Multidisciplinary management of colorectal adenocarcinoma associated with anal fistula: an Indian series.

AIM: Adenocarcinomas associated with anal fistula are rare and often present at an advanced stage. They are often mistaken for commonly occurring benign diseases, leading to delayed diagnosis. Previous reports have predicted inferior oncological outcomes for these cases compared with sporadic rectal cancers. We are presenting our series of patients with colorectal adenocarcinoma associated with anal fistula who were treated with multimodality therapy at a tertiary cancer centre in India. METHOD: This was a retrospective review of a prospectively maintained database of patients treated at our centre between 1 July 2013 and 31 March 2015. Of the 15 patients included in the study, 11 had prior intervention in the form of seton placement or fistulotomy. Fourteen patients had circumferential resection margin (CRM) involvement at initial workup and hence were given neoadjuvant chemoradiotherapy (NACRT). None of the patients had distant metastasis and only 15% had regional nodal involvement. RESULTS: All 13 patients included in the final analysis underwent abdominoperineal excision (APE). Ten patients (73%) underwent extralevator APE. Plastic reconstruction in the form of a V-Y advancement flap for perineal closure was required in six patients (46%). On histopathological examination, a mucinous component was found to be present in 11 patients (73%). The quality of total mesorectal excision was complete in 92% patients. The CRM was free in 92% of patients. Median overall survival and disease-free survival were not reached. CONCLUSION: Colorectal adenocarcinomas associated with fistula are locally aggressive malignancies with a low incidence of lymph node involvement and distant metastasis. NACRT, wider resection in the form of extralevator APE, and liberal use of plastic reconstruction may result in favourable outcomes.

Effect of fibrin glue derived from snake venom on the viability of autogenous split-thickness skin graft

The aim of this study was to analyze the effect of snake venom derived from fibrin glue on the viability of split-thickness skin graft. Nine crossbreed dogs were used. Full-thickness skin segments measuring 4X4 cm were bilaterally excised from the proximal radial area on each dog. A split-thickness skin graft was harvested from left lateral thoracic area using a freehand graft knife, and was secured to the left recipient bed using several simple interrupted sutures of 3-o nylon (sutured graft). A split-thickness skin graft was harvested from the right lateral thoracic area using a graft knife. Fibrin glue derived from snake venom was applied to the recipient bed, and 8 equidistant simple interrupted sutures of 3-0 nylon were used to secure the skin graft (glued graft). Viable and nonviable areas were traced on a transparent sheet and measured using a Nikon Photomicroscope connected to a KS-300 image analysis system. The skin graft and recipient bed were collected from three dogs at day 7,15, and 30 postoperative. The glued grafs had statistically higher graft viability than sutured grafts. Histological examination showed that the tissue repair process in the glued grafts was more accentuated than sutured grafts. It was possible to conclude that fibrin glue derived from snake venom increased survival of autogenous split-thickness skin graft.

Mechanical, biochemical, and morphological changes in the heart from chronic food-restricted rats.

Food restriction (FR) has been shown to induce important morphological changes in rat myocardium. However, its influence on myocardial performance is not completely defined. We examined the effects of chronic FR on cardiac muscle function and morphology. Sixty-day-old Wistar-Kyoto rats were fed a control (C) or a restricted diet (daily intake reduced to 50% of the amount of food consumed by the control group) for 90 days. Myocardial performance was studied in isolated left ventricular (LV) papillary muscle. Fragments of the LV free wall were analysed by light microscopy, and the ultrastructure of the myocardium was examined in the LV papillary muscle. The myocardial collagen concentration was also evaluated. FR decreased body weight (BW) and LV weight (LVW); the LVW/BW ratio was higher in the restricted group (C, 1.86+/-0.17 mg/g; FR, 2.19+/-0.31 mg/g; p < 0.01). In the FR animals, the cardiac fibers were polymorphic, some of them were of small diameter and others presented lateral infoldings; the ultrastructural alterations were focal and included reduction of sarcoplasmic content, absence and (or) disorganization of myofilaments and Z line, numerous electron dense and polymorphic mitochondria, and deep infoldings of the plasma membrane. The hydroxyproline concentration was higher in the FR animals (p < 0.01). FR prolonged the contraction and relaxation time of the papillary muscle and did not change its ability to contract and shorten. In conclusion, although a 90-day period of FR caused striking myocardial ultrastructural alterations and increased the collagen concentration, it only minimally affected the mechanical function.

