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1.
Nature ; 554(7691): 216-218, 2018 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-29420479

RESUMO

The atomic nucleus and its electrons are often thought of as independent systems that are held together in the atom by their mutual attraction. Their interaction, however, leads to other important effects, such as providing an additional decay mode for excited nuclear states, whereby the nucleus releases energy by ejecting an atomic electron instead of by emitting a γ-ray. This 'internal conversion' has been known for about a hundred years and can be used to study nuclei and their interaction with their electrons. In the inverse process-nuclear excitation by electron capture (NEEC)-a free electron is captured into an atomic vacancy and can excite the nucleus to a higher-energy state, provided that the kinetic energy of the free electron plus the magnitude of its binding energy once captured matches the nuclear energy difference between the two states. NEEC was predicted in 1976 and has not hitherto been observed. Here we report evidence of NEEC in molybdenum-93 and determine the probability and cross-section for the process in a beam-based experimental scenario. Our results provide a standard for the assessment of theoretical models relevant to NEEC, which predict cross-sections that span many orders of magnitude. The greatest practical effect of the NEEC process may be on the survival of nuclei in stellar environments, in which it could excite isomers (that is, long-lived nuclear states) to shorter-lived states. Such excitations may reduce the abundance of the isotope after its production. This is an example of 'isomer depletion', which has been investigated previously through other reactions, but is used here to obtain evidence for NEEC.

2.
Phys Rev Lett ; 130(12): 122503, 2023 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-37027850

RESUMO

The only proposed observation of a discrete, hexacontatetrapole (E6) transition in nature occurs from the T_{1/2}=2.54(2)-min decay of ^{53m}Fe. However, there are conflicting claims concerning its γ-decay branching ratio, and a rigorous interrogation of γ-ray sum contributions is lacking. Experiments performed at the Australian Heavy Ion Accelerator Facility were used to study the decay of ^{53m}Fe. For the first time, sum-coincidence contributions to the weak E6 and M5 decay branches have been firmly quantified using complementary experimental and computational methods. Agreement across the different approaches confirms the existence of the real E6 transition; the M5 branching ratio and transition rate have also been revised. Shell model calculations performed in the full fp model space suggest that the effective proton charge for high-multipole, E4 and E6, transitions is quenched to approximately two-thirds of the collective E2 value. Correlations between nucleons may offer an explanation of this unexpected phenomenon, which is in stark contrast to the collective nature of lower-multipole, electric transitions observed in atomic nuclei.

3.
Phys Rev Lett ; 128(25): 252501, 2022 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-35802446

RESUMO

The electric monopole (E0) transition strength ρ^{2} for the transition connecting the third 0^{+} level, a "superdeformed" band head, to the "spherical" 0^{+} ground state in doubly magic ^{40}Ca is determined via e^{+}e^{-} pair-conversion spectroscopy. The measured value ρ^{2}(E0;0_{3}^{+}→0_{1}^{+})=2.3(5)×10^{-3} is the smallest ρ^{2}(E0;0^{+}→0^{+}) found in A<50 nuclei. In contrast, the E0 transition strength to the ground state observed from the second 0^{+} state, a band head of "normal" deformation, is an order of magnitude larger ρ^{2}(E0;0_{2}^{+}→0_{1}^{+})=25.9(16)×10^{-3}, which shows significant mixing between these two states. Large-scale shell-model (LSSM) calculations are performed to understand the microscopic structure of the excited states and the configuration mixing between them; experimental ρ^{2} values in ^{40}Ca and neighboring isotopes are well reproduced by the LSSM calculations. The unusually small ρ^{2}(E0;0_{3}^{+}→0_{1}^{+}) value is due to destructive interference in the mixing of shape-coexisting structures, which are based on several different multiparticle-multihole excitations. This observation goes beyond the usual treatment of E0 strengths, where two-state shape mixing cannot result in destructive interference.

