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PubMed1988

Improved survival using oxygen free radical scavengers in the presence of ischemic bowel anastomosis.

A rat model was developed to determine the efficacy of oxygen free radical scavenger compounds in improving small bowel anastomotic healing in ischemia. 50 Sprague-Dawley rats underwent laparotomy and were divided into groups: I. sham operation; II. ischemia produced by ligation of mesenteric vessels along 3-5 cm of bowel; III. bowel transection and anastomosis; IV. ligation of vessels with bowel transection and anastomosis; V. ligation of vessels, bowel transection and IV administration of superoxide dismutase (SOD) (5000 U/kg) prior to anastomosis. All surviving animals were sacrificed after 2 weeks. Anastomotic tensile strength and histology were evaluated. Percent survival and the average length of survival for all groups is seen in the table below. (table: see text) A significant decrease in survival was present with the anastomotic group and the ischemic anastomotic group when compared with controls. An improved survival similar to ischemia alone was present in SOD group. No significant difference was noted between SOD and control groups. The results of this study indicate an improved survival rate and length of survival similar to controls in animals undergoing ischemic and penetrating injury to the bowel with the use of oxygen free radical scavenger compounds prior to anastomosis.

Anastomosis, Surgical↗

PubMedDate not supplied

Acute thrombosis of the infrarenal aorta. Therapeutic problems.

Acute thrombosis of the infrarenal aorta is a rare event, usually complicating aortic atherosclerotic lesions or aortic aneurysms. During the last twelve years, we treated 10 acute aortic thromboses out of 353 acute ischemias of the lower limbs (2.8%). The high mortality of our series (60%) is related to advanced age (71 years on average), severe underlying cardiopathy, and the frequent involvement of the renal and mesenteric vessels. In our experience Fogarty catheter thrombectomy is usually ineffective, and the surgical approach in high risk patients should be confined to axillobifemoral bypass graft.

Acute Disease↗

PubMed1986

Spontaneous hypertension in the fawn-hooded rat: a cardiovascular disease model.

The fawn-hooded (FH) rat develops hypertension spontaneously. Systolic blood pressure is already elevated at 5 weeks of age, increases with age, and the final range is 180-240 mmHg at the age of 1 year. Concomitantly with the rise in blood pressure proteinuria occurs and increases with age. Fawn-hooded rats reaching the accelerated phase of the hypertension are characterized by blood pressure values exceeding 220 mmHg, heavy proteinuria and increased heart, kidney, liver, adrenal and spleen weights. Those prone to malignant hypertensive disease show a period of increased water turnover for several weeks after weaning; during this period, they do not show the pronounced decrease in water intake upon fasting for 24 h as observed in FH rats of the same age prone to a milder form of hypertension, i.e. diuresis and drinking continue even when no food is consumed. The major cause of death for FH rats is malignant nephrosclerosis with the nephrotic syndrome and/or cardiac failure with chronic pulmonary congestion. Some animals die of bleeding from mesenteric vessels with periarteritis nodosa. In FH rats with malignant hypertension, heart, kidney, liver and spleen weights are significantly increased compared with FH rats of the same age with mild hypertension. Histopathology shows myocardial fibrosis and myocardial infarctions. Generalized arteriolosclerosis is common, sometimes accompanied with local fibrinoid degeneration and (peri)arteritis. Some major arteries show intimal proliferation. It is concluded that the FH rat provides an interesting model for the study of hypertension and its consequences.

Animals↗

PubMed1987

An experimental model for studying reversible intestinal ischemia.

We have developed a simple experimental model for studying reversible intestinal ischemia. The model is based on tenting the mesenteric vessels (artery and vein) to a tied loop of the small bowel in rat and, after a certain time, lowering them down again. Total and partial ischemia (created by tenting 2 and 1 cm, respectively) were demonstrated by laser Doppler flowmetry, as was the revascularization obtained after bringing the vessels down again. Alterations in mucosal permeability after ischemia were determined by depositing fluorescent dextran 3000 in the tied loop and measuring its concentration in the portal blood, and mucosal damage due to ischemia was assessed by measuring the activity of N-acetyl-beta-glucosaminidase, a lysosomal enzyme, in the gut lumen. There was a significant increase in the intestinal permeability to dextran 3000 after total ischemia for 10 min or more, and the permeability was directly related to the duration of the ischemia. After the intestine had been subjected to total ischemia for 30 min or more, the activity of N-acetyl-beta-glucosaminidase in the luminal contents was significantly increased. The permeability after partial ischemia for 30 min was less than that after total ischemia for 30 min. After total ischemia for 10 min followed by revascularization for 30 or 60 min, the permeability did not differ from that in animals not subjected to ischemia. It is concluded that this simple model may be used to study reversible small intestinal ischemia and factors that influence mucosal permeability.