Morphological aspects of rabbit masseter muscle after cervical sympathectomy.

The objective of this paper was to study the effect of sympathetic innervation on morphological and histochemical aspects of skeletal muscle tissue. Rabbit masseter muscle was studied using histochemical and immunohistochemical methods for periods of up to 18 months post-sympathectomy. The morphological and enzymatic characteristics of control masseter muscles were similar on both the left and right sides. The main features were muscle fibres with a mosaic pattern and a predominance of type IIa fibres, followed by type I. Type IIb fibres showed very low frequency. Sympathectomized animals showed varying degrees of metabolic and morphological alterations, especially 18 months after sympathectomy. The first five groups showed a higher frequency of type I fibres, whilst the oldest group showed a higher frequency of type IIb fibres. In the oldest group, a significant variation in fibre diameter was observed. Many fibres showed small diameter, atrophy, hypertrophy, splitting, and necrosis. Areas with fibrosis were observed. Thus cervical sympathectomy induced morphological alterations in the masseter muscles. These alterations were, in part, similar to both denervation and myopathy. These findings indicate that sympathetic innervation contributes to the maintenance of the morphological and metabolic features of masseter muscle fibres.

Distribution of different fibre types of M. extensor carpi radialis longus of the rat.

As revealed by the NADH-diaphorase and myosine ATPase, the M. extensor carpi radialis longus of the rat possesses at least 3 main kinds of fibres, with different distribution on the superficial and deep portions of the muscle. The superficial portion revealed that 67.68% are FG (fast-twitch-glycolytic) fibres, 14.72% are FOG (fast-twitch-oxidative) fibres and 17.60% are SO (slow-twitch-glycolytic) fibres. Already the deep portion revealed that 71.29% are SO (slow-twitch-glycolytic) fibres, 17.46% are FOG (fast-twitch-oxidative-glycolytic) fibres and 11.25% are FG (fast-twitch-glycolytic) fibres. The miosine ATPase reaction was used to demonstrate contracting characteristics. These findings suggest that the movements of fast contraction of the M. extensor carpi radialis longus are predominant.

Fiber types distribution in the digastric muscle of tufted capuchin monkey (Cebus apella).

Fiber types distribution in the digastric muscle of tufted capuchin monkey was studied by means of NADH-TR, myosin-ATPase, after alkaline and acid preincubations and SDH histochemical reactions. Three different types of fibers were found presenting an equal distribution. The percentage and types of fibers were as follow: 18.2% SO (Slow Oxidative), 38.4% FOG (Fast Oxidative Glycolytic) and 43.4% FG (Fast Glycolytic). FG fibers revealed the largest area. The relatively high concentration of fast twitch (81.2%) seems to indicate this muscle is involved with the acceleration and fast speed of jaw movements. Aerobic metabolism represented by SO + FOG fibers (56.6%) suggests that this muscle possesses an additional role than that related to the lowering of the jaw.

An ultrastructural study on the endocrine pancreas of Caiman latirostris, with special reference to pancreatic motilin cells.

Pancreatic endocrine cells of Caiman latirostris were investigated by electron microscopy using conventional and immunocytochemical methods. Ultrastructurally, four types of endocrine cells were classified according to the morphology of their secretory granules. Three types of endocrine cells were identified as either glucagon, insulin or somatostatin cells by the presence of such characteristic granules well established in mammals. The remaining endocrine cell type could not be classified by its ultrastructural features alone. Immunocytochemical observations confirmed the ultrastructural classification of glucagon, insulin and somatostatin cells. In addition, endocrine cells immunoreactive for either pancreatic polypeptide (PP) or motilin were identified. Morphometric analysis of PP- and motilin-immunoreactive granules demonstrated that they were the most polymorphous and smallest granules among the pancreatic endocrine cell granules. Although both PP and motilin granules closely resemble each other, motilin granules were smaller in size and more spherical in shape than PP granules.

Motilin-immunoreactive cells in the duodenum, pyloric stomach and pancreas of caimans (Caiman latirostris and Caiman crocodilus, alligatorinae): a further comparison using region-specific motilin antisera.

