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BACKGROUND: Intraoperative ultrasound has been used extensively during open surgery to assess bowel viability, to identify vascular structures, and to assess for congenital abnormalities. The extension of this technology in laparoscopic procedures has been hampered by the size of the equipment and the significant learning curve that accompanies its use. METHODS: Using a readily available Parks Inst. Co. Doppler Probe (8.1 MHz) and a 15-inch section of thick-walled, 9.5-mm OD Stainless Steel tubing, a Laparoscopic Doppler Probe was constructed. The parts were separately gas-sterilized, and a small segment of Penrose drain was used to create an airtight seal. The probe was passed through a 10-mm port, allowing assessment of vascular structures. RESULTS: Two Laparoscopic Doppler Probes were available for evaluation during a 1-month period at our hospital. Surgeons were then surveyed at the end of the 1-month period as to the utility of the devices. CONCLUSIONS: The Laparoscopic Doppler probe was used to identify the cystic artery during gallbladder dissection, to assess mesenteric blood vessels during laparoscopic colectomy, and to identify femoral vessels during laparoscopic preperitoneal hernia repair. It was found to be quick to construct, easy to use, and provided useful information to the operating surgeon.
OBJECTIVE: We wanted to determine bursting pressure in normal and ischemic colonic anastomoses in rats as well as the frequency and type of complications with the use of biological and synthetic adhesives. MATERIAL AND METHODS: We designed an experimental study using 80 Sprague-Dawley rats, weighing between 200 and 250 g, divided into four groups: one control group and three study groups. Anastomoses were realized using one layer of interrupted 6-0 polypropylene sutures. Each group was divided into two categories: normal colon (n = 10) and ischemic colon, induced by dividing mesenteric blood vessels (n = 10). Group 2 used octyl-cyanoacrylate, group 3 used N-2-butyl-cyanoacrylate, and group 4 used 40 mg/ml fibrinogen with 1000 u/ml of thrombin. Bursting pressure was measured with a manometer creating pressure in the anastomotic bowel using an infusion pump at 1 ml/min of NaCl 0.9%. Statistical analysis was performed with Student's t test, one-way ANOVA, chi square test or Fisher's exact test. RESULTS: Group 1: (control) normal 127.8 +/- 16.21 versus 109 +/- 17 with ischemia (p < 0.05); group 2: normal 145.5 +/- 89 versus ischemic colon 97.6 +/- 40 (p = 0.136); group 3: normal 145.7 +/- 34 versus 130.8 +/- 15.33 with ischemia (p = 0.22); group 4: normal 239 +/- 26.4 versus 196.5 +/- 14.3 with ischemia (0.000). Bursting pressure was statistically significant in group 4, showing greater pressures (p < 0.001). Bursting segment was shown to be higher outside the anastomoses. Complications such as adhesions and intestinal obstruction were seen more frequently in both cyanoacrylate groups. CONCLUSIONS: An increased bursting pressure was shown in the fibrinogen groups, having a greater tensile strength of the anastomoses. Pressures similar when anastomoses were treated with any of the other two synthetic adhesives.
BACKGROUND: The study concerns the prevalence of avian schistosomes in intermediate and definite hosts in Mazandaran Province, northern Iran. METHODS: A total of 14190 fresh-water snails belonging to various genera were sampled and tested for cercarial emission by lighting and then crushing. During the same period, the nasal blood vessels and mesenteric veins of aquatic birds, mainly belonging to the Anatidae family, were examined under dissecting microscope for detecting adult worms. RESULTS: Forty-seven (0.33%) of examined snails mainly Lymnaea gedrosiana, L.palustris, L.stagnalis, and Planorbis planorbis were found to be infected with larval stages of Trichobilharzia spp. Adult schistosomes were observed in 25 (18.1%) wild waterfowls. The most infected birds were Anas platyrhynchos, A.clypeata, and Aythya ferina, respectively. CONCLUSION: Annually migration of various species of aquatic birds toward the northern parts of Iran and the simultaneous presence of intermediate snails in the water resources of this area, combined with long hours of sunshine in the summer months, suggest that cercarial dermatitis could be a prominent health problem, especially among paddy field workers in this area.
Vascular remodeling is central to the pathophysiology of hypertension and atherosclerosis. The effects of antihypertensive drugs on this process are important to consider from a mechanistic and a pathogenetic point of view in relation to vascular complications of hypertension, e.g., decrease in vascular reserves, shift in cerebral blood flow autoregulation and atherosclerosis development. There is now evidence that, in addition to several other growth factors, vasoactive peptides such as angiotensin II may act as vascular smooth muscle growth promoting substances. Based on these data, the effects of perindopril, a potent and long-lasting angiotensin-converting enzyme (ACE) inhibitor, on structural and mechanical properties of the arterial wall, have been studied in animal models of hypertension as well as in humans. Perindopril completely reversed aortic medial hypertrophy and arterial stiffening observed in renovascular hypertensive rats. Similar benefits were reported in mesenteric resistance vessels of spontaneously hypertensive rats. The effect of perindopril was totally in keeping with potent inhibition of vascular ACE and emphasized the potential role of angiotensin II as a vascular growth modulator. Clinical studies confirmed animal experiments; both suggest that increases in arterial compliance and distensibility following perindopril is likely to be related to drug-induced modification of the arterial wall, at least partially independently of blood pressure reduction. The increase in arterial compliance was associated with a selective decrease in pulse pressure, a finding that is important, not only for the arterial wall, but also for the structure and function of the hypertensive heart.
