Intrauterine exposure to indomethacin.
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Female↗
Biomedical subjects
D Tibboel
Publications and source records attributed to D Tibboel.
Disturbed defecation after colectomy for aganglionosis investigated with monoclonal antineurofilament antibody.
Experience with 108 neonates treated for aganglionosis at the Sophia Children's Hospital, Rotterdam, between 1975 and 1983 has been reviewed. Twenty two of them suffered from disturbed defecation postoperatively, involving 16 cases of classical Hirschsprung's, 4 long-segment aganglionosis, 1 case of aganglionosis up to the cecum, and 1 total aganglionosis. The monoclonal antineurofilament antibody NF2F11 was used to investigate ganglionated as well as aganglionic bowel specimens of these patients as well as 17 patients from the remainder without postoperative constipation serving as controls. The original diagnosis was confirmed in all cases. Proximal ganglionated bowel of all 17 controls appeared normal, while the antibody revealed normal bowel in only 4 out of the 22 patients with postoperative constipation. In 18 cases this new staining technique revealed the picture of pseudo-obstruction. Early recognition of pseudo-obstruction in proximal ganglionated bowel would provide early warning of postoperative complications.
Antibodies, Monoclonal↗
Developmental aspects of gastroschisis.
The development of gastroschisis was studied experimentally as well as clinically, particularly concerning the characteristic fibrous coating of the protruding bowel loops, associated intestinal atresia, and postoperative hypoperistalsis without intestinal obstruction. Experimental investigation was carried out in the chicken embryo. The clinical study was a joint one, involving a total of 50 patients with gastroschisis seen at the Sophia Children's Hospital, Rotterdam, and the Royal Hospital for Sick Children, Glasgow, between 1972 and 1985. Some patients were followed antenatally. The results, correlating with previous experiments, were compared with data from the literature. The fibrous coating of the protruding bowel loops appeared to be a late occurrence and directly related to changes of the amniotic fluid secondary to the onset of renal function. Associated intestinal atresia and postoperative hypoperistalsis in the absence of an obstruction both appeared to be due to another late gestational event, consisting of ischemic changes of the bowel wall secondary to the compression of bowel loops and mesentery in the small abdominal wall defect.
Abdominal Muscles↗
Diagnosis of congenital neurogenic abnormalities of the bowel with monoclonal anti-neurofilament antibodies.
The diagnostic properties of two monoclonal, antineurofilament antibodies were tested in a retrospective investigation of bowel specimens of 24 cases of Hirschsprung's disease, eight cases of long-segment aganglionosis, eight cases of pseudo-obstruction, and six cases of chronic constipation. Immunohistochemical staining with the antibodies in combination with hematoxylin counterstaining revealed six distinctive and divergent pictures, demonstrating innervation disturbances in all cases. Apart from Hirschsprung's disease and long-segment aganglionosis, characteristic pictures also appeared for pseudo-obstruction and, diversely, for chronic constipation. In addition, anomalies were revealed in the ganglionic, proximal bowel of five patients with Hirschsprung's and two with long-segment aganglionosis, who had all suffered from chronic constipation postoperatively.
Antibodies, Monoclonal↗
The importance of mesenteric vascular insufficiency in meconium peritonitis.
The etiology of bowel perforations leading to meconium peritonitis was investigated in an attempt to explain the occurrence of such perforations in the absence of primary intestinal obstruction. Bowel specimens from 22 patients who had presented with meconium peritonitis during a 15-year period, as well as specimens from five patients with intestinal atresia without associated meconium peritonitis, were re-evaluated microscopically. An extensive review of the literature concerning meconium peritonitis, involving 1,084 patients, was compared with the results of a retrospective study of 69 patients from The Netherlands. In approximately 50 per cent of these cases there was no detectable primary cause of the bowel perforation. The pathologic findings, in combination with earlier experimental studies, indicate that vascular insufficiency may result in bowel wall perforation without prior intestinal obstruction. It is suggested that temporary decrease of mesenteric blood flow could lead to intestinal atresia and/or meconium peritonitis.
Birth Weight↗
Histopathological investigation of duplications of the alimentary tract.
