Adenocarcinoma of the Colon and Rectum

The site and the sex incidence of 555 carcinomas of the colon surgically resected at The Hospital of the Good Samaritan in Los Angeles were reviewed. Most of the carcinomas of the right and transverse colon were in female patients, and slightly more than half of the cancers of the left and rectosigmoid were in male patients. The largest tumors were found in the right and transverse colon. The incidence of carcinomas in the proximal colonic segments, especially the cecum, appears to be greater in patients of middle or upper socioeconomic groups, a phenomenon possibly related to diet.     

Vasoactive intestinal polypeptide and nitric oxide synthase distribution in the enteric plexuses of the human colon: an histochemical study and quantitative analysis

Vasoactive intestinal polypeptide (VIP) and nitric oxide synthase (NOS) positive innervation patterns were immunohistochemically and statistically evaluated in the human colon. Specimens from the right colon (cecum, ascending and right transverse colon) and left colon (left transverse and descending colon) were obtained surgically, fixed either in paraformaldehyde or in Carnoy's or in Bouin's, and paraffin embedded. Sections were stained with hematoxylin-eosin, toluidine blue, cresyl violet, neuron-specific enolase, anti-VIP, and anti-NOS. The same results were obtained regardless of the fixative used. Enolase-positive, VIP-positive, and NOS-positive cells were occasionally found within the circular muscle and interpreted as neurons. VIP-positive nerve fibers were evenly distributed within the circular muscle while NOS-positive ones were lacking in its inner portion. The left colon was richer in neurons than the right colon, at both plexuses. VIP- and NOS-positive neuron densities were higher at the left than at the right colon, whereas at all colonic levels VIP-positive neuron percentages at both plexuses and NOS-positive ones at the myenteric plexus were simular. At the submucous plexus the NOS-positive neuron percentage was lower than that of the VIP-positive one. In conclusion: (a) the right colon contains a lower number of neurons and of VIP- and NOS-positive ones than the left colon, and (b) VIP- and NOS-positive fibers are differently distributed in the inner and outer portions of the circular muscle.     

Circumauricular incision (water-drop shape) for mid- to lower face lift

The conventional method of mid- to lower face rhytidectomy that involves removing a strip of occipital scalp always creates a conspicuous transverse scar crossing the postauricular skin, which may leave a stair-step deformity at the occipital hairline. The author has designed a new face lift method using a circumauricular incision, shaped like a water droplet, that curves around the auricle. In this new method, the upper part of the "O" shape is modified to the tip of a water droplet. The dissection of the cheek and neck is performed as in the conventional method with light-retractor assistance. The temporal region above the deep temporal fascia is managed under endoscopic control. This dissection can extend to the forehead region lateral to the supraoptic nerve and around the lateral orbital rim to release the arcus marginalis. A mesentery of superficial temporal fascia is created cephalic to the zygomatic arch. The postauricular dissection is performed beneath the galea in the upper part and beneath the occipital scalp and neck skin in the lower area. The lifting vector is upward and backward for the anterior skin flap and upward for the posterior skin flap. The excess skin is trimmed around the ear. The wound at the upper pole of the incision is closed in a V-to-Y advancement fashion. The dog-ear is left above the normal hairline, and there is little or no hairy scalp to be removed. The skin pleating in the postauricular region will settle down spontaneously after several months. The dog-ear in the scalp will become smaller and flat as well. The scar around the ear is quite inconspicuous and well covered under the upper pole of the auricle. From the author's experience, the new "water drop" circumauricular incision is a good alternative for the mid- to lower face lift. It can also be used in conjunction with endoforehead lift for full-face rejuvenation.     

Topographic mapping of the superior transverse scapular ligament: a cadaver study to facilitate suprascapular nerve decompression

Division of the superior transverse scapular ligament for decompression of suprascapular nerve entrapment can be curative. However, the superior transverse scapular ligament can be difficult to locate, and large incisions are often required. This study was designed to determine the topographic coordinates of the superior transverse scapular ligament to permit reproducible surgical localization and reduce incision size. In 20 cadavers, the superior transverse scapular ligament was identified through a superior approach. Measurements were obtained from the superior transverse scapular ligament to external landmarks. The superior transverse scapular ligament was located 1.3 +/- 0.3 cm (+/- SD) posterior to the posterior border of the clavicle and 2.9 +/- 0.8 cm from the acromioclavicular joint in a two-dimensional surface plane. The depth of the superior transverse scapular ligament from the skin surface was 3.9 +/- 0.7 cm. An incision (mean length, 6.3 +/- 0.7 cm) derived from a novel system of planning marks facilitated access to the superior transverse scapular ligament. The authors conclude that the superior transverse scapular ligament can be located consistently through an incision located on the superior aspect of the shoulder on the basis of palpable topographic landmarks. The superior approach permits small incision size and the maintenance of local muscle anatomic integrity.     

