Outcome of Patients With Indeterminate Colitis Undergoing a Double-Stapled Ileal Pouch-Anal Anastomosis

INTRODUCTION The aim of this study was to assess the outcome of patients with indeterminate colitis undergoing double-stapled ileal pouch anal anastomosis.METHODS A retrospective review of demographic, disease-related, and outcome variables of all patients undergoing double-stapled ileal pouch anal anastomosis from August 1988 to January 2000 was undertaken. All patients were evaluated using the validated American Society of Colon and Rectal Surgeons Fecal Incontinence Severity Index. Patients with familial adenomatous polyposis, those who had undergone pouch revision or had S-configured pouches, and patients with a follow-up of less than three months were excluded from analysis.RESULTS Three hundred ninety-five patients underwent the double-stapled ileal pouch anal anastomosis; of these 303 patients were included for analysis. The mean duration of follow-up was 40 months. Fifty-six (18.1 percent) had a preoperative diagnosis of indeterminate colitis. Postoperatively, indeterminate colitis was diagnosed in 13 (4.3 percent), mucosal ulcerative colitis in 285 (94 percent), and Crohns disease in 5 (1.6 percent). The overall complication rate was 37.7 percent, 60 percent, and (30.7) percent in patients with mucosal ulcerative colitis, Crohns disease, and indeterminate colitis, respectively. Postoperative hemorrhage, abscess, and fistula occurred in 2.4 percent, 6.3 percent, and 3.9 percent, respectively, in patients with mucosal ulcerative colitis, and 0 percent, 15.3 percent, and 7.7 percent, respectively, in patients with indeterminate colitis. Small-bowel obstruction occurred in 8.5 percent, 20 percent, and 7.7 percent of patients with mucosal ulcerative colitis, Crohns disease, and indeterminate colitis, respectively. Pouchitis occurred in 4.6 percent of patients with mucosal ulcerative colitis but in none of the patients with indeterminate colitis. Dysplasia of the anal transition zone was seen in one patient each with mucosal ulcerative colitis and indeterminate colitis. These patients had consistent follow-up and neither showed any sign of evolution to neoplastic disease. None of the patients with indeterminate colitis had a postoperative diagnosis of Crohns disease during the follow-up period. Functional outcome was comparable in all three patient groups.CONCLUSION The outcome of the double-stapled ileal pouch anal anastomosis in patients with indeterminate colitis is similar to that of patients with mucosal ulcerative colitis. Therefore, it is a safe option in patients with indeterminate colitis.This work was funded in part by a research grant from the Eleanor Naylor Dana Charitable Trust Fund.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, June 2 to 7, 2001, San Diego, California.Poster presentation at the meeting of the Association of Coloproctology of Great Britain and Ireland, June 25 to 27, 2001, Harrogate, United Kingdom.Presented at the meeting of the International Society of University Colon and Rectal Surgeons, April 14 to 17, 2002, Osaka, Japan. Partially supported by the Japanese Organizing Committee of ISUCRS Congress, Osaka, Japan.     

Bovine Pericardium Buttress Reinforces Colorectal Anastomoses in a Canine Model

Purpose The consequences of an anastomotic leak or disruption can be devastating, particularly in the colorectal surgery population. The purpose of this study was to evaluate and compare colon anastomoses with or without a collagen matrix buttress derived from bovine pericardium. Methods A circular stapler was used to create colon-colon anastomoses in a canine model. Twenty animals underwent two anastomoses each: one buttressed with bovine pericardium, and one without any reinforcement. Staple lines were evaluated at Days 0, 3, 7, 14, 42, and 84. Three animals were killed at each time interval, and evaluation included bursting pressure, bursting location, and histology. Results Colon segments with nonbuttressed anastomoses were more likely to burst at the staple line (63 percent), whereas buttressed anastomoses were more likely to burst at the adjacent intestine (74 percent; P = 0.048). The burst pressure of nonbuttressed staple lines tended to be consistently, although not significantly, higher than the burst pressure of buttressed staple lines (P = 0.651). At histologic analysis, the bovine pericardium buttress demonstrated an ability to allow cellular ingrowth at Day 3 and neovascularization at Day 7. There was no evidence of stenosis or infection. Conclusions The use of a collagen matrix buttress in colorectal anastomoses was safe in a canine model. Our study indicates that true burst strength of the majority of buttressed anastomoses was greater than the adjacent intestine. Sponsored by Synovis Surgical Innovations, St. Paul, Minnesota. Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Seattle, Washington, June 3 to 7, 2006.     

Use of the "Single Suture" Technique to Expose the Anterior Surface of the Heart

A bstract The "single suture" technique, which consists of placing a suture in the oblique sinus of the posterior pericardium and connecting it to a vaginal tape, is commonly adopted in off-pump coronary artery revascularization to obtain elevation of the heart and coronary artery exposure. This report describes the use of this technique to expose the anterior wall of the heart in the setting of ventricular aneurysm repair.     

