Effect of supplementation with probiotics on colonic anastomoses in rats: morphological and tensiometric study / Efeito da suplementação com probióticos em anastomoses colônicas de ratos: estudo morfológico e tensiométrico

ABSTRACT Background: The use of probiotics positively modifies the composition and function of intestinal flora, improving the quality of intestinal anastomosis. Aim: To evaluate the impact of probiotic use on intestinal anastomosis of rats. Method: Thirty-six adult male Wistar rats (Rattus norvegicus albinus, Rodentia Mammalia) were used, with body weight ranging from 220-320 g. The animals were housed and acclimated individually in boxes receiving water and ration ad libitum. After initial acclimatization, the control group received perioperative ration ad libitum for 12 days (seven preoperatively and five postoperatively) associated with the maltodextrin formula at a dose of 250 mg/day in isocaloric and isovolumetric form. Likewise, the probiotic group received oral supplementation of probiotics dose of 250 mg/day, associated with isocaloric and isovolumetric diet. The probiotic chosen for this study was composed of strains (doses 1x109 CFU/g)12 Lactobacillus paracasei LPC-37, Bifidobacterium lactis HN0019, Lactobacillus rhamnosus HN001 and Lactobacillus acidophilus NCFM. Probiotics or placebo were administered orally with the aid of a dosimeter spatula. Both groups underwent two colostomies, one in the right colon and the second in rectosigmoid, followed by reanastomosis with eight separate 6-0 mononylon stitches. The sacrifice took place on the fifth day. The parameters evaluated included tensile strength, histology and collagen densitometry. Results: The rate of intestinal fistula for the control and probiotic groups were, respectively, 22.22% and 11.11% (p=0.6581).Perioperative supplementation with probiotics increased collagen deposition of types I and III (p<0.0001), improved maximum traction force and maximum rupture force, p=0.0250 and p=0.0116 respectively, fibrosis area (p<0.0001), and area of the inflammatory infiltrate (p=0.0115). Conclusions: The use of probiotics had a positive impact on the quality of intestinal anastomosis.

RESUMO Racional: A utilização de probióticos modifica positivamente a composição e função da flora intestinal melhorando a qualidade da anastomose intestinal. Objetivo: Avaliar o impacto da utilização de probióticos na anastomose intestinal de ratos. Método: Foram utilizados 36 ratos Wistar (Rattus norvegicus albinus, Rodentia Mammalia), machos adultos, com peso corporal variando entre 220 e 320 g. Os animais foram alojados e aclimatados individualmente em caixas recebendo água e ração ad libitum. Após aclimatação inicial, o grupo controle recebeu perioperatoriamente ração ad libitum por 12 dias (sete no pré-operatório e cinco no pós-operatório) associado à fórmula de maltodextrina na dose de 250 mg/dia de forma isocalórica e isovolumétrica. Na semana que precedeu o procedimento cirúrgico (período de sete dias) e no pós-operatório (por cinco dias), os ratos do grupo estudo receberam suplementação via oral de probióticos dose de 250 mg/dia, associado à dieta isocalórica e isovolumétrica. O probiótico utilizado era composto pelas cepas (doses 1x109 UFC/g)12 Lactobacillus paracasei LPC-37, Bifidobacterium lactis HN0019, Lactobacillus rhamnosus HN001 e Lactobacillus acidophilus NCFM. A administração de probiótico ou placebo foi realizada via oral, com auxílio de espátula com dosímetro. Os dois grupos foram submetidos à duas colostomias, uma em cólon direito e outra em retossigmóide, seguido de reanastomose com oito pontos separados de mononylon 6-0. O sacrifício ocorreu no quinto dia. Os parâmetros avaliados incluíram força tênsil, histologia e densitometria do colágeno. Resultados: A taxa de fístula intestinal para os grupos controle e probiótico foram, respectivamente, 22,22% e 11,11% (p=0.6581). A suplementação peroperatória com probióticos aumentou a deposição de colágeno dos tipos I e III (p<0.0001), melhorou a força máxima de tração e força máxima de ruptura, p=0,0250 e p= 0,0116 respectivamente, área de fibrose (p<0.0001), e área do infiltrado inflamatório (p=0.0115). Conclusões: A utilização de probióticos impactou positivamente na qualidade da anastomose intestinal.

