Colorectal stapled anastomoses. Experiences and results

The mechanism whereby passive Rh (D) immunoglobulins suppress the fetomaternal alloimmunization is still unclear. New in vitro tests are needed to better characterize the functional properties of polyclonal anti-Ds. The DAF assay was developed to monitor the antibody-dependent cell-mediated cytotoxicity (ADCC) and the phagocytosis of anti-Rh (D)-sensitized RBCs by effector cells. The principle of this test is based on the oxydization of the 2,7-diaminofluorene (DAF) by the pseudoperoxidase activity of free hemoglobin. The reaction is proportional to the hemoglobin concentration. This test was performed to determine and emphasize the efficacy of different polyclonal anti-D immunoglobulin preparations to mediate lysis and phagocytosis of sensitized RBCs by human peripheral mononuclear cells. The functional properties of different human RhD monoclonal antibodies were also analyzed and compared. The test was found to be convenient to perform and allowed the avoidance of radioactive labelling of RBCs for ADCC studies. It is mainly useful for the direct quantitation of phagocytosis.     

Endoscopic treatment of postoperative hemorrhage from a stapled colorectal anastomosis

We present the sixth reported case of endoscopic electrocoagulation to successfully treat postoperative hemorrhage from a stapled colorectal anastomosis. A literature review revealed 17 patients with postoperative hemorrhage from a combined total of 775 patients (1.8 per cent) after stapled colorectal anastomosis requiring blood transfusion and/or emergency surgery. Twelve of the 17 cases involved a circular stapler (71 per cent) used during an anastomosis to the rectum (69 per cent). Nonoperative therapy was successful in 14 of the 17 patients (82 per cent), using endoscopic electrocoagulation in six patients (43 per cent) and blood transfusion alone in another six patients (43 per cent). In follow-up there was one death (cardiac) and two anastomotic fistulas (one requiring temporary colostomy) in the nonoperative group. Both anastomotic fistulas occurred following hemorrhage from an anastomosis to the rectum using the circular stapler, one after endoscopic electrocoagulation and the second after blood transfusion alone. In summary, postoperative hemorrhage from a stapled colorectal anastomosis, although rare, is most likely to occur in a colorectal anastomosis constructed with the circular stapler. Nonoperative treatment is usually successful. Endoscopic electrocoagulation may be safely and effectively used in the early postoperative period to cease unremitting anastomotic hemorrhage.     

Anterior cruciate ligament

Anterior cruciate ligament surgery is currently widely practiced. Nevertheless it is a surgery which is performed electively, mostly in young healthy adults who chose to continue in their sporting endeavours. We present a short account of the various aspects of this surgery as well as our preferred technique and results.     

Urologic complications after simultaneous pancreas-kidney transplantation: hand-sewn versus stapled duodenocystostomy

Pancreas transplantation with bladder drainage of exocrine secretions may be associated with significant urologic complications. Stapled and hand-sewn duodenocystostomies were compared in 61 recipients of simultaneous pancreas-kidney transplants. Both methods resulted in similar urologic complication and allograft survival rates. Duodenal segment leaks were associated with significant morbidity and decreased patient and allograft survival.     

Reconstruction after proximal gastrectomy using a stapled, U-shaped jejunal pouch

Any model for the physiology of dystonia must be able to explain how dystonia can be produced in various circumstances. Brain lesions can cause dystonia; responsible sites include the basal ganglia, brainstem, and thalamus, but the most common site is the putamen. Dystonia can be hereditary, and genetic linkage has been found for both generalized and focal dystonia. The only genetic dystonia for which the gene product is known is Segawa disease, a hereditary progressive dystonia with marked diurnal fluctuation. The defect is in guanosine triphosphate cyclohydrolase I, a gene that makes a cofactor for the synthesis of dopamine, which explains why this form of dystonia should be amenable to treatment with levodopa. Another example of dystonia in which a disorder of dopamine pharmacology appears responsible is the dystonia occurring in Parkinson disease, either spontaneously or as a result of treatment. Curiously, the dystonia occurs at both peak and trough dopamine levels.     

Anterior interosseus nerve syndrome

A prolonged period of illness in a patient showing symptoms of reflexdystrophy is described. After going through several examinations and finally being referred to a pain clinic the patient demanded a second opinion from an orthopaedic surgeon. Her symptoms turned out to have been caused by a compression syndrome of the anterior interosseus nerve.     