Effects of Anastomoses on Solute Transcapillary Exchange in Countercurrent Systems

Objective : To investigate effects of anastomoses between the descending vasa recta (DVR) and the ascending vasa recta (AVR) on the distribution of small solutes in the interstitial fluid of the renal medulla. Methods : Countercurrent capillary loops, surrounded by a secretory epithelium, were used to model microvessels in the renal medulla. Anastomoses between the DVR and AVR were modeled as a decrease in cross-sectional area of the vessels and a decrease in flow velocity from the base to the tip of the capillary loop. When experimental data were used to evaluate parameters of the model, it was seen that diffusive transport of solute in the axial direction of the capillary was negligible, and the equations could be greatly simplified. Results : General formulae of the solute concentration distribution were derived for different degrees of shunting between the two limbs of the capillary loop. Analytical solutions for the steady-state solute distribution were obtained when the sizes of capillaries and flows in them were assumed to decrease linearly with the distance from the base to the tip of the capillary loop. When the effects of reduction in the size of the limbs were compared with the effects of reduction of flow velocities on solute distribution, it was found that, in the presence of anastomoses, change in flow velocity increases the axial gradient of the solute concentration more than change in the cross-sectional area. The combined effects of a decrease in flow velocity and cross-sectional area can easily double the axial gradient of the solute concentration for a modest degree of anastomotic shunting. Conclusions : In this study, we separated effects of anastomotic flow between the DVR and AVR from other factors affecting the complicated countercurrent solute exchanges in the renal medulla. Results from the model show that anastomoses increase the solute concentration in the medullary interstitium and also the axial gradient of the solute concentration there.     

深圳某高校学生寝室床尘螨类调查及相关影响因子分析

为了解深圳某高校学生寝室床尘螨类的孳生情况及相关影响因子。共收集宿舍床尘308份,螨孳生率为88%（271/308）。共分离螨6 163只,其中粉尘螨、屋尘螨和热带剥爪螨为优势螨类,分别占29.7%、21.7%和17.9%。性别（男/女）、床上覆盖物（竹席/床单）、空调安装与否和空调日使用时间（<2 h、2～8 h和>8 h）对螨的阳性率无显著影响（P>0.05）,但logistic模型分析显示男生寝室螨可能致敏危险性低于女生寝室（OR=0.55,P=0.038）,使用床单的危险性高于竹席（OR=2.13,P=0.040）。随着楼层增高,螨的阳性率和致敏危险性显著递减。     

Suture line ulceration: a complication of gastric partitioning

Gastric partition with formation of a proximal pouch by staples and reinforced sutures is a well-accepted operation for obesity. Experience at this institution has included 2 cases of ulcers occurring at the partition line, a complication not well-described previously. These ulcers were located on the lesser curvature, appeared benign, and were characterized by chronic, severe pain. A suture associated with the ulcer was demonstrated endoscopically in 1 patient, although it could not be removed perorally.     

Suture urolithiasis in the renal pelvis secondary to prior subtotal colectomy

We report upon a patient who underwent a subtotal colectomy 2 years prior to presenting for a percutaneous nephrolithotomy of a large stone in the left renal pelvis. At the time of surgery, a non-absorbable suture was found embedded in the stone. Both stone and suture were removed percutaneously.     

FBG Strain Monitoring of a Road Structure Reinforced with a Geosynthetic Mattress in Cases of Subsoil Deformation in Mining Activity Areas

This paper presents implementation of purpose-designed optical fibre Bragg grating (FBG) sensors intended for the monitoring of real values of strain in reinforced road structures in areas of mining activity. Two field test stations are described. The first enables analysis of the geogrid on concrete and ground subgrades. The second models the situation of subsoil deformation due to mining activity at different external loads. The paper presents a system of optical fibre sensors of strain and temperature dedicated for the investigated mattress. Laboratory tests were performed to determine the strain characteristic of the FBG sensor-geogrid system with respect to standard load. As a result, it was possible to establish the dependence of the geogrid strain on the forces occurring in it. This may be the basis for the analysis of the mining activity effect on right-of-way structures during precise strain measurements of a geogrid using FBG sensors embedded in it. The analysis of the results of measurements in the aspect of forecasted and actual static and dynamic effects of mining on the stability of a reinforced road structure is of key importance for detailed management of the road investment and for appropriate repair and modernization management of the road structure.     

The Effect of Capecitabine on the Healing of Colonic Anastomoses in Rats

Purpose Capecitabine is a fluoropyrimidine carbamate with antineoplasmatic activity, recommended for the treatment of colorectal cancer. This study was designed to assess the effectiveness of the perioperative administration of capecitabine on the healing process of colonic anastomosis. Methods Sixty Wistar rats were used, which were randomized in 2 groups of 30 each. The study group was subjected to colonic anastomosis and treated with therapeutic doses of capecitabine (359 mg/kg, or 2/3 of the mean toxic dose) by mouth one week before anastomosis and throughout the study. The control group received only placebo medication. Both groups were further divided into three subgroups, each of ten animals. In both study and control groups, ten animals were killed in each session on postoperative Days 3, 7, and 14. Results We found no negative impact on the healing of colonic anastomosis on capecitabine administration. The rate of anastomotic leakage and septic complications were not found to be significantly different between the study and control groups. The median bursting pressure was found to be significantly higher in the study subgroup killed on the third day (68 vs. 46 mmHg of the control group). Conclusions Perioperative administration of capecitabine does not have a negative impact on colonic anastomosis in rats. Presented at the International Congress on Colorectal Cancer, Chalkidiki, Greece, May 28 to 31, 2004. Presented at the Congress of Northern Greece Surgical Association, Alexandroupoli, Greece, October 14 to 15, 2005. Supported by the Procurement of Capecitabine, F. Hoffman La-Roche, Basle, Switzerland. Reprints are not available.