5.
Phys Rev Lett ; 125(19): 192505, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33216598

RESUMO

Mass-separated ^{187}Ta_{114} in a high-spin isomeric state has been produced for the first time by multinucleon transfer reactions, employing an argon gas-stopping cell and laser ionization. Internal γ rays revealed a T_{1/2}=7.3±0.9 s isomer at 1778±1 keV, which decays through a rotational band with perturbations associated with the approach to a prolate-oblate shape transition. Model calculations show less influence from triaxiality compared to heavier elements in the same mass region. The isomer-decay reduced E2 hindrance factor f_{ν}=27±1 supports the interpretation that axial symmetry is approximately conserved.

6.
Phys Rev Lett ; 122(21): 212502, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31283301

RESUMO

The ß-delayed γ-ray spectroscopy of neutron-rich ^{123,125}Ag isotopes is investigated at the Radioactive Isotope Beam Factory of RIKEN, and the long-predicted 1/2^{-} ß-emitting isomers in ^{123,125}Ag are identified for the first time. With the new experimental results, the systematic trend of energy spacing between the lowest 9/2^{+} and 1/2^{-} levels is extended in Ag isotopes up to N=78, providing a clear signal for the reduction of the Z=40 subshell gap in Ag towards N=82. Shell-model calculations with the state-of-the-art V_{MU} plus M3Y spin-orbit interaction give a satisfactory description of the low-lying states in ^{123,125}Ag. The tensor force is found to play a crucial role in the evolution of the size of the Z=40 subshell gap. The observed inversion of the single-particle levels around ^{123}Ag can be well interpreted in terms of the monopole shift of the π1g_{9/2} orbitals mainly caused by the increasing occupation of ν1h_{11/2} orbitals.

7.
Pediatr Surg Int ; 35(5): 559-563, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30778700

RESUMO

PURPOSE: We investigated the relationship between the affected lobe and symptom onset in prenatally diagnosed congenital pulmonary airway malformation (CPAM). METHODS: 53 CPAM patients diagnosed prenatally were reviewed retrospectively by creating 2 groups according to symptom onset. Group Sneo: (symptomatic during the neonatal period; n = 13) and group S > neo: (symptomatic after the neonatal period; n = 40) were compared for type of CPAM, affected lobes, types of symptoms/infections, treatment, duration of follow-up, and histopathology. Requirement for surgery (Sx) was then used to create three subgroups: Sneo + Sx, S > neo + Sx, and Sx-. RESULTS: Some cases had multiple affected lobes. In Sneo, symptoms developed in 55.6%, 50.0%, 0%, 0%, and 36.8% of right upper lobes (RUL), right middle lobes (RML), right lower lobes (RLL), left upper lobes (LUL), and left lower lobes (LLL) diagnosed with CPAM, prenatally. In S > neo, symptoms developed in 0%, 0%, 6.3%, 55.6%, and 33.3% of RUL, RML, RLL, LUL, and LLL diagnosed with CPAM, prenatally. CONCLUSION: In prenatally diagnosed CPAM, RUL and RML lesions are more likely to become symptomatic in neonates, and LUL lesions in infants. Surgery is recommended before the onset of respiratory infections after 1 year of age.


Assuntos
Malformação Adenomatoide Cística Congênita do Pulmão/diagnóstico por imagem , Lateralidade Funcional , Pulmão/diagnóstico por imagem , Ultrassonografia Pré-Natal , Idade de Início , Malformação Adenomatoide Cística Congênita do Pulmão/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , Pulmão/cirurgia , Masculino , Estudos Retrospectivos
8.
Phys Rev Lett ; 114(19): 192501, 2015 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-26024165

RESUMO

The ß-decay half-lives of 110 neutron-rich isotopes of the elements from _{37}Rb to _{50}Sn were measured at the Radioactive Isotope Beam Factory. The 40 new half-lives follow robust systematics and highlight the persistence of shell effects. The new data have direct implications for r-process calculations and reinforce the notion that the second (A≈130) and the rare-earth-element (A≈160) abundance peaks may result from the freeze-out of an (n,γ)⇄(γ,n) equilibrium. In such an equilibrium, the new half-lives are important factors determining the abundance of rare-earth elements, and allow for a more reliable discussion of the r process universality. It is anticipated that universality may not extend to the elements Sn, Sb, I, and Cs, making the detection of these elements in metal-poor stars of the utmost importance to determine the exact conditions of individual r-process events.