Acetylglucosaminidase↗

PubMed1986

Infusion volumes of Ringer's lactate and 3% albumin solution as they relate to survival after resuscitation of a lethal intestinal ischemic shock.

Previously, we have shown improved survival rate with colloid solutions of 2-4% concentration compared to 10% solutions or a colloid-free electrolyte solution, when given in volumes required to maintain the same intravascular volume expansion. This study examines the effect of increasing infusion volumes of Ringer's lactate (RL) and 3% albumin on survival time and blood volume expansion using the lethal intestinal ischemic shock model in rats. Shock was induced by exteriorization of the small intestine with added occlusion of the superior mesenteric vessels for 75 minutes. Untreated animals developed hemoconcentration to 60% in hematocrit (Hct), representing a plasma volume (PV) decrease to 57% of the preshock level. Infusion of 3% albumin increased PV linearly up to 200% above shock levels with infusion volumes of 0-45 ml/100 g bwt. RL increased PV linearly up to 80% above shock baseline level with infusion volumes up to 50 ml/100g. No further PV increase occurred despite increasing volumes of RL. No infusion volume, therefore, of RL restored PV to preshock levels. To achieve the same volume expansion up to 80% above the shock PV levels, 4.4 times larger volume of RL was needed compared to 3% albumin solution. With the same volumes infused (up to 45 ml/100 g), 4-5 times more of the 3% albumin volume infused remained in the vascular space compared to RL. Also, the excreted volume was larger with albumin than with RL, for the same volumes infused. Accordingly, the major portion of the infused RL (60-80%) was located in the extravascular space. No control animals survived 24 hours. Survival time was prolonged with both RL and 3% albumin infusions. The effect on survival time with albumin was obtained with approximately 25% of the fluid required for RL.

Albumins↗

PubMed1986

Effects of naloxone in intestinal shock in the rat.

The contribution of endogenous opioid peptides to the development of circulatory derangement in severe shock was studied using naloxone. A standardized intestinal shock was induced in rats by applying a pressure of 120 cm water on the mesenteric vessels for 60 min. The rats were then given either saline or naloxone. Mean arterial blood pressure improved and a less severe acidosis resulted in naloxone-treated animals compared to saline-treated. No differences were found in hematocrit, the degree of small intestinal mucosal lesions, or survival rates after 7 days comparing naloxone and saline treatment. Survival time increased after naloxone but not after saline treatment. The results support the hypothesis that endogenous opioid peptides contribute to cardiovascular collapse in intestinal shock.

Acid-Base Equilibrium↗

PubMed1979

[Perforations of the gastrointestinal tract by a fish bone].

A brief of the literature dealing with perforations of the gastrointestinal tract at its different levels with fish bones is set forth. In recent 20 years the author has managed to collect 68 observations published in the home literature. 6 cases of the perforation of the duodenum, the small intestine, the ileum with injuries to the mesenteric vessels, resulting in massive bleeding, the caecum and the colon in the hepatic angle are presented. All the patients were operated upon. 2 patients died.

Adult↗

PubMed1986

Hemostasis following inoculation and during spreading of colon carcinoma in the rat.

Platelet function following inoculation of chemically induced carcinoma was evaluated in the rat. The original line of tumor (NGW1) was obtained using N-methyl-N-nitrosoguanidine. After trypsin homogenation a cell suspension of 0.3 X 10(6) viable tumor cells was injected subserosally in the cecum of each animal. Controls received injections of equal volumes of 0.9% NaCl solution or trypsin. The animals were subjected to laparotomy 2, 4, and 6 weeks after inoculation. Platelet function was assessed in vivo by measuring bleeding time and blood loss during mesenteric vessel transection or liver resection upon laparotomy. Hemoglobin, hematocrit, platelet count, activated partial thromboplastin time, platelet aggregation, thromboxane B2, platelet factor 4, and fibrinogen levels were evaluated after sacrifice by exsanguination. Significant decrease in bleeding time and blood loss was observed in animals with local primary tumors as well as in rats with lymph node metastases. Hemoglobin and hematocrit were decreased in the presence of metastases. Platelet count was not changed. Activated partial thromboplastin time was not affected by the presence of tumor. Platelet aggregation in vitro was accelerated in the presence of primary tumor or lymph node metastases, as well as following addition of tumor cells to platelet suspensions. No changes in thromboxane B2 or platelet factor 4 could be registered. Fibrinogen levels were decreased in the presence of liver metastases. Enhancement of primary hemostasis and platelet function in the presence of colon carcinoma in the rat was demonstrated both in vivo and in vitro. Direct or indirect interaction of the tumor cell with thrombocytes may play a role in determining the metastatic potential of the neoplasm.

