Diverticular disease as a risk factor for sigmoid colon adenomas

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7 MONOFILAMENT vs. MULTIFILAMENT ABSORBABLE SUTURES IN INTESTINAL SURGERY. AN EXPERIMENTAL STUDY IN THE RABBIT M. Testini, P. Portincasa*,D. Piscitelli , G. Piccmni, G. Lissidini, GM Bonomo. Sezionedi Chmwia Genetale,Vascolareed Onwlogia Clinica,Dip. Applicazioni in Cbimrgia TecnologieIm&&e. *Se&me Medicina Interna, bipardmento &d&a Interna e Medicha Pubblica Sezionedi Anatomia Patologica, Dipatimento Anatomia Patologicae Genetica. UniversitB.degli Studi di Bari Univemitl di Bari - Policlinica In previous studieswe have occasionallyobserved different behavtourof small bowel anastonmses in relationto different suture materials(Eur Surg Res 1998,World 1 Surg, 2000,ZOOl). In this studs we evaluatedhow different suture materialsmcdifv the patternof intestinalanastomotic healingby comparing braidedor multifilament suture &ailj vs. monofilament (PDS). METHODS: 50 New Zealandmale rabbits were operated,under generalanesthesia,by ileal transectionand end-to-endanastomosisusing either a singlelay&inverting intemtpted510Vycril suture(proup A, N=25) or PDS (group B, N=25). Animals were sawified at 21 days after operation and anastomosis-containirmseemcnt~underwentmacmscooic and hvstoloaical examination. RESULTS: 44% of animal: inoup A hadintestinalstat&s with &u&m and inflammationat histolow: 12% of animalsin awtr B hadmild intestinalstenosis(but no ostmction) andmild tiammation at histology (Fish&exact test: 0.~03~0.025). Histological changesconcerned mainly leukocyte infiltration and exudation,and prolongedhealingprocess with fibrotic involution of the sc.v tissue.Stictue formationat anastomoticlevel could be strictly relatedto the type of sutureand especiallyto the braidednatureof suture material.CONCLUSIONS: Braidedor multifilament sutures induce excessive sea?tissue formation, fibrosis andhigh prevalenceof intestinalstrictures in the rabbit intestine;fmm these apetimental data,we speculatethat if small diameterstumpsneedto he anastomizedin humans,monofilament absolbablesutures migh bemore appropriate.


NORMAL HUMAN COLON EPITHELUU. CELLS PROPAGATED IN LONG-TERM CELL CULTURES SUPPORTJC POLYOMAVIRUS INFECTION FarbadF. Shadan,Luigi Ricciardiello,Ajay Gael, Wendy Smith, Dong K. Changand C. Richard Boland Dept ofMedicine and Cancer Center,UCSD and VAMC, La Jolla, CA Policlinico S. Orsola Background: Propagationof long-term cultures ofnormal human colon epithelial cells has beena major obstacleto the investigationof the molecularbasis of c&rectal cancer. To datewe have beensuccessll in optimizing the growth conditions of normal human colon epitbelial cells in longterm cultures with the goal of investigatingwhether thesecells suppoTtIC polyomavims replication in vitm Recently JC palyomwiw T-antigenDNA sequenceshave beendetectedm the normaland neo~lastictissuesofthe human aastmintestinaltract usina PCR analvsis. Actual viral infection of c&n tissueby JC virus, how&, hasnot beenproven tl& far andt& cell types involved in the support of a putative JC viral infection have not beenidentified. Aims: the objective in this work h&been to (1) optimize the conditions in which to pmpagatclong-term primary cultuns of normal human colon epithelial cells and (2) to determinewhetherhuman colon epithelial cells grown in culture support JC viral infection.Methods: Nomul human colon epithelial cells were grown in culture using a conditioned gmwth medium. Cells were infected with the Mad-l strain of JC virus andthe surviving epithelial cells were propagatedfwtixr in culture in comparison to uninfected contmls. Results: Normal human colon epithelialcells havebeensuccessfully gmvm in culture to senescenceat approximately 15 populationdoublings.Thesecells were found to support acuteJC virus infection as determinedbv the developmentofcvtopathic effect, formation of viral plaques, expression of T-antigen and&al capsid proteins,andbyihe detectionof intianuclearvi& DNA using in situ hybridization. Cellsthat survived this acuteviral infection have thus far continuedto propagatein culture indefinitely, exhibiting deereaseddoubling time andlacking any morphological signs of senescence.We arecurrently further characterizingthesecells with respect to tmnsfonnation.genome stability and differentiatedtimction.Conclusion: These ohsewatlons demonstratethat normal human colon epithelialcells can be successfully grown in culture to senescenceandare permissive to JC virus infection which appearsto delay or block senescence.