9.
Phys Rev Lett ; 113(4): 042502, 2014 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-25105611

RESUMO

A new isomer with a half-life of 23.0(8) ms has been identified at 2406 keV in (126)Pd and is proposed to have a spin and parity of 10(+) with a maximally aligned configuration comprising two neutron holes in the 1h(11/2) orbit. In addition to an internal-decay branch through a hindered electric octupole transition, ß decay from the long-lived isomer was observed to populate excited states at high spins in (126)Ag. The smaller energy difference between the 10(+) and 7(-) isomers in (126)Pd than in the heavier N=80 isotones can be interpreted as being ascribed to the monopole shift of the 1h(11/2) neutron orbit. The effects of the monopole interaction on the evolution of single-neutron energies below (132)Sn are discussed in terms of the central and tensor forces.

10.
Phys Rev Lett ; 112(13): 132501, 2014 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-24745408

RESUMO

A low-lying state in 131In82, the one-proton hole nucleus with respect to double magic 132Sn, was observed by its γ decay to the Iπ=1/2- ß-emitting isomer. We identify the new state at an excitation energy of Ex=1353 keV, which was populated both in the ß decay of 131Cd83 and after ß-delayed neutron emission from 132Cd84, as the previously unknown πp3/2 single-hole state with respect to the 132Sn core. Exploiting this crucial new experimental information, shell-model calculations were performed to study the structure of experimentally inaccessible N=82 isotones below 132Sn. The results evidence a surprising absence of proton subshell closures along the chain of N=82 isotones. The consequences of this finding for the evolution of the N=82 shell gap along the r-process path are discussed.

11.
Phys Rev Lett ; 111(15): 152501, 2013 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-24160593

RESUMO

The level structures of the very neutron-rich nuclei 128Pd and 126Pd have been investigated for the first time. In the r-process waiting-point nucleus 128Pd, a new isomer with a half-life of 5.8(8) µs is proposed to have a spin and parity of 8(+) and is associated with a maximally aligned configuration arising from the g(9/2) proton subshell with seniority υ=2. For 126Pd, two new isomers have been identified with half-lives of 0.33(4) and 0.44(3) µs. The yrast 2(+) energy is much higher in 128Pd than in 126Pd, while the level sequence below the 8(+) isomer in 128Pd is similar to that in the N=82 isotone 130Cd. The electric quadrupole transition that depopulates the 8(+) isomer in 128Pd is more hindered than the corresponding transition in 130Cd, as expected in the seniority scheme for a semimagic, spherical nucleus. These experimental findings indicate that the shell closure at the neutron number N=82 is fairly robust in the neutron-rich Pd isotopes.

12.
Transplantation ; 71(2): 199-202, 2001 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-11213059

RESUMO

BACKGROUND: Our purpose was to evaluate whether bladder transplantation (BTx) can be used for bladder augmentation (BA). METHODS: Bladders from infantile Brown-Norway rats (less than 21 days old) were excised and each transplanted into a pouch created in the distal omentum of a 6-week-old Lewis rat (fully allogeneic BTx). No immunosuppressant was used in group I (n=12). Intramuscular FK506 was used daily from the day of BTx in group II (n=16; 0.2 mg/kg), group III (n=22; 0.6 mg/kg), and group IV (n=16; 1.2 mg/kg) until harvesting 3, 4, 5, or 6 weeks after BTx. FK506 was used for only 2 weeks in group V (n=12; 0.6 mg/kg/day) and group VI (n=12; 1.2 mg/kg/day). Syngeneic bladder transplants acted as controls (n=16). Hematoxylin and eosin staining was used to examine all grafts. In six rats from group III, BA was performed by anastomosing the graft to the recipient bladder 10 days after BTx. RESULTS: Each successfully transplanted graft appeared macroscopically as a thin-walled cyst. Rejection was seen in all grafts from groups I, II, V, and VI, and was minimal or absent in groups III and IV. On medium to long-term follow-up the only side effect of FK506 observed was reduced weight gain. Graft survival in the control group was 100%. BA was successful in all six cases, and the mucosa was normal throughout each augmented bladder. CONCLUSIONS: This is the first report of the successful transplantation of infantile tissue without vascular anastomosis. Because of the efficient, safe immunosuppression possible with FK506, our BTx technique could find clinical application for creating viable vesical tissue that could be used for BA.


