Renal endarterectomy vs. bypass for combined aortic and renal reconstruction: Is there a difference in clinical outcome?

Are there differences in the patient characteristics and clinical outcome for transaortic renal endarterectomy vs. bypass grafting when either technique is combined with infrarenal aortic replacement for occlusive or aneurysmal disease? Two common perceptions persist: (1) combined aortic and renal procedures have a high risk and (2) bypass is easier and safer than endarterectomy. To address these controversies we compared 52 consecutive patients undergoing concomitant aortic and renal reconstruction between 1987 and 1991: 26 with bypass and 26 with endarterectomy. Bypass patients were older (70 vs. 64 years,p=0.001),had more extensive plaque extending into the distal renal artery and more severe baseline azotemia (creatinine=2.6 vs 1.7 mg/dl,p=0.01),more clinically evident coronary heart disease (89% vs. 56%,p=0.001),and a greater need for nephrectomy of a small nonfunctional pressor kidney (23% vs. 0%) than endarterectomy patients. In contrast, endarterectomy patients more commonly required aortic replacement for occlusive disease than for an aortic aneurysm (endarterectomy: 65% vs. 35%; bypass: 19% vs 81%,p=0.002)and tended to require more intraoperative technical revisions (12% vs. 4%) than bypass patients. Both groups, however, experienced no operative mortality, had similar cardiorespiratory morbidity, and achieved equal improvement in hypertension (69% vs. 65%). Bypass patients, who already had more severe preoperative azotemia than endarterectomy patients, showed less improvement in the creatinine level (Cr=2.1 vs. 1.4 mg/dl,p=0.01)and had greater need for late dialysis (30% vs. 4%,p=0.01).Only one patient on dialysis had graft occlusion. We conclude that patients requiring bypass are generally at a more advanced stage of both cardiovascular and renal disease and have a greater need for late dialysis than was previously recognized. Transaortic endarterectomy is a safe and effective choice in patients with bilateral orificial renal atheroma and aortic occlusive disease. Both procedures currently carry a lower operative risk than was previously predicted and have equal effectiveness in controlling renovascular hypertension.     

Interstitial fluid pressure in breast cancer,benign breast conditions,and breast parenchyma

Background: Interstitial fluid pressure (IFP) in rodent malignant tumors is reportedly much higher than in surrounding normal tissue. We hypothesized the same may be true in human invasive breast tumors. Methods: We measured IFP in the operating room in 25 patients undergoing excision breast biopsy under local anesthetic for diagnostic purposes. Results: In patients with invasive ductal carcinomas IFP was 29 ± 3 (SE) mm Hg, compared with ?0.3 ± 0.1 mm Hg in those with normal breast parenchyma (p < 0.001), 3.6 ± 0.8 mm Hg in those with benign tumors (p < 0.003), ?0.3 ± 0.2 mm Hg in those with noninvasive carcinomas (p = 0.034), and 0.4 ± 0.4 mm Hg in those with other benign breast conditions (p = 0.002). There was a direct correlation between IFP and tumor size (R ² = 0.3977; p = 0.021). No correlation was found between IFP and nuclear grade, angiolymphatic invasion, systemic blood pressure, metastasis to lymph nodes, or estrogen and progesterone receptors. Conclusions: IFP measurements may facilitate radiographic or ultrasound localization of small or nonpalpable malignant tumors in those patients undergoing needle aspiration cytology or stereotactic core needle biopsy.     

Post Roux-en-Y Gastric Bypass Biliary Dilation: Natural Process or Significant Entity?

Background

Changes in the biliary system after gastric bypass are not well defined. Dilation may be normal or due to biliary tract pathology. The purpose of this study is to review patients who underwent imaging of their biliary system both before and after Roux-en-Y gastric bypass in an effort to elucidate the effect this operation has on hepatic duct diameter.

Methods

Patients with imaging both before and at least 3?months after gastric bypass were analyzed. Hepatic duct was measured at the level of the porta hepatis to determine interval changes.