Motilin-immunoreactive cells in the duodenum, pyloric stomach and pancreas of Caiman latirostris and Caiman crocodilus were investigated using region specific antisera for porcine and canine motilin molecules. Motilin-immunoreactive cells were found in the duodenum, pyloric stomach and pancreas of both caiman species. These cells were primarily open-type endocrine ones in the epithelium of the duodenum and pyloric stomach. Motilin-immunoreactive cells were observed in both the exocrine and endocrine portions of the pancreas, and frequently exhibited one or more cytoplasmic processes of variable length. Since motilin-immunoreactive cells do not cross-react with serotonin or any of the other pancreatic and gut hormones, they are considered to be cell type independent from any of the other known pancreatic or gut endocrine cells. The molecular similarity between caiman motilin and porcine and canine motilins and the heterogeneity of the motilin molecule in the caiman digestive system is discussed.

[Anatomical notes on the capsular veins of the kidney of the cat]. / Considérations anatomiques des veines capsulaires du rein du chat (Felis domestica).

Capsular veins of 36 kidneys in cat (Felis domestica) have been investigated on macroscopical level. There are venous shunts on the superficial renal level which occur in both surfaces (dorsal and ventral) and different pathways of these vessels for comparative diagnosis. The collateral renal circulation may be sufficient to maintain the renal vascularization in stress conditions.

Study of motor units of M. pectineus of the dog (Canis familiaris).

Cross sections of M. pectineus of 6 adult dogs were used to study the number of motor units. Our results revealed that M. pectineus possesses 29,451 muscle fibres and 165 large nerve fibres. Since 60% of these latter fibres are motor fibres, the number of fibres per motor unit of M. pectineus is 294. This fact suggests that this muscle executes finely adjusted movements.

Fibre types of M. pectineus of the dog (Canis familiaris).

As revealed by the NADH-diaphorase, M. pectineus of the dog possesses at least three main kind of fibres: 45.99% of small and slow contracting-red fibres, presenting an intense reaction, specially in the subsarcolemmal region; 45.55% of large and fast contracting-white fibres, presenting a less intense reaction. The remainder 8.46% fibres possess intermediate characteristics. These findings suggest that the movements of slow and fast contraction of M. pectineus are somewhat equilibrated.

Fine structure of epidermal mucous cells of some Brazilian earthworms (Oligochaeta:Annelida).

Electron microscopic techniques were adopted to study the comparative morphology of the secretory granules of the epidermal mucous cells of 4 species of brazilian earthworms. 2 main types of secretory granules were described: A first type, presenting a central body with a high electron density and surrounded by a material with variable aspects and electron densities. The second type of secretory granule possesses an homogeneous aspect and a relatively low electron density. The size and the morphology of secretory granules reveal significant variations among the species and also inside a single specie.

Histochemical study of polysaccharides in some arteries of the region of the heart of black vulture (Coragyps atratus).

A comparative histochemical study of polysaccharides in some arteries of the region of the heart of black vulture was performed. With some exceptions, no variation in polysaccharides composition in all arteries studied were shown. Arterial walls present a sialo-mucopolysaccharidic complex and it is composed of: sialic acid, neutral mucopolysaccharides, hyaluronic acid and chondroitin sulfates. The concentration of these carbohydrates, mainly of the acidic ones, decrease from the inner portions of the media toward the adventitia.

Histochemical study of mucopolysaccharides in epidermal mucous cells and subjacent granular cells of Glossoscolex uruguayensis L. (Righi, 1978).

Histochemical study of mucopolysaccharides of both mucous secreting and subjacent granular cells of the epidermis of Glossoscolex uruguayensis L (Righi, 1978), has been done. Histochemical tests revealed two major types of mucous cells: large ortochromatic mucous cells and metachromatic mucous cells. The first ones possess alpha-amylase resistant, PAS-positive material, together with little mucic acid, and the latter present a very low rate of neutral mucopolysaccharides and to a variable degree, both carboxylate and sulphate mucopolysaccharides. A third cell type was also detected, presenting a frothy acid like material. Subjacent epidermal granular cells display alpha-amylase resistant, PAS-positive granules, with no acid mucus.

Histochemical study of polysaccharides in the aortic arch of some birds.

The histochemical study of polysaccharides in the aortic arch of the black vulture, turkey, peking duck, goose and duck, showed that a sialo-mucopolysaccharidic complex is present in the vessel wall and consists of: sialic acid, neutral mucopolysaccharides, hyaluronic acid and Chondrotin sulfate. The concentration of mucopolysaccharides, mainly of the acidic ones, decreases from the inner portions of the media towards the adventicia.