Effects of Aloe Vera on healing of colonic anastomoses: experimental rat study / Efeitos da Aloe Vera na cicatrização de anastomoses colônicas: estudo experimental em ratos

ABSTRACT Background: Although herbal medicinal products are being used widely throughout the World, beneficial and harmful effects have not been well documented. Our aim was to evaluate the effects of Aloe Vera (AV) on colonic anastomosis healing. Material and methods: 112 albino Wistar rats were randomly assigned into five main groups: preoperative Aloe Vera Group (P), pre- and postoperative Aloe Vera Group (PP), Control Group (C), sham Aloe Vera Group (SA) and Sham Control Group (SC). Groups P, PP, and SA received 1.6 mL/kg per day Aloe Vera by orogastric feeding catheter for 1 month prior to the experiment. Groups P, PP, and C underwent anastomosis of the distal colon, and subgroups (n = 4) of each were sacrificed on postoperative day 3, 7, 14 and 21. Anastomotic bursting pressure, perianastomotic collagen content and histopathological changes were studied. Results: The SC Group had significantly higher ABP when compared with the SA Group (p = 0.0002), although hydroxyproline content showed no difference. When ABP was compared between anastomosis groups, it was found significantly lower in Aloe Vera groups on Day 3 (P3 vs. C3, p = 0.003 and PP3 vs. C3, p = 0.007). Hydroxyproline content was significantly lower in Group PP than Group C, also on Day 3 (p = 0.05). Significant difference was not detected after Day 3 in any of the study parameters. Conclusion: Aloe Vera decreased tissue collagen content in the early postoperative period. It is advisable to call into question the concomitant usage of conventional medicine and the herbal supplements for the surgeons in their clinical practice.

RESUMO Fundamentação: Embora os medicamentos à base de plantas sejam amplamente utilizados no mundo inteiro, seus efeitos (benéficos e prejudiciais) não estão bem documentados. Este estudo teve como objetivo avaliar os efeitos da Aloe vera (AV) na cicatrização de anastomoses colônicas. Material e métodos: 112 ratos Wistar albinos foram distribuídos aleatoriamente em cinco grupos principais: AV pré-operatório (P), AV pré e pós-operatório (PP), controle (C), sham AV (SA) e sham controle (SC). Os grupos P, PP e SA receberam AV em uma dose de 1,6 mL/kg por dia por sonda de alimentação orogástrica por 1 mês antes do experimento. Os grupos P, PP e C foram submetidos a anastomose do cólon distal. Subgrupos (n = 4) de cada grupo foram sacrificados no terceiro, sétimo, 14° e 21° dias pós-operatórios. Os seguintes parâmetros foram avaliados: pressão de ruptura anastomótica (PRA), conteúdo de colágeno perianastomótico e alterações histopatológicas. Resultados: O grupo SC apresentou PRA significativamente maior quando comparado ao grupo SA (p = 0,0002), embora o conteúdo de hidroxiprolina não tenha apresentado diferença. Ao comparar a PRA entre os grupos de anastomose, ela foi significativamente menor no terceiro dia nos grupos que usaram AV (P3 vs. C3, p = 0,003 e PP3 vs. C3, p = 0,007). No terceiro dia, o teor de hidroxiprolina foi significativamente menor no grupo PP do que no grupo C (p = 0,05). Após o terceiro dia, não se observou diferença significativa em nenhum dos parâmetros do estudo. Conclusão: O uso de AV diminuiu o conteúdo de colágeno tecidual no período pós-operatório imediato. É aconselhável questionar o uso concomitante da medicina convencional e suplementos fitoterápicos na prática clínica.

