Arung, Willy; Meurisse, Michel; Detry, Olivier
Peritoneal adhesions represent an important clinical challenge in gastrointestinal surgery. Peritoneal adhesions are a consequence of peritoneal irritation by infection or surgical trauma, and may be considered as the pathological part of healing following any peritoneal injury, particularly due to abdominal surgery. The balance between fibrin deposition and degradation is critical in determining normal peritoneal healing or adhesion formation. Postoperative peritoneal adhesions are a major cause of morbidity resulting in multiple complications, many of which may manifest several years after the initial surgical procedure. In addition to acute small bowel obstruction, peritoneal adhesions may cause pelvic or abdominal pain, and infertility. In this paper, the authors reviewed the epidemiology, pathogenesis and various prevention strategies of adhesion formation, using Medline and PubMed search. Several preventive agents against postoperative peritoneal adhesions have been investigated. Their role aims in activating fibrinolysis, hampering coagulation, diminishing the inflammatory response, inhibiting collagen synthesis or creating a barrier between adjacent wound surfaces. Their results are encouraging but most of them are contradictory and achieved mostly in animal model. Until additional findings from future clinical researches, only a meticulous surgery can be recommended to reduce unnecessary morbidity and mortality rates from these untoward effects of surgery. In the current state of knowledge, pre-clinical or clinical studies are still necessary to evaluate the effectiveness of the several proposed prevention strategies of postoperative peritoneal adhesions. PMID:22147959
Beauchamp, P J; Quigley, M M; Held, B
Progesterone (P) has been shown to have potent antiinflammatory and immunosuppressive properties. Previous reports have suggested that the use of P decreases postoperative adhesion formation. To further evaluate the role of pharmacologic doses of progestogens in adhesion prevention, 42 mature New Zealand White rabbits underwent standardized injuries to the uterine horns, fimbriae, and pelvic peritoneum and received one of six treatments. Group S had intraperitoneal placement of normal saline (0.9%); group H received intraperitoneal placement of 32% dextran 70; group IM-P received intramuscular P-in-oil 10 days before and after laparotomy in addition to intraperitoneal saline; group IP-P had intraperitoneal placement of an aqueous P suspension; group DP received medroxyprogesterone acetate intraperitoneally; and group C received no intramuscular or intraperitoneal adhesion-prevention agents. The animals were sacrificed 6 weeks after laparotomy, and the adhesions were scored. Intraperitoneal saline (group S) significantly reduced the amount of adhesions when compared with the control group (C) (P less than 0.05). No significant difference was observed when group S was compared with group H. Intramuscular P added to saline (group IM-P) did not cause further reduction in adhesions when compared with group S. Both group IP-P and group DP had more adhesions than did group S (P less than 0.01). These data fail to support previous claims regarding adhesion prevention by the use of locally or parenterally administered progestogens. PMID:6237937
Schwarz, J; Donat, H
Female wistar rats were used for the testing of different substances to prevent postoperative intraabdominal adhesions. It could be demonstrated that the best results were obtained by dextran 70 with a concentration of 10%. Good effects were seen also by contrykal (aprotinin) and hylase (hyaluronidase). By the combination of dextran 70 30% with contrykal the spread of adhesions was very low but the effect was not significant better than with dextran 70 10% alone. For the prevention of intraabdominal adhesions operative techniques with minimal lesions are important too of the peritoneal epithelium. PMID:2466384
Bang, Sumi; Lee, Eungjae; Ko, Young-Gwang; Kim, Won Il; Kwon, Oh Hyeong
Methods for reducing and preventing postoperative abdominal adhesions have been researched for decades; however, despite these efforts, the formation of postoperative peritoneal adhesions is continuously reported. Adhesions cause serious complications such as postoperative pain, intestinal obstruction, and infertility. Tissue adhesion barriers have been developed as films, membranes, knits, sprays, and hydrogels. Hydrogels have several advantages when used as adhesion barriers, including flexibility, low tissue adhesiveness, biodegradability, and non-toxic degraded products. Furthermore, compared with preformed hydrogels, injectable hydrogels can fill and cover spaces of any shape and do not require a surgical procedure for implantation. In this study, pullulan was modified through reaction with 2,2,6,6-tetramethyl-1-piperidinyloxy (TEMPO) and 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (EDC) to introduce carboxyl and phenyl groups as crosslinking sites. The grafting of tyramine on pullulan allows crosslinking branches on pullulan backbone. We successfully fabricated pullulan hydrogel with an enzymatic reaction using horseradish peroxidase (HRP) and hydrogen peroxide (H2O2). The chemical structure of modified pullulan was analyzed with ATR-FTIR and (1)H NMR spectroscopies. Rheological properties were tested by measuring storage modulus with varying H2O2, HRP, polymer solution concentrations and tyramine substitution rates. Cell viability and animal tests were performed. The modified pullulan hydrogel is an invaluable advance in anti-adhesion agents. PMID:26879910
Kuru, Serdar; Bozkirli, Osman Bahadir; Barlas, Aziz Mutlu; Duymus, Mehmet Esat; Senes, Mehmet; Yumusak, Nihat; Yilmaz, Cevdet; Kismet, Kemal
This study aimed to determine the possible preventive effects of dexmedetomidine on postoperative intra-abdominal adhesions. Dexmedetomidine is a highly selective and potent α2 adrenergic agonist with sedative, analgesic, anxiolytic, sympatholytic, hemodynamic, and diuretic properties. In recent years, investigations have shown that dexmedetomidine possesses secondary antioxidant and also anti-inflammatory effects. Thirty Wistar albino male rats were randomized and divided into 3 groups of 10 animals each: group 1, sham-operated; group 2, cecal abrasion + peritoneal dissection; group 3, cecal abrasion + peritoneal dissection followed by daily intravenous injection of 10 μg/kg dexmedetomidine for 10 days. The animals were killed on postoperative day 21. Blood and cecal samples were taken for biochemical and histopathologic evaluation. In this study, biochemical and pathologic parameters were significantly better in the cecal abrasion + peritoneal dissection + dexmedetomidine group when compared with the cecal abrasion + peritoneal dissection group. Tissue malondialdehyde, myeloperoxidase, total sulfhydryl, and catalase were found to be significantly different between the cecal abrasion/peritoneal dissection + dexmedetomidine and the cecal abrasion/peritoneal dissection groups. Plasma malondialdehyde and total sulfhydryl values were also statistically different between these groups (P < 0.05). Statistical analyses of mean pathologic scores showed that the histopathologic damage in the cecal abrasion/peritoneal dissection + dexmedetomidine group was significantly less than the damage in the control group (P < 0.05 for all pathologic parameters). The results of this study show that dexmedetomidine had a significant preventive effect on postoperative intra-abdominal adhesions. We concluded that these effects might be due to antioxidant and anti-inflammatory activities. PMID:25594644
Hu, Jiancong; Fan, Dejun; Lin, Xutao; Wu, Xianrui; He, Xiaosheng; He, Xiaowen; Wu, Xiaojian; Lan, Ping
Abstract Peristomal adhesions complicate closure of defunctioning enterostomy. The efficacy and safety of sodium hyaluronate gel and chitosan in preventing postoperative adhesion have not been extensively studied. This study aims to evaluate the safety and efficacy of sodium hyaluronate gel and chitosan in the prevention of postoperative peristomal adhesions. This was a prospective randomized controlled study. One hundred and fourteen patients undergoing defunctioning enterostomy were enrolled. Patients were randomly assigned to receive sodium hyaluronate gel (SHG group) or chitosan (CH group) or no antiadhesion treatment (CON group) during defunctioning enterostomy. The safety outcomes included toxicities, stoma-related complications, and short-term and long-term postoperative complications. Eighty-seven (76.3%) of the 114 patients received closure of enterostomy, during which occurrence and severity of intra-abdominal adhesions were visually assessed by a blinded assessor. Incidence of adhesion appears to be lower in patients received sodium hyaluronate gel or chitosan but differences did not reach a significant level (SHG group vs CH group vs CON group: 62.1% vs 62.1% vs 82.8%, P = 0.15). Compared with the CON group, severity of postoperative adhesion was significantly decreased in the SHG and CH group (SHG group vs CH group vs CON group: 31.0% vs 27.6% vs 62.1%; P = 0.01). There was no significant difference in the occurrence of postoperative complications and other safety outcomes among the 3 groups. Sodium hyaluronate gel or chitosan smeared around the limbs of a defunctioning enterostomy was safe and effective in the prevention of postoperative peristomal adhesions. PMID:26705233
Ryan, Graeme B.; Grobéty, Jocelyne; Majno, Guido
This paper describes an experimental model of peritoneal adhesions, in the rat, based on two relatively minor accidents that may occur during abdominal surgery in man: drying of the serosa, and bleeding. Drying alone had little effect; drying plus bleeding consistently produced adhesions to the dried area. Fresh blood alone produced adhesions between the three membranous structures [omentum and pelvic fat bodies (PFBs)]. The formation of persistent adhesions required whole blood. Preformed clots above a critical size induced adhesions even without previous serosal injury; they were usually captured by the omentum and PFBs. If all three membranous structures were excised, the clots caused visceral adhesions. The protective role of the omentum, its structure, and the mechanism of omental adhesions, are discussed. These findings are relevant to the pathogenesis of post-operative adhesions in man. ImagesFig 3Fig 4Fig 5Fig 6Fig 7Fig 12Fig 13Fig 1Fig 2Fig 14Fig 15Fig 8Fig 9Fig 10Fig 11 PMID:5315369
Javaherzadeh, Mojtaba; Shekarchizadeh, Ali; Kafaei, Marjan; Mirafshrieh, Abass; Mosaffa, Nariman; Sabet, Babak
Objective: To determine the preventive effects of local administration of simvastatin for postoperative intra-abdominal adhesion formation in animal model of rat. Methods: In this experimental study, 32 Wistar albino rats as the animal model of intra-abdominal adhesion formation were included. Adhesions were induced in all the animals via abrasion of the peritoneal and intestinal surface during laparotomy. Afterwards, the rats were randomly assigned to receive simvastatin (30 mg/kg body weight) as a single intraperitoneal dose at the time of laparotomy (n=16) or normal saline in same volume at the same time (n=16). At the day 21, animals were euthanized and the adhesions were quantified clinically (via repeated laparotomy) and pathologically and compared between the two groups. Results: The baseline characteristics of the animals were comparable between two study groups. Clinically, in simvastatin group, 10 rats (62.5%) did not develop any adhesion and 6 (37.5%) had first-grade adhesion; whereas in the control group, 11 (68.8%) rats had first- and 5 (31.2%) had second-grade adhesions (p<0.001). Pathologically, in simvastatin group, 6 rats (37.5%) had first-grade adhesion, while in control group, 11 rats (68.8%) had first- and 5 (31.2%) had second-grade adhesions (p<0.001). Conclusion: Our findings suggest that intraperitoneal administration of simvastatin is an effective method for prevention of postoperative intra-abdominal adhesion formation in animal model of rat. PMID:27540550
Yang, Bing; Gong, ChangYang; Zhao, Xia; Zhou, ShengTao; Li, ZhengYu; Qi, XiaoRong; Zhong, Qian; Luo, Feng; Qian, ZhiYong
Background Poly (ethylene glycol)-poly (ɛ-caprolactone)-poly (ethylene glycol) (PEG-PCL-PEG, PECE) hydrogel has been demonstrated to be biocompatible and thermosensitive. In this study, its potential efficacy and mechanisms of preventing postsurgical abdominal adhesions were investigated. Results PECE hydrogel was transformed into gel state from sol state in less than 20 seconds at 37°C. None of the animals treated with the hydrogel (n = 15) developed adhesions. In contrast, all untreated animals (n = 15) had adhesions that could only be separated by sharp dissection (P < 0.001). The hydrogel adhered to the peritoneal wounds, gradually disappeared from the wounds within 7 days, and transformed into viscous fluid, being completely absorbed within 12 days. The parietal and visceral peritoneum were remesothelialized in about 5 and 9 days, respectively. The hydrogel prevented the formation of fibrinous adhesion and the invasion of fibroblasts. Also, along with the hydrogel degradation, a temporary inflammatory cell barrier was formed which could effectively delay the invasion of fibroblasts during the critical period of mesothelial regeneration. Conclusion The results suggested that PECE hydrogel could effectively prevent postsurgical intra-abdominal adhesions, which possibly result from the prevention of the fibrinous adhesion formation and the fibroblast invasion, the promotion of the remesothelialization, and the hydroflotation effect. PMID:22346350
Yeo, Yoon; Highley, Christopher B; Bellas, Evangelia; Ito, Taichi; Marini, Robert; Langer, Robert; Kohane, Daniel S
We studied the efficacy of an in situ cross-linked hyaluronic acid hydrogel (HAX) in preventing post-surgical peritoneal adhesions, using a rabbit sidewall defect-cecum abrasion model. Two cross-linkable precursors were prepared by modifying hyaluronic acid with adipic dihydrazide and aldehyde, respectively. The hydrogel precursors cross-linked to form a flexible hydrogel upon mixing. The hydrogel was biodegradable and provided a durable physical barrier, which was highly effective in reducing the formation of post-operative adhesions. Ten out of 12 animals in the untreated control group developed fibrous adhesions requiring sharp dissection, while only 2 out of 8 animals treated with HAX gels showed such adhesions, and those occurred in locations that were not covered by the hydrogel. We also studied means by which gel degradation time can be modulated by varying the precursor concentration and molecular weight. PMID:16750564
Kelekci, Sefa; Yilmaz, Bulent; Oguz, Serdar; Zergeroğlu, Sema; Inan, Ismet; Tokucoğlu, Selma
The current study was designed to investigate the efficacy of a hyaluronate/carboxymethylcellulose membrane for the prevention of post-operative adhesion in a rat uterine horn model. This is a prospective double-blinded controlled study. Nineteen injured uterine horns were treated with a hyaluronate/carboxymethylcellulose membrane as a barrier and 19 injured uterine horns without any treatment served as a control group. Two weeks later, second look laparotomies were performed in order to assess the degree of the adhesion. Total adhesion scores, histopathological analysis of inflammation process and vascularization of adhesions were compared with control group. P values of 5% or less were considered statistically significant. Animals treated with a hyaluronate/carboxymethylcellulose membrane had significantly reduced post-surgical adhesion scores when compared with control group. In histopathological examination, there was less vascularization in the treatment group. The types and extent of inflammation were similar in two groups. Clinically and histopathologically, a hyaluronate/carboxymethylcellulose membrane is effective in reducing postoperative adhesion formation in the rat uterine horn model. PMID:15502417
Tokita, Yohei; Yamamoto, Masahiro; Satoh, Kazuko; Nishiyama, Mitsue; Iizuka, Seiichi; Imamura, Sachiko; Kase, Yoshio
