Laparoscopic-assisted colectomy: a comparison of dissection techniques.
BACKGROUND AND OBJECTIVES: Mobilization of the colon and dissection of the mesentery are difficult laparoscopic techniques. Traditional methods have been used for this dissection, but often with great difficulty. The ultrasonically activated shears, when introduced in 1993, had the possibility to make this dissection less technically difficult. This is a retrospective review of the use of these shears for these techniques during laparoscopic-assisted colectomy. MATERIALS AND METHODS: Eighty-five patients underwent a laparoscopic-assisted right hemicolectomy or sigmoid resection. Colon mobilization and mesenteric dissection were completed intracorporeally. Complications, operative time, estimated blood loss, and length of stay were compared for resections completed with and without the ultrasonically activated shears. RESULTS: Thirty-six patients had laparoscopic-assisted colectomy without the shears, and 49 patients had the procedure with the shears. There were no complications due to the ultrasonic energy. Use of the shears resulted in shorter operative times (170 min. vs. 187 min., p=0.1989), similar median blood loss (98 mL vs. 95 mL, p=0.7620), and shorter lengths of stay (4.3 days vs. 6.9 days, p=0.0018). CONCLUSIONS: The ultrasonically activated shears are safe and effective for colon mobilization and mesenteric division. The use of the shears may result in shorter operative times and shorter lengths of stay. (+info)
A bile acid-induced apoptosis assay for colon cancer risk and associated quality control studies.
Bile acids are important in the etiology of colorectal cancer. Bile acids induce apoptosis in colonic goblet cells at concentrations comparable to those found in fecal water after high-fat meals. Preliminary evidence indicated that cells of the normal-appearing (nontumorous) portion of the colon epithelium of colon cancer patients are more resistant to bile salt-induced apoptosis than are cells from normal individuals. In the present study, 68 patients were examined, and biopsies were taken at 20 cm from the anal verge, cecum, and descending colon. The patients included 17 individuals with a history of colorectal cancer, 37 individuals with adenomas, and 14 individuals who were neoplasia free. The mean bile salt-induced apoptotic index among normal individuals was 57.6 +/- 3.47 (SE), which differed significantly (P < 0.05) from the mean value of 36.41 +/- 3.12 in individuals with a history of colon cancer. The correlation between independent observers was 0.89 (P < 0.001), indicating good interobserver reliability. Components of variance comparing interindividual versus intraindividual sources of variation suggested that site-to-site variability, both between regions of the colon and for adjacent biopsies, was larger than the interpatient variability for individuals with a history of neoplasia. Therefore, there was "patchiness" of the susceptibility of regions of the colon to bile acid-induced apoptosis in individuals with a history of neoplasia (a patchy field effect). There was no obvious correlation of low-apoptotic index regions with regions in which previous neoplasias had been found and removed. On the other hand, for normal, i.e., neoplasia-free, individuals, there was relatively less intraindividual variation compared to interindividual variation. Our assay shows an association between resistance to bile acid-induced apoptosis, measured at 20 cm from the anal verge, and colon cancer risk. Thus, this assay may prove useful as a biomarker of colon cancer risk. (+info)
Johanson-Blizzard syndrome: a prenatal ultrasonographic diagnosis.
Johanson-Blizzard syndrome is a rare autosomal recessive disorder characterized by aplasia of alae nasi, pancreatic insufficiency, aplasia cutis, anorectal anomalies and postnatal growth restriction. In this case report, we describe the prenatal sonographic findings of Johanson-Blizzard syndrome in a 21-week pregnancy of a consanguineous couple. Sonographic findings of aplastic alae nasi (beak-like nose) and dilated sigmoid colon led to the prenatal diagnosis. This is the first report of the prenatal sonographic diagnosis of Johanson-Blizzard syndrome. (+info)
Colonic carcinoma after ureterosigmoidostomy.
Urinary carcinogens promote late malignant transformation of the colon after a ureterosigmoidostomy. An unusual case is presented where, despite the early removal of the latter and hence cessation of urine flow, a colonic carcinoma developed at the site of previous anastomosis. The importance of surveillance of all patients who have undergone this procedure to avoid an iatrogenic cancer is emphasised. (+info)
pHi monitoring of the sigmoid colon after aortoiliac surgery. A five-year prospective study.