Effects of melatonin on colonic anastomosis healing following chemotherapy in rats

<p><b>INTRODUCTION</b>This study aimed to investigate the effects of melatonin on the healing of colon anastomosis following chemotherapy.</p><p><b>METHODS</b>32 rats were randomised into four groups: (a) control group, which underwent sigmoid colon transection and primary anastomosis; (b) melatonin group, which received melatonin daily following anastomosis; (c) 5-fluorouracil (5-FU) group, which received 5-FU for five days prior to anastomosis; and (d) 5-FU+melatonin group, which received 5-FU for five days prior to anastomosis and melatonin daily following anastomosis. The rats were sacrificed on Postoperative Day 7 and anastomotic bursting pressures were measured. The anastomotic segment was extracted for hydroxyproline, luminol and lucigenin measurement and histopathological examination. Blood samples were obtained from the vena cava for measurement of tumour necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-1β) plasma levels.</p><p><b>RESULTS</b>Compared to the 5-FU group, bursting pressures of anastomosis and hydroxyproline levels were significantly higher, while luminol and lucigenin levels were significantly lower, in the control and 5-FU+melatonin groups. In addition, TNF-α and IL-1β plasma levels were significantly lower in the control and 5-FU+melatonin groups than in the 5-FU group. Histopathological examination showed a significant decrease in inflammation and necrosis formation in the melatonin group when compared to the control group. The positive effect of melatonin was also seen in the rats that received 5-FU.</p><p><b>CONCLUSION</b>Our study results showed that the adverse effects of chemotherapy on the mechanical, biochemical and histopathological parameters of anastomosis healing were attenuated through melatonin treatment.</p>

Crohn's disease with ankylosing spondylitis in an adolescent patient who had undergone long ileo-colonic anastomosis for Hirschsprung's disease as an infant

Crohn's disease (CD) is a chronic, idiopathic, inflammatory disorder of the gastrointestinal tract. In rare cases, CD has been associated with Hirschsprung's disease (HD); however, the underlying pathophysiology of this and other comorbidities is not yet fully understood. In this report, we describe the case of a 17-year-old patient who was diagnosed with both CD and ankylosing spondylitis (AS), having undergone a long ileo-colonic anastomosis to treat HD at 12 months of age. To our knowledge, this is the first documented case of CD combined with AS in a patient with HD.

Application value of cruciform anastomosis in the laparoscopic radical resection of colon cancer / 中华消化外科杂志

Objective To evaluate the safety and feasibility of cruciform anastomosis in the laparoscopic radical resection of colon cancer.Methods The retrospective descriptive study was adopted.The clinicopathologic data of 9 patients with colon cancer who were admitted to the Shanxi Provincial Caner Hospital between December 2011 to October 2013 were collected.After the laparoscopic free colon and dissection of lymph nodes,the proximal and distal ends of the colon tumor were cut off using an ENDO-GIA,cutting one small incision on the both side of stump,and ENDO-GIA was put into the incision to staple the mesentery of colonic wall,finally,the beak-like common incision was closed by ENDO-GIA and digestive tract construction was conducted.Observation indices:(1)operative indices:operation time,time of cruciform colon anastomosis,volume of intraoperative blood loss,conversion to open surgery.(2)Tumor indices:number of lymph nodes dissected,distance to resection margin,R resection.(3)Surgical complications:anastomotic stoma incompetence,anastomotic leakage,anastomotic stenosis,twisting of bowel,wound liquefaction infection.(4)Postoperative recovery time:time for initial out-of-bed activity,time to anal exsufflation,time for fluid diet intake,duration of postoperative hospital stay.(5)Follow-up situations:follow-up using outpatient examination was conducted up to April 2014.Karnofsky performance status(KPS)score was used to evaluate the health conditions and tumor recurrence of anastomotic stoma and colonic cavity stenosis were detected by fibercoloscope.Measurement data with normal distribution were presented as x±s.Results(1)Operative indices:9 patients received successful total laparoscopic resection of colon cancer+D3 lymph node dissection+cruciform anastomosis,without conversion to open surgery.Operation time,time of cruciform colon anastomosis and volume of intraoperative blood loss were respectively(140±50)minutes,(43±26)minutes and(62±56)mL.(2)Tumor indices:the number of lymph nodes dissected was 17±6 percase.The distance to resection margin was more than 8 cm,and pathological findings showed no residual cancer.(3)Surgical complications:9 patients had no postoperative complications.(4)Postoperative recovery time:time for initial out-of-bed activity,time to anal exsufflation,time for fluid diet intake and duration of hospital stay were respectively(1.8±0.9)days,(2.4±1.2)days,(3.6±1.7)days and(9.6±2.5)days.All the patients were discharged from hospital at postoperative day 12,without the occurrence of readmission within postoperative day 30.(5)Follow-up situations:all the patients were followed up by outpatient examination at postoperative month 6,with KPS score≥90 and without the occurrence of tumor recurrence of anastomotic stoma and colonic cavity stenosis.Conclusion Cruciform anastomosis in the laparoscopic radical resection of colon cancer is safe and feasible.