Anterior tibial tendon rupture

Twelve patients with rupture of the anterior tibial tendon are presented. Nine patients were aware of an acute event prior to their symptom onset and three were not aware of any acute event. Complete rupture of the tendon was noted in 10 patients and incomplete rupture was seen in two patients. Treatment was individualized based on age, etiology, preinjury function, patient health, and personal considerations. Five patients were treated without surgery. Three preferred no orthotic devices, and two believed their function was improved with an ankle-foot orthosis. Seven patients were treated operatively using a variety of individualized reconstructive techniques. All operatively treated patients demonstrated increased function and strength. Based on our findings, operative reconstruction is recommended in appropriate patients.     

Anterior uveitis and leptospirosis

Seven patients with anterior uveitis due to leptospirosis are presented. The diagnosis was based upon serologic tests and exclusion of other etiologic possibilities. Six patients came from a well-known endemic area of leptospirosis during the time of epidemics and one case came from an area which was not known to be endemic at the time. In 5 patients the uveitis was bilateral. The disease was mild in all but 2 patents who needed systemic administration of steroids. The posterior part of the eye was not involved in any of the cases.     

Anterior patterning in mouse

The anteroposterior axis of the vertebrate embryo becomes explicit during gastrulation, the process that converts a relatively featureless embryonic precursor population into new tissues assembled into a recognisable body pattern. Vertebrate embryos arrive at gastrulation in very different states in terms of their size, cell number and reliance on factors inherited from the unfertilized egg. However, they emerge from gastrulation looking very similar, and there is now extensive molecular genetic evidence to indicate that the bare essentials of the gastrulation process have been well conserved during evolution. Here, we review recent findings in the mouse that suggest that anterior identity is, in fact, established before gastrulation starts. They suggest that it is first manifest in extraembryonic tissue and that this tissue is essential for the embryo to develop normal anterior structures, such as the forebrain. We also argue that this precocious anterior pattern could have a counterpart in other non-mammalian vertebrates.     

Anterior lenticonus and Alport's syndrome

A case of anterior lenticonus is reported in a 26 year old man with hemorrhagic nephritis related to familial Alport's syndrome. Anterior lenticonus is seen only as a part of Alport's syndrome. The authors describe its clinical, histologic and therapeutic aspects. They also discuss the other ocular manifestations, the nephritis and the sensorineural deafness.     

Anterior approach in hip prosthesis

The anterior approach for total hip endoprosthetics (THE) developed by K. J. Keggy was used in about 3,000 patients. It is characterized by rapid accomplishment, the possibility of anatomical inspection of the joint and correct orientation of the acetabular component of the endoprosthesis. Difficulties are not encountered in exposure of the femur and favorable conditions are provided for separation of the soft tissues. Considering our preference for noncemented THE, we have been using in the recent years a modified approach. The average duration of the operation, except for revision THE, did not exceed 90 minutes. The approach is atraumatic for the para-articular soft tissues, which provides the possibility of early postoperative mobilization and rehabilitation and reduced the duration of postoperative in-patient treatment to 7.3 days. The incidence of complications was not higher, and in many respects was even lower, than that reported in the literature dealing with primary and revision THE. At present we still use the anterior approach in all operations for THE although essential contradictions occur in discussion of the advantages of cemented implants over noncemented prostheses. The suggested method for THE is best for most patients.     

Anterior mediastinal lymphadenopathy in sarcoidosis

Several lymph node chains in the anterior mediastinum lie between the sternum and the trachea. On a lateral chest radiograph they form two distinct groups separated by the superior vena cava. One group projects anterior to the trachea and is formed by overlapping nodes of the anterior paratracheal and the left anterior mediastinal (prearterial) chains. The other is in front of the superior vena cava, composed of the right anterior mediastinal (prevenous) and horizontal chains. The position of these chains prevents them, even when enlarged, from being seen on posteroanterior chest radiographs or tomography: frequently they may not be appreciated on lateral chest films. Therefore lateral chest tomography is the best method to evaluate anterior mediastinal lymphadenopathy. With this technique, anterior mediastinal lymphadenopathy in sarcoidosis should be found more frequently than indicated in the literature.     

