Emergency left colon resection with primary anastomosis

Thirteen cases of emergency left colon resection with primary anastomosis are presented. Production of an empty bowel and use of parenteral hyperalimentation, to delay oral intake until healing is evidenced by bowel function, are absolutely necessary, The “elective environment,” assuring primary healing of the left colon anastomosis, consists of several factors: an empty decompressed bowel with adequate lumen, an antibiotic-depressed colon bacterial flora, assured blood supply, healthy bowel wall, and absence of anastomotic tension. The importance of not extraperitonealizing the anastomosis and the danger of long-term drains are emphasized. Read at the meeting of the American Society of Colon and Rectal Surgeons. Orlando, Florida, May 8 to 12, 1977.     

Intraperitoneally applied gentamicin increases collagen content and mechanical stability of colon anastomosis in rats

Background  Anastomotic leakage remains a serious complication in colorectal surgery, and is being caused by a multitude of factors. Recent reports reveal changes of the extracellular matrix as risk factors as well as gentamicin as a potential agent to influence wound healing. This experimental study was initiated to investigate the influence of intraperitoneally applied gentamicin on colonic anastomotic wound healing and in particular on mechanical stability, overall collagen content and collagen type I/III ratio. Materials and methods  Sixty Sprague Dawley rats were randomized to one of two groups. In each animal, a standard transverse colonic end-to-end anastomosis was performed. Immediately postoperative, either 5 ml gentamicin (1 ml/kg bodyweight) or NaCl 0.9% was applied intraperitoneally. On postoperative days 3, 5, and 14, ten of the animals in each group were sacrificed. Measurements of the anastomosis bursting pressure were performed on postoperative days 3 and 5. At each explantation time, the collagen per protein ratio, the collagen types I/III ratio, and both the expression of MMP-2, -9, and Ki67 were analyzed. Results  None of the animals died. None of the rats exhibited clinical evidence of anastomotic leakage. The bursting strength in the gentamicin group was significantly elevated on postoperative day 5. Both the overall collagen content and the collagen type I/III ratio in the gentamicin group were significantly increased 3, 5, and 14 days postoperatively compared to the control group. The expression of MMP-9 was significantly elevated in the gentamicin group both 3 and 5 days postoperatively. In contrast, there were no significant differences in the expression of MMP-9 14 days postoperatively. All investigated samples demonstrated positive staining for MMP-2 and Ki67 without statistically significant differences at any term, respectively. Conclusions  The present data confirm that intraperitoneally applied gentamicin is able to enhance healing and stability of colonic anastomosis due to an increase of both the overall collagen content and collagen type I/III ratio.     

福尔马林对大鼠气管及肺组织的影响

目的 观察暴露于福尔马林环境中大鼠气管、肺组织的光、电镜形态学改变,为研究福尔马林对呼吸系统的损伤提供理论基础.方法 12只雄性SD大鼠随机分成对照组和甲醛暴露组,每组6只,分别饲养在两个100 cm×60 cm×80 cm的自制透明福尔马林吸入箱内.对照组大鼠的自制吸入箱内放置一个1 000 ml烧杯,加入500 ml蒸馏水.在甲醛暴露组大鼠的烧杯内加入福尔马林500 ml,每天1次,每次12 h,次日倒掉前天剩余液体,重新补充500ml福尔马林.连续吸入25 d后处死大鼠,取气管、肺组织,通过光学显微镜和透射电镜观察其形态学改变.结果 与对照组相比,暴露组大鼠光学显微镜下可见气管及肺均呈轻度水肿及炎性改变,透射电镜下肺泡腔及上皮细胞内出现大量空泡,板层小体结构破坏明显,血管内皮吞饮泡增多及空泡形成.结论 福尔马林可导致大鼠气管及肺组织出现病理改变.     

