|Budget Amount *help
¥3,300,000 (Direct Cost : ¥3,300,000)
Fiscal Year 1999 : ¥900,000 (Direct Cost : ¥900,000)
Fiscal Year 1998 : ¥2,400,000 (Direct Cost : ¥2,400,000)
In our previous works in RESEARCH PROJECT, GRANT-IN AID FOR SCIENTIFIC RESEARCH from 1996 to 1998, we have found 1) the anorectal dysfunction in patients with anorectal malformation, Hirschsprung's disease and chronic constipation and 2) somatosensory evoked potential abnormalities in post-operative patients with biliary atresia. In comparison with adult's patients, a chronological improvement has been more frequently found in pediatric patients, which is the most important issue in the assessment of pediatric surgical diseases. So, chronological changes in patients with anorectal malformation and atresia were investigated.
1) anorectal malformation :
In an analysis of EAS EMG using magnetic spinal nerve stimulation, EMG latency was initially elongated in high-type patients (5.8vs. 3.8 msec, patients vs. controls). Maximum EMG response was obtained in response to lumbar spinal stimulation instead of sacral nerve stimulation, suggesting the congenital dysfunction of p
udendal nerve innervating EAS. In the long-term follow-up of the these patients up to 5 years revealed that these abnormal findings were gradually improved, associated with improvement of the bowel function. Furthermore, in the study of electrical pudendal nerve stimulation, initial abnormal findings, such as increased threshold to induce a twitch contraction of EAS or failure to induce a twitch contraction, was also chronologically improved. Chronological improvements of the sphincter function may contribute to the improvement of post-operative bowel function in patients with anorectal malformation.
2) biliary atresia :
Spinal evoked potential at the level of sacral segment was disturbed in long-standing icteric patients even with normal serum level of Vitamin E. In patients who restored a normal liver function after liver transplantation, these evoked potential abnormalities were gradually recovered. Somatosensory evoked potential abnormality in biliary atresia might be caused by the multi-factorial events related to the liver dysfunction.
These results suggest that both anorectal and somatosensory dysfunction in pediatric surgical patients were not permanent phenomena as in adults' patients and there is a good possibility of functional improvement after corrective surgical intervention. Less