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PubMed2003

Comparative evaluation of immune response after laparoscopical and open total mesorectal excisions with anal sphincter preservation in patients with rectal cancer.

AIM: The study of immune response of open versus laparoscopical total mesorectal excision with anal sphincter preservation in patients with rectal cancer has not been reported yet. The dissected retroperitoneal area that contacts directly with carbon dioxide is extensive in laparoscopic total mesorectal excision with anal sphincter preservation surgery. It is important to clarify whether the immune response of laparoscopic total mesorectal excision with anal sphincter preservation (LTME with ASP) in patients with rectal cancer is suppressed more severely than that of open surgery (OTME with ASP). This study was designed to compare the immune functions after laparoscopic and open total mesorectal excision with anal sphincter preservation for rectal cancer. METHODS: This study involved 45 patients undergoing laparoscopic (n=20) and open (n=25) total mesorectal excisions with anal sphincter preservation for rectal cancer. Serum interleukin-2 (IL-2), interleukin-6 (IL-6), tumor necrosis factor alpha (TNFalpha) were assayed preoperatively and on days 1 and 5 postoperatively. CD3+ and CD56+ T lymphocyte count, CD3- and CD56+ natural killer cell (NK) count and immunoglobulin (IgG/IgM/IgA) were assayed preoperatively and on day 5 postoperatively. The numbers of CD3+ and CD56+ T lymphocytes and CD3- and CD56+ NK cells were counted using flow cytometry. An enzyme-linked immunosorbent assay (ELISA) was used for IL-2, IL-6 and TNFalpha determination. And IgG, IgM, and IgA were assayed using immunonephelometry. RESULTS: The demographic data of the two groups had no difference. The preoperative levels of CD3+ and CD56+ T lymphocyte count, CD3- and CD56+ NK count, serum IgG, IgM, IgA, IL-2, IL-6 and TNFalpha also had no significant difference in the two groups (P>0.05). The CD3+ and CD56+ T lymphocyte counts had no obvious changes after surgery in laparoscopic (d=-0.79 +/- 3.83%) and open (d=0.42 +/- 2.09%) groups. The CD3- and CD56+ NK counts were decreased postoperatively in both laparoscopic (d=-7.23 +/- 11.33%) and open (d=-9.21 +/- 13.93%) groups. The differences of the determined values of serum IgG, IgM and IgA on the fifth day after operation subtracted those before operation were -2.56 +/- 2.14 g/L, -252.35 +/- 392.94 mg/L, -506.15 +/- 912.24 mg/L in laparoscopic group, and -1.81 +/- 2.10 g/L, -282.72 +/- 356.75 mg/L, -252.20 +/- 396.28 mg/L in open group, respectively. The levels of IL-2 were decreased after operation in both groups. However, the levels of IL-6 were decreased after laparoscopic surgery (d1=-23.14 +/- 263.97 ng/L and d5=-40.08 +/- 272.03 ng/L), and increased after open surgery (d1=27.38 +/- 129.14 ng/L and d5=21.67 +/- 234.31 ng/L). The TNFalpha levels were not elevated after surgery in both groups. There were no significant differences in the numbers of CD3+ and CD56+ T lymphocytes and CD3- and CD56+ NK cells, the levels of IgG, IgM, IgA, IL-2, IL-6 and TNFalpha between the two groups (P>0.05). CONCLUSION: There are no differences in immune responses between the patients having laparoscopic total mesorectal excision with anal sphincter preservation and those undergone open surgery for rectal cancer.

Adult↗

PubMed2003

Effectiveness of trisodium phosphate against Listeria monocytogenes on excised and nonexcised chicken skin.