Results

Thirty-three patients had postoperative imaging at least 3?months following gastric bypass. Mean hepatic duct diameter was 5.2?±?2 and 7.1?±?2.6?mm preoperatively and postoperatively, respectively (p?<?0.01). Patients with prior cholecystectomy had hepatic duct diameters of 7.9?±?1.3 and 9.5?±?3.5?mm preoperatively and postoperatively, respectively (p?=?0.3). Patients who had not previously undergone cholecystectomy had hepatic duct diameters of 4.3?±?1.1 and 6.4?±?1.8?mm preoperatively and postoperatively, respectively (p?<?0.01).

Conclusions

Hepatic duct diameter increases after Roux-en-Y gastric bypass. A better understanding of this phenomenon may limit the need for further work-up in patients with incidentally detected biliary dilation.     

Abdominoperineal excision of the rectum: A prospective study based on a standardized method

A prospective and consecutive series of 72 patients with rectal carcinoma was subjected to excision of the rectum. The operations were performed according to a standardized program based on previous studies and established surgical principles:

1. Two days on a liquid diet, laxative, and enemas.
2. Irrigation of the pelvic cavity with 5 liters of saline solution after removal of the specimen.
3. Leaving the pelvic peritoneum unsutured.
4. Obliteration of the presacral cavity with living omentum, uterus, or small intestine.
5. Suprapubic, closed suction drainage.
6. Primary closure of abdominal and perineal wounds without drainage.
7. Antibiotic prophylaxis against aerobic as well as anaerobic bacteria.
8. Parenteral nutrition from the first postoperative day and until the bowel acts properly.

Two patients died postoperatively (3%), and 93% achieved primary healing of the perineal wound.     

Der iliofemorale Crossover-Bypass kombiniert mit intraoperativer aortoiliakaler Stenteinlage

Objective: To study the outcome of treating biiliacal aortoiliac occlusive disease by combined procedures consisting in placement of an iliofemoral crossover bypass and aortoiliac stenting for inflow improvement. Design: Retrospective study of 24 patients with aortoiliac occlusive disease who were treated with this combined endovascular procedure. Materials: From March 1995 to July 1998 24 patients underwent this combined procedure. Mean age was 63.8 years (range 48–73 years). All aortoiliac stents were implanted intraoperatively followed by placement of an iliofemoral crossover bypass. In case of stenosis of the deep femoral artery, a femoral-femoral crossover bypass was preferred. Results: In the mean follow-up period of 42 months, primary assisted patency was 100%. Clinical signs of arterial occlusive disease were decreased to Fontaine stage IIa in all cases. Conclusions: This experience demonstrates that iliofemoral crossover bypass combined with simultaneous stent implantation for inflow improvement is an effective and low invasive treatment in patients with extensive aortoiliac occlusive disease.     

Muskuläre Sauerstoffspannung und nervale Impulsfortleitung bei Einsatz der Antischockhose Verminderung der Sauerstoffspannung im M. tibialis anterior und Einschränkung der Impulsfortleitung im N. peronaeus profundus infolge pneumatischer Druckeinwirkung durch Antischockhose

Object of the study: The aim of the study was to assess, whether the pneumatic pressure of an antishock-trouser (AST) of 20–40?mm?Hg induces a decreased oxygenation of the anterior tibial muscle and attenuates muscular response potential (MRP) of n. peronaeus profundus? Methods: Among 22 normotensive, healthy volunteers the AST were tested by applying pressure values between 0 and 100?mm?Hg and measuring the intracompartmental pressure, the muscular oxygen pressure as well as the MRP by electroneurographic means within a period of 6 hours. Results: The median initial intracompartmental pressure value of the m. tibialis anterior was 12.0?mm?Hg (Q_25%/Q_75%: 8.9/17.3), the muscular oxygen pressure 14.8?mm?Hg (Q_25%/Q_75%: 11.5/22.0). Transmission of the pneumatic AST-leg segment pressure to the muscle: 97.7% (Q_25%/Q_75%: 89.2/99.8). Already in the low AST pressure field (20–40?mm?Hg) a severe hypoxia occurred in one case. A reduction of MRP was noticed at an AST pressure rate of 10?mm?Hg. In 5 of 6 cases AST pressure values of 60?mm?Hg led to pathological pO₂-values within 5–20?minutes. Almost without exception AST-pressure rates Conclusions: We should demand that the AST are only applied with models where the pressure generated within the single segments can be controlled by pressure gauge. The application of the AST seems to be justified for polytraumatised in severe haemorrhagic shock where the risk of a local tissue ischemia with systemical consequences must deliberately be accepted.     

