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Biomedical subjects

S Nissan

Publications and source records attributed to S Nissan.

At least 73 records · Page 4Linked to original sources
PubMed1983

Rectal mucosal biopsy in aganglionosis and allied conditions.

Rectal mucosal biopsies were performed in 146 patients suspected of having Hirschsprung's disease. The biopsies were serially sectioned and screened for the presence of ganglion cells. In the 101 cases in which ganglion cells were found, the diagnosis of Hirschsprung's disease was ruled out. In 45 patients, histologic examination revealed the typical features of Hirschsprung's disease, i.e., the absence of ganglion cells and the presence of numerous hypertrophied nerve bundles. The varied morphologic features of Meissner's plexus in patients of different ages and the diagnostic pitfalls are described in detail. Serial frozen sections stained with hematoxylin-eosin were examined in eight cases of neonatal intestinal obstruction and enterocolitis. This method was found to be useful and reliable in emergencies. In three of these cases ganglion cells were found and major surgical procedures were avoided. In 73 cases, staining for acetylcholinesterase activity was performed. The results matched the microscopic findings in all but three false-positive cases.

Acetylcholinesterase↗
PubMed1983

Heredity in anal atresia.

Although anal atresia is known to occur occasionally in families and as part of genetically determined syndromes, the role of genetics in its causation is highly disputable. In this paper evidence is presented for multifactorial genetic determination as the mode of inheritance in anal atresia. This conclusion is argued as based on evidence from the literature as well as findings in an additional series of 48 cases which were collected as a family study.

Anus, Imperforate↗
PubMed1983

High anorectal atresia - surgical treatment through a sacro-coccygeal-perineal approach.

10 infants with high anorectal atresia had a primary colostomy and later a definitive pull-through operation was performed. This was accomplished through a sacro-coccygeal approach and enabled easy and precise identification of the pubo-rectalis sling of the levator ani muscle. Placement of the rectum inside this sling is the most important factor in achieving post-operative faecal continence in these infants. A follow-up period of 4--10 years showed good bowel control in 9 patients, although occasional slight soiling occurs.

Anal Canal↗
PubMed1982

Repeated endotracheal intubations and bronchial lavage in the postoperative treatment of tracheoesophageal fistula.

Recurrent pulmonary atelectasis occurs often in neonates following primary repair of esophageal atresia, leading to massive pneumonia and respiratory failure. The atelectasis is caused by tenacious mucous plugs which are presumably formed as a result of ciliary mucosal damage secondary to reflux of gastric fluid through a tracheo-esophageal fistula. Early aggressive treatment of the atelectasis by repeated gentle tracheal intubation with bronchial lavage and suction is advocated. This treatment is well tolerated and is preferred to continuous intubation with its inherent dangers for the neonatal patient.

Bronchoscopy↗
PubMed1982

Ammonia uptake by skeletal muscle in the hyperammonaemic rat.

A two-stage surgical occlusion of the portal vein was employed to produce hyperammonaemia in the rat. The procedure resulted in a significant rise of arterial blood ammonia level from 70 . 5 +/- 6 . 5 mumol/l (mean +/- SEM, n = 10) to 214 . 0 +/- 37 . 7 mumol/l and in a rise of venous blood ammonia from 65 . 0 +/- 9 . 4 mumol/l to 122 . 2 +/- 7 . 4 mumol/l during the first day following the complete vein occlusion. A marked increase of the arteriovenous difference of ammonia concentration from virtually zero in sham-operated controls to 72 +/- 9 (n = 8) mumol/l in rats 1 day after the surgical manipulation suggested uptake of ammonia by skeletal muscle. Rat muscle glutamine synthetase activity increased from 0 . 46 +/- 0 . 06 u/mg (n = 7) in controls to 2 . 7 +/- 0 . 3 u/mg (n = 7) on the fourth day following portal vein ligation, and muscle branched chain amino acids aminotransferase increased from 0 . 2 +/- 0 . 05 u/mg in controls to 0 . 96 +/- 0 . 1 u/mg (n = 7) during the first day of ligation. Glutamine dehydrogenase and aspartate aminotransferase activities were not affected by the surgical procedure. These observations suggest that ammonia trapping in skeletal muscle is coupled to glutamine formation via amination of glutamic acid. This conclusion was further supported by the finding that ammonia uptake correlated (r = 0 . 92) with enhanced release of glutamine from muscle and that treatment with methionine sulfoximine, a potent inhibitor of glutamine synthetase, changed the arteriovenous difference of glutamine from -0 . 92 +/- 0 . 01 mmol/l in ligated animals (net release) to +0 . 12 +/- 0 . 01 mmol/l (net uptake) in ligated and inhibitor-treated animals. Similarly, the inhibitor also abolished the arterio-venous difference of ammonia. Thus, the animal model of hyperammonaemia and the muscle enzyme assays reveal that skeletal muscle is involved in the regulation of blood ammonia level by conversion of ammonia, via glutamic acid, to glutamine.

Ammonia↗
PubMed1982

Pseudo and true Hirschsprung's disease in one family.

A case of a 35-yr-old woman with the characteristics of pseudo-Hirschsprung's disease is presented. The diagnosis was based on the following criteria: a history of chronic constipation since early infancy, a largely distended abdomen and an adynamic distal colon. The patient had a normal anosphincteric relaxation reflex and normal rectal myenteric ganglion cells. Resection of the distended large bowel failed to relieve the symptoms and was followed by distention of the entire small bowel. Complete cure was achieved after a Duhamel procedure. This patient is an adult, unlike the previously reported cases. Of special interest is the occurrence of true Hirschsprung's disease in one of her children.

Adult↗
PubMed1982

Elongation of the upper pouch in esophageal atresia.

A female newborn is presented with a Type I esophageal without a tracheoesophageal fistula. The distance between the ends of the esophageal pouches measured about four vertebrae. She was successfully managed by a primary esophagoesophagostomy following elongation of the upper pouch with esophageal bougies.

Esophageal Atresia↗
PubMed1981

The mild form of Hirschsprung's disease (short segment): fourteen-years experience in diagnosis and treatment.

From 1966 through 1980, 39 children were treated with anorectal myectomy for the mild form of Hirschsprung's disease. The mild form of Hirschsprung's disease is differentiated from the severe one mainly on clinical grounds. Of the entire group, only four patients needed a Duhamel procedure, one to three years after myectomy. One patient still uses occasional enema (11 years after operation). The remaining 34 patients are symptom-free (1--14 years after operation). Anorectal myectomy is the treatment of choice in the management of the mild form of Hirschsprung's disease.

Anal Canal↗
PubMed1980

Low anterior resection with a long posterior anorectal myectomy and sphincterectomy for Hirschsprung's disease.

Nine patients with the severe form of Hirschhsprung's Disease (HD) underwent low anterior resection with posterior anal myectomy and sphincterectomy. Good results were achieved in six patients. Three patients had bouts of enterocolitis following the surgical treatment which was attributed to residual spasm of the aganglionic rectum and the internal anal sphincter. Myectomy had to be redone in two patients. One patient developed constipation which responded to toilet training. One patient died at home of an unknown cause, and one patient was lost to follow-up. The different methods of treatment of HD are discussed with emphasis on the role of the internal anal sphincter. The relatively high complication rate in this small group of patients does not justify its use in the severe form of HD.

Anal Canal↗