The influence of sample type (i.e., excised versus nonexcised chicken skin) on the efficiency of trisodium phosphate (TSP) solutions in reducing Listeria monocytogenes populations and inhibiting their growth during refrigerated storage was studied. Whole chicken legs and excised chicken leg skin fragments inoculated with 10(8) CFU of L. monocytogenes per ml were dipped for 15 min in sterile tap water (control) or in a solution containing 8, 10, or 12% TSP. L. monocytogenes counts were determined after 0, 1, 3, and 5 days of refrigerated storage (2 degrees C). The decontamination effect of TSP was greater for excised skin than for whole legs. Microbial differences between control and TSP-treated samples were significantly larger for excised skin than for whole legs for 9 (75%) of 12 tested combinations of TSP concentrations and storage times. These differences varied from 1.05 +/- 0.26 log10 cycles (day 1) to 3.30 +/- 0.14 log10 cycles (day 5) for nonexcised-skin samples (whole legs) and from 1.54 +/- 0.48 log10 cycles (day 1) to 4.28 +/- 0.86 log10 cycles (day 5) for excised-skin samples. Significantly larger reductions were observed from the third day of refrigerated storage onward. The TSP concentration was a significant factor in the reduction of L. monocytogenes populations. These results suggest that bacteria are more readily accessible to TSP in excised than in nonexcised chicken skin and that the type of sample used to ascertain the efficacy of antimicrobial surface treatments may influence the findings of this type of study.

Animals↗

PubMed2000

Reducing the incomplete excision of non melanotic skin cancers in Australian general practice.

AIM: To develop a simple set of predictors of incomplete excision of non melanotic skin cancer and to test them prospectively. METHOD: Possible predictors were identified by a literature review and modified by a retrospective analysis of histologically confirmed excisions by the author between 1992 and early 1998. The composite set was then tested prospectively on non melanotic skin cancer excisions from April 1998 to September 1999. RESULTS: The set of predictors was used prospectively to identify lesions with which particular care should be taken to avoid incomplete excision. Using this method resulted in an overall reduction of incomplete excisions of about 50%. CONCLUSIONS: The application of a set of predictors is an effective method of reducing incomplete excisions. A number of factors related to the age of the patient, the site of the lesion and its macroscopic appearance made up the set of predictors. Their application showed that particular care needs to be taken with lesions on the head and neck and lesions on patients who are under 50 years of age.

Australia↗

PubMed2000

The treatment of pilonidal disease of the sacrococcygeal region by the method of limited excision and open wound healing.

Results of the surgical treatment of the pilonidal disease of the sacrococcygeal region in correlation with anaerobic infection are analyzed. Fifty patients with the disease recurrence (group A) and fifty patients presenting for operative treatment for the first time (group B) were observed. Twenty-five patients from group B were operated on by the method of limited excision and wound healing by open granulation and the other half were operated on by the method of excision and primary suture. The material for bacteriologic examination was obtained during the operative procedure. All patients underwent control examination at twelve months after the surgery. Recurrence was found in three (6%) group A patients and two (8%) group B patients operated on by the method of excision and open wound healing. Perioperative bacteriologic analysis showed anaerobic colonization in all study patients. Among the patients operated on by the method of excision and primary suture, recurrence was recorded in six (24%) cases. Bacteriologic analysis pointed to anaerobic colonization in five, and to aerobic colonization in only one patient. The significantly lower recurrence rates recorded with the method of limited excision and wound healing open granulation, were explained by favorable conditions for healing in such a wound (reduced conditions for anaerobic infection) compared to wound healing after excision and primary suture.

Adult↗

PubMed1975

Plasma scalpel excision of burns. An experimental study.

We used a plasma scalpel to excise experimental full-thickness burns in 12 pigs, followed by immediate skin autografting. The results were as follows: (1) The skin autograft takes were excellent following the plasma scalpel excisions, and they healed on essentially the same time scale as similar autografts following steel scalpel excisions, producing scars of similar sizes. (2) Pigs in which burn wounds were excised with a steel scalpel lost an average of approximately 5 gm of blood for every one gm lost in the animals which had excisions with the plasma scalpel. (3) The time required for a plasma scalpel burn excision was essentially the same as that required for a standard steel scalpel.

Animals↗

PubMed2000

Results of local excision of benign and malignant rectal lesions.