Assuntos
Bexiga Urinária/transplante , Animais , Animais Recém-Nascidos , Relação Dose-Resposta a Droga , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto/fisiologia , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Ratos , Ratos Endogâmicos BN , Ratos Endogâmicos Lew , Tacrolimo/administração & dosagem , Tacrolimo/efeitos adversos
13.
J Pediatr Surg ; 33(12): 1788-9, 1998 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-9869051

RESUMO

PURPOSE: To prevent the development of urethrocutaneous fistula after urethroplasty for hypospadias or recurrence after closure of a urethrocutaneous fistula, the authors developed a new simple technique wherein the readily available external spermatic fascia (ESF) surrounding the testis and cord is used as a pedicled blanket flap to cover the neourethra or the site of closure of a urethrocutaneous fistula. RESULTS: In three patients who had urethroplasty for hypospadias incorporating our ESF flap procedure, no urethrocutaneous fistula developed. It was also effective for closure of urethrocutaneous fistula in five patients, some of whom had had recurrent fistula formation.


Assuntos
Fístula Cutânea/prevenção & controle , Hipospadia/cirurgia , Retalhos Cirúrgicos , Uretra/cirurgia , Doenças Uretrais/prevenção & controle , Fístula Urinária/prevenção & controle , Adulto , Pré-Escolar , Humanos , Masculino , Prevenção Secundária
14.
J Pediatr Surg ; 34(4): 543-8, 1999 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-10235318

RESUMO

BACKGROUND/PURPOSE: In Hirschsprung's disease (HD), the aganglionic bowel is characterized by the presence of hypertrophic nerve trunks and increased numbers of adrenergic and cholinergic nerve fibers. Intestinal neuronal dysplasia (IND), if associated with HD, occurs proximal to the aganglionic segment in HD, and is characterized by dysplasia of parasympathetic nerves, hyperganglionosis, and giant ganglia. However, the cause of such abnormalities in HD and IND is unclear. Recent reports that mast cells (MC) have been observed in direct contact with nerve fibers generally, suggest that MC are essential for nerve growth and repair. MC synthesize, store, and release nerve growth factor (NGF). NGF supports the development and functional maintenance of sympathetic and cholinergic neurons. The aim of this study was to examine the colonic distribution of MC with respect to nerves in HD and HD associated with IND. METHODS: MC and NGF were examined immunohistochemically in ganglionic, transitional, and aganglionic segments of colon from 20 patients with HD (five patients associated with IND) and 15 age-matched controls. MC were counted in each of five random fields using light microscopy (x100). RESULTS: Interestingly, aganglionic and IND segments had large numbers of MC in all layers compared with ganglionic segments in HD patients and controls (P< .0001). The number of MC in transitional segments was significantly less compared with ganglionic segments in HD patients and controls (P< .01). MC stained positively for NGF, and some were found in contact with abnormal hypertrophic nerve trunks in HD and giant ganglia in IND. CONCLUSIONS: MC may cause hypertrophic nerve trunks and giant ganglia by releasing NGF and also may be an important factor in the excessive development of cholinergic and adrenergic nerve fibers in HD and IND.