Lack of information on the morbid anatomy of duplications of the alimentary tract stimulated an evaluation of patients with such duplications seen at the Sophia Children's Hospital, Rotterdam, from 1970 to 1984. There were 14 patients in all, involving 2 foregut, 6 midgut, and 4 hindgut duplications. Resected material of 12 of these patients has been investigated with particular emphasis on the presence of nervous tissue in these duplications. Routine histological as well as histochemical staining procedures have revealed nervous tissue in practically all duplications investigated. Considering the findings reported in the literature with reference to the earliest manifestation of nerve cells throughout the alimentary tract, the results demonstrate that duplications occur well before the 12th week of gestation.
Autonomic Nervous System↗
Pathologic explanation for postoperative obstipation in Hirschsprung's disease revealed with monoclonal antibody staining.
Until now, no pathologic explanation could be found for the postoperative obstipation occurring in some patients with intestinal aganglionosis. Twenty-two of 108 infants treated for intestinal aganglionosis suffered from postoperative obstipation. Resected material from these 22 patients and from 17 control subjects was investigated with monoclonal anti-neurofilament antibody staining. An abnormal staining pattern was revealed in 18 of the constipated patients. Consequently, this new immunohistochemical staining technic has revealed a hitherto unsuspected cause for postoperative obstipation in aganglionosis. The monoclonal antibody may provide early warning of such postoperative constipation.
Antibodies, Monoclonal↗
The development of the characteristic anomalies found in gastroschisis--experimental and clinical data.
Gastroschisis was investigated experimentally as well as clinically. An experimental model developed in the chick embryo demonstrated that the characteristic picture of gastroschisis evolved only if the herniated bowel was exposed to urine components in the allantoic fluid. Remarkable similarities were revealed on comparing changes in human amniotic fluid composition (from 30th week) with changes in chicken allantoic fluid composition (from 15th day of incubation). These changes correlate with progressive fibrotic coating of the exposed bowel loops leading to the characteristic picture of gastroschisis. No fibrous coating was found in human foetuses with a gestational age under 30 weeks, while investigation of these foetuses did confirm that gastroschisis itself occurs at an early developmental stage (6th-8th week). No primary structural defects were found in the nervous system of the bowel wall neither in the experimental gastroschisis model nor in the human cases investigated. The postoperative delay in intestinal motility affecting some gastroschisis patients was found to be secondary to multifocal ischaemic damage of the bowel wall.
Abdominal Muscles↗
Hirschsprung's disease studied with monoclonal antineurofilament antibodies on tissue sections.
In a retrospective study of Hirschsprung's disease two monoclonal antineurofilament antibodies were tested immunohistochemically. Biopsy samples of rectum and colon were fixed in formalin and embedded in paraffin. Tissue sections from normal controls and from unaffected colon of patients with Hirschsprung's disease showed partial staining of only some of the axon bundles in the myenteric and in the submucous plexus. In contrast, in all tissue sections from colon affected by Hirschsprung's disease there were heavily stained hyperplastic axon bundles. Sections of colon from patients with various other neurogenic disorders of the colon were studied by the same method; the characteristic Hirschsprung picture was never seen.
Antibodies, Monoclonal↗
Meconium peritonitis--a retrospective, prognostic analysis of 69 patients.
Meconium peritonitis being a rare anomaly, it is difficult to find the factors that determine the prognosis. In spite of the high mortality, this aspect has hardly ever been studied. A retrospective study of 69 patients from the Netherlands over a 15 year period, revealed that a patient with pneumoperitoneum and a generalized type of meconium peritonitis has a relatively favourable prognosis. Despite a more optimistic outlook expressed in recent publications, an overview of the world literature involving 1084 patients shows that the mortality for this disease has not dropped in the past 15 years and still amounts to 55%.
Female↗
The effect of fetal urine on the development of the bowel in gastroschisis.
