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- Agren, Magnus S., et al.
(författare)
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Action of matrix metalloproteinases at restricted sites in colon anastomosis repair: an immunohistochemical and biochemical study
- 2006
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Ingår i: Surgery. - : Elsevier BV. - 1532-7361 .- 0039-6060. ; 140:1, s. 72-82
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Tidskriftsartikel (refereegranskat)abstract
- Background. Dehiscence of colon anastomosis is a common, serious and potentially life-threatening complication after colorectal operation. In experimental models, impaired biomechanic strength of colon anastomoses is preventable by general inhibitors of matrix metalloproteinases (MMPs) and associated with collagen loss, which indicates a possible link between MMP-mediated collagen degradation and dehiscence. The precise localization of collagen degradation within the anastomotic area and the specific MMPs responsible are unknown. Methods. We have analyzed distinct zones within anastomoses using a novel microdissection technique for collagen levels, collagenolytic activity exerted directly by endogenous proteinases, and MMP-8 and MMP-9 immunoreactivity and their collagenolytic activity. Results. The most pronounced collagen loss was observed in the suture-holding zone, showing a 29% drop compared with adjacent micro-areas of 3-day-old anastomoses. Only this specific tissue compartment underwent a dramatic and significant increase in collagenolysis, amounting to a loss of 10% of existing collagen molecules in 24 hours, and was abolished by metalloproteinase inhibitors. The tissue surrounding suture channels was heavily infiltrated with CD68-positive histiocytes that expressed MMP-8 and to a lesser extent MMP-9. The collagenolytic effect of the interstitial collagenase MMP-8 was synergistically potentiated by the gelatinase MMP-9 when added to colon biopsies incubated in vitro. Conclusions. The unique finding of this study was that the specific tissue holding the sutures of a colon anastomosis lost the most collagen presumably through induction and activation of multiple MMPs that may explain the beneficial effects of treatment with non-selective MMP antagonists.
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| 2. |
- Wadman, Maria, et al.
(författare)
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Abdominal plain film findings in acute ischemic bowel disease differ with age.
- 2006
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Ingår i: Acta Radiologica. - : SAGE Publications. - 1600-0455 .- 0284-1851. ; 47:3, s. 238-243
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To evaluate the use and findings of abdominal plain film in acute ischemic bowel disease (AIBD) in different age subsets, and to correlate the clinical findings. Material and Methods: Eighty-nine radiographically examined patients with AIBD at Malmö University Hospital, Sweden between 1987 and 1996. Results: In 89%, the plain film displayed pathologic signs. Bowel dilatation was more common in the elderly. Of 68 patients aged ⩾71 years, 19 (28%) had colon gas/fluid levels with/without colon dilatation, and of 19 patients >84 years 16 (84%) had small-bowel dilatation. Of 20 patients aged <71 years, 1 (5%) had colon gas/fluid levels with/without colon dilatation, and 11 (55%) small-bowel dilatation ( P<0.05; P<0.05). Gasless abdomen was more common in the younger age group, noted in 5 of 20 (25%) patients aged <71 years, compared to 2 of 68 (3%) patients aged ⩾71 years ( P = 0.001). Of the patients with diarrhea, 13 of 33 (40%) had colon gas/fluid levels with/without colon dilatation compared to 2 of 29 (7%) without ( P = 0.003). In the elderly (⩾71years), 48 of 53 (91%) patients with bowel dilatation on plain film died, compared to 11 out of 16 (69%) without this finding ( P<0.05). Conclusion: Abdominal plain film findings differed with age. Bowel dilatation was more frequent in the elderly with AIBD, whereas gasless abdomen was more common in younger patients. The radiographic findings were associated with clinical symptoms and mortality.
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