Once a pathogen penetrates the surface epithelium, the process of immune activation begins. The pathogen is transported across the intestinal epithelium by M cells and presented to the underlying lymphocytes in Peyer's patches by MHCII positive enterocytes. At the same time, intraepithelial lymphocytes are activated and secrete interferon tau which increases the ability of enterocytes to present antigen. Simultaneously, intraepithelial lymphocytes may also cytolyse pathogens. In Peyer's patches, T-lymphocytes in parafollicular areas interact with antigen presenting cells and antigenic peptides to become activated. B-lymphocytes in follicular areas are also initially activated by the interaction of antigen and their surface Ig. B-lymphocyte activation is enhanced by helper T-lymphocytes so that B-lymphocytes begin to proliferate in germinal centres. Most B-lymphocytes at this stage are surface IgA positive whether induced by T-switch cells or by isotype specific T-lymphocytes. At the same time activated T-suppressor cells and contrasuppressors regulate the immune response to maintain it at an optim level. All these lymphocytes then leave Peyer's patches via blood vessels to mesenteric lymph nodes and the spleen where further cellular activation occurs. Thereafter, activated lymphocytes return to the intestine either directly or via the peripheral circulation. Those that reach the intestine directly, differentiate into effector cells and enter the lamina propria. In the lamina propria, plasma cells and cytotoxic T-lymphocytes destroy pathogens by secreting specific Ig and by cytotoxicity respectively. Activated helper T-lymphocytes in the lamina propria probably help in local responses by acting on the few resting B-lymphocytes present there. T-suppressor lymphocytes enter the epithelium to become intraepithelial lymphocytes and regulate responses by suppressor and contrasuppressor activities. Intraepithelial lymphocytes are also cytotoxic for luminal pathogens. Activated lymphocytes which do not return to the intestine directly enter the thoracic duct and thereby the general circulation. In this way a local gut response is converted into a systemic one and memory lymphocytes are disseminated throughout the body. In addition, suppressor and contrasuppressor T-lymphocytes also become available for peripheral effects. Large number of these lymphocytes remain in circulation, while others return to the intestine to provide local protection. A schematic representation of thetraffic of lymphocytes is shown in Fig. 3.
To assess the efficacy of and the complications associated with streptokinase in clinical use, we administered this drug prospectively to 9 patients with thromboembolism of the peripheral vessels from August 1984 to January 1987. The involved vessels included the renal artery, superior mesenteric artery and vessels of the lower extremities. During the course of treatment, thrombin time (TT), prothrombin time (PT), and partial thromboplastin time (PTT) were monitored regularly. Complications such as fever, chills, liver function abnormalities and hematuria were managed effectively. One patient experienced anaphylactic shock and required immediate discontinuation of streptokinase. Good results were obtained in all other patients. According to the results of our study, streptokinase offers the advantages of rapid lysis and complete resolution of clots in peripheral thromboembolic disease. The complications can be minimized if clinical and laboratory responses are monitored appropriately and patients are carefully selected.
The effect of hemorrhage and retransfusion on the rhythmic contraction of mesenteric lymphatic vessels was studied in 24 rats, anesthetized with pentobarbital. The rats were divided into four groups according to the amount of blood withdrawn: 0.5ml/100g body weight (BW), 1ml/100g, 2ml/100g, and 2.5ml/100g. Immediately following hemorrhage at the rate of 0.5ml/100g/min, lymphatic contraction frequencies were decreased to 67 +/- 12.5, 45 +/- 24.7, 43 +/- 33.1, and 31 +/- 17.8% of the prehemorrhage values in each of the above four groups, respectively (p less than 0.01). Twenty minutes after hemorrhage, lymphatic contraction frequencies were decreased to 70 +/- 17.2, 46 +/- 36.8, and 34 +/- 41.3% in the 0.5ml/100g, 2ml/100g, and 2.5ml/100g, respectively (p less than 0.05). Immediately following hemorrhage, the lymphatic contracted diameters were also reduced to 77 +/- 9.7 and 61 +/- 9.0% of the prehemorrhage values in the 1ml/100g and 2.5ml/100g groups, respectively (p less than 0.01). Twenty minutes after hemorrhage, all withdrawn blood was reinfused. Lymphatic contraction frequency and contracted diameter recovered after retransfusion in each group but 20 minutes after retransfusion, the lymphatic contraction frequency in the 2ml/100g group was still decreased to 42 +/- 30.3% (p less than 0.01). Lymphatic contraction frequency not only decreased proportionately with hypotension during hemorrhage but after retransfusion contraction frequency correlated directly with the mean arterial pressure 20 min after hemorrhage. These data suggest that mean arterial pressure and by inference capillary blood flow and tissue oxygenation are major factors regulating lymphatic vasomotion.