EFFECT OF OMEGA-3 FATTY ACID IN THE HEALING PROCESS OF COLONIC ANASTOMOSIS IN RATS / EFEITO DO ÁCIDO GRAXO ÔMEGA-3 NA CICATRIZAÇÃO DE ANASTOMOSE COLÔNICA EM RATOS

Background : The use of long-chain polyunsaturated fatty acids has been studied in the context of healing and tissue regeneration mainly due to its anti-inflammatory, immunoregulatory and antioncogenic properties. Previous studies have demonstrated beneficial effects with the use of enteral immunonutrition containing various farmaconutrients such as L-arginine, omega-3, trace elements, but the individual action of each component in the healing of colonic anastomosis remains unclear. Aim : To evaluate the influence of preoperative supplementation with omega-3 fatty acids on the healing of colonic anastomoses of well-nourished rats. Methods : Forty Wistar adult male rats, weighing 234.4±22.3 g were used. The animals were divided into two groups: the control group received for seven days olive oil rich in omega-9 oil through an orogastric tube, while the study group received isocaloric and isovolumetric omega-3 emulsion at a dose of 100 mg/kg/day, also for seven days. Both groups were submitted to two colotomies followed by anastomosis, in the right and left colon, respectively. Parameters evaluated included changes in body weight, anastomotic complications and mortality, as well as maximum tensile strength by using a tensiometer and collagen densitometry at the anastomotic site. Results : There were no differences in body weight or mortality and morbidity between groups. The value of the maximum tensile strength of the control group was 1.9±0.3 N and the study group 1.7±0.2, p=0.357. There was, however, a larger amount of type I collagen deposition in the study group (p=0.0126). The collagen maturation índex was 1.74±0.71 in the control group and 1.67±0.5 in the study group; p=0,719). Conclusions : Preoperative supplementation of omega-3 fatty acid in rats is associated with increased collagen deposition of type I fibers in colonic anastomoses on the 5th postoperative day. No differences were observed in the tensile strength or collagen maturation index.

Racional : O uso de ácidos graxos poliinsaturados de cadeia longa tem sido estudado no contexto de cicatrização e regeneração do tecido, principalmente devido a suas propriedades imunorreguladoras, antioncogênicas e anti-inflamatórias. Estudos anteriores demonstraram efeitos benéficos com o uso de imunonutrição enteral contendo vários farmaconutrientes (L-arginina, ômega-3, oligoelementos), mas a ação individual de cada componente na cicatrização de anastomose colônica permanece incerto. Objetivo : Avaliar a influência da suplementação no pré-operatório com ácidos graxos ômega-3 na cicatrização de anastomoses colônicas de ratos eutróficos. Método : Quarenta ratos Wistar, machos adultos, pesando 234,4±22,3 g foram divididos em dois grupos: grupo controle recebeu a suplementação de azeite de oliva (rico em ômega-9) por gavagem por sete dias e o grupo estudo recebeu ômega-3 em forma de emulsão isocalórica e isovolumétrica, também por gavagem, na dose de 100 mg/kg/dia por sete dias no pré-operatório. Ambos os grupos foram submetidos à duas colotomias seguidas de anastomose colônica, em cólon direito e cólon esquerdo, respectivamente. Foram avaliados a evolução do peso dos animais, morbimortalidade e realizados testes tensiométrico e de densitometria do colágeno dos corpos de prova. Resultados : Não houve diferenças na evolução do peso e na morbimortalidade entre os grupos. O valor da força de tração máxima do grupo controle foi de 1,9±0,3N e no grupo estudo de 1,7±0,2, p=0,357. Houve, no entanto, maior quantidade de colágeno tipo I (p=0,0126) na anastomose no grupo estudo. O índice de maturação do colágeno foi cálculado para os grupos (1,74±0,71 - grupo controle; 1,67±0,5 - grupo estudo, p=0,719). Conclusões : A suplementação pré-operatória com ácido graxo ômega-3 está associada ao aumento da deposição de colágeno do tipo I em anastomoses de cólon em ratos no 5º dia do pós-operatório, mas não exerce influência na resistência tênsil de colorrafia ou no índice de maturação do colágeno.

