Search PubMed⌕ Search

Biomedical subjects

S Kyzer

Publications and source records attributed to S Kyzer.

At least 19 recordsLinked to original sources
PubMed1995

Proliferative activity at rectal anastomoses performed with various suture materials. An experimental study.

BACKGROUND: Suture line recurrence continues to be an important cause of failure following curative resection for colorectal carcinoma. Our aim was to determine whether the nature of the suture material used affected the proliferative activity of colonic crypt cells at the anastomosis. METHODS AND MATERIALS: Sprague-Dawley rats were randomized into one control and three experimental groups. In each experimental group the proximal 2 cm of rectum were resected and anastomoses constructed with titanium clips, interrupted 6-0 Vicryl (Ethicon, Inc., Somerville, NJ), and interrupted 6-0 silk. Control animals had a sham operation. One-quarter of each group of rats were killed at 14, 30, 60, and 90 days. Each animal received intraperitoneal tritiated thymidine 30 minutes before death. Each anastomosis was harvested, and longitudinally oriented crypts were analyzed for the total number and position of labeled cells at five equal distances from the anastomosis. Random crypts were studied in the control group. RESULTS: Labeling indices were increased in almost all experimental groups at days 14, 30, 60, and 90. There were no persistent, statistically significant differences in labeling indices among the various suture materials. CONCLUSION: The type of suture material used did not significantly affect the proliferative rate in this animal model.

Anastomosis, Surgical↗
PubMed1995

Adenocarcinoma at ureterosigmoidostomy junction in a renal transplant recipient 15 years after conversion to ileal conduit.

In recent years, adenocarcinoma of the colon mucosa has become a recognized complication of ureterosigmoidostomy and in most cases the tumor arises at the site of ureterocolonic anastomosis. We report a case of a 29-year-old renal transplant recipient who developed two colonic carcinomas at the site of ureterosigmoidostomy 25 years after the urinary diversion and 15 years after conversion to an ileal conduit. This case emphasizes the need for a careful life-long follow-up of all patients who undergo ureterosigmoidostomy.

Adenocarcinoma↗
PubMed1994

Proliferative activity at colonic anastomoses as determined by statin. A nonproliferation-specific nuclear protein.

PURPOSE: One theory of anastomotic recurrence in large bowel carcinoma is that epithelial hyperplasia at the suture line causes metachronous carcinoma. METHODS: S44, a monoclonal antibody directed against statin, a nuclear protein expressed in quiescent cells, was used to determine whether the anastomosis represents an area with a high proliferation rate. During follow-up colonoscopic examination of patients who had undergone previous resection for colorectal carcinoma, biopsies were taken from the anastomotic site and from the mucosa 10 to 15 cm from the anastomosis. One side of 10 well-oriented crypts was counted for each patient with the number of nuclei positive for statin being determined by the presence of dark brown reaction product. RESULTS: The average percentages of statin-positive cells varied between 19.4 and 44.4 (average, 31.3 +/- 6.5) for the normal mucosa and 22.8 to 35.1 (average, 29.98 +/- 3.67) for the anastomotic mucosa. The differences were not significant. There were no differences between those patients in whom the postoperative time elapsed was two years or less and those greater than two years. CONCLUSION: This study is unique in that the proliferative activity at the site of colonic anastomosis was determined in a clinical setting, and patients in which the anastomoses were created anywhere from 1 to 14 years earlier were included. Using S44 as a marker, this study does not support the theory that suture line recurrence is a result of an enhanced proliferation rate.

Adult↗
PubMed1994

The prophylactic use of ureteral catheters during colorectal operations.

The necessity for preoperative ureteral catheter insertion for colorectal operations continues to be controversial. To determine our experience and what complications might be associated with ureteral catheter use, the charts of all patients in our department undergoing ureteral catheterization in combination with colorectal procedures between the years 1978 and 1989 were reviewed. The indications for operation, the presence or absence of urinary tract symptoms, and intravenous pyelogram findings (if performed) were recorded. Time for the procedure, size and number of catheters, and complications were noted. From the operative report, a retrospective grading of necessity for ureteral catheterization was assessed according to a scale from A to D. There were 120 ureteral catheterizations performed, bilaterally in 60 per cent of cases. Complications included renal colic (1), oliguria (1), and anuria (2). Intraoperatively, one ureter was cut and one ureter tied but recognized by palpation and ligature removed. Retrospective grading deemed ureteral catheterization necessary in 27.5 per cent of cases. We conclude that catheters are helpful in selected cases. For patients with bilateral catheter insertion, complications can be reduced by ensuring urine output prior to removal of the second catheter.

