Anastomosis Zone Research Articles

MODERN ASPECTS FOR ASSESSING DISTAL STUMP IN PLASTIC COLON SURGERIES

Aim. To improve the results of plastic surgical treatment of stomed patients after obstructive resection of the distal parts of the colon. Results. The results of surgical treatment of 20 patients who underwent operations for restoration of colon continuity after obstructive resections of the distal parts of the colon (Hartman type surgery) were analyzed. The postoperative examination of colonic stump including polyfocal biopsy of mucosa indicated that in 29 cases there were detected the confirmed morphological signs of diverse colitis. Techniques of transanal anastomosis decompression and intraluminal sanation of the zone of interintestinal anastomosis were used for treatment of all patients with moderate and marked endoscopic and morphological symptoms of diverse colitis. Conclusion. Thus, assessment of the distal part of the colon after obstructive resections permits to plan restoration of intestinal canal at early stages and to improve significantly surgical results. Application of the techniques of transcanal decompression and intraluminal sanation of the zone of anastomosis is an effective method for prevention of their failure.

Simple and efficient recycling of fungal selectable marker genes with the Cre-loxP recombination system via anastomosis

Reverse-genetics analysis has played a significant role in advancing fungal biology, but is limited by the number of available selectable marker genes (SMGs). The Cre-loxP recombination system has been adapted for use in filamentous fungi to overcome this limitation. Expression of the Cre recombinase results in excision of an integrated SMG that is flanked by loxP sites, allowing a subsequent round of transformation with the same SMG. However, current protocols for regulated expression or presentation of Cre require multiple time-consuming steps. During efforts to disrupt four different RNA-dependent RNA polymerase genes in a single strain of the chestnut blight fungus Cryphonectria parasitica, we tested whether Cre could successfully excise loxP-flanked SMGs when provided in trans via anastomosis. Stable Cre-producing donor strains were constructed by transformation of wild-type C. parasitica strain EP155 with the Cre-coding domain under the control of a constitutive promoter. Excision of multiple loxP-flanked SMGs was efficiently achieved by simply pairing the Cre-donor strain and the loxP-flanked SMGs-transformed recipient strain and recovering mycelia from the margin of the recipient colony near the anastomosis zone. This method was shown to be as efficient as and much less time consuming than excision by transformation-mediated expression of Cre. It also allows unlimited recycling of loxP-flanked SMGs and the generation of disruption mutant strains that are free of any foreign gene. The successful application of this method to Metarhizium robertsii suggests potential use for optimizing reverse-genetics analysis in a broad range of filamentous fungi.

TISSUE «OKSITSELANIM» AS A PREVENTING MEASURE TO COLONIC ANASTOMOSIS INSOLVENCY IN COMPARISON WITH LATEX TISSUE ADHESIVE

Objective. To develop a new way to enhance single-layer colonic anastomosis with oksitselanim tissue and to assess its effectiveness in comparison with anastomosis, reinforced by latex tissue adhesive (LTA). Material and methods. The study was performed on 48 white mongrel male rats. Both the groups underwent intersection of the colon with subsequent formation of anastomosis in an «end-to-end» single-row Pirogov-Mateshuk suture that in the control group was strengthened by latex tissue adhesive, and in the experimental group by oksitselanim tissue. The derivation of the experiment was carried out on 3, 7, 14, 30 days. Such parameters of blood as wbc, phagocytic index, phagocytic number, the level of circulating immune complexes, the activity of complement were studied. The swab was taken from the anastomosis zone for bacteriological examination. The presence of effusion, adhesions, abscess, anastomotic narrowing, expansion of the leading department were macroscopically evaluated. The mechanical strength of the anastomosis was determined by pneumohydropression method. The area of tanastomosis was taken for histological examination. Results. The comparison of the morphological patterns of the abdominal cavity, the results of microscopic and bacteriological study suggests a lower expression of local inflammatory changes and bacterial permeability of colonic anastomoses reinforced with «oksitselanim» tissue. The mechanical strength of anastomoses in the experimental group exceeds those in the control group. The comparative analysis of leukocyte counts, phagocytosis, levels of circulating immune complexes and complement activity suggests a more rapid and less intense non-specific inflammatory response in the experimental group. Conclusion. The «oksitselanim» preparation makes it possible to prevent quickly the development of infectious complications with minimal response of the body and provide better conditions for the tissue regeneration after the formation of intestinal anastomosis.

Computer-Aided Patient-Specific Coronary Artery Graft Design Improvements Using CFD Coupled Shape Optimizer.

