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1.
H. T. Brandsma B. M. E. Hansson T. J Aufenacker D. van Geldere F. M. van Lammeren C. Mahabier P. Steenvoorde T. S. de Vries Reilingh R. J. Wiezer J. H. W. de Wilt R. P. Bleichrodt C. Rosman 《Hernia》2016,20(4):535-541
Purpose
Parastomal hernia (PSH) is a common complication after colostomy formation. Recent studies indicate that mesh implantation during formation of a colostomy might prevent a PSH. To determine if placement of a retromuscular mesh at the colostomy site is a feasible, safe and effective procedure in preventing a parastomal hernia, we performed a multicentre randomized controlled trial in 11 large teaching hospitals and three university centres in The Netherlands.Methods
Augmentation of the abdominal wall with a retromuscular light-weight polypropylene mesh (Parietene Light?, Covidien) around the trephine was compared with traditional colostomy formation. Patients undergoing elective open formation of a permanent end-colostomy were eligible. 150 patients were randomized between 2010 and 2012. Primary endpoint of the PREVENT trial is the incidence of parastomal hernia. Secondary endpoints are morbidity, pain, quality of life, mortality and cost-effectiveness. This article focussed on the early results of the PREVENT trial and, therefore, operation time, postoperative morbidity, pain, and quality of life were measured.Results
Outcomes represent results after 3 months of follow-up. A total of 150 patients were randomized. Mean operation time of the mesh group (N = 72) was significantly longer than in the control group (N = 78) (182.6 vs. 156.8 min; P = 0.018). Four (2.7 %) peristomal infections occurred of which one (1.4 %) in the mesh group. No infection of the mesh occurred. Most of the other infections were infections of the perineal wound, equally distributed over both groups. No statistical differences were discovered in stoma or mesh-related complications, fistula or stricture formation, pain, or quality of life.Conclusions
During open and elective formation of an end-colostomy, primary placement of a retromuscular light-weight polypropylene mesh for prevention of a parastomal hernia is a safe and feasible procedure.The PREVENT trial is registered at: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2018.2.
We provide a new test of the feasibility of using contingent valuation to value informal care. We start with a theoretical model of informal caregiving and derive that willingness to pay depends positively on wealth and negatively on own health, whereas the effect of other's health is sign-ambiguous. These predictions are tested in two new data sets on patients' and caregivers' willingness to pay (WTP) and willingness to accept (WTA) for informal care. The data are generally consistent with the theoretical predictions: wealth generally has a positive impact and own health a negative impact. Other's health has a mixed effect. We find only small differences between WTP and WTA. Our findings suggest that contingent valuation may be a useful technique to value informal care in economic evaluations of health care. 相似文献
3.
Changes in Gelatinase Activity in the Gastrointestinal Tract After Anastomotic Construction in the Ileum or Colon 总被引:1,自引:1,他引:0
de Hingh IH Lomme RM van Goor H Bleichrodt RP Hendriks T 《Diseases of the colon and rectum》2005,48(11):2133-2141
PURPOSE The strength of the uninjured and anastomosed intestinal wall is determined by its submucosal connective tissue. Matrix degradation
by matrix metalloproteinases may result in loss of strength. It is known that anastomotic construction leads to up-regulation
of matrix metalloproteinase activity in the wound area, but no quantitative data are available as to the extent of this effect
throughout the intestinal wall. This study was designed to quantitate changes in gelatinolytic activity in the intestine after
anastomotic construction in the ileum or colon.
METHODS An anastomosis was constructed in the distal ileum or distal colon of rats, and animals were killed after one or three days.
Tissue samples (5 mm) were collected containing the suture line, its adjacent segments (2- × 5-mm in both directions) and
at nine other, more distant, sites throughout the gastrointestinal tract. Similar samples were collected from nonoperated
control rats. All samples were analyzed by quantitative gelatin zymography.
RESULTS In control rats, the most prominent gelatinolytic activities were found at 80 kDa, thought to represent a nonspecific proteolytic
activity, 60 kDa and 50 kDa, representing the proform and active form of matrix metalloproteinase-2, respectively. Activities
were higher in the small bowel than in the large bowel. Anastomotic construction led to massive up-regulation of an activity
at 105 kDa, and its dimer, believed to represent promatrix metalloproteinase-9. Matrix metalloproteinase-2 remained unaffected,
whereas the activity of the 80 kDa protein was significantly (P < 0.05) reduced. Significantly increased matrix metalloproteinase-9 activity was found in the actual anastomotic segments
and in the immediately adjacent tissue. Matrix metalloproteinase-9 activities in the anastomotic segments were highest at
Day 1 in the ileum and at Day 3 in the colon. Anastomotic construction in the ileum or colon did not lead to any significant
changes of any gelatinolytic activity at the more distant sites in the bowel wall.
CONCLUSIONS Up-regulation of gelatinase activity after anastomotic construction in the intestine is caused by matrix metalloproteinase-9.
Because the effect is local and not systemic, unwanted matrix degradation at distant sites seems unlikely.
Supported by the Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Reprints are not available. 相似文献
4.
On the origin of the 70 S component of bacteriophage phi-X174 总被引:1,自引:0,他引:1
5.
