Open lateral sphincterotomy - A method of choice in the treatment of chronic anal fissure. Indications and results

Aim: The key to the treatment of chronic anal fissures is the reduction of the abnormal values of anal resting pressure. The aim of the surgical treatment is to reduce the activity of the internal anal sphincter and to provide proper conditions for the fissure to cure, which can be achieved by internal sphincterotomy. In the modern surgical practice the internal sphincterotomy is performed away from the fissure, lateral of the last, using open or closed technique.Methods: In our study we performed open lateral internal sphincterotomy (OLST) of 82 patients with chronic anal fissure, compared to a control group of 231 patients, treated with different methods. Results: We didn`t register any recurrences in the sixth post-operative moth after OLST. 11% of patients with OLST were with registered incontinence after the sixth post-operative month compared with 4.4% in non-OLST patients. The data was statistically significant (p=0.032)Conclusion: Choosing an OLST as a method for treatment of chronic anal fissure requires careful selection of patients. It is not recommended for patients with a risk of incontinence like those with a previous birth trauma, age beyond 60 years, previous ano-rectal operations, neurological diseases and low values in anal resting pressure.Aim: The key to the treatment of chronic anal fissures is the reduction of the abnormal values of anal resting pressure. The aim of the surgical treatment is to reduce the activity of the internal anal sphincter and to provide proper conditions for the fissure to cure, which can be achieved by internal sphincterotomy. In the modern surgical practice the internal sphincterotomy is performed away from the fissure, lateral of the last, using open or closed technique.Methods: In our study we performed open lateral internal sphincterotomy (OLST) of 82 patients with chronic anal fissure, compared to a control group of 231 patients, treated with different methods. Results: We didn`t register any recurrences in the sixth post-operative moth after OLST. 11% of patients with OLST were with registered incontinence after the sixth post-operative month compared with 4.4% in non-OLST patients. The data was statistically significant (p=0.032)Conclusion: Choosing an OLST as a method for treatment of chronic anal fissure requires careful selection of patients. It is not recommended for patients with a risk of incontinence like those with a previous birth trauma, age beyond 60 years, previous ano-rectal operations, neurological diseases and low values in anal resting pressure

Primary amyloidosis with initial gastrointestinal manifestation. A case report

Introduction. Amyloidosis is a rare disease associated with extracellular accumulation of abnormal protein – amyloid in various organs and systems. This disease can be either acquired or hereditary, systemic or localized. At its core, it represents a grown, tumor-like neoplastic clone of the plasma cells in the bone marrow. Gastrointestinal amyloidosis is manifested by symptoms, such as diarrhea, steatorrhea, constipation, and very rarely – hemorrhages and perforations of the colon. Case presentation. We present a case of primary intestinal amyloidosis with recurrent hematochezia and abdominal pain in a 61-year-old woman. Colonoscopy revealed polyposis of the whole colon and a total colectomy was performed, followed by morphological and paraclinical examinations. Histologically, amyloid deposition, positive for Congo red, was found in the walls of the submucosal blood vessels and in the smooth muscle cells of the muscular layers. The laboratory tests indicated anemia, high erythrocyte sedimentation rate, and Bence-Jones proteins in urine. Conclusions. Our case is a demonstration of primary amyloidosis with intestinal localization that should be taken into consideration in the presence of recurrent hematochezia

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Risk profile of patients with colorectal cancer

Colorectal cancer (CRC) is the most popular neoplasm of the gastrointestinal system and is the third most commonly diagnosed cancer in the world and in Bulgaria. Our aim was to evaluate and analyze the risk profile of patients diagnosed with CRC. We studied 363 cases of patients with CRC treated at the Clinic of General Surgery at Lozenets University Hospital in Sofia for the period 2002-2012. Patients were categorized according to basic demographic characteristics, general and disease-specific risk factors and to the morphological and histological characteristics of CRC. Their average age was 67 years (±11 years), 42,7% were women and 57,3% were men. The most common general risk factors among patients with CRC were smoking, drinking alcohol and unbalanced diet and from the group of specific risk factors - the presence of adenomatous polyps of the colon. Morphologically, most patients had cancer in the rectosigmoid area of the colon (61,5%) and histologically, it was adenocarcinoma in the majority of the cases. Based on the TNM classification, 2,5% of patients with CRC were diagnosed at stage 0, 8% at stage I, 42,7% at stage II, 26,2% at stage III and 20, 6% atstage IV. Most CRC patients were diagnosed at an advanced stage of the disease. It is necessary to focus on targeted and detailed evaluation of the general and specific risk factors for CRC as well as in adequate screening of risk groups which would lead to an earlier diagnosis and improved prognosis