This study focused on the localization of transient receptor potential vanilloid type 1 (TRPV1) in the intestines in postoperative adhesion model rats and investigated the underlying mechanism for the anti-adhesion action of daikenchuto (DKT), especially in relation to TRPV1. Postoperative intestinal adhesion was induced by sprinkling talc in the small intestine. The expression of TRPV1 mRNA was examined by in situ hybridization and real-time RT-PCR. The effects of DKT and its major ingredient, hydroxy sanshool, with or without ruthenium red, a TRP-channel antagonist, on talc-induced intestinal adhesions were evaluated. The level of TRPV1 mRNA was higher in the adhesion regions of talc-treated rats than in normal small intestine of sham-operated rats. Localization of TRPV1 mRNA expression was identified in the submucosal plexus of both sham-operated and talc-treated rats; and in talc-treated rats, it was observed also in the myenteric plexus and regions of adhesion. Capsaicin, DKT, and hydroxy sanshool significantly prevented formation of intestinal adhesions. The effects of DKT and hydroxy sanshool were abrogated by subcutaneous injection of ruthenium red. These results suggest that pharmacological modulation of TRPV1 might be a possible therapeutic option in postoperative intestinal adhesion, which might be relevant to the prevention of postoperative adhesive obstruction by DKT. PMID:21186335
Malm, T; Bowald, S; Bylock, A; Busch, C
Pericardial adhesions after cardiac operations are a widely known phenomenon. They may severely complicate reoperations, making reentry hazardous, increasing bleeding, and prolonging the operation time. The anatomic orientation and visibility of both bypass grafts and coronary arteries are also impaired. With the aim of minimizing pericardial adhesions after cardiac operations, we studied the course of tissue regeneration after implantation of a new absorbable patch made from poly-hydroxy-butyrate. A total of 23 sheep were studied. Of these, 18 formed the test group and five served as control animals. The animals were killed at intervals of 2 to 30 months after the operation. In 14 of the 18 test animals no adhesions developed. In three animals loose adhesions were found, and in one with signs of postoperative infection there were moderate, generalized adhesions. All control sheep showed moderate adhesions; no infection was noted in this group. Light microscopy in the test group revealed a layer of mesothelium-like cells facing the epicardial side; this was already present in the early specimens. Poly-hydroxy-butyrate appeared to be slowly phagocytosed by polynucleated macrophages, which were still found occasionally in the late samples. Lymphocytes and platelets were rare. Scanning electron microscopy showed, on the epicardial side of the regenerated tissue, a mesothelium-like lining that completely covered the underlying collagen layer. The surface cell morphology grossly resembled that of native pericardium. It was concluded that in this animal model poly-hydroxy-butyrate pericardial patches decreased adhesions and preserved coronary anatomy. The findings in the control group demonstrated that pericardial surgery in the sheep was associated with adhesion formation. PMID:1513149
Qin, Fei; Ma, Yun; Li, Xiao; Wang, Xian; Wei, Yuanyi; Hou, Chuqi; Lin, Si; Hou, Lianbing; Wang, Chengxi
Up to 90% of patients develop adhesion following laparotomy. Upregulating fibrinolysis within the peritoneum reduces adhesions. Tanshinone IIA (Tan IIA) promotes fibrinolysis in hepatic fibrosis and the cardiovascular system and may play a role in preventing adhesions. We report preparation and characterization of liquid nanoparticles of Tan IIA for intravenous administration and investigate its feasibility in clinical practice. Tan IIA liquid nanoparticles (Tan IIA-NPs) were prepared using the emulsion/solvent evaporation method. Adhesions were induced in Sprague–Dawley rats by injuring the parietal peritoneum and cecum, followed by intravenous administration of various Tan IIA-NP dosages. The adhesion scores for each group were collected 7 days after the initial laparotomy. The activity of tissue-type plasminogen activator (tPA) was measured from the peritoneal lavage fluid. The messenger RNA and protein expression levels of plasminogen activator inhibitor-1 (PAI-1) were measured by quantitative real-time polymerase chain reaction and enzyme-linked immunosorbent assay. TGF-β1 and collagen I expressions were measured immunohistochemically in the ischemic tissues. The effects of Tan IIA-NPs and free-Tan IIA on tPA and PAI-1 were measured in vitro in TGF-β1-induced HMrSV5 cells. Tan IIA-NPs exhibited small particle size, high encapsulation efficiency, good stability for storage, and safety for intravenous administration. Tan IIA-NPs were effective in preventing adhesion. Tan IIA-NPs increased tPA activity in peritoneal lavage fluid, and tPA mRNA and protein expression, and decreased PAI-1 mRNA and protein expression in the ischemic tissues. Moreover, Tan IIA-NPs decreased TGF-β1 and collagen I expressions in the ischemic tissues. Tan IIA-NPs administered via tail veins upregulated fibrinolysis in the peritoneum. In vitro studies showed that these effects may be mediated by the TGF-β signal pathway. PMID:26056449
Aysan, Erhan; Bektas, Hasan; Ersoz, Feyzullah; Sari, Serkan; Kaygusuz, Arslan; Huq, Gulben Erdem
Background. Postoperative peritoneal adhesions (PPAs) are an unsolved and serious problem in abdominal surgery. Method. Viscous liquids of soybean oil, octyl methoxycinnamate, flax oil, aloe vera gel, and glycerol were used in five experiments, using the same methodology for each. Liquids were applied in the peritoneal cavity before and after mechanical peritoneal trauma. Results were evaluated by multivariate analysis. Results. Compared with the control group, macroscopic and microscopic adhesion values before (P < .001) and after (P < .05) application of viscous liquids significantly reduced PPAs. Values were significantly lower when liquids were applied before rather than after peritoneal trauma (P < .0001). Discussion. Viscous liquids injected into the peritoneal cavity before or after mechanical peritoneal trauma decrease PPA. Injection before trauma was more effective than after trauma. In surgical practice, PPA formation may be prevented or decreased by covering the peritoneal cavity with an appropriate viscous liquid before abdominal surgery. PMID:22363347
Revaux, A; Ducarme, G; Luton, D
Intrauterine adhesions are the most frequent complications after hysteroscopic surgery in women of reproductive age. The prevalence of intrauterine adhesions after hysteroscopic surgery is correlated to intrauterine pathology (myoma, polyp, or adhesions). Few clinical trials have demonstrated the efficiency of barrier agents developed in order to prevent adhesions after operative hysteroscopy. Adhesion barriers are mechanic agent (intrauterine device), fluid agents (Seprafilm, Hyalobarrier) and postoperative systemic treatment (estroprogestative treatment). In this article, we evaluate the efficiency of these barrier agents for adhesion prevention in hysteroscopic surgery, undertaking a review of clinical trials published. The most frequent published studies evaluate the anatomic efficiency of antiadhesion agents after hysteroscopic surgery in order to evaluate the fertility. Data are still insufficient to evaluate them for clinical use. There is a need for other randomised controlled trials. PMID:18308609
Urman, B.; Gomel, V.; Jetha, N. )
The aim of this study was to determine the effectiveness of hyaluronic acid solution in preventing intraperitoneal (IP) adhesions. The study design was prospective, randomized and blinded and involved 83 rats. Measured serosal injury was inflicted using a CO2 laser on the right uterine horn of the rat. Animals randomized to groups 1 and 2 received either 0.4% hyaluronic acid or its diluent phosphate-buffered saline (PBS) intraperitoneally before and after the injury. In groups 3 and 4, the same solutions were used only after the injury. Postoperative adhesions were assessed at second-look laparotomy. Histologic assessment of the fresh laser injury was carried out on uteri pretreated with hyaluronic acid, PBS, or nothing. Pretreatment with hyaluronic acid was associated with a significant reduction in postoperative adhesions and a significantly decreased crater depth. Hyaluronic acid appears to reduce postoperative IP adhesion formation by coating the serosal surfaces and decreasing the extent of initial tissue injury.
Ait Menguellet, S; Collinet, P; Cosson, M; Mariette, C; Triboulet, J-P; Vinatier, D
Adhesion barriers are intraperitoneal agents, solid or fluid, developed in order to prevent postoperative adhesions. In this article, we evaluate the efficiency of these new barrier agents for adhesion prevention in gynaecologic surgery, undertaking a review of controlled clinical trials published. Several human clinical trials demonstrated the safety and efficiency of both Interceed and Seprafilm. As far as other barrier agents are concerned, data are still insufficient to recommend them for clinical use. There is a need for other randomised controlled trials in order to evaluate functional efficiency of anti adhesion agents. PMID:17337231
Preparation and characterization of antiadhesion barrier film from hyaluronic acid-grafted electrospun poly(caprolactone) nanofibrous membranes for prevention of flexor tendon postoperative peritendinous adhesion
Chen, Shih-Hsien; Chen, Chih-Hao; Shalumon, K T; Chen, Jyh-Ping
Peritendinous adhesion is one of the common complications encountered after tendon injury and subsequent surgery, and it can be minimized by introducing a physical barrier between the injured site and the surrounding tissue. An electrospun hyaluronic acid-grafted poly(caprolactone) (PCL-g-HA) nanofibrous membrane (NFM) is proposed as an alternative to current antiadhesion barrier films. HA is covalently grafted to surface-aminolyzed PCL nanofibers, using carbodiimide as the coupling agent. Pristine PCL and PCL-g-HA NFMs were characterized by scanning electron microscopy, thermogravimetric analysis, X-ray photoelectron spectroscopy, Fourier-transform infrared spectroscopy, and mechanical testing. In vitro cell culture with fibroblasts showed that PCL-g-HA NFMs reduced cellular adhesion on the membrane surface while maintaining cell proliferation. Animal experiments using a rabbit flexor digitorum profundus tendon model confirmed the efficacy of PCL-g-HA in reducing peritendinous adhesion, based on gross observation, histology, joint flexion-angle measurements, gliding tests, and biomechanical evaluation. PMID:25187711
Lazarou, George; Apostol, Radu; Khullar, Poonam; Okonkwo, Linda; Nezhat, Farr
Background and Objectives: To determine if surgery using ultrasonic energy for dissection results in less adhesion formation than monopolar electrosurgical energy in the late (8 weeks) postoperative period. Methods: Injuries were induced in rabbits by using ultrasonic energy on one uterine horn and the adjacent pelvic sidewall and using monopolar energy on the opposite side. Eight weeks postoperatively, the rabbits underwent autopsy and clinical and pathologic scoring of adhesions was performed by blinded investigators. Results: There was no significant difference in clinical adhesion scores between the two modalities. The mean clinical score for monopolar cautery was 1.00 versus 0.88 for the Harmonic device (Ethicon Endo-Surgery, Cincinnati, Ohio) (P = .71). Furthermore, there was no significant difference found in the pathologic adhesion scores between the ultrasonic scalpel and monopolar energy. The mean pathologic score for monopolar electrosurgery was 4.35 versus 3.65 for the Harmonic scalpel (P = .30). Conclusion: Neither monopolar electrosurgery nor ultrasonic dissection is superior in the prevention of adhesion formation in the late postoperative period. PMID:26005316
Duron, J J
Small Bowel obstruction due to post-operative adhesions is a common problem in a general surgical practice. Any laparotomy initiates the lifelong risk of this complication. Mortality rates have improved dramatically in the last three decades. The basic evaluation and treatment of small bowel obstruction is well defined but many individual strategies may result from the variety of clinical presentations and from techniques and equipment available to a local surgical practice. Recent advances in surgical techniques and preventive strategies may improve overall results. Results will remain linked to the continuous aging of the populations of Western countries. PMID:14978440
Bianchi, Enrica; Boekelheide, Kim; Sigman, Mark; Lamb, Dolores J.; Hall, Susan J.; Hwang, Kathleen
Post-operative adhesions are a critical problem in pelvic and abdominal surgery despite a multitude of studies dedicated to finding modalities to prevent their occurrence. Ghrelin administration promotes an anti-fibrotic response in a surgical mouse model of adhesion-induction, but the mechanisms mediating this effect have not been established. In the current study, the molecular mechanisms that underlie the anti-adhesion effect of ghrelin were investigated. Post-surgical adhesions were experimentally created in C57BL/6 wild-type mice via a combination of ischemic peritoneal buttons and cecal multiple abrasions. Ghrelin or saline intraperitoneal injections were given twice daily from two days before surgery to selected time points post-surgically to assess the phenotypic and molecular effects of treatment (1 day (n = 20), 4 days (n = 20) and 20 days (n = 40) after surgery). Endpoints included the scoring of adhesions and gene and protein expression analysis of pro-fibrogenic factors conducted on peritoneal ischemic tissue by quantitative PCR and Western blot. Ghrelin administration significantly reduced post-surgical adhesions and down-regulated pro-inflammatory gene and protein expression, including Tgfb3 and Tgfbr2. The up-regulation of inhibitory proteins Smad6 and Smad7 confirmed the ghrelin-induced blockage of TGF-β signaling. Ghrelin is a candidate therapeutic drug for post-operative adhesion prevention, inhibiting inflammatory responses via blockage of the TGF-β signaling pathway at the onset of surgery before the occurrence of the granulation-remodeling phase. PMID:27082244
Deng, Lulu; Li, Qin; Lin, Guixian; Huang, Dan; Zeng, Xuxin; Wang, Xinwei; Li, Ping; Jin, Xiaobao; Zhang, Haifeng; Li, Chunmei; Chen, Lixin; Wang, Liwei; Huang, Shulin; Shao, Hongwei; Xu, Bin; Mao, Jianwen
P-glycoprotein (P-gp) is encoded by the multidrug resistance (MDR1) gene and is well studied as a multi-drug resistance transporter. Peritoneal adhesion formation following abdominal surgery remains an important clinical problem. Here, we found that P-gp was highly expressed in human adhesion fibroblasts and promoted peritoneal adhesion formation in a rodent model. Knockdown of P-gp expression by intraperitoneal injection of MDR1-targeted siRNA significantly reduced both the peritoneal adhesion development rate and adhesion grades. Additionally, we found that operative injury up-regulated P-gp expression in peritoneal fibroblasts through the TGF-β1/Smad signaling pathway and histone H3 acetylation. The overexpression of P-gp accelerated migration and proliferation of fibroblasts via volume-activated Cl- current and cell volume regulation by enhancing phosphorylation of the chloride channel-3. Therefore, P-gp plays a critical role in postoperative peritoneal adhesion formation and may be a valuable therapeutic target for preventing the formation of peritoneal adhesions. PMID:26877779
Gholamali, Abbasi; Sepideh, Pojhan; Susan, Emami
Swelling or oedema of forehead or eyelids is a common consequence of hair transplantation surgery. However, this results in increased morbidity and absence from work due to unaesthetic appearance. To study various physical and therapeutic modalities to reduce or completely prevent the occurrence of such oedema. Three hundred forty hair transplant patients were recruited in the study and were categorized into 8 groups depending upon the intervention employed. There were 32 dropouts in the study due to various reasons. Patients who were administered steroid with tumescent solution had the highest number of patients without oedema, with only 3 out of 117 patients developing oedema. Physical measures like position of head during sleeping, application of occlusion bands or ice packs did not show satisfactory results. Addition of triamcinolone to tumescent anaesthetic solution is a very effective technique of preventing post-operative swelling. PMID:21031066
Postoperative Complications Leading to Death after Coagulum Pyelolithotomy in a Tetraplegic Patient: Can We Prevent Prolonged Ileus, Recurrent Intestinal Obstruction due to Adhesions Requiring Laparotomies, Chest Infection Warranting Tracheostomy, and Mechanical Ventilation?
