Eighty-four patients had colectomy with ileostomy and oversewing of the rectum for Crohn's colitis. Seventy-two patients were operated on because of intractable disease, colitis in combination with rectal fistulas, and toxic megacolon. The operative mortality was 6 percent, and neither emergency surgery nor treatment with steroids correlated with operative morbidity. After a median 7.7 years of follow-up, 25 ileorectal anastomoses had been undertaken, 16 of which were successful. Twenty-nine protectomies were performed; the resulting 10-year cumulative risk of proctectomy was 50 percent. While the risk of proctectomy was significantly less among patients with a normal rectum at colectomy compared with patients with proctitis, the initial macroscopic degree of proctitis did not correlate with the risk of subsequent proctectomy. The 5-year cumulative ileal resection rate in 29 patients with a rectum in situ but out of circuit was 29 percent. The possibility of a future ileorectal anastomosis should still be considered in patients with proctocolitis.

Formation of NO, enzymatically catalyzed by NO synthases in both endothelial cells and autonomic nerves, seems to explain some noncholinergic nonadrenergic tissue reactions. We studied the possible role of NO in vagally induced pancreatic exocrine secretion using isolated perfused porcine pancreas (n = 11) with intact vagus nerve (VN) supply. Electrical stimulation of the VN (8 Hz, 10 mA) and infusions of vasoactive intestinal polypeptide (VIP, 2 x 10(-9) M) were carried out before and after addition to the perfusate of the NO synthase inhibitors N omega-nitro-L-arginine methyl ester (L-NAME, 10(-4) M) or NG-nitro-L-arginine (L-NNA, 10(-5) M) with and without further addition of L-arginine (10(-3) M). We also studied the effects of L-arginine alone and of sodium nitroprusside (10(-4) M). In all experiments VN and VIP caused a profuse exocrine secretion (43 +/- 7 and 44 +/- 11 times basal secretion). The inhibitors increased vascular resistance approximately twofold but had no effect on the vascular relaxation caused by VIP and VN. The exocrine fluid response to VN was reduced to 19 +/- 5 and 4.7 +/- 1.8% (L-NAME and L-NNA), and response to VIP was reduced to 54 +/- 12 and 35 +/- 13%. Protein and bicarbonate outputs largely paralleled flow rate. Addition of L-arginine (no effects alone) to L-NAME restored the responses to VN (to 100 +/- 21% of controls) and increased VIP responses (to 65 +/- 11%).(ABSTRACT TRUNCATED AT 250 WORDS)

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Pancreatic spasmolytic polypeptide (PSP) is a peptide that is isolated from the porcine pancreas and that affects intestinal motility and growth of intestinal tumour cells in vitro. The peptide was recently demonstrated to be present in large amounts in pancreatic juice. The cellular origin of the peptide, however, is largely unclarified and the localization was therefore studied of PSP in pigs using immunohistochemistry. Positive immunoreactions were seen in the pancreas, the stomach, the duodenum, the jejunum and the ileum. In the pancreas, the PSP immunoreaction was seen in all acinar cells; no immunoreaction was seen in the endocrine islets. In the stomach, it was localized to the mucous cells of the glands in the cardiac gland region, the corpus and the pylorus. In the duodenum a strong immunoreaction was present in Brunner's glands and in the cells of their excretory ducts. In the jejunum and ileum, PSP immunoreactivity was seen in some of the cells in the epithelium of the crypts of Lieberkühn. A peptide chromatographically identical to highly purified PSP was identified in pancreas and stomach extracts. Thus epithelial cells in all parts of the stomach and small intestine contribute to the supply of PSP to the gut lumen.