Bodies Resection

Holton and Wood (3) reported the permanent disappearance of the reflex hyperventilation evoked by hypoxia in two asthmatic patients after removal of both carotid bodies (glomectomy). Baroreflexes were also abolished in these subjects, but recovered within a few weeks. Thus, reinnervation of the carotid sinuses by regenerating barosensory fibers resulted in recovery of baroreceptor function, while a similar timing and degree of regeneration of chemosensory fibers failed to reinstate ventilatory chemoreflexes. This means that carotid body cells—presumably glomus cells—are required for chemoreceptor fimction. 

Later reports (4-9) have confirmed that carotid chemoreceptor function is permanently lost after resection of the carotid bodies in humans. Therefore, these reports provide a first indication that the carotid body parenchyma is required for oxygen sensing. In other words, carotid nerve chemosensory fibers by themselves are unable to detect changes in O2 level. 

Reestablishment of Chemoreceptor Function by Regenerating Chemosensory Fibers 

Mitchell et al. (13) and Kienecker et al. (14) reported that the neuromata resultmg from carotid nerve section attained recovery of chemosensory responses. 

In a similar vein, Belmonte et al. (17) observed that carotid nerves regenerated into superior cervical ganglia, organs extremely well vascularized, also failed to regain chemoreceptor activity. Therefore, all evidence available suggests that regenerating chemosensory nerve fibers recover chemoreception only when reestablishing contact with carotid body tissue. 

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Minerals require a suitable mucosal surface across which to enter the body. Resection or diversion of a large portion of small bowel obviously affects mineral absorption. Extensive mucosal damage due to mesenteric infarction or inflamatory bowel disease or major diversion by jejunoileal bypass procedures reduces the available surface area. Minerals whose absorption occurs primarily in the proximal intestine, e.g., copper or iron, are affected differently than those absorbed more distally, e.g., zinc. In addition, the integrity of the epithelium, the uptake of fluids and electrolytes, the intracellular protein synthesis, the energy-dependent pumps, and the hormone receptors must be intact. 

Bellville, I.W., Whipp, B.J., Kaufman, R.D. et al. 1979. Central and peripheral chemoreflex loop gain in normal and carotid body-resected subjects. J. Appl. Physiol. 46 843. 

Lugliani R, Whipp BJ, Seard C, Wasserman K. Effect of bilateral carotid body resection on ventilatory control at rest and during exercise in man. N Engl J Med 1971 ... 

Honda Y, Watanabe S, Hashizume I, Satomura Y, Hata N, Sakakibara Y, Sever-inghaus JW. Hypoxic chemosensitivity in asthmatic patients two decades after carotid body resection. J Appl Physiol 1979 46 632-638. 

Venneire P, de Backer W, van Maele R, Bal J, van Kerckhoven W. Carotid body resection in patients with severe chronic airflow limitation. Bull Eur Physiopathol Respir Clin Respir Physiol 1987 23 165S-169S. 

In 1998, the FDA approved fibrin sealant for three specific indications. These include hemostasis at the time of cardiac surgical operations [8] (Fig. 2) as well as at the time of operative procedures to treat splenic trauma. The application of the fibrin sealant which consists of normal biologic components in the body s clotting cascade creates a localized clot which further enhances inherent clotting ability. Although approved for these specific hemostatic indications only, fibrin sealant is useful as a hemostat in a wide variety of off-label clinical situations as well [9,10]. These include such applications as hemostasis for liver trauma or resection [11], vascular anastomoses [12], tonsillectomy [13], peripheral joint replacement [14], dental extractions [15], and bum debridement [16]. 

Since there is no true excretion of iron from the body, iron-deficiency anemia occurs mostly because of inadequate absorption of iron or excess blood loss. Inadequate absorption may occur in patients who have congenital or acquired intestinal diseases, such as inflammatory bowel disease, celiac disease, or bowel resection. Achlorhydria and diets poor in iron also may contribute to poor absorption of iron. In contrast, iron deficiency also may occur in patients who exhibit a higher rate of iron loss from the body. This is manifested in... 

