Influence of Preoperative Feeding on the Healing of Colonic Anastomoses in Malnourished Rats

Background: Malnutrition influences healing of gastrointestinal anastomoses. The authors hypothesize that colonic anastomotic healing is decreased by malnutrition and might be improved by preoperative feeding. Methods: Eighty adult male Wistar rats were divided into 4 groups: (1) control rats 1 (C1), fed regular chow ad libitum for 21 days; (2) malnourished pair‐fed rats (M), fed 50% of the food ingested by the control rats for 21 days; (3) preoperative nutrition rats (PRE), fed 50% of the average of the controls for 21 days and then fed preoperative nutrition with regular chow ad libitum for 1 week before the operation; and (4) control rats 2 (C2), fed regular chow ad libitum for 28 days. On days 21 (C1 and M) and 28 (PRE and C2), rats underwent 2 colonic transections and, subsequently, 2 end‐to‐end anastomoses. Rats were killed on postoperative day 5. The anastomoses were ressected for tensile strength and histological analysis. Results: PRE rats showed increased maximal tensile strength vs the M group (0.09 ± 0.01 vs 0.15 ± 0.01; P < .05) and similar values of maximal tensile strength as the controls (0.15 ± 0.01 vs 0.15 ± 0.02; P = .91). Collagen type I was higher in controls vs the PRE group (6.13 ± 0.39 vs 4.90 ± 1.53; P < .05); nevertheless, the PRE group showed higher collagen type I than M rats (4.90 ± 0.36 vs 3.83 ± 0.35; P < .05). Conclusions: Preoperative feeding for 7 days increases the maximal tensile strength, as well as the percentage area of mature collagen, approaching similar values as the control group.     

PTK787在SCID小鼠-人AML模型中的抗骨髓血管生成作用研究

目的 观察酪氨酸激酶抑制剂PTK787在SCID小鼠-人急性髓系白血病模型中对血血管内皮生长因子受体-2mRNA (VEGFR-2mRNA)、外周血CD33阳性表达率以及骨髓微血管密度的影响,探讨PTK787抗急性髓系白血病的作用机制.方法 (1) 采用RT-PCR法分析30例不同组别之间SCID小鼠VEGFR-2mRNA水平的差异.(2) 利用流式细胞仪检测外周血CD33表达.(3) 采用SP免疫组化法,用兔抗人vWF (von Wille-brand factor)多克隆抗体标记骨髓内皮细胞,比较不同组别小鼠之间的骨髓微血管密度(MVD)的差异.结果 (1) 患病组SCID小鼠外周血VEGFR-2mRNA灰度扫描比为(0.3257±0.0709),高于正常组(0.0826±0.0315) (P<0.05),治疗组为(0.1411±0.0404),与正常组比较(P<0.05).(2) 外周血白细胞CD33的阳性率,治疗组(9.41±1.35%)及患病组(15.08±2.90%)与正常组(0.81±0.11%)比较,P值均<0.01,差异有统计学意义;治疗组与患病组比较,P<0.05,差异有统计学意义.(3) 患病组SCID小鼠中骨髓微血管数为(20.4±3.2)个/HP,显著高于正常组(14.2±2.1)个/HP(P<0.001),治疗组为(15.6±2.4)个/HP,与正常组相似(P>0.05).结论 PTK787在体内可以有效的抑制血管生成,一定程度具有抗白血病细胞增生的作用.     

Microvascular reconstructions in oral and maxillofacial surgery — Results of a survey among oral and maxillofacial surgeons in Germany,Austria, and Switzerland

