ヒルシュスプルング病の組織化学的診断法 : ことに非特異的コリンエステラーゼ染色法の有用性について

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  • Nonspecific Cholinesterase Staining for Supportive Diagnostic Method of Hirschsprung's Disease

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Histochemical diagnosis using acetylcholinesterase (AChE) staining is very useful for differentiation of Hirschsprung's disease from idiopathic constipation. This method can show marked proliferation of nerve fibers in aganglionic segment of the colon. We have studied histochemically the localization of AChE and ChE (nonspecific cholinesterase) in specimens obtained by either operation or suction biopsy. ChE activities were observed in nerve plexus and not detected in nerve fibers. Electromicroscopically, the localization of ChE were detected mainly around the ganglion cells and neuropils. AChE activities in specimens obtained by rectal biopsy can be falsely negative or positive. In our studies, false negative cases could be avoided by suitable position of rectal biopsy or appropriate evaluation of AChE activities. False positive findings were observed in two cases of CIIPS (chronic idiopathic intestinal pseudo-obstruction syndrome) and a case of septic neonate. In these cases, ChE staining was useful for detection of ganglion cells. Though the AChE staining alone can produce false negative or false positive result, we could get good result by using both AChE and ChE staining in the same materials. For these reasons, we recommend ChE staining for supportive diagnostic method of Hirschsprung's disease and examination of intestinal dysfunction.

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