1. A method is described for the measurement of colonic mucosal-submucosal blood flow in man, by studying surgically created colostomies. 2. A local radioisotopic clearance technique utilizing a stable preparation of [125I]4-iodoantipyrine is employed. The indicator is injected directly into the colostomy under study and its gamma emission is recorded by a scintillation detector. 3. A radioautographic study was carried out at laparotomy in humans to facilitate the interpretation of the recorded washout curves. This demonstrated that the tracer was cleared from both the mucosa and submucosa throughout the period of study. 4. Mucosal-submucosal blood flow was calculated according to Kety (1949) from the monoexponential clearance curves obtained, and amounted to 31.7 +/- 11 ml./min. 100 g (S.D. of an observation, n = 30). 5. The results from two consecutive measurements in seventeen patients showed that the mean change between first and second readings was not significant (t test). In addition the between-patient variation (12.2) was significantly greater than the within-patient variation (2.6) for consecutive recordings (F test; P less than 0.01). 6. The within-patient between-days variation (12.9; n = 10) was found to be similar to the between-patient variation. 7. It is concluded that the technique permits measurement of local colonic blood flow in man and by consecutive measurements, it may be used to evaluate local changes in blood flow following reflex or pharmacological stimulation.
Fistula formation following closure of a colostomy occurs most frequently when closure is carried out within the first few weeks of construction and may be related to an impaired local microcirculation. Using a recently described method for measuring colonic mucosal-submucosal blood flow, the variations in local flow which occur during the first month after colostomy construction were determined in 8 patients. Mean blood flow increased from 6.9 +/- 1.8 ml min-1 100 g-1 (s.d.) at 7 days to 31.1 +/- 12.5 ml min-1 100 g-1 (s.d.) at 28 days. In a further 40 consecutive patients undergoing colostomy closure, blood flow measurements were made before operation. Eight patients developed a faecal fistula, and in 5 of these patients mucosal-submucosal blood flow was found to be less than 15 ml min-1 100 g-1. In every successful colostomy closure blood flow was greater than 15 ml min-1 100 g-1. This study provides evidence that a subnormal blood flow is one of the factors associated with fistula formation following the operation of colostomy closure.
The accurate assessment of local blood flow by recording the washout of a deposit of radiolabelled 4-iodoantipyrine (4-IAP) requires the use of a stable radiopharmaceutical. This communication shows that it is possible to produce a 125I and 131I-4-IAP compound which fulfills this requirement under simulated conditions of use.
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