Anorectal manometric evaluation of children and adolescents postsurgery for Hirschsprung's disease

Background: Little is known about anorectal function in patients after surgery for Hirschsprung's disease. Therefore, the authors evaluated anorectal sphincter function after corrective surgery. Methods: Thirty-five patients were studied after corrective surgery for Hirschsprung's disease. Sixteen of them had anorectal manometry performed also before surgery. The clinical outcome, the highest anal resting pressure, the presence of the rectosphincteric reflex (RSR), and of high amplitude propulsive waves were evaluated. Results: A total of 89% were doing poorly. Three had a fair and only one had a good outcome at the time of manometry 4.4 years after corrective surgery. RSR was absent in 33 and abnormal in 2 patients. The preoperative anal resting pressure was 45 [plusmn] 14 mm Hg and postoperatively 45 [plusmn] 13 mm Hg (P [gt ] .3). The anal resting pressure was 44 [plusmn] 16 mm Hg in the 19 patients evaluated only postoperatively. Propulsive waves [ge ]50 mm Hg were present in 60% of patients. Conclusions: Four years postsurgery, patients had a persistent absence of RSR regardless of the type of surgery. There was no significant difference in anal resting pressure between patients with and without sphincterotomy or between different surgical procedures. The presence of propulsive waves was not a prognostic indicator for achieving bowel control. J Pediatr Surg 38:191-195.     

Akute perioperative Störungen der Nierenfunktion

The increasing life expectancy in industrial nations leads to an increase in the number of elderly and aged persons treated in hospital. Increasingly more complex operations are being carried out on this group of patients. Renal dysfunction in the preoperative situation increases morbidity and mortality. Acute kidney injury (AKI) is nearly always part of a multi-organ dysfunction syndrome in critically ill patients. The treatment strategy of the AKI should be oriented to the degree of organ dysfunction. However, the stage of organ dysfunction is mostly unknown so that the therapeutically exploitable interval is often missed. The same therapy is practically always used for all patients: administration of fluids and diuretics often under the premise of“the kidneys must be rinsed”. A unified classification of the continuation of kidney function disorders using the RIFLE criteria (risk, injury, failure, loss, endstage kidney disease) can assist recognition of early stages of kidney failure in order to react correspondingly with therapeutic measures and to critically question or optimize the use of conservative treatment strategies.     

Predicting anal sphincter defects: the value of clinical examination and manometry

Introduction and hypothesis

The aims of this study were, firstly, to determine the diagnostic accuracy of an anal incontinence score, clinical examination and anal manometry in identifying anal sphincter defects and, secondly, to establish manometric cut-off values associated with sphincter defects.

Methods

One hundred fifty-nine women were evaluated by clinical examination, anal manometry and endoanal ultrasound (EAU). Accuracy measures were calculated, using EAU as the gold standard.

Results

Perineal body length (p?=?0.84) and pelvic floor muscle strength (p?=?0.10) were not associated with anal sphincter defects. Anal inspection was associated with anal sphincter defects (p?Conclusions Clinical assessment has a poor sensitivity for detecting anal sphincter defects. The proposed manometric cut-off values can be used to either reassure or identify women who may need further assessment by EAU.     

Die silikonbeschichtete Polyesterprothese

Introduction. Alloplastic bypass grafting still represents a compromise. To achieve primary tightness of polyester prostheses, coating with bovine collagen or gelatin is necessary. However, surface modification with a neutralizing silicone elastomer offers the possibility of dispensing with these xenogen-coating substances. Materials and methods. Forty-six mongrel dogs were randomly assigned to abdominal aortic repair with a silicone-coated or conventional polyester prosthesis (Microvel^®). After 3, 7, 14, 30, 90 days, and 5 months, the grafts were reexamined for patency and biological behavior. Results. The silicone group showed good handling properties compared to the controls. At reexamination three animals from the silicone group were obliterated (two at day 90, one at 5 months) and four from the control group (at days 14 and 90, two at 5 months); one bypass graft in each group was partially thrombosed. No differences in the healing course and no systemic depositions of silicone were detected. Conclusion. Silicone coating leads to improved handling characteristics of polyester prostheses with comparable patency rates. Therefore, coating with potentially harmful xeno-reacting substances can be avoided.     

