Healing in the gastrointestinal tract

Healing in the GI tract is rapid when free of complications: Unlike cutaneous healing, in which progress can be observed on a daily basis and intervention instituted early if necessary, healing of the intestinal anastomosis is anatomically obscured from inspection, allowing the surgeon only the patient's parameters of general well-being to judge the success of the operation. For the same reason, complications usually require re-operation, with the associated morbidity of a laparotomy and additional general anesthetic. This places a great responsibility on the surgeon to be cognizant of all the preoperative, intraoperative, and postoperative factors relating to anastomotic healing that might compromise the healing process. Bearing these in mind, along with attention to technical detail, should limit complications to an acceptable level. Patients most at risk are (1) those who perioperatively develop physiologic problems that lead to shock, hypoxia, and resultant anastomotic ischemia, (2) those with radiation-induced tissue injury, (3) those with sepsis, and (4) those with preoperative bowel obstruction. Malnourishment, malignancy, diabetes, steroids, and age also influence outcome to varying degrees. Future advancement in the field of GI healing lies in our ability to manipulate the early struggle between collagen synthesis and collagen breakdown. A profound understanding of the molecular and biochemical pathways and the factors that control them will bring us closer to this goal. Clinically, this may be accomplished by the introduction of wound healing enhancers into the anastomotic site, possibly by incorporating them into suture materials, biofragmentable anastomotic rings, or staple materials. Already much is known about the influence of different cytokines and growth factors on collagen regulation, knowledge that will help resolve many of the long-standing problems associated with GI surgery.     

Expanding forces in aqueous outflow pathways of a nonaccommodating mammal: an approach via comparative dynamic morphology

Six dog eyes were fixed by intracameral perfusion of fixative at pressures of 0, 5, 10, 15, 20, and 25 cm of water. Eight dog eyes were fixed after the injection in both ocular chambers of a number of cholinergic agents, either singly or in combination. Under the effect of miotics and under increased ocular pressure, the aqueous pathways expand. An analysis of the forces involved in expansion of the exit pathways reveals the primary role of the detached ciliary body in nonaccommodating mammals. Two mechanisms appear to have been conserved in dogs and humans throughout evolution. The first is an active mechanism: the opening of the trabecular meshwork as a consequence of the combined action of the ciliary muscle and the iris and its insertion ligaments-the uveoscleral trabeculate-in dogs, and the longitudinal portion of the ciliary muscle and scleral spur in humans. The second is a passive mechanism: the infundibular arrangement of the drainage structures assisted by the traction on the zonular ligament of the lens, which responds to an increase in pressure in the anterior chamber by widening the pathways, thus favoring outflow.     

Lesions of the tracheobronchial tree after the aspiration of a tablet of ferrous sulfate

Foreign body aspiration requires emergency bronchoscopic examination when the product is chemically active. We describe the case of a female patient who aspirated a ferrous sulfate tablet that, in spite of being extracted immediately, caused lesions that persisted in the bronchial tree for 6 weeks. We then discuss the potential of ferrous sulfate substance to cause damage to the tracheobronchial tree.     

Nature-nurture in the classroom: entrance age, school readiness, and learning in children

The impact of entrance age on reading and mathematics achievement in 1st grade was examined. Methodological problems with past research were identified, including small size of achievement differences, failure to take background variables into account, and confusion of achievement levels with degree of learning. Using a pre-post design, growth of reading and mathematics was examined in younger 1st graders, older 1st graders, and older kindergarteners. Comparisons of background information on these groups with children who were either held out prior to or retained an extra year in kindergarten, produced minimal background differences. Results revealed that younger 1st graders made as much progress over the school year as did older 1st graders and made far more progress than older kindergarteners. Overall, findings demonstrated that, in itself, entrance age was not a good predictor of learning or academic risk.     

Is the breast best for children with a family history of atopy? The relation between way of feeding and early childhood morbidity

BACKGROUND: Previous studies reported that breast-feeding protects children against a variety of diseases, but these studies were generally conducted on "high-risk" or hospitalized children. This paper describes the results of our study on the effects of breast-feeding on rate of illness in normal children with a family history of atopy. METHODS: A historic cohort approach of 794 children with a family history of atopy was used to assess the effects of breast-feeding on illness rates. Family history of atopy was based on allergic diseases in family members as registered by the family physician. Illness data from birth onwards were available from the Continuous Morbidity Registration of the Department of Family Medicine. Information on breast-feeding was collected by postal questionnaire. We then compared rates of illness between children with a family history of atopy who were and who were not breast-fed. RESULTS: Breast-feeding was related to lower levels of childhood illness both in the first and the first three years of life. In the first year of life they had fewer episodes of gastroenteritis, lower respiratory tract infections, and digestive tract disorders. Over the next three years of life they had fewer respiratory tract infections and skin infections. CONCLUSIONS: Our results suggest a protective effect of breast-feeding among children with a family history of atopy that is not confined to the period of breast-feeding but continues during the first three years of life. Breast-feeding should be promoted in children with a family history of atopy.