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Journal of Gastrointestinal Surgery :... Dec 2020To evaluate the clinical value of CT angiography (CTA), CT colonography (CTC), and image fusion in the preoperative evaluation of laparoscopic complete mesocolic... (Randomized Controlled Trial)
Randomized Controlled Trial
Clinical Value of Multi-Slice Spiral CT Angiography, Colon Imaging, and Image Fusion in the Preoperative Evaluation of Laparoscopic Complete Mesocolic Excision for Right Colon Cancer: a Prospective Randomized Trial.
PURPOSE
To evaluate the clinical value of CT angiography (CTA), CT colonography (CTC), and image fusion in the preoperative evaluation of laparoscopic complete mesocolic excision (CME) for right colon cancer.
METHODS
In this randomized prospective study, 80 patients undergoing laparoscopic CME for right colon cancer were randomly divided into two groups: image fusion [the original images were reconstructed using CTA and CTC, then fused into three-dimensional images of the blood vessels and intestines (n = 40)] and control (without CTA and CTC reconstruction before surgery). All patients underwent plain and enhanced abdominal CT before surgery.
RESULTS
In the image fusion group, the gastrocolic trunk of Henle was present in 33 cases, and its branches originated from the colon vein, right gastroepiploic vein, and superior anterior pancreaticoduodenal vein. Among these patients, 5 exhibited the right gastroepiploic vein and superior anterior pancreaticoduodenal vein; 21 exhibited a gastrointestinal trunk consisting of 2 or 3 branches of the right gastroepiploic vein, right colon vein, and middle colon vein; and 7 exhibited 3 or 4 gastro-pancreatic and colon trunks consisting of the right colon vein, middle colon vein, right gastroepiploic vein, and superior anterior pancreaticoduodenal vein. The correspondence with the anatomy actually observed during surgery was 100%. Compared with the conventional CT group, the duration of the operation in the image fusion group was shorter, with reduced intraoperative bleeding, and more lymph node dissection. There were no significant differences in the incidence of complications and length of hospital stay between the two groups (p > 0.05).
CONCLUSIONS
For laparoscopic CME for right colon cancer, CTA, CTC, and image fusion were effective preoperative evaluation methods, which avoided some unseen dangers in the operation process and led to better therapeutic outcomes.
Topics: Colectomy; Colonic Neoplasms; Computed Tomography Angiography; Humans; Laparoscopy; Lymph Node Excision; Mesocolon; Prospective Studies
PubMed: 31845142
DOI: 10.1007/s11605-019-04460-1 -
Clinics in Colon and Rectal Surgery May 2019Early in the 21st century, the costs of health care in the United States have spiraled out of control, where the per capita spending is $9,237 per person-the highest in... (Review)
Review
Health Care Policy and Outcomes after Colon and Rectal Surgery: What Is the Bigger Picture?-Cost Containment, Incentivizing Value, Transparency, and Centers of Excellence.
Early in the 21st century, the costs of health care in the United States have spiraled out of control, where the per capita spending is $9,237 per person-the highest in the world. By 2020, an estimated 20% of GDP will be spent on health care. The issue of cost and quality is now becoming a national crisis, with ∼50% of hospitals losing money on clinical operations, forcing closure of essential critical access hospitals, and forcing health care workers to relocate or change professions. This crisis will only worsen with the graying of America, as an estimated 17% of Americans will be over the age of 65 years by the year 2020. The policy and financial structures on which these changes are based are important factors of which practicing surgeons should be aware. This review discusses recent national health care policy reform and specific topics including cost-containment legislation, value-based incentives and penalties, transparency, and centers of excellence in colorectal surgery.
PubMed: 31061652
DOI: 10.1055/s-0038-1677028 -
Journal of the American Veterinary... Oct 2023To describe the clinical, laboratory, and ultrasonographic findings; treatment; and outcome of cattle with mesenteric torsion (MT).
OBJECTIVE
To describe the clinical, laboratory, and ultrasonographic findings; treatment; and outcome of cattle with mesenteric torsion (MT).
ANIMALS
61 cattle with MT between November 1, 1986, and December 31, 2019.