Experimental studies by the resin-casting method on the vascular structure of the colon following stapler anastomoses

A Russian stapler and an EEA^® stapler were used for end-to-end anastomosis of the canine descending colon. The vascular structures of the anastomotic sites were investigated for postoperative changes at two, three, four, five, and six weeks after anastomosis by using the resin-casting method, with a scanning electron microscope. The two techniques of anastomotic stapling led to the following differences: at two weeks or more following anastomosis, it was found that, compared with the EEA stapler, the site stapled with the Russian device showed a slightly more markedly irregular microvascular pattern of the capillary network in the mucosal membranes along the anastomotic suture line and what were believed to be microulcerations as well. Samples of the Russian stapler at two and three weeks postoperatively showed that the fault zones had developed in the vascular casts of the mucosal capillary system between the area of irregular vasculature and the normal mucosa. It was clearly established, however, that the microvascular channels in the mucosal membrane of the anastomotic site across the orad and anad segments of the colon had already formed after two weeks with both of the stapling techniques. New microvessels grew within a range of about 10μ in diameter from the cut-off surface of the mucosa and united. No necrotic destruction of tissue or deficiency findings had manifested themselves in the inverted cuff zone of the anastomotic site, and the staple had been enveloped by the blood vessels of the submucosal layer and embedded in the intestinal wall during the period of two to six weeks. New microvessels, 10 to 15μ in diameter, were found to have already formed in the two-week samples, passing vertically across the lumen of the closed eye of the staple, and no differences in vascular structure were detected, depending on the different shapes of staples used. Five to six weeks after the anastomotic surgery, the mucosal membranes in the anastomotic site showed a normal vascular structure with only minute residual indentations.     

白水河并殖吸虫囊蚴透射电镜观察

目的观察白水河并殖吸虫囊蚴的超微形态学特征。方法应用透射电镜(TEM)观察白水河并殖吸虫囊蚴壁和囊内蚴虫。结果囊蚴壁内壁是由电子密度较低而均匀的物质构成,未见细胞和微管道结构,厚度为13.1μm,囊壁和囊内蚴虫之间有一定空隙;囊内蚴虫的体被由外皮层、肌层、皮层细胞组成,外皮层为一合体层,包括外质膜、基质、基质膜,外皮层表面呈指状突起,皮层基质内有皮棘,其根部位于基质膜,顶端被外质膜覆盖。结论通过透射电镜观察,白水河并殖吸虫囊蚴壁和囊内蚴虫的体被结构与其它几种并殖吸虫有相同点也有差异性。     

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.     

Effect of parenteral zinc sulfate on colon anastomosis repair in the rat

BACKGROUND AND AIMS: To prevent colonic anastomotic dehiscence, pharmaceutical interventions should inhibit degradation of existing submucosal collagen fibers and accelerate the synthesis of new collagen molecules. Zinc has multiple functions in collagen metabolism and was recently found beneficial in colonic anastomosis repair. We have investigated the effect of daily intraperitoneal zinc (2 mg/kg) injections on the development of the biomechanical integrity of left colon anastomoses. MATERIALS AND METHODS: Sixty Sprague-Dawley male rats (median 245 g) were allocated to treatment with zinc sulfate in saline (n = 30) or with saline alone (n = 30) starting 1 h before the anastomoses were made. Serum zinc levels and anastomotic breaking strength were determined on postoperative days 3 (n = 30) and 7 (n = 30). The initial breaking strength or suture-binding capacity was determined in additional ten non-treated animals (277 g). RESULTS: The breaking strength of the anastomoses decreased in the two groups combined (n = 30) by 50% (p < 0.001) on day 3 but was regained by postoperative day 7 compared with the initial anastomotic biomechanical strength. Serum zinc levels also increased from day 3 to day 7 in both intervention groups and correlated significantly with breaking strength (r = 0.57, p < 0.001). Although the median serum zinc level was 14% higher (p < 0.01) on day 7 in zinc-treated than in saline-treated animals, the breaking strength did not differ significantly between zinc-treated and saline-treated rats on either day 3 (p = 0.95) or day 7 (p = 0.70). CONCLUSION: In contrast to previous report in rabbits, we failed to demonstrate the beneficial effects of parenteral zinc supplementation on colon anastomosis repair in a rat model.     

Genetics study and transmission electron microscopy of pili in susceptible and resistant clinical isolates of Mycobacterium tuberculosis

ObjectiveTo study genetic bases and morphology of pili in Mycobacterium tuberculosis (M. tuberculosis).MethodsPCR and sequencing were used to investigate two related pili, Mtp and Flp genes in clinical isolates of M. tuberculosis. The primers were designed and PCR program were set for whole genes amplification. PCR products of the two genes from all isolates were sequenced by an applied biosystems apparatus and the results were analysed by online software. In the other hands, harvested cells from fresh cultures of isolates were undergoing specific sample preparation for sectional and negative staining for transmission electron microscopy.ResultsElectrophoresis revealed two specific bonds of 361 bp for Mtp and 150 bp for Flp genes and confirmed primer and PCR conditions designing. There were not any mutations in sequencing results of Mtp and Flp in comparison with reference sequence. Transmission electron microscopy examination revealed two distinct types of pili in the isolates as a bundle-forming pilus and rope-like pilus. From total investigated cells, 10% harbored pili in their structure.ConclusionsTwo genes of pili in all clinical isolates of M. tuberculosis were conserved and two morphological types of pili were detected. We proposed that by targeting pili proteins by a suitable inhibitor, it could affect the pathogenesis especially in resistant forms.     