Vaidyanathan, Subramanian; Soni, Bakul; Singh, Gurpreet; Hughes, Peter
A 22-year-old male sustained C-6 tetraplegia in 1992. In 1993, intravenous pyelography revealed normal kidneys. Suprapubic cystostomy was performed. He underwent open cystolithotomy in 2004 and 2008. In 2009, computed tomography revealed bilateral renal calculi. Coagulum pyelolithotomy of left kidney was performed. Pleura and peritoneum were opened. Peritoneum could not be closed. Following surgery, he developed pulmonary atelectasis; he required tracheostomy and mechanical ventilation. He did not tolerate nasogastric feeding. CT of abdomen revealed bilateral renal calculi and features of proximal small bowel obstruction. Laparotomy revealed small bowel obstruction due to dense inflammatory adhesions involving multiple small bowel loops which protruded through the defect in sigmoid mesocolon and fixed posteriorly over the area of previous intervention. All adhesions were divided. The wide defect in mesocolon was not closed. In 2010, this patient again developed vomiting and distension of abdomen. Laparotomy revealed multiple adhesions. He developed chest infection and required ventilatory support again. He developed pressure sores and depression. Later abdominal symptoms recurred. This patient's general condition deteriorated and he expired in 2011. Conclusion. Risk of postoperative complications could have been reduced if minimally invasive surgery had been performed instead of open surgery to remove stones from left kidney. Suprapubic cystostomy predisposed to repeated occurrence of stones in urinary bladder and kidneys. Spinal cord physicians should try to establish intermittent catheterisation regime in tetraplegic patients. PMID:23533931
Background To translate the concept of full-conditioning (FC) from animal experiments to the human, and to evaluate the efficacy for adhesion prevention. FC consisted of decreasing acute inflammation by 86% CO2+ 10% N2O + 4% O2 for the pneumoperitoneum, cooling of the peritoneal cavity, humidification, heparinized rinsing solution and 5 mg of dexamethasone as demonstrated in animal models. Methods A randomized controlled trial (RCT: NCT01344486) comparing standard laparoscopy with full conditioning together with a barrier in a 2/3 ratio in 44 women undergoing deep endometriosis surgery at KULeuven. The primary aim was reduction of adhesions. Secondary aims were CO2 resorption, postoperative pain and recovery. Randomization was performed after signing informed consent. Adhesion scoring during second look laparoscopy and pain scoring were done blindly. Results In the FC group (n = 16) adhesions were completely prevented in 12/16 women whereas in the control group (n = 11) all women had severe adhesions (P < 0.0005). Also the area, density and severity of adhesions were less. (P <0.001). In the control group, severity, density and area of adhesions were strongly interrelated (P = 0.0001 for all areas) suggesting a common enhancing factor. In the FC group CO2 resorption (P < 0.001), postoperative pain (P < 0.001), and CRP concentrations (P < 0.01) were lower while clinical recovery was faster (P < 0.0001) and time to first flatus (P < 0.002) shorter. In conclusion This translational research confirms in the human the efficacy of FC in reducing CO2 resorption and adhesions with in addition less postoperative pain, lower postoperative CRP concentrations and an accelerated recovery. PMID:24326155
Feng, Ming-xuan; Hong, Dun
Postoperative epidural adhesion is one of the most common causes of failed back surgery syndrome (FBSS), which can lead to back and leg pain or neurological deficit. Prevention of epidural adhesion after laminectomy is critical for improving the outcomes of lumbar surgery. The main origins of epidural fibrosis are raw surface of erector muscles and rupture fibers of intervertebral disc. The main current preventive methods for epidural adhesion include the usage of implants, chemicals and low dose radiation. However, most of them are still in experiment period. There are still controversies on the clinic usage of autograft free fat, ADCON-L, and Mitomycin C (MMC). The optimal implants are characteristics of better biocompatibility, degradable absorption and capability of existing for a certain period in body. The optimal medicine should have good effect on anti-desmoplasia, less side effects and long half-life. Besides, the combination of biodegradable medical film and drug and the mixture of two or more medical films are also the research frontlines of epidural adhesion. Further researches are required to explore new materials and drugs with stable and most favorable effect in preventing epidural adhesion. PMID:26757539
Wei, Guangbing; Chen, Xin; Wang, Guanghui; Jia, Pengbo; Xu, Qinhong; Ping, Gaofeng; Wang, Kang; Li, Xuqi
Background Postoperative intra-abdominal adhesions are common complications after abdominal surgery. The exact molecular mechanisms that are responsible for these complications remain unclear, and there are no effective methods for preventing adhesion formation or reformation. The aim of the study reported here was to investigate the preventive effects and underlying potential molecular mechanisms of selective cyclooxygenase-2 (COX-2) inhibitors in a rodent model of postoperative intra-abdominal adhesions. Materials and methods The expression of COX-2 in postoperative intra-abdominal adhe-sions and normal peritoneal tissue was examined by immunohistochemistry and Western blot analysis. Assays were performed to elucidate the effect of COX-2 inhibition on hypoxia-induced fibroblast activity in vitro and on intra-abdominal adhesion formation in vivo. Results Hypoxia-induced COX-2 expression in peritoneal fibroblasts was increased in postoperative intra-abdominal adhesions. Inhibition of COX-2 attenuated the activating effect of hypoxia on normal peritoneal fibroblasts in vitro. Data indicate that selective COX-2 inhibitor prevents in vivo intra-abdominal adhesion by inhibition of basic fibroblast growth factor and transforming growth factor-beta expression, but not through an antiangiogenic mechanism. Furthermore, using selective COX-2 inhibitors to prevent intra-abdominal adhesions did not adversely affect the weight, bowel motility, or healing of intestinal anastomoses in a rat model. Conclusion These results show that hypoxia-induced COX-2 expression in peritoneal fibroblasts is involved in the formation of intra-abdominal adhesions. Inhibition of COX-2 prevents postoperative intra-abdominal adhesions through suppression of inflammatory cytokines. PMID:26109851
Zhu, Lin; Zhang, Yu-Qing
N,O-Carboxymethyl chitosan (NOCC) can prevent postsurgical adhesion formation. Here, we described the preparation of a novel silkworm pupa NOCC and its effects on the prevention of postoperative adhesion in a rat cecal abrasion model. The degree of deacetylation (DDA) of silkworm pupa chitosan was only 49.87 ± 0.86%; regardless, it was used as the raw material to construct the novel silkworm pupa NOCC, which had a weaker crystallinity than the NOCC standard. Sixty male Sprague-Dawley rats were divided into three groups and treated as follows: 0.9% normal saline solution as a negative control, medical anti-adhesion gel as a positive control and the silkworm pupa NOCC anti-adhesion solution. Two and three weeks after surgery, the animals were killed and the adhesion formation was scored. The silkworm pupa NOCC solution significantly decreased the levels of WBC, TNF-α, IL-1β, IL-2, IL-6 and IL-8 but had no effect on IL-4. Additionally, a lower level of TGF-β1 expression was found in the silkworm pupa NOCC group, and significantly less collagen (P<0.01) and fewer inflammatory cells and fibroblasts were detected in the animals of this group. These results suggested that the novel NOCC from silkworm pupa using the method described here have potential applications in the prevention of postoperative intestinal adhesion. PMID:26838865
Zheng, Peng; Xu, Jianmin
Anastomotic leak is a major complication after colorectal resection. Risk factors for anastomotic leak include patient and disease related factors, preoperative factors(e.g. use of neoadjuvant chemoradiation and mechanical bowel preparation), intraoperative factors(e.g. anastomotic techniques, performing of water injection test, preventive colostomy, and surgical procedures, etc; postoperative factors, such as postoperative medication use, etc. Early diagnosis of anastomotic fistula is crucial, which can be made by combining laboratory examination with imaging examination or take the prediction and diagnosis model as reference. Once diagnosed, anastomotic leak should be managed immediately according to individual status and severity of disease. As for intraperitoneal anastomosis, no matter whether the bowel lack of blood supply or not, original anastomosis should be removed and terminal loop ileumstomy should be created. As for extraperitoneal anastomosis(mainly low rectal anastomosis), adequate drainage and terminal loop ileumstomy can be considered when anastomosis is slightly cracked or invisible due to adhesion. When anastomosis is severely cracked or blood supply is too limited, however, we must disconnect the original anastomotic and create a proximal colostomy. PMID:27112466
Way, Tzong-Der; Hsieh, Shih-Rong; Chang, Chi-Jung; Hung, Tsung-Wei; Chiu, Chun-Hwei
Homopolymers and copolymers synthesized from biocompatible monomers with polyethylene glycol (PEG) and polycaprolactone side chains, were applied to separate healing tissues and prevent postsurgical adhesions. The results of the contact angle and the ESCA spectra reveal the presence of more PEG segments on the surface of the PEMC1 film than the P(EM) 3(EMC4) 1 film. The effects of the molecular structures on the surface properties, including the wetting properties and the anti-tissue adhesion behaviors, of the films were examined. Fluorescent polymer was fixed on the surface of the film to form the marking dot. The in vivo degradation behaviors of the surface-marked films were investigated non-invasively by monitoring the location of the fluorescent signal. The degradation behaviors of various films observed in the animal study were consistent with those observed by in vivo imaging. Proper arrangement of PEG segments on the polymer side chain helped to keep a large proportion of PEG segments close to the surface of the film. Such an arrangement represents an effective means of preventing postoperative tissue adhesion.
Richardson, Rebecca J.; Hammond, Nigel L.; Coulombe, Pierre A.; Saloranta, Carola; Nousiainen, Heidi O.; Salonen, Riitta; Berry, Andrew; Hanley, Neil; Headon, Denis; Karikoski, Riitta; Dixon, Michael J.
Appropriate development of stratified, squamous, keratinizing epithelia, such as the epidermis and oral epithelia, generates an outer protective permeability barrier that prevents water loss, entry of toxins, and microbial invasion. During embryogenesis, the immature ectoderm initially consists of a single layer of undifferentiated, cuboidal epithelial cells that stratifies to produce an outer layer of flattened periderm cells of unknown function. Here, we determined that periderm cells form in a distinct pattern early in embryogenesis, exhibit highly polarized expression of adhesion complexes, and are shed from the outer surface of the embryo late in development. Mice carrying loss-of-function mutations in the genes encoding IFN regulatory factor 6 (IRF6), IκB kinase-α (IKKα), and stratifin (SFN) exhibit abnormal epidermal development, and we determined that mutant animals exhibit dysfunctional periderm formation, resulting in abnormal intracellular adhesions. Furthermore, tissue from a fetus with cocoon syndrome, a lethal disorder that results from a nonsense mutation in IKKA, revealed an absence of periderm. Together, these data indicate that periderm plays a transient but fundamental role during embryogenesis by acting as a protective barrier that prevents pathological adhesion between immature, adhesion-competent epithelia. Furthermore, this study suggests that failure of periderm formation underlies a series of devastating birth defects, including popliteal pterygium syndrome, cocoon syndrome, and Bartsocas-Papas syndrome. PMID:25133425
Sancakli, Hande Sar; Yildiz, Esra; Bayrak, Isil; Ozel, Sevda
Objective: To evaluate the post-operative sensitivity of occlusal restorations using different dentin adhesives performed by an undergraduate and a post-doctorate dentist. Materials and Methods: One hundred and eighty-eight molar occlusal restorations were placed in 39 patients (ages between 18 and 30) using 3 different kind of adhesive systems; Optibond FL (OBF), Clearfil Protect Bond (CPB), and iBond (IB) by a post-doctorate dentist or a fifth-year dental student according to the manufacturers’ instructions. Post-operative sensitivity to cold and air was evaluated using a Visual Analog Scale (VAS) after 24 hours, 30, 90, and 180 days. Data were analyzed using the Mann-Whitney U and Friedman tests (P < 0.05). Results: Post-operative sensitivity scores for OBF and CPB were higher for the dental student (P < 0.05), while IB scores did not differ statistical significantly according to the operator (P > 0.05). Conclusion: Operator skill and experience appears to play a role in determining the outcome of post-operative sensitivity of multi-step adhesive systems although the post-operative sensitivity was low. It is suggested that the less experienced clinicians (rather than experienced clinicians) should better use the self-etching dentin bonding systems with reduced application steps to minimize the potential risk of post-operative sensitivity of dental adhesives. PMID:24966741
Hashash, Jana G; Regueiro, Miguel
Postoperative Crohn's disease recurrence remains common, and preventing additional surgery remains a challenge. A critical step to postoperative management of Crohn's disease is being able to identify patients who should receive immediate postoperative therapy from the patients who can wait for recurrence prior to starting medications. All patients, regardless of their risk for recurrence, are advised to undergo a colonoscopy at 6 to 12 months after surgery to evaluate for endoscopic evidence of Crohn's disease. Further management of patients depends on symptoms and the presence or absence of endoscopic recurrence. PMID:27086006
Awonuga, Awoniyi O.; Fletcher, Nicole M.; Saed, Ghassan M.; Diamond, Michael P.
