Search results for: Colonic anastomosis

Authors: Mohammad Emran, Colton Wayne, Shannon M Koehler, P. Stephen Almond, Haroon Patel

Abstract:

Purpose: Assessment of anastomotic perfusion in Hirschsprung disease using Indocyanine Green (ICG)-near-infrared (NIR) fluorescence angiography. Introduction: Anastomotic stricture and leak are well-known complications of Hirschsprung pull-through procedures. Complications are due to tension, infection, and/or poor perfusion. While a surgeon can visually determine and control the amount of tension and contamination, assessment of perfusion is subject to surgeon determination. Intraoperative use of ICG-NIR enhances this decision-making process by illustrating perfusion intensity and adequacy in the pulled-through bowel segment. This technique, proven to reduce anastomotic stricture and leak in adults, has not been studied in children to our knowledge. ICG, an FDA approved, nontoxic, non-immunogenic, intravascular (IV) dye, has been used in adults and children for over 60 years, with few side effects. ICG-NIR was used in this report to demonstrate the adequacy of perfusion during transanal pullthrough for Hirschsprung’s disease. Method: 8 patients with Hirschsprung disease were evaluated with ICG-NIR technology. Levels of affected area ranged from sigmoid to total colonic Hirschsprung disease. After leveling, but prior to anastomosis, ICG was administered at 1.25 mg (< 2 mg/kg) and perfusion visualized using an NIR camera, before and during anastomosis. Video and photo imaging was performed and perfusion of the bowel was compared to surrounding tissues. This showed the degree of perfusion and demarcation of perfused and non-perfused bowel. The anastomosis was completed uneventfully and the patients all did well. Results: There were no complications of stricture or leak. 5 of 8 patients (62.5%) had modification of the plan based on ICG-NIR imaging. Conclusion: Technologies that enhance surgeons’ ability to visualize bowel perfusion prior to anastomosis in Hirschsprung’s patients may help reduce post-operative complications. Further studies are needed to assess the potential benefits.

Keywords: Colonic anastomosis, fluorescence angiography, Hirschsprung disease, pediatric surgery, SPY, ICG, NIR.

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Authors: Rongguo Yan, Guozheng Yan, Banghua Yang

Abstract:

The colonic tissue is a complicated dynamic system and the colonic activities it generates are composed of irregular segmental waves, which are referred to as erratic fluctuations or spikes. They are also highly irregular with subunit fractal structure. The traditional time-frequency domain statistics like the averaged amplitude, the motility index and the power spectrum, etc. are insufficient to describe such fluctuations. Thus the fractal box-counting dimension is proposed and the fractal scaling behaviors of the human colonic pressure activities under the physiological conditions are studied. It is shown that the dimension of the resting activity is smaller than that of the normal one, whereas the clipped version, which corresponds to the activity of the constipation patient, shows with higher fractal dimension. It may indicate a practical application to assess the colonic motility, which is often indicated by the colonic pressure activity.

Keywords: Colonic pressure activity, erratic fluctuations, fractal dimension and spikes.

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Authors: Elina Ligere, Valts Ozolins, Lauris Smits, Normunds Sikora, Ivars Melderis, Laila Feldmane, Aris Lacis, Vladimir Kasyanov

Abstract:

Biomechanical properties of infantile aorta in vitro in cases of different standard anastomoses: end-to-end (ETE), extended anastomosis end-to-end (EETE) and subclavian flap aortoplasty (SFA) used for surgical correction of coarctation were analyzed to detect the influence of the method on the biomechanics of infantile aorta and possible changes in haemodinamics. 10 specimens of native aorta, 3 specimens with ETE, 4 EEET and 3 SFA were investigated. The experiments showed a non-linear relationship between stress and strain in the infantile aorta, the modulus of elasticity of the aortic wall increased with the increase of inner pressure. In the case of anastomosis end-to-end the modulus was almost constant, relevant to the modulus of elasticity of the aorta with the inner pressure 100-120 mmHg. The anastomoses EETE and SFA showed elastic properties closer to native aorta, the stiffness of ETE did not change with the changes in inner pressure.

Keywords: biomechanics, coarctation, mechanical properties, neonatal aorta

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Authors: Inas E. Darwish, Alia M. Arab, Tarek A. Azeim, Teshreen M. Zeitoun, Wafaa A. Hewedy, Moemen A. Heiba, Iman S. Emara

Abstract:

Inflammatory bowel disease (IBD) is a chronic relapsing-remitting condition that afflicts millions of people throughout the world and impairs their daily functions and quality of life. Treatment of IBD depends largely on 5-aminosalicylic acid (5- ASA) and corticosteroids. The present study aimed to clarify the effects of 5-aminosalicylic acid, budesonide and currcumin on 90 male albino rats against trinitrobenzene sulfonic acid (TNB) induced colitis. TNB was injected intrarectally to 50 rats. The other 40 rats served as control groups. Both 5-ASA (in a dose of 120 mg/kg) and budesonide (in a dose of 0.1 mg/kg) were administered daily for one week whereas currcumin was injected intraperitonially (in a dose of 30 mg/kg daily) for 14 days after injection of either TNB in the colitis rats (group B) or saline in control groups (group A). The study included estimation of macroscopic score index, histological examination of H&E stained sections of the colonic tissue, biochemical estimation of myeloperoxidase (MPO), nitric oxide (NO), and caspase-3 levels, in addition to studying the effect of tested drugs on colonic motility. It was found that budesonide and curcumin improved mucosal healing, reduced both NO production and caspase- 3 level. They had the best impact on the disturbed colonic motility in TNBS-model of colitis.

Keywords: Colitis, curcumin, nitric oxide.

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Authors: Simon Bambang Widjanarko, Novita Wijayanti, Aji Sutrisno

Abstract:

There is long history of konjac tubers being used as a cure for certain diseases in China and Japan. Konjac flour is prepared from konjac tubers and it contains high concentration of glucomannan. Konjac Glucomannan (KGM) is dietary fiber and the role of which has been demonstrated in weight reduction, lowering blood cholesterol and sugar level, promoting intestinal activity etc. Konjac glucomanan has a property of swelling by absorbing water, more than a hundred times its own weight. Therefore it helps increasing weight of feces, water content of feces, and promotes satiety feeling. Mode of actions of dietary fibre as laxatives agents includes holding water inside the bowel lumen, inhibition of water absorption in the colon and stimulating colonic motility. Number of fecal pellets did not effected in rats were fed on 300 and 600 mg/kg of konjac flour, as well as constipated control and Dulcolax treatment. Water content, weight of fecal pellets and gastrointestinal transit ratio were higher in rats treated with 600 mg/kg than 300 mg/kg of konjac flour. Rats were administered with Dulcolax showed the highest gastrointestinal transit ratio, followed by 600 mg/kg konjac flour. The lowest feed consumption was noted in 600 mg/kg konjac flour diet group.

Keywords: Laxative, konjac flour, Amorphophallus muelleri Blume, glucomannan, constipation.

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