Abdominoperineal resection for rectal cancer: is the pelvic drain externalization site an independent risk factor for perineal wound healing?

Aim. The aim of this paper is to investigate if the insertion of the pelvic drainage tube via the perineal wound could be considered as an independent risk factor for perineal healing disorders, after abdominoperineal resection for rectal malignancy. Patients and Methods. The last two decades, 75 patients underwent elective abdominoperineal resection for malignancy. In 42 patients (56%), the pelvic drain catheter was inserted through the perineal wound (PW group), while in the remaining 33 (44%) through a puncture skin wound of the perineum (SW group). Patients' data with respect to age (P = 0.136), stage (P > 0.05), sex (P = 0.188) and comorbidity (P = 0.128) were similar in both groups. 25 patients (PW versus SW: 8 versus 17, P = 0.0026) underwent neoadjuvant radio/chemotherapy. Results. The overall morbidity rate was 36%, but a significant increase was revealed in PW group (52.4% versus 9%, P = 0.0007). In 33.3% of the patients in the PW group, perineal healing was delayed, while in the SW group, no delay was noted. Perineal healing disorders were revealed as the main source of increased morbidity in this group. Conclusion. The insertion of the pelvic drain tube through the perineal wound should be considered as an independent risk factor predisposing to perineal healing disorders.

Defunctioning ileostomy closure following low anterior resection by chemotherapy.

AIM: The aim of this study is to review the time between formation and closure of loop ileostomies following total mesorectal excision in patients with rectal cancer. PATIENTS AND METHODS: A retrospective study of 170 patients who underwent low anterior resection for rectal cancer, between 1990 and 2009. Loop ileostomies were created in 8 patients. RESULTS: Of the 8 patients with defunctioning loop ileostomies, 4 received adjuvant chemo-radiotherapy, 3 received neo-adjuvant chemo-radiotherapy and 1 did not receive anything. There was 12.5% morbidity. The time from formation to closure for the patient with no adjuvant therapy was 3 months and for those with adjuvant therapy was 7 months. This was a significant delay. CONCLUSION: Time between formation and closure of loop ileostomy following anterior resection of rectum is significantly delayed by adjuvant chemotherapy.

Anastomotic leakage following low anterior resection for rectal cancer.

AIM: Aim of this study is to present the incidence of anastomotic leakage after anterior resection for rectal cancer and to demonstrate the therapeutic approach for the treatment of this complication. PATIENTS AND METHODS: Between 1990 and 2009, 170 patients underwent low anterior resection with total mesorectal excision (TME). RESULTS: A total of 14 (8.2%) anastomotic leaks were confirmed. Reoperation was carried out in six patients with major leaks. Eight patients with minor leaks were treated conservatively by nutritional support and antibiotic therapy. CONCLUSION: The incidence of anastomotic leakage after anterior resection of the rectum for rectal cancer is relatively low.

Breast tumor developed in a pregnant rat after treatment with the teratogen Cycloheximide.

AIM: To describe histochemically and immunohistochemically a breast tumor presented in a pregnant rat given Cycloheximide to examine its teratogenic and embryotoxic effect on the embryos. METHODS: Cycloheximide was injected in pregnant Wistar rats at a dose of 3 mg/kg.b.w. on both 10th and 11th gestational days. In one of the rats, a large breast tumor developed rapidly. Histochemical staining with Hematoxylin-Eosin and Masson Trichrome and immunohistochemical identification with mouse monoclonal antibodies: a) Estrogen Receptor A and b) Estrogen Receptor B was performed. RESULTS: Analysis with A-receptor and B-receptor showed that the breast tumor which was developed after treatment with Cycloheximide was malignant. Positive immunohistochemical reaction was evident especially with A-receptor indicating the malignancy of the tumor. CONCLUSIONS: Cycloheximide is a known toxic and teratogenic agent and potentially a carcinogenic drug. Thus it should be used with extreme caution as a pesticide.

Detection of tract formation for prevention of bile peritonitis after T-tube removal. Case report.

Bile leakage after removal of T-tube is a relatively rare complication caused by inadequate tract formation around the tube. We report a case of bile peritonitis after removal of a latex T-tube. The patient underwent reoperation and a new T-tube was introduced. The T-tube was removed six weeks later. Immediately after removal of the tube, the cutaneous ostium of the tube was catheterized with a thin Nelaton catheter. The administration of gastrographin showed the presence of an intact tract. The removal of the t-tube was uneventful. We would propose this method for detecting the tract after removal of the T-tube in order to prevent severe bile leakage after inadequate tract formation.