Abdominal Wound Dehiscence after Caesarean Section

In a series of 2,175 patients delivered by caesarean section a dehiscence of the abdominal wound occurred in 50. Wound dehiscence was eight times more common with a vertical incision than with a low transverse incision of the abdominal wall; with the vertical incision the incidence of partial and complete dehisence was 2·94% and with the low transverse incision no complete dehiscence occurred and the incidence of partial dehisence was 0·37%. The increased use of the low transverse incision would greatly reduce the serious complication of wound dehiscence after caesarean section.     

直切口与横S形切口治疗髌骨骨折对术后瘢痕形成及关节功能的影响比较

目的:观察和比较直切口与横S形切口治疗髌骨骨折对术后瘢痕形成及关节功能的影响。方法:回顾性分析2014年3月~2016年9月85例髌骨骨折患者的临床资料,包括采取手术直切口40例与采取手术横S形切口45例,比较两组的切口长度、手术时间、术后并发症以及随访时的瘢痕形成比例和Bostman关节功能评分。结果:两组的手术时间、术后切口感染及切口皮肤坏死发生率比较差异均无统计学意义(P0.05),但横S形切口组的切口长度为127.79±5.55,明显长于直切口组的72.64±6.75(P0.05);横S形切口组的术后局部麻木发生率为24.4%,明显高于直切口组的7.5%(P0.05);术后随访12周时,横S形切口组的Bostman评分为20.63±5.73,明显低于直切口组的26.83±4.76(P0.05);随访24周时,两组的Bostman评分比较差异无明显统计学意义(P0.05)。横S形切口组的瘢痕形成发生率为33.3%,明显高于直切口组的17.5%(P0.05)。结论:直切口用于治疗髌骨骨折的创伤明显小于横S形切口,术后瘢痕形成更少,关节功能恢复更快,但横S形切口的显露更好,在临床实际中应根据髌骨骨折患者的具体情况合理抉择手术切口方式。     

不同切口下乳腺癌根治术的临床疗效对比分析

目的:探讨不同切口下乳腺癌根治术的临床效果。方法:将140例乳腺癌患者根据治疗方法的不同分为对照组60例和治疗组80例,两组都行乳腺癌改良根治术,对照组采用Halsted-Meyer纵切口,治疗组采用Stewart横切口。比较两组手术并发症的发生情况、术后局部复发与远处转移的情况以及生存质量的改变情况。结果:所有患者都顺利完成手术,与对照组相比,治疗组术后皮瓣下积液、皮瓣坏死、上肢淋巴水肿的并发症发生率均明显降低(P0.05),术后躯体、心理、社会支持、精神评分均明显升高(P0.05),术后6个月的局部复发率与远处转移率均明显降低(P0.05)。结论:横切口下实施乳腺癌改良根治术能减少术后并发症,提高患者的术后生存质量,改善患者的远期预后。     

Surgical treatment of thyrotoxic exophthalmos

Conservative treatment of thyrotoxic exophthalmos has not given satisfactory results. Our observations, modifications of the standard surgical technique, and the results of orbital decompression for this condition are presented. Through a transverse incision close to the lower eyelid margin, the floor and the lateral orbital wall are explored. The posterior part of the orbital floor and the zygomatic part of the lateral orbital wall, as well as the periorbital fat, are removed. Through an incision made over the medial margin of the orbit, the medial orbital wall is explored and its ethmoidal part is removed. By the same approach, further retrobulbar fat is removed. Through an upper eyelid incision, fat is removed from the eyelid region and the levator aponeurosis is divided. This produces satisfactory symmetrical decompression of the orbit with good correction of exophthalmos and a significant decrease in the signs and symptoms of this condition.     

