Intraoperative irrigation of the colon to permit primary anastomosis

A technique is described which permits intraoperative application of antegrade bowel irrigation to clear the obstructed or loaded colon of faeces with minimal risk of contamination. The procedure extends the indications for safe primary anastomosis in surgery of the left colon.     

Sutureless anastomosis in the surgery of the gastrointestinal tract

The idea of the sutureless anastomosis is not a new one, but only the introduction of the VALTRAC-BAR instrument made the wide clinical application possible. The authors have applied this instrument in the case of 32 patients in a two years period. It was used in intestinal procedures in 28, in gastric resection in 4 occasions, respectively. In one case spontaneously recovered stercoral fistula was observed. According to our experiences, the instrument can be used advantageously in preparing anastomoses in the gastrointestinal tract.     

Total laparoscopic ultrasonic colon dissection: is the colonic anastomosis safe?

Harvesting split-thickness skin grafts from the abdomen is difficult when using a conventional hand dermatome. In this study, pneumoperitoneum was created in 10 patients before skin grafts were taken. No complications arose from the insufflation, and the conventional dermatome was then easy to use. Pneumoperitoneum provides more abdominal surface area, allowing the surgeon to harvest a greater number of larger, more uniform grafts during a single procedure, even when working near an anatomical protuberance.     

Primary anastomosis in the treatment of acute disease of the unprepared left colon

Between June 1, 1990 and December 31, 1996, 58 consecutive patients with unprepared colons were urgently explored for nontraumatic disease with intent to proceed with primary left-sided colonic anastomosis. Unprotected anastomoses were not attempted in 15 patients. The causes of exclusion included preoperative and intraoperative shock in three patients, and three patients were on long-term high-dose steroids, four had gross fecal contamination of the peritoneal cavity, four had large pelvic abscesses, and one had ischemic colitis. All 43 patients undergoing anastomosis without protective colostomy had stapled anastomoses. Indications included complicated diverticular disease in 32 cases. There were nine cases of obstruction from colorectal carcinoma and one obstruction due to sigmoid volvulus. There was one case of perforation from pseudomembranous enterocolitis. The most common complications were: atelectasis in nine cases, wound infection in two cases, and prolonged ileus in two cases. Pelvic abscess occurred in one case. There was one wound dehiscence. There was one anastomotic dehiscence, and there was no mortality. Operative time averaged 85 minutes and hospital length of stay 9.7 days. Primary anastomosis of the unprepared left colon is safe in most urgent and emergent situations, thus avoiding the significant morbidity and cost of colostomy closure.     

Trauma to the colon in civilian surgery

An unusual congenital portosystemic shunt was identified in one dog and two cats with clinical signs and laboratory evidence of hepatic dysfunction. In all the animals, the abnormal vessel arose from the portal system between the left medial and quadrate liver lobes and travelled within the falciform fat, exiting the abdomen through the caudal ventral left diaphragm. The intrathoracic course of these vessels was not established. The anatomical location of this anomalous vessel may have hindered attempts at ultrasonographic identification since it was not visualised before surgery in any of the animals. In addition, while the anatomical location of the vessel may facilitate rapid identification and surgical attenuation, it could predispose the vessel to trauma during the coeliotomy approach. It is hypothesised that this form of portosystemic communication results from failure of a portion of the left umbilical vein to degenerate during embryogenesis. This is in contrast to other forms of congenital extrahepatic portosystemic shunt that are presumed to be developmental errors resulting in an abnormal communication between the embryonic vitelline and cardinal venous systems. The prognosis for animals with the vascular anomaly reported here is probably similar to that for animals with other forms of congenital portosystemic shunt.     

Laparoscopic intracorporeal anastomosis in the colon using the biofragmentable anastomotic ring--an animal study

The authors report about surgical treatment of herpes simplex encephalitis, although conservative management of this disease is the method of choice in the first place. They draw a lesson from this case that certain cases of large space occupying lesions of infectious origin leading to brain stem compression may require surgical management, even if they customary treatment is conservative.     

Dilatation of the left colon with a Foley catheter: an aid to staple anastomosis

Balloon dilatation of the left colon using a Foley catheter was performed in 26 patients prior to staple anastomosis. A 28-mm stapler was then used in six (23%) patients, a 29-mm in seven (27%), a 31-mm in eleven (42%) and a 33-mm in two (8%). Two anastomoses failed (7.9%) and one patient developed local recurrence. None of the remainder developed a symptomatic stricture. Flexible sigmoidoscopy was performed on 18 patients at least 3 months after surgery, revealing that one (5.5%) had developed an asymptomatic stricture. A 28-mm stapler had been used in this case. This technique of dilating the left colon with a Foley catheter is a useful aid to staple anastomosis in large bowel surgery.     

