慢性胰腺炎大鼠肠运动功能和肌间神经丛NOS阳性神经元的变化

目的观察大鼠慢性胰腺炎时肠运动功能和肌间神经丛NOS阳性神经元的变化,探讨慢性胰腺炎大鼠肠动力障碍的可能机制。方法 SD雄性大鼠20只随机分为假手术组(n=10)和慢性胰腺炎组(n=10),用质量浓度为30 g/L TNBS乙醇盐溶液逆行胰胆管灌注制作慢性胰腺炎模型;假手术组注射等体积生理盐水。造模成功后胃内灌服质量浓度为10 g/L台盼蓝溶液,测定小肠推进比。取胰腺组织进行HE染色,观察病理变化。取末段回肠制作肌间神经丛全层标本,应用双重免疫荧光染色法观察肌间神经丛神经元,计算NOS阳性神经元占总神经元的百分比。结果假手术组肌间神经丛NOS阳性神经元的比例为(29.40±2.03)%,慢性胰腺炎组肌间神经丛NOS阳性神经元的比例为(39.62±1.75)%,两组比较,差异有统计学意义(P0.05)。慢性胰腺炎组大鼠小肠推进比显著降低[(49.70±3.74)%vs(31.14±3.23)%,P0.05]。NOS阳性神经元比例与小肠推进比呈负相关(r=-0.853,P0.05)。结论慢性胰腺炎大鼠存在肠动力障碍,同时回肠肌间神经丛NOS阳性神经元发生了重塑,慢性胰腺炎肠动力障碍可能与NOS抑制性神经元的表达上调相关。     

小肠肌间神经丛神经元体外培养抑制肠平滑肌细胞的增殖

目的:观察培养的肠肌间神经丛神经元对平滑肌细胞增殖的抑制作用.方法:成年♀Sprague-Dawley大鼠结肠环行平滑肌细胞体外培养,当平滑肌细胞增殖并形成细胞薄层覆满玻片时,植入小肠肌间神经丛神经节和结肠平滑肌细胞共同培养10 d.培养体经固定后行双重免疫荧光染色,记数VIP阳性神经元占总神经元的百分比,观察VIP阳性神经元和平滑肌细胞的生长关系.结果: 体外培养后VIP阳性神经元占总神经元的百分比为27.3%±5.6%,VIP阳性神经纤维所分布之处,平滑肌细胞明显减少.结论:VIP阳性神经元调节肠平滑肌细胞的增殖.     

腹泻型肠易激综合征模型大鼠结肠黏膜下神经丛神经元的改变

目的 检测慢急性联合应激腹泻型肠易激综合征(IBS-D)模型大鼠结肠黏膜下神经丛(SMP)神经元总数以及特异性标志物阳性神经元的变化,从肠神经系统(ENS)水平推断神经元改变在肠易激综合征(IBS)发病中的作用.方法 建立慢急性联合应激IBS-D大鼠模型,留取大鼠结肠制作SMP全层铺片标本.应用免疫组织荧光双染法检测SMP中神经元总数以及乙酰胆碱转移酶(CHAT)、血管活性肠肽(VIP)和一氧化氮合酶(NOS)阳性神经元数目和比例,评价IBS-D模型大鼠ENS神经元的改变.结果 IBS-D模型大鼠结肠SMP神经节和神经元总数无明显改变.与对照组相比,IBS-D模型大鼠结肠SMP中VIP阳性神经元比例明显增高(62.2%±6.2%比55.4%±5.4%,P<0.05),NOS阳性神经元比例亦明显增高(15.0%±4.0%比10.5%±2.9%,P<0.05),ChAT阳性神经元比例无明显改变.结论 IBS-D模型大鼠结肠SMP中VIP阳性神经元和NOS阳性神经元比例增高,提示在慢急性联合应激诱发1BS-D时,ENS中SMP神经元的变化可能通过增加肠道分泌而导致或加重腹泻症状.     

大鼠肠易激综合征肠黏膜下神经丛可塑性的研究

目的探讨大鼠肠黏膜下神经丛内肠神经元及兴奋性神经递质在肠易激综合征(IBS)不同亚型发病中的意义及替加色罗干预的结果。方法成年雄性SD大鼠45只,均分为IBS伴腹泻组(IBS-D)、IBS伴便秘组(IBS-C)、替加色罗干预的IBS-D组、替加色罗干预的IBS-C组和空白对照组共5组。分别采用乙酸灌肠和冰水灌胃方法制成IBS-D和IBS-C大鼠模型,替加色罗干预的两组每日加用替加色罗2 mg/kg体质量灌胃7 d。用蛋白基因产物9.5(PGP9.5)的免疫组化方法及兴奋性神经递质乙酰胆碱的组化染色法检测各组大鼠肠黏膜下神经丛内肠神经元及兴奋性神经递质的变化。结果①肠黏膜下神经丛内肠神经元数目IBS-D模型组(13.19±0.93)和IBS-C组(13.17±1.93)显著低于对照组(18.36±1.71)(P值均<0.01);替加色罗干预的IBS-D组(15.48±1.56)高于IBS-D组,替加色罗干预的IBS-C组(14.82±1.61)高于IBS-C组(P值均<0.05)。②肠黏膜下神经丛内胆碱酯酶阳性的神经元数目IBS-C组(7.56±0.39)显著低于对照组(10.43±1.39)及IBS-D组(10.03±1.13)(P值均<0.01),IBS-D组与对照组差异无统计学意义(P>0.05)。替加色罗干预的IBS-C组(9.51±1.47)显著高于IBS-C组(P<0.01),与对照组差异无统计学意义(P>0.05)。结论肠黏膜下神经丛内肠神经元数量的减少可能是实验大鼠IBS-D模型和IBS-C模型发病的共同机制;IBS-C模型组大鼠胆碱酯酶阳性的神经元数目显著减少与其症状相关。     

