Postoperative rectal anastomotic complications.

Colorectal cancer represents the most common tumour of the gastrointestinal tract and the second most common tumour in men as well as women. The trend of increasing incidence of colorectal cancer is alerting. We undertook a retrospective study on 588 patients with rectal cancer and operated by rectal resection with anastomosis between the years 2002-2012. In our sample, we observed 54 (9.2 %) cases of anastomosis insufficiencies requiring reoperation. Out of 54 insufficient anastomoses, 36 (66 %) were in the lower two thirds of the rectum and only 18 (34 %) in the oral one. Although we have observed similar occurrences of anastomosis insufficiency in both groups - classical vs. staple suture (9.5 % and 9.0 %, respectively), the majority of stapler anastomoses (94 %) were made in the aboral part of the rectum. However, we can state that a majority of authors prefer the staple anastomosis as the one with lowest risk, mainly in the distal region of anastomosis. The high ligation of inferior mesenteric artery was performed in 182 (31 %) patients; out of these, we observed anastomosis insufficiency in 12 cases (22 %), which is exactly similar to that in the group of patients without high ligation of the inferior mesenteric artery. We did not observe the use of antibiotics in therapeutical doses as a positive factor for anastomosis insufficiencies, and neither was oncological therapy observed as a risk factor. In our group of patients we agreed that age, level of anastomosis and corticosteroids are high-risk factors. The purpose of these reports, is for the sake of future to share and reference our experiences with cases of rectal and rectosigmoideal resection over the last 11 years. We consider it important to reference our results, especially the risk factors regarding the healing of rectal anastomosis, because anastomotic healing is a surgical problem with potentially deadly consequences for patients (Tab. 4, Ref. 24).

The effect of postoperative pain treatment on the incidence of anastomotic insufficiency after rectal and rectosigmoideal surgery.

The aim of prospective study was to evaluate the pain relief in the postoperative period and consumption of opioid and non-opioid analgesics as a risk factor of the anastomotic insufficiency after rectal and rectosigmoideal resection for carcinoma. Anastomotic insufficiency is one of the most feared and life threatening early complications. No articles about the effect of the response to opioid therapy in the postoperative period on the risk of this major clinical problem have been published. We compared the effect of opioid and non-opioid analgesics in 109 patients who underwent rectal and rectosigmoideal resection in a prospective study. We evaluated the appearance of anastomotic insufficiency and clinical conditions in the relationship with the pain relief in the postoperative period and consumption of opioid and non-opioid analgesics. The pain intensity and the consumption of analgesics were significantly increased in the group of nonresponders. The rate of PONV (postoperative nausea and vomiting) in the responders and nonresponders groups was 69% and 78%, respectively. However, the differences did not reach significant level. Other clinical conditions were not significantly different between the both groups, too. The difference in the incidence of anastomotic insufficiency between both groups was highly significant, 6% cases of anastomotic insufficiency in the responders group and 19% in nonresponders group (χ2 = 7.73; p=0.0054). Nonrespoders to opioid therapy and their high consumption of second-line analgesics is a high risk factor for anastomotic insufficiency.

Impact of diffuse nitrate pollution sources on groundwater quality--some examples from Czechoslovakia.

In several regions of Czechoslovakia with intensive agricultural production, the correlation between the amount of nitrogen fertilizer applied and the nitrate content in groundwater has been recognized. Nitrate pollution of groundwater is considered to be the most serious source of nonpoint pollution in Czechoslovakia. A program of research into the effects of farming activities on groundwater quality in Czechoslovakia is under way on experimental fields (20 to 30 hectares) and, simultaneously, in regions in which shallow, vulnerable aquifers occur. The importance of the soil organic matter's stability for maintaining the groundwater quality is emphasized. Research based on nitrogen and organic carbon balance has shown that the restoration of a soil-groundwater system is a complicated process that usually requires changes in the extent and intensity of agricultural activities and consistent attention to the effects produced by natural conditions. Regional investigation of the impact of farming on shallow aquifers in the fluvial deposits of the Elbe River in Bohemia has proved the hydrochemical instability and vertical hydrochemical heterogeneity of these aquifers. The WASTEN deterministic model was used for modeling the transport and transformation of various types of inorganic fertilizers. The input data is based on laboratory and field measurements. Special topics are the verification of model calculations and the time and spatial variability of input data with respect to the unsaturated zone. The research results are being used for making regional and national agro-groundwater managerial schemes more precise, as well as for decision-making.

Aliesterase activity in normal and postheparin human blood sera.

An enzyme with characteristics typical of aliesterase has been found in human blood serum using a gas solid chromatographic assay technique. This conflicts with the findings of several authors that aliesterase is absent in the human blood. Another aliesterase is released into the blood stream after intravenous administration of heparin. Partial purification of the aliesterase in normal (preheparin) and postheparin sera was effected by column chromatography using CM- and DEAE-Sephadex. The preheparin aliesterase and postheparin aliesterase have different pH optima of 7.0 and 8.5 respectively. The preheparin aliesterase activity was very sensitive to sodium fluoride and insensitive to a negatively charged detergent, sodium lauryl sulfate, unlike the postheparin esterase which was highly sensitive to sodium lauryl sulfate and comparatively less sensitive to sodium fluoride.