Fibrinogen and thrombin concentrations are critical for fibrin glue adherence in rat high-risk colon anastomoses

OBJECTIVE: Fibrin glues have not been consistently successful in preventing the dehiscence of high-risk colonic anastomoses. Fibrinogen and thrombin concentrations in glues determine their ability to function as sealants, healers, and/or adhesives. The objective of the current study was to compare the effects of different concentrations of fibrinogen and thrombin on bursting pressure, leaks, dehiscence, and morphology of high-risk ischemic colonic anastomoses using fibrin glue in rats. METHODS: Colonic anastomoses in adult female Sprague-Dawley rats (weight, 250-350 g) treated with fibrin glue containing different concentrations of fibrinogen and thrombin were evaluated at post-operative day 5. The interventions were low-risk (normal) or high-risk (ischemic) end-to-end colonic anastomoses using polypropylene sutures and topical application of fibrinogen at high (120 mg/mL) or low (40 mg/mL) concentrations and thrombin at high (1000 IU/mL) or low (500 IU/mL) concentrations. RESULTS: Ischemia alone, anastomosis alone, or both together reduced the bursting pressure. Glues containing a low fibrinogen concentration improved this parameter in all cases. High thrombin in combination with low fibrinogen also improved adherence exclusively in low-risk anastomoses. No differences were detected with respect to macroscopic parameters, histopathology, or hydroxyproline content at 5 days post-anastomosis. CONCLUSIONS: Fibrin glue with a low fibrinogen content normalizes the bursting pressure of high-risk ischemic left-colon anastomoses in rats at day 5 after surgery. .

The effects of ghrelin on colonic anastomosis healing in rats

OBJECTIVES: In addition to its roles in the stimulation of growth hormone secretion and the regulation of appetite and metabolism, ghrelin exerts immunomodulatory, anti-inflammatory and antioxidant actions in several organ systems. In this study, we investigated the effects of ghrelin on the healing of experimental colonic anastomoses. METHODS: Wistar rats were randomly divided into two groups (n = 10 in each). A segment of colon was excised, and an end-to-end anastomosis was performed in the distal colon. The Ghrelin Group received 10 ng/kg/day IP ghrelin for seven days postoperatively, whereas the Control Group received an identical volume of saline. On the seventh postoperative day, the anastomotic bursting pressures and hydroxyproline levels were measured, and adhesion formation around the anastomoses was examined. Histopathological analyses were performed to evaluate inflammatory cell infiltration, fibroblast infiltration, collagen density and neovascularization. RESULTS: In the Ghrelin Group, the bursting pressure and hydroxyproline levels were significantly higher than in the Control Group. The adhesion formation scores were lower in the Ghrelin Group than in the Control Group. Although the inflammatory cell infiltration was diminished in the Ghrelin Group, the degrees of fibroblast infiltration, collagen density and neovascularization were not significantly different between the groups. CONCLUSION: Our results indicate that ghrelin improves the healing of colonic anastomoses in rats.