Assuntos
Colo/inervação , Sistema Nervoso Entérico/crescimento & desenvolvimento , Doença de Hirschsprung/etiologia , Mastócitos/fisiologia , Sistema Nervoso Entérico/patologia , Doença de Hirschsprung/patologia , Humanos , Técnicas Imunoenzimáticas , Lactente , Recém-Nascido , Fibras Nervosas/química , Fibras Nervosas/patologia , Fatores de Crescimento Neural/fisiologia
15.
J Pediatr Surg ; 34(2): 273-6, 1999 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-10052803

RESUMO

PURPOSE: The aim of this study was to examine whether administration of probiotics to infants can change the ratio of intestinal flora and thereby decrease serum endotoxin produced by potentially pathogenic microorganisms. METHODS: Nine infants including five with of biliary atresia, two with omphalocele, one each with Hirschsprung's disease and imperforate anus were studied. All patients were stable, and no antibiotics were given during this study. A probiotic mixture consisting of Streptococcus faecalis, Clostridium butyricum and Bacillus mesentericus was administered orally to each infant at 2 g/day for 2 weeks. Fecal aerobic and anaerobic bacterial cultures, serum endotoxin level, and other biochemical parameters were examined. RESULTS: In fecal cultures, anaerobic bacteria including Bifidobacterium increased significantly whereas Escherichia coli, Streptococcus, and Klebsiella tended to decrease. The ratio of anaerobic to aerobic bacteria increased five times as a result of administration of probiotics, and serum endotoxin levels decreased. CONCLUSIONS: Probiotics affect intestinal bacterial flora by increasing anaerobic bacteria and decreasing the population of potentially pathogenic microorganisms. A decrease in luminal endotoxin may result in less endotoxin translocation or bacterial translocation.


Assuntos
Translocação Bacteriana , Endotoxinas/sangue , Intestinos/microbiologia , Probióticos/administração & dosagem , Administração Oral , Contagem de Colônia Microbiana , Fezes/microbiologia , Feminino , Humanos , Lactente , Masculino , Estatísticas não Paramétricas
16.
J Pediatr Surg ; 34(2): 308-11, 1999 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-10052811

RESUMO

PURPOSE: The aim of this study was to determine whether chemokines such as serum IP-10 levels in patients with biliary atresia (BA) correlate with liver function and histology and assess its value as a medium to long-term prediction of prognosis in postoperative BA patients. METHODS: Thirty postoperative BA patients (mean age, 10.8+/-3.5 years) and eight normal controls (mean age, 10.3+/-3.3 years) were studied. The BA patients were divided into three groups according to liver function. Group I (n = 8) was jaundice free, had normal liver function and no evidence of severe cholangitis or portal hypertension. Group II (n = 12) had moderate liver dysfunction. Group III (n = 10), had severe liver dysfunction. Hepatic histology was assessed using conventional needle biopsy. Serum IP-10 levels were determined using a specific enzyme-linked immunosorbent assay (ELISA). RESULTS: Serum levels of IP-10 in group III (458.0+/-240.0 pg/mL) were significantly higher than those in group II (233.6+/-126.9 pg/mL; P < .0001). Levels in group II were also significantly higher than those in group I (144.8+/-23.4 pg/mL; P < .05), but there was no significant difference between group I and controls (107.9+/-34.0 pg/mL). Liver biopsy findings showed a progression of fibrosis and mononuclear cell infiltration from group I to group III. There was intimal hyperplasia and swelling of endothelial cells of branches of the hepatic artery in the portal area in group III. CONCLUSION: Because IP-10 levels correlate closely with histological findings in postoperative BA patients, it would appear to play a specific role in hepatocyte death and hepatic artery changes, thus providing important information about progressive fibrosis in BA patients that facilitates treatment decision making and prediction of prognosis.


