From 1987 to 1991, we performed intraoperative colonoscopy on 66 patients as a result of the following indications: the air leakage test (53%), detection of a previous malignant polypectomy site (20%), inability to complete preoperative colonoscopy (17%), detection of the source of intestinal bleeding (4%), and detection of impalpable colonic lesions (4%). Intraoperative colonoscopy was successful in 61/66 patients and provided information that altered the planned operation in 10 of 61 completely examined patients. The air leakage test proved useful in detecting subclinical anastomotic leaks. The indications for intraoperative colonoscopy have been expanded, and this procedure is often useful when one is attempting to decide on the appropriate surgical strategy for patients.

Anastomosis, Surgical↗

PubMedDate not supplied

Effects of timing on ventriculoarterial coupling and mechanical efficiency during intraaortic balloon pumping.

To evaluate the effects of deflation timing of an intraaortic balloon (IAB) on ventriculoarterial (VA) coupling and left ventricular (LV) mechanics, we assessed contractility: Emax (mmHg/ml); VA coupling: Ea/Ees; myocardial oxygen consumption: LV pressure-volume area (PVA); and energy efficiency: external work (EW)/PVA during IAB pumping, using four different timing intervals of IAB deflation in eight dogs weighing 19.8 +/- 3.8 kg. In the conventional timing group (G-conv), the IAB was deflated before LV systole. In the real time group (G-1, 2, 3), the IAB was deflated during isovolumic contraction (ICP), and the group was subdivided into three groups based on time of deflation: G-1 at the onset of ICP, G-2 at the midpoint of ICP, and G-3 at the end of ICP. Percent changes in values with IAB compared to those without assist were calculated. Based on the results, IAB deflation during ICP reduces LV end-systolic pressure and significantly optimizes VA coupling and LV efficiency during IAB support, compared with conventional timing.

Animals↗

PubMedDate not supplied

Selective transfer of cyclosporin to thoracic lymphatic systems by the application of lipid microspheres.

To overcome some of the disadvantages of present cyclosporin A (CsA) therapy, lipid microspheres incorporating CsA (lipo-CsA) were designed and their selective transfer to thoracic lymphatic systems was evaluated in vivo. It was found that concentrations of CsA in lymph-ducts were about 46 times higher after 2 h and 9-10 times higher after 3 h following oral administration of lipo-CsA, compared with those of conventional CsA. The concentrations in plasma produced by lipo-CsA were also higher than those produced by conventional CsA.

Animals↗

PubMedDate not supplied

Effect of cyclosporine on the uptake of monoclonal antibody to cardiac myosin.

Monoclonal antibody to cardiac myosin labeled with indium-111 diethylenetriamine pentaacetic acid holds promise as a noninvasive marker of cardiac graft rejection. Uptake of antibody has correlated with histologic evidence of rejection in nonimmunosuppressed animals. Whether this correlation will apply with immunosuppression has important clinical implications. Fifty-two heterotopic heart transplantations were performed between isogeneic and nonisogeneic strains of rats. Cyclosporine-treated (15 mg/kg day subcutaneously for 9 days) and untreated control animals were killed on day 9, 48 hours after injection of radiolabeled antibody. Donor and recipient hearts were submitted for scintillation scanning and histologic analysis. In untreated animals, antibody uptake was significantly greater in nonisogeneic than in isogeneic donor hearts, correlating with a significantly higher rejection score and increased myocyte necrosis in the former. Between isogeneic groups, cyclosporine-treated donor hearts had significantly higher antibody uptake and donor/native antibody uptake ratios than did untreated isogeneic hearts. There was, however, no significant difference in the histologic degree of rejection or myocyte necrosis between isogeneic groups. Between cyclosporine-treated and untreated nonisogeneic animals, donor heart antibody uptake and donor-native heart antibody uptake ratios were not significantly different. Nonetheless, the histologic grade of rejection and presence of myocyte necrosis was significantly greater in untreated than in treated nonisogeneic hearts. There were no abnormalities in the native hearts. In this model, cyclosporine treatment correlates with an increased uptake of antimyosin antibody in both isogeneic and nonisogeneic donor hearts, out of proportion to histologic evidence of rejection or myocyte necrosis. This effect may lead to false-positive results in clinical tests utilizing antimyosin antibody uptake as a marker of rejection in the presence of cyclosporine therapy.

Animals↗

PubMedDate not supplied

Comparative anatomy and histochemistry of human and canine latissimus dorsi muscle.

Gross and histologic studies of human and canine latissimus dorsi muscle were carried out to identify anatomic and histochemical properties that may be relevant to its use as a resource muscle, particularly for heart reconstruction. In both human and canine latissimus dorsi, three distinct muscle segments were observed, differing in direction of fibers, fiber characteristics, thickness, and blood supply. The entire canine latissimus dorsi could also be separated into superficial and deep layers, whereas only the anterolateral segment of human latissimus dorsi was separated further by the neurovascular bundle. Histochemical studies suggested significant differences between the ratios of fast to slow fibers in the superior and anterolateral segments of human muscle. Variation in size, weight, and shape within and between subjects demonstrates a need for careful evaluation of the potential resource muscle.

Aged↗

PubMedDate not supplied

The efficacy of whole gut irrigation with polyethylene glycol electrolyte solution in elective colorectal surgery for cancer.

Sixty-four patients undergoing elective operations for cancer of the colon and rectum were given mechanical bowel preparation in the form of whole gut irrigation with polyethylene glycol electrolyte solution. When their colonic cleansing scores were compared, it was found that the preparation was significantly less effective in the left colon (n = 49) than in the right (n = 15), the mean (SEM) scores being 3.8 (0.56) and 2.65 (1.01), respectively, p less than 0.001. We then compared the scores of 26 patients with stenosing lesions with those of 38 that were not: in the right colon the score for stenosing tumours was 3.9 (0.14) compared with 3.8 (0.25) for non-stenosing tumours. In the left colon, however, they were 2.3 (0.23) and 2.9 (0.18), respectively (p less than 0.01). We conclude that stenosis of the colon caused by malignant lesions reduces the efficacy of mechanical bowel preparation with polyethylene glycol electrolyte solution in the left colon but not in the right colon.

Colon↗

PubMedDate not supplied

IgE rheumatoid factor in a case of rheumatoid arthritis with pleuritis.

IgE rheumatoid factor (RF) was detected in sera from 4 out of approximately 100 rheumatoid patients using a solid phase enzyme-linked immunosorbent assay. All 4 patients had extraarticular lesions. A quantitative analysis revealed that over 60% of total IgE in the serum and pleural fluid from a rheumatoid patient with pleuritis had RF activity. The changes in the level of serum IgE RF in our case paralleled the disease activity. This study suggests that IgE RF may play some role in the pathogenesis of certain extraarticular features of RA.

Absorption↗

PubMedDate not supplied

Colonic J pouch-anal reconstruction with gluteus maximus transposition for a post-irradiation rectovaginal fistula.

A 44-year-old female with rectal cancer underwent anoabdominal rectal resection and colonic J pouch-anal anastomosis after preoperative intraluminal brachytherapy. Pelvic sepsis developed a rectovaginal fistula. We attempted to close the fistula and restore the anal function with coloanal re-anastomosis and bilateral gluteus maximus transposition. She regained good anal function without recurrence of the fistula.

Adult↗