This study aims to (i) demonstrate the efficacy of a new surgical planning framework for complex cardiovascular reconstructions, (ii) develop a computational fluid dynamics (CFD) coupled multi-dimensional shape optimization method to aid patient-specific coronary artery by-pass graft (CABG) design and, (iii) compare the hemodynamic efficiency of the sequential CABG, i.e., raising a daughter parallel branch from the parent CABG in patient-specific 3D settings. Hemodynamic efficiency of patient-specific complete revascularization scenarios for right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex artery (LCX) bypasses were investigated in comparison to the stenosis condition. Multivariate 2D constraint optimization was applied on the left internal mammary artery (LIMA) graft, which was parameterized based on actual surgical settings extracted from 2D CT slices. The objective function was set to minimize the local variation of wall shear stress (WSS) and other hemodynamic indices (energy dissipation, flow deviation angle, average WSS, and vorticity) that correlate with performance of the graft and risk of re-stenosis at the anastomosis zone. Once the optimized 2D graft shape was obtained, it was translated to 3D using an in-house “sketch-based” interactive anatomical editing tool. The final graft design was evaluated using an experimentally validated second-order non-Newtonian CFD solver incorporating resistance based outlet boundary conditions. 3D patient-specific simulations for the healthy coronary anatomy produced realistic coronary flows. All revascularization techniques restored coronary perfusions to the healthy baseline. Multi-scale evaluation of the optimized LIMA graft enabled significant wall shear stress gradient (WSSG) relief (~34%). In comparison to original LIMA graft, sequential graft also lowered the WSSG by 15% proximal to LAD and diagonal bifurcation. The proposed sketch-based surgical planning paradigm evaluated the selected coronary bypass surgery procedures based on acute hemodynamic readjustments of aorta-CA flow. This methodology may provide a rational to aid surgical decision making in time-critical, patient-specific CA bypass operations before in vivo execution.

Análise tensional e morfológica da anastomose colônica na colite induzida por ácido acético a 10%, em ratos Wistar, tratados com extrato aquoso de aroeira-do-sertão a 10% (Myracrodruon urundeuva fr. all.)

Verify, from a morphologic and tensional view point, the effect of the 10% aqueous extract of aroeira-do-sertão on the colonic anastomosis, during the occurrence of 10% acetic acid induced colitis, in Wistar rats. There were used 48 Wistar rats, distributed in two groups. All animals were subjected to induction of colitis by aqueous solution of 10% acetic acid. Twenty-four hours later, the animals were subjected to laparotomy, transverse total colotomy and end-to-end anastomosis with 5-0 polypropylene. Group A (vehicle), animals treated with carboxymethylcellulose based vehicle. Group B (aroeira), animals treated with 10% aroeira aqueous extract. Both treatments were by means of enema. Groups A and B were distributed in subgroups A3, A7, A14 and A21; B3, B7, B 14 and B21, according to the foreseen euthanasia date (days 3, 7, 14 and 21). On these dates, the animals were relaparotomized, the colonic segment containing the anastomosis was ressected subjected to the pressure test and then to the, histological analysis. For the momphologic study, the slides were dyed with hematoxilin-eosine and the healing status was evaluated based on a score chart that ranked from 0 to 16. The higher the score, the better the healing. On the evaluation of the morphologic study, which quantifies the evolution and degree of healing, as a final result of the healing process, the group aroeira was superior to the group vehicle (p<0.05) on the twenty-first day, showing higher velocity on tissue repair that occurs by regeneration and not by fibrosis. With respect to the tension test, there was a statistically significant difference on day 3, with predominance of the group aroeira over the group vehicle (p<0.05). The 10% aroeira-do-sertão aqueous extract, has healing activity on the colonic anstomosis during the occurrence of 10% acetic acid induced colitis. It improves the resistance to tension on the colonic anastomosis zone on the 3rd day.

Laparoscopic bipolar coagulation of uterine vessels to treat symptomatic leiomyomas

Laparoscopic bipolar coagulation of uterine vessels was performed in three women with symptomatic myomas who required conventional surgical treatment. Uterine size and dominant myoma size were assessed by ultrasonography before and after surgery. Both uterine arteries, as well as anastomosis zone of uterine arteries with ovarian arteries, were occluded in all three women. Surgery was uneventful, and patients were hospitalized for only 2 days. All women experienced improvement in symptoms with no complications. Postoperative ultrasound showed progressive reduction in size of the dominant myoma. A larger series and longer follow-up are required to evaluate long-term effects and to identify appropriate candidates.

Arterial supply of the acetabulum in the fetus: application to periacetabular surgery in childhood.

The need to perform triple osteotomies of the pelvis passing very close to the articular surface leads to the isolation of bony fragments whose vascularisation may be precarious. To assess the risks of such surgery, we undertook an anatomic study of the vascularisation of the acetabulum in the fetus. 53 specimens were injected to study the vessels to the acetabulum and their distribution within the osteocartilaginous specimen. The acetabular a., a branch of the obturator a., gives a central pedicle distributed to the acetabular fossa, the triradiate cartilage and ending in the three primary bony components. The superior gluteal, inferior gluteal, internal pudendal and obturator aa. form a periacetabular vascular circle. The abundant vascularity of the acetabulum makes massive necrosis improbable in the child. However, there is a zone of precarious anastomosis at the anterior portion of the acetabulum.

