Vascular anastomosis techniques in renal transplants

In our series of 250 RT's 192 (76.8%) from living donors and 58 (23.27%) from cadaver donors, there were 207 (88.8%) kidneys with a single renal artery, 40 (16%) with a double artery and 3 (1.2%) with a triple artery. End to side anastomosis to common iliac vessels was the most frequently used technique for kidneys with a single renal artery (52%). Extracorporeal renal surgery was performed on 83.7% of kidneys with multiple arteries. There were 32 (12.8%) complications with 6 (2.4%) unsuccessful RT's due to technical reasons. The actuarial survival of patients and grafts after 5 years from live donors was 87% and 69% and from cadaver donors was 78% and 46%, respectively.     

Vascular evolution of single-layer end-on colonic anastomosis

One hundred eighty left colonic single-layer end-on anastomoses performed on 90 rats by microsurgical techniques, using polydioxanone monofilament absorbable sutures, were examined histopathologically and microangiographically at nine different times, from two to 180 days. There was no anastomotic leakage. The vascular state after suturing and the evolution of the neovascularization are described. The neovascularization appeared to follow the same process of evolution as tissue restoration. It began early, was greatest on the seventh day, and diminished thereafter. When granulation tissue was narrow, the anastomoses were barely hypervascular, the neovascularization assured by submucosal plexus. A voluminous granulation tissue was hypervascular, had a slower evolution, and neovascularization was then assured above all by the peritoneal formations adherent to the suture.     

Experimental laser anastomosis of the colon

PURPOSE: Our previous experimental work showed the feasibility of colon anastomosis using laser; however, it also revealed a narrowing tendency after laser anastomosis. Long-term observation of the postoperative course of laser anastomosis was planned to assess this point. METHODS: Clinical observation and histologic examination of transverse colotomies (average, 21.2 mm) in New Zealand white rabbits (n=12) closed with a 1,064-nm neodymiumyttrium aluminum garnet (Nd:YAG) laser were carried out up to the third postoperative month, compared with closure of colotomies using a single layer of interrupted sutures of 5-0 Maxon^® (Davis & Geck, Pearl River, NY) in a control group (n=12). RESULTS: Whereas the narrowing tendency was observed up to one month after the operation in the laser group (P<0.05), it disappeared at three months following the operation without causing abnormal weight loss during the experiment. Simultaneously, there was again a marked decrease in adhesion formation following laser anastomosis (P<0.01). Collagen fibers were observed earlier in the laser group. CONCLUSIONS: An earlier commencement of collagen synthesis after laser anastomosis was proved. A narrowing tendency, which was observed from seven days to one month postoperatively, disappeared at three months after laser anastomosis without exerting any effect on growth.Supported from private sources (Colorectal Service), by the Colorectal Unit Research Fund, and by a St. Vincent's Hospital Research Grant.     

Restoration of the normal squamous lining in Barrett's esophagus by argon beam plasma coagulation

Objective: Barrett's esophagus is associated with significantly increased risk of development of esophageal adenocarcinoma. Replacing columnar epithelium with the normal squamous lining in this condition offers the possibility of decreasing the risk of degeneration to invasive adenocarcinoma. This study aimed to establish the feasibility of argon beam plasma coagulation (ABPC), in conjunction with control of gastroesophageal reflux, to restore the squamous lining.
Methods: Thirty patients with Barrett's esophagus (four low-grade dysplasia, three high-grade) were recruited from our surveillance program, and underwent endoscopic ABPC.
Results: Twenty-seven patients completed treatment, with macroscopic replacement of their columnar lining by squamous epithelium, histologically confirmed in all 27, and followed up for a median of 9 months (range, 6–18 months). Two patterns of squamous replacement were identified: 70% of patients showed squamous epithelium with no persistent intestinal metaplasia, and in 30% the new squamous epithelium covered areas of underlying intestinal metaplasia. One patient has withdrawn from the study. Two esophageal perforations, with one death, occurred early in the study.
Conclusion: ABPC, in conjunction with control of gastroesophageal reflux, allows squamous regrowth in both benign and dysplastic Barrett's esophagus. Despite the theoretical safety advantages of ABPC over techniques such as laser, esophageal perforation may occur with this technique. It is too soon to recommend ABPC for dysplastic or nondysplastic Barrett's because follow-up is too short to show a decreased incidence of and mortality from adenocarcinoma.     

Histopathological diagnosis of endobronchial endometriosis treated with argon laser

The authors present a case of endobronchial endometriosis with catamenial haemoptysis. The lesion was diagnosed as endobronchial endometriosis based on histopathological examination of a bronchial biopsy from the right second carina. Fibreoptic bronchoscopic examination revealed a tiny hyperaemic submucosal area with bleeding and a brown-coloured diverticulum at bottom of this lesion encompassing a 2-cm2 area at the right second carina. Multiplanar reconstructions of a spiral CT scan revealed a 0.5-cm lesion that looked like a diverticulum at the right second carina. The patient was treated with argon laser at bronchoscopy. Following treatment, the patient has been asymptomatic with no recurrence of haemoptysis.     

