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Biomedical subjects

S Kyzer

Publications and source records attributed to S Kyzer.

At least 37 records · Page 2Linked to original sources

The value of nuclear morphometry in the management of patients with colorectal polyps that contain invasive adenocarcinoma.

Haggitt's classification is a useful guide in the management of patients with large bowel polyps which contain invasive adenocarcinoma in that patients with levels 1 to 3 require no operation. Nuclear morphometry has been shown to be a useful prognostic discriminant for patients with invasive carcinoma of the large bowel. The nuclear shape factor of 44 polyps with invasive carcinoma was studied to determine whether this parameter was of value to define those patients with Haggitt level 4 who should have a resection. The shape factor of 50 interphase nuclei was obtained through the use of image analysis by tracing the nuclear profiles as digitized on a video screen. The nuclear shape factor was defined as the degree of circularity of the nucleus, a perfect circle recorded as 1.0. Our previous experience showed a nuclear shape factor greater than 0.84 was associated with a poor outcome. The overall mean shape factor was 0.71 (0.59-0.85). There was a tendency for the patients with residual disease to have values in the upper range. Our findings suggest that nuclear morphometry fails to add any predictive information in this clinical situation.

Adenocarcinoma

The stapled functional end-to-end anastomosis following colonic resection.

To determine the results of our experience with the use of staples for construction of anastomoses following colonic resection, a series of 223 anastomoses performed in 205 patients was reviewed. Indications for operation included malignancy, benign neoplasms, inflammatory bowel disease, and several miscellaneous entities. A functional end-to-end anastomosis using the standard GIA cartridge and the TA 55 instruments was performed. The operative mortality was 1.5% with none of the deaths related to the anastomosis. Intraoperative complications encountered included bleeding (21), leak (1), tissue fracture (1), instrument failure (4), and technical error (3). Early postoperative complications related or potentially related to the anastomosis included bleeding (5), pelvic abscess (1), fistula (1), peritonitis (2), ischemia of anastomosis (1). Late complications included five patients with small bowel obstruction, two of whom required operation. Anastomotic recurrences developed in 5.9% of patients. Our experience gained with stapling instruments has shown them to be a reliable method for performing anastomoses in the colon in a safe and expeditious manner.

Adolescent

Proliferative activity of colonic mucosa at different distances from primary adenocarcinoma as determined by the presence of statin: a nonproliferation-specific nuclear protein.

The field change is one hypothesis concerning the development of colorectal carcinoma. Removal of a carcinoma without its entire surrounding altered mucosa may result in the development of a recurrence. S44, a monoclonal antibody directed against statin, a nuclear protein expressed in nonproliferating cells in either a quiescent or senescent state, was used to determine the rate of cell growth in colorectal mucosa at different distances from carcinomas. The specimens of 18 patients undergoing resection of a colorectal carcinoma were immediately opened after operation, and strips of mucosa were taken at distances of 1 cm, 5 cm, and 10 cm from the carcinoma. For each location, 10 longitudinally oriented crypts were evaluated for statin-positive cells identified by the presence of a dark brown peroxidase-conjugated antibody reaction product. The average percentage of statin-positive cells per crypt was significantly lower at a 1-cm distance from the carcinoma compared with the mucosa located 5 and 10 cm from the carcinoma (20.89 +/- 4.33 at 1 cm, 32.41 +/- 5.27 at 5 cm, and 34.23 +/- 6.45 at 10 cm). None of the calculated parameters showed any significant difference between the 5-cm and 10-cm locations. The fact that the proliferation rate of the mucosal cells returns to the normal level at 5 cm from the margin of the carcinoma suggests that cells located within this distance still retain proliferative potential even though they are morphologically indistinguishable from their normal counterparts. We conclude that failure to remove this transitional, potentially proliferative mucosa may result in subsequent development of anastomotic or perianastomotic recurrences.

Antibodies, Monoclonal

Experience with the use of the circular stapler in rectal surgery.