Metastasis is a process by which malignant cells leave their primary site and spread to distant locations throughout the body. It is the formation of metastasis that makes cancer such a lethal disease. The presence of metastasis is therefore the main cause of morbidity and mortality in patients with cancer. While primary tumors are potentially resectable, most metastases are resistant to all current forms of cancer treatment. Approximately 30% of patients with newly diagnosed solid cancers (excluding nonmelanoma skin cancers) have clinically detectable metastases, while another 30% may have occult micrometastases (L2). Clearly, to reduce mortality from cancer, we have to be able to prevent or treat metastasis. 

Figure 11.1 Ultrastructure of the human lung alveolar barrier. The tissue specimen is obtained via lung resection surgery. (A) Section through a septal wall of an alveolus. The wall is lined by a thin cellular layer formed by alveolar epithelial type I cells (ATI). Connective tissues (ct) separate ATI cells from the capillary endothelium (en) within which an erythrocyte (er) and granulocyte (gc) can be seen. The minimal distance between the alveolar airspace (ai) and erythrocyte is about 800-900 nm. The endothelial nucleus is denoted as n. (B) Details of the lung alveolar epithelial and endothelial barriers. Numerous caveolae (arrows) are seen in the apical and basal plasma membranes of an ATI cell as well as endothelial cell (en) membranes. Caveolae may partake transport of some solutes (e.g., albumin). (C) ATII cells (ATII) are often localised in the comers of alveoli where septal walls branch off. (D) ATII cells are characterised by numerous multilamellar bodies (mlb) which contain components of surfactant. A mitochondrion is denoted as mi.

Fibrosarcoma is a mesenchymal tumour originating from fibroblasts it can therefore occur ubiquitously in the whole body. (12) It was first described by R.H. Jaefe in 1924. About 35 cases have been reported so far. This type of tumour has a firm consistency and contains cystic structures with focal necroses and haemorrhages. It possesses a fibrous pseudocapsule and consists of fascicu-larly arranged, spindle-like or fusiform tumour cells embedded in parallel collagen fibres. The non-epithelial stroma marker vimentin is overexpressed. These cells may exhibit marked polymorphism. Fibrosarcoma mainly occurs in men of advanced age. Therapy consists of tumour resection and adjuvant chemotherapy. (280,281)... 

This unusual form of lactic acidosis is due to increased production and accumulation of D-lactate in circulation. The normal isomer synthesized in the human body is L-lactate but the D-lactate isomer can occur in patients with jejunoileal bypass, small bowel resection, or other types of short bowel syndrome. In these patients, ingested starch and glucose bypass the normal metabolism in the small intestine and lead to increased delivery of nutrients to the colon where gram-positive, anaerobic bacteria (e.g., Lactobacilli) ferment glucose to D-lactate. The D-lactate is absorbed via the portal circulation. 

Recurrence of tumors after curative surgery is a life-threatening event for cancer patients, and the prevention of such recurrence is one of the most important problems to be resolved at the clinical level. The major cause of recurrence after curative resection in cancer patients is considered to be free tumor cells in the body fluid and invisible micrometastases in the distant organs which were already present at the time of removal of the primary neoplasm or had been shed from the primary tumor during surgical manipulation. To prevent recurrence and improve survival rates of cancer patients after curative resection, careful detection and subsequent chemotherapy for micrometastasis may be promising. To date, however, conventional adjuvant... 

It is partly owing to adaptation of the remaining small intestine to reabsorb bile acids that the length of ileal resection is not correlated with fecal bile acid excretion (64,101). In addition, accompanying malnutrition may limit the capacity of the liver to enhance its bile acid synthesis, so that in patients with extensive intestinal resections fecal bile acid excretion may be only moderately increased (64,101). In these cases, serum cholesterol is usually very low and depletion of body cholesterol in the presence of insufficiently enhanced cholesterol synthesis may be one factor for limited bile salt production. 

PMMA is also injected into vertebral bodies for fixation of fragility fractures of the spine, injected into screw holes to augment internal fixation in osteopenic bone, and injected into stmctural voids following resection of benign tumors to control dead space and support the surrounding bone. In many of these applications antimicrobial powder can be added to the PMMA for drug delivery when local delivery of antimicrobials is needed. 

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