METHODS
Medical records were retrospectively reviewed. Results were compared for cattle that survived versus did not survive to hospital discharge.
RESULTS
All cattle had abnormal demeanor. The most common clinical signs were tachycardia (80.3% [49/61]), tachypnea (65.0% [39/60]), and lower rectal temperature (59.3% [35/59]). Signs of colic occurred in 65.6% (40/61). The most common gastrointestinal findings were an empty or almost empty rectum (100% [59/59]), reduced or absent motility of the small intestines (96.6% [57/59]) or rumen (93.2% [55/59]), positive ballottement and/or percussion and simultaneous auscultation on the right side (91.7% [55/60]), and dilated small (49.2% [29/59]) and large intestines (spiral colon and/or cecum, 44.1% [26/59]) detected during transrectal examination. The most common laboratory findings were acidosis (82.6%, [38/46]) hypermagnesemia (74.5% [35/47]). Ultrasonographic findings included reduced or absent small intestinal motility (86.7% [26/30]) and dilated small intestines (83.8% [31/37]). The spiral colon was dilated in 32.4% (12/37) of the cattle. Eighty-two percent (50/61) of the cattle underwent right flank laparotomy and the MT could be reduced in 34.4% (21/61). Twenty-three percent (14/61) of the cattle survived to hospital discharge, and 77.0% (47/61) were euthanized before hospital discharge.
CLINICAL RELEVANCE
Dilated small and large intestines (spiral colon, cecum) combined with a severely abnormal demeanor and tachycardia are characteristic findings in cows with MT. Immediate surgical treatment is paramount.
Topics: Female; Cattle; Animals; Pregnancy; Retrospective Studies; Intestine, Large; Intestine, Small; Cecum; Colon; Cattle Diseases
PubMed: 37451675
DOI: 10.2460/javma.23.05.0243 -
Acta Gastro-enterologica Belgica 2023Motorized spiral enteroscopy is proven to be effective in antegrade and retrograde enteroscopy. Nevertheless, little is known about its use in less common indications....
BACKGROUND AND STUDY AIMS
Motorized spiral enteroscopy is proven to be effective in antegrade and retrograde enteroscopy. Nevertheless, little is known about its use in less common indications. The aim of this study was to identify new indications for the motorized spiral enteroscope.
METHODS
Monocentric retrospective analysis of 115 patients who underwent enteroscopy using PSF-1 motorized spiral enteroscope between January 2020 and December 2022.
RESULTS
A total of 115 patients underwent PSF-1 enteroscopy. 44 (38%) were antegrade procedures and 24 (21%) were retrograde procedures in patients with normal gastrointestinal anatomy with conventional enteroscopy indications. The remaining 47 (41%) patients underwent PSF-1 procedures for secondary less conventional indications: n=25 (22%) enteroscopy-assisted ERCP, n=8 (7%) endoscopy of the excluded stomach after Roux-en-Y gastric bypass, n=7 (6%) retrograde enteroscopy after previous incomplete conventional colonoscopy and n=7 (6%) antegrade panenteroscopy of the entire small bowel. In this group of secondary indications, technical success rate was significantly lower (72.5%) as compared to technical success rates in the conventional groups (98-100%, p<0.001 Chi-square). Minor adverse events occurred in 17/115 patients (15%), all treated conservatively (AGREE I and II).
CONCLUSION
This study demonstrates the capabilities of PSF-1 motorized spiral enteroscope for secondary indications. PSF-1 is useful to complete colonoscopy in case of long redundant colon, to reach the excluded stomach after Roux-en-Y gastric bypass, to perform unidirectional pan-enteroscopy and to perform ERCP in patients with surgically altered anatomy. However, technical success rates are lower as compared to conventional antegrade and retrograde enteroscopy procedures, with only minor adverse events.
Topics: Humans; Cholangiopancreatography, Endoscopic Retrograde; Retrospective Studies; Endoscopy, Gastrointestinal; Intestine, Small; Stomach; Double-Balloon Enteroscopy
PubMed: 37428159
DOI: 10.51821/86.2.11779 -
Veterinary Pathology May 2021Swine dysentery (SD) is an enteric disease associated with strongly β-hemolytic spp. that cause mucohemorrhagic diarrhea primarily in grower-finisher pigs. We...
