Laparoscopy or conventional open surgery for patients with ileocolonic Crohn's disease? A prospective study.

BACKGROUND: Crohn's patients have been considered challenging laparoscopic candidates. The aim of this study was to analyze the short-term and long-term outcomes of laparoscopic and open surgery in consecutive patients with ileocolonic Crohn's disease. METHODS: Patients were enrolled prospectively but not randomized between August 2002 and October 2006. Patients and disease-specific characteristics, intraoperative variables, and short-term and long-term postoperative outcomes were analyzed. RESULTS: Overall, 146 consecutive patients were included in the study: 59 in the laparoscopic operation group and 87 in the open operation group. Laparoscopic patients were younger (P = .001), with a lower body mass index (BMI) (P = .008). Operative time was similar between the 2 groups. Blood loss was less in the laparoscopic group (P = .012), and postoperative blood transfusions were administered only to patients in the open group. Narcotic requirement, which was expressed as days on the IV narcotics and as morphine equivalent, was less in the laparoscopic group (P = .01). Duration of stay was less in the laparoscopic group, 5.5 versus 7.0 days, (P = .001). Using step-wise multiple regression analysis, the use of laparoscopic operation was associated with a lesser hospital stay (P < .05). Complication rates were similar, which included 1 anastomotic leak that required reoperation in each group. At a median follow-up of 19 months, there have been no disease recurrences. CONCLUSIONS: In selected patients, laparoscopy leads to a faster recovery without increasing morbidity and without compromising remission. It should be considered a safe and effective alternative to open operation.

Preservation of the anal transition zone in ulcerative colitis. Long-term effects on defecatory function.

INTRODUCTION: The anal transition zone (ATZ) after ileal pouch anal anastomosis (IPAA) for ulcerative colitis is considered at risk for dysplasia and persistent or recurrent disease activity. The long-term fate of the ATZ and the effects of histologic changes on defecatory function are not well-known. METHODS: To evaluate the inflammatory and preneoplastic changes of the ATZ in patients without preoperative dysplasia, yearly biopsies of the ATZ were obtained and functional results recorded on a questionnaire/diary. Histologic changes were correlated with simultaneous assessment of defecatory function. RESULTS: Between 1992 and 2006, 225 patients underwent a stapled IPAA. A total of 238 successful biopsies of the ATZ were performed. There was no dysplasia found. Acute inflammation was noted in 4.6%, chronic inflammation in 84.9%, and normal mucosa in 10.5% of cases. Patients with chronic inflammation reported an average of 6.2+/-1.7 bowel movements/day and 93.2% of them were able to delay a bowel movement for at least 30 min. The presence of chronic ATZ inflammation did not seem to have a negative impact on function, with 96.1% of patients reporting perfect continence, and only 5.3% using protective pads. CONCLUSIONS: Preservation of the ATZ in selected patients is safe and offers excellent long-term functional results. New onset dysplasia was not noted. Chronic inflammation had limited clinical impact. Presence of ATZ inflammation in a total of 89.5% of patients warrants life-long surveillance with biopsies.

Hippocampal pyramidal cells in adult Fmr1 knockout mice exhibit an immature-appearing profile of dendritic spines.

Fragile X syndrome (FXS) is a common form of mental retardation caused by the absence of functional fragile X mental retardation protein (FMRP). FXS is associated with elevated density and length of dendritic spines, as well as an immature-appearing distribution profile of spine morphologies in the neocortex. Mice that lack FMRP (Fmr1 knockout mice) exhibit a similar phenotype in the neocortex, suggesting that FMRP is important for dendritic spine maturation and pruning. Examination of Golgi-stained pyramidal cells in hippocampal subfield CA1 of adult Fmr1 knockout mice reveals longer spines than controls and a morphology profile that, while essentially opposite of that described in the Fmr1 knockout neocortex, appears similarly immature. This finding strongly suggests that FMRP is required for the processes of spine maturation and pruning in multiple brain regions and that the specific pathology depends on the cellular context.

Dendritic spine abnormalities in the occipital cortex of C57BL/6 Fmr1 knockout mice.

Fragile X syndrome (FXS) is the most common form of inherited mental retardation. Observed neuropathologies associated with FXS include abnormal length, morphology, and density of dendritic spines, reported in individuals with FXS and in Fmr1 knockout (KO) mice, an animal model of FXS. To date, however, these neuropathologies have been studied in Fmr1 KO mice bred in a FVB background (a strain with genetic mutations that complicate interpretation of results) and findings have been inconsistent. Here, Golgi-Cox impregnation was used to investigate length, morphology, and density of dendritic spines on layer V pyramidal neurons in visual cortices of Fmr1 KO and wildtype (WT) mice bred in a C57BL/6 background. We report that spine abnormalities in these animals parallel abnormalities reported in humans with FXS, perhaps to a greater degree than KO mice bred in an FVB background. Specifically, Fmr1 KO mice bred in a C57BL/6 background exhibited significantly more longer dendritic spines and fewer shorter spines, as well as more spines with immature-appearing morphology and fewer with mature-appearing morphology than WT littermates. Spine length abnormalities were demonstrated to be largely independent of spine morphology abnormalities, as the length phenotype was observed in KOs even within a morphological category. Fmr1 KO mice also had a greater overall spine density than WTs. These findings provide powerful support for the essence of the dendritic spine abnormalities in the absence of FMRP, now found to be largely consistent with human data across two mouse backgrounds.