Bio-fragmentable anastomosis ring in urological surgery involving the gastrointestinal tract: early experience and a historical review of mechanical intestinal anastomosis

We present our experience with use of a bio-fragmentable mechanical device for intestinal anastomosis in 14 patients. No anastomotic leakage occurred in our patients. The technique was easy to learn and shortened the operating time by at least 30 minutes. Our impression is that during time-consuming extensive onco-urological procedures involving the gastrointestinal tract, the use of such a device allows for a shorter operative time to the benefit of the patient and surgeon.     

Same-day surgery: the nurse''s role

The examination covered 44 patients (16 males and 28 females) with chronic bronchitis (CB) associated with diseases of the nose and paranasal sinuses. Most of the patients (63.6%) had allergic rhinosinusopathy (ARSP). The kind of nasal and sinus affection varied with CB form (catarrhal or purulent). Aggravation of ENT disorders provoked deterioration of external respiration. Bronchial and maxillary mucosa showed identical changes in CB patients with purulent affection of the paranasal sinuses. Cytological examinations of the smear, lavage and sputum discovered a tendency to increased count of eosinophil leukocytes in all the samples from CB plus ARSP patients. On cytograms of bronchial lavage from patients with polypous-purulent ARSP there were also low counts of macrophages and lymphocytes. This is likely to reflect pronounced defects of local defense of the bronchi promoting progressive inflammatory and allergic processes.     

The role of lactic acid bacteria in colon cancer prevention

The ex vivo effect of triflusal and acetylsalicylic acid (ASA) on platelet interaction with the subendothelium using the Baumgartner perfusion system (wall shear rate 350 s-1) was assessed in blood from 10 healthy volunteers who given a 15-day course of triflusal 600 mg per day and ASA 400 mg per day in a cross-over trial. The percentage of platelets on the subendothelium showed a decrease of 62% in samples from subjects on ASA and a decrease of 93% in those from subjects on triflusal (P < 0.005). The percentage of the subendothelial surface covered by platelets was reduced by 23.3% after treatment with ASA, mainly due to inhibition of aggregates (75.2%), and by 29.9% after treatment with triflusal, mainly due to inhibition of aggregates (89.6%) and of adhesion (25%). The subendothelial surface covered by activated platelets (adhesions and thrombi) showed 32.5% inhibition after treatment with triflusal and 11.6% after treatment with ASA (P < 0.043 vs. triflusal). In the in vitro experiments, 10 mumol.l-1 triflusal did not modify the percentage of the subendothelium covered by platelets. HTB 1 mmol.l-1 inhibited adhesion (26%) and aggregates (18%). We conclude that HTB participates in the ex vivo effects of triflusal on the platelet-subendothelium interaction.     

The role of a bidirectional cavopulmonary anastomosis in the correction and palliation of complex congenital cardiopathies

Between May 1990 and January 1998, 68 patients underwent bidirectional cavo-pulmonary anastomosis. We evaluated all patients in whom the bidirectional cavo-pulmonary anastomosis was associated with additional pulmonary flow (group A) and those in whom it was associated with biventricular repair (group B). Group A included 23 patients (33.8%), 14 males and 9 females, mean age 25 years and 6 months (range 4 months-16 years). Diagnoses were double outlet right ventricle (6), univentricular heart (6), tricuspid atresia (5), congenitally-corrected transposition of the great arteries with ventricular septal defect and pulmonary stenosis (3), right isomerism (2) and pulmonary atresia with atrioventricular canal (1). Group B included 13 patients (19.1%), 6 males and 7 females, mean age 13 years and 7 months (range 1 year-37 years). Diagnoses were pulmonary atresia with intact ventricular septum (4), Ebstein's anomaly (3), tetralogy of Fallot (3), atrioventricular canal (1), hypoplastic right ventricle (1), and pulmonary and tricuspid insufficiency (1). Four patients (17.3%) in group A died in the postoperative period, whereas there was no postoperative mortality in group B. Follow-up data were available in 31 patients (19 from group A, 13 from group B). Mean follow-up was 1 year and 6 months (range 30 days to 6 years). Evaluation was done by NYHA class functional status. In group A, 14 patients are doing well (NYHA I or II), while five patients (26.3%) underwent Fontan operation with one death. All group B patients are currently doing well (NYHA class I or II). In group A, complications were pericardial effusion (7), transient superior vena cava syndrome (5), pleural effusion (4), chylothorax (1) and rhythm disturbance (1). Complications in group B involved neurological events (2), pleural effusion (1) and rhythm disturbance (1). Bidirectional cavo-pulmonary anastomosis can be associated with additional pulmonary flow with good short- and intermediate-term outcome. Concern remains for the ability to properly regulate the amount of effective pulmonary blood flow. Bidirectional cavo-pulmonary anastomosis can be associated with biventricular repair in patients with diminutive right ventricles, amenable to anatomic complete correction, with good clinical outcome.     

