Impact of anal manipulation and pouch design on ileal pouch function.

The frequency of defecation, leakage, maximum resting pressure, and maximum squeeze pressure of the anal canal, maximum tolerated volume, and pouch compliance were evaluated in 116 consecutive patients following total proctocolectomy (TPC) with ileal pouch anal anastomosis (IPAA) and after temporary ileostomy closure. Sixty-nine patients had a double ileal loop pouch ("J") and 47 a triple ("S") design. Seventy patients had mucosal proctectomy and hand-sewn IPAA (mucosectomy) and 46 a stapled IPAA without mucosal proctectomy (stapled). Fifty percent of the S and 30% of the J pouch patients did not have nocturnal defecations. The avoidance of anal manipulation in the stapled group resulted in higher anal canal resting pressures and a lower incidence of leakage. The maximum tolerated volume and compliance was greater in the S pouch group than in the J group. Although the median frequency of defecation was equal in both pouch groups, fewer S pouch patients had nocturnal defecations. Anal canal resting tone may be the primary factor affecting continence following TPC and IPAA, but a compliant pouch may prevent leakage if sphincter function is compromised.     

Gular pouch diversity in the Chamaeleonidae

Numerous chameleon species possess an out-pocketing of the trachea known as the gular pouch. After surveying more than 250 specimens, representing nine genera and 44 species, we describe two different morphs of the gular pouch. Species of the genera Bradypodion and Chamaeleo, as well as Trioceros goetzei, all possess a single gular pouch (morph one) formed from ventral expansion of soft tissue where the larynx and trachea meet. Furcifer oustaleti and Furcifer verrucosus possess from one to four gular pouches (morph two) formed by the expansion of soft tissue between sequential hyaline cartilage rings of the trachea. In Trioceros melleri, examples of both morphs of the gular pouch were observed. Morphometric data are presented for 100 animals representing eight species previously known to possess a gular pouch and two additional species, Bradypodion thamnobates and Bradypodion transvaalense. In the species with the absolutely and relatively largest gular pouch, Chamaeleo calyptratus, a significant difference was found between sexes in its width and volume, but not its length. In C. calyptratus, we show that an inflated gular pouch is in contact with numerous hyoid muscles and the tongue. Coupled with the knowledge that C. calyptratus generates vibrations from the throat region, we posit that the tongue (M. accelerator linguae and M. hyoglossus) and supporting hyoid muscles (i.e., Mm. sternohyoideus profundus et superficialis and Mm. mandibulohyoideus) are involved in the production of vibrations to produce biotremors that are amplified by the inflated gular pouch and used in substrate-borne communication.     

Isolated pouch of the anterior gastric wall

Summary Another modification of the original Pavlov pouch is presented. The exact details are given. The operation is described as being simple, and the innervation seems to be maintained intact.Presented by Active Member Academy of Medical Sciences, USSR, Prof. V. N. Chernigovsky     

Disorders of the suprapatellar pouch of the knee

Proper recognition and treatment of pathological conditions of the suprapatellar pouch of the knee is dependent on the knowledge of normal pouch anatomy and of the various conditions which affect this area of the knee and contribute to knee pain. This article includes a comprehensive review of the surgical anatomy of the pouch, current surgical techniques and review of the common conditions that have a predilection for this often overlooked area of the knee.     

The development of the Syrian hamster cheek pouch

The objective of this study was to provide a detailed account of the morphogenesis and early cytodifferentiation of the hamster cheek pouch. Although the newborn "cheek pouch" is used for in vitro studies of the effects of retinoids and carcinogens, its rudimentary structure has not been adequately described. Complete paraffin serial sections of the heads of 14- and 15-day fetuses were cut in three planes to determine the location and shape of the earliest pouch rudiments. Complete paraffin serial sections were prepared from pouch rudiments dissected from hamsters at birth and at daily intervals from 3 to 12 days postnatal. Semithin Epon sections were examined by light microscopy and ultrathin sections by transmission electron microscopy. The pouch can appear in the fetus as two solid epithelial ingrowths from the lining of the oral cavity. They are the margins of an ingrowing sheet of oral epithelium which becomes leaflike at about the time of birth, as it grows caudad into the tissue of the cheek. The central cells of the ingrowth accumulate large quantities of glycogen before differentiating as a stratum spinosum 5 days after birth. Within the stratum spinosum, groups of cells containing keratohyalin granules initiate the stratum granulosum. Keratinized cells appear within the stratum granulosum areas. Spaces appear between keratinized cells, and the spaces coalesce to form the pouch cavity between 7 and 12 days postnatal. Soon afterward, this cavity opens to the oral cavity to make a pouch, and the ultrastructure of the cheek pouch epithelium closely resembles that of the adult.     

Histoarchitecture of the ileal pouch after total colectomy

Total colectomy and the construction of an ileal pouch reservoir that preserves the patient's continence has become a surgical option for the treatment of patients who undergo total colectomy. By using histologic, electron microscopic, and morphometric methods, the histoarchitecture of the terminal ileal pouch, now functioning as a neorectum, was compared with preoperative biopsies from the normal terminal ileum, transverse colon, and rectum from patients undergoing the construction of a pouch as well as controls. Twelve patients, each of which had undergone a total colectomy with an ileal J-pouch anal anastomosis in our hospital between 1984 and 1987, were included in the study. Over a three year period a progressive transformation to a colonic type mucosa was observed in the ileal pouch. While total mucosal thickness remained unchanged, the number and size of the crypts increased dramatically, making some specimens indistinguishable from normal colonic mucosa on histologic examination. The number of mucus producing goblet cells and Paneth cells increased, whereas the endocrine cell population demonstrated no change. The possible metabolic and physiologic consequences of this mucosal transformation are discussed.     

