Emergency Left Colon Resection for Acute Perforation. Primary Anastomosis or Hartmann's Procedure? A Case-matched Control Study

Background: The optimal treatment remains controversial for acute left-sided colon perforation. Therefore, the effectiveness and safety of primary anastomosis versus Hartmann's operation (HP) was compared in a case-matched control study. Methods: Thirty consecutive patients with primary anastomosis and protective ileostomy (PAS) were matched to 30 HP patients, controlling for age, gender, American Society of Anesthesiologists (ASA) score, body mass index (BMI), and peritonitis severity (Hinchey). In a second analysis, PAS patients with purulent peritonitis (Hinchey 3) were matched to patients with primary anastomosis without ileostomy (PA). Results: Hospital mortality was similar between HP (17%) and PAS (10%). Complication frequency and severity (requiring re-intervention or admission to the Intensive Care Unit [ICU]) were comparable for the first operation (60% versus 56% and 30% versus 32%). The stoma reversal rate was higher in PAS than in HP (96% versus 60%, p=0.001), with significantly fewer complications (23% versus 66%, p=0.02), and lower severity (7% versus 33%, p=0.02). Additional analysis of PAS versus PA showed similar morbidity (52% versus 41%, p=0.45) and complication severity (18% versus 24%, p=0.51), whereas overall operation time and hospital stay were significantly shorter in PA (169 versus 320 min, p=0.003, 17 versus 28 days, p<0.001). Conclusions: Primary anastomosis and protective ileostomy is a superior treatment to HP in acute left-sided colon perforation. In the absence of feculent peritonitis an ileostomy appears unnecessar

Self-Assembly of Individually Addressable Complexes of C60 and Phthalocyanines on a Metal Surface: Structural and Electronic Investigations

The hosting properties of a close-packed layer of phenoxy-substituted phthalocyanine derivatives adsorbed on Ag(111) were investigated for the adsorption of C60 molecules. The C60 molecules bind to two clearly distinguishable sites, namely, to the underlying metal substrate in between two adjacent phthalocyanine derivatives, leading to structural and electronic properties analogous to those of C60 adsorbed on Ag(111), and to the core of the underlying phthalocyanine derivative, indicative of the formation of 1:1 donor-acceptor (D-A) dyads through a true host-guest interaction. The electronic properties have been determined by scanning tunneling spectroscopy measurements on individual D-A dyads.

Photoinduced Energy Transfer Processes within Dyads of Metallophthalocyanines Compactly Fused to a Ruthenium(II) Polypyridine Chromophore

An unsymmetric, peripherally octasubstituted phthalocyanine (Pc) 1, which contains a combination of dipyrido[3,2-f:2‘,3‘-h] quinoxaline and 3,5-di-tert-butylphenoxy substituents, has been obtained via a statistical condensation reaction of two corresponding phthalonitriles. Synthetic procedures for the selective metalation of the macrocyclic cavity and the periphery of 1 were developed, leading to the preparation of the key precursor metallophthalocyanines 3−5 in good yields. Two different strategies were applied to the synthesis of compact dyads MPc−Ru(II) 6−8 (M = Mg(II), Co(II), Zn(II)). Intramolecular electronic interactions in these dyads were studied by absorption, emission, and transient absorption spectroscopy. Upon photoexcitation, these dyads exhibit efficient intramolecular energy transfer from the Ru(II) chromophore to the MPc moiety

Two-Dimensional Multiphase Behavior Induced by Sterically Hindered Conformational Optimization of Phenoxy-Substituted Phthalocyanines

Symmetrically substituted phthalocyanines (Pcs) with eight peripheral di-(tert-butyl)phenoxy (DTPO) groups self-organize on Ag(111) and Au(111) substrates into various assembly structures. These different structural phases were studied by scanning tunneling microscopy (STM). On the basis of high-resolution STM images, molecular models are provided for each phase that account for the observed unequal surface densities. Notably, the specificity of the studied Pc derivative featuring the peripheral phenoxy groups remarkably increases its conformational possibilities. Particularly, the rotational degrees of freedom allow all the DTPO substituents to be arranged above the plane of the Pc core, forming a bowl-like structure, which in turn enables the interaction of the Pc core with the metal substrate. The proximity of the Pc core to the metal substrate together with the steric entanglement between neighboring DTPO substituents causes significant retardation of the thermodynamic optimization of the conformations.

Synthesis and Electrochemical and Photophysical Studies of Tetrathiafulvalene-Annulated Phthalocyanines

The synthesis of tetrakis(tetrathiafulvalene)-annulated metal-free and metallophthalocyanines 5−8 via the tetramerization of the phthalonitrile derivative 4 is reported. All of them have been fully characterized by electronic absorption spectroscopy, thin-layer cyclic voltammetry, mass spectrometry, and elemental analysis. Their solution electrochemical data show two reversible four-electron oxidation waves, indicating that these fused systems are strong π-electron donors, which give rise to tetra- or octaradical cation species. For the metal-free phthalocyanine 5, additionally a reversible one-electron wave was found in the negative direction arising from the reduction of the macrocycle. Moreover, the tetrathiafulvalene unit acts as an efficient reductive electron-transfer quencher for the phthalocyanine emission, but upon its oxidation, an intense luminescence is switched on

Recurrent laryngeal nerve monitoring during esophagectomy and mediastinal lymph node dissection

BACKGROUND: Patients who undergo surgery to the esophagus and lungs are in jeopardy of recurrent laryngeal nerve (RLN) damage during the procedure. This study was designed to investigate the feasibility of intraoperative monitoring of the RLN for single-lung ventilation esophagus and lung surgery. METHODS: Twelve consecutive patients booked for esophagus or lung surgery were included in this prospective, observational study. Six patients underwent transthoracic esophagectomy for carcinoma of the esophagogastric junction or lower esophagus, five had a lobectomy, and one underwent a pneumonectomy for lung carcinoma. Intraoperative, noninvasive RLN identification and monitoring was performed unilaterally (n = 8) or bilaterally (n = 4) using a handheld stimulator and a laryngeal surface electrode. The correct functioning of the nerve monitoring system was tested directly at the vagus nerve. Diagnosis of postoperative RLN paralysis was performed using indirect laryngoscopy. RESULTS: During the surgical procedures, we monitored a nerve signal in all 12 patients. In one patient with lower esophagus carcinoma, a nerve signal could be detected only on one side. Postoperative indirect laryngoscopy showed normal vocal cord movement in all patients. CONCLUSIONS: Intraoperative RLN identification and monitoring during single-lung ventilation surgery is technically feasible, easy, and reliable. The introduction of standardized RLN monitoring during this type of surgery may reduce the incidence of permanent RLN paralysis