Adult↗
PubMed1993

Hidden colostomy.

For the patient with an unresectable carcinoma of the rectum, establishment of a "hidden" colostomy rather than formal colostomy, provides a better interim quality of life. When necessary, the "hidden" colostomy can readily be converted to a formal colostomy without the need for a laparotomy or general anesthetic. We conclude that surgeons should remember this technique when the appropriate situation occurs.

Colostomy↗
PubMed1992

The care of patients with colorectal polyps that contain invasive adenocarcinoma. Endoscopic polypectomy or colectomy?

BACKGROUND: The appropriateness of resection in patients from whom polyps with invasive adenocarcinoma were excised has been questioned. METHODS: To determine the results of this policy, the authors reviewed the outcome of 42 patients from whom 44 such polyps were removed. Each polyp was categorized for the level of invasion according to the classification of Haggitt. RESULTS: Level 1 invasion was found in 27%; level 2, in 9%; level 3, in 11%; level 4, in 39%; and uncertain, in 14%. The histologic grade was well differentiated in 48% of patients and moderately differentiated in 52%. No polyps contained poorly differentiated adenocarcinoma; lymphatic and vascular invasion were not encountered. Excision was judged complete in 23 patients; 11 underwent resection, and in none was residual adenocarcinoma identified. In 14 patients, margins could not be evaluated; of 12 patients who underwent resection, residual adenocarcinoma was found in 1. Of the seven patients with positive margins who underwent resection, residual adenocarcinoma was found in only two. In the resected specimens in which residual carcinoma was encountered, all original lesions were designated level 4. None of the patients treated by polypectomy alone has experienced a recurrence at a mean follow-up time of 66 months (range, 12-152 months). CONCLUSIONS: The authors conclude that only patients with level 4 invasion require resection.

Adenocarcinoma↗
PubMed1992

[Unusual presentation of malignant melanoma of the small intestine].

2 patients with unusual presentations of malignant melanoma involving the small intestine, a 75-year-old woman and a 78-year-old man, are described. One underwent laparotomy for diagnosis and removal of a retroperitoneal mass, with no preoperative evidence of the primary disease. The other underwent emergency laparotomy for small bowel obstruction due to intussusception, which was found to result from a metastatic melanoma. A melanoma had been completely resected from the patient's thigh a month previously, but full investigation before the operation for intussusception failed to establish the diagnosis. Malignant melanoma tends to spread to the small intestine, but tumors of this organ are very rare. Preoperative diagnosis is important since it may improve the outcome of surgical intervention, as well as the prognosis in general.

Aged↗
PubMed1992

[Complications of laparoscopic cholecystectomy].

92% of our first 60 laparoscopic cholecystectomies were successful. Postoperative complications included fever in 10 cases (17%), urinary retention in 5 (8%), intraabdominal abscess in 2 (3%), biliary leakage in 1 (2%) and unexplained abdominal pain in 10 (17%). Although laparoscopic cholecystectomy has obvious advantages, it also has major as well as minor complications.

Abdominal Pain↗
PubMed1992

The value of nuclear morphometry in the management of patients with colorectal polyps that contain invasive adenocarcinoma.

Haggitt's classification is a useful guide in the management of patients with large bowel polyps which contain invasive adenocarcinoma in that patients with levels 1 to 3 require no operation. Nuclear morphometry has been shown to be a useful prognostic discriminant for patients with invasive carcinoma of the large bowel. The nuclear shape factor of 44 polyps with invasive carcinoma was studied to determine whether this parameter was of value to define those patients with Haggitt level 4 who should have a resection. The shape factor of 50 interphase nuclei was obtained through the use of image analysis by tracing the nuclear profiles as digitized on a video screen. The nuclear shape factor was defined as the degree of circularity of the nucleus, a perfect circle recorded as 1.0. Our previous experience showed a nuclear shape factor greater than 0.84 was associated with a poor outcome. The overall mean shape factor was 0.71 (0.59-0.85). There was a tendency for the patients with residual disease to have values in the upper range. Our findings suggest that nuclear morphometry fails to add any predictive information in this clinical situation.

