ABSTRACT
The anatomical studies of intersphincteric resection (ISR) have made remarkable progress in recent years. The anatomy of internal, external sphincter and hiatal ligament has been further understood. In this paper, the generation and functional mechanism of ISR related anatomy are described from the embryonic development process, and then the influence of hiatal ligament and internal sphincter on ISR surgery is analyzed respectively according to the anatomical characteristics. Finally, the correlation analysis of anatomical factors on the common problems of mucosal bleeding and instrument anastomosis in ISR is carried out. The objective of this paper is to improve the safety of ISR surgery by providing detailed anatomical explanations.
Subject(s)
Humans , Anal Canal/surgery , Rectal Neoplasms/surgery , Clinical Relevance , Anastomosis, SurgicalABSTRACT
Intersphincteric resection (ISR) involves the anatomy of hiatal ligament, internal and external sphincter and conjoined longitudinal muscle. The hiatal ligament is actually a branch of the longitudinal muscle of rectum, shown as an uneven ring attached to the levator ani muscle. The internal sphincter is the end of the circular muscle of rectum which begins at the level of hiatal ligament formation. The distance from the upper boundary of internal sphincter to dentate line is significantly different among individuals. Although there is adipose tissue in the space between the internal and external sphincters, no evidence of mesentery structure in the anal canal is found as in the rectum. The conjoined longitudinal muscle is the remaining branch of the longitudinal muscle, whose return passes through the external sphincter and ends at the anococcygeal ligament/coccyx after reaching the anal margin. The synergistic action of conjoined longitudinal muscle and the hiatal ligament participates in the defecation process. The individualized difference of ISR-related anatomy affects the operation, especially the anastomosis.
Subject(s)
Humans , Anal Canal/surgery , Anastomosis, Surgical , Pelvic Floor , Rectal Neoplasms , Rectum/surgeryABSTRACT
OBJECTIVE: To prepare PLGA magnetic nanoparticles loaded with tetrandrine, heat the nanoparticles by inductive heating system, and study the particle size, morphology and drug release before and after heating. METHODS: Co-loaded PLGA NPs were prepared by emulsion solvent diffusion method; the physicochemical and magnetic characteristics of co-loaded PLGA NPs were investigated by DLS, SEM, TEM and VSM; RP-HPLC and ICP-MS analysis were used to measure the tetrandrine and Fe3O4 loading and entrapment efficiency. The EASYHEAT system was applied to heat the nanoparticles and further investigate the changes of particle size, morphology and drug release after inductive heating. RESULTS: Tetrandrine-loaded PLGA magnetic nanoparticles showed spherical shape with smooth surface and the Fe3O4 NPs were homogeneously distributed inside the polymeric nanoparticles; VSM result indicated that the co-loaded PLGA NPs were superparamagnetic; both tetrandrine and Fe3O4 showed good loading and entrapment efficiency. After being heated to 45℃, the diameter of co-loaded PLGA NPs increased; the morphology changed from a spherical shape into a nondefined, irregular shape; arrangement or aggregation of the incorporated Fe3O4 NPs were found. In addition, the drug release amount was also increased. CONCLUSION: With superparamagnetic property, the tetrandrine loaded-PLGA magnetic nanoparticles can effectively control the drug release behavior by inductive heating.
ABSTRACT
Objective: The aim of this study was to evaluate the effect of mucosa suspension procedure (MSP) by comparing procedure for prolapse and hemorrhoids (PPH). Methods: We compared the safety, clinical outcome, and cost between PPH and MSP for the surgical treatment of hemorrhoidal disease. A total of 80 patients with II and III degree hemorrhoids were included in the study. MSP group (n=40) and PPH group (n=40) were applied at random. Results: Both MSP and PPH are safe surgical treatments for patients with II and III degree hemorrhoids. Complications of the patients, such as persistent pain and tenesmus in the MSP group were less than the PPH group. Moreover, MSP had lower costs. Conclusion: MSP is a safe, effective, and inexpensive procedure for patients with hemorrhoidal disease. We consider that this technique should be widely used.
Objetivo: El objetivo del estudio fue comparar la seguridad, los resultados clínicos y el costo entre el procedimiento quirúrgico de suspensión de la mucosa y el manejo quirúrgico del prolapso para el tratamiento de las hemorroides. Métodos: Se incluyeron en el estudio 80 pacientes quienes presentaban hemorroides sintomáticas grado II y III; 40 (50%) recibieron como tratamiento el procedimiento quirúrgico de suspensión de la mucosa y 40 (50%) recibieron el manejo quirúrgico del prolapso. Resultados: Ambos tratamientos quirúrgicos fueron eficientes y seguros observando una menor proporción de persistencia del dolor y tenesmo con el procedimiento quirúrgico de suspensión de la mucosa con costos más bajos para este tipo de cirugía. Conclusión: La suspensión de la mucosa es un procedimiento eficaz, seguro y de bajo costo para los pacientes con enfermedad hemorroidal. Esta técnica debería usarse más ampliamente.
