Prosthetic graft placement using the deep forearm veins in hemodialysis patients: a preliminary report.

When the superficial arm veins are not suitable for the creation of a conventional endogenous arteriovenous (A-V) fistula or the placement of a prosthetic graft in the forearm, the use of the deep forearm veins as an outflow system to construct an A-V graft access seems to be a reasonable alternative. Using this approach, we placed 6 prosthetic grafts in 6 hemodialysis patients in whom conventional methods had failed. Adequate functioning of this 'deep vein'-type vascular access in these 6 patients has been maintained for 3, 6, 11, 15, 19 and 24 months, respectively, without complications or any need for further interventions. Only one graft failed after 6 months. Our preliminary results indicate that this technique can be used successfully when the superficial forearm veins have been exhausted, thus avoiding the use of upper-arm or axillary veins.

Long-term evaluation of sclerotherapy for haemorrhoids. A prospective study.

BACKGROUND: Sclerotherapy is one of the older methods of conservative treatment of haemorrhoids. It has been widely used and the early results are considered satisfactory although the long-term results are not as good as expected. AIMS: The evaluation of long-term results of sclerotherapy in patients with symptomatic 1st and 2nd degree haemorrhoids. METHODS: From 1990 until 1996, 240 outpatients, 154 men and 86 women, with symptomatic 1st and 2nd degree haemorrhoids, underwent sclerotherapy. The most common symptoms were bleeding for patients with 1st degree haemorrhoids and prolapse for patients with 2nd degree. After 3 years all patients were called and examined and their symptoms were recorded. 38 patients were excluded. RESULTS: 3 years after sclerotherapy 20 patients (20.2%) with 1st degree haemorrhoids and 9 patients (8.7%) with 2nd degree were symptoms free. 42 patients (42.4%) with 1st degree haemorrhoids and 66 patients (64.1%) with 2nd degree were worse, and the remainder were either improved or unchanged. Bleeding and prolapse were the most frequent recurrent symptoms. CONCLUSION: The frequency of recurrent symptoms 3 years after sclerotherapy for symptomatic 1st and 2nd degree haemorrhoids is high. Sclerotherapy appears to be an inappropriate method of treatment for symptomatic 1st and especially 2nd degree haemorrhoids.

Effect of early postoperative enteral feeding on the healing of colonic anastomoses in rats. Comparison of three different enteral diets.

This experimental study compares the effects of early postoperative administration of three enteral diets of different compositions on the healing of colonic anastomoses. Sixty Wistar rats were subjected to colonic anastomoses. Following surgery, the rats were randomly allocated to four groups of 15 each. The rats in control group A received an electrolyte and glucose solution, the rats in group B received a complete balanced nutrition, in group C a complete balanced nutrition supplemented with fiber and in group D an isocaloric specialized elemental nutrition enriched with glutamine. The rats were sacrificed on day 7 following operation. Rupture of the anastomosis was higher in rats of the control group compared to the other three groups. Adhesion formation was more extensive in group A in comparison to the other three groups. The anastomotic bursting pressures were statistically significantly higher in groups C and D compared to the other two groups (p < 0.05). There was no statistically significant difference between group C and D (p > 0.05) while a statistically significant difference was noted between group B and group A (p < 0.05). Histological examination showed more profound inflammatory reaction in group A compared to the other three groups. There was also a statistically significant difference between group B and groups C and D while inflammatory reaction was of no statistically significant difference between group C and group D. Healing of the anastomoses was statistically significantly impaired in group A compared to the other three groups. There was no statistically significant difference between group C and group D while a statistically significant difference was found between group B and groups C and D. In conclusion, early postoperative enteral feeding improves healing of experimental colonic anastomoses in rats. This effect was more evident when fiber-supplemented diets or diets enriched with glutamine were administered.

Effect of early versus delayed postoperative injection of 5-fluorouracil plus interferon-alpha on colonic healing.

The purpose of this study was to determine whether delayed, postoperative, intraperitoneal treatment with 5-fluorouracil (5-FU) plus interferon-alpha-2a (IFN) has adverse effects on colonic healing, as does early treatment. Seventy male Wistar rats underwent colonic anastomoses. The rats were randomized to one of four groups. Early intraperitoneal injection was given to groups 1 and 2 which was repeated once daily for the first 3 postoperative days. Treatment was delayed in groups 3 and 4, from the 4th to the 7th postoperative day. A 0.9% NaCl solution was injected in the rats of control groups 1 and 3. In groups 2 and 4, we infused 5-FU (20 mg/kg/day) and IFN (45,000 IU/kg/day). All the animals were sacrificed on the 8th postoperative day. The anastomotic rupture rate was significantly higher in the rats of group 2 compared to control group 1 (p < 0.05), while there were no differences between groups 3 and 4 (p > 0.05). Abscess formation and adhesions were more frequent in group 2 compared to control group 1, while no differences were observed between groups 3 and 4. Anastomotic bursting pressure was statistically significantly lower in the rats of group 2 compared to group 1 (p < 0.05); no differences were noticed between groups 3 and 4 (p > 0.05). Simultaneous histologic evaluation showed a more profound inflammatory reaction and delayed anastomotic healing in group 2 compared to control group 1; there were, however, no differences between groups 3 and 4. In conclusion, the immediate, postoperative, intraperitoneal injection of 5-FU plus IFN impairs colonic healing while delayed treatment (starting on the 4th postoperative day) has no adverse effects on wound healing.

