Magyar sebészet
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The healing of colonic anastomoses is determined by several factors such as microcirculation, the strength of the inflammatory response, and the time required for regeneration. We investigated the effects of pentoxifylline--a drug which improves microcirculation and modulates leukocyte functions--on the healing of experimental anastomosis on the left colon of rats. As a result of drug treatment (0.25 mg/100 g, i.p.) in Group I anastomosis bursting pressure (ABP) was by 56 +/- 17% higher at day 2 than in controls with no pentoxifylline treatment. ⋯ Pentoxifylline treatment also suppressed the peritoneal inflammatory response assessed with peritoneal reaction index (2.0 +/- 0.3 vs. 1.1 +/- 0.2, p < 0.01). The results of the present study show that pentoxifylline treatment shortens the time needed for the healing of colonic anastomosis. These observations suggest that pentoxifylline medication can prevent failure of colonic anastomoses.
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Extended gastric and esophageal resection is still associated with high postoperative morbidity and mortality. We performed a retrospective analysis of the perioperative management of 72 patients who had undergone such operations during a one-year period. Patient and management variables were analyzed by multivariate statistical methods to identify pre-, intra-, and postoperative factors which influence the results. ⋯ Enteral nutrition was given through a jejunal tube that had been inserted intraoperatively. Calorie intake was built up step by step to a maintenance level of 31.2 kcal/day, which was administered until oral feeding could be started (mean duration 10.94 days; maximum duration: 42 days). We conclude that careful selection of patients, appropriate intra- and postoperative management, with adequate postoperative pain control can reduce postoperative morbidity and length of inpatient stay.