Management of congenital pouch colon based on the Saxena-Mathur classification

Background

Management guidelines with regard to congenital pouch colon (CPC) are not clearly defined with regard to the type of pouch present. The aim of this study was to outline the management strategy and surgical approach to CPC using the Saxena-Mathur classification based on anatomical morphology of the pouch.

Methods

During a 12-year period (1995-2007), 426 patients were surgically managed for anorectal malformations at the RNT Medical College, Udaipur. Congenital pouch colon was documented in 80 patients and categorized into 5 types according the anatomical morphology. The management strategy depended upon the location of the pouch and its condition at the time of the surgery.

Results

In type 1 and type 2 CPC, a 1-stage (pouch excision and pull-through) or 3-stage procedure (ileostomy, pouch-coloplasty with pull-through, and ileostomy closure) was performed depending on the condition of the pouch (ischemic or healthy). In type 3 and type 4 CPC, a 3-stage procedure (pouch excision with colostomy, pull-through, and colostomy closure) was performed in all patients. In type 5 CPC, a 3-stage procedure (distal pouch excision with proximal pouch-coloplasty with ileostomy, pull-through, and colostomy closure) was successful.

Conclusion

Management of CPC patients according the Saxena-Mathur classification provides a well-defined algorithm in the surgical approach according to the anatomical morphology of the pouch.     

Role of plain abdominal radiographs in predicting type of congenital pouch colon

Background  

Congenital pouch colon (CPC) is a rare form of high ano-rectal malformation (ARM) in which part of or the entire colon is replaced by a pouch with a fistula to the genito-urinary tract. According to the Saxena-Mathur classification CPC is divided into five types. Although plain abdominal radiographs are taken in infants with suspicion of CPC to detect large dilatation of the pouch, the determination of the type of CPC is made during surgical exploration. Since large variations in the length of normal colon are present in the various types, management strategy options can be determined only at the time of surgery.     

Disposition of the hypolipidaemic agent, 6-amino-2-mercapto-5-methylpyrimidine-4-carboxylic acid, in Sprague-Dawley rats.

The disposition of [2-14C]6-amino-2-mercapto-5-methylpyrimidine-4-carboxylic acid has been determined in rats following intravenous and oral administration. A two-compartment pharmacokinetic model fitted to the blood and urinary data predicted its maximum terminal (beta) half-life to be 38 h. Urinary and faecal excretion accounted for approximately 30 and 8% of the administered radioactivity, respectively. The parent compound accounted for 88% of the urine radioactivity after oral administration. In a tissue distribution study, the largest percentages of radioactivity were found in the skin and carcass; by 24 h, all other organs contained less than 1% of the administered radioactivity. The drug was highly water soluble, not extensively bound to plasma proteins, nor taken up by red blood cells. The drug uptake by human fibroblasts or rat aorta cells appeared to be by passive diffusion.     

Structure Activity Relationships of 4-Substituted 1-Acyl and 1,2-Diacyl-1,2,4-triazolidine-3,5-diones as Anti-inflammatory Agents in Rodents

1-Acyl and 1,2-diacyl 1,2,4-triazolidine-3,5-diones proved to be potent anti-inflammatory agents in rodents at 8 or 20 mg/kg. They were effective against induced edema, pleurisy, and septic shock. Furthermore, these agents were potent in blocking the writhing reflex suggesting that they should be effective against local pain generated by inflammatory processes. These compounds were not lysosomal hydrolytic enzyme or proteolytic enzyme inhibitors in mouse liver, macrophages or human leukocytes. However, the agents were potent inhibitors of prostaglandin and leukotriene de novo synthesis and have potential in acting as free radical scavengers.     

Acute Toxic and Teratogenic Effects of Cyclic Imides in Rodents

Four structurally different cyclic imides or related derivatives (o-(N-phthalimido)acetophenone ( 1 ), 2,3-dihydrophthalazine-1,4-dione ( 2 ), N-(4-methylphenyl)diphenamide ( 3 ), and 4,6-dihydro-5H-dibenz[c,e]azepine ( 4 ) were examined for acute toxicity in mice at multiple doses, for long term toxicity at a single dose in rats, and for deleterious effects on fertility and pup development in rodents. No deleterious effects were observed when mice were administered agents at 20, 50, and 100 mg/kg/day for seven days. All other measured characteristics and values were normal for the four compounds. The principle effect of the compounds was to reduce the percent pregnancies in treated mice compared to the controls. Compound 2 afforded the greatest reduction of pregnancy (54%) at 100 mg/kg/day. Compounds 3 and 4 caused a minor reduction in pregnancy (12-20%). The compounds did not appear to cause measureable teratogenic effects; pups of treated rodents thrived and survived as well as controls. There were no effects on murine male fertility when compounds were administered at 20, 50, and 100 mg/kg/day for six weeks.