Subject(s)
Humans , Hemorrhoids , Mucous Membrane , ProlapseABSTRACT
<p><b>OBJECTIVE</b>To investigate the expression and activity of fatty acid amide hydrolase (FAAH) in the colon and its role in children with slow transit constipation (STC).</p><p><b>METHODS</b>Patients were divided into constipation group (n=21) and control group (n=15). The constipation group was consistent with the diagnostic criteria for STC. Western blotting, immunohistochemistry and real-time PCR were used to examine the FAAH expression in surgical specimen of colon. The location and distribution of FAAH and cannabinoid receptor type 1 (CB1) were detected by immunofluorescence double staining. The biological activity of colon FAAH was detected by high-performance liquid chromatography.</p><p><b>RESULTS</b>Western blotting revealed that FAAH protein expression in the ascending colon, descending colon and sigmoid colon were significantly decreased in the myenteric neurons and absorption cells in the constipation group as compared with the control group (8.68+/-3.4 vs 10.47+/-3.7, 8.21+/-1.2 vs 9.95+/-6.4, 8.01+/-7.2 vs 9.79+/-3.4, all P<0.05). The same results were found by immunohistochemistry and real-time PCR. The FAAH hydrolysis activity in the ascending colon, descending colon or sigmoid colon decreased significantly in the constipation group, as compared with the control group [(0.51+/-0.23) nmol x min(-1) x mg(-1) vs (0.84+/-0.24) nmol x min(-1) x mg(-1), (0.39+/-0.25) nmol x min(-1) x mg(-1) vs (0.55+/-0.44) nmol x min(-1) x mg(-1), (0.35+/-0.37) nmol x min(-1) x mg(-1) vs (0.58+/-0.48) nmol x min(-1) x mg(-1), all P<0.05].</p><p><b>CONCLUSION</b>FAAH expression and hydrolysis activity in the colon decrease in children with STC. FAAH may play a role in the pathogenesis of slow transit constipation in Children.</p>
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Amidohydrolases , Metabolism , Case-Control Studies , Chronic Disease , Colon , Metabolism , Constipation , MetabolismABSTRACT
<p><b>OBJECTIVE</b>To investigate the expression of reversion-inducing cysteine-rich protein with Kazal motifs (RECK), matrix metalloproteinase-9 (MMP-9), and vascular endothelial growth factor-C (VEGF-C) in colorectal cancer.</p><p><b>METHODS</b>S-P immunohistochemistry was used to detect the expression of RECK, MMP-9 and VEGF-C in colorectal cancer specimen. Colorectal mucosal tissue at least 10 cm away from the tumor was used as control.</p><p><b>RESULTS</b>The positive expression of RECK in colorectal cancer was significantly lower than that in the controls(53.3% vs. 100%, P<0.05). Both MMP-9 and VEGF-C were over expressed compared with the controls(86.7% vs. 23.3% and 71.7% vs. 13.3% respectively, P<0.01). The expression of RECK was negatively correlated with that of MMP-9 and VEGF-C, and the expression of MMP-9 was positively correlated with that of VEGF-C. There were significant associations between the expression of these proteins and lymph node metastasis, distant metastasis, and TNM staging (all P<0.05).</p><p><b>CONCLUSIONS</b>RECK expression is low in colorectal cancer, while MMP-9 and VEGF-C expressions are high. Combined testing of these 3 markers is important in the evaluation of tumor metastasis and invasion, and is helpful in the prediction of the prognosis.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Colorectal Neoplasms , Genetics , Metabolism , Pathology , GPI-Linked Proteins , Metabolism , Matrix Metalloproteinase 9 , Metabolism , Prognosis , Vascular Endothelial Growth Factor C , MetabolismABSTRACT
<p><b>OBJECTIVE</b>To investigate the clinicopathological characteristics of advanced colorectal cancer which was 30 mm or smaller in diameter.</p><p><b>METHODS</b>Retrospective analysis documented 80 patients with small advanced colorectal cancer from May 1985 to May 2002. According to the diameter of tumors, all patients were divided into three groups: Group A (10 mm or less), Group B (11-20 mm), Group C (21-30 mm). Considering the number of patients in Group A was smaller, we combined Group A with Group B as Group D. Then various clinicopathological characteristics were compared between Group C and Group D.</p><p><b>RESULTS</b>The most common site of small advanced colorectal cancer was sigmoid colon and rectum that accounted for 36.2% and 35.0% of all cases. The average diameter of total tumors was 23.3 mm. Type 2 was the most common macroscopic type (63.7%) and the moderate differentiation was seen in 77.5% of cases. Thirty-eight (47.5%) cases had lymph node metastasis. Three (3.8%) cases had liver metastasis and three (3.8%) cases had peritoneal metastasis. The frequency of lymph node metastasis was found significantly different between Group C and Group D (54.2% vs. 28.6%, P < 0.05) , as well as between the groups with different depth of invasion (P < 0.05). Curability A resection was performed in 69 (86.2%) cases.</p><p><b>CONCLUSIONS</b>Tumor size and depth of invasion are related to lymph node metastasis in small advanced colorectal cancer. However, the small size of tumor may not always be a reliable parameter for estimating the risk of lymph node metastasis. Small colorectal cancers also do not always mean the early stage. Surgeons should be aware of the features of small advanced colorectal cancers to select ideal management and perform perfect resection.</p>