口服小剂量螺内酯抗高血压大鼠心肌纤维化

目的观察口服小剂量螺内酯对自发性高血压大鼠(SHR)血压、心肌间质和血管周围胶原沉积的干预,探讨螺内酯在高血压心肌纤维化进展期对心脏的保护作用。方法20只雄性SHR随机分为螺内酯组(10只)和安慰剂组(10只),另设Wistar-kyoto鼠7只(WKY组)。Western blot方法分析Ⅰ型胶原的表达;天狼猩红-苦味酸染色观察心肌胶原容积分数(CVF)和血管周围胶原面积(PVCA)。结果与安慰剂组比较,螺内酯组Ⅰ型胶原含量、CVF、PVCA显著降低(P<0.01),收缩压、舒张压、平均动脉血压、血K+、心脏重量指数、左心室重量指数、心率未见明显差异。结论口服小剂量螺内酯通过减少Ⅰ型胶原的沉积,起到抗高血压大鼠心肌纤维化的作用。     

螺内酯对原发性高血压大鼠左心室功能的影响

目的用超声评价螺内酯对原发性高血压(高血压)大鼠(SHR)心肌组织胶原含量和心功能的影响。方法20只雄性高血压大鼠随机分为螺内酯组(n=10)和安慰剂组(n=10),另设WKY组(n=7)。螺内酯组螺内酯用双蒸水溶解后以20 mg.kg-1.d-1灌胃;安慰剂组和WKY组用等容积双蒸水灌胃,连续16周。超声心动图观察大鼠左心房内径,室间隔和后壁厚度,射血分数,背向散射积分(IBS);背向散射积分周期变化(PPI)。取心肌标本,称取左心室重量,计算左心室质量指数,制备心肌组织石蜡切片,天狼猩红饱和苦味酸染色,观察心肌胶原容积分数(CVF)和血管周围胶原面积(PVCA)。结果与WKY组比较,安慰剂组大鼠心肌肥厚指标:左心室质量指数室,室间隔及左心室后壁厚度增加;心脏功能指标:左心房内径、射血分数增大,E/A比值减少;纤维化指标:胶原容积分数、血管周围胶原面积增加,声学密度指标背向散射积分升高,背向散射积分周期变化降低,差异有统计学意义(P<0.05)。治疗16周,与安慰剂组比较,螺内酯组上述指标均有改善,差异有统计学意义(P<0.05)。结论高血压大鼠左心室胶原沉积、心肌肥厚、舒张功能减退,收缩功能受损。螺内酯治疗能减少高血压大鼠局部胶原沉积,改善左心室功能。     

结缔组织生长因子与高血压大鼠心肌纤维化相关性及伊贝沙坦的干预研究

目的探讨结缔组织生长因子(CTGF)在高血压大鼠心肌纤维化发生发展中的作用,以及伊贝沙坦改善高血压所致心室重构和心肌纤维化可能的作用机制。方法20只12周龄雄性自发性高血压大鼠(SHR)随机分为SHR组和伊贝沙坦(IRB)组各10只,IRB组每只大鼠予以伊贝沙坦50 mg.kg-1.d-1灌胃,给药时间12周,同时取10只12周龄雄性Wistar大鼠作为对照组(WKY组),用免疫组织化学的方法对转化生长因子β1(TGF-β1)、CTGF在3组大鼠的左室心肌的分布及表达进行半定量分析;用逆转录-聚合酶链反应检测TGF-β1、CTGF mRNA在心肌表达水平;用MOSSON染色法观察左室心肌胶原形态,图像分析测量胶原容积分数(CVF)和血管周围胶原面积(PVCA)。结果(1)左室重量指数(LVI)、CVF、PVCA在SHR大鼠组明显高于WKY大鼠组(P<0.01);与SHR组比较,伊贝沙坦组则显著降低(P<0.05)。(2)CTGF主要在血管平滑肌和心肌间质中表达,相关分析表明:CTGF与TGF-β1(r=0.562,P<0.05)、CVF(r=0.715,P<0.01)、PVCA(r=0.786,P<0.01)呈正相关;(3)CTGF及其mRNA在SHR组左室心肌中的表达较WKY组明显增强(P<0.05),与SHR组比较,IRB组则明显减少。结论高血压大鼠心室肌CTGF表达增加,伊贝沙坦能抑制高血压大鼠心室肌CGTF表达,且明显改善了高血压心室重构和心肌纤维化。     