This report provides our personal experience along with a general overview of the use of the circular stapler in rectal surgery. To determine the results of our experience with the use of the circular stapler for construction of anastomoses following resection, a series of 215 anastomoses performed in 214 patients was reviewed. The patients ranged in age from 33 to 88 years. There were 116 men and 98 women. Indications for operation included malignancy, diverticular disease, villous adenoma, Crohn's disease, and rectal procidentia. The types of operation performed included removal of varying portions of the large bowel. The anastomosis was performed in a uniform manner with the EEA (United States Surgical Corp., Norwalk, CT) and more recently the CEEA (United States Surgical Corp., Norwalk, CT). The operative mortality was 0.47 percent, with the death being unrelated to the anastomosis. Intraoperative complications encountered included bleeding, difficult extraction, instrument failure, incomplete doughnuts, deficient anastomoses, and miscellaneous problems. Early postoperative complications included one leak and a number of complications unrelated to the anastomoses. Anastomotic stenosis developed in 27 patients, but only 8 were permanent and only 3 of these were symptomatic. Two of these patients were treated with balloon dilatation. Anastomotic recurrences developed in 13.1 percent of patients. Our experience gained with the circular stapling device and that reported in the literature have shown it to be a reliable method of performing anastomoses to the rectum in a safe and expeditious manner.

Adult

Sialic acid level in maternal and neonatal lymphocytes and sera correlated to birth order and sex of the neonate.

Sialic acid (N-acetylneuraminic acid) was determined 1 h after normal term deliveries on peripheral blood lymphocytes from 42 mother-neonate pairs and in 29 maternal and neonatal sera. Results were evaluated according to maternal parity and sex of the neonate. The cases were divided into two groups: primiparae, and secundi- and multiparae. In primiparae the sialic acid level on lymphocytes from male neonates and from their mothers was by 23-30% decreased as compared to female neonatal and maternal cells. In the higher parity group, a significantly increased sialic acid level was found on lymphocytes from male as compared to female neonates, and maternal serum sialic acid concentration, unrelated to the newborns' sex, was by 17-20% increased as compared to primiparae. The results suggest that with increasing parity higher levels of sialic acid on male neonatal cells may possibly contribute to mask fetal male-specific histocompatibility antigens. Increased sialic acid levels in maternal sera from secundi- and multiparae suggest its possible contribution to an increased serum blocking effect.

Birth Order

Histochemical localization of Statin--a non-proliferation-specific nuclear protein--in nuclei of normal and abnormal human thyroid tissue.

Surgical specimens of 29 human thyroid masses, both benign and malignant, were examined by means of a novel monoclonal antibody immunoreactive to statin, which is expressed only in quiescent G0 cells. The nuclei of normal thyroid follicle tissue together with nodular goitres and follicular adenomata had similar labelling indices of 96 +/- 2.67, 95 +/- 2.43 and 94 +/- 1.98 respectively. By contrast the labelling indices of papillary and undifferentiated thyroid malignancies were 82 +/- 3.05 and 15.2, respectively. These results indicate that normal thyroid tissues as well as benign thyroid tumors have similar non-proliferative activities. The differentiated papillary cancers have a smaller non-cycling compartment, the smallest being present in the most biologically aggressive undifferentiated thyroid cancer. The immunohistological evaluation of statin in the nuclei of human thyroid malignancies correlates with their biological behaviour in an inverse relationship.

Adenoma

Rumenectomy-induced proliferation in duodenal villous epithelium is mechanistically related to the disappearance of statin, a non-proliferation-specific nuclear protein.