In this review, we discuss the pathophysiology of adhesion development, the impact of physiological changes associated with pregnancy on markers of adhesion development, and the clinical implications of adhesion development following cesarean delivery (CD). Although peritoneal adhesions develop after the overwhelming majority of intra-abdominal and pelvic surgery, there is evidence in the literature that suggests that patients having CD may develop adhesions less frequently. However, adhesions continue to be a concern after CD, and are likely significant, albeit on average less than after gynecological operations, but with potential to cause significant delay in the delivery of the baby with serious, lifelong consequences. Appreciation of the pathophysiology of adhesion development described herein should allow a more informed approach to the rapidly evolving field of intra-abdominal adhesions and should serve as a reference for an evidence-based approach to consideration for the prevention and treatment of adhesions. PMID:21775773
Urman, B.; Gomel, V. )
The local application of 0.25% or 0.4% HA before the induction of a measured laser injury on the rat uterine horn was associated with a significant reduction (P less than 0.05) in postoperative IP adhesions when compared with the group of animals pretreated with the diluent vehicle PBS or received no pretreatment. However, 0.4% HA, when applied in a similar manner, was ineffective in reducing reformation of adhesions after microsurgical adhesiolysis.
Introduction Evaluation of treatment attempts in postoperative adhesion formation is pivotal for the prevention of several morbidities including infertility, pelvic pain, bowel obstruction, and subsequent intraoperative complications. The purpose of this systemic review was to assess the literature on the rat uterine horn model for adhesion formation and treatment modalities to prevent adhesion in the most frequently used experimental animal model. Material and methods We performed a systemic review of publications from January 1st 2000 to December 31st 2013 via a PubMed search. A high number of agents were evaluated for the prevention of postoperative adhesion formation in the rat uterine horn model. Results According to most of the studies, adjuvants such as antiinflamatuars, antiestrogens, antioxidants were effective to prevent adhesion formation. Conclusions Prevention of adhesion formation is pivotal and numerous types of agents were described in the literature were summarized in this review. PMID:25995741
Wu, Haixiao; Germanov, Alexey V.; Goryaeva, Galina L.; Yachmenev, Alexander N.; Gordienko, Dmitriy I.; Kuzin, Victor V.; Skoroglyadov, Alexander V.
Background Intra-articular adhesion is one of the common complications of post knee surgery and injury. The formation of joint adhesion can lead to serious dysfunction. Rosuvastatin (ROS) is a new 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor, with multiple biological effects. In our study, the object was to evaluate the effectiveness of ROS in the prevention of post-operative knee adhesion in rats. Material/Methods Femoral condyle exposing surgery was performed on 45 healthy Sprague Dawley rats. Gelatin sponges soaked with 20 mg/kg of ROS, 10 mg/kg of ROS, or saline were used to cover the surgical site. The post-operative knee joints were fixed in a flexed position with micro Kirschner wires for four weeks. ROS effectiveness for treating intra-articular adhesion was determined with visual score evaluation, hydroxyproline content, histological analyses, immunohistochemistry, and inflammatory and vascular endothelial growth factors expression. Results The animals’ recovery was stable after surgery. The hydroxyproline content, visual score, and inflammatory vascular growth factors expression levels suggested that, compared with the control group, the ROS treatment groups showed better outcomes. ROS prevented joint adhesion formation, collagen deposition, and vascularization at the surgical site, and also inhibited inflammatory activity post-operatively. Compared with the 10 mg/kg ROS group, the 20 mg/kg ROS group showed significantly better outcomes. Conclusions The local application of ROS reduced intra-articular adhesion formation, collagen deposition, and vascularization at the surgical site, and inhibited inflammatory activity post-operatively. These results suggested optimal concentration of ROS to be 20 mg/kg. PMID:27115197
Chen, Chih-Hao; Chen, Shih-Hsien; Shalumon, K T; Chen, Jyh-Ping
Postoperative adhesion formation is the major complication that could occur after acute tendon surgery. The application of an anti-adhesive membrane at the post-surgical site is deemed as a potential way to solve this problem by preventing adhesive fibrotic tissue development. In this study, we fabricated electrospun composite poly(ethylene glycol) (PEG)/poly(caprolactone) (PCL) nanofibrous membrane (NFM) to prevent peritendinous adhesions, which could act as a barrier between the tendon and surrounding tissues, without interrupting mass transfer and normal tendon gliding. PCL/PEG NFMs of 0% PEG (PCL), 25% PEG (25PECL), 50% PEG (50PECL) and 75% PEG (75PECL) were prepared and characterized for physico-chemical properties. The PCL NFM shows the lowest protein permeability while 25PECL NFM exhibited the largest fiber diameter, smallest pore size and the largest ultimate stress and strain. The 75PECL NFM had the lowest water contact angle and the highest Young's modulus. In vitro cell adhesion and migration experiments with fibroblasts indicate that all NFMs could prevent cell penetration, with 75PECL NFM having the least cell attachment. In vivo application of 75PECL NFM on the repaired site of rabbit flexor tendon rupture model demonstrated improved efficacy compared with the PCL NFM and a commercial anti-adhesion barrier (Seprafilm™), from gross observation, histological analysis and functional assays. We concluded that 75PECL NFM could function as an effective anti-adhesion membrane after tendon surgery in a clinical setting. PMID:26115533
Liu, Meng; Zhang, Hao; Du, Bo-Xiang; Xu, Feng-Ying; Zou, Zui; Sui, Bo; Shi, Xue-Yin
Abstract Newly developed neurokinin-1 receptor (NK-1R) antagonists have been recently tried in the prevention of postoperative nausea and vomiting (PONV). This systematic review and meta-analysis was conducted to explore whether NK-1R antagonists were effective in preventing PONV. The PRISMA statement guidelines were followed. Randomized clinical trials (RCTs) that tested the preventive effects of NK-1R antagonists on PONV were identified by searching EMBASE, CINAHL, PubMed, and the Cochrane Library databases followed by screening. Data extraction was performed using a predefined form and trial quality was assessed using a modified Jadad scale. The primary outcome measure was the incidence of PONV. Meta-analysis was performed for studies using similar interventions. Network meta-analysis (NMA) was conducted to compare the anti-vomiting effects of placebo, ondansetron, and aprepitant at different doses. Fourteen RCTs were included. Meta-analysis found that 80 mg of aprepitant could reduce the incidences of nausea (3 RCTs with 224 patients, pooled risk ratio (RR) = 0.60, 95% confidence interval (CI) = 0.47 to 0.75), and vomiting (3 RCTs with 224 patients, pooled RR = 0.13, 95% CI = 0.04 to 0.37) compared with placebo. Neither 40 mg (3 RCTs with 1171 patients, RR = 0.47, 95% CI = 0.37 to 0.60) nor 125 mg (2 RCTs with 1058 patients, RR = 0.32, 95% CI = 0.13 to 0.78) of aprepitant showed superiority over 4 mg of ondansetron in preventing postoperative vomiting. NMA did not find a dose-dependent effect of aprepitant on preventing postoperative vomiting. Limited data suggested that NK-1R antagonists, especially aprepitant were effective in preventing PONV compared with placebo. More large-sampled high-quality RCTs are needed. PMID:25984662
Background Many factors have been put forward as a driving mechanism of surgery-triggered adhesion formation (AF). In this study, we underline the key role of specific surgical trauma related with open surgery (OS) and laparoscopic (LS) conditions in postoperative AF and we aimed to study peritoneal tissue inflammatory reaction (TIR), remodelling specific complications of open surgery (OS) versus LS and subsequently evaluating AF induced by these conditions. Methods A prospective randomized study was done in 80 anaesthetised female Wistar rats divided equally into 2 groups. Specific traumatic OS conditions were induced by midline incision line (MIL) extension and tissue drying and specific LS conditions were remodelled by intraperitoneal CO2 insufflation at the 10 cm of water. TIR was evaluated at the 24th, 72nd, 120th and 168th hour by scoring scale. Statistical analysis was performed by the non-parametric t test and two-way ANOVA using Bonferroni post-tests. Results More pronounced residual TIR was registered after OS than after LS. There were no significant TIR interactions though highly significant differences were observed between the OS and LS groups (p < 0.0001) with regard to surgical and time factors. The TIR change differences between the OS and LS groups were pronounced with postoperative time p < 0.05 at the 24th and 72nd; p < 0.01 - 120th and p < 0.001 - 168th hrs. Adhesion free wounds were observed in 20.0 and 31.0% of cases after creation of OS and LS conditions respectively; with no significant differences between these values (p > 0.05). However larger adhesion size (41.67 ± 33.63) was observed after OS in comparison with LS (20.31 ± 16.38). The upper-lower 95% confidential limits ranged from 60.29 to 23.04 and from 29.04 to 11.59 respectively after OS and LS groups with significant differences (p = 0.03). Analogous changes were observed in adhesion severity values. Subsequently, severe TIR parameters were followed by larger sizes of severe
Walfisch, Asnat; Beloosesky, Ron; Shrim, Alon; Hallak, Mordechai
In spite of the recognized occurrence of cesarean-attributable adhesions, its clinical significance is uncertain. The presence of adhesions during a repeat cesarean section can make fetal extraction lengthy and the procedure challenging and may increase the risk of injury to adjacent organs. Two methods for adhesion prevention are discussed, peritoneal closure and use of adhesion barriers. Peritoneal closure appears to be safe in the short term. In the long term, conflicting evidence arise from reviewing the literature for possible adhesion reduction benefits. A systematic review of the literature on the use of adhesion barriers in the context of cesarean section yielded only a few studies, most of which are lacking in methodology. For now, it appears that the available evidence does not support the routine use of adhesion barriers during cesarean delivery. PMID:24858198
Stoicea, Nicoleta; Gan, Tong J; Joseph, Nicholas; Uribe, Alberto; Pandya, Jyoti; Dalal, Rohan; Bergese, Sergio D
Postoperative nausea and vomiting (PONV) is a complication affecting between 20 and 40% of all surgery patients, with high-risk patients experiencing rates of up to 80%. Recent studies and publications have shed light on the uses of alternative treatment for PONV through their modulation of endogenous opioid neuropeptides and neurokinin ligands. In addition to reducing PONV, hypnosis was reported to be useful in attenuating postoperative pain and anxiety, and contributing to hemodynamic stability. Music therapy has been utilized to deepen the sedation level and decrease patient anxiety, antiemetic and analgesic requirements, hospital length of stay, and fatigue. Isopropyl alcohol and peppermint oil aromatherapy have both been used to reduce postoperative nausea. With correct training in traditional Chinese healing techniques, acupuncture (APu) at the P6 acupoint has also been shown to be useful in preventing early PONV, postdischarge nausea and vomiting, and alleviating of pain. Electro-acupuncture (EAPu), as with APu, provided analgesic and antiemetic effects through release and modulation of opioid neuropeptides. These non-pharmacological modalities of treatment contribute to an overall patient wellbeing, assisting in physical and emotional healing. PMID:26734609
Stoicea, Nicoleta; Gan, Tong J.; Joseph, Nicholas; Uribe, Alberto; Pandya, Jyoti; Dalal, Rohan; Bergese, Sergio D.