Adenosine Diphosphate↗

PubMed1985

[Peritoneal amyloidosis in Waldenström's macroglobulinemia. X-ray computed tomographic aspects].

A 74 years old man, know to have Waldenström's macroglobulinemia was hospitalized for intestinal obstruction. Upper gastrointestinal barium study revealed an extrinsic stenosis of duodenum. Ultrasonography and abdominal computed tomography revealed a diffuse mesenteric infiltration with medium level echoes and encasing of mesenteric vessels. Histologic examination of biopsies taken at exploratory laparotomy disclosed amyloidosis of the epiploon and mesentery. The review of amyloidosis in macroglobulinemia shows peritoneal amyloidosis to be a very rare event. Sonographic, computed tomographic and pathologic findings of this unusual case are discussed.

Aged↗

PubMed1985

[Reconstruction of large defects of the oral mucosa with free, revascularized jejunum transplants].

The resection of oropharyngeal cancer often creates large mucosal defects which may impair chewing, swallowing or speech function severely. Therefore, proper reconstruction is crucial for the patient. In five cases with cancer of the floor of the mouth, the tongue, the cheek and the soft palate respectively, a successful reconstruction was achieved by means of a free revascularized jejunal graft. Tumour resection and preparation of the jejunal graft are performed synchronously by two surgical teams. After suturing the graft into the oropharyngeal defect its mesenteric vessels are usually anastomosed to the facial artery and the external jugular vein. Results showed that the jejunal graft is a most adequate substitute for oropharyngeal defects and superior to skin flaps. In a sixth patient the graft was lost because of an arterial thrombosis. This failure was not life threatening, but led to a poor functional result. Postoperative radiation therapy was tolerated by the transplanted jejunal mucosa in spite of a marked inflammatory reaction.

Adult↗

PubMed1979

[Acute primary ischemic enteritis and colitis. Clinico-pathological and physio-pathological findings].

By opposition to acute post-operative ischaemic enterocolitis, the authors isolate, with the aid of seven cases, the intestinal lesions which spontaneously occur on the small intestines and on the colon and due to an ischaemic mechanism without thrombosis of the mesenteric vessels. After the description of clinical and anatomical features, they point out the main part of the vascular factor in the genesis of the lesions.

Aged↗

PubMed1966

Serological diagnosis of Schistosoma mansoni infection. Conglutinative complement absorption test in human and experimental infections.

The conglutinative complement absorption test, using adult worm antigen (Schistosoma mansoni), was performed on the sera of 100 bilharziasis patients and of 111 non-infected individuals. If the sera that inhibit conglutination when diluted to 1: 40 or more are considered as reactive, the sensitivity of the test is 93.7% (six sera were anticomplementary). No reactive sera were found among the control group. In mice experimentally infected with S. mansoni, specific inhibition of conglutination began about the thirtieth day after exposure, when sexually mature schistosomes, migrating from the liver to the mesenteric vessels, were able to lay eggs.

Agglutination Tests↗

PubMed1980

[Neurogenic tumours: clinical and therapeutic aspects (author's transl)].

Tumours of the nervous system are rare. Clinical and therapeutic aspects are discussed with relation to 54 cases. The benign tumours of the peripheric nerves such as neurinomas and neurofibromas, show a high rate of malignant degeneration. For this reason, every tumour of the soft tissues has to be removed and should be examined by the pathologist. In cases of retroperitoneal and intestinal localisation an early diagnosis is frequently impossible. For differential diagnosis laparotomy or thoracotomy are always indicated. X-ray examinations of the kidneys, the thorax as well as the intestines and mesenteric vessels show satisfactory results. The neurogenic sarcomas and neuroblastomas are discovered late because of their hidden localisation and poor symptoms. The poor prognosis has not been improved by cytostatsis and radiation.

Adolescent↗

PubMedDate not supplied

[Pancreatic cancer. An appraisal of 147 cases (author's transl)].

