Effect of Alprostadil on Colorectal Anastomoses Under Relative Ischemia.

BACKGROUND: Anastomotic leak after colorectal surgery, which remains a serious clinical problem that causes augmented morbidity and mortality, is usually favored by ischemia. The aim of this study was to determine whether alprostadil may improve anastomotic wound healing under ischemic condition. METHODS: Ninety-three adult Wistar rats were randomized into three groups: control, ischemia (by devascularization along the first 2 cm at each anastomotic end), and ischemia plus alprostadil. Resection of a colonic segment at the colorectal junction and an anastomosis was performed. Animals were euthanized at 8 d. Surgical site infection, anastomotic leak, and grade of intra-abdominal adhesions using a validated scale were determined. Bursting pressure and tension were calculated and histologic examination of the anastomosis was performed. RESULTS: The ischemic group revealed an increased anastomotic leak rate (14/31 versus 3/31) and a lower bursting pressure and tension when compared to control group, validating therefore the experimental model. After intraperitoneal injection of alprostadil, anastomotic leak rate was significantly lower (5/31) and the bursting pressure and tension were significantly increased. Histologic examination revealed a lower presence of inflammatory cells, and a significantly higher neovascularization and a higher presence of fibroblasts in treated animals when compared with the ischemic group. CONCLUSIONS: Alprostadil may have a positive effect on colonic anastomotic wound healing under relative ischemic condition. Alprostadil administration increases anastomotic bursting pressure, decreases leak rate, and reverses most of the histological changes caused by blood flow decrease. These protective effects could be caused by vasodilation, stimulation of neovascularization, and immunomodulatory properties.

Effect of pentoxifylline on the healing of ischemic colorectal anastomoses.

PURPOSE: The aim of this study was to evaluate the effect of pentoxifylline on the healing of experimental ischemic colorectal anastomoses. METHODS: Ninety-three Wistar rats were randomized into three groups (n = 31) and underwent resection of a colonic segment at the colorectal junction. Group A rats received standard end-to-end anastomoses. Ischemic anastomoses were performed in Groups B and C rats by coagulating mesocolon vessels 2 cm along each anastomotic end. Group C rats were treated with intraperitoneal injection of pentoxifylline. Wound complications, intra-abdominal abscesses, intraperitoneal adhesions, and anastomotic leaks and stenosis were recorded. Bursting pressure and tension were calculated. Histologic examination of the anastomosis was also performed. RESULTS: Ischemia increased wound and intra-abdominal infections, adhesion formation, and anastomotic stenosis. Anastomotic leakage was significantly higher in Group B (45.2 percent) than in Group A (9.7 percent). Bursting pressure and tension were significantly lower in Group B (118.19 mmHg and 48.43 N/m) than in Group A (191.84 mmHg and 86.82 N/m). There was evidence for decreased perianastomotic fibrosis and neutrophils presence after induced ischemia and a strong tendency to reduced neovascularization. Pentoxifylline administration ameliorated the effects of ischemia, reducing wound and intra-abdominal infections, adhesion formation, and leaks (16.1 percent). Anastomotic strength increased (bursting pressure and tension of 205.55 mmHg and 87.68 N/m, respectively). Treated Group C had significantly higher neutrophils infiltration and fibrosis formation and a strong tendency to increased neovascularization compared with Group B. CONCLUSIONS: Selective anastomotic devascularization induces ischemia and impairs experimental anastomotic healing, increasing leakage rate. These effects may be ameliorated by pentoxifylline administration.

Carcinoma de mama en el varón. Análisis de 5 casos y revisión bibliográfica / Breast carcinoma in males. Analysis of 5 cases and bibliographic review

El carcinoma de mama es muy poco frecuente en el varón (0,1 a 0,2 por ciento de todos los cánceres masculinos), lo que condiciona diagnósticos más tardíos que ensombrecen el pronóstico. Se presentan una serie de 7 carcinomas de mama en 6 varones con edad media de 60 años (47 a 72 años) y tiempo medio primer síntoma-intervención de 14,3 meses (5 a 30 meses). Los estadios fueron I(1), II(3), III(1) y IV(1). El estudio histopatológico evidenció 6 carcinomas ductales infiltrantes (1 multicéntrico) y 1 intraductal (multicéntrico). Tratados 5 de ellos con mastectomía radical modificada, uno mediante mastectomía radical de Halsted y otro con tumorectomía simple + linfadenectomía axilar. Recibieron tratamiento coadyuvante 5 pacientes: 2 quimioterapia, 1 radioterapia, 1 quimioterapia + radioterapia y 1 hormonoterapia. Fallece uno al noveno día del posoperatorio por enfermedad diseminada en estadio terminal y otro a los 3,5 años de enfermedad metastásica; sobreviven los 4 restantes libres de enfermedad a los 7, 5, 5 y 5 años. Se analizan los aspectos diagnósticos y terapéuticos en una amplia revisión bibliográfica concluyendo que es una neoplasia de unas características y pronóstico similar en ambos sexos, si bien se publica peores resultados en el varón debido a la mayor demora en el diagnóstico respecto al femenino