Subject(s)
Rectal Neoplasms/therapy , Colostomy , Combined Modality Therapy , Humans , Rectal Neoplasms/pathologySubject(s)
Digestive System Surgical Procedures/methods , Endoscopy, Digestive System , Minimally Invasive Surgical Procedures/methods , Rectal Neoplasms/surgery , Anal Canal , Digestive System Surgical Procedures/instrumentation , Humans , Minimally Invasive Surgical Procedures/instrumentation , Neoplasm Recurrence, Local , Postoperative Complications , Surgical InstrumentsABSTRACT
Intestinal epithelial cells migrate from the base of the crypt to the villi where they are shed. However, little is known about the cell shedding process. We have studied the role of apoptosis and wound healing mechanisms in cell shedding from human small intestinal epithelium. A method preparing paraffin sections of human small intestine that preserves cell shedding was developed. A total of 14 417 villus sections were studied. The relationship of cell shedding to leukocytes (CD45), macrophages (CD68) and blood vessels (CD34) were studied by immunohistochemistry. Apoptotic cells were identified using the M30 antibody against cleaved cytokeratin 18 and an antibody against cleaved caspase-3. Potential wound healing mechanisms were studied using antibodies against Zona Occludens-1 (ZO-1) and phosphorylated myosin light chains (MLCs). We found that 5.3% of villus sections contained a shedding cell. An eosin-positive gap was often seen within the epithelial monolayer beneath shedding cells. Shedding was not associated with leukocytes, macrophages or blood vessels. Cells always underwent apoptosis during ejection from the monolayer. Apoptotic bodies were never seen in the monolayer but morphologically normal cells that were positive for M30 or cleaved caspase-3 were often seen. ZO-1 protein was usually (41/42) localized to the apical pole of cells neighboring a shedding event. Phosphorylated MLCs could be identified in 50% of shedding events. In conclusion, cell shedding is associated with apoptosis though it remains unclear whether apoptosis initiates shedding. It is also associated with phosphorylation of MLCs; a process associated previously with wound healing.
Subject(s)
Anoikis/physiology , Apoptosis/physiology , Ileum/cytology , Intestinal Mucosa/cytology , Tissue Fixation/methods , Adult , Aged , Female , Humans , Male , Membrane Proteins/metabolism , Middle Aged , Myosin Light Chains/metabolism , Phosphoproteins/metabolism , Sulfonamides , Wound Healing , Zonula Occludens-1 Protein , beta-Alanine/analogs & derivativesABSTRACT
Therapy for adhesions encompasses their prevention and treatment. They are reduced in number and severity by good surgical technique but anti-adhesion agents are useful adjuncts. Small bowel obstruction secondary to adhesions requires surgery following resuscitation if signs of peritonism develop. Otherwise a trial of conservative therapy is advocated.
Subject(s)
Postoperative Complications/therapy , Tissue Adhesions/therapy , Abdomen , Humans , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Intestine, Small , Pharmaceutical Solutions/therapeutic use , Postoperative Complications/drug therapy , Postoperative Complications/surgery , Reoperation , Tissue Adhesions/drug therapy , Tissue Adhesions/surgeryABSTRACT
Stapled haemorrhoidectomy is an effective procedure for symptomatic haemorrhoids with mucosal prolapse. The advantages over the conventional surgical technique include reduced postoperative pain, shorter hospital stay and earlier return to work.
Subject(s)
Hemorrhoids/surgery , Surgical Stapling/methods , Anesthesia , Decision Making , Equipment Design , Humans , Patient Selection , Postoperative Care/methods , Rectal Prolapse/surgery , Surgical Instruments , Surgical Stapling/instrumentationABSTRACT
The follow up of patients after colorectal cancer surgery remains controversial. It may be intensive or minimal. The authors describe an intensive follow-up regimen and discuss the leading role of the colorectal specialist nurse. In the absence of evidence from randomized trials, the most persuasive arguments for routine follow up are patient support and audit.
Subject(s)
Colorectal Neoplasms/nursing , Ambulatory Care/organization & administration , Follow-Up Studies , Humans , Neoplasm Recurrence, Local/nursing , Nurse Clinicians , Nurse's Role , Oncology Nursing/methods , Quality of Health Care , Social Support , United KingdomABSTRACT
Ulcerative colitis is potentially cured by total excision of the colon and rectum. Crohn's disease is an unremitting condition in which operations are frequently multiple and in which the minimum amount of bowel possible should be excised.
Subject(s)
Colitis, Ulcerative/surgery , Crohn Disease/surgery , Colectomy/methods , Duodenal Diseases/surgery , Humans , Laparoscopy/methods , Postoperative Complications/etiology , Stomach Diseases/surgeryABSTRACT
Laparoscopic surgery for inflammatory bowel disease is an expanding field, which has physical benefits to the patient and economic benefits to the trust and community.
Subject(s)
Colitis, Ulcerative/surgery , Crohn Disease/surgery , Laparoscopy/methods , Colectomy/methods , Colonic Pouches , Contraindications , Humans , Surgical StomasABSTRACT
This study assesses the practicality, mortality and morbidity of the STAR procedure for debulking of large rectal tumours prior to transanal endoscopic microsurgery.