Effects of antiadhesive agents on the healing of intestinal anastomosis

PURPOSE: The effects of antiadhesive agents on the healing of intestinal anastomosis were investigated. METHODS: Eighty rats were divided into eight groups. Colotomy and anastomosis were performed to all rats. Saline solution (control), carboxymethylcellulose, aprotinin, verapamil, tenoxicam, cyclosporine, and dextran 70 were administered intraperitoneally. Vitamin E was administered intramuscularly. The rats were killed 15 days later. Anastomotic healing was assessed by bursting pressure and the hydroxyproline content of the anastomotic tissues. The results were evaluated by Mann-WhitneyU test. RESULTS: The mean (± standard deviation) bursting pressures of carboxymethylcellulose, cyclosporine, and aprotinin groups (108 ± 6.73, 122.5 ± 14.39, and 127 ± 20.23, respectively) were significantly lower than those of the control group (234 ± 6.19). The mean level of hydroxyproline in the anastomotic tissues was significantly lower in the carboxymethylcellulose and cyclosporine groups (8.92 ± 0.6 and 8.32 ± 0.63) than that in the control group (16.33 ± 0.68). CONCLUSION: These findings indicate that carboxymethylcellulose and cyclosporine had adverse effects on intestinal anastomosis in rats.Presented at the Turkish Surgical Congress 98, zmir, Turkey, May 6 to 10, 1998.     

Comparative studies on the ultrastructure of malignant melanoma in fish and human by freeze-etching and transmission electron microscopy

Summary Malignant melanomas (MM) in the fish Xiphophorus and in humans were studied both by transmission electron microscopy (TEM) and freeze-etching (FE). In both fish and human melanomas the cells show interdigitations of the plasma membranes. The nuclei are large and lobulated and have many nuclear pores. Melanosomes are abundant and melanosome complexes (compound melanosomes) occur regularly. Pinocytotic vesicles could be demonstrated in fish and human melanomas showing local differences in frequency and distribution patterns in the tumor. Intercellular junctions are lacking in MM cells from fish and humans. The FE technique showed considerable avantages in demonstrating membrane-surface peculiarities such as nuclear pores or pinocytotic vesicles. The FE replicas of fish melanomas are like those of humans. These findings may support the hypothesis that melanoma in fish and humans reflect the same biological phenomenon.     

Single-layer anastomosis of the colon and rectum

A total of 116 one-layer end-to-end anastomoses of the colon and the rectum in 112 patients were studied. Three patients died postoperatively (2.6 per cent). Significant disruption of anastomosis requiring a diverting colostomy occurred in five patients. The study is presented to draw attention to the safety of the single-layer anastomosis.     

Role of the antiangiogenetic drug paclitaxel on healing of intestinal anastomosis: an experimental study

Background The aim of intraperitoneal administration of antineoplastic agents is the prevention of the implantation of tumoral cells after surgical intervention or the treatment of peritoneal carcinomatosis. The efficiency of intraperitoneal administration of paclitaxel, which is also an antiangiogenetic agent, has been investigated recently. The aim of this experimental study was to evaluate, taking into consideration its antiangiogenetic properties, the effects of intraperitoneal paclitaxel on healing of end to end colonic anastomosis. Methods 42 rats were allocated to 2 main groups (n = 21 for each group) to be evaluated on postperative day 3 (group A) and postoperative day 7 (group B). Each of the two main groups was divided into 3 subgroups (7 rats each). These subgroups were determined as control and two treatment groups administered paclitaxel in a dose of 2.5 mg/kg and 3.5 mg/kg intraperitoneally. Anastomosed segments of colon were harvested on postoperative day 3 or 7 and evaluated to determine bursting pressure of anastomoses, hydroxyproline levels and neovascularization with CD–31. Results In both groups, there were no significant differences between control and paclitaxel–treated groups with respect to bursting pressure. The level of hydroxyproline showed a significant decrease in all paclitaxel–treated groups compared with control groups (p = 0.001). Neovascularization was found to be decreased significantly on day 3 in the doses of paclitaxel 2.5 mg/kg (6.4 ± 1.63) and 3.5 mg/kg (5.89 ± 1.01) compared with control (8.02 ± 0.88) (p = 0.029 and p = 0.005, respectively). There were no significant differences in neovascularization in either groups on postoperative day 7. Conclusion We suggest that intraperitoneal administration of paclitaxel during surgical procedure decreases the hydroxyproline content and neovessel formation that are necessary for healing of intestinal anastomosis.     