Postoperative nausea and vomiting (PONV) is a complication affecting between 20 and 40% of all surgery patients, with high-risk patients experiencing rates of up to 80%. Recent studies and publications have shed light on the uses of alternative treatment for PONV through their modulation of endogenous opioid neuropeptides and neurokinin ligands. In addition to reducing PONV, hypnosis was reported to be useful in attenuating postoperative pain and anxiety, and contributing to hemodynamic stability. Music therapy has been utilized to deepen the sedation level and decrease patient anxiety, antiemetic and analgesic requirements, hospital length of stay, and fatigue. Isopropyl alcohol and peppermint oil aromatherapy have both been used to reduce postoperative nausea. With correct training in traditional Chinese healing techniques, acupuncture (APu) at the P6 acupoint has also been shown to be useful in preventing early PONV, postdischarge nausea and vomiting, and alleviating of pain. Electro-acupuncture (EAPu), as with APu, provided analgesic and antiemetic effects through release and modulation of opioid neuropeptides. These non-pharmacological modalities of treatment contribute to an overall patient wellbeing, assisting in physical and emotional healing. PMID:26734609
Sawada, T; Tsukada, K; Hasegawa, K; Ohashi, Y; Udagawa, Y; Gomel, V
The aim of this study was to evaluate the efficacy of cross-linked hyaluronate hydrogel (HA gel) as an adjuvant for postoperative adhesion prevention, in a mouse uterine horn model. In experiment 1 uterine horns were abrased with iodine. HA gel was applied to the injured surface before closure in the treatment group. In experiment 2, after injuring the uterine horns, three stitches were placed at equal distances around the uterine horns to appose the injured medial surfaces of the two horns during healing. HA gel was inserted between the uterine horns in the treatment group. In experiment 3 prevention of adhesion reformation was assessed. After lysis of adhesions that were induced as in experiment 2, HA gel was introduced between the serosal surfaces of apposing uterine horns. Untreated animals served as controls in each experiment. Statistical analysis was carried out using Student's t-test. The adhesion score was significantly lower in the HA gel group on the 14th day compared with controls in all the experiments: in experiment 1, 0.3 +/- 0.4 versus 1.7 +/- 1.2; in experiment 2, 0.9 +/- 1.0 versus 2.6 +/- 0.5; and in experiment 3, 1.5 +/- 0.9 versus 2.2 +/- 0.6 respectively. Cross-linked HA gel significantly reduced de-novo adhesions (P< 0.03) and adhesion reformation (P < 0.03). PMID:11157833
Scheithauer, S; Artelt, T; Bauer, M; Waeschle, R M
Postoperative wound infections represent a relevant complication of invasive interventions. Current European prevalence data show that for participating hospitals from Germany (n = 132) surgical site infections represent the most commonly occurring nosocomial infection with 24.3 %. This corresponds to a point prevalence of 1.31 %. It is assumed that approximately 25-33 % of all infections acquired in hospital could be prevented if all possible precautions would be taken. Recent studies have indicated that this rate might be even higher for individual infection entities. Infection control measures can be divided into general measures, which are valid for prevention in many fields and for many infection entities and into specific precautions related to hospital-specific circumstances or specific infection entities. In this article the various hygiene measures and recommendations are presented with respect to the level of evidence. PMID:27146286
Chowdhury, Tumul; Schaller, Bernhard
Abstract Hypotension and bradycardia are commonly observed after the spinal anesthesia and various mechanisms have been postulated for these hemodynamic changes. A middle-aged otherwise healthy male Caucasian patient developed several episodes of bradycardia postoperatively after the umbilical hernia repair under subarachnoid block (SAB) while trying to lean forward and move his legs. Episodes were aborted when patient was advised to relax in supine position. The common mechanism of bradycardia and hypotension under SAB is postulated as sympathetic blockade, decrease venous return, and parasympathetic over-dominance leading to a decrease in right arterial pressure and pressure in the great veins as they enter the right atrium. But over time, the parasympathetic inhibition is usually withdrawn first, leading to the risk of severe bradycardia that is probably favored by the reverse Trendelenburg position as described in our case. Postoperative severe hemodynamic changes can occur even under stable spinal anesthesia; however, can be prevented by vigilant monitoring and simple maneuver which includes maintenance of relax posture on the bed. PMID:27258501
Reigel, D H; Bazmi, B; Shih, S R; Marquardt, M D
Leptomeningeal adhesion formation frequently complicates operations and diseases of the central nervous system. Chronic adhesive arachnoiditis may follow intraspinal surgery for disc, tumor, and closure of myelomeningocele, eventually producing pain and declining neurological status of the patient. Reoperation for scar removal is seldom successful as the arachnoidal adhesions reform. Poloxamer 407 (P407) has been shown to reduce postoperative peritoneal adhesion formation in rats and golden hamsters. In a rabbit model, we investigated the potential of P407 to prevent the production of arachnoidal adhesions and nerve root scarring following laminectomy and surgical meningeal injury. The lumbar spinal roots of 8 New Zealand white rabbits were surgically isolated under magnification. One root sleeve axilla was opened and immediately closed with 10-0 suture (control site) and a second root sleeve axilla was opened, P407 injected, and closed with 10-0 suture (treatment site). Five of 7 rabbits treated with P407 and followed for 7-42 days showed no arachnoidal adhesions at the level of the nerve root. Four New Zealand white rabbits had the lamina removed, and the dura over the spinal cord was opened at two sites separated by one to two lumbar segments. At one site P407 was inserted beneath the dura following durotomy, and the other site was opened in a similar fashion and immediately closed without the insertion of P407. There was a 50% reduction in leptomeningeal adhesion formation with the use of P407. P407 may be useful in neurosurgery for the prevention of arachnoidal adhesions. PMID:8398849
Boot, D A; Hughes, S P
Zenoderm (Ethicon Ltd., Edinburgh, Scotland) is porcine skin dermis specially treated so as to be weakly antigenic when implanted. Its use as an extradural spinal and nerve root membrane to reduce postoperative adhesions after laminectomy was tested in 22 rabbits with laminectomy in the second and fourth lumbar vertebra. The sites were reviewed histologically two to 36 weeks after operation. Histologic sections showed that Zenoderm was initially surrounded by hematoma that organized into fibrous tissue and, later, bone. When Zenoderm was placed immediately adjacent to the dura, dense adhesions formed, which were slower to resolve than those in the control sites. The rate of Zenoderm resorption was variable. In general, Zenoderm did not excite excessive fibrous tissue formation and was slowly replaced by bone. Contrary to the experience of others, it was unusual to find adhesions between the laminectomy site, and the dura began disappearing after six to nine weeks. In rabbits, Zenoderm is unlikely to prevent adhesions forming after lumbar disc surgery. The resorption rate is variable, and laminectomy sites are unsuitable for the investigation of material for the prevention of spinal dural adhesions. PMID:3542330
Matoba, Mari; Hashimoto, Ayumi; Tanzawa, Ayumi; Orikasa, Taichi; Ikeda, Junki; Iwame, Yoshizumi; Ozamoto, Yuki; Miyamoto, Hiroe; Yoshida, Chiko; Hashimoto, Toru; Torii, Hiroko; Takamori, Hideki; Morita, Shinichiro; Tsujimoto, Hiroyuki; Hagiwara, Akeo
Postoperative intra-abdominal or intrathoracic adhesions sometimes cause significant morbidity. We have designed three types of alginate-based treatments using strongly cross-linked (SL), weakly cross-linked (WL), and non-cross-linked (NL) alginate with calcium gluconate. In rat experiments, we compared the antiadhesive effects of the three types of alginate-based treatments, fibrin glue treatment (a standard treatment), and no treatment against adhesions caused by polyglycolic acid (PGA) mesh (PGA-induced adhesions). The antiadhesive materials were set on the PGA sheet fixed on the parietal peritoneum of the abdomen. Fifty-six days later, the adhesions were evaluated macroscopically by the adhesion scores and microscopically by hematoxylin-eosin staining and immunostaining. We also tested the fibroblast growth on the surface of the antiadhesive materials in vitro. The antiadhesive effects of WL and NL were superior to the no treatment and fibrin glue treatment. A microscopic evaluation confirmed that the PGA sheet was covered by a peritoneal layer constructed of well-differentiated mesothelial cells, and the inflammation was most improved in the NL and WL. The fibroblast growth was inhibited most on the surfaces of the NL and WL. These results suggest that either the WL or NL treatments are suitable for preventing PGA-induced adhesions compared to SL or the conventional treatment. PMID:26078949
Fujisawa, Takanobu; Komasawa, Nobuyasu; Fujiwara, Atsushi; Kido, Haruki; Minami, Toshiaki
We successfully performed intraoperative dexmedetomidine (DEX) administration for the prevention of emergence agitation or postoperative delirium after lung resection in four patients (71.3 ± 5.7 year old, 3 males and 1 female) with a past history of postoperative delirium. DEX was started at 0.35-0.45 μg x kg(-1) x hr(-1) continuously without loading. The average time from DEX initiation to extubation was 141.3 ± 94.4 minutes. No patient had emergence agitation, and DEX administration was continued until the following morning with monitoring in all patients without any symptoms of delirium. Intraoperative DEX administration may be beneficial for the prevention of emergence agitation or postoperative delirium in patients with a past history of postoperative delirium. PMID:27188116
Dasiran, F; Eryilmaz, R; Isik, A; Okan, I; Somay, A; Sahin, M
The prominent cells in the late phase of wound healing during proliferation and matrix deposition are fibroblasts. Foreign materials in the operation site like prosthesis prolong the inflammation and induce fibroblast proliferation (8). 3 different prostheses used in this study induced chronic inflammation and fibrosis and provided an effective repair. Dense and thick adhesions due to fibrosis also induced strong adhesions to omentum and small intestine if only polypropylene mesh used for hernia repair. However, there was no difference between SprayGel treated polypropylene mesh and Sepramesh when compared for fibrosis. It also prevents the intraabdominal adhesion formation. It is nontoxic, sticky adherent, non- immigrant and easy to use both in open and laparoscopic surgeries. This experimental study revealed that polyethyleneglycol applied polypropylene mesh accomplishes hernia repair with significantly less adhesion formation than polypropylene mesh alone while securing a remarkable economy than adhesion barrier coated dual meshes (Tab. 6, Fig. 7, Ref. 23). Text in PDF www.elis.sk. PMID:26084740
Catena, Fausto; Di Saverio, Salomone; Coccolini, Federico; Ansaloni, Luca; De Simone, Belinda; Sartelli, Massimo; Van Goor, Harry
Intra-abdominal adhesions following abdominal surgery represent a major unsolved problem. They are the first cause of small bowel obstruction. Diagnosis is based on clinical evaluation, water-soluble contrast follow-through and computed tomography scan. For patients presenting no signs of strangulation, peritonitis or severe intestinal impairment there is good evidence to support non-operative management. Open surgery is the preferred method for the surgical treatment of adhesive small bowel obstruction, in case of suspected strangulation or after failed conservative management, but laparoscopy is gaining widespread acceptance especially in selected group of patients. "Good" surgical technique and anti-adhesive barriers are the main current concepts of adhesion prevention. We discuss current knowledge in modern diagnosis and evolving strategies for management and prevention that are leading to stratified care for patients. PMID:27022449
Huang, Chien-Feng; Jeng, Yachung; Chen, Kuo-Dong; Yu, Ji-Kuen; Shih, Chao-Ming; Huang, Shih-Ming; Lee, Chen-Hsen; Chou, Fong-Fu; Shih, Ming-Lang; Jeng, Kee-Ching; Chang, Tzu-Ming
are positively associated with strategy of surgery and postoperative hypocalcemia prevention. PMID:25685337
Chen, Jim; Wu, Jinshan; Chalson, Helen; Merigan, Lynn; Mitchell, Andrew
Background Although liver transplantation has been widely practised, post-operative bacterial infection is still a frequent complication which contributed to an increased risk of fatality. There were studies on preoperative use of probiotics for liver transplant patients and acquired reduction in postoperative sepsis and wound infection, but the relevant clinical experience with pre- and probiotics is still limited. Objectives This study is to assess fibre and probiotic use aimed at preventing bacterial sepsis and wound complications in patients undergoing liver transplantation. Study methods There were a total of sixty-seven adult patients scheduled for liver transplantation were included in a public teaching hospital. From January to December 2011, 34 continuous patients following liver transplantation were put on fibre + probiotics. In retrospectively, from January to December 2010, 33 continuous patients were collected as a control group and they were only received fibre post operation. The incidence of bacterial infections was compared in patients receiving either fibre and lactobacillus or fibre only. Statistical analysis was performed using SPSS 15. The t test, fisher’s and chi- square test was used to compare discrete variables. Results In summary, in the analysis of 67 liver transplant recipients, 8.8% group A patients developed infections compared to 30.3% group B patients. The difference between groups A and B was statistically significant in both cases. In addition, the duration of antibiotic therapy was significantly shorter in the lactobacillus-group. Wound infection was the most frequent infections and enterococci the most frequently isolated bacteria. Fibre and lactobacilli were well tolerated in most cases. The operating time, amount of intra- and post-operatively transfused units of blood, fresh frozen plasma and albumin did not differ significantly between the groups. Conclusions Combined fibre and probiotics could lower the incidence of
Bitner, Jason; Hilde, Leana; Hall, Kenneth; Duvendack, Tammy
Postoperative hypothermia (ie, a core temperature lower than 96.8 degrees F [36 degrees C]), is a problem frequently seen in surgical patients, especially those undergoing total joint replacement. Patients who experience hypothermia may have increased recovery times and postoperative complications. A team of clinical staff members and personnel from the performance improvement (PI) department of a hospital used a PI model to incorporate use of preoperative forced-air warming blankets that resulted in improved postoperative core temperatures. PMID:17499055
Yong-Hing, K; Reilly, J; de Korompay, V; Kirkaldy-Willis, W H
In repeat lumbar surgery for failure of the original operation to provide lasting relief, well-organized fibrous tissue is often noted binding together the dura, nerve roots, and erector spinae muscles. Lumbar laminectomy was carried out in 46 dogs and seven groups of animals studied. Gelfoam failed to prevent fibrosis. Free fat grafts prevented fibrosis whether the graft was placed at the laminectomy site or around the nerve roots. Vascularization of the grafts was demonstrated by injection of India ink before sacrifice. Ligamentum nuchae, which is similar to ligamentum flavum in its high elastic content, was also effective in preventing scar formation. The operative biopsy findings at reexploration in four patients who had free fat grafts following laminectomy are presented. PMID:7361199
Kim, Yong-Shin; Kim, Yong-Il; Seo, Kwon-Hui; Kang, Hye-Rim
Objective The aim of this study was to investigate the optimum dosage of dexmedetomidine for prevention of postanesthetic shivering. Methods One-hundred thirty two ASA physical status I-II patients scheduled for elective laparoscopic total hysterectomy were enrolled in this randomised, placebo-controlled study. Patients were randomly allocated to receive dexmedetomidine in four groups: group S (0.9% normal saline), group D0.5 (dexmedetomidine 0.5 µg/kg), group D0.75 (dexmedetomidine 0.75 µg/kg), group D1.0 (dexmedetomidine 1.0 µg/kg). Time to extubation and tympanic temperature during and after operation were measured. Shivering was graded (0-3 scale) upon patients arrival to the PACU and every ten minutes thereafter up to forty minutes. Sedation and first rescue analgesic time at the PACU were evaluated. Results The incidence of shivering was significantly lower in group D0.75 and D1.0 than in group S (P < 0.05). There were significantly fewer patients with a shivering score of 2 or 3 in groups D0.75 and D1.0 than in group S (P < 0.05, P < 0.001). Extubation time was shorter in group S than in groups D0.75 and D1.0 (P < 0.05). Tympanic temperature at 40 minutes postoperatively in the recovery room was higher in group S than in the other dexmedetomidine groups (P < 0.05) Fewer patients required rescue analgesia in groups D0.75 and D1.0 than in group S (P < 0.001), and the time to rescue analgesia was longer in group D1.0 than in group S (P < 0.001). Modified Observer's Assessment of Alertness/Sedation (MOAA/S) at arrival in the PACU was lower in all dexmedetomidine groups than in group S (P < 0.05). Conclusions Our results suggest that dexmedetomidine 0.75 or 1.0 µg/kg provides effective prophylaxis against postoperative shivering as well as an analgesic effect. Though potential for intraoperative requirement for atropine, sedation in the immediate recovery period and delayed extubation time with dexmedetomidine was noted, there were no major clinical impacts
Wang, Y Q; Wei, J Q; Dai, D Z
Intestinal adhesions were induced in rats by stabbing the terminal part of the ileum. Adhesion prevention by ibuprofen and changzhankang (CZK), which was composed by traditional Chinese medicines, was evaluated with a grading system. All of the 13 rats in the non-treated group created severe adhesions. The severity was significantly modified by orally administered CZK of 20 g/kg (in crude drugs) once or twice daily for five days (P less than 0.01 and P less than 0.05 compared with the non-treated). Intramuscular injection of ibuprofen (35 mg/kg, 3 times daily) also alleviated the severity of adhesions. There was no significant difference between the ibuprofen-treated and CZK-treated groups though some of the rats were virtually free from adhesion formation in the latter. It is plausible to expect CZK to become a promising drug used in treating intestinal adhesions, for the natural drug has greater security and less side effects than synthesized drugs. PMID:1954667
Mayer, M; Yedgar, S; Hurwitz, A; Palti, Z; Finzi, Z; Milwidsky, A
Activity of peritoneal plasminogen activator and its regulation by dextran and other macromolecules that clinically suppress postoperative adhesions was studied. Plasminogen activator activity was assayed by a two-stage globinolytic assay that monitors formation of plasmin, as well as by cleavage of a chromogenic peptide substrate (S-2444) in the presence of aprotinin (Trasylol). Plasminogen activator activity was located on the outer surface of human peritoneum. Incubation of peritoneal tissue with buffer in vitro (conditioning) prompted release of plasminogen activator into the conditioning medium. The released plasminogen activator formed a single band on sodium dodecyl sulfate-gel electrophoresis at an apparent molecular weight of 174,000 and was markedly suppressed by antiserum raised against human melanoma tissue-type plasminogen activator. Nonspecific proteolytic activity did not accumulate in the medium during conditioning. The presence of dextran 80 during conditioning of peritoneum reversibly suppressed tissue-bound plasminogen activator activity and reduced plasminogen activator activity in the spent medium. A similar inhibition of peritoneal plasminogen activator was induced by dextran 500, methyl cellulose, and polyvinylpyrrolidone. Dextran, when added to the medium after conditioning, had no direct inhibitory effect on plasminogen activator activity. Dextran did not induce peritoneal production of inhibitor(s) of trypsin, chymotrypsin, or urokinase. On the basis of these findings, two possible mechanisms for the effect of viscous polymers in the reduction of adhesion formation are proposed. These mechanisms consider the importance of peritoneal tissue-type plasminogen activator for removal of fibrin clots and suggest that polymer coating either prevents the shedding of plasminogen activator into the abdominal cavity or reduces the access of fibrin clots to the serosal surfaces. PMID:2459968
Hoare, Todd; Yeo, Yoon; Bellas, Evangelia; Bruggeman, Joost P.