This study described the endogenous infections and bacterial translocation from GI tract caused by immunosuppression after burn. In the group of burned plus injected dexamethasone (DXM) (BIS, n = 31), the rate of enteric bacteria translocation was 67.4%, the rate of visceral abscess was 65.5%, much more higher than in the group of only DXM (IS, n = 15). The translocation of intestinal bacteria also was found in the group of only burned (BU 3/15) and control (ck, 1/23), but endogenous infection did not occur in both group. The bacteria cultured from the rat organs are mainly enteric bacilli and corynebacterium. It was assumed that the endogenous infection was originated from the conditions in which the micro-ecologic system of indigenous intestinal flora was disturbed, immunologic function was suppressed by the overlapped effect of burn and injection of DXM, the biological antagonism among the intestinal flora was attenuated, and the intestinal bacilli overgrew, passed through the epithelia of intestine into lymphatic vessel and mesenteric lymph nodes, then colonized and multiplied in other organs, resulting in endogenous infection.
The effects of intravenous infusion of solutions of varied colloid osmotic pressure on mesenteric lymph pressure were measured by a glass micropipette. The lymph pressure was 4.0 +/- 1.6 cm H2O between the second and third valve of rat mesenteric lymphatic vessels with diameter of 101 +/- 25 micron (mean +/- SD). Intravenous infusion of 1 ml/100g body weight (B.W.) of isotonic saline, 5% glucose solution, and 20% glucose solution increased the lymph pressure by 1.6 +/- 0.5 cm H2O, 1.5 +/- 0.3 cm H2O and 2.0 +/- 1.0 cm H2O, respectively. Infusion of 2 ml/100g B.W. of the same solutions increased the lymph pressure by 3.3 +/- 1.3 cm H2O, 3.3 +/- 1.6 cm H2O and 3.7 +/- 0.8 cm H2O, respectively. Infusion of hydroxyethyl starch solution, with colloid osmotic pressure of 25 mmHg, minimally altered the lymph pressure. One ml/100g B.W. infusion of low molecular weight dextran solution, with colloid osmotic pressure of 162 mmHg, decreased the lymph pressure by 1.3 +/- 0.9 cm H2O, and 2 ml/100g B.W. infusion of this solution decreased the lymph pressure by 2.0 +/- 1.0 cm H2O. The different effects on lymph pressure derive from the differences in colloid osmotic pressure of these solutions in conformity with the Starling hypothesis.
A 54-year-old male with the chief complaint of bilateral flank pain was admitted to our hospital. Blood chemistry test revealed marked azotemia and retrograde pyelogram showed bilateral hydronephrosis with median shift of narrowed ureters. Abdominal CT scan demonstrated a well-defined dense mass around the aorta implicating bilateral ureters. These findings were interpreted as aortic perianeurysmal fibrosis resulting in bilateral ureteral obstruction. On laparotomy, a large hard mass was found in the lower part of aorta, vena cava, common iliac vessels, inferior mesenteric artery and bilateral ureters. Because of the extension of the mass, ureterolysis and intraperitoneal displacement of ureters wrapped with isolated omentum was performed. Postoperative recovery from azotemia and ureteral obstruction was satisfactory. Biopsy specimen of the mass showed marked fibrosis with non-specific inflammation.
A case of isolated tumorous amyloidosis with diffuse lesion in the small intestine in a 86-year-old female is described. Macroscopically, the wall of the small intestine, exclusive of a 10-cm distal part, was found to be thickened up to 1.5 to 2 cm, solid and yellowish-white. The mucosal folds were rough, appeared as polypoid processes up to 0.6 X 1.2 1.2 cm in size and swelled in the intestinal lumen. Diffuse deposits of amyloid were histologically found in the submucosal layer, partially in the mucosa and vessel wall, mesenteric lymph nodes. In staining properties, the amyloid was more similar to the primary one; it was shown to fluoresce in polarized light. Amyloid was not identified in other visceral organs.
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The production rate and flow of the lymph in mesenteric lymph vessels under normal conditions and after horizontal vibration of 5 Hz frequency and 20 mm amplitude were measured by means of intravital, intravenous injection of trypan blue water solution. The investigations were carried out on 66 Wistar rats of both sexes. It was found, that 3 and 7-hour vibration and everyday 7-hour vibration applied during a week result in the acceleration of lymph flow, whereas 3- and 4-week vibrations result in reduction of production and flow of the lymph. In all cases the lymph flow speed becomes normal after one day break. The results obtained show that low frequency vibration causes reversible functional changes in small intestine lymphatic system. These changes more probably result from hemodynamic disturbances. The applied vibration parameters did not cause any perceptible morphological changes in the lymphatic system.