The role of intraoperative echocardiography in valve surgery

The widespread use and popularity of intraoperative echocardiography (IOE) has resulted from advances in cardiac surgery, reparative procedures for valvular heart disease and, most specifically, mitral valve repair. IOE has grown exponentially and is becoming an integral part of the planning and evaluation of many types of surgical procedures such that it is now considered standard of care especially for the perioperative management of patients undergoing mitral and aortic valve repair. This article discusses the application of intraoperative echocardiography and focus specifically on valvular heart disease as this represents the most widely accepted indication for the procedure in current clinical practice.     

Infantile hepatic hemangioendothelioma: the role of surgery

The antihypertensive effect of corilagin, one of the ellagitannins purified from the seeds of Euphoria longana Lam. (Sapindaceae), was investigated in the spontaneously hypertensive rat (SHR). Administration of corilagin into conscious SHR at 5 mg/kg produced an antihypertensive effect equivalent to that induced by 1 mg/kg of guanethidine. This dose-dependent hypotensive effect was comparable with that observed in anesthetized SHR animals. Corilagin did not modify the baroreflex sensitivity in phenylephrine-challenged SHR. Corilagin reduced plasma noradrenaline in a dose-dependent fashion, an effect that was maintained in adrenalectomized rats. Failure of the antagonists for alpha2-adrenoceptors, idazoxan and yohimbine, as well as for dopamine receptors, haloperidol and domperidone, to reverse the antihypertensive actions of corilagin ruled out the participation of these receptors. Moreover, corilagin attenuated the pressor effects of methoxamine and Bay K8644 to a similar degree, indicating the direct effect of corilagin on vascular activity in rats. These results suggest that corilagin possesses the ability to lower blood pressure through the reduction of noradrenaline release and (or) direct vasorelaxation.     

Antimicrobial prophylaxis in orthopaedic surgery: the role of teicoplanin

Associational responses from 128 schizophrenic people and 120 healthy ones were collected. Four words with aggressive emotional shade were given as the stimuli. Semantic analysis of stimulus words was made, which made it possible to obtain a range of content categories. The collected material was analysed then according to them. Significant differences in five content categories were discovered. Basing on these differences we can infer that associational meaning at schizophrenic people is in some way varied. It was also possible to draw some conclusions concerning emotional life of the examined people.     

The role of surgery in the management of low back pain

Life-history characteristics of female threespine stickleback (Gasterosteus aculeatus) were examined in 12 populations, 11 freshwater and one anadromous, within the Cook Inlet region of Alaska. Because this area has been deglaciated during the last 20 000 years, the freshwater populations are recently derived, probably independently, from the local marine or anadromous stickleback. Freshwater threespine stickleback have undergone considerable morphological evolution within this region, apparently in response to environmental factors including predatory regimes and environmental productivity. Our freshwater study populations were selected to sample this range of morphological variation in order to determine whether life-history traits and morphologies have followed similar evolutionary trajectories. Freshwater populations could be categorized generally into one of three ecomorphotypes: those inhabiting relatively productive lakes having one or more piscivorous fishes present, and in which the stickleback exhibit a fully developed pelvic girdle; those inhabiting low-calcium lakes that lack piscivorous fishes, and in which the pelvic structures are incomplete; those living in streams with piscivorous fishes, in which the stickleback have fully developed pelvic girdles. The anadromous population constituted a fourth ecomorphotype that lives in marine waters, and is robustly armored. The freshwater populations showed considerable variation in all life-history traits assessed, and this variation generally corresponded to our ecomorphological classifications. Nevertheless, within each ecomorphotype there was sufficient variation to suggest that morphological and life-history traits may not always respond in the same manner in response to the same selective regime.Copyright 1998 The Linnean Society of London     

The role of plastic surgery in the treatment of malignant melanoma

For the majority of patients with melanoma today, surgical extirpation with primary closure or skin grafting is the optimal mode of treatment. The more complex plastic surgery techniques are particularly useful for reconstruction of the head and neck region and for the extensive surgical defects that require more than the conventional methods of reconstruction.