Adipose-tissue-derived Stem Cells Enhance the Healing of Ischemic Colonic Anastomoses: An Experimental Study in Rats

PURPOSE: This experimental study verified the effect of adipose-tissue-derived stem cells (ASCs) on the healing of ischemic colonic anastomoses in rats. METHODS: ASCs were isolated from the subcutaneous fat tissue of rats and identified as mesenchymal stem cells by identification of different potentials. An animal model of colonic ischemic anastomosis was induced by modifying Nagahata's method. Sixty male Sprague-Dawley rats (10-week-old, 370 +/- 50 g) were divided into two groups (n = 30 each): a control group in which the anastomosis was sutured in a single layer with 6-0 polypropylene without any treatment and an ASCtreated group (ASC group) in which the anastomosis was sutured as in the control group, but then ASCs were locally transplanted into the bowel wall around the anastomosis. The rats were sacrificed on postoperative day 7. Healing of the anastomoses was assessed by measuring loss of body weight, wound infection, anastomotic leakage, mortality, adhesion formation, ileus, anastomotic stricture, anastomotic bursting pressure, histopathological features, and microvascular density. RESULTS: No differences in wound infection, anastomotic leakage, or mortality between the two groups were observed. The ASC group had significantly more favorable anastomotic healing, including less body weight lost, less ileus, and fewer ulcers and strictures, than the control group. ASCs augmented bursting pressure and collagen deposition. The histopathological features were significantly more favorable in the ASC group, and microvascular density was significantly higher than it was in the control group. CONCLUSION: Locally-transplanted ASCs enhanced healing of ischemic colonic anastomoses by increasing angiogenesis. ASCs could be a novel strategy for accelerating healing of colonic ischemic risk anastomoses.

Adrenomedulline improves ischemic left colonic anastomotic healing in an experimental rodent model

BACKGROUND: Leakage from colonic anastomosis is a major complication causing increased mortality and morbidity. Ischemia is a well-known cause of this event. This study was designed to investigate the effects of adrenomedullin on the healing of ischemic colon anastomosis in a rat model. METHODS: Standardized left colon resection 3 cm above the peritoneal reflection and colonic anastomosis were performed in 40 Wistar rats that were divided into four groups. To mimic ischemia, the mesocolon was ligated 2 cm from either side of the anastomosis in all of the groups. The control groups (1 and 2) received no further treatment. The experimental groups (3 and 4) received adrenomedullin treatment. Adrenomedullin therapy was started in the perioperative period in group 3 and 4 rats (the therapeutic groups). Group 1 and group 3 rats were sacrificed on postoperative day 3. Group 2 and group 4 rats were sacrificed on postoperative day 7. After careful relaparotomy, bursting pressure, hydroxyproline, malondialdehyde, interleukin 6, nitric oxide, vascular endothelial growth factor, and tumor necrosis factor alpha levels were measured. Histopathological characteristics of the anastomosis were analyzed. RESULTS: The group 3 animals had a significantly higher bursting pressure than group 1 (p<0.05). Hydroxyproline levels in group 1 were significantly lower than in group 3 (p<0.05). The mean bursting pressure was significantly different between group 2 and group 4 (p<0.05). Hydroxyproline levels in groups 3 and 4 were significantly increased by adrenomedullin therapy relative to the control groups (p<0.05). When all groups were compared, malondialdehyde and nitric oxide were significantly lower in the control groups (p<0.05). When vascular endothelial growth factor levels were compared, no statistically significant difference between groups was observed. Interleukin 6 and tumor necrosis factor alpha were significantly decreased by adrenomedullin therapy (p<0.05). The healing parameters and inflammatory changes (e.g., granulocytic cell infiltration, necrosis, and exudate) were significantly different among all groups (p<0.05). CONCLUSION: Adrenomedullin had positive effects on histopathologic anastomotic healing in this experimental model of ischemic colon anastomosis.

Effects of the histamine H2 receptor antagonist famotidine on the healing of colonic anastomosis in rats

BACKGROUND: Failure of anastomotic healing is one of the major complications in colorectal surgery. Because histamine plays an important role in immune and inflammatory reactions, we demonstrate the effects of famotidine on the healing of colonic anastomosis in rats. METHODS: Twenty-eight Sprague-Dawley rats were used in the study. Excision and end-to-end anastomosis was performed in the distal colon of the rat. The Famotidine Group received 2 mg/kg/day famotidine; the Control Group received the same amount of saline. Bursting pressure of anastomoses and hydroxyproline content of perianastomotic tissues were evaluated on the third and seventh days following surgery. RESULTS: Bursting pressures and hydroxyproline contents for the Famotidine Group were significantly lower than the equivalent parameters for the Control Group on both the third and seventh days post-surgery. CONCLUSIONS: According to our findings, famotidine exerts detrimental effects on the anastomotic bursting pressure and hydroxyproline content of perianastomotic tissues in the colon of rats.