Local excision of selected rectal cancers is an acceptable alternative to radical surgery. The results of local excision of various rectal lesions using either the transanal or trans-sacral approach were reviewed over a 10-year period at this institution. A total of 56 procedures were performed on 47 patients (50 transanal/six trans-sacral). The trans-sacral approach was used six times on five patients for lesions averaging a distance of 8 cm from the anal verge. The transanal approach was used 50 times on two patients for lesions occurring at an average distance of 5 cm from the anal verge. Twenty-six malignant lesions were excised (25 transanal/one trans-sacral) with pathologies ranging from poorly to well-differentiated adenocarcinoma. Staging included 12 T1 lesions (46%), 10 T2 lesions (38%), and four T3 lesions (16%). Eighteen malignancies were completely excised and recurrence occurred in four of 18 (22%) with an average follow-up of 2.3 years (range 0-10 years). Local recurrence occurred in two patients (T1 and T2 lesions) and recurrence was in the form of distant metastasis in two patients (two T3 lesions). Three of the recurrences occurred in patients with T3 lesions (three of four; 75%), two occurred in a patient with a T2 lesion (two of 10; 20%), and one occurred in a patient with a T1 lesion (one of 12; 8%). There were no cancer-related deaths during the study period. Twenty-six premalignant lesions (adenomatous polyps) and four benign lesions were excised (25 transanal/five trans-sacral). Local recurrence occurred 10 times with an average follow-up of 1.8 years. In conclusion local excision of certain rectal cancers is an acceptable alternative in the treatment of these malignancies.

Adenocarcinoma↗

PubMed1996

Effect of root perturbation and excision on nitrate influx and efflux in barley (Hordeum vulgare) seedlings.

The effects of perturbation and excision on net NO3- uptake, influx and efflux in roots of 8-day-old barley (Hordeum vulgare L.) seedlings induced with NO3- or NO2- were determined. Perturbation was simulated by mechanically striking the intact roots with a glass rod. Perturbation or excision of roots and subsequent division into small segments had little effect on NO3- influx, but briefly inhibited net uptake which recovered within a few min. While in perturbed roots net uptake rates recovered to the same level as in control roots, full recovery did not occur in excised roots. Inhibition of net uptake was due to stimulation on NO3- efflux. The recovery time and level of inhibition of net NO3- uptake and/or stimulation of efflux were a function of extent of perturbation, or the number of segments following excision, and root NO3- concentration. NO3- efflux was further stimulated when roots were perturbed after cytoplasmic NO3- had been depleted, indicating that both the plasmalemma and tonoplast may be affected. In excised roots both NO3- influx and efflux decreased with age due to depletion of energy sources. The results indicate that root perturbation and excision had no effect on NO3- influx but inhibited net uptake by stimulating efflux.

Glucose↗

PubMed1992

Excision of 5'-terminal deoxyribose phosphate from damaged DNA is catalyzed by the Fpg protein of Escherichia coli.

Homogeneous Fpg protein of Escherichia coli has DNA glycosylase activity which excises some purine bases with damaged imidazole rings, and an activity excising deoxyribose (dR) from DNA at abasic (AP) sites leaving a gap bordered by 5'- and 3'-phosphoryl groups. In addition to these two reported activities, we show that the Fpg protein also catalyzes the excision of 5'-terminal deoxyribose phosphate (dRp) from DNA, which is the principal product formed by the incision of AP endonucleases at abasic sites. Moreover, the rate of the Fpg protein catalysis for the 2,6-diamino-4-hydroxy-5-formamidopyrimidine-DNA glycosylase activity is slower than the activities excising dR from abasic sites and dRp from abasic sites preincised by endonucleases. The product released by the Fpg protein in the excision of 5'-terminal dRp from an abasic site preincised by an AP endonuclease is a single base-free unsaturated dRp, suggesting that the excision results from beta-elimination. The release of 5'-terminal dRp by crude extracts of E. coli from wild type and fpg-mutant strains shows that the Fpg protein is one of the major EDTA-resistant activities catalyzing this reaction.

Bacterial Proteins↗

PubMed2003

Factors affecting outcome after incomplete excision of cervical intraepithelial neoplasia.