The effectiveness of rheological blends of high molecular weight hyaluronic acid (HA) and low molecular weight hydroxypropyl methylcellulose (HPMC) in the prevention of peritoneal adhesions post-surgery is demonstrated. The physical mixture of the two carbohydrates increased the dwell time in the peritoneum while significantly improving the injectability of the polymer compared to hyaluronic acid alone. HA-HPMC treatment decreased the total adhesion area by ~70% relative to a saline control or no treatment in a repeated cecal injury model in the rabbit. No significant cytotoxicity and minimal inflammation was associated with the blend, and no chemical or physical processing was required prior to their use beyond simple mixing. PMID:24365709
Bel, Alain; Ricci, Massimo; Piquet, Julie; Bruneval, Patrick; Perier, Marie-Cécile; Gagnieu, Christian; Fabiani, Jean-Noël; Menasché, Philippe
Reduction in mediastinal adhesions is an issue in cardiac surgery. To evaluate a porcine-bioengineered collagen membrane (Cova™ CARD) intended to promote tissue regeneration, 18 sheep underwent a sternotomy and a 30 min period of cardiopulmonary bypass. They were divided into three equal groups: pericardium left open, placement of an e-polytetrafluoroethylene membrane (Preclude®) taken as a non-absorbable substitute comparator and placement of the absorbable Cova™ CARD membrane. Four months thereafter, the study animals underwent repeat sternotomy and were macroscopically assessed for the degree of material resorption and the intensity of adhesions. Explanted hearts were evaluated blindly for the magnitude of the inflammatory response, fibrosis and epicardial re-mesothelialization. The bioengineered membrane was absorbed by 4 months and replaced by a loosely adherent tissue leading to the best adhesion score. There was no inflammatory reaction (except for a minimal one in an animal). Fibrosis was minimal (P = 0.041 vs Preclude®). The highest degree of epicardial re-mesothelialization, albeit limited, was achieved by the bioengineered group in which five of six sheep demonstrated a new lining of mesothelial cells in contrast to two animals in each of the other groups. This collagen membrane might thus represent an attractive pericardial substitute for preventing post-operative adhesions. PMID:22268067
Hager, W. David; Livengood, Charles H.; Hoyme, Udo
Bacterial contamination of the operative site is a common occurrence in obstetrics and gynecology. The widespread use of antibiotic prophylaxis has reduced but not eliminated serious postoperative infections. For most operations, a single dose of a limited-spectrum drug has been as effective as a multidose regimen. In the differential diagnosis it is important to consider cellulitis, abscess, necrotizing fasciitis and septic pelvic thrombophlebitis. Abscess and necrotizing fasciitis are expected to require invasive therapy in addition to antibiotics, while cellulitis and septic pelvic thrombophlebitis should respond to medical management alone. Although a postoperative fever is a warning sign of possible infection, it may also be caused by the antibiotics that are given for treatment. The use of prolonged courses of antibiotics once the patient is clinically well is discouraged. While clinical guidelines are provided for use in the diagnosis and management of postoperative infections, these recommendations are intended for general direction and not as an exclusive management plan. PMID:12839635
Zhang, Weizhong; Li, Xuanyi; Comes Franchini, Mauro; Xu, Ke; Locatelli, Erica; Martin, Robert C; Monaco, Ilaria; Li, Yan; Cui, Shusen
We introduced curcumin-loaded nanomicelles into a tendon-healing model to evaluate their effects on tendon healing and adhesion. Three groups consisting of 36 rats underwent rupture and repair of the Achilles tendon. The treatment group received an injection of curcumin-loaded nanomicelles (gold nanorods [GNRs]-1/curcumin in polymeric nanomicelles [curc@PMs] at a dosage of 0.44 mg curcumin/kg in 0.1 mL saline) into the surgical site and exposed to laser postoperatively at weeks 1, 2, and 3, for three times 10 seconds each, on the surgical site in the rats that underwent tendon rupture and repair, while the other two groups received 0.44 mg curcumin/kg in 0.1 mL saline and 0.1 mL of saline, respectively. The specimens were harvested at 4 weeks and subjected to biomechanical and histological evaluation. The scoring results of tendon adhesion indicated that GNRs-1/curc@PMs group was in the lowest grade of peritendinous adhesions compared to the other groups. Histological assessment further confirmed the preventive effect of GNRs-1/curc@PMs on tendon adhesion. These findings indicated greater tendon strength with less adhesion in the group treated with GNRs-1/curc@PMs combined with laser exposure, and that nanoparticle-based therapy may be applied to prevent adhesion in clinical patients. PMID:27382278
Meier Bürgisser, Gabriella; Müller, Angela; Bonavoglia, Eliana; Fessel, Gion; Snedeker, Jess G.; Giovanoli, Pietro
Purpose. One of the great challenges in surgical tendon rupture repair is to minimize peritendinous adhesions. In order to reduce adhesion formation, a physical barrier was applied to a sutured rabbit Achilles tendon, with two different immobilization protocols used postoperatively. Methods. Thirty New Zealand white rabbits received a laceration on the Achilles tendon, sutured with a 4-strand Becker suture, and half of the rabbits got a DegraPol tube at the repair site. While fifteen rabbits had their treated hind leg in a 180° stretched position during 6 weeks (adhesion provoking immobilization), the other fifteen rabbits were recasted with a 150° position after 3 weeks (adhesion inhibiting immobilization). Adhesion extent was analysed macroscopically, via ultrasound and histology. Inflammation was determined histologically. Biomechanical properties were analysed. Results. Application of a DegraPol tube reduced adhesion formation by approximately 20%—independently of the immobilization protocol. Biomechanical properties of extracted specimen were not affected by the tube application. There was no serious inflammatory reaction towards the implant material. Conclusions. Implantation of a DegraPol tube tightly set around a sutured tendon acts as a beneficial physical barrier and prevents adhesion formation significantly—without affecting the tendon healing process. PMID:25101292
Wang, Wei; Wang, Yan; Wu, Haibo; Lei, Liming; Xu, Shiqin; Shen, Xiaofeng; Guo, Xirong; Shen, Rong; Xia, Xiaoqiong; Liu, Yusheng; Wang, Fuzhou
Postoperative cognitive dysfunction (POCD) is a subtle disorder of thought processes, which may influence isolated domains of cognition and has a significant impact on patient health. The reported incidence of POCD varies enormously due to lack of formal criteria for the assessment and diagnosis of POCD. The significant risk factors of developing POCD mainly include larger and more invasive operations, duration of anesthesia, advanced age, history of alcohol abuse, use of anticholinergic medications, and other factors. The release of cytokines due to the systemic stress response caused by anesthesia and surgical procedures might induce the changes of brain function and be involved in the development of postoperative cognitive dysfunction. The strategies for management of POCD should be a multimodal approach involving close cooperation between the anesthesiologist, surgeon, geriatricians, and family members to promote early rehabilitation and avoid loss of independence in these patients. PMID:25306127
Nakamura, Takatoshi; Sato, Takeo; Naito, Masanori; Ogura, Naoto; Yamanashi, Takahiro; Miura, Hirohisa; Tsutsui, Atsuko; Yamashita, Keishi
Introduction: Risk factors for recurrence postoperative small bowel obstruction in patients who have postoperative abdominal surgery remain unclear. Materials and Methods: The study group comprised 123 patients who underwent surgery for ileus that developed after abdominal surgery from 1999 through 2013. There were 58 men (47%) and 65 women (53%), with a mean age of 63 years (range, 17 to 92 y). The following surgical procedures were performed: lower gastrointestinal surgery in 47 patients (39%), gynecologic surgery in 39 (32%), upper gastrointestinal surgery in 15 (12%), appendectomy in 9 (7%), cholecystectomy in 5 (4%), urologic surgery in 5 (4%), and repair of injuries caused by traffic accidents in 3 (2%). Laparoscopic surgery was performed in 75 patients (61%), and open surgery was done in 48 (39%). We examined the following 11 potential risk factors for recurrence of small bowel obstruction after surgery for ileus: sex, age, body mass index, the number of episodes of ileus, the number of previously performed operations, the presence or absence of radiotherapy, the previously used surgical technique, the current surgical technique (laparoscopic surgery, open surgery), operation time, bleeding volume, and the presence or absence of enterectomy. Results: The median follow-up was 57 months (range, 7 to 185 mo). Laparoscopic surgery was switched to open surgery in 11 patients (18%). The reason for surgery for postoperative small bowel obstruction was adhesion to the midline incision in 36 patients (29%), band formation in 30 (24%), intrapelvic adhesion in 23 (19%), internal hernia in 13 (11%), small bowel adhesion in 20 (16%), and others in 1 (1%). Postoperative complications developed in 35 patients (28%): wound infection in 12 (10%), recurrence of postoperative small bowel obstruction in 12 (10%), paralytic ileus in 4 (3%), intra-abdominal abscess in 3 (2%), suture failure in 1 (1%), anastomotic bleeding in 1 (1%), enteritis in 1 (1%), and dysuria in 1 (1
Yao, M; Sun, Y; Yan, J
In the study, 27 dogs were divided into three groups: A, B and C. Then all of the dogs had their lumbar intervertebral disks removed. Into the wounded cavity of group A, 1 ml of dimethicone was dropped and gelatin sponge was applied on the surface of the nerve root of group B. Group C was served as the control. The dogs were killed and the operation area was removed respectively 2 weeks, 4 weeks, and 12 weeks after the operation for macroscopical observation, nerve root motility measurement and histological examination. The result of the experiment proved that dimethicone was fairly effective in the prevention from secondary nerve root adhesion. While gelatin sponge in the process of its absorption induced the formation of quite a few scar tissues, thus aggrevating nerve root adhesion. PMID:9594172
Geller, Elizabeth J
Postoperative urinary retention (POUR) is a frequent consequence of gynecologic surgery, especially with surgical correction of urinary incontinence and pelvic organ prolapse. Estimates of retention rates after pelvic surgery range from 2.5%–43%. While there is no standard definition for POUR, it is characterized by impaired bladder emptying, with an elevation in the volume of retained urine. The key to management of POUR is early identification. All patients undergoing pelvic surgery, especially for the correction of incontinence or prolapse, should have an assessment of voiding function prior to discharge. There are several ways to assess voiding function – the gold standard is by measuring a postvoid residual. Management of POUR is fairly straightforward. The goal is to decompress the bladder to avoid long-term damage to bladder integrity and function. The decision regarding when to discontinue catheter-assisted bladder drainage in the postoperative period can be assessed in an ongoing fashion by measurement of postvoid residual. The rate of prolonged POUR beyond 4 weeks is low, and therefore most retention can be expected to resolve spontaneously within 4–6 weeks. When POUR does not resolve spontaneously, more active management may be required. Techniques include urethral dilation, sling stretching, sling incision, partial sling resection, and urethrolysis. While some risk of POUR is inevitable, there are risk factors that are modifiable. Patients that are at higher risk – either due to the procedures being performed or their clinical risk factors – should be counseled regarding the risks and management options for POUR prior to their surgery. Although POUR is a serious condition that can have serious consequences if left untreated, it is easily diagnosed and typically self-resolves. Clinician awareness of the condition and vigilance in its diagnosis are the key factors to successful care for patients undergoing surgical repair. PMID:25210477
Chung, Young-Jun; An, Se-Young; Yeon, Je-Yeob; Shim, Woo Sub; Mo, Ji-Hun
Objectives Postoperative bleeding and adhesion formation are the two most common complications after endoscopic sinus surgery (ESS). The former sometimes can be life threatening and the latter is the most common reason requiring revision surgery. This study was designed to evaluate the effect of newly developed chitosan gel (8% carboxymethyl chitosan, Surgi shield) on hemostasis and wound healing after ESS. Methods A prospective, randomized, double-blind controlled trial was conducted in 33 patients undergoing symmetric ESS. At the conclusion of the operation, Surgi shield was randomly applied on one side of the nasal cavity, with the opposite side acting as control and the bleeding quantity of the surgical field was evaluated every 2 minutes. And then, Merocel was placed in the ethmoidectomized areas of the both sides. Five milliliters of Surgi shield was applied to the Merocel of intervention side and saline was applied to the other side. Merocel in both nasal cavities was removed and 5 mL of Surgi shield was applied again to the intervention side on the second day after surgery. The nasal cavity was examined using a nasal endoscope and the degree of adhesion, crusting, mucosal edema, infection, and granulations were graded at 1, 2, and 4 weeks after surgery. Results Complete hemostasis was rapidly achieved in the Surgi shield applied side compared with the control side at 2, 4, 6, 8, and 10 minutes after application of Surgi shield (P#x0003d;0.007, P#x0003d;0.004, P<0.001, P#x0003d;0.001, and P<0.001, respectively). There were significantly less adhesions on the Surgi shield applied side at postoperative 1, 2, and 4 weeks (P#x0003d;0.001, P<0.001, and P<0.001, respectively). The degree of mucosal edema, infection, crusting, or granulation formation assessed by the endoscopic features in the Surgi shield applied side was not significantly different from that of the control side (P>0.05). No adverse effects were noted in the patient series. Conclusion Surgi shield
Napp, M; Gümbel, D; Lange, J; Hinz, P; Daeschlein, G; Ekkernkamp, A