Assuntos
Atresia Biliar/sangue , Atresia Biliar/patologia , Quimiocinas CXC/sangue , Fígado/citologia , Atresia Biliar/cirurgia , Criança , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Testes de Função Hepática , Masculino , Valor Preditivo dos Testes
17.
J Pediatr Surg ; 34(2): 312-5, 1999 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-10052812

RESUMO

BACKGROUND/PURPOSE: A successful Kasai procedure is effective in creating biliary drainage and radically altering the natural history of infants with biliary atresia (BA). Since its introduction in the 1950s, long-term follow-up would appear to show that only 30% to 50% of patients have a good long-term prognosis despite initially good surgical outcome. The authors reviewed their experience in treating BA from 1968 to 1997 to assess long-term outcome. MATERIALS AND METHODS: The records of 163 patients treated surgically for BA from 1968 to 1997 were reviewed. Forty-eight (29%) were alive at the end of 1997, of whom, 14 had received liver transplants (LT). Surviving patients who had not undergone transplantation were divided into two groups according to clinical condition: group A, normal liver function without cholangitis (CG) and portal hypertension (PH) and group B, liver dysfunction with CG or PH. The study period was divided arbitrarily into three periods, 1968 to 1975 (period I, n = 34); 1976 to 1985 (period II, n = 81); 1986 to 1997 (period III, n = 48). RESULTS: Thirty-four patients were alive without LT at the end of 1997. There were eight patients (mean age, 16.3+/-4.8 years) in group A, and 26 patients (mean age, 14.3+/-7.6 years) in group B. Recently, four group A patients (mean age, 19.3+/-1.9 years) shifted to group B because of sudden deterioration in condition involving severe CG with multiple bile lakes (n = 2), uncontrollable intestinal bleeding (n = 1), and liver atrophy (n = 1). Survival deteriorated with length of follow-up. There were three survivors from 34 patients treated in period I, 16 survivors from 81 patients treated in period II (three had LT), and 29 survivors from 48 patients treated in period III (11 had LT). CONCLUSIONS: Although satisfactory bile drainage can be obtained with portoenterostomy, our data suggest that liver function can deteriorate progressively, with a possible turning point in late adolescence, indicating that as the length of follow-up increases, clinical assessment should be regular and comprehensive. The timing of LT in postoperative BA patients with deteriorating liver function is a vital management issue.


Assuntos
Atresia Biliar/cirurgia , Portoenterostomia Hepática/mortalidade , Adolescente , Adulto , Colangite/etiologia , Feminino , Seguimentos , Humanos , Hipertensão Portal/etiologia , Transplante de Fígado , Masculino , Taxa de Sobrevida , Resultado do Tratamento
18.
J Pediatr Surg ; 34(2): 370-2, 1999 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-10052826

RESUMO

BACKGROUND/PURPOSE: The aim of this study was to evaluate the advantages or disadvantages of laparoscopic pyloromyotomy compared with open transumbilical fold pyloromyotomy. METHODS: Thirty consecutive laparoscopic extramucosal pyloromyotomies (LP) performed from 1994 to 1997 were compared with 30 consecutive open pyloromyotomies (OP) performed during the same period with regard to age at operation, body weight, thickness of hypertrophied pyloric muscle, operating time, time of return to full feeding, frequency of postoperative emesis, surgical complications, and degree of surgical stress reflected by interleukin-6 (IL-6). LP was performed according to conventional techniques, and OP was performed using a transumbilical fold approach. RESULTS: The groups were matched for age at operation, preoperative clinical and physical status, laboratory data, and size of the hypertrophied pylorus assessed by ultrasonography. There was a learning curve with LP; the average operating time required for the first 10 cases was significantly longer than the time required for OP, but later cases took just as long as OP cases. Time taken to full feeding was significantly shorter in the LP group than the OP group (LP, 38 hours v OP, 64 hours). One case was converted from LP to OP because of mucosal perforation. The incidence of postoperative emesis was significantly higher in the OP group than in the LP group (OP, 25% v LP, 3%). The mean length of hospitalization was significantly shorter in LP (P < .01). The intraoperative peak values of IL-6 in LP were significantly lower than those in the OP group (P < .01). CONCLUSIONS: The advantages of LP are improved cosmesis, decreased surgical stress with earlier postoperative recovery, and shorter hospitalization. Because LP uses reusable devices, and the mean period of hospitalization is shorter, average operating costs could be reduced, representing a net saving in total hospital charges.