A gastroschisis model was successfully developed in the chicken embryo. The embryologic anatomy of this laboratory animal enabled the inducement of an abdominal wall defect, whereby the eviscerated abdominal contents were not exposed to fetal urine. A total of 999 embryos underwent a surgical intervention at an early developmental stage, from the 5th-8th day of the incubation period. Twenty-four hour mortality was 7%. Surgery carried out on the 5th day resulted in the largest number of survivors, 25% of the induced lesions had healed and gastroschisis did not occur. The characteristic picture of gastroschisis only evolved when the herniated bowel was exposed to urine components. Histologic studies were carried out with the aid of various staining techniques to determine the development and distribution of the enteric ganglia in experimental gastroschisis. Contrary to similar studies that would point to damage of enteric ganglion cells as being responsible for the delay in intestinal motility, no ganglionic injury was noted in our bowel studies.
Animals↗
[Pheochromocytoma in a 14-year-old boy].
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Adolescent↗
Developmental abnormalities of the olfactory bulb: a comparative teratological and experimental study of the pig and chick embryo.
We collected newborn pigs with facial dysmorphy. In ten animals complete unilateral or bilateral hare lip was found to be associated with agenesis, aplasia, or hypoplasia of the olfactory bulbs. In order to get insight into a possible pathomorphogenetic relation between these types of clefts, malformations of the olfactory bulbs, and the role of the derivatives of the olfactory placode, the right olfactory placode was extirpated in 180 chick embryos at stage 17-18 according to Hamburger and Hamilton. Forty of the 78 surviving embryos showed shortening and deviation of the upper bill to the right, absence of the right nasal ostium, and agenesis of the right olfactory bulb. These results provide experimental evidence that the olfactory placode induces the outgrowth of the olfactory bulb. The further suggest an involvement of the olfactory placode in the normal development of the face.
Animals↗
An experimental study of the effect of an intestinal perforation at various developmental stages.
The effect of an experimentally induced intestinal perforation was studied in chick embryos. In 5 different groups of embryos a perforation was induced at 5 different developmental stages, while an equal number of sham operations was carried out for each stage. The results demonstrate that the effect of an intestinal perforation is determined by the developmental stage at which this perforation occurs. There was an inverse relationship between the developmental stage at which the perforation was induced and the remaining traces of the perforation site at the end of incubation. A perforation induced at an earlier developmental stage was more likely to lead to intestinal atresia coupled with only microscopic signs of meconium peritonitis. The severity of the adhesions increased concurrently with the developmental stage.
Animals↗
The pathogenesis of atresias of the small bowel and colon.
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Animals↗
The effect of experimentally induced intestinal perforation at an early developmental stage.
In chick embryos we studied the effect on intestinal development of an experimentally induced perforation and a vascular lesion performed at an early developmental stage. The results show that an intestinal perforation will heal, but may lead to intestinal atresia with microscopic signs of meconium peritonitis. Conversely, a vascular lesion induced at an early stage of development does not lead to intestinal atresia, while a vascular lesion performed at a late stage of development does result in intestinal atresia, but without any signs of meconium peritonitis.
Animals↗
The "microscopic" type of meconium peritonitis.
An evaluation of patients with meconium peritonitis shows that, apart from the fibro-adhesive type, the (Pseudo) cystic and the generalized type, a fourth type can be distinguished. In a case of this fourth type, the "microscopic" type of meconium peritonitis, no signs of a peritonitis are found on macroscopic examination of the abdominal cavity. Conversely, microscopic examination will reveal meconium components focally outside the bowel. The clinical and histological data of 14 patients are discussed. It is pointed out that a significantly large number of patients with meconium peritonitis also have atresia of the small bowel. Based on the patient evaluation, a hypothesis is brought forward concerning the pathogenesis of these atresias.
Female↗
[Atresia of the jejunum, ileum and colon; a retrospective study].
The results are described of a retrospective study of 142 patients with atresias of the jejunum, ileum and colon in the Netherlands. It is pointed out that pregnancy had often been complicated by polyhydramnios. This may lead to an early diagnosis in the prenatal period. Whenever a neonate presents with bilious vomiting or distension of the abdomen, closer examination for intestinal atresia should take place. The production of meconium does not rule out the diagnosis of intestinal atresia.
Adolescent↗