Mammaplasty combining vertical and transverse approaches through a vertical incision

An adjustable vertical marking is described for vertical mammaplasty in mild and moderate hypertrophy or ptosis of the breast. A vertical rectangular flap with the pedicle supported at the inframammary fold provides fullness for the upper or the lower pole of the breast. It is fixed over the pectoralis aponeurosis along the upper pole to the base of the pedicle. Length, width, and thickness of the vertical rectangular flap change regarding the extent of breast ptosis and hypertrophy. Two transverse triangular flaps, dissected in the lower pole of the breast, are supported on the inferior half of the vertical pillars at the incision margins. The criss-crossing of the triangular flaps creates a transverse support sling, avoiding the downward displacement of the breast. The vertical flap is applied in conjunction with the triangular flap to attempt to achieve projection and support for the breast with long-term stabilization of the mammary cone. Resection of mammary tissue is performed transversely just above the pedicle of the vertical flap.     

Neuromuscular structures specific to the submucosal border of the human colonic circular muscle layer

The circular muscle layer of the human caecum and ascending colon is clearly subdivided into two portions: an outer one which includes the bulk of the circular muscle layer, and an inner one made up of only six to eight rows of cells. In the right transverse colon no demarcation can be observed, but a difference exists between the innermost and the outermost cells, since those of the two innermost rows possess some peculiarities with regard to the sarcoplasmic reticulum, glycogen particles, caveolae, and intercellular junctions. In the left part of the colon, the circular muscle layer is also divided into two portions. In fact, the innermost smooth muscle cells still possess peculiar morphologies, progressively increase in number, and become separate from each other making up a superficial muscle network. A fibrous lamella, along and inside which a ganglionated nerve plexus runs, is strictly apposed to the submucosal border of the circular muscle layer of the entire colonic length. A second nerve plexus runs between the two portions of the circular muscle layer. Both these plexuses are accompanied by interstitial cells of Cajal in the right colon only. The peculiar organization of the entire submucosal border of the human colonic circular muscle layer distinguishes it from other parts of the gut and probably represents a structural basis for control of human colonic motility. The presence of putative pacemaker cells (interstitial cells and peculiar smooth muscle cells) indicates that the inner border of human colonic circular muscle layer possesses pacemaking activities. Moreover, the interstitial cell--smooth muscle cell ratio differs depending on the colonic level; two main regions can be identified: the right and the left colon. Consequently, we might expect regional variation in pacemaking.     

应用电视胸腔镜进行三切口食管癌根治术的手术配合及护理体会

目的：总结应用电视胸腔镜（video,assistedthoracoscopic surgeryVATS）在三切口食管癌根治术中的手术配合过程。方法：回顾2011年5月至2013年5月共38例中上段食管癌患者应用电视胸腔镜进行三切口食管癌根治术,术中胸部采用微创技术,使用胸腔镜器械进行食管游离和淋巴结清扫,腹部小切口进行胃部游离并制作管状胃,最后颈部切口进行食管胃吻合。结果：顺利完成38例中上段食管癌患者的手术配合,手术护士可以通过电视胸腔镜观察手术进程,熟练默契的配合每个手术步骤,术中出血较少,胸部手术时间30．60min,无一例中转开胸病例。结论：电视胸腔镜手术安全,有效,微创,便于操作,手术时间较短。     

Endoscopic forehead lift: review of technique,cases, and complications

Endoscopy has provided a significant improvement in the surgical rejuvenation of the upper face. It offers a minimally invasive alternative that avoids many of the undesirable effects associated with the coronal approach. The standard minimal access forehead endoscopic procedure consists of a subperiosteal undermining through three small triangular prehairline incisions. To successfully elevate the eyebrows, it is essential to release the periosteum at the level of the supraorbital rims and ablate the brow depressor muscles of the glabella. Until the periosteum reattaches itself, elevation is maintained by a temporary suspension suture between staples at the incision sites and 5 cm posterior to the hairline. The transverse closure of the triangular skin incisions achieves some additional elevation. The biplanar approach adds a partial subcutaneous undermining of the forehead to the endoscopic technique and allows plication of the frontalis muscle and excision of excess forehead skin. It is offered to patients with very ptotic eyebrows, deep transverse wrinkles, or a high forehead. The prehairline incision is a disadvantage but is tolerated quite well in older patients. The medical records of 393 consecutive patients who underwent endoscopic forehead lift from 1994 to 2000 were reviewed. Because seven patients had the endoscopic forehead lift repeated, the number of forehead endoscopies totaled 400. The complication rate was quite acceptable and did not markedly increase when a forehead lift was performed in combination with other facial procedures. The endoscopic forehead lift consistently attenuated the transverse forehead wrinkles, reduced the glabellar frown lines, and raised the eyebrows. It provided an appearance that was less tired and angry in addition to opening the area around the eyes. Long-term follow-up has shown that the endoscopic forehead lift produces lasting and predictable results.     

