[The biocompatibility of suture materials used in colon surgery. An experimental study in the rat]

BACKGROUND

The aim of this experimental study was to compare the tissue behavior of biofragmentable anastomotic ring (BAR) with other synthetic materials used in colonic surgery.

METHODS

Thirty-three rats were divided into four groups: group 1, sham-operated control animals without material implanted; group 2, with fragments of polypropylene monofilament implanted extraperitoneally in abdominal wound, between musculature and peritoneum; group 3, with metal clips implanted extraperitoneally in abdominal wound, between musculature and peritoneum and group 4, with fragments of biofragmentable anastomotic ring implanted extraperitoneally in abdominal wound, between musculature and peritoneum. Animals were sacrificed 30 days after the operation. Macroscopic and histological criteria were used to characterize the resistance of the wound and the tolerance of the host to the foreign material.

RESULTS

The inflammatory cell reaction of host tissue was significantly greater in group 4 compared with other groups (p < 0.05). In three cases, in group 4, we observed the adhesion of implanted fragment to epiploa. The enumeration of giant cells and the degree of fibrotic reaction was similar in all groups with material implanted, but no significant difference between the groups was observed. Our findings showed the greater biocompatibility of polypropylene and metallic clips, compared to the biofragmentable ring anastomosis. The strong inflammatory reaction in the host tissue caused by biofragmentable anastomotic ring may explain partially clinical postoperative complications (anastomotic wound infection and/or dehiscence and/or stricture).

CONCLUSIONS

In conclusion, the choice of suture materials should be based not only on the mechanical properties, but also on their biological interactions between host and suture materials and on the evaluation of their effective cost/benefit.

[Anatomo-clinical considerations on intrahepatic calculosis]

After reviewing the anatomoclinical classification of intrahepatic lithiasis, the authors underline the need to perform hepatic resections in selected cases. The case reported is an example of the indications for this type of surgery.

[Continuous suture in laparotomy using an absorbable eyelet thread according to the Smead Jones technique]

In 78 patients undergoing laparotomy suturing was carried out using absorbable thread (polyglyconate - Maxon) with eyelet to obtain a continuous knot-free suture according to Smead Jones' technique. A prospective study was made of all surgical wounds three months after the operation to evaluate the reliability of this technique. On examination, wounds were fully healed in 98% of patients. Less than 2% of patients revealed infections, dehiscence or anomalous granulations of the wound. No laparocele were observed at the time of control using this method. Continuous suture using a trimethylene polyglyconate (Maxon) thread with eyelet according to the Smead Jones technique was found to be safe and effective. A follow-up after a longer interval will be performed in this group of patients in order to confirm these conclusions.

[The impact of conventional proctocolectomy on sexual function]

Seventy-one women who had a proctocolectomy for ulcerative colitis (n. 41) or Crohn's disease (n. 30) were interviewed in the follow-up clinic for gynaecological problems and fertility. Forty-nine per cent (35/71) of the women had a distressing vaginal discharge after proctocolectomy, compared with 9% before surgery. At the gynaecological examination 45% (32/71) had a heavy vaginal secretion without any signs of an acute vaginal infection. In 68% (30/44) fluid retention in the vagina was associated with a caudally firmly-fixed and dilated posterior vaginal fornix. Twelve per cent (8/66) of the women reported dyspareunia before surgery. After surgery, 27% (18/66) complained of this symptom. Fertility was significantly reduced after surgery since only 37% (10/27) of the women who attempted to become pregnant succeeded within five years follow-up. The corresponding figure before surgery was 72% (39/54). Those who conceived went through pregnancy and parturition without any incident, 6 of 24 delivered by cesarean section. Fifty-seven men who had a proctocolectomy for ulcerative colitis (n.41) or Crohn's disease (n. 30) were interviewed in the follow-up clinic for the presence of sexual disturbances and their incidence was studied. Fifty-seven per cent of elderly patients (above 40 years old) complained of reduced libido and sexual satisfaction. In younger patients (below 40 years old) 33% complained of an impaired quality of sexual life and 22% complained of an impaired sexual satisfaction. However, despite some sexual dysfunction, 56% reported improved sexual life and 67% improved sexual satisfaction. This may be explained by improved general health and increased libido after removal of diseased bowel.(ABSTRACT TRUNCATED AT 250 WORDS)

