Mucosal Edges Research Articles

Expression of catenins and E-cadherin during epithelial restitution in inflammatory bowel disease.

Catenins are cytoplasmic proteins associated with E-cadherin, the prime mediator of cell-cell adhesion. Perturbation in any of these molecules results in altered intercellular adhesion, cell differentiation, and increased migration. In this study, the expression and cellular localization of catenins and E-cadherin in inflammatory bowel disease were examined. The expression of E-cadherin; alpha-, beta-, and gamma-catenin; and p120 was evaluated immunohistochemically in 31 paraffin-embedded colonic specimens from 21 patients with ulcerative colitis and Crohn's disease. Loss of normal membranous E-cadherin and alpha-catenin staining was detected at the mucosal edges around epithelial ulcerations in all cases of active ulcerative colitis and in 50 per cent of cases with active Crohn's disease. Reduced expression of p120 protein was also found at the margins of ulcerated mucosa in all cases of active ulcerative colitis and in 75 per cent of those with active Crohn's disease. There was a statistically significant correlation between the expression of E-cadherin, alpha-catenin and p120 and disease activity. There were no changes in beta- and gamma-catenin expression in either ulcerative colitis on Crohn's disease. These findings indicate that altered expression of E-cadherin, alpha-catenin, and p120 occurs during mucosal ulceration in inflammatory bowel disease. These changes may be involved in promoting cell migration during epithelial restitution of the gastrointestinal mucosa.

Use of buccal mucosal flaps for the correction of congenital soft palate defects in three dogs.

To present an alternative surgical technique for the repair of soft palate defects in dogs. Three Foxhound cross dogs. Bilateral buccal mucosal flaps, based at the palatoglossal arches, were raised. One flap was rotated so that the mucosal side created the floor of the nasopharynx. The second flap was rotated so that the mucosal side formed the roof of the oropharynx. The mucosa of the remnant of the soft palate and the pharyngeal walls was incised and the flaps sutured to these free mucosal edges. The caudal ends of the two flaps were sutured to each other. Complete closure of the soft palate defect was obtained in all three dogs. The dogs were monitored for between 1.5 and 3 years postoperatively, and no long-term problems were encountered. This surgical technique resulted in an excellent functional separation of the oropharynx and nasopharynx and allowed reconstruction of a large bilateral soft palate defect. By using the buccal mucosal flaps, as described in this report, a tension-free closure of large soft palate defects can be obtained, thereby eliminating a major cause of failure of this type of reconstructive surgery.

Ligation of the bronchus in the base in pneumonectomy

The circular ligation of the bronchus stump in the base without lumen suture retaining the nourishing graft along the back semicircle is proposed. The bronchus stump formed by the method proposed endures the endobronchial pressure more than 1 atm. In aseptic conditions the adhesion follows the pattern seen in first intention retaining the blood supply of the terminal part for all terms after the operation. The rate decrease of postoperative complications in the stump is determined by the exception of sputum congestion and infection penetration along the suture channel, the provision of the optimal contact of the mucosal edges and its primary adhesion in short terms and prolonged reliable hermeticity, coservation.

Optimization of uretero-intestinal anastomosis in urinary diversion: an experimental study in dogs. III. A new antireflux technique for uretero-ileal anastomosis: a serous-lined extramural tunnel.

A new antireflux uretero-ileal reimplantation technique suitable for use with bladder substitutes is presented. This procedure entails creation of a serous-lined extramural tunnel. Following detubularization of the bowel segment, the adjacent flaps are approximated by continuous 4/0 non-absorbable sutures 1.5 cm from the cut edges. The ureters are laid in the trough thus fashioned. "Button-holes" are created in the bowel flaps and a mucosa-to-mucosa uretero-ileal anastomosis is carried out. The mucosal edges of the flaps are then approximated by one layer of continuous 4/0 (PGA) suture resulting in closure of this artificial tunnel. The feasibility and functional outcome of this technique were experimentally investigated in 8 dogs. Follow-up was carried out up to 30 weeks. Assessment by intravenous urography and ascending studies showed that the procedure is an efficient method of providing an unobstructed unidirectional flow of urine.

Voice Preservation Technique in the Surgical Treatment of Postcricoid Cancer

In patients with freedom from invasion to anterior half of the larynx in postcricoid and cervical esophageal cancer, reconstruction of vocal tract with preservation of the anterior half of the larynx is applied with oncologic rationality and we performed the procedure in three cases of T2N1. At neck dissection bilateral superior thyroid neurovascular pedicles and unilateral inferior thyroid vessels were preserved. The larynx and upper part of the trachea were devided on the frontal plane and the posterior half with the hypopharynx and cervical esophagus was removed. The anterior half of the part was preserved and the mucosal edges of the cut surface extending from the appropriate margin of membranous portion of the trachea to the aryepiglottic folds were longitudinally approximated to reconstruct a thin tube to rehabilitate the voice. The pharyngoesophagus was replaced by either deltopectoral flap or forearm flap. Postoperative aspiration was minimal and voice rehabilitation was satisfactory.

Prevention of tracheal stricture in end-to-end anastomosis.