糖尿病大鼠回肠肌间神经丛mGluR1及mGluR5的表达

目的:了解糖尿病大鼠胃肠动力障碍时,回肠肌间神经丛有无形态学异常,以及第Ⅰ组代谢型谷氨酸受体mGluR1、mGluR5的表达变化,探讨谷氨酸能神经在糖尿病胃肠病变发生中的作用.方法:40只大鼠随机分为糖尿病组和对照组,给与高脂饮食结合腹腔注射STZ 30mg/kg造糖尿病模型.运用肌间神经丛铺片观察谷氨酸能神经的分布及形态特征,并对其神经节和神经元进行定量研究.以及运用免疫荧光染色和RT-PCR方法观察大鼠回肠肠神经系统肌间神经丛的代谢型谷氨酸受体mGluR1、mGluR5的表达变化.结果:糖尿病大鼠肠神经系统肌间神经丛的谷氨酸能神经节和神经元的数目较对照组明显减少(mGluR1:4.5±3.1 vs 7.3±2.4;142.25±28.24 vs 175.34±34.83,均P＜0.05;mGluR5:4.3±2.1 vs 7.9±2.8.133.37±35.73 vs 168.34±32.66,均P＜0.05),荧光强度较对照组减弱(mGluR1:145.23±28.78 vs 167.72±30.56.均P＜0.05;mGluR5:141.54±18.46 vs 172.53±29.74.均P＜0.05),mGluR1、mGluR5受体mRNA表达减少(1.05±0.27 vs 1.43±0.47,0.95±0.30 vs 1.60±0.39.均P＜0.01).结论:糖尿病大鼠回肠肠壁的肌间神经丛的神经节和神经元数目减少,以及兴奋性递质受体mGluR1、mGluR5的表达减少是导致胃肠道肌层兴奋性降低,肌层收缩减弱,引起糖尿病胃肠病变的一个重要机制.     

吡喹酮对日本血吸虫感染鼠血管活性肠肽和物质P的影响

目的探讨吡喹酮对日本血吸虫感染小鼠的结肠肌间神经丛中血管活性肠肽(VIP)和物质P(SP)的影响。方法30只昆明小鼠分成2组,每组15只。2组小鼠经皮感染日本血吸虫尾蚴后,治疗组给予吡喹酮500mg/kg,对照组给予生理盐水。应用免疫组织化学技术和计算机彩色病理图文分析系统,观察吡喹酮治疗后日本血吸虫感染小鼠的结肠肌间神经丛内VIP和SP的免疫反应性变化。结果治疗组小鼠结肠肌间神经丛内VIP和SP的免疫反应强度的灰度均值均较对照组显著降低(P<0.05)。结论吡喹酮治疗可以使日本血吸虫感染小鼠的结肠肌间神经丛中VIP和SP含量降低。     

肠道嗜铬细胞数量和5-羟色胺受体3表达在大鼠衰老过程中的变化及意义

目的 检测不同鼠龄SD大鼠肠道推进率、肠道黏膜嗜铬细胞数量和肠肌间神经丛5-羟色胺受体3(5-HT3R)的表达,探讨生理性衰老过程中肠道运动功能变化的规律及其机制. 方法 80只健康SD大鼠分为3月龄、9月龄、18月龄、24月龄及30月龄5组,每组各16只.以印度墨汁为标记物,检测大鼠的肠道推进率;采用免疫组化链霉亲和素-生物素-过氧化物酶复合物(SABC)法染色,检测大鼠空肠、回肠和结肠黏膜及黏膜下嗜铬细胞的数量以及肠肌间神经丛5-HT3R的表达.结果肠道推进率30月龄组大鼠为(52.1±9.8)%,明显低于3月龄组(67.2±13.5)%(t=7.013,P=0.001);30月龄组大鼠空肠、回肠及结肠黏膜和黏膜下嗜铬细胞数量分别为(11.1±3.0)个、(10.6±1.9)个和(10.2±4.3)个,较3月龄组(22.9±6.2)个、(25.8±7.1)个和(23.0±5.7)个减少(t=3.640,t=3.384,t=4.154,均为P<0.01);大鼠空肠和结肠的5-HT3R表达30月龄组分别为4.8±1.4和9.3±4.2,较9月龄组的8.9±1.5和14.5±5.3减少(t=3.464,t=3.003,均为P<0.01),回肠5-HT3R 30月龄组和3月龄组分别为5.0±1.3和9.0±1.7(t=4.549,P<0.001). 结论 老年大鼠肠道推进率、肠道嗜铬细胞数量及肠肌间神经丛5-HT3R表达均显著降低,并随年龄增长而逐渐明显;老年大鼠肠道运动功能的明显下降与肠嗜铬细胞数量以及肌间神经丛5-HT3R的表达显著降低有一定的相关性.     