Swine dysentery (SD) is an enteric disease associated with strongly β-hemolytic spp. that cause mucohemorrhagic diarrhea primarily in grower-finisher pigs. We characterized alteration of colonic mucin composition and local cytokine expression in the colon of pigs with acute SD after (Bhyo) infection and fed either a diet containing 30% distillers dried grains with solubles (DDGS) or a control diet. Colonic tissue samples from 9 noninoculated pigs (Control, = 4; DDGS, = 5) and 10 inoculated pigs experiencing acute SD (Bhyo, = 4; Bhyo-DDGS, = 6) were evaluated. At the apex of the spiral colon, histochemical staining with high-iron diamine-Alcian blue revealed increased sialomucin ( = .008) and decreased sulfomucin ( = .027) in Bhyo pigs relative to controls, with a dietary effect for sulfomucin. Noninoculated pigs fed DDGS had greater expression of sulfomucin ( = .002) compared to pigs fed the control diet. Immunohistochemically, there was de novo expression of mucin 5AC (MUC5AC) in the Bhyo group while mucin 2 (MUC2) expression was not significantly different between groups. RNA in situ hybridization to detect the pro-inflammatory cytokine IL-1β often showed increased expression in the Bhyo group although without statistical significance, and this was not correlated with MUC5AC or MUC2 expression, suggesting IL-1β is not a major regulator of their secretion in acute SD. Expression of the anti-inflammatory cytokine TGF-β1 was significantly suppressed in the Bhyo group compared to controls ( = .005). This study reveals mucin and cytokine alterations in the colon of pigs with experimentally induced SD and related dietary effects of DDGS.
Topics: Animal Feed; Animals; Colon; Cytokines; Diet; Dysentery; Mucins; Swine; Swine Diseases
PubMed: 33686884
DOI: 10.1177/0300985821996657 -
Acta Veterinaria Scandinavica Apr 2024Torsion of the spiral colon (TSC) describes twisting of the spiral colon around its mesentery. The present study reviewed the medical records of 58 cows and heifers with...
BACKGROUND
Torsion of the spiral colon (TSC) describes twisting of the spiral colon around its mesentery. The present study reviewed the medical records of 58 cows and heifers with TSC and described the findings, treatment and outcome.
RESULTS
All cases had an abnormal general condition, and the main vital sign abnormalities were tachycardia (72.4%), tachypnoea (67.2%) and decreased rectal temperature (51.8%). Signs of colic were seen in 62.1% of the cows. The most common intestinal abnormalities were an empty or almost empty rectum (96.6%), reduced or absent rumen motility (93.2%), positive ballottement and/or percussion and simultaneous auscultation on the right side of the abdomen (87.9%), reduced or absent intestinal motility (84.5%) and dilatation of the large intestines (spiral colon and/or caecum, 70.7%) diagnosed by transrectal palpation. The main biochemical changes were hypermagnesaemia (70.8%), hypocalcaemia (70.8%), and acidosis (66.7%). Haemoconcentration was found in 63.8%. The main ultrasonographic findings were reduced to absent small intestinal motility (83.3%), dilated small intestines (69.6%) and ascites (66.7%). The spiral colon was dilated in 44.0% of the cows and the caecum in 24.0%. The actual site of torsion could not be visualised. Based on the clinical findings, TSC was diagnosed in 22.4% and caecal dilatation in 50.0% of the cows. A tentative diagnosis of small intestinal ileus was made in another 10.3% of the cows, and a definitive diagnosis of small intestinal ileus in 17.3%. Fifty-three cows underwent right flank laparotomy, and the TSC could be reduced in 26. Twenty-six of the 58 (44.8%) cows were discharged and 32 (55.2%) were euthanased before, during or after surgery.
CONCLUSIONS
Acute illness, a sparse amount of faeces in the rectum and dilated spiral colon and caecum are characteristic findings of TSC. The final diagnosis often relies on the surgical or postmortem findings. Cattle with TSC should be treated surgically without delay. The prognosis is guarded with a survival rate of 44.8%.