Although surgical site infections (SSI) in dermatologic operative procedures are extremely rare, it is important to understand risks and etiological factors to initiate risk assessment and specific preventive measures. SSI commonly are associated with a complicated, long-term and expensive outcome. Typical wound pathogens of these infections include a variety of multiresistant organisms along with Staphylococcus aureus, Staphylococcus epidermidis, hemolytic streptococci and the gram-negative bacilli Escherichia coli and Pseudomonas aeruginosa. Effective hygienic measures as part of an adequate quality management system should consider the critical points in the development of SSI, particularly in the setting of an outpatient dermatologic unit, such as preparation of the operative area, preoperative skin antisepsis, hand hygiene, safe and skilled technique by surgeons, and barrier nursing to prevent spread of pathogens. The baseline infection incidence in dermatologic surgery inherently is low; nevertheless significant improvements can be achieved by implementation of risk-adapted infection control measures. PMID:24445942
Elmowla, Rasha Ali Ahmed Abd; El-Lateef, Zienab Abd; El-khayat, Roshdy
Intracranial surgery means any surgery performed inside the skull to treat problems in the brain and surrounding structures. Aim: Evaluate the impact of nursing educational program on reducing or preventing postoperative complications for patients after intracranial surgery. Subjects and methods: Sixty adult patients had intracranial surgery (burr…
Khan, Babar A.; Gutteridge, Daniel
Delirium is highly prevalent among elderly post-operative patients with no pharmacological intervention approved by the Food and Drug Administration for prevention or treatment. We conducted a systematic evidence review to critically appraise literature related to the pharmacotherapy of post-operative delirium. Ten studies fulfilled our inclusion criteria with two interventions for delirium treatment and eight interventions for delirium prevention in post-operative patients. The quality of evidence of delirium treatment studies was poor, whereas the quality of evidence in delirium prevention studies ranges from moderate to high. Delirium treatment studies find similar delirium duration and length-of-stay outcomes between haloperidol and either morphine or ondansetron. Risperidone was found to reduce the conversion of sub-syndromal delirium to delirium in one study compared to placebo. Haloperidol, olanzapine, and ketamine were each found to reduce delirium incidence, whereas rivastigmine had no impact on delirium incidence or duration. Lighter anesthesia as monitored by bi-spectral index led to a decreased delirium incidence. Considering results from studies conducted prior to the dates of this review, the current evidence suggests that certain pharmacologic classes and lighter sedation using BIS monitoring may prevent post-operative delirium, although a conclusive recommendation for clinical practice must await further research. PMID:25729334
Kurt, Atilla; Karanlık, Hasan; Soylu, Sinan; Özgür, İlker; Soydinç, Hilal Oğuz; Duranyıldız, Derya; Olgaç, Vakur; Şen, Fatma; Asoğlu, Oktar
Objective We aimed to evaluate the effect of intraperitoneal cetuximab administration on the healing of anastomosis and development of early adhesion formation in a rat model. Materials and Methods Twenty-four female rats were used. A colon segment was resected and end-to-end anastomosis was performed. The rats were randomized into three groups after the performance of colonic anastomosis and received 10 mL of intraperitoneal solution including study drugs after closure of abdominal cavity: normal saline was administered to the normal saline group (n=8), cetuximab (400 mg/m2) was administered to the postoperative 1 group (n=8) 1 day after surgery, and cetuximab (400 mg/m2) was administered to the peroperative group (n=8) during surgery. Results The mean adhesion grade was 2.63±0.92, and 0.50±0.76 and 0.63±0.74 for control and test groups, respectively. Cetuximab reduced adhesion formation in test groups (p<0.05). When all groups were compared, it was found that vascular endothelial growth factor levels decreased significantly only in the abdomen (p<0.05). Hydroxyproline levels and anastomosis bursting pressure were examined, and a statistical difference was found between groups (hydroxyproline p<0.05, bursting pressure p<0.05). However, when postoperative 1 day group was compared with the control group, it was found that there was no difference between groups according to these parameters (p>0.05), but when peroperative group was compared with the control group a significant decrease was observed in both parameters. Histopathological healing score was also evaluated. No statistical difference between groups was found. Conclusion Twenty-four hours later from the operation, intraperitoneal cetuximab therapy may be a safe and feasible treatment for metastatic colorectal patients. PMID:27528807
Introduction The ideal measures to prevent postoperative delirium remain unestablished. We conducted this systematic review and meta-analysis to clarify the significance of potential interventions. Methods The PRISMA statement guidelines were followed. Two researchers searched MEDLINE, EMBASE, CINAHL and the Cochrane Library for articles published in English before August 2012. Additional sources included reference lists from reviews and related articles from 'Google Scholar'. Randomized clinical trials (RCTs) on interventions seeking to prevent postoperative delirium in adult patients were included. Data extraction and methodological quality assessment were performed using predefined data fields and scoring system. Meta-analysis was accomplished for studies that used similar strategies. The primary outcome measure was the incidence of postoperative delirium. We further tested whether interventions effective in preventing postoperative delirium shortened the length of hospital stay. Results We identified 38 RCTs with interventions ranging from perioperative managements to pharmacological, psychological or multicomponent interventions. Meta-analysis showed dexmedetomidine sedation was associated with less delirium compared to sedation produced by other drugs (two RCTs with 415 patients, pooled risk ratio (RR) = 0.39; 95% confidence interval (CI) = 0.16 to 0.95). Both typical (three RCTs with 965 patients, RR = 0.71; 95% CI = 0.54 to 0.93) and atypical antipsychotics (three RCTs with 627 patients, RR = 0.36; 95% CI = 0.26 to 0.50) decreased delirium occurrence when compared to placebos. Multicomponent interventions (two RCTs with 325 patients, RR = 0.71; 95% CI = 0.58 to 0.86) were effective in preventing delirium. No difference in the incidences of delirium was found between: neuraxial and general anesthesia (four RCTs with 511 patients, RR = 0.99; 95% CI = 0.65 to 1.50); epidural and intravenous analgesia (three RCTs with 167 patients, RR = 0.93; 95% CI = 0.61 to 1
Syed, Hasan R; Snyder, Rita; McGowan, Jason E; Jha, Ribhu T; Nair, Mani N
Study Design: Retrospective chart analysis. Objective: The objective of this study is to describe the senior author’s (MNN) experience applying a widely available surgical drape as a postoperative sterile surgical site dressing for both cranial and spinal procedures. Summary of Background Data: Surgical site infection (SSI) is an important complication of spine surgery that can result in significant morbidity. There is wide variation in wound care management in practice, including dressing type. Given the known bactericidal properties of the surgical drape, there may be a benefit of continuing its use immediately postoperatively. Methods: All of the senior author’s cases from September 2014 through September 2015 were reviewed. These were contrasted to the previous year prior to the institution of a sterile surgical drape as a postoperative dressing. Results: Only one surgical case out of 157 operative interventions (35 cranial, 124 spinal) required operative debridement due to infection. From September 2013 to September 2014, prior to the institution of a sterile surgical drape as dressing, the author had five infections out of 143 operations (46 cranial, 97 spinal) requiring intervention. Conclusion: The implementation of a sterile surgical drape as a closed postoperative surgical site dressing has led to a decrease in surgical site infections. The technique is simple and widely available, and should be considered for use to diminish surgical site infections. PMID:26798570
Polymeropoulos, Evangelos; Bagos, Pantelis; Papadimitriou, Maria; Rizos, Ioannis; Patsouris, Efstratios; Τoumpoulis, Ioannis
Purpose: Several studies have investigated the administration of vitamin C (vitC) for the prevention of postoperative atrial fibrillation (AF) after cardiac surgery. However, their findings were inconsistent. The purpose of this meta-analysis was to evaluate the efficacy of vitC as prophylaxis for the prevention of postoperative AF in cardiac surgery. Methods: A systematic search of PubMed, EMBASE, Google Scholar, the Cochrane Library, and clinical trial registries, was performed. 9 studies, published from August 2001 to May 2015, were included, with a total of 1,037 patients. Patients were randomized to receive vitC, or placebo. Results: Cardiac surgery patients who received vitC as prophylaxis, had a significantly lower incidence of postoperative AF (random effects OR=0.478, 95% CI 0.340 – 0.673, P < 10-4). No significant heterogeneity was detected across the analyzed studies (I2=21.7%), and no publication bias or other small study-related bias was found. Conclusion: Our findings suggest that VitC is effective as prophylaxis for the prevention of postoperative AF. The administration of vitC may be considered in all patients undergoing cardiac surgery. PMID:27478787
Testori, Tiziano; Drago, Lorenzo; Wallace, Steven S.; Capelli, Matteo; Galli, Fabio; Zuffetti, Francesco; Parenti, Andrea; Deflorian, Matteo; Fumagalli, Luca; Weinstein, Roberto L.; Maiorana, Carlo; Di Stefano, Danilo; Valentini, Pascal; Giannì, Aldo B.; Chiapasco, Matteo; Vinci, Raffaele; Pignataro, Lorenzo; Mantovani, Mario; Torretta, Sara; Pipolo, Carlotta; Felisati, Giovanni; Padoan, Giovanni; Castelnuovo, Paolo; Mattina, Roberto; Del Fabbro, Massimo
Introduction. Maxillary sinus surgery is a reliable and predictable treatment option for the prosthetic rehabilitation of the atrophic maxilla. Nevertheless, these interventions are not riskless of postoperative complications with respect to implant positioning in pristine bone. Aim. The aim of this paper is to report the results of a clinical consensus of experts (periodontists, implantologists, maxillofacial surgeons, ENT, and microbiology specialists) on several clinical questions and to give clinical recommendations on how to prevent, diagnose, and treat postoperative infections. Materials and Methods. A panel of experts in different fields of dentistry and medicine, after having reviewed the available literature on the topic and taking into account their long-standing clinical experience, gave their response to a series of clinical questions and reached a consensus. Results and Conclusion. The incidence of postop infections is relatively low (2%–5.6%). A multidisciplinary approach is advisable. A list of clinical recommendation are given. PMID:22927851
Wallenborn, Jan; Gelbrich, Götz; Bulst, Detlef; Behrends, Katrin; Wallenborn, Hasso; Rohrbach, Andrea; Krause, Uwe; Kühnast, Thomas; Wiegel, Martin; Olthoff, Derk
Objectives To determine whether 10 mg, 25 mg, or 50 mg metoclopramide combined with 8 mg dexamethasone, given intraoperatively, is more effective in preventing postoperative nausea and vomiting than 8 mg dexamethasone alone, and to assess benefit in relation to adverse drug reactions. Design Four-armed, parallel group, double blind, randomised controlled clinical trial. Setting Four clinics of a university hospital and four district hospitals in Germany. Participants 3140 patients who received balanced or regional anaesthesia during surgery. Main outcome measures Postoperative nausea and vomiting within 24 hours of surgery (primary end point); occurrence of adverse reactions. Results Cumulative incidences (95% confidence intervals) of postoperative nausea and vomiting were 23.1% (20.2% to 26.0%), 20.6% (17.8% to 23.4%), 17.2% (14.6% to 19.8%), and 14.5% (12.0% to 17.0%) for 0 mg, 10 mg, 25 mg, and 50 mg metoclopramide. In the secondary analysis, 25 mg and 50 mg metoclopramide were equally effective at preventing early nausea (0-12 hours), but only 50 mg reduced late nausea and vomiting (> 12 hours). The most frequent adverse drug reactions were hypotension and tachycardia, with cumulative incidences of 8.8% (6.8% to 10.8%), 11.2% (9.0% to 13.4%), 12.9% (10.5% to 15.3%), and 17.9% (15.2% to 20.6%) for 0 mg, 10 mg, 25 mg, and 50 mg metoclopramide. Conclusion The addition of 50 mg metoclopramide to 8 mg dexamethasone (given intraoperatively) is an effective, safe, and cheap way to prevent postoperative nausea and vomiting. A reduced dose of 25 mg metoclopramide intraoperatively, with additional postoperative prophylaxis in high risk patients, may be equally effective and cause fewer adverse drug reactions. Trial registration Current Controlled Trials ISRCTN31625370. PMID:16861255
Huang, Yu-Ling; Lin, Hui-Ling; Wang, Fang; Wu, Shu-Fang Vivienne
Pressure sores are a common complication caused by long periods of bed rest following major surgery. These sores may increase patient postoperative pain, increase the risk of infections, lengthen the pe-riod of hospitalization, and increase the duration and costs of nursing care. Therefore, maintaining the skin integrity of surgical patients is an important responsibility for operating room nurses and an indicator of nursing care quality. While pressure-sore risk assessment tools and interoperative strategies are available and used in foreign countries, there has been little related research conducted in Taiwan. After examining the relevant literature and considering the current postoperative pressure sore situation in Taiwan, the author developed a postoperative pressure sore care protocol as a reference for clinical staff. Protocol procedures include major breakthrough developments in areas such as post-survey risk assessment for pressure ulcers, pressure ulcer prevention strategies that take surgery-related risk factors into consideration, extra care and protection measures for surgical supine patients, and post-pressure sores. The developed postoperative pressure sore protocol may be incorporated into surgical care procedures during the post-surgical care period in order to effectively prevent the occurrence of post-surgery pressure ulcers. Furthermore, the developed protocol offers the potential to improve and strengthen the quality of surgical care in terms of both healthcare and post-surgical care. PMID:26645449
Sylvester, J.E.; Greenberg, P.; Selch, M.T.; Thomas, B.J.; Amstutz, H.