A simple method of intestinal anastomosis (ileocolostomy) in rats.

A simple method of ileocolostomy was performed in rats. The colon near the cecum was ligated, including its arteries and veins. Main artery and vein of the cecum were ligated. Then, the cecum was cut out. A longitudinal incision was made on the anti-mesenteric side of the proximal end of the colon, approximately 7-8 mm long. A 21-G needle was inserted toward the incision 2 cm away from the proximal end of the anti-mesenteric side of the colon. A nylon suture was knotted once to the distal end of the ileum and was introduced into the tip of the needle which had previously been passed through the colon. Then, the needle was removed. The suture was pulled to introduce the distal end of the ileum into the colonic lumen. Then, the suture was knotted once on the colon again to fix the ileum to the colon. The incision in the proximal end of the colon was not closed. At the 2nd week after the operation, X-ray examinations demonstrated that the ileocolonic passages with no leakage at the anastomotic site were quite satisfactory. At the 4th week after the operation, there were no macroscopic or microscopic complications at the anastomotic site. The mucosal and serosal epithelia of the ileum and colon continued smoothly. This simple method may be very effective in preparing anastomosis in the gastrointestinal tract, especially in small laboratory animals for nutritional and surgical experiments.     

Dual curved incisions for trans-metacarpophalangeal surgery

Two transverse curved incisions have been used for surgical procedures on all 4-finger MP joints. The edema and hematoma beneath the incision are reduced, and the skin healing is excellent. The exposure is more than sufficient for all the commonly employed surgical procedures on these 4 joints. The final appearance is as good as with a single transverse curved incision.     

Studies of the degraded carrageenan-induced colitis of rabbits. I. Changes in the epithelial glycoprotein O-acylated sialic acids associated with ulceration

Summary Ulceration of the large intestine, induced in New Zealand white rabbits by the administration of 1% w/v degraded carrageenan for periods of up to nine weeks, was studied by a combination of histochemical and chemical procedures for the identification ofO-acylated sialic acid. The onset of the disease was rapid, visible faecal blood being observed within five days. Caecal ulceration was diffuse throughout the mucosa being more prominent and frequent on the transverse folds. In some cases large, discrete ulcers were observed in the rectal portion of the lower colon, while in a small number of cases there were ulcers at the caecal end of the upper colon. The ulceration was characterized by oedema, congestion, haemorrhage, inflammation and mucosal ulceration. The inflammatory exudate consisted of macrophages, lymphocytes, a few plasma cells and, in animals treated for a long peroid, aggregates of eosinophils. The ulceration was associated with a marked reduction in the proportion of the caecal epithelial glycoprotein sialic acids which were neuraminidase-resistant and/or substituted in the side chain. Histochemical studies indicated that changes in side chain substitution were more marked at the margins of the ulcers and could be observed in sections of colon that showed no evidence of ulceration.     

Patterns of DNA methylation in the normal colon vary by anatomical location,gender, and age

Alterations in DNA methylation have been proposed to create a field cancerization state in the colon, where molecular alterations that predispose cells to transformation occur in histologically normal tissue. However, our understanding of the role of DNA methylation in field cancerization is limited by an incomplete characterization of the methylation state of the normal colon. In order to determine the colon’s normal methylation state, we extracted DNA from normal colon biopsies from the rectum, sigmoid, transverse, and ascending colon and assessed the methylation status of the DNA by pyrosequencing candidate loci as well as with HumanMethylation450 arrays. We found that methylation levels of repetitive elements LINE-1 and SAT-α showed minimal variability throughout the colon in contrast to other loci. Promoter methylation of EVL was highest in the rectum and progressively lower in the proximal segments, whereas ESR1 methylation was higher in older individuals. Genome-wide methylation analysis of normal DNA revealed 8388, 82, and 93 differentially methylated loci that distinguished right from left colon, males from females, and older vs. younger individuals, respectively. Although variability in methylation between biopsies and among different colon segments was minimal for repetitive elements, analyses of specific cancer-related genes as well as a genome-wide methylation analysis demonstrated differential methylation based on colon location, individual age, and gender. These studies advance our knowledge regarding the variation of DNA methylation in the normal colon, a prerequisite for future studies aimed at understanding methylation differences indicative of a colon field effect.     

