[Show abstract][Hide abstract] ABSTRACT: Diabetes mellitus often causes anastomotic leakage leading to severe complications after surgery. The purpose of this study was to determine whether collagen synthesis is correlated with the anastomotic strength in diabetic animals in special reference to collagen type differences.
Thirty Lewis rats weighing approximately 250 g were made diabetic by tail vein injection of streptozotocin (STZ). Laparotomy was performed through a midline incision under ether anesthesia. A colonic segment 5 cm distal to the ileocecal junction was transected then anastomosed with absorbable suture. Anastomotic strength was measured on days 3, 5, 7 and 14 postoperatively, and compared with normal rats. Collagen type I and type III mRNA together with the total collagen concentration were measured in anastomotic sites.
Anastomotic strength in diabetic rats was significantly lower on day 7, but gradually recovered up to day 14. There was no statistical significance between the two groups in hydroxyproline concentrations. Although the expressions of mRNA of collagen type III in both groups were statistically not different, that of collagen type I in the diabetes group merely increased and was clearly less than that of the control group.
Anastomotic integrity in diabetic rats was significantly damaged on day 7 after surgery but recovered by day 14. This is caused not by the total contents of collagen accumulation but by the decrease of newly formed collagen type I contents.
No preview · Article · Feb 2004 · Digestive Surgery
[Show abstract][Hide abstract] ABSTRACT: Although bursting pressure and tensile strength have long been measured to evaluate anastomotic techniques, it has yet to be clarified whether or not they are correlated, what implications they have, and which should be used as a gold standard.
Using an experimental model to estimate pressure and tension in the same colonic anastomosis, the following variables were measured in 48 rats between days 0 and 14: bursting pressure (BP); minimal tensile strength (MITS) necessary to break a part of the anastomosis, and maximal tensile strength (MATS) needed to disrupt the whole anastomosis. Also, circulatory wall tension (CWT) was derived from BP and the anastomotic circumference (AC), and longitudinal wall tension (LWT) from MITS and AC. These variables were compared using correlation and regression analysis.
During the lag phase (days < or = 4) there was poor correlation between pressure-related and tension-related variables whereas highly significant correlations were noted in the subsequent fibroplastic phase (day > or = 5). It was shown by regression lines that positive MITS and MATS were expected when BP was zero.
Contrary to the previous assumption, no correlation was found between BP and tensile strength in the critical postoperative period. Based on our present and previous studies, measurement of MITS is recommended to evaluate the healing of colonic anastomosis.
No preview · Article · Jan 1999 · Digestive Surgery
[Show abstract][Hide abstract] ABSTRACT: Expression of insulin-like growth factor-2 (IGF-2) has been reported in tissue specimens and cell lines of human colorectal cancers. However, the effects of IGF-2 in colorectal cancer patients are not well known. In this study, IGF-2 staining was performed on tissue samples from 92 patients with colorectal cancer, and the relationship of IGF-2 staining to clinicopathological variables, proliferating cell nuclear antigen (PCNA) staining and patient survival was analyzed. IGF-2 staining was correlated with tumor progression, PCNA staining and patient survival. Our results suggest that IGF-2 plays an important role in tumor progression and that IGF-2 staining is useful as a prognostic factor in colorectal cancer patients.
[Show abstract][Hide abstract] ABSTRACT: We reported a new method of restorative proctocolectomy using posterior approach and pull-through reconstruction. This method obviated transanal manipulation, a major factor causing damage to the internal sphincter, thus preventing fecal incontinence due to sphincter dysfunction. Also, temporary ileostomy was not necessary because the spout of an S-pouch was pulled down below the anal verge and its distal free end acted as a diverting stoma while the more proximal, healing zone (future anastomotic line) was kept from fecal contamination. This method was applied to a 32-year-old woman with familial polyposis coli and a 50-year-old woman with ulcerative colitis. Their bowel movements steadily decreased to three times and five times a day, respectively. There was no fecal leakage or perianal excoriation. The advantages as well as disadvantages of this method compared with the conventional techniques were discussed.
No preview · Article · Oct 1994 · Nippon geka hokan. Archiv für japanische Chirurgie