G Manes, G Lombardi A Balzano

Gasttwentemlagy Unit, A.O.R.N. “A. Cardarelli”, Naples, Italy Backmound and aim: The aim of this study is to check if the pressures of anal cd are ahvays increased in patients with Chronic Ad Fkwnes (CAF) since the anal hypertonia is believed to play an important mle in the patbgenesis ofthe Bfsures. Matesid and Mcthh Water-perfused, four-channel, computer-assisted tnmmetq (Dym System, M&s s.r.l., Bologna, It&) was performed in 73 patients (52 men, 21 women; mean age 41 yrs, range 18-71) with CAF. No patient s&red t?oombdlammatory bowel diseasesor systemic diseases.Anal RestbIg Pressure (ARP) was recorded in mmHg Gth the stationary pullthrough tedmique and the computer klentm the Mean Ptesswe (Pm), mean ARP at 4-3-2-I cm t?om the anal verge (ARP 4-3-2-l). The resuhs were compared with those horn 9 healthy volwdeers (mean age 41 yrs, raw Zl68).AnalcanalwasconsideredhypmonicwheaeverRnwashigher2 Standard Deviations (SD) than that of contm& htonic whenever Pm was lower 2 SD. &g&s: Variations of Pm were observed in CAF. FTssmEs CONTBOIS ABP(pm) 73 9 [email protected] 3I (42.5%) Nommtonia (3s51 mm&l 38 (52%) 9 (IOwo) Hypotonia (< 35mm&J 4 (5.5%) No diiTbrence of ARP 4-3-l cm was observed between patients and controls ARP 2 was higher in hypertonic andtmtmtonic anal canal.

CWS~USIOSSS: The aoal caoal in CAF CRII be hypamnic, mrmoionic and somtimes hypmnk. ARP at 2 em hm anal verge is ORenitlmmed. These resuhs hypothesize a reappr&al of the patlmgenesisof CAF.


DIVBRTICULAR DISEASE AS A RISK FACTOR FOR SIGMOID COLON ADENOMAS SergioMothi, CesateHassan,Angelo Zullo, Vincenm De Francesco, Virginia Festa, Fausto B&era& Domenico F&a, Tommaso Stmffolini Gastmentemlogy‘wuovo Regina Ma&e&a” Hospital,Rome; Gastmentemlogy “Riuniti” Hospital, Foggia,Gastmentemlogy“San Camillo de Lellis” Hospital, Rieti, Italy. OspedaieNuovo Regina Mxgherita Background:Diverticular diseaseandc&rectal neoplasiasharesimilar epidemiologicalfeatures andrisk factors. Our aim was to evaluatea possibleassociationbetweandiverticular diseaseand both adenomasandc&rectal cawx in patientsundergoingtotal colonoswpy. Methods: Overall, 630 consecutiveoatientswere recmited from the 3 Units. Inclusion criteria were ageabove45 years andthe perform&e of total colonoscopy. A questionnairewas filled out regardingdemographic andclinical data Adenomaswere defined as advancedwhen their size was > L cm in diameter,the percentageof the villous componentwas >30% and/or a high gradedysplasia was present.Results: At endoscopy,291(47%) out of 630 patientshadevidenceof diverticular disease.Adenomaswere found in 92 131.9%)oatientswith divetticular diseaz andin 98 (28.9%) patientswithout divtiicula @ = NS). T& prev.&ce of admomas locatedin the sigmoidcolon was &ificcantly higher in patientswith diverdada than in controls (64.1% vs 41.8X: p < 0.05). Similarly, the detectionof advancedadenomaslocatedin the sipmaidcolon was mm-elikely in patientswith divnticula than in contmls (59.6% vs 37.5%; p < O.OS).Colorectalcancer prevalmc~was similar in patientswith andwithout divert&la (8.3% YS7.1%; p = NS), andno differenceregarding site was detected betwea the two groups. Conclusions:&dents with diverticular diseasehave a higher risk of harboringboth ademxnasand advancedadenomasin the sigmoid colon. A carefal examinationof this tract is advised in thesepatients.

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