This study aimed to evaluate the use of microvascular free flaps (MFF) in oral and maxillofacial surgery (OMFS) in Germany, Austria, and Switzerland.A dynamic online questionnaire, using 42–46 questions, was sent to OMF surgeons based in hospitals in Germany, Austria, and Switzerland. The questionnaire was evaluated internally and externally. Aside from general information, data were collected on organizational aspects, approaches, MFF types and frequency, presurgical planning, intraoperative procedures, perioperative medications, flap monitoring, and patient management.Participants mostly performed 30–40 MFF each year (11/53). Most stated that the COVID-19 pandemic did influence MFF frequency (25/53) to varying extents. Radial forearm flap was most frequently used (37/53), followed by ALT (5/53), and fibula flap (5/53). Primary reconstruction was performed by most participants (35/48). Irradiated bony transplants were mostly used for implant placement after 12 months (23/48). Most participants (38/48) used reconstruction plates, followed by miniplates (36/48), PSI reconstruction (31/48), and PSI miniplates (10/48). Regarding the postoperative use of anticoagulants, low-molecular-weight (37/48) and unfractioned heparins (15/48) were widely used, most often for 3–7 days (26/48). Clinical evaluation was mostly preferred for flap monitoring (47/48), usually every 2 h (34/48), for at least 48 h (19/48).Strong heterogeneity in MFF reconstructions in OMFS was found, especially regarding the timepoints of reconstruction, types of osteosynthesis, and postoperative MFF management. These findings provide the chance to further compare the different treatment algorithms regarding relevant MFF aspects, such as postoperative management. This could create evidence-based treatment algorithms that will further improve the clinical outcomes in MFF reconstructions.     

Early use of microvascular free tissue transfer in the management of electrical injuries

High-tension electricity can cause devastating injuries which may result in major soft-tissue loss, limb loss and sometimes major threat to life. Deep structures may be exposed and require flap cover, but microvascular flap transfer in electrical burn has a comparatively high-failure rate. This article aims to evaluate the outcome of early reconstruction of such injuries using free tissue transfer. In the course of 3 years (2004-2006), 16 free tissue transfers were performed in 13 cases of electrical injury from 24h to 3 weeks after trauma. All flaps survived except one. The failure was due to vascular erosion and secondary haemorrhage. There was no incident of vascular occlusion. Thus, if wound debridement is meticulous and microvascular anastomosis is performed well away from the trauma site, free flaps should survive as well in electrical burn cases as in any other.     

The “hanging technique” of vascular transposition in microvascular decompression for trigeminal neuralgia: technical report of four cases

The successful long-term outcome of microvascular decompression for trigeminal neuralgia is largely dependent on the maintenance of the isolation between the trigeminal nerve and the offending vessel, avoiding also the development of scar tissue around the nerve. We propose an alternative technique to achieve this target by "hanging" the offending vessel from the overlying tentorium using a strip of autologous tissue without interposing any foreign material.     

Chronologic analysis of symptomatic change following microvascular decompression for hemifacial spasm: value for predicting midterm outcome

The objectives of this study are to categorize the patterns of symptomatic change and to chronologically analyze them. From January 2004 to February 2006, microvascular decompression was performed on 236 consecutive patients. Follow-up time was at least over 1 year (mean, 17.1 months). We categorized the postoperative courses into five different groups according to the similarity of the temporal changes of the residual symptoms. The symptomatic change during each follow-up interval was chronologically analyzed among five different groups. The five improvement patterns included group A (immediate recovery without relapse), group B (temporary relapse followed by cure), group C (slow but steady improvement that leads to cure after one or more months), group D (recurrence with sustained symptoms), and group E (no improvement or improvement to some extent that does not lead to cure). The symptomatic change in the successful groups (groups A, B, and C) differed from that in the unsatisfactory groups (groups D and E), especially during the follow-up interval between postoperative 3 weeks and 3 months (p = 0.014). This finding was true with (p = 0.029) or without (p = 0.015) the relapse curve. Therefore, we can predict the postoperative result as early as 3 months after the surgery. Overall cure rate in this series (93.2%) was nearly correspondent to the estimated cure rate at the first postoperative year (93.4%). Postoperative 3 months can be the most efficient and earliest time to predict the postoperative result.     