Progress in the treatment of thoracic aortic aneurysms

Progress in the management of thoracic aortic aneurysm includes the following aspects:

1. the concepts of the disease itself, which is frequently generalized so that the second most common cause of late death is rupture of another aneurysm;
2. the diagnostic techniques used: computed tomographic scanning as well as aortography;
3. the medical treatment: with beta blockade and antihypertensive drugs in stable aortic injury in the patient with multiple critical injuries;
4. that hypothermic circulatory arrest with cardiopulmonary bypass and brain temperatures down to 16–20°C has increased successful aortic arch replacement from 50–75% to over 90%;
5. that rapid autologous transfusion by means of a modified Hemonetics machine can collect and process a unit of shed blood in 2–3 minutes and has reduced transfusion requirements by more than half;
6. the vigorous treatment of both consumptive and dilutional coagulopathies;
7. the new reconstructive techniques: involving composite valve graft replacement of the aortic valve, root, and arch as well as coronary artery reattachment;
8. that the use of viable tissue flaps in the treatment of infected aortic grafts as well as intravenous and local irrigation with antibiotics was successful in 8 of 9 of our cases;
9. that graft replacement with intensive antibiotic therapy was effective in 19 of 22 of our patients with mycotic thoracic aortic aneurysm.

     

Improvement of Type 2 Diabetes Mellitus (T2DM) After Bariatric Surgery—Who Fails in the Early Postoperative Course?

Backround

Diabetes surgery in nonobese or moderately obese patients is an emerging topic. The identification of preoperative factors predicting diabetes outcome following bariatric surgery, especially for metabolic nonresponders, is imperative.

Methods

Between 2005 and 2011, 235 patients underwent bariatric surgery for morbid obesity. Eighty-two of 235 patients had type 2 diabetes mellitus (T2DM). Data from this subgroup were investigated with univariate and multivariate analyses to identify predictors for metabolic nonresponse after surgery.

Results

Diabetes did not improve in 17/82 patients within 3?months after surgery. No correlation between excess body weight loss and metabolic response was detected. In univariate analysis, preoperative duration of diabetes was significantly longer in the nonresponder group (9.146 vs. 6.270?years; *p?=?0.016), preoperative HbA1c levels were significantly higher among the nonresponders than among the responders (8.341 vs. 7.781?%; *p?=?0.033), and more patients in the nonresponder group were reliant on a multi-drug approach preoperatively (*p?=?0.045). In multivariate analysis, age, preoperative doses of insulin, and preoperative oral antidiabetics showed positive correlation to metabolic nonresponse after surgery (*p?=?0.04; *p?=?0.021; *p?=?0.021). Metabolic failure rate was lower after Roux-en-Y gastric bypass compared to other bariatric procedures (**p?=?0.008).

Conclusions

A long history of preoperative T2DM, high preoperative HbA1c levels, and a preoperative therapy consisting of diverse approaches to diabetes treatment may be factors predicting failure of diabetes improvement in the early postoperative course after bariatric surgery. Age, preoperative insulin, and oral antidiabetic medication can be regarded as independent, significant predictors for metabolic outcome after bariatric surgery.     

