DETECTION OF SIGNIFICANT DISORDERS OF INTESTINAL MICROCIRCULATION IN VARIOUS MODELS OF COLITIS
Kruschewski M; Rohweder J; Foitzik T; Hotz H; Buhr HJ, Abt. fÂur Allgemein-, GefÂass- und Thoraxchirurgie, UniversitÂatsklinikum Benjamin Franklin, Freie UniversitÂat Berlin. Langenbecks Arch Chir Suppl Kongressbd, 1997, 114:, 435-7
The role of changes in the capillary bed of the colon for the ethiopathology
and the course of chronic inflammatory bowel diseases is unknown. The results
of morphological and physiological studies are contradictory. The present
study systematically examines the microcirculation of the colonic mucosa
in two different experimental models of inflammatory bowel disease by means
of intravital microscopy. Significant impairment of the capillary blood
flow in the colonic mucosa in acute as well as in chronic inflammatory
stage of the disease was found. The findings suggest that impairment of
the capillary blood flow is an important factor in the course of chronic
inflammatory bowel disease. The influence of drugs on impaired colonic
microcirculation in inflammatory bowel diseases and subsequent changes
in pathomorphology and the course of the disease will be examined in further
studies.
ANGIO-ARCHITECTURE OF THE COLON IN CROHN DISEASE AND ULCERATIVE COLITIS. LIGHT MICROSCOPY AND SCANNING ELECTRON MICROSCOPY STUDIES WITH REFERENCE TO THE MORPHOLOGY OF THE HEALTHY LARGE INTESTINE
Kruschewski M; Busch C; Dörner A; Lierse W, Chirurgische Abteilung, Klinikum Niederberg, Velbert. Langenbecks Arch Chir, 1995, 380:5, 253-9
The etiology and the pathogenesis of the chronic inflammatory bowel
diseases known as Crohn’s disease and ulcerative colitis have not been
defined. Therefore, in this study the main emphasis was placed on description
of the pathologic anatomy. Disturbed blood supply and vascular disorders
have been discussed as etiopathogenetic factors. The results in the literature
are frequently contradictory. For this reason, the vascular system of the
colon in Crohn’s disease and ulcerative colitis was systematically examined
by means of various morphological methods in this study. Microvascular
corrosion casting and translucent specimens were taken from operative specimens
taken from 12 patients with Crohn’s disease and 8 with ulcerative colitis.
For comparison, tumor-free parts of 6 colon cancer specimens were examined.
The evaluation was done by scanning electron- and/or stereoscopic microscopy.
In the presence of chronic inflammatory bowel disease dilatation of the
submucosal veins, caliber differences in the tunica muscularis and rarefaction
of the penetrating blood vessels were found. In summary, an impairment
of the blood flow in the tunica muscularis can be postulated. For the
first time, the resulting venous stasis has been described, in contrast
to the previously described disturbed arterial blood supply.
SURGERY IN CROHN'S DISEASE: WHEN, WHERE AND WHY THE RECURRENCES?
Del Gaudio A, Bragaglia RB, Boschi L, Del Gaudio GA, Fuzzi N, Department
of Surgery,
University of Bologna, School of Medicine, S.Orsola-Malpighi Hospital,
Italy.
Hepatogastroenterology 1998 Jul-Aug;45(22):978-84
One frustrating feature in the surgical management of Crohn’s disease
is the high recurrence rate
which may lead to reoperation. It is common opinion that relapses occur
haphazardly both in time
and in site, and the causes remain unknown. When does a recurrence
really arise after surgery? Is
the site of recurrence determined by definite causes? Is there a relapsing
factor? Between 1965 and
1995, 177 patients underwent surgery for Crohn’s disease. The procedures
performed in 145
cases were those popular at the time, while a recent series of 20 selected
patients was managed following a new approach based on epiploonplasty.
This strategy stems from the strong conviction that Crohn’s disease
is not a primary bowel disease but the result of stasis
and superimposed infection due to a primary hemolymphatic disorder
of the mesentery. The five-year recurrence rate was 62% in patients
operated on according to standard procedures, while no recurrences were
reported in the epiploonplasty group. Among 12
remaining patients with recurrent disease, two cases are reported
in detail because they provide
evidence in favor of the hemolymphatic theory. This study also maintains
that recurrences, viewed
with the hemolymphatic disorder in mind, occur immediately after surgery,
while the superimposed
intestinal inflammatory process and stricturing events may appear clinically
at different time intervals
during follow-up. The site of recurrences usually corresponds to the
mesenteric region subjected to
compression. Altered mesenteric microcirculation appears to be the
true essence of the
disease.