Intraoperative mapping-guided argon laser ablation of malignant ventricular tachycardia

Intraoperative mapping-guided laser ablation of arrhythmogenic myocardium was performed in 5 patients with refractory sustained ventricular tachycardia (VT). Using a 15-W argon laser coupled to a 300-mu optical fiber, a bloodless laser ventriculotomy was successfully performed in 4 patients with VT. Visually- and mapping-guided endocardial ablation of 7 VT morphologic patterns was performed. Five of the 7 sites of VT origin were unresectable using standard resection techniques. Postoperatively, spontaneous and inducible VT was suppressed in all patients (without antiarrhythmic drugs in 4 patients and with a previously ineffective drug 1 patient). Mean pulmonary capillary wedge pressure, cardiac index and left ventricular ejection fraction were unchanged (p greater than 0.2) from preoperative values. Mean maximal creatinine kinase-MB isoenzyme concentration was 139 +/- 75 IU. All patients were New York Heart Association functional class II at discharge. During follow-up, no spontaneous arrhythmia has recurred in any patient. Thus, intraoperative argon laser ablation is effective for VT ablation alone or in conjunction with standard surgical resection techniques.     

Treatment outcomes of modified argon laser photocoagulation for conjunctivochalasis

To determine the effectiveness of conjunctivoplasty using a modified argon laser photocoagulation method on patients with conjunctivochalasis (CCh). This study included 25 cases of symptomatic inferior CCh. After staining the surface of a redundant conjunctiva using a dark-purple marker, low-energy argon laser photocoagulation (500 μm spot size for 0.5 seconds at power 300 mW) was applied under topical anesthesia for a mean of 80 times. The patients were aged 67.6 ± 7.1 years (mean ± standard deviation). During a mean follow-up period of 7.8 months (range of 6–12 months), the CCh grades of 21 eyes (84%) decreased after laser conjunctivoplasty. Calculated reduction rates of grades 1, 2, and 3 were 90%, 75%, and 67%, respectively. Patient subjective symptoms were improved in 80% of cases. No postoperative complications such as conjunctival scarring or persistent ocular irritation were observed. Our modified argon laser photocoagulation method employs staining the conjunctival surface to increase the thermal laser energy absorbed by the target. This novel technique is simple and effective for treating mild-to-moderate-grade CCh in outpatient clinics.     

Vascular reactions to laser in vivo

Platelet aggregates form in arterial vessels following exposure of the vessels to a single pulse ruby-red laser beam. Usually, a small cluster of red blood cells occupies the center of the aggregate. It appears that endothelial damage is not required for the platelet aggregation, but that platelet activity is initiated by rupture of red blood cells, possibly through the release of ADP from the injured red cells. Also, no shape change is noted in platelets that adhere to the vessel wall or to each other.     

氩激光治疗糖尿病视网膜病变黄斑水肿

目的观察氩激光治疗糖尿病视网膜病变黄斑水肿的临床疗效。方法对274例（364只眼）糖尿病视网膜病变黄斑水肿患者,首选激光治疗,根椐病变性质对其黄斑区周围行氩激光光凝术。术后3m检查视力、OCT、FFA。结果术后3m显效165只眼（45．18％）,有效164只眼（45．05％）无效35只眼（9．61％）。黄斑水肿完全消退170只眼（46．70％）,部分消退159只眼（43．68％）,总有效率为90．38％。结论氩激光治疗早期糖尿病视网膜病变黄斑水肿效果较好。     

First experimental sutureless laser anastomosis of the large bowel

Large bowel anastomoses were successfully performed without sutures on New Zealand white rabbits using 1,064 nm, 0.4-W power pulsating Nd:YAG laser to create tissue welding. PURPOSE: The aim of this study was to assess long-term results of our experimental data and summarize our experimental work on laser colon anastomosis. METHODS: This experimental study investigated long-term integrity, degree of narrowing, animal body weight change, visual findings, microscopic appearance, and collagen concentration of laser colon anastomoses, compared with those of conventional sutured anastomoses at thirty and ninety postoperative days. RESULTS: Two animals in the laser group died without leakage. Postsurgical course in all remaining rabbits studied was uneventful. Bursting pressures in the two groups were equivalent, but the laser group exhibited a consistent narrowing tendency. However, laser anastomoses demonstrated fewer and milder adhesions, and animals showed a better recovery of body weight. Histologically, laser anastomoses showed better layer-to-layer reconstitution without foreign body response and with less fibrosis. Difference in collagen (hydroxyproline) concentration did not reach statistical significance. CONCLUSION: The nature of tissue welding via laser remains undefined, but there is definitely a future for laser bowel anastomosis.     

Nature and extent of histological changes induced by argon laser photocoagulation in canine gastric mucosa.