Changes in blood volume during acute normovolemic hemodilution with 5% albumin or 6% hydroxyethylstarch and intraoperative retransfusion

Question. What is the impact of acute preoperative normovolemic hemodilution (ANH) on blood volume, intravascular colloid, and loss of red cells in the perioperative period? Methods. In 20 patients undergoing radical hysterectomy, preoperative ANH was performed to a hematocrit of 22% using 5% albumin (albumin group; n=10) or 6% hydroxyethylstarch solution (HES group; n=10). Intraoperative retransfusion of ANH blood was started at a hematocrit of 18%. Plasma volume (indocyanine green-dilution technique), hematocrit, and plasma protein concentration were measured before and after ANH, before retransfusion, and postoperatively. Red cell volume (labelling erythrocytes with fluorescein) was determined before and after ANH and postoperatively. In the HES group hydroxyethylstarch concentrations were measured in plasma and urine. Results. After removal of about 1,500 ml of blood and replacement with 15% more colloid solution, the blood volume was maintained in both groups after ANH. After a mean blood loss of about 1,800 ml, an average of 150 ml of red cells were saved due to ANH in both groups. Conclusions. Double label measurements of blood volume demonstrated that with the colloids used a surplus of 15% of colloid infusion in relation to blood removal was necessary to generate isovolemia after ANH.     

Der neuroprotektive Einfluss des Glutamat-Antagonisten Acamprosat nach experimenteller zerebraler Ischämie Ein Vergleich mit dem Lipidperoxidase-Inhibitor U-101033E

Introduction. This study investigates the effects of acamprosate, a glutamatergic modulator, and the lipid peroxidation inhibitor U-101033E on neurological outcome following incomplete cerebral ischemia and reperfusion in rats. Material and methods. Twenty-seven male Sprague-Dawley rats were randomly assigned to one of the following treatment groups: 1 (n=9, control, no drug treatment), 2 (n=9, 2×200 mg/kg acamprosate ip), and 3 (n=9, 2×0.3 mg/kg U-101033E iv). Background anesthesia was maintained using a combination of fentanyl and O₂/N₂O (FiO₂=0.3). Ischemia was produced by combined unilateral common carotid artery ligation and hemorrhagic hypotension to a mean arterial blood pressure (MAP) of 35 mm Hg for 30 minutes. Functional neurological deficit was evaluated for the following 3 days after cerebral ischemia. Results. At the third postischemic day, five control animals and five animals treated with U-101033E were dead for stroke-related reasons. Surviving animals presented severe neurological deficits. In contrast, acamprosate improved neurological outcome, with stroke-related death occurring in one animal only and a minor neurological deficit in the surviving rats. Discussion. The present study demonstrates that acamprosate, in contrast to U-101033E, significantly reduces neurological deficits following transient hemispheric ischemia. The neuroprotective mechanisms of acamprosate may be related to its antiglutamatergic effect with consecutive reduction of transmembraneous Ca⁺⁺ flux through NMDA-activated ion channels.     

Urinary Evaluation After RYGBP: a Lithogenic Profile with Early Postoperative Increase in the Incidence of Urolithiasis

Background

The objective of this study was to assess predictors for new-onset stone formers after Roux-en-Y gastric bypass (RYGBP).

Methods

One hundred and fifty-one obese patients underwent RYGBP and were followed for 1 year. The analysis comprised two study time points: preoperative (T0) and 1 year after surgery (T1). They were analyzed for urinary stones, blood tests, and 24-h urinary evaluation. Nonparametric tests, logistic regression, and multivariate analysis were conducted using SPSS 17.

Results

Median BMI decreased from 44.1 to 27.0 kg/m² (p?<?0.001) in the postoperative period. Urinary oxalate (24 versus 41 mg; p?<?0.001) and urinary uric acid (545 versus 645 mg; p?<?0.001) increased significantly postoperatively (preoperative versus postoperative, respectively). Urinary volume (1310 versus 930 ml; p?<?0.001), pH (6.3 versus 6.2; p?=?0.019), citrate (268 versus 170 mg; p?<?0.001), calcium (195 versus 105 mg; p?<?0.001), and magnesium (130 versus 95 mg; p?=?0.004) decreased significantly postoperatively (preoperative versus postoperative, respectively). Stone formers increased from 16 (10.6 %) to 27 (17.8 %) patients in the postoperative analysis (p?=?0.001). Predictors for new stone formers after RYGBP were postoperative urinary oxalate (p?=?0.015) and uric acid (p?=?0.044).

Conclusions

RYGBP determined profound changes in urinary composition which predisposed to a lithogenic profile. The prevalence of urinary lithiasis increased almost 70 % in the postoperative period. Postoperative urinary oxalate and uric acid were the only predictors for new stone formers.     

