No abstract

Massive small bowel resection (SBR) is characterized by increased proliferation of residual gut mucosa and pancreas. Neurotensin (NT), a gut tridecapeptide, stimulates growth of normal gut mucosa and pancreas. This study examined whether NT affected growth of the small intestine and the pancreas after either distal or proximal SBR. Male Fischer 344 rats were divided into four groups. Group 1 underwent ileal transection with reanastomosis (SHAM) and group 2 underwent 70% distal SBR. Group 3 underwent SHAM operation (jejunal transection), and group 4 underwent 70% proximal SBR. After operation, each group was further subdivided to receive either saline (control) or NT (300 micrograms/kg) subcutaneously in gelatin every 8 hours for 7 days. At death, the pancreas and proximal jejunum (from groups 1 and 2) or distal ileum (from groups 3 and 4) were removed, weighed, and analyzed for DNA, RNA, and protein content. Both proximal and distal SBR significantly increased mucosal growth in the remnant intestine; a more pronounced effect was noted with proximal SBR. Administration of NT significantly augmented the adaptive changes in both groups of rats by mechanisms involving increases in both cell size (hypertrophy) and cell number (hyperplasia). Pancreatic growth was stimulated by distal (but not proximal) SBR; NT did not augment this response. The authors conclude that NT augments intestinal growth after SBR by mechanisms involving an increase in overall mucosal cellularity. Administration of NT may be therapeutically useful to enhance mucosal regeneration during the early period of adaptive hyperplasia after SBR.

Of 26 patients who underwent both coronary artery bypass grafting and abdominal surgery at our institution between 1977 and 1992, nine had severe coronary artery disease associated with UICC stage I gastric cancer. They were treated by coronary artery bypass grafting followed by a curative operation for gastric cancer; the initial four patients underwent two-staged surgery (group A), and the most recent five patients underwent simultaneous surgery (group B). The cardiac surgery was performed first in all patients, and in group A the interval between the two procedures was 2 to 7 weeks. There were no significant differences between the two groups in terms of preoperative characteristics: sex, age, preoperative complications, NYHA class, prior myocardial infarction, ejection fraction, cardiac index, number of vessels diseased, or number of grafts. There were no significant differences between the two groups in terms of blood loss during the gastric operation (A: 649 +/- 194 ml; B: 842 +/- 326 ml) or the operating time (A: 371 +/- 106 minutes; B: 343 +/- 46 minutes). Two group A patients had postoperative complications (one had arrhythmia, and one died of sepsis caused by sutural insufficiency). On the other hand, four group B patients had complications (three cases of transient hyperbilirubinemia and one case of postoperative bleeding; none died). The postoperative hospital stay after gastrectomy was not prolonged in group B compared with group A (A: 41.7 +/- 22.7 days; B: 46.0 +/- 25.0 days). In conclusion, simultaneous procedure of coronary artery bypass grafting and gastric surgery can be performed safely, although careful management is indispensable.

One serious factor threatening the life of patients with well-differentiated carcinoma of the thyroid gland is invasion of the neoplasma to the upper respiratory system. Of 120 patients with differentiated thyroid carcinoma, resection of the trachea was followed by end-to-end anastomosis in 10 cases. Total laryngectomy and terminal tracheostomy were done in 2 cases. Ten cases are alive and well 6 months to 4 years following the surgery.Zusammenfassung. Da die Infiltration zur Luftr6hre bei fortgeschrittenen Schilddrfisencarcinom hitufigste Todesursache ist, ist eine kombinierte Trachea-Rekonstruktion ein wichtiges Vorgehen. Von 120 Schilddrtisencareinomen wurden 3 Laryngektomien, 4 Trachea-Resektionen mit End-zu-End-Anastomosen, 3 Anastomosen zwischen Ringknorpel und Trachea und 3 Anastomosen zwischen Schildknorpel und Trachea durchgefiihrt. AuBer 2 Patienten, die postoperativ verstarben, sind weitere 10 Patienten 6 Monate his 4 Jahre nach der Operation ohne Tumorrezidiv gesund. Summary.We developed a plastic prosthesis for easy implantation at any position in the tracheobronchial tree.It was designed after the Hagen-Poiseuille principle, permitting maximum air velociy and the expulsion of bronchial secretions. The prosthesis was implanted in 14 dogs after resection of the lower trachea. Three dogs died from prosthesis dislocation and asphyxia. No other complications were seen, such as sepsis, artery erosion, or stenosis. We believe that in the near future this prosthesis may be useful for selected patients.Zusammenfassung. Wit entwickelten eine Silastikprothese, um eine einfache Implantation in jeder H6he des Bronchialbaumes zu erm6glichen. Sie ist nach dem Prinzip des Hagen-Poiseuilleschen Gesetzes -maximalen Luftgeschwindigkeit -gebaut und erleichtert damit die Bronchialtoilette. Die Prothese wurde bei 14 Hunden nach Resektion der unteren Trachea eingesetzt. 3 Hunde starben wegen Prothesendislokation an Erstickung. Andere Komplikationen -wie Sepsis, Arterienarrosion oder Stenosen -traten bei keinem der Versuchstiere auf. Wir glauben, an absehbarer Zeit, dieses Prothesenmodell in ausgew~hlten F~llen, auch am Menschen, einzusetzen. Schliisselwfirter: Trachea-Prothese -Hagen-Poiseuille.