福辛普利对SHR左室肥厚和心肌纤维化的影响

目的探讨福辛普利对自发性高血压大鼠(SHR)左心室肥厚(LVH)和心肌纤维化的影响。方法18只16周龄SHR大鼠,随机分为福辛普利治疗组(SHR-F)和SHR空白对照组(SHR-C);另设同源的WKY大鼠8只为正常对照组。治疗组口服福辛普利20mg·kg-1·d-1,给药8周后处死动物,取左心室心肌称重,计算左心室/体重比(LVW/BW),Masson三色法染色观察左心室心肌胶原变化,计算机图像分析测量心肌切片的胶原容积分数(CVF)和血管周围胶原面积(PVCA)。结果SHR空白对照组的SBP、LVW/BW、CVF、PVCA均显著高于WKY对照组(P<0.01),与SHR空白对照组相比,福新普利治疗组能有效降低SHR的SBP,改善SHR左心室肥厚(P<0.01〉并使左心室内膜及心肌小动脉周围的胶原减少(P<0.01〉。结论福辛普利可有效降低SHR血压,部分逆转心肌纤维化和左室肥厚。     

厄贝沙坦对SHR左心室肥厚和心肌纤维化的影响

目的 探讨厄贝沙坦对自发性高血压大鼠(SHR)左心室肥厚(LVH)和心肌纤维化的影响。方法 16只16周龄雄性SHR,随机分为厄贝沙坦治疗组和SHR空白对照组;另设同源的WKY大鼠8只为正常对照组。治疗组予厄贝沙坦15 mg/（kg·d）灌胃给药,8周后处死动物,测量左心室心肌厚度并称质量,计算左心室质量/体质量比(LVM/BM);通过Van Gieson染色法观察左心室心肌胶原变化,对左心室心肌胶原容积分数(CVF)和血管周围胶原面积(PVCA)进行定性和半定量分析;HE染色光镜观察左心室心肌病理变化。结果 与WKY组相比,SHR对照组的尾动脉收缩压(SBP)、LVM/BM、左心室壁厚度、CVF、PVCA、均显著增高(P<0.01);与SHR对照组相比,厄贝沙坦治疗组能有效降低SHR的SBP,改善LVH(P<0.01),减少心肌间质及心肌小动脉周围的胶原(P<0.01)。结论 厄贝沙坦可有效降低SHR血压,减轻心肌纤维化和LVH。     

贝那普利和氨氯地平对自发性高血压大鼠十二指肠、脑组织胆囊收缩素表达的影响

目的探讨贝那普利和氨氯地平对自发性高血压大鼠(SHR)胆囊收缩素(CCK)mRNA及蛋白表达的影响。方法 45只14周龄雄性SHR随机分为SHR组(n=15)、贝那普利组[盐酸贝那普利灌服0.90mg/(kg·d),n=15]、氨氯地平组[苯磺酸氨氯地平灌服0.45mg/(kg·d),n=15],另以Wistar-Kyoto(WKY)大鼠作为正常对照组(n=15),SHR组及WKY组每日灌服同体积的蒸馏水,干预8周,测定各组大鼠安静清醒状态下尾动脉压,应用酶联免疫吸附试验(ELISA)法检测血清中CCK的含量;采用逆转录聚合酶链反应(RT-PCR)检测十二指肠中CCK mRNA表达;采用Western blot法检测十二指肠和脑中CCK蛋白表达。结果干预8周后,与WKY组比较,SHR组血压升高[收缩压/舒张压(201.0±14.6)/(157.4±16.2)比(136.3±12.0)/(102.9±10.2)mm Hg],十二指肠中CCK mRNA和蛋白表达显著降低,脑中CCK蛋白表达显著降低(均P0.05),但血清CCK水平差异无统计学意义(P0.05);与SHR组比较,贝那普利组与氨氯地平组血压降低[(181.5±17.5)/(145.4±18.3)、(188.4±14.5)/(145.6±13.8)比(201.0±14.6)/(157.4±16.2)mm Hg,均P0.05],贝那普利组与氨氯地平组十二指肠中CCK mRNA和蛋白表达、脑中CCK蛋白表达显著升高(均P0.05)。结论 SHR十二指肠和脑组织中CCK调节失衡,贝那普利和氨氯地平可能通过调节CCK的表达而降压。     