Assuntos
Laparoscopia/métodos , Estenose Pilórica/cirurgia , Ingestão de Alimentos , Humanos , Hipertrofia/cirurgia , Lactente , Recém-Nascido , Laparoscópios , Complicações Pós-Operatórias , Fatores de Tempo , Resultado do Tratamento
19.
J Pediatr Surg ; 34(11): 1599-602, 1999 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-10591550

RESUMO

BACKGROUND/PURPOSE: Anorectal achalasia (AA) may persist after pull-through (PT) for Hirschsprung's disease (HD), which may cause postoperative enterocolitis (POE) and constipation. The authors modified the Soave PT (modified Soave PT, MSPT) to eliminate AA, and present their results. METHODS: This was a 16-year retrospective review of 43 patients with histologically proven HD of the rectosigmoid or sigmoid colon treated by MSPT. The MSPT involves excision of the posterior rectal cuff and an intraoperative internal sphincterotomy, allowing the PT colon to fit nicely. RESULTS: Mean age at MSPT was 16.7 months (16 were < or =3 months old [37%]; 7 were neonates [16%]). Mean follow-up was 9.2 years. Six of 43 cases (14%) had preoperative enterocolitis; only 2 of 43 (5%) had single episodes of POE. At review, 37 of 43 were older than 4 years; 29 (78%) had normal bowel function (14 had experienced soiling after MSPT, which resolved after a mean of 6.4 years); and 8 (21%) had problematic bowel function: 3 had occasional soiling, 1 had soiling only before defecation, 3 (8%) had constipation requiring laxatives or enemas, and 1 had significant soiling. CONCLUSION: MSPT is safe and may contribute to a reduction in the incidence of POE and constipation.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Doença de Hirschsprung/cirurgia , Esfinterotomia Endoscópica/métodos , Feminino , Seguimentos , Doença de Hirschsprung/diagnóstico , Humanos , Lactente , Recém-Nascido , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos Retrospectivos , Resultado do Tratamento
20.
J Pediatr Surg ; 32(1): 38-40, 1997 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-9021564

RESUMO

Intraoperative biopsies are essential for accurately distinguishing between Hirschsprung's disease (HD) and intestinal neuronal dysplasia (IND), and vital for determining the extent of abnormal bowel for surgical correction. IND can be associated with HD and can be a cause of postoperative complications. Routine hematoxylin and eosin (H&E) staining is sometimes inadequate for identification of ganglion cells in biopsy specimens and can be the cause of confusion. The authors found synaptophysin (SY) to be more specific as an indicator of abnormal bowel innervation and invaluable for surgical planning. Twenty patients (15 with HD, 3 with IND, and 2 with IND complicating HD) received biopsies intraoperatively. There was markedly reduced immunoreactivity (ie, a decreased number of SY-positive synapses) seen in the intestinal smooth muscle layers of transitional, aganglionic, and IND bowel segments, whereas immunoreactive synapses were abundantly present in the smooth muscle layers of ganglionic colon in HD. SY immunoreactivity also showed ganglion cells and hypertrophic nerve trunks clearly. Rapid SY staining is a simple and consistently reliable method for the intraoperative evaluation of the distribution of synapses in myenteric plexuses as well as smooth muscle layers.


Assuntos
Doença de Hirschsprung/cirurgia , Intestinos/cirurgia , Cuidados Intraoperatórios , Sinaptofisina , Anticorpos , Biópsia , Corantes , Estudos de Avaliação como Assunto , Gânglios/anormalidades , Gânglios/patologia , Doença de Hirschsprung/patologia , Humanos , Hipertrofia , Imuno-Histoquímica , Lactente , Enteropatias/patologia , Enteropatias/cirurgia , Intestinos/inervação , Intestinos/patologia , Músculo Liso/inervação , Músculo Liso/patologia , Plexo Mientérico/patologia , Planejamento de Assistência ao Paciente , Complicações Pós-Operatórias , Reprodutibilidade dos Testes , Sinapses/ultraestrutura , Sinaptofisina/imunologia
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