Immediate and long-term results of surgical management of low imperforate anus in girls.

BACKGROUND: The majority of girls with imperforate anus are reported to have a malformation of the low variety. Despite this, much of the literature has focused on the more complex, high lesions. METHODS: This study reviews our experience with 44 girls with low imperforate anus from a 22-year period. RESULTS: The incidence of associated anomalies was 61%, which is higher than generally reported. All patients in the study had anal fistulae. Fifty-seven percent had perineal fistulae, 23% had fourchette fistulae, and 20% had vestibular fistulae. Cutback anoplasty was performed in 55%, Potts transfer anoplasty was used in 27%, and 18% of patients were treated with either limited posterior sagittal anorectoplasty or anterior sagittal anorectoplasty. Surgical complications were uncommon. Long-term follow-up was carried out by telephone survey. This showed 89% of the girls to be successfully toilet trained. However, 47% of patients experience at least occasional soilage or episodic fecal incontinence. CONCLUSIONS: Low imperforate anus can be successfully treated using a variety of procedures without colostomy. Most girls with low imperforate anus are successfully toilet trained, but problems with continence persist in a significant number of these patients.

Inhibition of nitric oxide-induced vasodilation by gap junction inhibitors: a potential role for a cGMP-independent nitric oxide pathway.

Studies have provided evidence for the role of gap junctional intercellular communication in syncytial tissue function. This study tested the hypothesis that the vasodilating effects of nitric oxide (NO) rely on gap junctions. The effects of the gap junction inhibitors octanol (10(-4) mol/l) and heptanol (10(-3) mol/l) were examined on acetylcholine-, the NO-donor S-nitroso-N-acetyl-penicillamine (SNAP)-, and guanosine-3',5'-cyclic monophosphate (cGMP)-induced relaxation. In addition, we tested varying concentrations of the gap junction inhibitor sucrose on SNAP-induced relaxation in the presence and absence of methylene blue, an inhibitor of guanylate cyclase. Helical strips of rat thoracic aorta were placed in muscle baths for isometric force measurements. Tissues treated with SNAP and cGMP were denuded of endothelium. Tissues incubated in octanol and heptanol exhibited 4- to 7-fold rightward shifts in acetylcholine-induced and 6- to 15-fold rightward shifts in SNAP-induced relaxation. Both octanol and heptanol produced 2-fold rightward shifts in cGMP-induced relaxation, comparably less in magnitude than shifts produced in acetylcholine- and SNAP-induced relaxation. Sucrose (10(-2) to 10(-1) mol/l) produced a concentration-dependent rightward shift of up to 30-fold in relaxation to SNAP. Incubation with methylene blue (10(-6) mol/l) altered this rightward shift only slightly, indicating a possible cGMP-independent mechanism for NO. These findings support the hypothesis that NO-induced vasodilation, through both cGMP-dependent and -independent pathways, relies on gap junctional communication.