[Total thyroidectomy in recurrent goiters (anatomicosurgical observations with the operating microscope)]

The relapses of the multinodular goitre, often linked with an insufficient surgical treatment of primitive lesions, make serious problems about the operating technique. The current guidance of surgeons is directed towards the complete thyroidectomy which profits, during the operating time, by the use of microscope to identify and to protect the recurrent nerves. This equipment has to be used by those equipped which know how to use it. In our work we report the results obtained with this technique and it's underlined how the complete thyroidectomy for the benign relapsing goitre could be considered curative towards those cases which present hidden microcarcinoma.

[The functional and manometric-volumetric results following abdominal rectopexy for total rectal prolapse]

Functional changes after the posterior abdominal rectopexy for the treatment of rectal prolapse are not fully understood. We studied the effects of Wells' or Ripstein's rectopexy on functional characteristics as related to anal sphincter function, rectal volume and sensory function in 21 patients with complete rectal prolapse. We have observed an improvement of continence over 70 per cent in both groups. However, an absent or a decreased call to stool, constipation and evacuation difficulties are the aftermath of Wells' rectopexy, while these complaints appear basically unaffected by Ripstein's technique. Sensory thresholds for sense of filling and urge were significantly raised after Wells' rectopexy even one year after operation, whereas after Ripstein's operation sense of filling was not significantly affected and while sense of urge was increased early postoperatively, it was not significantly changed at one year postoperative control. In conclusion, when fecal incontinence appears associated to a complete rectal prolapse has good chances to improve postoperatively. Preoperative evacuation difficulties seems to be unaffected by a posterior abdominal rectopexy, Wells or Ripstein, but an extensive dissection of the rectum with the division of the lateral stalks, as it is performed in Wells' operation, seems to be a procedure that can create a further burden of problems to the patient and it seems coupled to a manovolumetric elevation of rectal sensory thresholds.

[Protective effect of citicoline on renal ischemia]

The protective role of cyticholine was investigated on rabbit and dog kidneys subjected to temporary ischaemia. Following right nephrectomy, the right kidneys of 13 rabbits were subjected to warm ischaemia for 60'. Death occurred for various reasons within 48 hr. Histological examination suggested that tubular epithelium damage was less in the animals treated with cyticholine. In a similar experiment on 6 dogs after local and general infusion of cyticholine, warm ischaemia for 90' was followed by death in 33%, compared with 87.5% of the controls. Blood creatinine and BUN returned to normal between the 6th and the 8th days in the four surviving animals. The data suggest that cyticholine assists the functional recovery of kidneys subjected to warm ischaemia for more than 30' and limits tubular damage.

[Morphological studies of gastric arteries in patients with gastro-duodenal ulcer]

Microscopic lesions of the gastric arteries have been studied in 21 patients subjected to resection for gastroduodenal ulcer. The left gastric artery, particularly in patients with gastric ulcer, presents lesions to the intima and media and these can lead to obliteration of the lumen, classifiable as atherosclerotic disease. The seriousness of the lesions would seem to be independent of sex and age. In some cases gastric artery lesions were compared with those to the arterioles in the vicinity of the ulcer. At least as far as the gastric district is concerned, there would not appear to be any gravity correlation between large and small vessels. Some aspects of the vascular pathogenesis of gastroduodenal ulcer are discussed.

[Effects of slowly progressive constriction on the proximal pancreas of the rabbit]

Slow, progressive constriction with cellophane tape was experimented on the proximal segment of the rabbit pancreas. Histological examination of the distal segment over a period of 10-30 days showed the appearance of morphological changes reminiscent of chronic pancreatopathy in man. Stress is laid on the need for an experimental model suitable for the provocation of chronic forms, particularly if similar results can be obtained on animals of larger size.