Colonic healing after early intraperitoneal administration of 5-fluorouracil and interferon in rats.

The aim of this experimental study was to investigate whether the intraperitoneal perioperative injection of 5-flurouracil (5-FU)--with or without the addition of interferon (INT)--influences colonic healing. We used 57 male Wistar rats which were subjected to anastomosis of the colon. Intraoperatively, the rats were randomised into one of three groups. The rats in the control group (group 1, n = 15) received a 0.9% NaCl solution; the rats in group 2 (n = 21), 5-FU (20 mg/Kg/day), and those in group 3 (n = 21), 5-FU (20 mg/Kg/day) plus INT (45,000 IU/Kg/day). These drugs were injected intraperitoneally during the operation and once daily for the next two days. The rats were sacrificed on post-operative days 3, 5 or 8. The rupture rate of the anastomoses was statistically significantly higher in groups 2 and 3, compared with the control group (P < 0.05); no differences were observed between groups 2 and 3. Abscess and adhesion formation were more marked in groups 2 and 3 than in the control group; however no differences were recorded between groups 2 and 3. The anastomotic bursting pressure was statistically significantly lower in groups 2 and 3 compared to the control group (P < 0.05), on post-operative days 5 and 8; however, no differences were measured between groups 2 and 3. Histologic evaluation also showed a more profound inflammatory response in groups 2 and 3, compared with group 1. In conclusion, the intraperitoneal, intraoperative administration of 5-FU hinders colonic healing in rats. The additional intraperitoneal injection of interferon does not seem to aggravate this adverse effect.

Influence of intraperitoneal 5-fluorouracil plus folinic acid on the healing of colonic anastomoses in rats.

We studied the effects of intraperitoneal 5-fluorouracil (5-FU) administration with or without the addition of folinic acid (FA) on the healing of colonic anastomoses in rats immediately after surgery. Sixty-three male Wistar rats were subjected to colonic anastomosis. During surgery, the rats were randomized into one of three groups. Therapy was administered as an intraoperative intraperitoneal injection which was repeated once daily for the first 2 postoperative days. A 0.9% NaCl solution was administered to the rats in the control group. In group 2, we injected 5-FU (20 mg/kg/day) and in group 3 5-FU (20 mg/kg/day) plus FA (2 mg/kg/day). The rats were sacrificed on postoperative days 3, 5 or 8. Rupture of the anastomosis was significantly higher in the rats of groups 2 and 3, compared with the control group (p < 0.05). There were, however, no differences between groups 2 and 3. Formation of adhesions and abscesses was more common in groups 2 and 3 than in the control group for all study days. A significant difference in the anastomotic bursting pressure was measured for the control group in comparison to groups 2 and 3 on days 5 and 8 (p < 0.05). Histologic evaluation also showed a more profound inflammatory reaction and delayed healing of the anastomoses in groups 2 and 3, compared to the control group. Therefore, the perioperative intraperitoneal administration of 5-FU can inhibit the healing of colonic anastomoses in rats. The addition of an intraperitoneal injection of FA does not aggravate this negative effect.

Ultrastructural alterations of the rat intestinal epithelium fed with polymeric, oligopeptidic or elementary full diet, following starvation.

In this study the ultrastructure of rat jejunal epithelial cells was examined, following a starvation period of 72 hours and an enteral refeeding period of 12 days, with either Nutrison, Pepti 2000, or Nutri 2000. Most changes occurred in the animals examined immediately after the 72-hour starvation period; these mainly included a significant decrease in microvilli population, occasional cell membrane disintegration, and a usual microvesicular appearance and degranulation of the rough endoplasmic reticulum. No alterations were found in the normally-fed animals (control group). This was also practically the same for the Pepti 2000 group. In the Nutrison group, a small amount of changes were found, while in the Nutri 2000 group many alterations were detected, which nevertheless were fewer than in the starved animals. The results demonstrate that the micromorphological alterations of the intestinal epithelium caused by starvation improve faster when an oligopeptidic formula is provided, which consequently results in faster and better absorption of the nutrients.