PURPOSE: Conservative treatment for cervical intraepithelial neoplasia (CIN) by ablative or excisional techniques is widely used. However, women with incomplete excision have a variable risk of CIN recurrence. The aim of this study was to identify possible risk factors for recurrence of CIN after large loop excision of the transformation zone (LLETZ) with involved margins of excision. METHODS: All cases of women treated with LLETZ for CIN between 1989-2000, in whom histological evaluation of the excised specimen revealed extension of CIN to the excision margins, were retrospectively studied. A woman was considered to have recurrence when she had histologically confirmed CIN following a second LLETZ or hysterectomy during the follow-up period. The characteristics that were examined as possible risk factors were age, parity, smoking habit, grade of initial lesion and extension to the endo- or ectocervical margin. RESULTS: Treatment failure was diagnosed in 18 out of 65 (27.7%) women with involved margins. The only characteristic that reached statistical significance was age. The mean age of women with recurrence was 35.8 years, whereas the mean age of women without recurrence was 32.8 years (p = 0.044). Also, a trend was evident in women with high-grade initial lesions (CIN II-III) (p = 0.168) and involvement of the endocervical margins (p = 0.149). No differences were observed between the two groups regarding parity and smoking habit. CONCLUSIONS: Increased age is a risk factor for recurrence in women with incomplete excision of CIN after LLETZ. Larger studies are required for definite conclusions.

Adult↗

PubMed1992

Cervical conization: cold knife and laser excision in residency training.

During a 2-year period, 293 consecutive conizations performed by residents in obstetrics and gynecology were reviewed. One hundred sixty-one patients underwent laser excision and 132 women were treated by cold knife conization. Average operating times for laser excision and knife conization were 31 and 33 minutes, respectively. Combined minor and major complication rates for laser and knife cones were 19 and 30%, respectively. Major complications including cervical stenosis and heavy bleeding were seen in 20% of knife conizations and 6% of laser excisions. Average blood loss for knife conization was 65 mL, and average blood loss for laser conization was 34 mL. Among those examined in follow-up with cervical cytology and colposcopy, no patient in the laser excision group showed evidence of persistent dysplasia, compared with one patient (3%) in the knife conization group. The reported data suggest no difference in operating time, length of anesthesia, or success of treatment between laser excision and knife conization performed by residents in training. Fewer complications were seen in the laser excision group.

Anesthesia, Obstetrical↗

PubMed2005

[Influence of tangential excision within 24 postburn hours on the local wound inflammatory response in patients with deep partial thickness burn].

OBJECTIVE: To investigate the influence of early tangential excision within 24 postburn hours on local wound inflammatory response and tissue injury in patients with deep partial thickness burn. METHODS: Twelve patients with deep partial thickness burn were enrolled in the study. Tangential excision was performed within 24 postburn hours. The same wound of a patient was divided into three areas for harvesting tissue samples, i.e. pre-operation, post-operation and non-operation areas. For each patient, the biopsies from the pre-operation area were harvested before tangential excision, while those from post-operation and non-operation areas were harvested during 5 to 7 postburn days (PBDs). The contents of IL-8, MPO and MDA in wound tissue were determined by tissue culture and chemical colorimetry, respectively. HE and Mason's staining were employed to assess the degree of necrosis of the wound tissue. RESULTS: The IL-8, MPO and MDA contents in the local wound tissue after tangential excision were 6.83 +/- 1.85 microg/L, 4.07 +/- 0.87 U/g, and 8.94 +/- 5.66 micromol/g, respectively, which were significantly lower than those from non-operation area (P < 0.01). The inflammatory response in the non-operative wound area was distinct with expansion of necrotic tissue area. In contrast, the local inflammatory response of the wound after tangential excision was ameliorated without the enlargement of necrotic tissue area. CONCLUSION: Tangential excision within 24 postburn hours could be beneficial in ameliorating local inflammatory response, and in preventing progressive deepening of the burn wounds, thus it could accelerate wound healing in patients with deep partial thickness burn.

Adult↗

PubMed2005

Mismatch dependent uracil/thymine-DNA glycosylases excise exocyclic hydroxyethano and hydroxypropano cytosine adducts.