The tissue changes in canine gastric mucosa caused by exposure to an argon laser beam vary from mild mucosal oedema to complete cell destruction. Intermediate degrees of damage cause an inflammatory cell response with the formation of granulation tissue, particularly in the submucosa. The rate of healing is similar to that after other forms of injury to the gastric mucosa. Cell destruction at the surface of the mucosa starts with energies greater than 8 Joules on any one spot, and occurs at greater depths as the energy is increased but, unless cells are actually destroyed, the extent of histological damage is limited to a zone 1 mm lateral to, or below, the area exposed to the laser beam. Haemostasis is achieved by thermal contraction of bleeding vessels and of the surrounding tissue, thrombosis only occurring as a secondary effect.     

Personal experiences with the use of the argon laser in gastroenterology

The argon laser was used in 30 persons with various lesions of the alimentary canal. Of 17 patients with an intensive haemorrhage (gastric or duodenal ulcer, gastric erosions, haemorrhage after an endoscopic polypectomy) the treatment was successful in 15 cases. In 8 patients the basis of an endoscopically removed malignant rectosigmoid polyp was treated: in one case a recidivation developed, in the remaining 7 cases during the following 13 to 24 months no local recidivation was to be observed. Of the 4 patients with an obturating carcinoma (oesophagus, rectum) we were only once successful in removing the tumour masses and thus again rendering possible the passage. In the last patient in question a recidivation of a rectum carcinoma in the anastomosis was concerned, in which the prominuing tumour mass could be removed; after 20 months no other recidivation could be established.     

Esophago-bronchial fistula treated by the Over-The-Scope-Clipping (OTSC) system with argon beam electrocoagulation: A case report

Rationale:An esophago-bronchial fistula is one of the rare postoperative complications of esophageal cancer. There are various medical treatments, including suturing, endoscopic clip, and fibrin glue. However, these treatments often lead to unsatisfactory results, causing physicians to opt for surgical alternatives. The Over-The-Scope-Clipping (OTSC) system offers an alternative method for fistula closure. It can capture a large amount of tissue and is able to compress the lesion until it has fully healed. However, data indicating the efficacy of OTSC for esophago-bronchial fistula are limited.Patient concerns:A 64-year-old man presented with an esophago-bronchial fistula after surgery for esophageal cancer. We chose to use a stent as the first line of treatment, but the fistula did not close.Diagnoses:Intractable esophago-bronchial fistula associated with esophageal surgery.Interventions and Outcomes:On the 94th postoperative day, fistula closure with OTSC was performed, and no leakage of the contrast agent was observed during fluoroscopy. We also attempted to close the fistula by combining OTSC and argon plasma coagulation (APC) to burn off the scar tissue from around the fistula. The fistula gradually shrank after a total of 4 rounds of OTSC, and closure of the fistula was achieved on the 185th postoperative day. There were no adverse events during the treatment of this case.Lessons:We demonstrate that OTSC is useful in the management of esophago-bronchial fistulas, and may become a standard procedure for the endoscopic treatment of esophago-bronchial fistulas, replacing the use of stents, clips, or glue.     

Curative ablation of a polypoid oesophageal spindle cell carcinoma with argon beam diathermy

We present the successful management of dysphagia in a 90-year-old woman by argon beam diathermy. Symptoms were caused by a rare polypoid oesophageal spindle cell carcinoma. Long-term symptom relief was achieved and confirmed by post-procedural oesophago-gastroduodenoscopy and endoscopic ultrasound scan.     

First experimental sutureless end-to-end laser anastomosis of the large bowel

Completely sutureless end-to-end large bowel anastomoses were successfully created in New Zealand white rabbits (n = 26) by using a low-energy (0.4-W wave of power) Nd:YAG laser to produce welded anastomoses. In this study, the short-term integrity, degree of narrowing, macroscopic appearance, and microscopic findings were compared with those of the conventional interrupted onelayer anastomosis (n = 24) at zero, one, four, and seven days after surgery. Two rabbits in the laser group died from leakage. All remaining animals had an uneventful postoperative course. The bursting pressures in the laser group at zero, one, and four days were lower than those in the control group. The narrowing index of the laser anastomosis was higher than that of the suture anastomosis at four and seven days. However, the laser anastomoses showed fewer adhesions, no instances of bowel obstruction, and histologic healing with less fibrosis. The technique of laser anastomosis presents a promising alternative to suturing in reconstitution of the large bowel.     

Colorectal anastomosis by invagination

Summary A case of rectal perforation with several interesting features has been presented. After radical left colectomy, a stricture developed at the colorectal anastomosis. Dilatation by means of a sigmoidoscope caused perforation. An inflammatory mass developed at the colorectal anastomosis. Resection of this area had to be limited owing to the extent of previous surgery, and a satisfactory end-to-end anastomosis could not be performed. Therefore, colorectal anastomosis by invagination was performed and, subsequently, satisfactory healing without stricture occurred.