Evaluation of the microcirculation in hypertension and cardiovascular disease.

The ability to investigate the microvascular structure and function is important in improving our understanding of pathophysiological processes in hypertension and related cardiovascular disease. A range of techniques are available or emerging for investigating different aspects of the microcirculation in animals and humans. Techniques such as experimental intravital microscopy and clinical intravital microscopy (e.g. orthogonal polarization spectral imaging) allow visualization at the level of single microvessels. Venous occlusion plethysmography can be used to measure blood flow in organs, and laser Doppler flowmetry to measure red cell flux in small areas of tissue. Positron emission tomography, myocardial contrast echocardiography, and magnetic resonance imaging provide three-dimensional imaging of local blood flow. The current and potential clinical usefulness of these different techniques is evaluated. The technical quality and availability for clinical use of some of the techniques should improve dramatically during the next few years. 'Molecular imaging'-the combination of these techniques with genetic, molecular, and computational approaches-offers great potential for use in research and in diagnosis and the monitoring of disease progression or the results of therapy. Closer attention to the microcirculation will ultimately improve the treatment and prevention of many of the most important forms of cardiovascular disease.

Cancer of ileostomy: a late complication of colectomy for ulcerative colitis.

Cancer arising at an ileostomy site represents a rare late complication of total colectomy performed for ulcerative colitis. There are no more than 36 published cases in the literature. We describe a case of adenocarcinoma of the mucocutaneous junction at the ileostomy site, occurring 31 years after total colectomy for ulcerative colitis. Wide excision of the moderately differentiated adenocarcinoma was performed with refashioning of the ileostomy. Polypoid adenomas or adenocarcinomas of the ileostomy after colectomy performed for non-neoplastic conditions are extremely uncommon. Biopsies of polypoid lesions at the stoma site are recommended.

Gastric re-resection in emergency.

BACKGROUND/AIMS: We reviewed a consecutive series of patients with acute complications following gastric resection, in order to evaluate the role of gastric re-resection as the operation of choice in emergency. METHODOLOGY: Records of 90 patients with acute complications following gastric resection observed from January 1991 to January 1996 were retrospectively analyzed. RESULTS: Hemorrhagic events occurred in the vast majority of cases (87), either as acute complications after a long time since surgery (78 cases) or as early postoperative complications (9). Among late acute complications, three cases were related to bleeding cancer of the gastric stump. Anastomotic obstructions presenting as acute complications occurred in 3 cases. Emergency surgery was indicated in three cases of acute obstruction, in 1 case of bleeding cancer of the gastric stump, in 9 (12%) out of the 75 remaining late acute hemorrhagic complications and in 1 (11%) out of 9 early hemorrhagic complications. Completion gastrectomy was chosen in the one case of bleeding cancer of the gastric stump with indication for emergency surgery. Gastric re-resection was performed in 11 cases: 9 for hemorrhagic complications and 2 for obstructive acute complications. In two cases, one for hemorrhage and one for occlusion, other surgical procedures were carried out. CONCLUSIONS: Gastric re-resection can represent the most suitable operation in acute complications following gastric resection.