Anterior rhinomanometry in nasal allergen challenges

Even simple and relatively safe provocation procedures like nasal allergen challenges, should aim to allow detection of positivity with the less possible discomfort to the patient. The objective of this work was to evaluate if the use of rhinomanometric measurements during nasal provocation procedures could allow a decrease in the total administered allergen dose, causing less symptoms to the patients but without increasing the number of false-negatives, comparatively to clinical scores or nasal peak-flow measurements. Our results showed that performing rhinomanometric measurements during nasal HDM challenge procedures can lead in many patients to a reduction in the total dose of allergen administered during the challenge, without loss of sensitivity or specificity. This allergen dose reduction translates in less time consumed during the provocation and less patients' discomfort.     

Anterior choroidal artery aneurysm and stroke

We report the unique combination of a mid anterior choroidal artery (AChA) aneurysm and ischemic stroke presenting as a movement disorder in a young man. The mechanism for stroke in the AChA territory may either reflect a cause or an effect of aneurysm formation. We provide evidence for both arguments and speculate on the anatomic basis for the initial presentation of hemibody spasm.     

Anterior shoulder instability. Current review

During the past several decades, the treatment of anterior shoulder instability has evolved substantially. Treatment initially was based on conservative management with rehabilitation protocols for shoulder girdle strengthening. Functionally disabling instability and recurrent dislocation precluded the acceptance of conservative management as the definitive treatment for all patients. Attention then was turned to open repair strategies. Despite generally positive results, a significant number of complications became evident. With time, however, techniques improved and surgical complications were lessened. As shoulder arthroscopy was more widely practiced, the surgical reconstruction of instability became significantly less invasive. A high learning curve has been associated with the new arthroscopic techniques, and higher redislocation rates than those of open procedures have limited their acceptance by many orthopaedic surgeons. This review article examines the anatomy and pathology of anterior shoulder dislocations, and critically reviews the actual laboratory and clinical data supporting use of these various treatment options. Only through careful examination of well-controlled scientific studies can clinicians devise their own treatment protocol for symptomatic anterior instability of the shoulder.     

Anterior chamber scroll and corneal edema

This case represents the successful removal of a transparent anterior chamber scroll and the subsequent resolution of corneal edema overlying the tissue. It emphasizes the clinical observation that a small area of endothelial touch can be associated with a disproportionately large area of overlying corneal edema, and may indeed be the cause of it.     

Anterior maxillary aesthetics utilizing all-ceramic restorations

The use of all-ceramic systems has increased significantly during recent years, due to the improved strength and the introduction of a new generation of dental adhesive agents and resin cements. Both factors permit reliable and predictable results in single jacket crown restorations in the maxillary anterior region. Due to their natural appearance, the all-ceramic materials, especially the glass ceramics, blend harmoniously with the oral environment and are particularly appreciated where aesthetics is a priority. The learning objective of this article is to demonstrate a routine utilization of all-ceramic systems in the maxillary anterior region, preceded by a proper case selection. Two clinical cases are used to illustrate the preparation procedure, the importance of well-integrated provisional restorations, and the accuracy in transferring provisional information onto the final jacket crowns.     

Video-assisted thoracic surgical non-rib spreading simultaneously stapled lobectomy (VATS(n)SSL)

We have previously shown that alendronate can prevent human PC-3 ML tumor cell metastasis to the bone (Wang and Stearns, 1991, Differentiation, 48, 115-25). In this paper, ELISAs and Western blots showed that TGF-beta1 stimulated the secretion of a 72 kDa matrix metalloproteinase 2 (MMP-2) to enhance the solubilization of radiolabeled collagen 1 by metastatic human prostate PC-3 ML cells. A potent bisphosphonate compound, alendronate, inhibited MMP-2 secretion to block solubilization of collagen 1. Alendronate failed to inhibit MMP-2 activity directly, but instead appeared to block cellular secretion of MMP-2. Alendronate failed to inhibit secretion of tissue inhibitor of metalloproteinase-2 (TIMP-2; the inhibitor of MMP-2) and the decrease in collagen 1 solubilization observed may occur, in part, from changes in the molar stoichiometry of TIMP-2 to MMP-2. We conclude that alendronate may be a potent inhibitor of bone resorption based on its ability to block MMP-2 secretion by tumor cells.