Exocyclic adducts of DNA bases, such as etheno- and hydroxyalkano- ones, are generated by a variety of bifunctional agents, including endogenously formed products of lipid peroxidation. In this work we selectively modified cytosines in the 5'-d(TTT TTT CTT TTT CTT TTT CTT TTT T)-3' oligonucleotide using: chloroacetaldehyde to obtain 3,N(4)-alpha-hydroxyethano- (HEC) and 3,N(4)-etheno- (epsilonC), acrolein to obtain 3,N(4)-alpha-hydroxypropano- (HPC) and crotonaldehyde to obtain 3,N(4)-alpha-hydroxy-gamma-methylpropano- (mHPC) adducts of cytosine. The studied adducts are alkali-labile which results in oligonucleotide strain breaks at the sites of modification upon strong base treatment. The oligonucleotides carrying adducted cytosines were studied as substrates of Escherichia coli Mug, human TDG and fission yeast Thp1p glycosylases. All the adducts studied are excised by bacterial Mug although with various efficiency: epsilonC >HEC >HPC >mHPC. The yeast enzyme excises efficiently epsilonC>HEC>HPC, whereas the human enzyme excises only epsilonC. The pH-dependence curves of excision of eC, HEC and HPC by Mug are bell shaped and the most efficient excision of adducts occurs within the pH range of 8.6-9.6. The observed increase of excision of HEC and HPC above pH 7.2 can be explained by deprotonation of these adducts, which are high pK(a) compounds and exist in a protonated form at neutrality. On the other hand, since epsilonC is in a neutral form in the pH range studied, we postulate an involvement of an additional catalytic factor. We hypothesize that the enzyme structure undergoes a pH-induced rearrangement allowing the participation of Lys68 of Mug in catalysis via a hydrogen bond interaction of its epsilon-amino group with N(4) of the cytosine exocyclic adducts.

Base Pair Mismatch↗

PubMed1987

Evidence for two independent pathways of biologically effective excision repair from its rate and extent in cells cultured from sun-sensitive humans.

Repair-proficient human cells can be sensitized to exposure to UV radiation at 254 nm by postirradiation incubation in the presence of the eukaryotic alpha polymerase inhibitor, aphidicolin. The degree of sensitization has been examined in cells cultured from humans suffering from various types of sun-sensitive syndromes. Xeroderma pigmentosum (XP) variant and Bloom's cell lines (both excision proficient) were strongly sensitized by aphidicolin. An excision repair proficient Cockayne's cell line and a deficient XPD line were both sensitized to a level similar to the sensitivity of excision deficient XPA cells. In contrast, three XPC cell lines which show intermediate UV-induced repair replication and UV sensitivity were sensitized little (in one case) or not at all (in two cases) to UV by postirradiation inhibition of the alpha polymerase. These results lead us to conclude that there are two independent pathways of biologically effective excision repair, the major one of which involves the alpha polymerase and a second, less efficient and slower pathway which is independent of the alpha polymerase and which is the only pathway operating in two of the three XPC strains tested. The rates of biologically effective excision repair were similar in normal, XP variant, and Cockayne's cell lines, but these rates were considerably higher than published rates of dimer excision measured under similar conditions.

Aphidicolin↗

PubMed1987

[Problems and planning of excision of large basaliomas].

At the excision of 1083 basal cell carcinomas, the clinically detectable diameters and the safe margins along the tumor border were calculated. The excision edges were histologically controlled. 115 of the 1083 tumors showed diameters exceeding 20 mm. The frequency of excisions with negative or positive edges corresponded to the safe margin and depth of the incision. Our results showed that even for large tumors a safe margin of more than 5 mm is seldom appropriate. The excision should always include the subcutaneous tissue as well as the underlying tissue, if the site of the lesion permits it. The excised edges should be histologically controlled with regard to radical excision. Our findings are illustrated by an exemplary case.

Basal Cell Carcinoma↗

PubMed1987

The effect of complete burn wound excision and closure on postburn oxygen consumption.

We determined the effect of complete excision and closure of the burn wound on the postburn increase in oxygen consumption. Twelve sheep were given a 15% of total body surface full-thickness burn and were monitored for 7 days. By the third day, a 50% increase in O2 consumption, VO2, was noted, as was a significant increase in cardiac index and decrease in mixed venous PO2, compared to baseline. The hypermetabolic process persisted for the 7-day pre-excision period. On the seventh postburn day all sheep were anesthetized for 2 hours with halothane and placed on positive pressure ventilation, and then one half of these sheep underwent excision and closure. During anesthesia, VO2 decreased to 76 +/- 15 ml/min/M2, a value significantly lower than even the preburn awake baseline of 122 +/- 14 ml/min/M2 and the 7-day postburn value of 180 +/- 18 ml/min/M2. Quantitative cultures, before excision, revealed the wounds to be noninfected (less than 10(5) organisms per gram). In six animals, the burns were totally excised to fascia and closed with full-thickness defatted hide from other sheep obtained at the same time under sterile conditions. In these animals, the VO2 returned to preburn baseline by 24 hours postexcision and remained there for the 3-day postexcision study period. In the other six burned sheep, the 15% full-thickness burns remained. The hypermetabolic state returned to the 7-day postburn level on return to the awake state and persisted for the remainder of the study. We conclude that complete excision and wound closure can reverse the postburn increase in O2 consumption.