We undertook this study to determine the effect of rumenectomy (a known cause of duodenal crypt cell hyperplasia) on the epithelial growth kinetics of the crypt-villus axis in rat duodenum. Ten rats were randomly assigned to control (gastrotomy) and experimental (rumenectomy) groups. After 14 days rats were sacrificed and representative sections were stained with the monoclonal antibody to statin, a non-proliferation-specific protein, by the immunoperoxidase procedure. In the control group, the mean percentages of statin-positive cells in the proximal duodenum, distal duodenum, proximal jejunum, and distal jejunum were 79 +/- 8.5, 79.5 +/- 5.7, 85 +/- 1.4, and 83.5 +/- 0.7, respectively. In the rumenectomy group, statin-positive nuclei were found in the region of the villous apices only, and the corresponding values for the above four areas were 26.2 +/- 4.9, 24.5 +/- 3.5, 31.7 +/- 4.5, and 80.5 +/- 2.1. Except for distal jejunum, the differences in statin expression in the control and experimental groups were significant (p less than 0.001). Rumenectomy leads to the disappearance of statin from the villous column cells of the duodenum and proximal small bowel. The lack of expression of statin in the rumenectomy group documents the potential usefulness of this measure in future studies in neoplasia were understanding of the proliferative status is of crucial importance.

Animals

New approach to surgical treatment of ulcerative colitis and polyposis coli without pelvic pouch. Experimental study in dogs.

A new method for the surgical treatment of ulcerative colitis and polyposis coli is described. Instead of preparing a pelvic pouch, the natural rectal pouch stripped of the diseased mucosa was used experimentally in dogs. The undisturbed muscular cuff of the rectum (12 cm from the anal verge) was covered by healthy vascularized mucosa of small bowel in such a manner that the dog could use its rectum as usual before surgery. The results are encouraging. The rectal reservoir is spared, with its sensitivity, continence and motor activity covered by healthy mucosa. The dogs thrived.

Adenomatous Polyposis Coli

Esophageal transection with automatic stapler device for bleeding esophageal varices. Case report and review of the literature.

The EEA stapler offers a relative easy technique for the control of severe bleeding from esophageal varices. Two cases are reported in which this technique in combination with proximal gastric devascularization and splenectomy was found to be superior to the performance of portosystemic shunt in emergency cases. The results of portocaval shunts created during severe bleeding from esophageal varices are not satisfactory because of the high mortality rate varying between 36% and 47% (1, 2) and the development of postoperative encephalopathy. For these reasons the tendency today, in cases of severe bleeding from esophageal varices where conservative treatment was unsuccessful, is that the surgeon should attack the bleeding area itself (3). Support for this opinion may be found in the publications of Sugiura and Futagawa (4, 5) and of Koyama et al. (6) about their long-term good results obtained after esophageal transection for bleeding esophageal varices.

Adult

Rectal bleeding induced by Dipyridamole.

Nineteen patients treated continuously with Dipyridamole were evaluated for rectal bleeding. Thirteen suffered from overt rectal bleeding and six served as controls. Hemorrhoids were found in all patients. Contact bleeding was found in 16. The bleeding continued despite rubber band ligation, and stopped only on withdrawal of the drug.

Dipyridamole

The influence of peritoneal closure on formation of intraperitoneal adhesions: an experimental study.

Adhesion formation to the peritoneal scar was investigated in 108 white Wistar rats which had undergone midline laparotomy under ether anaesthesia. In 92 rats a microtrauma was produced by rubbing the intraperitoneal organs with dry gauze. After this procedure in 46 rats the abdominal cavity was closed by suturing the peritoneum and fascia, and in another 46 rats the peritoneum was left untouched. In the remaining 16 rats a sham operation was performed. The rats were sacrificed after 7, 14, 30 and 60 days and adhesion formation to the peritoneal scar was studied microscopically and macroscopically. It was found that in rats in which the peritoneum layer was sutured a significantly higher amount of adhesion to scar developed. The results of the sham operation proved that the method of abdominal-wall closure is responsible for the adhesion formation to scar after laparotomy.

Animals

Spontaneous rupture of the common bile duct.

Spontaneous rupture of the common bile duct in adults is very rare. The authors report only the 14th case in the Western literature. A 25-year-old woman had signs of peritonitis suggestive of a perforated appendix, but at operation the appendix appeared normal and a large amount of bile was found in the peritoneal cavity. A 2-mm tear was found on the anterior wall of the common bile duct. The patient recovered without complications after T-tube drainage and cholecystectomy. In this patient none of the factors thought to cause spontaneous rupture of the common bile duct were present, so the authors conclude that the case may be classified as idiopathic spontaneous rupture of the common bile duct.

Cholangiography