Rathke's pouch grafts in adult brain sites

Donor tissue containing Rathke's pouch (RP) with its associated mesenchyme and neural lobe was isolated from 15-day fetal rats and stereotaxically transplanted either to hypothalamic hypophysiotropic sites or to cerebral cortex of adult females for 30 days. Hosts either were intact or had been hypophysectomized 2–4 weeks prior to transplantation of Rathke's pouch. Grafts in the hypothalamus of either intact or hypophysectomized hosts were pleomorphic and large, often as wide as 1–2 mm, and occasionally larger. Grafts in the cortex of either intact or hypophysectomized hosts were nodular and occasionally projected upward in association with the meninges (cortex/meninges grafts). Certain features were characteristic of the grafts in all experimental groups, i.e., development of histotypic pars distalis with cell cords and fenestrated capillaries. In all experimental groups gonadotrophs and somatotrophs, when present, were localized at the graft margin adjacent to the connective-tissue interface; mammotrophs, when present, were distributed throughout the graft. Features specific to each experimental group also were apparent. Grafts in the hypothalamus of both intact and hypophysectomized hosts typically were encapsulated by a labyrinthine meshwork of cell processes, whereas cortex/meninges grafts directly abutted dense connective tissue or neural tissue. In hypothalamic grafts in intact hosts, moderately differentiated mammotrophs, gonadotrophs, and somatotrophs could be identified by their cytological features and immunopositivity for prolactin, luteinizing hormone, and growth hormone, respectively. In hypothalamic grafts in hypophysectomized hosts, mammotrophs were absent, and gonadotrophs and somatotrophs were poorly granulated and not abundant. Grafts in the cortex of intact hosts contained numerous, well-differentiated mammotrophs, gonadotrophs, and somatotrophs. Many of the mammotrophs in these grafts were hypertrophied, and profiles of exocytosis were common. In grafts in the cortex of hypophysectomized hosts, mammotrophs were either absent or very few, whereas gonadotrophs and somatotrophs were numerous. Gonadotrophs in these grafts were dramatically hypertrophied, although exocytosis was rare. The results indicate that development of histotypic pars distalis may occur in hypophysiotropic and nonhypophysiotropic brain sites and that the hormonal state of the host as well as implantation site modulate cytodifferentiation of specific pars distalis cell types.     

Critical appraisal of air pouch infection model in rats

The aim of this study was to assess the efficacy and pharmacokinetic profiles of gentamicin, vancomycin, and levofloxacin in a rat air pouch model, in which Staphylococcus aureus (ATCC 25293) was used as the test organism. Antibiotic treatments (i.p.) were started 1 hour after bacterial inoculation and continued for 5 days. Bacterial counts and antibiotic concentrations were determined in pouch exudates that were obtained on the 5th day of antibiotic treatment. The following observations were made: 1) The concentrations of gentamicin or vancomycin in the exudate were found to be below the detection limit. 2) Levofloxacin and ciprofloxacin exhibited a dose-dependent effect on bacterial counts in the exudate. 3) The antibacterial efficacy of levofloxacin was found to be enhanced when the total daily dose of 10 mg was divided into smaller parts. The present study also showed that the air pouch infection model was a valuable tool to assess the pharmacokinetic and pharmacodynamic properties of antibiotics.     

Delayed hypersensitivity in the hamster cheek pouch.

A method is described for eliciting a delayed hypersensitive cell mediated immune response in the Syrian hamster cheek pouch. Using a sensitizing dose of 0.1% DNCB and a challenge dose of 0.01% DNCB 14 days later resulted in a histologically positive lymphocyte infiltrate in the challenge area. These results indicate that the hamster cheek pouch may not be an immunologically inert site and may be used for cell mediated immunity studies.     

Transplantation of a denervated gastric pouch into the omentum

Summary The author describes a 2-stage transplantation of a completely denervated isolated stomach pouch to the omentum.This is a technically simple operation and gives almost the same results as the transplantation of organs into the mammary gland. It has, however, some advantage over the classical method.The principle of this operation may be employed for transplantation of other abdominal organs.Presented by Active Member AMN SSSR V. N. Chernigovskii     

Quail Rathke''s pouch differentiation an electron microscopic study

Summary Adenohypophyseal region of quail embryo has been examined by electron microscopy from stage 12 to stage 21 of Zacchei (1961).The Seessel's pouch develops prior to the early stages of adenohypophysis formation, then regresses while Rathke's pouch proliferates and differentiates.From Rathke's pouch formation by stage 12 (48 h of incubation) until appearance of the first secretory granules by stage 21 (6 days of incubation), there are no major ultrastructural modifications in adenohypophyseal cells. Mitochondria, Golgi vesicles, polysomic ribosomes, pinocytotic vesicles, and mitotic figures become more numerous while nucleocytoplasmic ratio and the number of ribosomes and lipid droplets decreases. The major change is the appearance of secretory granules by day 6 of incubation. This phenomenon occurs at the same time as in chick embryo, despite an incubation period shorter for quail than for chick. Mitotic figures are mainly distributed near the pouch lumen, while secretory granules are first located in the peripheral cells of the cephalic part ofpars distalis primordium. The hypothetical role of mesenchyme and vascularization is discussed.This work has been supported by a grant from DGRST, no. 77.7.9665