Cajal间质细胞和肠神经元在急性坏死性胰腺炎豚鼠小肠组织中的改变

目的 探讨Cajal间质细胞(ICC)和肠胶质神经元数量在ANP豚鼠小肠组织中的改变及对肠动力的影响.方法 24只豚鼠随机分为对照组、ANP 24 h组和48 h组,各8只.采用腹腔注射20%L-精氨酸制作ANP模型.器官浸浴技术评价离体小肠的运动.HE染色观察胰腺和小肠组织病理改变.应用免疫荧光法检测ICC标志物酪氨酸激酶(C-KIT)和肠神经胶质细胞标志物的蛋白基因产物9.5 (PGP9.5).结果 ANP 24 h和48 h组胰腺组织呈明显水肿、坏死,小肠黏膜腺体结构紊乱,炎症细胞浸润.小肠运动的频率分别为(10.25±1.56)次/min和(10.37±1.41)次/min,运动振幅分别为(159.65±24.30)g*s和(156.64±17.01)g*s,较对照组明显下降;肌间丛ICC量从对照组的(0.273±0.03)%降至ANP组(0.104±0.04)%和(0.129±0.05)%,而肠神经元数量无明显变化.结论 ANP豚鼠模型存在小肠动力功能的障碍,肠肌间丛Cajal间质细胞数量的减少可能是小肠动力功能抑制的重要因素.     

短波胃电刺激对大鼠孤束核及下丘脑c-fos表达的影响及其机制

目的 探讨肠肌间神经丛及中枢神经系统相关核团(孤束核及下丘脑)是否参与介导外源性短波胃电刺激调控中枢感觉功能.方法 雄性Wistar大鼠15只,分为对照组、胃电刺激组、去肠肌间神经丛组,均于胃底、胃体交界处植入一对电极,去肠肌间神经丛组大鼠同时胃浆膜面予苯扎氯胺处理,后两组均予短波胃电刺激,持续30 min.SP免疫组化法观察延髓孤柬核及下丘脑c-fos表达.结果 胃电刺激组和去肠肌间神经丛组大鼠每高倍视野下孤束核处c-fos阳性神经元数量分别为(71.6±7.4)和(63.4±10.8)个,下丘脑处则分别为(224.2±47.3)和(249.1±44.0)个,两组间差异无统计学意义(P＞0.05),但均显著高于对照组[(36.4±8.6)和(90.2±47.3)个,P值均＜0.05].结论 孤束核及下丘脑可能是介导短波胃电刺激治疗作用的中枢核团,而肠神经系统不参与介导此作用.     

六味安消胶囊及其组分对豚鼠结肠P物质和黏蛋白2表达的影响

背景:六味安消胶囊能明显加快胃排空,促进肠推进运动。目的:探讨六味安消胶囊及其组分对豚鼠结肠P物质(SP)和黏蛋白2(MUC2)表达的影响。方法:20只豚鼠随机分为4组:正常对照组、大黄组、诃子组和六味安消胶囊组,后3组分别予相应药物灌服30天。处死动物,观察结肠黑变情况;对盲肠和近段结肠切片行SP、MUC2免疫组化染色和图像分析;对肌间神经丛铺片行嗜银染色,计数神经元细胞数。结果:大黄组结肠有黑变,以盲肠和近段结肠为著。大黄组、诃子组和六味安消胶囊组近段结肠SP免疫反应阳性纤维较正常对照组显著增多(阳性面积比:6.2%±1.7%、5.3%±0.8%和5.4%±0.9%对2.1%±0.7%,P<0.01),免疫阳性增强(灰度:131.50±1.16、133.79±0.63和133.78±0.67对146.20±2.03,P<0.01),大黄组近段结肠SP免疫阳性又显著强于诃子组和六味安消胶囊组(P<0.05)。各组盲肠和近段结肠MUC2的表达无明显差异。大黄组肌间神经丛神经元细胞数显著低于其余各组(11.60±1.52对17.00±1.87、18.60±3.78和17.80±2.95,P<0.05)。结论:六味安消胶囊可能通过其主药大黄改变肠道内SP含量而发挥消积导滞作用。六味安消胶囊和大黄对结肠MUC2的表达无明显影响。     

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。     

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。     

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。     

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.