Topics: Cattle; Animals; Female; Pregnancy; Retrospective Studies; Cattle Diseases; Colon; Ileus
PubMed: 38622685
DOI: 10.1186/s13028-024-00738-w -
Journal of Zoo and Wildlife Medicine :... Jun 2020Gastrointestinal (GI) pathology is common in elasmobranchs; however, information regarding normal GI transit time and the effect of therapeutics on GI motility is...
RADIOGRAPHIC DETERMINATION OF GASTRIC EMPTYING AND GASTROINTESTINAL TRANSIT TIME IN COWNOSE RAYS () AND WHITESPOTTED BAMBOO SHARKS () AND THE EFFECT OF METOCLOPRAMIDE ON GASTROINTESTINAL MOTILITY.
Gastrointestinal (GI) pathology is common in elasmobranchs; however, information regarding normal GI transit time and the effect of therapeutics on GI motility is lacking. The objective of this study was to determine baseline gastric emptying and GI transit times in cownose rays () and whitespotted bamboo sharks () via radiographic barium sulfate contrast studies. Additionally, a pilot study was undertaken to determine the effect of metoclopramide on GI transit time in whitespotted bamboo sharks. Eight cownose rays and eight whitespotted bamboo sharks were administered a 98% w/w barium sulfate suspension at 8 ml/kg via orogastric tube. Post-contrast radiographs were obtained at 2 min, 3, 6, 12, and 23 hr for rays; and 2 min, 3, 6, 9, 12, 16, 25, 30, 36, and every 12 hr until complete gastric emptying occurred for sharks. In cownose rays, the mean and standard error were established for time of initial spiral colon filling (3.4 ± 0.4 hr), complete spiral colon opacification (12 ± 0 hr), initial spiral colon emptying (21.6 ± 1.4 hr), and complete gastric emptying (23 ± 0 hr). In bamboo sharks, the mean and standard error were established for time of initial spiral colon filling (5.3 ± 0.5 hr), complete spiral colon opacification (12.4 ± 1.3 hr), initial spiral colon emptying (22.5 ± 2.7 hr), and complete gastric emptying (39.9 ± 3.3 hr). Cownose rays had a significantly shorter time to spiral colon filling and complete gastric emptying compared with bamboo sharks ( < 0.05). Whitespotted bamboo sharks ( = 8) were administered metoclopramide (0.4 mg/kg orally once daily for 10 days) and the barium series was repeated. Complete gastric emptying time was significantly shorter in treated sharks compared with control ( < 0.05), suggesting that metoclopramide may be a useful therapeutic for GI motility disorders in elasmobranchs.
Topics: Animals; Antiemetics; Female; Gastric Emptying; Gastrointestinal Motility; Gastrointestinal Tract; Gastrointestinal Transit; Male; Metoclopramide; Pilot Projects; Sharks; Skates, Fish; Species Specificity
PubMed: 32549562
DOI: 10.1638/2019-0015 -
Annals of Anatomy = Anatomischer... Apr 2023The cranial mesenteric artery exhibits a species-specific ramification pattern that adapts to the morphology of the intestinal tract. The degu is a strictly herbivorous...
BACKGROUND
The cranial mesenteric artery exhibits a species-specific ramification pattern that adapts to the morphology of the intestinal tract. The degu is a strictly herbivorous rodent with a well-developed large intestine with a spiral loop in the ascending colon; therefore, the cranial mesenteric artery likely demonstrates a degu-specific ramification pattern. Thus, we traced the cranial mesenteric artery to establish the detailed ramification pattern of the branches.
METHODS
Eighteen male degus were injected with 0.3-0.8 ml of a latex mixture and water at a 1:1 ratio in conjunction with red acrylic paint coloring using a catheter inserted into the thoracic aorta. The cranial mesenteric artery was traced using a surgical microscope and photographed using a digital camera.
