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[The difficult rectal stump].

Abstract

During proctectomy for rectal cancer, section and closure of the rectal stump with TA55 before stapled low colorectal anastomosis could be very difficult, especially in obese patient. In this situation, others solutions includes use of TA30 or Roticulator, closure of rectal stump by suture, use of laparoscopic endoGIA. If no device can be used, manuel colo-anal anastomosis can be performed after rectal version, instead of stapled very low colorectal anastomosis.

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BibTeXRIS

Y Panis. 2002. [The difficult rectal stump].. https://doi.org/10.1016/s0003-3944(02)00790-3

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Horseradish peroxidase (HRP) retrograde tracing techniques and morphometric analyses were performed to investigate synaptic remodeling associated with neuronal and glial changes in the dorsal motor nucleus of the vagus (DMV) of cats after vagal-hypoglossal nerve anastomosis (VHA). At 25 days postoperation (dpo), in the early target-reinnervation stage, there were 50% fewer presynaptic boutons containing round vesicles (R) or round and large dense-cored synaptic vesicles (R+D) contacting HRP-labeled DMV motoneurons. The loss of R boutons was maintained throughout the remaining postoperative intervals up to 500 dpo, whereas R+D boutons were further reduced at 123 dpo but were restored at 315 dpo, so that, by 500 dpo, 71.4% of them had gained access to the DMV motoneurons. Boutons containing pleomorphic synaptic vesicles (P) were completely disconnected from the DMV motoneurons at 25 dpo and did not reappear even in the long-term reinnervation stage. Loss and recovery of presynaptic boutons occurred in parallel with changes in astroglial ensheathment of the DMV motoneurons. It is suggested that synaptic remodeling associated with astroglial ensheathment in the DMV may be influenced by some retrogradely transported factors/signals derived from the newly acquired target organ, viz. tongue skeletal musculature. Our results further suggest that the observed changes in boutonal configurations may be attributable to modified functions of the DMV motoneurons induced by VHA.

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[New strategies in surgical management of coarctation of the aorta 1975-2001].

AIM: This article presents the early and late surgical results of 401 newborns and infants among the 569 children with coarctation of aorta who were operated on between 1975-2001. RESULTS: The early results were dependent on the anatomy of the aortic arch, the age and weight of babies and the types of the associated heart defects. The mortality rate was reduced from 15% (isolated coarctation 7.3%, complex coarctation 34%) to 3.0% (isolated 1.9%, complex 4.9%). 77.3% of 320 infants (follow-up 1 month-26 years, mean: 17 years) were free from re-operation or intervention. The (extended) end-to-end anastomosis and the subclavian flap method produced the best surgical results. CONCLUSIONS: They suggest the extended end to end anastomosis technique for repair of the aortic arch together with the reconstruction of the associated heart defects in the youngest age if it is possible. The balloon angioplasty of the recoarctation of the aorta produces a good result.

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