Gut, 1991,32, A1203-A1260 A 1203 British Society of Gastroenterology Gut: first published as 10.1136/gut.32.10.A1203 on 1 October 1991. Downloaded from The 1991 Autumn Meeting of the British Society of Gastroenterology was held at the University of Warwick from 9-11 September under the presidency of Professor Sir Robert Shields. Below are printed the 323 abstracts selected by the Programme Committee of the Society for oral and poster presentation. contraction and anal canal electrosensitivity The results showed that 95% of affected individuals (40/42) were informative with at COLORECTAL: SURGERY, INFLAMMATION AND were not significantly different. one probe (diagnostic accuracy 90-98%). NEOPLASIA Plugs were judged easy to insert (82% of least 45% were informative for flanking or remove (88%) and leakage occurred Some uses) (diagnostic accuracy >99%). during 20% of uses. Eleven patients would use markers Obstructed colon: do metalloproteinases the plug if it became commercially available. Altogether 82% of at risk individuals (27/33) for one or more probes. In 22 have a role in anastomotic dehiscence? plug may have a role in the were informative The anal by bowel management of patients with anorectal incon- cases prior risk had been reduced D L P LACOMBE, F J SAVAGE, R M HEMBRY, P B examination. Only one had the high risk allele. BOULOS (Department of Surgery, University tinence. Success depends on patient preference rather than underlying anorectal physiological Of 11 unscreened individuals, six had the low College and Middlesex School of Medicine, risk allele, three carried the high risk allele, and London and Strangeways Research Laboratory, parameters. two were uninformative. Cambridge) Indirect evidence suggested that In conclusion, DNA analysis can accurately collagenase is a factor in colonic anastomotic Failure of internal sphincter relaxation: the identify high risk family members. In conjunc- leakage. This study examined immunohisto- cause offissure? tion with clinical assessment it can also be used chemically the distribution of collagenase, and to considerably reduce an individual's risk. other metalloproteinases: stromelysin and R FAROUK, G S DUTHIE, D C C BARTOLO, A B This information can be used to reduce the gelatinase and their inhibitor, tissue inhibitor MACGREGOR, R MILLER (Departments ofSurgery, frequency of subsequent bowel screening. In of metalloproteinases (TIMP) in a rabbit Royal Infirmary ofEdinburgh and Bristol Royal our study population, 16/42 families (38%) colonic anastomosis. Infirmary) We carried out ambulatory measure- could benefit from DNA analysis. Develop- An anastomosis was formed after transection ments of internal anal sphincter electromyo- ment of preserved tissue DNA analysis from (group 1 n= 12), after resection of a 3 cm gram (EMG) with anal pressures using a deceased relatives would make a further segment of distal colon (group 2 n= 12) and computerised system to determine whether 16 families potentially informative. Direct after obstruction by a silicone ring placed the failure of internal sphincter (IAS) relaxation mutation probes would be needed for analysis day before resection (group 3 n= 12). Rabbits was the cause of anal fissures. in the remaining 10 families, which comprise of were killed 0 5, one, three, and seven days later Fifteen patients (median age=36 years isolated cases. and tissue taken from the anastomosis (A), (interquartile range 26-40); eight male) with and 3 5 (P1), and 20 (P2) cm anal fissures and 11 normal volunteers (age= 36 distal (D) (P0), mucosal proliferation after ileorec- proximally. years (25-71); six male) underwent fine wire Reduced In all groups, intra- and extracellular enzyme anal sphincter electromyography and anal tal anastomosis in familial adenomatous http://gut.bmj.com/ and TIMP were present at the anastomosis. In manometry. The median (range) IAS EMG polyposis may explain rectal polyp regression group 3 only,intracellular gelatinase occurred frequency was fissure=0-45 Hz (0.31-05), K C R FARMER, RK S PHILLIPS (St Mark's in the submucosa of the resected segment normal=0-41 Hz (0.25-0-44; p<0-01*). Hospital, London and Professorial Surgical Unit, and all postoperative tissue, extracellular Median anal pressures were fissure=118 cm St Bartholomew's Hospital, London) Rectal collagenase, gelatinase, stromelysin, and H20 (89-127), normal=90 cm H20 (60-130; polyp regression occurs in familial adenoma- TIMP were seen in the mucosa of D, A, P0, p<0002*). A direct linear relation between the tous polyposis (FAP) after ileorectal anastomo- and P1 but at seven days they were restricted to IAS EMG frequency and resting anal pressure sis (IRA). Because neoplasia and epithelial cell the anastomosis. was seen in both groups. The median number turnover are related, we determined the effect on September 28, 2021 by guest. Protected copyright. In the obstructed colon changes in the metal- of anorectal sampling episodes per hour was of IRA on rectal mucosal proliferation in FAP. loproteinases are less confined and may justify fissure=2 (1-4), normal=5 (4-6; p<0-01*). Endoscopic biopsy specimens of flat rectal reluctance for primary anastomosis in humans. Fewer episodes of sampling occurred at night mucosa were taken from eight FAP patients in both groups. Anal ultra-slow wave activity before colectomy and 12 FAP patients with an was noted in seven patients with fissures but established IRA. Mucosal proliferation was An analplug for use in anorectal incontinence not in the normal group. assessed by flash labelling proliferating cells The IAS EMG frequency is higher than T J O'KELLY, M SMILGIN HUMPHRIES, N IMCC with bromodeoxyuridine. Labelled cells were anal fissures and corre- MORTENSEN (Department of Surgery, John normal in patients with visualised on paraffin sections using an anti- Radcliffe Hospital, Oxford) We have developed lates directly with higher resting anal pres- bromodeoxyuridine monoclonal antibody. relaxation occurs on a new disposable anal plug for use in anorectal sures. Internal sphincter Twenty crypt columns were analysed. Micro- incontinence. Two tulip shaped designs (large fewer occasions in patients with fissures com- adenomas were excluded. Statistics: Mann- and small) have been trialled. Fourteen incon- pared with controls. Whitney U test. tinent patients (idiopathic 10, post anal surgery *Mann-Whitney U test. The mean labelling index (mean (SD) per- 2, spina bifida 2) median age 61 years (range centage labelled cells/crypt of FAP precolec- 18-82 years) used the plugs for two weeks, Polymorphic DNA probes and predictive tomy patients (13-2 (2.5)%) was significantly keeping a diary ofplug performance. familial adenomatous polyposis: greater than that of FAP patients with estab- diagnosis of lished IRAs (7.0 (1-4)%); (p=00002). Before Patients used more of the small plugs (small a population based study 12-1 (0.9) (mean (SEM)) v large 9-6 (1-0); p= colectomy, more labelled cells were in the 0-046 Wilcoxon signed rank test) but, there D G MORTON, F MACDONALD, M RINDL, middle and upper zones of the crypt was no difference in overall (small 133 (16) hrs R CULLEN, J HAYDON, J GIBSON, C McKEONN, (p<0005); by contrast more labelled cells were v large 97 (15) hrs) or individual plug use time J NEOPTOLEMOS, M KEIGHLEY, M HULTEN in the lower zone after IRA (p<0 005). (small 11.1 (141) hrs v large 10.3 (1.1) hrs). (University Department of Surgery, Regional Colectomy and IRA in FAP is associated There was no correlation between duration of Genetic Services and East Birmingham Depart- with a significant reduction in rectal mucosal plug use and anal canal pressures or sensation. ment of Ophthalmology, Birmingham) The cell proliferation. These findings may explain In the 10 patients who preferred the small plug, putative gene for familial adenomatous poly- both polyp regression in FAP after IRA and maximum resting anal canal pressure (MRP) posis (FAP) has closely linked flanking also the low rectal cancer risk. was lower than in those who liked the larger markers which can be used for predictive plug (small 39 (9.5) cm H20 v 91 (9.0) cm H20; diagnosis, but their value in population based P53 and the adenoma-carcinoma sequence p=0034 Student's t test). Maximum voluntary screening is poorly defined. Therefore, we undertook a study of 42 families (261 N SCOTT, P SAGAR, J STEWART, G E BLAIR, M F individuals) from a circumscribed population DIXON, P QUIRKE (Departments of Pathology, The accuracy of the data in these abstracts is the Surgery and Biochemistry, University of Leeds, responsibility of the authors since the abstracts have not of 5 5 million, using probes I1227, CIIPII, been subject to peer review. ECB27, and YN5. Leeds) p53 is a tumour suppressor gene which A1204 British Society ofGastroenterologv encodes a 53kD nuclear phosphoprotein. colorectal cancers were stained with AUA 1, paque centrifugation, the cells were cultured Mutations in conserved regions of the gene CAM 5.2, Ber EP4, 8.134, PR1A3, PR3B10, with autologous colorectal cancer cells at a ratio however, result in over-expression of a mutant HMFG2, 41.2, ICR2, anti-CEA. AUA1 and of 100:1 tumour cell and 100 U of interleukin 2 protein which acts as a classic oncoprotein. Ber EP4 were selected as both stained the cell for three to four weeks. The tumour cell Gut: first published as 10.1136/gut.32.10.A1203 on 1 October 1991. Downloaded from We have used immunohistochemistry to lines (2/2), colorectal cancer cryostat sections numbers, lymphocyte numbers and lympho- detect mutant p53 in 5% of 38 sporadic adeno- (9/9), malignant ascites (5/5) and were negative cvte cvtotoxicitv were assessed at weekly mas and 44% of 100 adenocarcinomas of the for benign ascites (0/5). intervals. large bowel. We conclude that p53 mutation In 25 patients, 400 ml of normal saline were Control cultures of tumour cells and inter- is a late event in the adenoma-carcinoma instilled into the peritoneal cavity at the begin- leukin 2 alone grew exponentially but in the sequence comparable with chromosome 17p ning and end of the operation, aspirated after mixed cultures all the tumour cells were killed deletions and deletions of the DCC gene.