Effects of dietary n-3 fatty acids on the composition of cholesteryl esters and triglycerides in plasma and liver perfusate of the rat.

The effects of polyunsaturated fatty acids of the omega-3 family (PUFA n-3), (addition of fish oil), on the molecular composition of cholesteryl esters and triglycerides in plasma and liver perfusate of rats were studied. Rats fed a diet rich in saturated fatty acids (addition of lard) served as controls. Supplemention with PUFA n-3 not only decreases the plasma concentrations of free cholesterol, cholesteryl esters, and triglycerides, it also significantly alters the plasma composition of cholesteryl esters and triglycerides. Analyses of liver perfusate indicate a decrease in triglycerides secretion by in vitro perfused liver and reciprocal changes in relative contents of cholesteryl esters fractions with C(16) and C(20) acyl chains. This finding may be a result of chain-shortening of long-chain fatty acids probably in peroxisomal beta-oxidative system. Alterations in plasma cholesteryl esters and triglycerides composition of the fish oil group could be affected further by additional factors such as increased plasma cholesterol esterification activity and presence of triglyceride species of intestinal origin.

Some aspects of the use of heteropoly anions in elemental analysis by simple potentiometric ion-pair formation-based titration.

The possibility of the use of heteropoly anions formed by addition of phosphate to the solutions of either molybdate or tungstate in the determination of phosphorus by the simple method of potentiometric titration was studied. The heteropoly anions are titrated on the ion-pairing principle using a titrant containing a lipophilic counter-ion, i.e. 1-(ethoxycarbonyl)pentadecyltrimethylammonium bromide (Septonex), the titration being monitored by carbon paste electrode, although other liquid membrane-based electrodes can also be used. Calibration plots of the titrant end-point consumption vs. concentration are not linear, but allow one to evaluate the content of phosphorus. Similar procedures, when optimized, should be elaborated for determination of numerous other elements forming heteropoly anions.

Gas chromatographic study of cholesterol esterification during postheparin lipolysis in vitro in hypertriglyceridemia.

Direct gas chromatographic method for quantitative determination of plasma neutral lipids was used for the study of cholesterol esterification in vitro. Fully automated computerized method permits the determination of lipid classes (free cholesterol, cholesteryl esters, and triglycerides), as well as their fractions according to the molecular weight, without previous derivatization. All components are determined from one analysis. The method is highly precise and accurate. The coefficient of variation for free and esterified cholesterol is 1.21 and 1.11% in the concentration range 30--430 and 75--545 mg/dl, respectively. The LCAT activity was determined as a decrease in the free cholesterol concentration after one hour's incubation; from the same analysis, the recovery control as an increase in the esterified cholesterol concentration was calculated. The mean difference was 1.06%, maximum difference did not exceed 4%. The LCAT activity in the reference group was 97.2 +/- 28.2 mumol/l/h and was significantly lower than that in hyperlipdemic one. Intravenous administration of heparin had an inhibition effect in subjects with hyperlipidemia of type IV, while only slight changes in the reference group and an increase in hyperlipidemia of type III were observed.

Decomposition of molecular types of triglycerides by lipoprotein lipase in man.

1. The lipoprotein triglycerides of human plasma can be separated by gas chromatography according to their carbon number into four main groups: C48, C50, C52 and C54. We studied the decomposition of molecular types of triglycerides by posttheparin lipoprotein lipase in vitro. 2. Decomposition of the molecular type C52 does not depend on its concentration. Decomposition of the molecular types C48, C50 and C54 is in a direct correlation to their concentration. 3. The above mechanism assures stability of the triglyceride profile of human plasma, which is species specific and is expressed by the figures: C48--9%, C50--20%, C52--43%, C54--20%, remainder 8%. 4. The plasma triglyceride profile can be altered by dietetic factors. After drinking cream, the triglyceride composition is: C48--12%, C50--22%, C52--37%, C54--14%, remainder 15%. Selective decomposition of molecular types of triglycerides ensures that the profile, after a given time, returns to the original state.

[Essential fatty acids in carcinoma]. / Esenciální mastné kyseliny u karcinomu.

Carcinomatous tissue consumes intensely polyenic fatty acids which are the building elements of growing biomembranes. The authors compared plasma levels of essential fatty acids (EFA) in three groups of subjects: 1. patients with carcinoma, 2. control group, 3. groups with sub-nutrition. The profile in these three groups differs significantly. In patients with carcinoma the level of derived EFA is reduced (20:4w6, 20:5w3, 22:6w3), while primary EFA (linoleic acid 18:2w6) is unaltered. The results suggest that in patients with carcinoma there is a specific reduction of EFA essential for the formation of cellular biomembranes. The reduction is probably due to the increased consumptions of derived EFA by carcinomatous tissues.