Heart: SEM of microvascular corrosion casting of feline models

Introduction: Scanning electron microscopy (SEM) of corrosion vascular casts of the heart allows morphological and anatomical three dimensional observations and description of the distribution, diameter and internal surface of the collected replicas. SEM method gives quantitative information for the vascularization.Aim: To investigate the microcirculatory bed of the heart in experimental feline models by SEM of corrosion vascular casts.Materials and methods: Polymerized vascular casts with following corrosion of the heart have been obtained from 14 sexually mature tomcats (Felis silvestris catus) with body weight from 2.9 kg to 4.0 kg. The obtained microvasculature replicas have been studied by SEM.Results: In the proventricular myocardium of the feline models, the capillaries are relatively S-like curved, equally distributed and form network-like structures with predominant Y-like anastomoses. In the ventricular myocardium the capillaries are grouped in tufts and form between themselves and Y-type anastomoses, as predominate these of H type.Conclusion: This finding gives us to make a motivation, regarding the hemodynamics that the observed morphological features are extremely beneficial to provide a steady and permanent blood flow, which itself favors the metabolic and gas exchange

Imaging modalities for investigation of the rabbit liver anatomy

In the modern world of science and practice the non-invasive imaging methods are included in anatomical investigation of the liver. Data concerning the rabbit liver imaging anatomical features are scarce and contradictory. The classical anatomical data are also object of discussion. There are two theories which interpret the lobar division of the rabbit liver. The anatomical images by 2D ultrasonography of the rabbit liver were in different planes. The rabbit liver was composed of five lobes. The histosonographic results demonstrated correspondence between the brightness and sharpness of the organ`s images and its histological features. 2D ultrasound study was compared to 3D ultrasound investigation. The visualization of the organ demonstrated a well visible right hepatic lobe, as the left one was subdivided into lateral and medial. The rabbit liver was visualized in three geometric planes. By color Doppler ultrasound, we obtained anatomical information in real time, which gave data for topography of the rabbit liver blood and biliary vessels, connected to variations of the color Doppler spectrum from blue to red gamma. The images of the organ at CT were anatomical scans in transverse, dorsal and sagittal planes. By axial CT study the anatomical data presented topographic features of the organ. Metric information for the size of the organ was collected. By helical CT the information was with higher value and presented the density of the liver lobes and gall bladder in Hounsfield units. The MRI images were in voxel based matrix. T2 sequence was suitable for transversal and sagittal anatomical study of the rabbit liver and its closeness to adjacent organs. T1 was used to study the organ in dorsal plane, because it gave better tissue contrast to rabbit liver toward the close structures from cranial abdominal region

Transversal, sagittal and dorsal anatomical MRI study of the rabbit liver

Magnetic resonance imaging (MRI) is an applicable method for the contemporary anatomical visualization of small mammals` abdominal organs. The anatomical object studied is separated into voxel units, depending on the magnetic field. The anatomical objects are obtained on thin scan levels. We studied the liver of ten sexually mature, clinically healthy New Zealand white rabbits in T2- and T1-weight­ed sequence.On a transversal plane, T2-weighted sequence, the anatomical boundary between the left and right liver lobes was not defined. The left medial lobe of the liver was hyperintense compared to the left lateral lobe. The gallbladder demonstrated a hypersignal. Medial to the quadrate lobe was the gallbladder. The cystic duct demonstrated hy­persignal to the parenchyma. The right, left medial and left lateral lobes of the liver had dark grey tissue contrast.On sagittal T2 of the abdominal region at the level of the plane, 10 mm to the left, the left medial lobe of the liver was hypointense. Caudal to the left medial lobe was the lateral one. In the sagittal plane, 20 mm to the left, the me­dial and left lateral lobes and papillary process were hyposignal anatomical findings. In the sagittal plane, at 10 mm to the right, the right lobe was cranial to the fundus and body of the stomach. The papillary process touched the fundus of the stomach. The caudate process reached the right adipose capsule of the kidney. In the sagittal plane, 20 mm to the right, the left medial and quadrate lobes were caudal to the right lobe. The caudate lobe was dorsal.In the dorsal plane (T1-weighted sequence), 15 mm ventral to the spine, the right lobe was cranial to the other lobes. Left to the median plane was the left lobe. In the dorsal plane, 30 mm to the spine, the right lobe was cov­ered by the caudate lobe. The left medial lobe covered the left one. In the plane, 45 mm ventral to the spine, the right and left lobes were hyposignal findings in the same anatomical plane