Delayed reanastamosis of small bowel in Crohn's disease has been made possible, largely by parenteral nutrition. We describe a patient with multiple resections resulting in loss of all the small and large bowel except the duodenum and 70 cms of proximal jejunum ending in a jejunostomy and a 150 cm long isolated loop of jejuno-ileum. The short proximal bowel proved adequate for energy and protein nutrition, with small frequent meals but gave rise to a persistent negative balance of water, sodium, potassium and magnesium. This was corrected by overnight perfusion of the isolated loop with an electrolyte solution with added glucose polymer to enhance sodium absorption. The critical rate of perfusion and concentration of glucose polymer were determined by a series of studies. The patient and her husband carried out this regimen for a year at home. The isolated loop was subsequently reanastamosed to the proximal jejunum allowing resumption of normal eating without further electrolyte disturbance.

Journal Article↗

PubMed1983

Distinguishing between cognitive and somatic trait and state anxiety in children.

The study was conducted to develop self-report measures of cognitive and somatic trait and state anxiety for children and to evaluate the utility of distinguishing between cognitive and somatic anxiety. Sixty-seven fourth grade children anticipated and then performed a mathematics task either in a high- or low-stress condition. While the children anticipated performing the task, measures of seven cognitive behaviors were obtained by means of both a think aloud procedure and a questionnaire. The results of the study indicated that reliable trait and state measures of cognitive and somatic anxiety were successfully developed. Further, the trait measures of cognitive and somatic anxiety were found to be relatively impervious to induced anxiety states. As expected, cognitive trait anxiety but not somatic trait or state anxiety was found to be related to task performance. High cognitive state and/or trait anxiety was found to be associated with more preoccupation and performance denigration as well as taking less of an analytic attitude toward the situation. Somatic trait and state anxiety were found to be associated with preoccupation. In general, the results support the construct validity of the measures developed and the utility of distinguishing between cognitive and somatic anxiety in children.

Achievement↗

PubMed1983

Calcium regulation of glycoproteins IIb and IIIa in human platelet membranes.

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Calcium↗

PubMed1983

Mechanisms of action of neurotensin on motility of canine gastric corpus in vitro.

Increasing concentrations of neurotensin produced a biphasic contractile response, inhibition followed by excitation, when added to full-thickness circular strips of canine gastric corpus muscle cut in a circular orientation and incubated at 37 degrees C in vitro. The inhibitory response (mean effective concentration (EC50) 7 x 10(-9)M) was not altered by addition of concentrations of tetrodotoxin or scorpion venom sufficient to block field-stimulated neural responses nor by any other antagonist tested. Therefore, it would appear that inhibition is due to an excitation of the smooth muscle receptor. The excitatory response (EC50 4 x 10(-7)M) was only present in full-thickness strips, i.e., was absent in strips of circular muscle, and was reduced by mepyramine or histamine tachyphylaxis. Pretreatment with disodium cromoglycate or repeated doses of 48/80 to extinction of the response completely eliminated the excitatory response as did repeated doses of substance P to tachyphylaxis. Since 48/80 and substance P have been shown to degranulate mast cells and disodium cromoglycate to stabilize mast cell membranes, neurotensin would appear to produce excitation by releasing histamine and other material from mast cells. In contrast to in vivo studies, where two classes of receptors producing inhibition were found, i.e., a high-affinity receptor on adrenergic nerves and a lower affinity receptor on smooth muscles, in vitro there appears to be only one class of receptor producing inhibition on the smooth muscle itself as no neural receptors were found. The neurotensin receptor responsible for excitation appeared to be on mast cells. The action of neurotensin thus depends upon the locus and the affinity of the receptor and the presence of the receptor on the method of study, i.e., in vivo vs. in vitro.

Animals↗

PubMed1983

Cholinergic control mechanisms for immunoreactive motilin release and motility in the canine duodenum.

The relationship of immunoreactive (IR) motilin release from the duodenum to duodenal motility changes was investigated in anaesthetized dogs. Stimulation of one or both vagi at 5 or 15 Hz or field stimulation of intrinsic duodenal nerves produced significant increases in duodenal vein IR motilin concentrations and accompanying increases in duodenal motility. However, only stimulation of both vagi at 15 Hz produced significant changes in peripheral venous concentrations of IR motilin. These occurred after a delay at a time when both the duodenum and the antrum were quiescent. Either hexamethonium or atropine blocked IR motilin release induced by stimulation of intrinsic or extrinsic nerves while only atropine inhibited the release induced by intraarterial carbachol. The response stimulated by carbachol and blocked by atropine was tetrodotoxin insensitive and the muscarinic receptor involved was presumably located on a nonneural structure. The site sensitive to hexamethonium was presumably the neural pathway which terminated at the muscarinic receptor. Concomitant studies of duodenal motility responses to vagal and field stimulation suggested a conventional neural pathway with preganglionic cholinergic nerves in the vagus, postganglionic cholinergic nerves in the duodenum (activated by field stimulation) and a smooth muscle muscarinic receptor. Activation of antral motility by stimulation of the abdominal vagus or intraarterial carbachol injections to the antrum increased duodenal IR motilin release in the absence of duodenal motility. Thus activation of the intrinsic nerves which cross the pylorus initiated IR motilin release as well as inhibited duodenal motility.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1983

Does substance P comediate with acetylcholine in nerves of opossum esophageal muscularis mucosa?

In opossum esophagus the highest density of varicose substance P-like immunoreactive deposits was in the muscularis mucosa, and this muscle layer, which is thick and prominent, was the most sensitive in contracting to exogenous substance P. On field stimulation, a tetrodotoxin-sensitive biphasic contraction was produced; an initial phasic component was followed after cessation of stimulation by a prolonged tonic component. This contractile response was unaffected by guanethidine or antagonists to several nerve mediators and to histamine and serotonin antagonists. Each component showed a different frequency dependence. The phasic component was abolished by atropine and potentiated by physostigmine; the tonic component was reduced or abolished after carbachol or physostigmine and potentiated by atropine. The tonic component was inhibited after substance P tachyphylaxis or by the substance P antagonist [D-Pro2, D-Trp7,9]substance P. On electron microscopic examination, the majority of nerve varicosities contained a mixture of small agranular and large granular vesicles. We postulate that acetylcholine and substance P may coexist in and be coreleased from nerves of this muscle and that the acetylcholine release occurs first, causing an initial phasic response and delaying and diminishing the release of substance P. The two mediators cause muscle contraction by actions on independent receptors.

Acetylcholine↗

PubMed1983