Ultrastructural alterations in adult Schistosoma mansoni, harbored in non-antihelminthic treated and low-inflammatory mice by transmission electron microscopy (TEM)

This original study suggests that alterations observed on tegumental structure and egg quality of adult Schistosoma mansoni harvested from TS mice are due to their high immune tolerogenic and low-inflammatory capacity. The tegument of worms harvested from genetically selected mice for extreme phenotypes of immune oral tolerance, resistance (TR) and susceptibility (TS) were analyzed by transmission electron microscopy (TEM). Parasites recovered from TR mice showed no tegumental morphological changes. However, specimens collected from TS mice exhibited tubercle swelling with blunted and shortened spines in lower density. These tegumental alterations were similar to those described with artemether or praziquantel treatment, but without to affecting the worm surveillance, supporting observations that the host immune system influences the development and function of the tegument of worms harbored in non-antihelminthic treated TS mice. TS mice showed a higher percentage of dead eggs and a lower percentage of immature eggs than TR mice, but had similar quantities of collected eggs. This suggests that in TS mice the alterations in adult worm tegument prevented egg development, but not egg production or worm survival. These results corroborate our previous scanning electron microscopy (SEM) study indicating the influence of the host immune regulatory profile on the development and function of the worm's reproductive system and tegument.     

Effects of recombinant human growth hormone and nandrolone phenylpropionate on the healing of ischemie colon anastomosis in rats

Purpose Recombinant human growth hormone and nandrolone phenylpropionate are two different anabolic agents. This study was designed to investigate the effects of these anabolic agents on the healing of ischemie colon anastomosis in rats. METHODS: Seventy adult male Wistar rats were divided into five groups (n = 14). Group I was the sham laparotomy group. In the other groups, surgical procedures consisting of transsection and anastomosis were made at a distance 3 cm from the peritoneal reflection. Group II was the nonischemic control group. Ischemie colon model was produced in the remaining groups. Group III was the untreated control group. Groups IV and V received recombinant human growth hormone and nandrolone phenylpropionate, respectively. Bursting pressure and hydroxyproline levels were measured on the third and seventh postoperative days to evaluate anastomotic healing. RESULTS: Recombinant human growth hormone increased both collagen deposition and bursting pressure significantly at postoperative Days 3 and 7 compared with the sham and untreated control groups (P < 0.005). When compared with the untreated control, nandrolone phenylpropionate significantly increased collagen deposition at postoperative Days 3 and 7 (P < 0.005) and bursting pressure only at postoperative Day 3 (P < 0.005). CONCLUSIONS: Recombinant human growth hormone has more favorable therapeutic effects on the healing of ischemie colonie anastomoses than nandrolone phenylpropionate. Recombinant human growth hormone also improves healing of nonischemic colonie anastomosis.     

Mechanical behavior of colonic anastomosis in experimental settings as a measure of wound repair and tissue integrity

INTRODUCTION Investigating wound healing and attempting to improve its outcome necessitates process quantification[1]. Parameters for anastomotic repair and adhesion formation[2] may be mechanical, biochemical, or histological. Histology is not a primary …     

Early experience of the compression anastomosis ring (CAR~(TM) 27) in left-sided colon resection

AIM:To evaluate clinical validity of the compression anastomosis ring(CARTM27) anastomosis in left-sided colonic resection. METHODS:A non-randomized prospective data collection was performed for patients undergoing an elective left-sided colon resection,followed by an anastomosis using the CARTM27 between November 2009 and January 2011.Eligibility criteria of the use of the CARTM27 were anastomoses between the colon and at or above the intraperitoneal rectum.The primary short-term clinical endpoint,rate of ...     