Perforation is a serious complication of diverticular disease. The sigmoid is the main affected anatomic site of perforated diverticulitis and sigmoid resection followed either by Hartmann procedure or primary anastomosis are the standard surgical approaches. Surgery, however, does not cure diverticular disease. About 50% of patients have residual diverticula. The morbidity of residual diverticula appears to be low [1]. However, adequate follow-up studies on recurrent diverticulitis after surgery are lacking. We report a rare case of recurrent perforated diverticulitis in the subcutaneous tissue in proximity of the colostomy after a Hartmann procedure for perforated diverticulitis of the sigmoid colon. 相似文献
6.
7.
de Jong GM Aarts F Hendriks T Boerman OC Bleichrodt RP 《The Journal of surgical research》2009,154(1):167-176
Liver metastases of colorectal carcinoma occur in about 50-60% of patients. To improve survival of these patients, there is an urgent need for new treatment strategies. For this purpose, the availability of a preclinical model to develop and test such treatments is mandatory. An ideal animal model for studying liver metastases of colorectal origin should mimic all aspects of the metastatic development in humans and be practical, predictable, and optimal in terms of ethical considerations. Thus far, no model has been developed which satisfies all these conditions. As a consequence, choosing an animal model for the study of liver metastases requires compromises and choices about the necessary characteristics that depend on the purpose of the intended experiments. This overview addresses the advantages and disadvantages of different animal models used for research on experimental liver metastases of colorectal origin. Based on data available in literature, we conclude that heterotopic injection of undifferentiated syngeneic tumor cells in immunocompetent rodents covers most of the desired characteristics. Both subcapsular as well as intraportal injection will yield suitable models and the eventual choice will depend on the aim of the study. 相似文献
8.
L. A. E. Posma R. P. Bleichrodt R. M. L. M. Lomme B. M. de Man H. van Goor T. Hendriks 《Journal of gastrointestinal surgery》2009,13(6):1099-1106
Introduction During bowel surgery, perioperative blood loss and hypotension can lead to transient intestinal ischemia. Recent preclinical
studies reveal that the strength of intestinal anastomoses can be compromised after reperfusion. So far, this phenomenon has
not been investigated in the very first days of healing when wound strength is lowest.
Material and Method Ischemia was induced in rats by clamping both the superior mesenteric artery and ileal branches for 30 min. Immediately after
declamping, anastomoses were constructed in both terminal ileum and descending colon. The same was done in control groups
after sham-ischemia. Anastomotic bursting pressure and breaking strength were measured immediately after operation (day 0)
and after 1, 2, or 3 days. Anastomotic hydroxyproline content, gelatinase activity, and histology were analyzed.
Results and Discussion In ileal anastomoses, at day 1, both the breaking strength and bursting pressure were significantly (p < 0.05) lower in the ischemic group, while at day 2, this was the case for the bursting pressure only. In the colon, the
bursting pressure in the ischemic group was lower at day 1. Anastomotic hydroxyproline content remained unchanged. Increased
presence of the various gelatinase activities was found in ileum only at day 0 and in colon at days 1 and 2. Histological
mucosal damage was found in ischemia–reperfusion groups.
Conclusion Transient mesenteric ischemia can negatively affect anastomotic strength during the very first days of healing, even if the
tissue used for anastomotic construction looks vital. 相似文献
9.
G. de Jong T. HendriksG. Franssen W. OyenO. Boerman R. Bleichrodt 《European journal of surgical oncology》2011,37(3):258-264
Purpose
Radiofrequency ablation (RFA) has shown to improve survival in patients not eligible for surgical resection of colorectal liver metastases. However, recurrences after RFA are a major problem. Adjuvant radioimmunotherapy (RIT) after surgical resection of liver metastases has shown to improve survival. The aim of the present study was to test the hypothesis that adjuvant RIT might be an effective way to prevent recurrent liver metastases after RFA in an experimental model.Methods
Tumours in the liver were induced by intrahepatic injection of 300 000 CC531 cells in male Wag/Rij rats (n = 60). Ten days later, the intrahepatic tumours were treated with RFA. Adjuvant RIT (177Lu-labelled monoclonal antibody MG1 at 300 MBq/kg) was administered intravenously either at the day of RFA (day 10) or 7 days later. Control rats received no treatment. Primary endpoint was survival.Results
Administration of 177Lu-MG1 resulted in a transient decrease in body weight, compared to no adjuvant treatment. However, no other signs of clinical discomfort were registered. Log rank test showed that the survival curves of the groups treated with RIT, either at day 10 or day 17, did not differ significantly from the survival curve of the rats that did not receive adjuvant treatment (P = 0.902).Conclusion
This study shows that adjuvant RIT does not increase survival after RFA of colorectal liver metastases in rats. 相似文献10.
Nienhuijs SW Rosman C Strobbe LJ Wolff A Bleichrodt RP 《International journal of surgery (London, England)》2008,6(4):351-356
Pain is a prominent issue in inguinal hernia repair research as its persisting appearance is a severe complication. The interest is also urged by the combination of a high number of repairs with an estimated risk for chronic postoperative pain of 11%. Almost every healthcare provider could encounter this complication. Pain is a complex study subject, mostly defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Various explanatory factors for pain following hernia repair have been reported. Most investigators, however, discuss only a few aspects. In the present review, these factors are collected to provide a more holistic synopsis of pain following hernia repair. It may be a resource for understanding this and other postsurgical pain. 相似文献