We report a rare case of incarcerated rectal prolapse with ileal strangulation occurring after a Gant-Miwa procedure with anal encircling (Thiersch's procedure) for recurrent rectal prolapse. The patient was a 78-year-old woman who presented to our outpatient clinic the day after sudden rectal protrusion had occurred. She had undergone a Gant-Miwa procedure for rectal prolapse 4 years previously, and another Gant-Miwa procedure with anal encircling for recurrent rectal prolapse 18 months earlier. The patient attempted to reduce the prolapse manually, but was unsuccessful. On admission, a 10 x 4-cm semispherical mass was observed extra-anally, with a necrotic surface. We performed an emergency laparotomy, which rerealed a prolapse of the anterior wall of the rectum with part of the ileum protruding into the sac formation. Thus, we resected the incarcerated ileum followed by primary anastomosis and proctectomy (Hartmann's procedure) with good results. This case demonstrates that ileal strangulation can occur as a complication of rectal prolapse recurrence after perineal repair.
Mitchell, Dodge (1) and Day (2) reported that cataract develops in rats fed on hyper lactose and hypergalactose diets. Consequently, lactose and galactose are regarded as factors in cataract development. On the other hand, Takuma and Takayama (3) observed that cataracts developed from purified lactose can be inhibited by the addition of whey to the diet. Similar results were obtained by Tamura and coworkers (4). However, the nature of the factor in whey playing a key role here has not been determined. In 1957, Ogihara (5), one of our laboratory staff, reported that neutral fatty acids in whey have this inhibiting effect. Later, we made studies of the factor contained in whey and whey powder and further advanced the analytical studies of these fatty acids.
It has been long recognized that severe diarrhea, sometimes followed by death, de velops in young albino rats and mice because of hyperlactose and hypergalactose diets and that rat cataract also develops. Similar results have been reported by Guha (1). It was described in our previous paper (2, 3) that symptoms resulted from the activity of Leloir's enzyme system being deranged by the excessive lactose and galactose.Each rat was given 4 ml of whey/day , or the amount of filtrate corresponding to 4 ml of whey/day .Fro. 1. Methods of extraction of active factors.
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