Effects of aging on abdominal wall healing in rats

PURPOSE: The aim of this study was to assess abdominal wall healing in old and young adult rats. METHODS: On average, young animals were 110 days old and old animals were 762 days old. A 4.0 cm median laparotomy was performed under anesthesia, followed by laparorrhaphy on two synthesis planes, i.e. peritoneum-muscle-aponeurosis and skin, using continuous 5.0 nylon sutures. The animals were evaluated on the 3rd, 7th, 14th and 21st postoperative days. The resistance of the two planes was studied separately and a histopathologic analysis was performed on sections stained with hematoxylin-eosin and Sirius Red. Immunohistochemical analysis was also carried out using PCNA, LCA and CD34. RESULTS: The skin scars gained resistance in a similar manner at the initial time points, but those of young rats were more resistant on the 21st day (p=0.0029). Total and type III collagen content was similar in the two groups and type I collagen content was higher in young animals on the 14th day. Inflammatory cell infiltration was more marked in the skin wounds of young animals on the 3rd day (p=0.0190). Reepithelialization was similar and angiogenesis was more intense in the skin wounds of young animals on the 14th day (p=0.0062). The peritoneum-muscle-aponeurosis wounds gained similar resistance during the early phases, but were more resistant on the 14th day (p=0.0005) and on the 21st day (p=0.0023) in old rats Collagen concentration was higher in the wounds of old animals on the 3rd day (p=0.0112) and in the wounds of young animals on the 21st day (p=0.0348). The inflammatory reaction was more intense in the wounds of old animals on the 3rd day (p=0.0060) and angiogenesis was more intense on the 14th day (0.0432). CONCLUSION: Although there are some differences in the healing course between young and old animals, age, of itself, does not impair the healing of abdominal wall wounds in rats

Maximizing the general success of cecal intubation during propofol sedation in a multi-endoscopist academic centre

<p>Abstract</p> <p>Background</p> <p>Achieving the target of 95% colonoscopy completion rate at centres conducting colorectal screening programs is an important issue. Large centres and teaching hospitals employing endoscopists with different levels of training and expertise risk achieving worse results. Deep sedation with propofol in routine colonoscopy could maximize the results of cecal intubation.</p> <p>Methods</p> <p>The present study on the experience of a single centre focused on estimating the overall completion rate of colonoscopies performed under routine propofol sedation at a large teaching hospital with many operators involved, and on assessing the factors that influence the success rate of the procedure and how to improve this performance, analyzing the aspects relating to using of deep sedation. Twenty-one endoscopists, classified by their level of specialization in colonoscopic practice, performed 1381 colonoscopies under deep sedation. All actions needed for the anaesthesiologist to restore adequate oxygenation or hemodynamics, even for transient changes, were recorded.</p> <p>Results</p> <p>The "crude" overall completion rate was 93.3%. This finding shows that with routine deep sedation, the colonoscopy completion rate nears, but still does not reach, the target performance for colonoscopic screening programs, at centers where colonoscopists of difference experience are employed in such programs.</p> <p>Factors interfering with cecal intubation were: inadequate colon cleansing, endoscopists' expertise in colonoscopic practice, patients' body weight under 60 kg or age over 71 years, and the need for active intervention by the anaesthesiologist. The most favourable situation - a patient less than 71 years old with a body weight over 60 kg, an adequate bowel preparation, a "highly experienced specialist" performing the test, and no need for active anaesthesiological intervention during the procedure - coincided with a 98.8% probability of the colonoscopy being completed.</p> <p>Conclusions</p> <p>With routine deep sedation, the colonoscopy completion rate nears the target performance for colonoscopic screening programs, at centers where colonoscopists of difference experience are employed in such programs. Organizing the daily workload to prevent negative factors affecting the success rate from occurring in combination may enable up to 85% of incomplete procedures to be converted into successful colonoscopies.</p

IMPLEMENTATION OF A GUIDELINE VERSUS USE OF INDIVIDUAL PROGNOSTIC FACTORS TO PRIORITIZE WAITING LISTS FOR UPPER GASTROINTESTINAL ENDOSCOPY

Abstract BACKGROUND: Studying factors associated with positive gastroscopies in dyspeptic patients can help limit and rationalize waiting lists for endoscopies. Dyspepsia guidelines have a controversial role because their main purpose is to provide specifications on efficient global management of primary care patients. AIM: To assess and weigh the risk of major endoscopic diagnoses against different age groups, gender, Helicobacter pylori infection, compliance with European Society of Primary Care Gastroenterology (ESPCG) guideline statements, and participation of prescribing general practitioners in a quality improvement programme for dyspepsia management, based on these guidelines. METHODS: We consecutively studied the outcomes of 752 gastroscopies with respect to two sets of useful results: the first considered diagnoses of carcinoma, gastric and duodenal ulcer; the second excluded duodenal ulcer. RESULTS: A diagnosis of cancer or gastric/duodenal ulcer was associated with male sex (odds ratio (OR)=1.81, P=0.016), age above 41 years (OR=3.24, P=0.009) and particularly with positivity to H. pylori (OR=4.49, P<0.001), while the risk increased by two and a half times in gastroscopies conforming with ESPCG guidelines (OR=2.47, P=0.003). In the second set of analysis, we noted a statistically significant correlation between cancer or gastric ulcer and compliance with ESPCG guidelines (OR=4.69, P=0.013), but not with H. pylori positivity (OR=1.83, P=0.11); a linear relationship was observed across age groups, with a 60% increase in the risk of disease with every 5-year increase in age (OR=1.59, P=0.002). CONCLUSION: Participation of general practitioners in the Dyspepsia Management Programme (DMP) was not significantly associated with a positive gastroscopy