Adenocarcinoma↗
PubMed1992

The stapled functional end-to-end anastomosis following colonic resection.

To determine the results of our experience with the use of staples for construction of anastomoses following colonic resection, a series of 223 anastomoses performed in 205 patients was reviewed. Indications for operation included malignancy, benign neoplasms, inflammatory bowel disease, and several miscellaneous entities. A functional end-to-end anastomosis using the standard GIA cartridge and the TA 55 instruments was performed. The operative mortality was 1.5% with none of the deaths related to the anastomosis. Intraoperative complications encountered included bleeding (21), leak (1), tissue fracture (1), instrument failure (4), and technical error (3). Early postoperative complications related or potentially related to the anastomosis included bleeding (5), pelvic abscess (1), fistula (1), peritonitis (2), ischemia of anastomosis (1). Late complications included five patients with small bowel obstruction, two of whom required operation. Anastomotic recurrences developed in 5.9% of patients. Our experience gained with stapling instruments has shown them to be a reliable method for performing anastomoses in the colon in a safe and expeditious manner.

Adolescent↗
PubMed1992

Proliferative activity of colonic mucosa at different distances from primary adenocarcinoma as determined by the presence of statin: a nonproliferation-specific nuclear protein.

The field change is one hypothesis concerning the development of colorectal carcinoma. Removal of a carcinoma without its entire surrounding altered mucosa may result in the development of a recurrence. S44, a monoclonal antibody directed against statin, a nuclear protein expressed in nonproliferating cells in either a quiescent or senescent state, was used to determine the rate of cell growth in colorectal mucosa at different distances from carcinomas. The specimens of 18 patients undergoing resection of a colorectal carcinoma were immediately opened after operation, and strips of mucosa were taken at distances of 1 cm, 5 cm, and 10 cm from the carcinoma. For each location, 10 longitudinally oriented crypts were evaluated for statin-positive cells identified by the presence of a dark brown peroxidase-conjugated antibody reaction product. The average percentage of statin-positive cells per crypt was significantly lower at a 1-cm distance from the carcinoma compared with the mucosa located 5 and 10 cm from the carcinoma (20.89 +/- 4.33 at 1 cm, 32.41 +/- 5.27 at 5 cm, and 34.23 +/- 6.45 at 10 cm). None of the calculated parameters showed any significant difference between the 5-cm and 10-cm locations. The fact that the proliferation rate of the mucosal cells returns to the normal level at 5 cm from the margin of the carcinoma suggests that cells located within this distance still retain proliferative potential even though they are morphologically indistinguishable from their normal counterparts. We conclude that failure to remove this transitional, potentially proliferative mucosa may result in subsequent development of anastomotic or perianastomotic recurrences.

Antibodies, Monoclonal↗
PubMed1992

Experience with the use of the circular stapler in rectal surgery.

This report provides our personal experience along with a general overview of the use of the circular stapler in rectal surgery. To determine the results of our experience with the use of the circular stapler for construction of anastomoses following resection, a series of 215 anastomoses performed in 214 patients was reviewed. The patients ranged in age from 33 to 88 years. There were 116 men and 98 women. Indications for operation included malignancy, diverticular disease, villous adenoma, Crohn's disease, and rectal procidentia. The types of operation performed included removal of varying portions of the large bowel. The anastomosis was performed in a uniform manner with the EEA (United States Surgical Corp., Norwalk, CT) and more recently the CEEA (United States Surgical Corp., Norwalk, CT). The operative mortality was 0.47 percent, with the death being unrelated to the anastomosis. Intraoperative complications encountered included bleeding, difficult extraction, instrument failure, incomplete doughnuts, deficient anastomoses, and miscellaneous problems. Early postoperative complications included one leak and a number of complications unrelated to the anastomoses. Anastomotic stenosis developed in 27 patients, but only 8 were permanent and only 3 of these were symptomatic. Two of these patients were treated with balloon dilatation. Anastomotic recurrences developed in 13.1 percent of patients. Our experience gained with the circular stapling device and that reported in the literature have shown it to be a reliable method of performing anastomoses to the rectum in a safe and expeditious manner.

Adult↗