Intraoperative lymph mapping with preoperative vein mapping to prevent postoperative lymphorrhea following paramalleolar bypass surgery in patients with critical limb ischemia

Purpose

Paramalleolar bypass surgery requires a long incision to harvest the great saphenous vein (GSV), which is often associated with intractable postoperative lymphorrhea. To prevent this complication, we developed a novel method of intraoperative lymph imaging and preoperative vein mapping for vein harvesting.

Methods

Thirteen consecutive patients with critical limb ischemia (CLI) underwent both preoperative vein mapping and intraoperative lymph mapping (Group A). Duplex vein mapping was performed to mark the GSV. Lymph mapping was performed with indocyanine green fluorescence lymphography. Paramalleolar bypasses were performed using reversed GSV grafts, with careful ligation of the subcutaneous lymph collector vessels above the GSV. The development of intractable postoperative lymphorrhea and the length of the postoperative hospital stay were compared with those in the previous ten consecutive CLI patients without lymph mapping who underwent paramalleolar bypass (Group B).

Results

The occurrence of intractable wound lymphorrhea by the 30th postoperative day was 3/10 (30 %) in Group B, while it was 0/13 (0 %) in Group A (p < 0.05). The length of the postoperative hospital stay was 31.7 ± 8.8 and 57.5 ± 39.5 days (Group A and Group B, respectively, p < 0.05).

Conclusions

Intraoperative lymph mapping and preoperative vein mapping are technically feasible and can positively contribute to the prevention of postoperative lymphorrhea after GSV harvesting.     

Association of TNF-α −308 G > A and ACE I/D gene polymorphisms in hemodialysis patients with arteriovenous fistula thrombosis

Purpose

Tumor necrosis factor-α (TNF - α) -308 G > A promoter polymorphism seems to be associated with adverse clinical outcome in hemodialysis patients (HD). Angiotensin-converting enzyme (ACE) gene may be the causative factor contributing to the deterioration of renal functions. The aim of this study was to investigate the relationship between vascular access failure and the genetic polymorphisms of ACE and TNF-α gene.

Methods

We enrolled and genotyped 47 HD patients with arteriovenous fistula (AVF) thrombosis, 51 HD patients without AVF thrombosis, and 40 healthy controls. The genotypes of these polymorphisms were determined by polymerase chain reaction and restriction fragment length polymorphism.

Results

The genotype distribution of TNF-α ?308 G > A in patients with thrombosis was significantly different from the patients without thrombosis (p = 0.008). There was no significant difference between the two groups in terms of ACE I/D polymorphism (p = 0.213).

Conclusion

Our results propose that TNF-α ?308 G > A genotype may be a potential genetic marker on HD patients with AVF thrombosis.     

Factors Associated with False-Negative Sentinel Lymph Node Biopsy in Melanoma Patients

Introduction

Some melanoma patients who undergo sentinel lymph node (SLN) biopsy will have false-negative (FN) results. We sought to determine the factors and outcomes associated with FN SLN biopsy.

Methods

Analysis was performed of a prospective multi-institutional study that included patients with melanoma of thickness > 1.0 mm who underwent SLN biopsy. FN results were defined as the proportion of node-positive patients who had a tumor-negative sentinel node biopsy. Kaplan–Meier survival analysis and univariate and multivariate analyses were performed.

Results

This analysis included 2,451 patients with median follow-up of 61 months. FN, true-positive (TP), and true-negative (TN) SLN results were found in 59 (10.8%), 486 (19.8%), and 1,906 (77.8%) patients, respectively. On univariate analysis comparing the FN with TP groups, respectively, the following factors were significantly different: age (52.6 vs. 47.6 years, p = 0.004), thickness (mean 2.1 vs. 3.1 mm, p = 0.003), lymphovascular invasion (LVI; 3.7 vs. 13.7%, p = 0.037), and local/in-transit recurrence (LITR; 32.2 vs. 12.4%, p < 0.0001); these factors remained significant on multivariate analysis. Overall 5-year survival was greater in the TN group (86.7%) compared with the TP (62.3%) and FN (51.3%) groups (p < 0.0001); however, there was no significant difference in overall survival comparing the TP and FN groups (p = 0.32).