RESULTS
The arteries emerging from the cranial mesenteric artery exhibited frequent variations in number, distribution area, anastomosis pattern, and branching order. In the most frequent cases (22%), the cranial mesenteric artery sequentially gave rise to caudal pancreaticoduodenal, middle colic, right colic, jejunal, and ileocolic arteries. The right and middle colic arteries exhibited four different ramification patterns. In the most common cases (67%), the middle and right colic arteries emerged independently from the cranial mesenteric artery. The former was distributed to the transverse and descending colon, whereas the latter sent branches to the spiral loop of the ascending colon.
CONCLUSIONS
The complex ramification pattern of the right colic artery in the degu may be an adaptation to the characteristic running pattern of the ascending colon. Thus, we present the first comprehensive report of the arterial branching pattern of the cranial mesenteric artery in the degu.
Topics: Animals; Male; Octodon; Colic; Mesenteric Arteries; Mesenteric Artery, Superior; Intestines; Colon
PubMed: 36754241
DOI: 10.1016/j.aanat.2023.152067 -
Journal of the Mechanical Behavior of... Jan 2018In the present work, we propose the first structural constitutive model of the passive mechanical behavior of the swine colon that is validated against physiological...
In the present work, we propose the first structural constitutive model of the passive mechanical behavior of the swine colon that is validated against physiological inflation-extension tests, and accounts for residual strains. Sections from the spiral colon and the descending colon were considered to investigate potential regional variability. We found that the proposed constitutive model accurately captures the passive inflation-extension behavior of both regions of the swine colon (coefficient of determination R=0.94±0.02). The model revealed that the circumferential muscle layer does not provide significant mechanical support under passive conditions and the circumferential load is actually carried by the submucosa layer. The stress analysis permitted by the model showed that the colon tissue can distend up to 30% radially without significant increase in the wall stresses suggesting a highly compliant behavior of the tissue. This is in-line with the requirement for the tissue to easily accommodate variable quantities of fecal matter. The analysis also showed that the descending colon is significantly more compliant than the spiral colon, which is relevant to the storage function of the descending colon. Histological analysis showed that the swine colon possesses a four-layer structure similar to the human colon, where the longitudinal muscle layer is organized into bands called taeniae, a typical feature of the human colon. The model and the estimated parameters can be used in a Finite Element framework to conduct simulations with realistic geometry of the swine colon. The resulting computational model will provide a foundation for virtual assessment of safe and effective devices for the treatment of colonic diseases.
Topics: Animals; Biomechanical Phenomena; Colon; Computer Simulation; Elasticity; Finite Element Analysis; Humans; Models, Biological; Muscle, Smooth; Stress, Mechanical; Swine; Tensile Strength
PubMed: 28922650
DOI: 10.1016/j.jmbbm.2017.08.031 -
PloS One 2019The term heterotopy of the spiral colon encompasses a dysmorphological condition in which the spiral loops of the ascending colon (SLACs) do not form an orderly...
The term heterotopy of the spiral colon encompasses a dysmorphological condition in which the spiral loops of the ascending colon (SLACs) do not form an orderly spiraling mass adjacent to the left side of the mesojejunum. As a consequence, the spiral loops are spread over a larger surface, making them more or less movable. It has been hypothesized that the abnormal position of the spiral loops of the ascending colon might constitute a predisposing factor for an intestinal obstruction or an ileus condition. The objective of the present study was to evaluate the anatomy of the spiral loops of the ascending colon in a population of healthy calves and to determine the prevalence of dysmorphism. The investigation was carried out on 1113 slaughtered veal calves. In 472 out of the 1113 calves, the spiral loops showed conformational aspects different from what has so far been described as normal in reference textbooks. In 91 calves the condition was definitely considered a pathological deviation from normality: in fact, the spiral colon had lost its typical spiral shape with random spacing between the loops, and it was nearly or completely detached from the mesojejunum. The lack of a broad attachment of the spiral loops of the ascending colon to the mesentery could provoke an alteration of the intestinal centre of gravity, enhancing the already asymmetrical distribution of weight between the jejunum and the descending colon.
Topics: Animals; Cattle; Cattle Diseases; Choristoma; Colon, Ascending; Male; Prevalence
PubMed: 30978255
DOI: 10.1371/journal.pone.0215402