Effect of thalidomide on the healing of colonic anastomosis, in rats / Efeito da talidomida na cicatrização de anastomoses colônicas em ratos

PURPOSE: Thalidomide, because of its anti-inflammatory properties, as re-emerged as an option for the treatment of Crohn's disease refractory to standard therapy. We studied the effect of thalidomide on the healing of colonic anastomosis. METHODS: Sixty male rats (Rattus norvegicus), were divided into 3 groups of 20 animals each, respectively receiving 0.5 or 1.0 mg/kg thalidomide by the oral route for 7 days, or saline solution (control). All animals were submitted to continuous end-to-end anastomosis with 6-0 Prolene sutures. After sacrifice the anastomoses were analyzed macroscopically and submitted to determination of hydroxyproline, to histology and to immunohistochemistry for metalloproteinase 1, metalloproteinase 1 inhibitor and vascular endothelial growth factor (VEGF). RESULTS: Statistical analysis of the data showed no significant difference in macroscopic aspect or hydroxyproline determination (p= 0.5403). In the immunohistochemical analysis, the following p values were obtained: p = 0.5817 for VEGF, p = 0.1854 for metalloproteinase 1, and p = 0.0023 for metalloproteinase 1 inhibitor, with this last value being considered statistically significant. CONCLUSION: We conclude that thalidomide influenced collagen maturation. There was a stronger action of metalloproteinases, possibly indicating a negative tendency for the healing process.

OBJETIVO: Sabe-se que agentes farmacológicos podem influenciar no processo de cicatrização. A talidomida, devido às suas propriedades antiinflamatórias, tem ressurgido como uma opção no tratamento da doença de Crõhn refratária à terapêutica convencional. Neste trabalho, estudamos o efeito da talidomida na cicatrização de anastomoses colônicas no rato. MÉTODOS: Foram utilizados 60 animais Rattus norvegius, com peso médio de 300g. Organizou-se 3 grupos de 20 animais, sendo um grupo controle (AC), um grupo (BD), com administração de talidomida 0,5 mg/kg por 7 dias e um grupo (AD) com administração de talidomida 1,0 mg/kg por 7 dias. Foi realizada anastomose término-terminal contínua de prolene 6-0. O sacrifício foi no 7º. dia pós operatório e as anastomoses foram analisadas quanto a aspecto macroscópico, dosagem de hidroxiprolina, histologia em hematoxilina-eosina e imuno-histoquímica para metaloproteinase 1, inibidor de metaloproteinase 1 e VEGF. RESULTADOS: Não houve diferença estatisticamente significante para a observação macroscópica e para dosagem de hidroxiprolina (p=0,5403). Na análise imunohistoquímica, para VEGF houve p=0,5817, para metaloproteinase 1, p=0,1854 e para inibidor de metaloproteinase, p=0,0023, considerado estatisticamente significante. CONCLUSÃO: Concluímos que a talidomida influenciou na maturação do colágeno. Notou-se maior ação das metaloproteinases, que pode significar uma tendência negativa para o processo cicatricial.

Laparoscopy and colonoscopy for left-sided colonic carcinoma with acute bowel obstruction / 中华普通外科杂志

Objective To evaluate the effect of via-anal preoperative depression with assistance of colonoscopy and primary stage laparoscopic cancer resection and anastomosis for the treatment of malignant obstruction of left-sided colon. Methods Eleven cases of malignant left-sided colonic obstruction were treated from December 2004 to August 2007 by this modality.With the help of colonoseopy and the guiding of radiography,ileus tube was inserted into the proximal bowel of the obstructive site via anus.We used the tubes to decompress the dilated bowel.Patient's symptom,bowel sounds,abdominal girth,intra-abdominal pressure,plain abdominal radiograph were observed.After the relief of bowel obstruction,elective laparoseopic colorectal resection and anastomosis was accomplished in one stage with routine preoperative preparation.Results After 5～14 days of depression by ileus tube,the relief of bowel obstruction was achieved in all these patients hence emergency operation wag avoided.Elective first-staged laparoseopic resection and anastomosis was performed in all 11 cases.The complications such as anastomotic leakage and incisional/abdominal cavity infection were not observed.After an average 15.2-month fouow up,local recurrence rate,incisional or port implantation rate,and tunlor-free survival rate were 9%,0 and 91% respectively. Conclusions First-staged laparoscopic resection and anastomosis assisted by preoperative colonoscopic depression in malignant left-sided colonic obstruction is a safe and effective procedure.

