Wound sepsis after cholecystectomy. Influence of incidental appendectomy

We undertook a prospective study of the effect of incidental appendectomy on the safety of cholecystectomy in patients under the age of 50 years. One hundred twenty patients were randomized to have either cholecystectomy alone or cholecystectomy and appendectomy. All patients received preoperative antibiotic cover. Both groups were well matched for age, sex, obesity, and length of hospital stay. Twelve patients were withdrawn from the trial. Wound infections occurred in three of the 56 patients in the cholecystectomy group (5.3%) and in two of the 52 patients in the cholecystectomy plus appendectomy group (3.8%). Incidental appendectomy is a safe addition to elective cholecystectomy.     

Vagal stimulation-induced gastric acid secretion in the anesthetized rat

The dynamics of gastric acid secretion induced by electrical stimulation of the cervical vagus in the anesthetized rat were investigated using a continuous collection-titration system permitting high temporal resolution. Stimulation with pulse rates of 2 or 4 impulses/s (pps) produced maximal gastric acid responses with small cardiovascular effects. With continuous stimulation, secretion was sustained for at least 1 h. Frequency-response profiles suggested that the parietal cells are innervated predominantly by fine-caliber C-fibers. Continuous stimulation was 3 times as effective as stimulation in bursts of higher frequencies. The minimal latency for the onset of secretion was 2.6 min at 4 pps, however, one- and two-min stimulations still produced proportionate but delayed secretory responses. It is concluded that, with low frequency cervical vagus stimulation, the rat stomach preparation described and employed in the present experiment is a useful model for further studies on the interaction of neural and humoral factors on gastric acid secretion.     

Risky behavior in teens with cystic fibrosis or sickle cell disease: a multicenter study

OBJECTIVE: To determine the prevalence and age of onset of common risky behaviors such as smoking and sexual activity in teens with cystic fibrosis and those with sickle cell disease and to compare their behaviors with those of adolescents in the general population. DESIGN: Survey. SETTING: All five major pediatric tertiary care centers in North Carolina (study participants with sickle cell disease or cystic fibrosis) and North Carolina public schools (comparison population). PARTICIPANTS: Three hundred twenty-one adolescents with cystic fibrosis or sickle cell disease aged 12 to 19 years (mean age, 15.6 years; 49% female). Demographically matched comparison teens for each group were selected from 2760 in-school adolescents (mean age, 16.0 years; 51% female). MAIN OUTCOMES MEASURES: Prevalence of tobacco and marijuana use, alcohol use, sexual intercourse, sexually transmitted diseases, seat belt use, weapon carrying, and age of onset of these behaviors. RESULTS: Chronically ill teens reported significantly less lifetime and current use of tobacco, marijuana, and alcohol; less sexual intercourse; less weapon carrying, less drunk driving, and more seat belt use than their peers. Nonetheless, 21% of the teens with cystic fibrosis and 30% of those with sickle cell disease had smoked; sexual intercourse was reported by 28% and 51%, respectively. Age of onset of these behaviors was frequently older for the chronically ill teens. CONCLUSION: Teens with cystic fibrosis or sickle cell disease took more potentially damaging health risks than might be expected, although the prevalence was lower than reported by their peers. Future longitudinal studies should examine the relationships between chronic illness, physical and psychosocial maturation, and risky behavior. Screening for psychosocial issues, including risky behaviors, should be incorporated into the routine health care of chronically ill teens.     

Maternal predictors of early breast milk output

Previous attempts to show a quantitative relationship between maternal hormone levels and early milk output have used small sample sizes and simple correlations. Women of mixed parity and similar socio-economic status and education were recruited to a study using multivariate analysis to look for these associations. Hormone levels (oestradiol, progesterone, prolactin and thyrotropin (TSH)) were determined for 91 mothers at four time points (ante- and postnatally) from finger-prick blood spots by fluoro-immunoassay. Milk output at 1 and 4 weeks was determined from 24-h test weighings. Parity was found to be the most significant factor affecting breast milk volume at 1 wk postpartum (multiparous women delivered 142 ml more milk in 24 h than primiparous women). Total time spent feeding had a strong association with breast milk volume, with increasing time having a negative effect. Multiple regression analysis, controlling for parity and time spent feeding, showed a positive association of milk output at 1 wk with antenatal progesterone and antenatal prolactin levels. At 4 wk, higher postpartum oestradiol levels had a negative association and antenatal progesterone levels a positive association with milk output. This study demonstrates that there are quantitative associations between antenatal maternal hormone levels and breast milk output in the early postnatal period.     

