagotomy on the gastric electrical and contractile activities and on gastric emptying of solid food were studied in dogs. Proximal gastric vagotomy produced only minimal alteration of the electrical activity and did not significantly alter the response of the electrical and contractile activities to vagal stimulation (insulin) and local stimulation (food). Barium meal studies showed no delay in gastric emptying time after proximal gastric vagotomy but significant delay after truncal vagotomy. The findings support the clinical impression that gastric motility and empyting (solid) remain relatively normal after proximal gastric vagotomy.

Canine gastric sling fibers: Contractile properties

The contractile properties of canine sling fibers and the longitudinal and circular muscles were characterized and compared. The longitudinal and circular muscles developed spontaneous contractions, but the sling fibers developed no spontaneous phasic contractions. The cholinergic receptors of all three muscles were excitatory. The alpha- and beta-adrenergic receptors of the longitudinal and circular muscles were inhibitory, but the sling fiber alpha-adrenergic receptors were excitatory and the beta receptors inhibitory. Large concentrations of atrophine induced contractions of all three muscles. Some of the contractile properties of the sling fibers are more similar to those of the distal esophageal circular muscle than to those of the gastric longitudinal and circular muscles. The sling fibers together with the esophageal circular muscle may play an important role in the gastroesophageal sphincter mechanism.

Chronically implanted catheters for recording gastrointestinal pressures in animals

The open tube method with a low pressure-volume coefficient is a suitable way of studying intraluminal pressure changes in the stomach or intestine in animals. For long-term studies in awake, unrestrained animals, a fixed, implanted, and durable catheter offers many advantages as this method avoids the problems of passage and positioning of the catheter and possible stimulation of the bowel by its motion against the mucosa. We have described a simple method of construction and implantation of silicone rubber catheters in the stomach of the dog which can be used to measure pressure changes over a long period of time.

Diverting ileostomy for colonic Crohn's disease part I: Significance of ulcers 5 mm in depth or deeper on the preoperative barium enema

In patients with colonic Crohns disease who had failed to respond to medical treatment, a diverting ileostomy resulted in persistent relief of symptoms in 60% of the cases. The authors reviewed the radiographs performed prior to diverting ileostomy on 15 patients who had colonic Crohns disease. A number of spike-like ulcers in the colon, 5 mm in depth or deeper, of various types, occurred in patients in whom surgery had failed. Ulcers 5 mm or greater in depth destroy the colonic muscularis propria and, if numerous, probably result in irreversible changes. If studies on larger numbers of patients confirm this finding, diverting ileostomy would be indicated before numerous deep ulcers develop.

Diverting ileostomy for colonic Crohn's disease part 2: Radiological findings in the colon following diversion

In 14 patients, the radiological and clinical features preceding and following diverting ileostomy were evaluated. Clinical improvement was usually associated with disappearance of ulcers and nodules. There was either no change in length or width of the colon or only slight increases or decreases in length or width, in various combinations. Clinical relapses were all severe enough to warrant colectomy and were marked by severe narrowing or narrowing and shortening of the colon, or reappearance of ulcers or nodules. Asymptomatic radiographic relapses also occurred. Radiological follow-up is therefore essential, and intestinal continuity should not be re-established for some time after a radiological relapse has become evident.

The current status of electrogastrography

SummaryMost of our present concepts and basic knowledge of gastric muscle electrophysiology are based on animal studies. A brief review of those studies which are relevant in understanding the human studies are presented.The studies of human electrogastrography and the present concepts of clinical electrogastrography are reviewed. The various types of electrodes used to record the electrogastrograms, and their advantages and disadvantages are discussed. The physiological data presently available from electrogastrograms are presented.ZusammenfassungDer Großteil der heute vorherrschenden Konzepte und Kenntnisse der Magenmuskel-Elektrophysiologie beruht auf Beobachtungen am Tier. Der Autor erläutert die zum Verständnis der beim Menschen vorliegenden Verhältnisse notwendigen Gegebenheiten. Die Anwendungsmöglichkeiten der Elektrogastrographie beim Menschen und der Stand der klinischen Elektrogastrographie werden eingehend dargestellt. Verschiedene auf diesem Gebiet angewendete Elektrodentypen und deren Vor- und Nachteile werden erläutert. Die Studie stellt ebenfalls eine Übersicht der bis jetzt erhaltenen physiologischen Resultate dar.