Influência da cola Bioglue® na deiscência de anastomose colônica: estudo experimental / Influence of Bioglue® surgical adhesive on colonic anastomosis dehiscence: experimental study

A grande parte da morbimortalidade associada com a cirurgia colorretal, é associada com a deiscência anastomótica. Trabalhos experimentais sobre a utilidade de adesivos tissulares nas anastomoses colônicas são controversos, assim como estudos clínicos prospectivos randomizados são ausentes. O adesivo cirúrgico BioGlue®, formado por dois componentes - albumina sérica bovina purificada e glutaraldeído, forma uma ligação co-valente entre esses dois componentes e as proteínas teciduais no local de aplicação. O objetivo do estudo é avaliar a eficácia da BioGlue® na prevenção da deiscência anastomótica colônica em ratos. Foram utilizados 30 ratos machos da raça Wistar albino. A anastomose colocolônica foi confeccionada com sutura em pontos separados com polipropileno 5-0 (grupo 1) e aplicação da cola BioGlue® envolvendo a anastomose (grupo 2). Avaliaram-se a formação e extensão das aderências, a pressão de ruptura nas anastomoses e as alterações histológicas. Apenas um animal do grupo 1 (7 por cento) faleceu, sendo constatada na necropsia, obstrução intestinal com grande distensão de alças. A mortalidade no grupo 2, por outro lado, foi de 10 animais (67 por cento), sendo observado: distensão de alças intestinais, vazamento anastomótico e, em algumas situações, franca peritonite fecal por deiscência quase que total da anastomose. O presente trabalho nos permitiu concluir que, o uso da Bioglue® nas anastomoses colônicas realizadas em ratos, promoveu um aumento na morbimortalidade que foi estatisticamente significante comparado à sutura convencional.

The great part of the morbimortality associated with the colorretal surgery, is related with the anastomotic dehiscence. Experimental trials on the utility of tissue adhesives in the colonic anastomosis are controversial, as well as prospective randomized clinical studies are absent. BioGlue® Surgical Adhesive(BSA) is a two-component surgical adhesive composed of purified bovine serum albumin and glutaraldehyde. The glutaraldehyde molecules covalently bond (cross-link) the BSA molecules to each other and, upon application, to the tissue proteins at the repair site. The aim of this study is to evaluate the effectiveness of the BioGlue® in the prevention of the anastomotic colonic dehiscence in rats. Thirty male Wistar rats had been used. The colocolonic anastomosis was confectioned with separate stitches with polypropylene 5-0 (group 1) and the application of the BioGlue® Surgical Adhesive (group 2). The formation and extension of the adhesions, the histological alterations and the rupture pressure had been evaluated. In the group 1, we have only 7 percent of mortality (01 animal), being evidenced in the autopsy, intestinal obstruction with major bowel distension. The mortality in group 2, on the other hand, was 67 percent (10 animals), being observed: bowel distension, anastomotic dehiscence and, in some situations, fecal peritonitis because of anastomotic total dehiscence. We concluded in the present study that, the use of BioGlue® Surgical Adhesive in colonic anastomosis in rats, is associated with an increase of the morbimortality in comparison with conventional suture which was statistically significant.

EFFECT OF SOD ON THE HEALING OF COLONIC ANASTOMOSIS IN THE RAT / 重庆医科大学学报

One hundred and twenty-four male wistar rats were allocated rendomly to control and SOD group. The tensile strength, hydroxyproline contents and histologic changes of colonic anastomosis and MDA contents in plasma were observed on the 1st, 3rd, 7th day after surgery. The results show tensile strength and hydroxypr-oline contents in SOD group were much higher than that in control (P