Tension-free repair versus modified Bassini technique (Andrews technique) for strangulated inguinal hernia: a comparative study.

BACKGROUND: To compare tension-free hernia repair to a modified Bassini technique (Andrew's technique) used to treat complicated inguinal hernia. METHODS: In the period 1990-2004, 75 patients were submitted to emergency operation because of strangulated inguinal hernia. 33 patients underwent tension-free repair utilizing a polypropylene mesh (group A), whereas the remaining 42 patients underwent a modified Bassini technique (group B). RESULTS: Mean operative time was significantly longer for group B (91.5+/-9.3 min vs 75.7+/-10.5 min, p<0.05). Postoperative hospital stay was also significantly longer in group B compared to group A (10.3+/-3.4 days vs 4.5+/-2.1 days, p<0.01). Postoperative complication rate did not differ significantly between the two groups (5/33, 15.1% vs 5/42, 11.9%, p=n.s.). No mesh had to be removed. At follow-up (mean 9+/-4.2 years), there was one recurrence in group A (1/33, 3%) and two recurrences in group B (2/42, 4.7%) (p=n.s.). CONCLUSION: The presence of a strangulated inguinal hernia cannot be considered a contraindication for the use of a prosthetic mesh.

Functional capacity of the thyroid autograft: an experimental study.

BACKGROUND: The aim of this study was to investigate the functional capacity of thyroid autografts after total thyroidectomy in a rabbit model. MATERIAL AND METHODS: Thirty-eight rabbits underwent total thyroidetomy. One of the two thyroid lobes was cut into 1-mm pieces and was introduced intramuscularly into the right quadriceps muscle (group A, n = 10), the right rectus abdominalis muscle (group B, n = 10), and the right sacrodorsalis muscle (group C, n = 10). Another group of 8 rabbits underwent total thyroidectomy without autologous implantation and served as the control group (group D). The animals were observed for 8 weeks with weekly measurements of thyroid hormones. At the end of the 8th week, a scintigram was performed. The autografts were removed 2 days later. RESULTS: The thyroid hormone levels showed a gradual decrease until the 2nd-5th week after implantation, followed by a gradual increase and establishment of euthyroid levels between the 5th and 8th weeks. Respectively, an increase of thyreotropin hormone was noted with maximal values in the 4th week, followed by a gradual decrease until the end of the 8th week. The scintigram at the end of the 8th week revealed the presence of functional thyroid tissue in all cases. Functional thyroid follicles were found in all animals who survived. In 35.7% of the autografts, we noted the development of fibrous tissue and gigantocytic granulomas in the periphery, which could be interpretated as a "foreign body" reaction. CONCLUSION: Thyroid autografts can completely substitute thyroid function after total thyroidectomy.

[Unusual complications of the Peutz-Jeghers-syndrome in two consecutive generations of the same family]. / Ungewöhnliche Komplikationen des Peutz-Jeghers-Syndroms in zwei Generationen derselben Familie.

The Peutz-Jeghers syndrome is an autosomal dominant inherited disease, characterized by the presence of hamartomatous polyposis of the gastrointestinal tract and perioral mucocutaneous pigmentation. The incidence of surgical complications in these patients is relatively rare, and correlates with the size and location of the polyps. We report on two complications of the Peutz-Jeghers syndrome which occurred in two generations of the same family. There was a perforation and an invagination of the small intestine. Both cases were treated by resection of the small intestine.

[Skin and soft tissue defects at the lower extremities -- primary and secondary procedures (author's transl)]. / Deckung von Haut- und Weichteildefekten an der unteren Extremität. Indikation und Ergebnisse gestielter Fernlappenplastiken bei der primären und sekundären Versorgung grösserer Defekte.

Methods of surgical reconstruction which are available for wound closure on the lower extremities, following injury of full-thickness defects, are discussed -- especially in relation to indications of primary and secondary procedures. Special mention is given to cross-leg-flaps and tube pedicles of the legs. Indications and technical considerations involved in the treatment of 31 patients with cross-leg-flaps and 38 patients with tube pedicles are reported, as the results obtained from these operations. Out of 50 abdominal tube pedicles (38 patients), 12% were unsuccessful. 30 of the 31 cross-leg-flap were grafted successfully to their predestined sit.