Behavioral and epigenetic consequences of oxytocin treatment at birth.

Oxytocin is used in approximately half of all births in the United States during labor induction and/or augmentation. However, the effects of maternal oxytocin administration on offspring development have not been fully characterized. Here, we used the socially monogamous prairie vole to examine the hypothesis that oxytocin exposure at birth can have long-term developmental consequences. Maternally administered oxytocin increased methylation of the oxytocin receptor (Oxtr) in the fetal brain. As adults, oxytocin-exposed voles were more gregarious, with increased alloparental caregiving toward pups and increased close social contact with other adults. Cross-fostering indicated that these effects were the result of direct action on the offspring, rather than indirect effects via postnatal changes in maternal behavior. Male oxytocin-exposed offspring had increased oxytocin receptor density and expression in the brain as adults. These results show that long-term effects of perinatal oxytocin may be mediated by an epigenetic mechanism.

Seasonal variations in hair zinc concentrations in Canadian and African children.

Proximal occipital scalp hair samples were collected during three survey periods from 30 omniverous Canadian boys aged 75.6 +/- 10.4 months (mean +/- SD) and 66 rural Malawian children (37 M; 29 F) aged 62 +/- 10 months (mean +/- SD) consuming predominantly plant-based diets. Hair samples were washed and then analyzed for zinc and copper using instrumental neutron activation analysis. Selected anthropometric measurements were also taken and dietary intakes calculated from weighed dietary records. A marked seasonal variation in hair zinc concentrations occurred in both groups; levels were highest in the season with shortest daylight hours (i.e. December/January in Canada vs July/August in Malawi). A similar trend was not observed for hair copper concentrations. Changes in hair zinc were not associated with changes in growth indices, age, socio-economic group, method of infant feeding, in either group, but were related to intakes of protein (per 1000 kcal) (p = 0.02, r = -0.36), zinc (mg day-1) (p = 0.01, r = -0.39), and dietary fiber (g day-1) (p = 0.04, r = 0.28), in the Malawian children during the second survey period. The seasonal effect on hair zinc concentrations must always be considered when interpreting hair zinc concentrations in children; its etiology remains unclear.

Alternatives in the treatment of hemorrhoidal disease.

Pain, bleeding, protrusion, soilage, itching, and burning are anorectal complaints associated with hemorrhoidal disease. Although hemorrhoidectomy remains the treatment of choice for grade 3 and 4 hemorrhoids, symptoms can be controlled short of hemorrhoidectomy, the alternative methods being effective in lesser degrees of involvement, such as grades 1, 2, and 3. Cryosurgery and dilation are fading alternatives; laser is becoming more widely used, but results have not been fully evaluated. Sclerotherapy, rubber band ligation, and infrared coagulation are also effective alternatives for patients who demand nonsurgical therapy.

Puborectalis sphincteroplasty for anal incontinence.

Difficulty in rectal emptying, incontinence, solitary ulcer with bleeding, physical finding of lax puborectalis musculature, obtuseness of the anorectal angle, and bulging of the anterior rectal wall into the proctoscope suggest incontinence amenable to puborectalis plication. Puborectalis plication sphincteroplasty is useful in correcting patulousness and incontinence attendant with rectal procidentia, as well as certain cases of lax or nonresponsive puborectalis muscle related to idiopathic collagen disorders. Anorectal burning after correction of patulousness is related to irritable bowel aggravation, as occurred in one of my nine patients. Despite the short follow-up, preliminary results seem to warrant puborectalis sphincteroplasty in selected patients.

Preventing colorectal cancer.

Knowledgeable patients should not die of colorectal cancer. Increasing the intake of dietary fiber, decreasing fat consumption, and increasing the use of modern technology to detect adenomatous polyps and early cancer can greatly decrease the mortality associated with colorectal cancer.

Postoperative anorectal bleeding.

Forty-three postoperative anorectal bleeding episodes were encountered in the treatment of 4,059 anorectal operations, an incidence of 1.06 per cent. One-third of the postoperative bleeding occurred within the first 48 hours and reflects technical errors; nearly half of the bleeding occurred from the seventh to the 11th postoperative days; the cause of this delayed bleeding remains obscure.

Iatrogenic supralevator fistula.

This study scrutinizes supralevator fistula and evaluates a method of successful management. We reviewed 3,190 anorectal operations done between January 1970 and July 1976; 370 of these were for fistula, an incidence of 11.7%. Our data of 350 low or midlevel fistulas and 17 supralevator fistulas (seven deep ischiorectal sinuses and ten high intermuscular abscesses intraluminally drained) are correlated with those from another series. Three extrasphincteric fistulas were studied. The initial origin of these fistulas is cryptoglandular disease with the extrasphincteric supralevator fistula probably resulting from surgery. Surgical technics are described. Improper management of supralevator abscesses can result in an iatrogenically produced extrasphincteric fistula, a difficult and sometimes impossible fistula to cure.

Sloughage of the anus and lower rectum following aortic graft replacement: report of a case.

The successful management of a near-complete sloughage of the anal outlet following aortic graft replacement is reported. Oxygenation in the immediate postoperative period along with appropriate antibiotics may be beneficial in preventing such sloughage. Embolic phenomena or bacterial growth, or both, may have been factors in causing the extensive sloughage.

Omental pedicle graft rectopexy for rectal procidentia: preliminary report of a new method.

Twenty-six patients with rectal procidentia were satisfactorily treated by omental pedicle graft. Ten patients had anterior resection in addition to the omental pedicle graft procedure. There was no mortality and the morbidity was low. This is a preliminary report of the procedure. The entity of internal procidentia remains ill-defined, but with new demonstrative techniques it may become clearer and receive greater attention. The omental pedicle graft procedure is recommended for cautious trial because of the short follow-up period.

Leiomyosarcoma of the rectum.

We have reported a case of leiomyosarcoma of the rectum. These tumors comprise 0.1% of all rectal tumors, with about 100 cases having been reported. Symptomatology is nonspecific; digital examination is the most effective method of detection. Local surgical excision is as effective as abdominoperineal resection.

Simplified anterior resection: Use of the ta stapler.

Forty consecutive anterior resections using TA stapler were studied. No mortality, no clinical leak, and no infection were encountered in this group. The stapler is recommended as an aid in simplifying the operation and lessening the operative time.

Focal dermal hypoplasia (Goltz's syndrome) manifesting as condyloma acuminatum: report of a case and review of the literature.

A new case of Goltz's syndrome, focal dermal hypoplasia, is documented. The literature is reviewed. The composite individuality warrants considering Golt'z syndrome a separate syndrome in the ectodermal dysplasias. Caution against diagnosing "condyloma-like" lesions occurring in ectodermally dysplastic patients as condyloma acuminatum is urged. Neoplastic transformation and the tendency to recurrence after surgical exicision of the cutaneous angiofibromas pose a difficult problem in surgical management.