Studies on the bridging of irreducible gaps in severed ventral roots: An experimental study in cats

Previous studies on cats have shown that lumbosacral ventral roots regenerate when approximated end-to-end using a microfilter tubulation technique. The present report deals with the outcome of ventral root anastomosis in 12 cats in which divided ventral root stumps, both from identical and from non-physiological spinal levels (one segment apart), were tubulated end-to-end with an intervening irreducible defect (10–20 mm) in continuity. In one series of animals (7 cats) the tubulated root gap was filled with autogenous dorsal root grafts. In another series (5 cats) no grafts were used. After sufficient time for regeneration and clinical observation (38–52 weeks), the roots were studied with electrophysiological and histological methods. Positive evidence of histological regeneration, bridging the zone of anastomosis, was encountered in 2 (of 5) animals in the non-grafted series and in 4 (of 7) animals in the grafted series. In addition, 2 of the grafted animals showed bioelectrical regeneration with evidence of refunctioning root-nerve-muscle connections. No animal, however, showed spontaneous use of the re-innervated muscle group in walking, so-called “useful functional regeneration”.

Genetics of Sordaria Fimicola. III. Cross-Compatibility Among Self-Fertile and Self-Sterile Cultures

Carr, A. J. H. (Univ. Coll. Wales, Aberystwyth), and Lindsay S. Olive. Genetics of Sordaria fimicola. III. Cross compatibility among self-fertile and self-sterile cultures. Amer. Jour. Bot. 46(2) : 81-91. Illis. 1959.—Cross-compatibility in Sordaria fimicola is shown to be dependent upon a number of factors controlling the sexual process, from hyphal anastomosis and nuclear migration on through to perithecial formation and nuclear compatibility. Fertile cultures which were incompatible through inability to anastomose were induced to cross by the use of a third culture which would anastomose with both. Certain spontaneous or irradiation-produced sterility mutants were found to be compatible if the sterility genes were at different loci, through complementation by the wild-type alleles. In some pairings, cross-karyogamy was preferential, and in one case, only hybrid perithecia were produced. Fully fertile recombinants segregated from these crosses in frequencies which indicated that the sterility loci were unlinked. Certain sterility genes were found to influence hyphal anastomosis, nuclear migration, and the development of fertile sector heterokaryons from the zone of anastomosis. Mutant factors at two loci in a U.V. mutant causing self-sterility were found also to be responsible for lethality in ascospore germination. Factors in one sterility mutant controlled the production of a sterility-inducing substance which diffused into the medium. In some crosses, complementation of two sterile cultures towards fertility is shown to require a balanced nuclear ratio. Factors are described which increase the inhibitory effect of one sterility gene, while another factor was found to suppress its effect and thereby make the culture self-fertile. It is concluded that, since there is recombination between the sterility loci, these results do not represent the derivation of balanced heterothallism from a normally homothallic system, although it may lead by evolutionary progression to such a life cycle. The possible physiologic action of the sterility genes is discussed.

GENETICS OF SORDARIA FIMICOLA. III. CROSS‐COMPATIBILITY AMONG SELF‐FERTILE AND SELF‐STERILE CULTURES

Carr, A. J. H. (Univ. Coll. Wales, Aberystwyth), and Lindsay S. Olive. Genetics of Sordaria fimicola. III. Cross compatibility among self‐fertile and self‐sterile cultures. Amer. Jour. Bot. 46(2) : 81‐91. Illis. 1959.—Cross‐compatibility in Sordaria fimicola is shown to be dependent upon a number of factors controlling the sexual process, from hyphal anastomosis and nuclear migration on through to perithecial formation and nuclear compatibility. Fertile cultures which were incompatible through inability to anastomose were induced to cross by the use of a third culture which would anastomose with both. Certain spontaneous or irradiation‐produced sterility mutants were found to be compatible if the sterility genes were at different loci, through complementation by the wild‐type alleles. In some pairings, cross‐karyogamy was preferential, and in one case, only hybrid perithecia were produced. Fully fertile recombinants segregated from these crosses in frequencies which indicated that the sterility loci were unlinked. Certain sterility genes were found to influence hyphal anastomosis, nuclear migration, and the development of fertile sector heterokaryons from the zone of anastomosis. Mutant factors at two loci in a U.V. mutant causing self‐sterility were found also to be responsible for lethality in ascospore germination. Factors in one sterility mutant controlled the production of a sterility‐inducing substance which diffused into the medium. In some crosses, complementation of two sterile cultures towards fertility is shown to require a balanced nuclear ratio. Factors are described which increase the inhibitory effect of one sterility gene, while another factor was found to suppress its effect and thereby make the culture self‐fertile. It is concluded that, since there is recombination between the sterility loci, these results do not represent the derivation of balanced heterothallism from a normally homothallic system, although it may lead by evolutionary progression to such a life cycle. The possible physiologic action of the sterility genes is discussed.

EXPERIMENTAL INVESTIGATION

The search for the most perfect way of hollow organ obturation has been done through the history of gastro-intestinal tract surgery. lmi present time sucn aspects of the problem asmorphological changes peculiarities in the process of intestine wound repair in the zone of anastomosis and biological impermeabilty of intestine fistula, possibilities of entero entero anast6mosis different types formation are not researched enough and remain actual.