Rare association of a patient with Alagille syndrome and mitral valve regurgitation.

A 9-year-old patient with known Alagille syndrome presented to our institution with progressive mitral valve regurgitation due to prolapse of the posterior valve leaflet. She underwent successful mitral valve replacement with a mechanical prosthesis 4 years after the initial diagnosis. To the best of our knowledge, an association between mitral valve regurgitation and Alagille syndrome has not been previously described.

Healing of colon anastomoses covered with fibrin glue after immediate postoperative intraperitoneal administration of 5-fluorouracil.

PURPOSE: The aim of this experimental study was to investigate whether covering the colonic anastomoses with fibrin glue can protect the colonic healing from the adverse effects of 5-fluorouracil (5-FU), when it is injected intraperitoneally immediately after colon resection. METHODS: Sixty-four rats were randomized to one of four groups. After resection of a 1-cm segment of the transverse colon, an end-to-end sutured anastomosis was performed. Rats of the control group and the fibrin glue group were injected with 6 ml of solution 0.9 percent NaCl intraperitoneally. Rats in the 5-FU and the 5-FU + fibrin glue groups received 5-FU intraperitoneally. The colonic anastomoses of the rats in the fibrin glue group and in the 5-FU + fibrin glue group were covered with fibrin glue. All rats were killed on the 8th postoperative day and the anastomoses were examined macroscopically. The bursting pressure measurements were recorded and the anastomoses were graded histologically. RESULTS: The leakage rate of the anastomoses was significantly higher in the rats of the 5-FU group than in those of the fibrin glue group and those of the 5-FU + fibrin glue group (37.5 percent vs. 0 percent, P = 0.020). The adhesion formation score was significantly higher in rats of the 5-FU group than in the other groups. Bursting pressures were also significantly lower in the 5-FUgroup than in the other groups ( P < 0.001). Rats in the 5-FU + fibrin glue group developed significantly more marked neoagiogenesis than rats in the other groups. Rats in the 5-FU + fibrin glue group also presented significantly more fibroblast activity than those in the 5-FU group. ( P = 0.004) CONCLUSIONS: The immediate postoperative, intraperitoneal administration of 5-FU inhibited wound healing. However, when the colonic anastomoses were covered with fibrin glue, the injection of 5-FU had no adverse effects on the healing of the anastomoses.

Sutureless colonic anastomosis in the rat: a randomized controlled study.

The aim of the present study was to evaluate the effect of glue tissue on the healing of colonic anastomosis in rats. Two groups of 20 Wistar rats each were used. Following laparotomy, a segment of 1 cm of the colon was resected, 10 cm from the ileocecal valve. In the control group, the anastomosis was sutured in a single layer with 6-0 polypropylene interrupted extramucosal sutures. In the glue group, the anastomosis was performed by using 2-octyl cyanoacrylate (Dermabond, Ethicon). Rats were sacrificed on day 7 following operation. Integrity of the anastomoses, existence of perianastomotic abscess or peritonitis, and adhesion formation were recorded. Anastomoses were resected including a 2.5-cm of bowel on either side. Bursting pressures were measured and the specimens were sent for histological examination. Anastomotic dehiscence occured in 20% of the animals in each group. Adhesion formation was more extensive in the glue group compared to the control group, but this difference was not statistically significant (p=0.074). Bursting pressures of the anastomoses between the two groups were not statistically significant (p=0.897). The wound healing process, as assessed by inflammatory cell infiltration, blood vessel neodevelopment, collagen deposition and fibroblast activity, did not differ statistically between the two groups (p>0.05). In conclusion, 2-octyl cyanoacrylate provides, under experimental conditions, a sutureless anastomosis equal in healing to the conventionally sutured one. The outcome may differ under demanding clinical situations.