Repair of major defects of the chest wall and spine with the latissimus dorsi myocutaneous flap.

The latissimus dorsi myocutaneous flap is a remarkably durable and versatile flap. Flap necrosis did not occur in any of our patients. One can safely carry with it skin segments as narrow as 3 cm, or as wide as 30 cm. In addition to the 5 cases presented, we have used the flap to repair axillary burn contractures, for breast reconstruction after a transverse incision, and for coverage of the upper arm and shoulder. The applications of this flap challenge the creative imagination of the surgeon and allow a simplified reconstruction, compared to other good methods. The newly described posterior advancement of a latissimus dorsi myocutaneous flap is suggested as the preferred method to repair meningomyelocele defects.     

Comparison of prebiotic effects of arabinoxylan oligosaccharides and inulin in a simulator of the human intestinal microbial ecosystem

In this study, the prebiotic potential of arabinoxylan oligosaccharides (AXOS) was compared with inulin in two simulators of the human intestinal microbial ecosystem. Microbial breakdown of both oligosaccharides and short-chain fatty acid production was colon compartment specific, with ascending and transverse colon being the predominant site of inulin and AXOS degradation, respectively. Lactate levels (+5.5 mM) increased in the ascending colon during AXOS supplementation, while propionate levels (+5.1 mM) increased in the transverse colon. The concomitant decrease in lactate in the transverse colon suggests that propionate was partially formed over the acrylate pathway. Furthermore, AXOS supplementation strongly decreased butyrate in the ascending colon, this in parallel with a decrease in Roseburia spp. and Bacteroides / Prevotella / Porphyromonas (−1.4 and −2.0 log CFU) levels. Inulin treatment had moderate effects on lactate, propionate and butyrate levels. Denaturing gradient gel electrophoresis analysis revealed that inulin changed microbial metabolism by modulating the microbial community composition. In contrast, AXOS primarily affected microbial metabolism by 'switching on' AXOS-degrading enzymes (xylanase, arabinofuranosidase and xylosidase), without significantly affecting microbial community composition. Our results demonstrate that AXOS has a higher potency than inulin to shift part of the sugar fermentation toward the distal colon parts. Furthermore, due to its stronger propionate-stimulating effect, AXOS is a candidate prebiotic capable of lowering cholesterol and beneficially affecting fat metabolism of the host.     

The correlative effect of the stem apex on the level of endogenous gibberellins inBryophyllum crenatum leaves

Following a one-side transverse incision made into the middle stem part ofBryophyllum crenatum below one of the two opposite leaves, the leaf is exposed to an enhanced effect of correlatively inhibitory substances passing out of the apical part of the stem. Within 28 days this results in a formation of adventitious roots above the incision. The flow of correlatively inhibiting substances interrupted by the incision induces, as early as within 24 h, a decrease in the level of endogenous gibberellins in the leaf above the inoision.     

Ambulatory 24-h colonic manometry in healthy humans

Our aim was to investigate motor activity of the healthy, relatively unprepared colon in the ambulatory state. Twenty-five age- and gender-matched adults had a six-sensor solid-state probe inserted into the proximal transverse colon without sedation. Subjects ambulated freely and ate standard meals. In 528 h of recording, we found a lower (P < 0.05) area under the curve during the night. Waking induced a threefold increase in motility, whereas meals induced a twofold increase. Women showed less activity (P < 0.05) in the transverse/descending colon than men. The transverse/descending colon showed more (P < 0.05) activity than the rectosigmoid colon. Seven patterns were recognized; predominantly, they were simultaneous, propagated, or periodic bursts of 3-cycles/min (cpm) waves. A specialized propagating pressure wave with a high amplitude (>105 mmHg) and a prolonged duration (>14 s) occurred in all subjects (mean 10/day), mostly after waking, after meals, or with defecation. A 3-cpm motor activity was seen in the rectosigmoid region predominantly at night. The colon exhibits a wide spectrum of pressure activity around the clock, with gender and regional differences and circadian rhythm. This comprehensive study provides qualitative and quantitative normative data for colonic manometry.