微血管减压术治疗三叉神经痛的预后影响因素研究

目的　探讨影响微血管减压术治疗三叉神经痛手术疗效的因素。方法　分析 6 2例经微血管减压术治疗的三叉神经痛患者的临床特征、术中所见和术后疗效。血管对神经根的压迫程度分为单纯接触、接触和移位、单纯粘连、粘连和移位、萎缩五种。手术疗效包括术后疼痛立即缓解、延迟缓解、明显减轻和无效。结果　 6 2例患者起病时均表现为典型三叉神经痛 ,但在术前 17例已经转变为不典型。术中发现压迫血管与三叉神经根之间单纯接触 14例、接触和移位 7例、单纯粘连 15例、粘连和移位 18例、萎缩 8例。术后平均随访 14个月 ,疼痛在术后立即缓解 32例 (5 1 6 % ) ,延迟缓解 17例 (2 7 4 % ) ,明显减轻 11例 (17 7% ) ,无效 2例。结论　病程短、症状典型、以动脉压迫为主且能够充分减压的患者 ,术后多能获得好的疗效。相反 ,以静脉压迫为主 ,病程长及症状不典型的患者 ,术后疗效多不理想     

微血管减压术治疗三叉神经痛182例

目的观察微血管减压术治疗三叉神经痛的疗效和安全性。方法采取微血管减压手术治疗182例患者,对手术入路及血管神经隔离方法进行改良。结果手术早期的总有效率为97.3%,无一例发生脑脊液漏、颅内感染等严重并发症。结论微血管减压术是治疗三叉神经痛的安全、有效方法,手术方法的改良有利于提高手术治疗的有效率和防止并发症生。     

AQPs在宫颈鳞癌癌变过程中的表达及意义

目的研究水通道蛋白(aquaporins,AQPs)在正常宫颈组织、宫颈上皮内瘤样变(CIN)和宫颈鳞癌中的表达,分析其与宫颈鳞癌临床病理资料的相关性,探讨其在宫颈鳞癌病变中的可能作用及意义。方法免疫组化检测47例宫颈鳞癌、37例CIN、16例正常宫颈组织中AQPs的表达及分布。双重免疫组化染色法检测宫颈鳞癌中AQP1与VEGF,AQP3与VEGF,AQP8与VEGF的共同表达与分布。结果①AQP1在3组宫颈组织间质的微血管内皮细胞中表达;②AQP3、AQP4、AQP5和AQP8在正常宫颈鳞状上皮细胞、CIN异形细胞及宫颈鳞癌癌细胞胞质和(或)胞膜中表达;③AQP1在CIN的表达高于正常宫颈组织和宫颈鳞癌(P<0.05),在临床Ⅰ期宫颈鳞癌的表达高于临床Ⅱ期(P<0.05);④AQP3、AQP4、AQP5、AQP8在正常宫颈组织、CIN、宫颈鳞癌的表达逐渐增高;⑤AQP3在低分化组宫颈鳞癌中的表达高于中-高分化组(P<0.05);⑥AQP1和VEGF,AQP3和VEGF,AQP8和VEGF在宫颈鳞癌中共同表达。结论 AQP1、AQP3、AQP4、AQP5和AQP8在宫颈鳞癌癌变过程中起了一定的作用;AQP1、AQP3和AQP8可能参与宫颈鳞癌微血管的形成。     

Microvascular decompression as a surgical management for trigeminal neuralgia: long-term follow-up and review of the literature

This retrospective study summarizes our experience based on treating 62 patients with trigeminal neuralgia treated with microvascular decompression. All patients had typical trigeminal neuralgia symptoms, with 24 of them (38%) having failed to benefit from other previous treatment paradigms. We excluded subjects with atypical and/or secondary forms of trigeminal neuralgia. Follow-up duration ranged from 5 months to 10 years 6 months, with recurrence being identified in three patients (4.8%).We found that the superior cerebellar artery is the leading offending vessel in our cases (33.9%; 21 patients). Interestingly, seven patients (11.3%) underwent an early reoperation 12-48 h later after the first operation was deemed ineffective. This subgroup recovered satisfactorily following isolation of the pathogenic vessels. Overall, no mortality was observed in our patients, and the only permanent morbidity outcome was a case of facial nerve palsy (1.6%). We conclude that microvascular decompression and its reapplicaiton for patients who showed no pain relief immediately after the first decompression are safe and effective treatments for trigeminal neuralgia.