OBJECTIVES: to determine whether sigmoid-pHi diagnose colon ischaemia after aortoiliac surgery? DESIGN: single-centre, non-randomised, prospective study. PATIENTS AND METHODS: of 83 patients operated on between 1994 and 1998, 41 with risk factors for the development of colon ischaemia were monitored peri- and/or postoperatively with sigmoid-pHi. Peri-operative mortality was 26% (8/31) after operation for a ruptured abdominal aortic aneurysm (AAA), nil after operation for non-ruptured AAA. Thirty-five postoperative colonoscopies were performed. All non-survivors were examined post-mortem. RESULTS: of six patients developing colon ischaemia after emergency operations (five for ruptured AAA) all had pHi-values <7.1 for 16-80 h. In two patients with transmural gangrene, and who had pHi-values below 6.6, pHi-monitoring permitted early diagnosis, colectomy and recovery. Three patients with mucosal gangrene were treated conservatively and recovered. Nine patients without ischaemic lesions had pHi-values <7.1, during 1-5 h, without adverse outcome. Bilateral ligation of the internal iliac arteries increased the risk of colon ischaemia (p<0.0001). CONCLUSIONS: pHi-monitoring was diagnostic for colon ischaemia. Mucosal and transmural gangrene were distinguished. The importance of the internal iliac circulation was demonstrated. The low mortality rate, and the fact that no patient died from bowel ischaemia, suggests that sigmoid pHi-monitoring may improve survival after ruptured AAA. (+info)
V gamma 2 TCR repertoire overlap in different anatomical compartments of healthy, unrelated rhesus macaques.
Gammadelta T cells show preferential homing that is characterized by biased TCR repertoire at different anatomical locations. The processes that regulate this compartmentalization are largely unknown. A model that allows repeated multiple sample procurement under different conditions and enables with relatively straightforward extrapolation to a human situation will facilitate our understanding. The peripheral blood Vgamma2 T cell population is the best-characterized human gammadelta T cell subset. To determine its diversity at multiple immunocompartments matching blood, colon, and vagina samples from rhesus macaques were investigated. Four joining segments used in Vgamma2-Jgamma transcripts were identified, including one segment with no human counterpart. Like in humans, the rhesus peripheral blood Vgamma2 TCR repertoire was limited and contained common sequences that were shared by genetically heterogeneous animals. Furthermore, this subset comprised several phylogenetically conserved Vgamma2 complementarity-determining region 3 (CDR3) motifs between rhesus and humans. Common sequences were also found within the colon and vagina of the same animal, and within the peripheral blood and intestine of different unrelated animals. These results validate rhesus macaques as a useful model for gammadelta TCR repertoire and homing studies. Moreover, they provide evidence that the concept of limited but overlapping Vgamma TCR repertoire between unrelated individuals can be extended including the mucosa of the digestive and reproductive tract. (+info)
Statistical analysis of diverticulosis of the colon.
Forty-four cases of diverticulosis of the colon were detected among 2,662 cases examined by barium enema in Tohoku University. This corresponds to 1.7% in frequency. On the other hand, 21 cases were found among 1,511 cases examined in Hirosaki University, giving 1.4% in frequency. It was more frequent in the male. The frequency, as calculated on the basis of the numbers of cases examined by barium enema in separate age groups, showed the gradual increase with age except for above the eighth decade. The location where the diverticulum was most frequently seen was the right colon; namely, cases in which the diverticulum occurred from the cecum to the ascending colon and those in which it was found only in the ascending colon occupied 61.4 and 71.4% of the total cases, respectively. Diverticulitis as a complication was rare, while coincidence of polyp or carcinoma was sometimes observed. Furthermore, the value of fiberscopy for the diagnosis of diverticulosis of the colon was discussed, and its usefulness for the detection of complication was emphasized. (+info)
Characterization and autoradiographic localization of neurotensin binding sites in human sigmoid colon.
Radioiodinated neurotensin ((125)I-NT) was used to characterize and localize NT binding sites in normal human sigmoid colon. Specimens were obtained from patients (30-77 years old) undergoing resection for colon carcinoma. Specific binding of (125)I-NT to sigmoid circular muscle membranes was enhanced by o-phenanthroline (1 mM) but other peptidase inhibitors were ineffective. (125)I-NT bound to a high-affinity site of K(d) = 0.88 +/- 0.09 nM and B(max) = 4.03 +/- 0.66 fmol/mg of wet weight tissue (n = 14), although in the majority of patients another site, of low but variable affinity, could also be detected. Specific binding of 50 pM (125)I-NT was inhibited by NT(8-13) > NT > SR142948A > or = neuromedin N > or = SR48692, consistent with binding to the NT1 receptor. In autoradiographic studies, dense specific binding of (125)I-NT was seen over myenteric and submucosal ganglia, moderate binding over circular muscle, and sparse binding over longitudinal muscle and taenia coli. Levocabastine, which has affinity for the NT2 receptor, did not inhibit specific binding of (125)I-NT in membrane competition or autoradiographic studies. NT contracted sigmoid colon circular muscle strips with a pD(2) value of 6.8 +/- 0.2 nM (n = 25). The contractile responses to NT were significantly potentiated in the presence of tetrodotoxin (1 microM), indicating a neural component. Results from functional studies support actions for NT on both muscle and enteric neurons, consistent with the presence of NT receptors on circular muscle and ganglia of human sigmoid colon. The lack of inhibition by levocabastine suggests that the second binding site detected does not correspond to the NT2 receptor. (+info)