Anesthesia↗

PubMed1986

Endocardial excision versus encircling endocardial ventriculotomy. A comparison of effects on ventricular structure and function.

Although endocardial excision and encircling endocardial ventriculotomy are being performed in patients with extensive triple-vessel disease and compromised ventricular function, long-term effects of the operative intervention on structure and function of the left ventricle have not been determined. These procedures were performed in healthy dogs in three groups: control (ventriculotomy alone), endocardial excision, and encircling endocardial ventriculotomy (five dogs per group). Six weeks later, through a left thoracotomy, an arterial line, left atrial line, and Swan-Ganz catheter were inserted. Cardiac output measurements permitted calculation of left ventricular stroke work index, and gated nuclear ventriculograms permitted calculation of left ventricular volume indices. Myocardial performance (stroke work index/end-diastolic volume index relation), systolic elastance (systolic blood pressure/end-systolic volume index relation) and diastolic pressure-volume relationship (left atrial pressure/end-diastolic volume index relation) were determined from volume loading studies. In the endocardial excision group, the left atrial pressures were increased at similar end-diastolic volumes (p less than 0.05 by performance and systolic elastance were similar in the three groups. On completion of hemodynamic studies, the hearts were excised. Gross and light microscopic examination showed that the inner layer of myocardium was scarred in the area of intervention after both endocardial excision and encircling endocardial ventriculotomy. In neither group was there significant morphologic change elsewhere in the myocardium. Both endocardial excision and encircling endocardial ventriculotomy have little effect on long-term structure and function when performed in healthy canine hearts.

Animals↗

PubMed1986

[Follow-up studies after incomplete excision of cervical carcinoma in situ].

To understand the biological nature and the treatment of cervical carcinoma in situ (CIS), numerous (216) incompletely excised specimens obtained by conization at Auckland University's National Women's Hospital were examined and the histological findings with long-term follow-up were correlated. Follow-up studies were possible in 211 patients for two years or more; 88.4% were followed up for at least five years. There was no evidence of recurrence in 62.9% of the total series. Recurrences were related to the area of CIS in the cervix, and the incompletely excised sites and blocks. Micro-invasive carcinoma was found in four patients (1.90%) and invasive carcinoma (stage Ib "occ") in two (0.95%). The following conclusion has been drawn: If CIS is incompletely excised by conization, follow-up examinations are essential. When the CIS is small in the cervix or it is incompletely excised only outside the endocervix, spontaneous disappearance can be expected. In the entire series, including patients in whom the incomplete excision left a fairly large CIS remnant, the nonrecurrence rate was unexpectedly high. These findings suggest that the continued existence of incompletely excised CIS is significantly inhibited by a considerable damage to the conization.

Carcinoma in Situ↗

PubMed1985

Nucleotide excision repair of DNA in eukaryotes: comparisons between human cells and yeast.

Little is known about the molecular mechanism of nucleotide excision repair in eukaryotes. Studies on human cells have been stimulated by the availability of excision repair-defective cell lines from patients suffering from the autosomal recessive disease xeroderma pigmentosum. Such studies have contributed appreciably to an understanding of the genetic complexity of excision repair in human cells. However, to date no human excision repair genes or gene products known to complement the repair defect in xeroderma pigmentosum cells have been isolated. The yeast Saccharomyces cerevisiae is an interesting model for exploring the molecular mechanism of nucleotide excision repair in eukaryotic cells. As is true in human cells, multiple yeast genes are involved in this phenomenon and at least five genes are required for the specific incision of ultraviolet-irradiated DNA in vivo. These five genes have been isolated by molecular cloning and the nucleotide sequences of four of them have been determined. Each of these cloned genes will be used for overexpression of protein and it is anticipated that the purification and characterization of these proteins will provide insight into the biochemistry of nucleotide excision repair in eukaryotes.

Base Sequence↗