缬沙坦和螺内酯抑制自发性高血压大鼠心肌纤维化的对比研究

目的比较缬沙坦和螺内酯对自发性高血压大鼠(SHR)心肌纤维化的抑制作用及二者对SHR心肌整合素β1和纤维黏连蛋白(FN)表达的影响,探讨SHR心肌纤维化的机制。方法将18只6周龄SHR随机均分成3组缬沙坦组(缬沙坦30mg·kg-1·d-1),螺内酯组(螺内酯20mg·kg-1·d-1)和SHR组,并与雄性同周龄WKY6组只比较,实验期14周。比较血压、左室重量/体重(LVM/BW)、胶原容积分数(CVF)和血管周围胶原面积(PVCA),并用免疫组化法检测4组大鼠心肌整合素β1和FN的表达。结果(1)缬沙坦组和螺内酯组血压〔(1125±88)mmHg和(1316±51)mmHg〕、LVM/BW〔(284±014)×10-3和(322±015)×10-3〕、CVF〔(321±022)%和(400±028)%〕、PVCA〔(062±015)%和(094±056)%〕均显著低于SHR组(P<005),缬沙坦组与螺内酯组比较,差异有显著性(P<005);(2)SHR组心肌整合素β1和FN的表达明显高于WKY组〔其积分吸光度值(A)分别为(15687±2033)、(5430±800)和(45665±4127)、(15718±2830),P<001,而缬沙坦组和螺内酯组FN的沉积较SHR组(45665±4127)均显著减少〔分别为(20047±1680)和(21358±800),P<005〕;缬沙坦组整合素β1的表达(9892±135)较SHR组下降(P<005),而螺内酯组整合素β1的表达与SHR组差异无显著性(P>005)。结论缬沙坦和螺内酯不仅可以良好控     

贝那普利阻断RAS系统对自发性高血压大鼠心肌JAK-STAT信号通路的影响

目的探讨贝那普利对自发性高血压大鼠(SHR)心肌组织JAK-STAT信号转导通路及细胞凋亡的影响。方法30周龄WKY大鼠12只,同龄SHR24只,随机分为SHR组,贝那普利组10mg/(kg·d)。RT-PCR法检测AT1mRNA、AT2mRNA表达,免疫组化法检测心肌组织STAT1、STAT3表达及TUNEL末端标记法进行细胞凋亡检测。结果与SHR组比较,贝那普利组AT1mRNA表达水平显著降低(P<0.01),AT2mRNA表达水平显著增高(P<0.01)。与SHR组比较,贝那普利能降低STAT1表达(P<0.01),升高STAT3表达(P<0.01)。贝那普利组心肌细胞凋亡显著低于SHR组(P<0.01)。结论贝那普利能调节心肌组织JAK-STAT信号转导通路,抑制细胞凋亡,从而发挥其心脏保护作用。     

麝香保心丸对自发性高血压大鼠心肌纤维化的干预研究

目的探讨麝香保心丸对自发性高血压大鼠（SHR）心肌纤维化的影响。方法24只8周龄雄性SHR大鼠,随机分为两组：麝香保心丸干预组（SB组）、SHR阳性对照组（SHR组）,每组12只;12只同龄雄性正常血压京都威斯特大鼠（WKY）作为正常对照组（WKY组）。SB组每只大鼠每天给予麝香保心丸112.5mg/kg溶于1.5mL蒸馏水中灌胃,SHR组及WKY组给予等量蒸馏水灌胃,持续16周。处死动物后,称取左室重量（LVM）,计算左室相对重量（LVM/BW）,然后取左室组织标本进行MASSON染色观察胶原纤维增生情况,测定胶原容积分数（CVF）、血管周围胶原面积（PVCA）。透射电镜观察心肌细胞超微结构变化。结果SB组的LVM、LVM/BW明显低于SHR组（P〈0.05）,但仍高于WKY组（P〈0.05）。MASSON染色：SB组与SHR组比较,纤维组织明显减少,心肌细胞间隙较清晰,血管周围胶原聚积明显减少,但比WKY组纤维组织增多。SB组CVF、PVCA较SHR组明显降低（P〈0.05）,但SB组与WKY组比较,CVF增加（P〈0.01）,PVCA也增加（P〈0.05）。电镜下所见：WKY组大鼠心肌纤维结构清晰,且排列整齐,线粒体排列整齐,无肿胀变性,间质中胶原纤维少且排列稀疏。SHR组大鼠线粒体略肿胀,间质中成纤维细胞、胶原纤维明显增生且胶原纤维排列紊乱。SB组与SHR组比较线粒体排列整齐,无肿胀变性,间质中成纤维细胞、胶原纤维明显减少。结论麝香保心丸具有减轻SHR心肌纤维化、改善心脏功能的作用。     