The development of stenosis at the suture line after tracheal resection and end-to-end anastomosis of the trachea is associated with failure to approximate the tracheal ends. Evidently, stenosis invariably will occur if the viable mucosal edges are not properly adapted to each other. We developed a method of anastomosis affording accurate approximation of the tracheal ends and particularly of the mucosa by doing Z-plasties in the mucosa. This method of tracheal anastomosis, which is comparatively easy and safe to perform, may be used reliably and without the development of mucosal structures.

Vasovasostomy — is the microscope necessary?

Many techniques for vasovasostomy have been described, with each author suggesting his technique as the most effective procedure. Theoretical considerations such as leakage of sperm, obstruction, and narrowing of anastomosis suggest that a stentless technique with exact approximation of mucosal edges results in improved success rates. Careful macroscopic surgery with loupes, fine suture material, and experience on the part of the surgeon will give good results and pregnancy rates of 50 per cent. The value of microsurgery, however, becomes obvious when the anastomosis is performed in the convoluted portion of the vas and the epididymis. The microscope allows more mobility in allowing one to determine if the patient has a block proximal to the vasectomy site and then bypass these blocks. The success of vasovasostomy depends greatly on the surgeon's experience with the actual surgical technique. Although technique is of paramount importance, there are factors other than technique that determine the pregnancy rate. Factors important in the success of vasovasostomy, macro- and microscopic techniques, basic concepts, principles and techniques of the various procedures, and the merits and limitations of each procedure, will be discussed.

Vasovasostomy—Microscopic Versus Macroscopic Techniques

Many different surgical techniques of vasovasostomy can be successful. Many factors, both technical and nontechnical, play a role in determining pregnancy. Theoretical considerations such as leakage of sperm, obstruction and narrowing of the anastomosis, suggest that a stentless technique with exact approximation of mucosal edges will result in a better success rate. Careful macroscopic surgery with the use of fine suture material, and experience on the part of the surgeon, will give good results and pregnancy rates of up to 50%. Microsurgery becomes quite important when the anastomosis is performed in the convoluted portion of the vas and epididymis. The microscope allows more mobility in permitting one to determine if the patient has a block proximal to the vasectomy site, and then bypass these blocks. Conventional macroscopic techniques do not allow for this freedom of choice. Factors other than technique are also important and are discussed.

Surgical management of large nasal septum perforations

Summary A promising technique is described which incorporates a free pericranial autograft into the repair of nasal septum perforations. Nasal mucosal flaps are raised and advanced over the perforation. Then the graft is inserted over the perforation between the mucosa and the remaining septal cartilage. The graft appears to improve the survival of the repair, and also allows success even when complete closure of mucosal edges is unobtainable.

Closure of large nasal septum perforations.

A technique which shows promise in surgery for nasal septum perforations is described. Mucosal flaps are raised and advanced over the perforation. Then a pericranial autograft is inserted over the perforation between the mucosa and the remaining septal cartilage. The graft appears to improve the survival of the repair, and also allows success even when complete closure of mucosal edges is unobtainable.

Barium granuloma of the rectum.

Summary Three cases of traumatic granulomatous ulcers of the rectum following barium enema examination are presented and medical literature is reviewed briefly. Barium granulomatous ulcers were induced experimentally in dogs by injecting unsterile barium sulfate suspension into the submucosa of the rectum. The indurated overhanging mucosal edges of the ulcers were debrided in one group of animals to determine whether this would shorten healing time. Ulcers in the control group were smaller, less deep, and healed faster than in the treated group. An intramural or perirectal abscess caused by extravasation of barium sulfate should be drained preferably by enlarging the site of perforation and without unduly excising the mucosal edges of the ulcer. Epithelization occurs despite retained barium crystals. The crystals pass within the lymphatic vessels to the regional lymph nodes. In five of 22 dogs studied, squamous metaplasia at the ulcer site in the rectum was found unexpectedly. No such findings have been described in medical literature heretofore.

Why surgical repairs of cleft palate fail

1. 1. The successful surgical apposition of the mucosal edges of a cleft palate does not necessarily correct the disability. 2. 2. Many surgical procedures have been tried in an attempt to correct the disability without consistent success. 3. 3. Failures are due to breakdown of suture line; excessive scar formation; lack of tissue and interference with growth. 4. 4. A new era is coming in which the cleft palate case is being treated by the cooperative efforts of all the specialties involved in the problem.

USE OF AN ABDOMINAL FLAP GRAFT IN CONSTRUCTION OF A PERMANENT ILEOSTOMY

THE PATIENT who must have a permanent ileostomy has been materially benefited by the technic of Dragstedt and his associates, 1 who covered the terminal ileum with a split thickness of skin, thus providing a greater length of bowel externally and facilitating the collection of fecal material into a suitable container. The inherent tendency, however, of both the bowel and a split thickness graft to contract may, over a period of time, result in a marked shortening of the ileostomy. In 1 patient for whom we made such an ileostomy, the original 3½ inches (9 cm.) of skincovered ileum over a period of eighteen months contracted to the point that only ¼ inch (0.6 cm.) of skin remained and the mucosal edges of the bowel were in contact with the skin of the abdomen. This occurred in spite of a primary take of the graft. There would undoubtedly be less