Conclusions

This is the largest study to evaluate FN SLN results in melanoma, with a FN rate of 10.8%. FN results are associated with greater patient age, lower mean thickness, less frequent LVI, and greater risk of LITR. However, survival of patients with FN SLN is not statistically worse than that of patients with TP SLN.     

Preservation of the Pyloric Ring Confers Little Benefit in Patients Undergoing Total Pancreatectomy

Background

The clinical significance of preservation of the pyloric ring in total pancreatectomy (TP) has not been elucidated.

Methods

A total of 48 consecutive patients underwent TP and were categorized into two groups based on the absence or presence of pylorus resection: the TP (N = 33) and pylorus-preserving TP (PPTP) (N = 15) groups. Preoperative patient background, intraoperative conditions, postoperative complications, and long-term nutritional status were retrospectively compared between the two groups.

Results

Patient background was similar between the groups, with the exception of the prevalence of preoperative diabetes mellitus (55 and 20 %, respectively; p = 0.021). There were no differences between groups with respect to operative times, blood loss, or blood transfusion. The PPTP group was more likely to have postoperative delayed gastric emptying than was the TP group (53 and 21 %, respectively; p = 0.029), and it tended to become increasingly severe. The length of the postoperative fasting period was significantly longer in the PPTP group than in the TP group (mean 15 ± standard deviation [SD] 10.8 and 9 ± 9.7 days, respectively; p = 0.023). The body weights in the TP group started to recover by 1 year postoperatively, whereas those in the PPTP group continued to decrease. Serum hemoglobin levels tended to be higher in the TP group than in the PPTP group at 1 year postoperatively.

Conclusions

Preservation of the pyloric ring provided little or no benefit to short-term outcome or long-term nutritional status among patients who underwent TP.     

Biocompatible heterogeneous porous gel matrix NeuroGelTM promotes regeneration of rat sciatic nerve within tubular silicone prosthesis (experimental study)

Background

The purpose of this study was to investigate the ability of NeuroGel? to promote and enhance the regeneration of rat sciatic nerve within a 10-mm gap using silicone tubular prosthesis, and to evaluate and compare the regeneration outcomes versus autologous grafting.

Methods

The 10-mm gap of rat sciatic nerve was bridged through silicone tubular prosthesis filled with dehydrated NeuroGel?, and NeuroGel? saturated with rat NGF-B (NG30-NGG60, NGgfB30-NGgfB60). To assess the regeneration of the peripheral nerve we utilized three general and most commonly applied methods: electrophysiologic, hystomorphometric, and functional methods.

Results

The average M-wave amplitude (A_MW index), or the intermediary index of the number of regenerated axons, in animal groups NGG60 and NGgfB60 60 days post-op was: 2.44?±?0.57 mV and 1.87?±?0.48 mV. These indices were statistically lower compared to the indices obtained after autologous grafting. The average impulse conduction velocity along motor fibers (V_MF index), or the intermediary index of myelination rate, was: 13.3 mm/ms and 13.3 mm/ms, respectively, statistically equal to indices obtained after autologous grafting. The average density (D) of regenerated fibers (direct numerical indicator in contrast to intermediary A_MW index) in animal groups NGG60 and NGgfB60 was: 4,920?±?178.88 and 5,340?±?150.33 per mm², respectively. These indices were statistically higher versus indices obtained after autologous grafting. Myelination rates of regenerated fibers in animal groups NGG60 and NGgfB60 were 73 and 86 %, respectively. They were also statistically higher. The average sciatic functional index (SFI) in NGG60 and NGgfB60 was: ?25.57?±?3.05 and ?24.124?±?4.8, respectively, which is statistically equal to indices obtained after autologous grafting.

Conclusions

Neurogel? strongly promotes the regeneration of rat sciatic nerve within silicone tubular prosthesis. After bridging a 10-mm gap through silicone prosthesis with Neurogel? or Neurogel? +NGF-B-modified intraluminal space, the myelination rate of regenerated axons of rat sciatic nerve appeared to be higher, and the axon count and functional recovery is similar to results seen with the autografting technique.