RESUMEN
BACKGROUND: Preoperative radiotherapy (RT) is an increasingly popular form of adjunct therapy for rectal cancer; however, little is known about its effects on matrix metalloproteinase (MMP) expression in colonic anastomotic healing. METHODS: Wistar rats were irradiated to a total dose of 25 or 40 Gy. Four days after the end of RT, an end-to-end colorectal anastomosis was performed. Animals were sacrificed at 1, 3, and 7 days after the anastomosis. A control group was studied similarly, but was not irradiated. RESULTS: No significant differences were found in peritonitis rate and anastomotic complications. The average bursting pressure and breaking strength were only reduced significantly in the rats irradiated with 40 Gy. However, the concentration and the content of hydroxyproline in anastomotic tissues were unchanged. In irradiated rats, MMP-2 and MMP-9 were significantly increased at 40 Gy, but not at 25 Gy. On the other hand, 25-Gy irradiation induced a smaller increase in the levels of the tissue inhibitors of metalloproteinase-1 compared with the controls. CONCLUSION: Anastomotic strength is adversely affected by high-dose fractionated preoperative RT. In contrast, preoperative RT at 25 Gy in five fractions over 5 days is safe with regard to the maintenance of wound strength in colorectal anastomosis.
Asunto(s)
Colon/cirugía , Metaloproteinasa 2 de la Matriz/efectos de la radiación , Metaloproteinasa 9 de la Matriz/efectos de la radiación , Neoplasias del Recto/radioterapia , Cicatrización de Heridas/efectos de la radiación , Anastomosis Quirúrgica , Animales , Fenómenos Biomecánicos , Hidroxiprolina/efectos de la radiación , Masculino , Cuidados Preoperatorios , Dosificación Radioterapéutica , Radioterapia Adyuvante/métodos , Ratas , Ratas Wistar , Neoplasias del Recto/cirugía , Inhibidor Tisular de Metaloproteinasa-1/efectos de la radiaciónRESUMEN
Gastrosplenic fistula formation resulting from primary gastric malignancy is rare and should be managed as a matter of emergency. We report a patient who was diagnosed with primary non-Hodgkin's lymphoma and who underwent surgical treatment for gastrosplenic fistula.
Asunto(s)
Fístula/cirugía , Fístula Gástrica/cirugía , Linfoma de Células B/complicaciones , Enfermedades del Bazo/cirugía , Neoplasias Gástricas/complicaciones , Fístula/diagnóstico por imagen , Fístula/etiología , Gastrectomía , Fístula Gástrica/diagnóstico por imagen , Fístula Gástrica/etiología , Gastroscopía , Humanos , Linfoma de Células B/patología , Masculino , Persona de Mediana Edad , Tomografía de Emisión de Positrones , Radiografía Abdominal , Esplenectomía , Enfermedades del Bazo/diagnóstico por imagen , Enfermedades del Bazo/etiología , Estómago/patología , Neoplasias Gástricas/patología , Tomografía Computarizada por Rayos XRESUMEN
Adult intussusception occurs infrequently and differs from the childhood condition in its presentation, cause, and treatment. Nonspecific symptoms can delay diagnosis; most cases are diagnosed at emergency laparotomy. Increased use of computed tomographic scanning to evaluate patients with abdominal pain can enhance reliable preoperative diagnosis. Treatment entails simple bowel resection in most cases. Reduction is controversial, especially in cases of colonic intussusception. This report describes the diagnosis and management of a case of adult ileal intussusception caused by an inflammatory fibroid polyp-a rare lesion of the gastrointestinal tract.