Longitudinal columnar organization within the dorsal motor nucleus represents separate branches of the abdominal vagus

To identify the distribution of central preganglionics associated with each branch of the subdiaphragmatic vagus, the fluorescent tracer True Blue (TB) was administered intraperitoneally to rats with 4 out of 5 branches cauterized, and then, after 72 h, the animals were sacrificed for histological analysis. Each vagal branch contained the axons of a topographically distinct column of cells within the dorsal motor nucleus of the vagus (DMN). The columns representing the 4 branches with the largest numbers of efferents are organized as paired, bilaterally symmetrical, longitudinal distributions on either side of the medulla. Each DMN side contains a column occupying the medial two-thirds or more of the nucleus and corresponding to one of the gastric branches (left DMN, anterior gastric; right DMN, posterior gastric). Also on each side, the lateral pole of the DMN consists of a coherent cell column corresponding to one of the celiac branches (left DMN, accessory celiac; right DMN, celiac). The fifth branch, the hepatic, is represented by a limited number of somata forming a diffuse column largely coextensive with that representing the anterior gastric branch. At some levels of the DMN, the columns overlap. Labeled cells observed in the reticular formation were correlated in number, left-right ratios and response to vagotomy with those in the DMN, which suggests that they are displaced cells of the nucleus. Distributions of labeled cells in the nucleus ambiguus and the retrofacial nucleus were not tightly correlated with those of the DMN. An analysis of cell counts obtained for each of the individual branches suggests that vagal axons do not generally send collaterals through more than one branch.     

Stomach serosal arteries distinguish gastric regions of the rat

Because the stomach in situ has few distinctive surface features and changes shape dramatically with food intake, we have used micro-CT imaging combined with two distinct contrast agents to (1) characterize the pattern of arteries, potential landmarks, on the stomach wall and (2) evaluate how meal-related shape changes affect the size of the different regions. Images generated with a contrast agent injected directly into the heart during perfusion enabled a thorough look at the organizational features of the stomach angioarchitecture. The stomach receives its blood supply primarily from two pairs of vessels, the gastric and gastroepiploic arteries. Each of the three regions of the stomach is delineated by a distinctive combination of arterial fields: the corpus, consistent with its dynamic secretory activity and extensive mucosa, is supplied by extensive arterial trees formed by the left and right gastric arteries, travelling, respectively, on the ventral and dorsal stomach surfaces. These major arteries course circularly from the lesser towards the greater curvature, distally along both left (or ventral) and right (or dorsal) walls of the corpus, and branch rostrally to supply the region. The muscular antrum is characterized by smaller arterial branches arising primarily from the right gastroepiploic artery that follows the distal greater curvature and secondarily from small, distally directed arteries supplied by the large vessels of the left and right gastric arteries. The forestomach, essentially devoid of mucosal tissue and separated from the corpus by the limiting ridge, is vascularized predominantly by a network of small arteries issued from the left gastroepiploic artery coursing around the proximal greater curvature, as well as from higher order and smaller branches issued by the gastric and celiac arteries. These distinctive arterial fields appear to distinguish the major gastric regions, irrespective of the degree of fill of the stomach. Volume assessments of stomach compartments were made from images of iodine-stained stomachs. By varying the delay time between eating and perfusion, we were able to probe the emptying behavior of the stomach and demonstrate that the regions of the stomach empty at different rates, thus changing the relative dimensions of the organ regions. Notably, and despite these shape changes, the gastric arteries appear to form a regular, particularly recognizable, and lateralized pattern corresponding to the corpus that should be of use in guiding surgical and experimental interventions.     

C-Kit mutant mice have a selective loss of vagal intramuscular mechanoreceptors in the forestomach

Intramuscular arrays are one of two major classes of vagal afferent mechanoreceptors that innervate the smooth muscle wall of the proximal gastrointestinal tract. They consist of rectilinear telodendria that distribute in the muscle sheets, parallel to the long axes of muscle fibers. Intramuscular arrays appear to make direct contact with the muscle fibers, but they also course on, and form appositions with, intramuscular interstitial cells of Cajal. These complexes formed by intramuscular arrays and intramuscular interstitial cells of Cajal suggest that intramuscular arrays might require either structural or trophic support of the interstitial cells of Cajal for normal differentiation and/or maintenance. To evaluate this hypothesis, we have examined the morphology and distribution of vagal afferent endings in the c-Kit mutant mouse that lacks intramuscular interstitial cells of Cajal. Vagal afferents were labeled by nodose ganglion injection of either wheat germ agglutinin-horseradish peroxidase conjugate or a tagged dextran, and the labeled afferent terminals in the stomach were mapped using a standardized quantitative sampling scheme. Intramuscular arrays were dramatically reduced (in circular muscle by 63%; in longitudinal muscle by 78%) in the c-Kit mutant mice relative to their wild-type littermates. Additionally, a substantial number of the surviving axons and terminals in the mutant stomachs were morphologically aberrant. Moreover, the loss of intramuscular arrays in mutants appeared to be selective: the structure, distribution and density of intraganglionic laminar endings, i.e., the other vagal mechanoreceptors in smooth muscle, were not significantly altered. Finally, the conspicuous decrease in intramuscular array density in mutants was associated with a non-significant trend toward loss of nodose ganglion neurons. Collectively these findings suggest that interstitial cells are required for the normal development or maintenance of vagal intramuscular arrays. Therefore, the c-Kit mutant mouse will be valuable for determining the role(s) of interstitial cells in intramuscular array development as well as for providing an animal model with the intramuscular array class of vagal afferents selectively ablated.