Out of 147 exocrine cancers of the pancreas 17 (11.6%) were considered as inoperable. Extensive lesions are frequent: liver metastasis (33%) invasion of surrounding tissues (duodenum-portal vein - mesenteric vessels) 29%, regional lymph nodes metastases (25%), peritoneal carcinomatosis (13%). For these reasons, non curative operations were the most frequent: bilio-intestinal anastomosis (56.4%), exploratory laparotomy (14.9%). Our resection rate is low: 16% (21 cases), with performance of 15 pancreatico-duodenal resections (71%), 5 total pancreatectomies (24%) and 1 left pancreatic resection. We note a mortality rate of 19%: 20% four resections, 17% after palliative anastomosis. The mean survival rate was 11.5 months following pancreatico duodenal resections and 4,8 months following anastomotic procedures. No survival after 5 years is registered.

Adult↗

PubMed1984

[The free jejunal graft for the reconstruction of the hypopharynx and cervical esophagus].

The free jejunal transfer for primary reconstruction of the cervical oesophagus after laryngo-pharyngectomy was described more than 20 years ago. Its popularity as a surgical method has increased in recent years with improvement in microsurgical techniques. Tumour resection and preparation of the jejunal graft are performed synchronously by two surgical teams. After suturing the graft into the defect the mesenteric vessels are usually anastomosed to the superior thyroid pedicle. In this series four patients are presented, in three there were no complications, in the fourth a fistula developed despite adequate vascularisation of the transfer. The jejunal graft has proved to be a good functional replacement for the cervical oesophagus. Experience in other series have shown the risks of necrosis, fistulae, stenosis and abdominal complications to be minimal.

Adult↗

PubMed1984

[Limit of efficacy of lymph node dissection in surgery of colon and rectal cancer].

The lymphatic flow of colon and rectum toward the central part of the body can be divided into 7 groups, according to our anatomical understanding of it. After applying a staging method to each lymphatic flow, we analysed 1600 large bowel cancers which were resected at Cancer Institute Hospital during 35 years from 1946. Resectability for cure, 5-year survival rate after surgery were calculated on each stage of 7 groups and the efficacy of lymph node dissection for cancer cure is discussed. The following lymph nodes are defined within the border of effective approach of surgery, lymph nodes within 10 cm anal and oral side from tumor border, lymph nodes up to the root of superior or inferior mesenteric vessels, lymph nodes up to the bifercation of iliac artery, inguinal lymph node metastasis discovered within 6 months after surgery for primary site.

Colonic Neoplasms↗

PubMed1984

Paraduodenal hernia: diagnosis and surgical management.

Paraduodenal hernia is an unusual cause of intestinal obstruction, but one with which all surgeons should be familiar. We reviewed the anatomy, pathophysiology, initial symptoms, radiographic criteria for diagnosis, and subsequent therapy of five patients treated for paraduodenal hernia at Walter Reed Army Medical Center. Contrast radiography of the small intestine remains the mainstay of preoperative diagnosis. Essential components of treatment include bowel reduction and obliteration of the hernia defect by simple closure or by wide opening of the sac. Further recommendations include sparing the inferior mesenteric vessels during the repair of left paraduodenal hernias and transpositioning the right colon to the left side of the abdomen for repair of right paraduodenal hernias.

Adult↗

PubMed1984

Effects of extended systematic lymphadenectomy for adenocarcinoma of the rectum--significant improvement of survival rate and decrease of local recurrence.

The effects of extended systematic lymphadenectomy were evaluated by the rate of survival of the patients and incidence of local failure in 643 patients with single primary adenocarcinoma of the rectum, who were operated on at the National Cancer Center Hospital from 1962 to 1981. Our extended systematic lymphadenectomy consists of high ligation of the inferior mesenteric vessels and meticulous dissection of the abdominopelvic lymphatic system. Potentially curative resection was performed on 495 patients (77%) with seven operative deaths (1.4%). Extended systematic lymphadenectomy was carried out on 74 of 168 patients with Dukes B cancer and 89 of 213 patients with Dukes C cancer. Five-year survival rates for patients with or without systematic extended lymphadenectomy were 83.2% vs 63.7% (P less than 0.05) in Dukes B and 52.5% vs 30.8% (P less than 0.05) in Dukes C classes. The cumulative incidence of local failure at 5 years was decreased from 26.1% to 8.4% (P less than 0.01) and from 44.3% to 24.5% (P less than 0.01) by extended lymphadenectomy in Dukes B and C classes, respectively. Prolongation of operation time (plus 60 min), slight increase in blood loss (plus 150 ml) and no increase in operative mortality (1/161, 0.6%), were observed in the case of extended lymphadenectomy.

Adenocarcinoma↗