依那普利或氯沙坦对SHR左室肥厚和心肌纤维化的影响

目的 :观察自发性高血压大鼠 (SHR)左室肥厚和心肌纤维化各指标的改变 ,以及依那普利和氯沙坦的保护作用。方法 :雄性 SHR(n=30 )自第 1 0周始服用依那普利 (2 0 mg.kg- 1 .d - 1 ) ,或氯沙坦 (2 5 mg.kg - 1 .d - 1 ) ,或二者合用 (依那普利1 0 mg.kg - 1 .d - 1 ,氯沙坦 1 2 .5 mg.kg - 1 .d - 1 )至第 1 6周 ,并以年龄、性别、数量配对的未治疗 SHR和 Wistar- kyoto(WKY)大鼠作对照。测定收缩压 (SBP)、左室重量 (L VM)以及左室重量指数 (L VMI)和左室心肌胶原含量 ;计算机图象分析心肌细胞大小、心肌胶原容积分数 (CVF)和血管周围胶原面积(PVCA)。结果 :SHR的 SBP、L VM、L VMI、心肌胶原含量、心肌细胞的横截面积、CVF和 PVCA均显著高于 WKY对照组 (P<0 .0 0 1 )。 SHR治疗组上述指标显著低于 SHR未治疗组 (P<0 .0 1 ) ,依那普利与氯沙坦之间无显著差别 (P<0 .0 5 )。二者合用比单用依那普利或氯沙坦更有效 (P<0 .0 5 )。结论 :依那普利和氯沙坦可显著的降低血压、逆转 SHR早期左室肥厚和心肌纤维化 ,而且二者合用在逆转左室肥厚和心肌纤维化方面效果更明显     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

CagA-Hp抗体IgG与胃炎的组织学分析

研究幽门螺杆菌(Hp)感染与胃炎的关系。方法对204例慢性胃炎患者胃粘膜进行观察分析,并测定其中137例Hp阳性患者血清CagA-Hp抗体IgG水平,与组织学对照。结果慢性萎缩性胃炎伴肠上皮化生患者血清CagA抗体IgG明显高于对照组(P＜0.01);其他类型胃炎患者血清CagA抗体IgG水平无明显增高(P＞0.05)。结论CagA-Hp可能是导致慢性萎缩性胃炎伴肠上皮化生的因素之一,对这类患者应密切随访观察。     

慢阻肺急性加重期患者预后的影响因素分析

目的探讨慢性阻塞性肺病急性加重期(AECOPD)患者预后的相关危险因素。方法回顾性调查、收集58例AECOPD患者可能影响其预后的相关因素,并对其分别进行单因素分析。并进行Logistic多元逐步回归进行多因素分析,筛选影响AECOPD患者预后的独立危险因素。结果单因素分析后将结果 P0.1的因素纳入多因素Logistic回归,分析发现是否合并呼吸衰竭、气促程度、白细胞计数、APACHEⅡ、应用抗氧化剂、慢阻肺治疗依从性为影响AECOPD患者预后不佳的独立因素(P0.05)。结论根据AECOPD患者预后的独立危险因素,及早判断,选择合适的后续治疗方案,对提高其生存率及生存质量具有重要意义。     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Results of treatment of fistula-in-ano

To evaluate the application of Parks' classification in the management of patients with fistula-in-ano, a study was undertaken to assess the outcome of surgery, especially with respect to the recurrence rate and alteration of continence. A retrospective analysis of 160 consecutive patients who were classified at the time of operation was conducted. The distribution of fistulas was as follows: intersphincteric, 41.9 percent, transsphincteric, 52.1 percent, suprasphincteric, 1.3 percent, extrasphincteric, 0. A horseshoe extension occurred in 8.8 percent of the fistulas and 3.8 percent did not exactly conform to the classification as they were either complex or combinations of more than one type of fistula. The sole immediate postoperative complication was bleeding, which occurred one week postoperatively and ceased spontaneously (0.7 percent). Alteration in continence occurred in 6 percent of patients with 2.6 percent experiencing temporary incontinence to flatus, 1.3 percent to liquid stool, and 0.7 percent to solid stool. Permanent loss of control for flatus occurred in one patient (0.7 percent) and for liquid stool in one patient (0.7 percent). No patients suffered loss of control for solid stool. Recurrence developed in 6.3 percent of patients, all between five and 25 months postoperatively. Classifcation was found to be a useful guide in the operative management of patients with fistula-in-ano. Read at the joint meeting of the American Society of Colon and Rectal Surgeons with the Section of Colo-Proctology, Royal Society of Medicine, and the Section of Colonic and Rectal Surgery, Royal Australasian College of Surgeons, New Orleans, Louisiana, May 6 to 11, 1984.