Application of electron microscopy in gastroenterology

Electron microscopy has long been used in research in the fields of life sciences and materials sciences. Transmission and scanning electron microscopy and energy-dispersive X-ray spectroscopy (EDX) analyses have also been performed in the field of gastroenterology. Electron microscopy and EDX enable (1) Observation of ultrastructural differences in esophageal epithelial cells in patients with gastroesophageal reflux and eosinophilic esophagitis; (2) Detection of lanthanum deposition in the stomach and duodenum; (3) Ultrastructural and elemental analyses of enteroliths and bezoars; (4) Detection and characterization of microorganisms in the gastrointestinal tract; (5) Diagnosis of gastrointestinal tumors with neuroendocrine differentiation; and (6) Analysis of gold nanoparticles potentially used in endoscopic photodynamic therapy. This review aims to foster a better understanding of electron microscopy applications by reviewing relevant clinical studies, basic research findings, and the state of current research carried out in gastroenterology science.     

Measurement of amyloid fibril mass-per-length by tilted-beam transmission electron microscopy

We demonstrate that accurate values of mass-per-length (MPL), which serve as strong constraints on molecular structure, can be determined for amyloid fibrils by quantification of intensities in dark-field electron microscope images obtained in the tilted-beam mode of a transmission electron microscope. MPL values for fibrils formed by residues 218–289 of the HET-s fungal prion protein, for 2-fold- and 3-fold-symmetric fibrils formed by the 40-residue β-amyloid peptide, and for fibrils formed by the yeast prion protein Sup35NM are in good agreement with previous results from scanning transmission electron microscopy. Results for fibrils formed by the yeast prion protein Rnq1, for which the MPL value has not been previously reported, support an in-register parallel β-sheet structure, with one Rnq1 molecule per 0.47-nm β-sheet repeat spacing. Since tilted-beam dark-field images can be obtained on many transmission electron microscopes, this work should facilitate MPL determination by a large number of research groups engaged in studies of amyloid fibrils and similar supramolecular assemblies.     

Ultrastructural evidence of intercalated disc remodelling in arrhythmogenic right ventricular cardiomyopathy: an electron microscopy investigation on endomyocardial biopsies.

AIMS: The ultrastructural features of the myocardium in arrhythmogenic right ventricular cardiomyopathy (ARVC) have not been systematically investigated so far. The recent discovery of gene mutations encoding intercalated disc proteins prompted us to perform a transmission electron microscopy study on endomyocardial biopsies. METHODS AND RESULTS: Twenty-one ARVC probands who fulfilled the international Task Force diagnostic criteria underwent right ventricular endomyocardial biopsy and screening of desmosome (D) protein encoding genes. Myocyte intercalated discs were analysed by transmission electron microscope and the data were compared with those of 10 controls and 10 patients with idiopathic dilated cardiomyopathy. Extensive fibro-fatty replacement with a residual myocardium of 59+/-23% was found in ARVC biopsy samples. Pathogenic D gene mutations were identified in 10 (48%): desmoglein-2 in four, desmoplakin in three and plakophilin-2 in three. Mean D length and D percent length of intercalated disc were significantly higher, D number was significantly lower and D gap was widened in ARVC. Moreover, abnormally located D in 75%, abnormal small junctions in 52%, and pale internal plaques in 32% of ARVC patients were found in the presence of a normal intercalated disc convolution index. CONCLUSION: The ultrastructural evidence of intercalated discs remodelling in ARVC, together with the positive screening of D protein encoding genes in half of probands, are in keeping with an intercellular junction cardiomyopathy.     

嗜卷书虱雌性成虫外部形态扫描电镜观察

目的了解嗜卷书虱(Liposcelis bostrychophila)雌性成虫外部形态结构。方法采用直接镜检法(directicopy)从黄芪(Radix Astragali)饮片中分离嗜卷书虱,用生理盐水温和洗涤,用2.5%戊二醛固定,临界点干燥后采用扫描电镜观察。结果电镜观察雌性嗜卷书虱成虫长约1 000~1 300μm,头部较大,有1对咀嚼口器;有复眼1对,分别由7个小眼组成;有触角1对,由1节柄节(scape SC)、1节梗节(pedicel PE)和13节螺纹样鞭节(flagellomeres FL)组成;背板和胸板狭窄,各1对;腹部较大,分节状;足3对,且第3足腿节扁平膨大。结论扫描电镜观察嗜卷书虱复眼小眼数7个,SI毛短小,同周围小毛的长度相当;无PNS毛等结构,为其分类和生态学研究奠定了基础。