Formation of heterotopic bone (HTB) following total hip replacement may partially or completely ankylose the joint space, causing pain and/or limiting the range of motion. Patients at high risk for formation of HTB postoperatively include those with previous HTB formation, heterotopic osteoarthritis, and active rheumatoid spondylitis. Patients in these high risk groups have a 63-69% incidence of post-operative HTB formation, usually seen radiographically by 2 months post-operation. From 1980-1986 twenty-nine hips in 28 consecutively treated patients were irradiated post-operatively at the UCLA Center for the Health Sciences. The indication for irradiation was documented HTB formation previously in 26 of the 27 hips presented below. From 1980-1982 patients received 20 Gray (Gy) in 2 Gy fractions; from 1982-1986 the dose was reduced to 10 Gy in 2 Gy fractions. Twenty-seven hips in 26 patients completed therapy and were available for evaluation, with a minimum of 2 month follow-up, and a median follow-up of 12 months. Three of 27 hips developed significant HTB (Brooker grade III or IV) post-operatively, whereas 5 of 27 hips developed minor, nonsymptomatic HTB (Brooker grade I). When irradiation was begun by postoperative day 4, 0 of 17 hips formed significant HTB. If irradiation began after post-operative day 4, 3 of 10 hips formed significant HTB (Brooker grade III or IV). These 3 hips received doses of 10 Gy in one hip and 20 Gy in the other 2 hips. There were no differences in the incidence or severity of side effects in the 10 Gy vs. the 20 Gy treatment groups. Eighteen hips received 10 Gy, 8 hips 20 Gy and, 1 hip 12 Gy. In conclusion, 10 Gy in 5 fractions appears as effective as 20 Gy in 10 fractions at preventing post-operative formation of HTB. For optimal results, treatment should begin as early as possible prior to post-operative day 4.
Mortazavi, Vajihesadat; Fathi, Mohammadhossein; Soltani, Fereidon
Background: Bleaching the discoloured teeth may affect the tooth/composite interface. The aim of this in vitro experimental study was to evaluate the effect of vital tooth bleaching on microleakage of existent class V composite resin restorations bonded with three dental bonding agents. Methods: Class V cavities were prepared on buccal surfaces of 72 intact, extracted human anterior teeth with gingival margins in dentin and occlusal margins in enamel, and randomly divided into 3 groups. Cavities in the three groups were treated with Scotch bond Multi-Purpose, a total etch system and Prompt L-Pop and iBond, two self-etch adhesives. All teeth were restored with Z250 resin composite material and thermo-cycled. Each group was equally divided into the control and the bleached subgroups (n = 12). The bleached subgroups were bleached with 15% carbamide peroxide gel for 8 hours a day for 15 days. Microleakage scores were evaluated on the incisal and cervical walls. Data were analyzed using Kruskal-Wallis, Mann-Whitney and Bonferroni post-hoc tests (α = 0.05). Results: Bleaching with carbamide peroxide gel significantly increased the microleakage of composite restorations in Prompt L-Pop group at dentinal walls (P = 0.001). Bleaching had no effect on microleakage of restorations in the Scotch bond Multi-Purpose and iBond groups. Conclusion: Vital tooth bleaching with carbamide peroxide gel has an adverse effect on marginal seal of dentinal walls of existent composite resin restorations bonded with prompt L-Pop self-etch adhesive. PMID:22132010
Choi, Ki-Young; Kang, Sam-Suk; Kim, In-Young; Jung, Tae-Young; Jang, Woo-Yeol
Objective The endocrine dysfunction after the operation for suprasellar arachnoid cysts is not rare. The careful operation to prevent structures can prevent this complication, but it is not enough and effective to prevent it. Authors present technical surgical considerations to prevent this complication with a review of our suprasellar arachnoid cyst patients who had postoperative endocrine dysfunction. Methods From January 2002 to December 2009, eight patients who had suprasellar arachnoid cysts with visual impairment underwent surgery. The mean age was 57.1 years (range, 33-77). Preoperatively, their endocrine function was clinically normal, and laboratory hormonal levels were within normal ranges. Cyst fenestration was performed by craniotomy (n=6) or by a neuro-endoscopic procedure (n=2), and, simultaneously, along with a cyst wall biopsy. Results The surgery was uneventful in all eight patients, and there were no neurological morbidities. However, in four patients, endocrine dysfunction occurred postoperatively. We compared these four patients (group A) to the other 4 patients without endocrine dysfunction (group B) with intraoperative findings and with the histopathological findings of the cyst wall biopsy. The group A patients had more abundant vasculature on the cystic wall than the group B patients according to both the intraoperative findings and the histopathological findings. Conclusion When performing a surgical cyst wall fenestration, surgeons should try to minimize the destruction of the cystic wall vasculature and not to make the fenestration at a site that contains many vascular striae. PMID:21716897
... adhesions Ovarian cyst References Munireddy S, Kavalukas SL, Barbul A. Intra-abdominal healing: gastrointestinal tract and adhesions. Surg Clin N Am Kulaylat MN, Dayton, MT. Surgical complications. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, ...
Poehnert, D; Grethe, L; Maegel, L; Jonigk, D; Lippmann, T; Kaltenborn, A; Schrem, H; Klempnauer, J; Winny, M
Background: Abdominal operations are followed by adhesions, a prevalent cause of abdominal pain, and the most frequent cause for bowel obstruction and secondary female infertility. This rat study addresses adhesion prevention capability of Adept®, Interceed®, Seprafilm®, and a novel device, 4DryField® PH which is provided as powder and generates its effect as gel. Methods: Sixty-eight male Lewis rats had cecal abrasion and creation of an equally sized abdominal wall defect, and were grouped randomly: A control group without treatment (n=10); two groups treated with 4DryField® PH using premixed gel (n=15) or in-situ gel technique (n=16); one group each was treated with Seprafilm® (n=8), Interceed® (n=9), or Adept® (n=10). Sacrifice was on day 7 to evaluate incidence, quality, and quantity of adhesions, as expressed via adhesion reduction rate (AR). Histologic specimens were evaluated. Statistical analyses used ANOVA and unpaired t-tests. Results: 4DryField® PH significantly reduced incidence and severity of adhesions both as premixed gel (AR: 85.2%) and as in-situ made gel (AR: 100%), a comparison between these two application techniques showed no differences in efficacy. Seprafilm® did not reduce incidence but severity of adhesions significantly (AR: 53.5%). With Interceed® (AR: 3.7%) and Adept® (AR: 16.1%) no significant adhesion-reduction was achieved. Except for inflammatory response with Interceed®, histopathology showed good tissue compatibility of all other devices. Conclusion: 4DryField® PH and Seprafilm® showed significant adhesion prevention capabilities. 4DryField® PH achieved the highest adhesion prevention effectiveness without restrictions concerning mode of application and compatibility and, thus, is a promising strategy to prevent abdominal adhesions. PMID:27429589
Papadima, Artemisia; Gourgiotis, Stavros; Lagoudianakis, Emmanuel; Pappas, Apostolos; Seretis, Charalampos; Antonakis, Pantelis T.; Markogiannakis, Haridimos; Makri, Ira; Manouras, Andreas
Background: Postoperative nausea and vomiting (PONV) are frequently encountered after thyroidectomy. For PONV prevention, selective serotonin 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists are considered one of the first-line therapy. We report on the efficiency of granisetron and tropisetron, with that of placebo on the prevention of PONV in patients undergoing total thyroidectomy. Methods: One hundred twenty-seven patients were divided into three groups and randomized to receive intravenously, prior to induction of anesthesia, tropisetron 5 mg, or granisetron 3 mg, or normal saline. All patients received additionally 0.625 mg droperidol. All episodes of postoperative PONV during the first 24 h after surgery were evaluated. Results: Nausea visual analogue scale (VAS) score was lower in tropisetron and granisetron groups than the control group at all measurements (P<0.01) except for the 8-h measurement for tropisetron (P=0.075). Moreover, granisetron performed better than tropisetron (P<0.011 at 4 h and P<0.01 at all other points of time) apart from the 2-h measurement. Vomiting occurred in 22.2%, 27.5%, and 37.5% in granisetron, tropisetron, and control groups, respectively (P=0.43). Conclusions: The combination of the 5-HT3 antagonists with droperidol given before induction of anesthesia is well tolerated and superior to droperidol alone in preventing nausea but not vomiting after total thyroidectomy. PMID:23717236
Osipova, N A; Petrova, V V; Lastukhin, A V; Kudriavtsev, S B; Vashakmadze, L A; Khomiakov, V M
A procedure has been developed and tested to prevent and treat postoperative pain syndrome during extensive thoracoabdominal surgery for esophageal cancer. The procedure is based on the preventive (12 hours before anesthesia and surgery) application of Durogesic (fentanyl transdermal therapeutic system (TTS)) at an opioid release rate of 50 microg/h for 72 hours. By the end of surgery and anesthesia when intravenous injection of fentanyl is stopped, analgesia continues to be maintdined due to its therapeutic dose coming from TTS. This prevents the development of acute opioid tolerance, hyperalgesia, and destabilization state in the early postanesthetic period and creates the basis for continuous multimodal postoperative analgesia in combination with nonopioid components (lornoxicam, perfalgan) and with none or minimal need for the injectable opioid. This allows an operated patient to have a comfort and stable state. A further investigation on the comparative assessment of the developed procedure with other variants of perioperative systemic and combined anesthesia-analgesia is to be conducted. PMID:20734844
Lahsaei, Seyed M.; Amini, Afshin; Tabatabei, Seyed M. N.; Mehrabani, Golnoush
Background: Postoperative nausea and vomiting are some of the important and common side effects of anesthesia after surgery occurring in almost 20-30% of patients and is the second factor of a patient's complaint and inconvenience after pain. This study compares the effect of oral cetirizine and ondansetron in the prevention of postoperative nausea and vomiting in adults. Materials and Methods: In a blind and prospective study in fall 2010, 300 patients aged 18-65 years who were among ASA I-II in Chamran Orthopedic Hospital were randomly divided into three equal groups receiving cetirizine, ondansetron, and placebo, respectively. General anesthesia was identical. After operation (after 1-2 h in the recovery room, after 2-12 and 12-24 h in the ward), the presence or absence and any nausea or vomiting was recorded. Results: The postoperative nausea and vomiting (PONV) rate after 1-2 h in the recovery room, after 2-12 and 12-24 h in the ward in placebo, and both groups of cetirizine and ondansetron were 50%, 21%, and 11%, respectively while the difference was significant (P value < 0.05). Regarding the number of vomiting, the least was related to ondansetron (especially in the first 2-12 h) but the difference was not significant (P > 0.05). Conclusion: The PONV rate in cetirizine and ondansetron groups was less than the placebo group. PMID:23798943
Murayama, I; Sato, H; Suzuki, T; Ootsuka, Y; Song, K; Yamagata, M; Fukase, T; Iwai, S
To prevent stricture of an anastomotic site after operation of esophageal cancer, a new surgical technique, the "double-stapling method," was designed and applied clinically to 29 patients. According to the surgical technique, an automatic suture device for endoscopy was inserted from the side of the lesser curvature of the stomach to the esophageal side after performing end-side anastomosis between the esophagus and the stomach tube using a conventional circular anastomotic device to perform anastomosis between the anterior wall of the esophagus and the posterior wall of the stomach tube. As a result, a conventional anastomotic site, which was a plane (two dimensional), was transformed into a three-dimensional configuration. In the postoperative measurement of the anastomotic site using a measurement forceps, the inner diameter of the site was 8.6+/-3.1 mm in the circular group, while it was 17.2+/-4.5 mm in the DS group, showing a significant difference (p < 0.0001). Minor leakage was observed in three patients as a postoperative complication, but no postoperative hemorrhage occurred. PMID:9820722
... the office or may be done in the operating room. HSG and SHG are also useful screening tests for intrauterine adhesions. HSG is an x-ray procedure during which a dye that can be seen ... A special operating hysteroscope is used to cut the scar tissue. ...
Yepez, Juan B; de Yepez, Jazmin Cedeño; Arevalo, J Fernando
We describe a new surgical technique, intraoperative peripheral anterior capsulotomy (IPAC), to prevent early postoperative capsular block syndrome (CBS). Eighty consecutive patients (80 eyes) had phacoemulsification and intraocular lens implantation with IPAC in the presence of a small (4.5 to 5.0 mm) anterior continuous curvilinear capsulorhexis (CCC). Patients were followed for a mean of 16 months (range 6 to 24 months), and none developed CBS or other complications. Our series suggests that IPAC may be an alternative to prevent CBS in high-risk eyes, including those with a small anterior CCC or ophthalmic viscosurgical device material trapped in the capsular bag. This surgical technique is safe, effective, inexpensive, and easy to perform. PMID:15342044
Gómez-Arnau, J I; Aguilar, J L; Bovaira, P; Bustos, F; De Andrés, J; de la Pinta, J C; García-Fernández, J; López-Alvarez, S; López-Olaondo, L; Neira, F; Planas, A; Pueyo, J; Vila, P; Torres, L M
Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Española de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol. PMID:21033457
Naghshineh, Elham; Shiari, Samira; Jabalameli, Mitra
Background: Cesarean section is a major operation that can be the predictor of postoperative pain and discomfort and, therefore, providing the effective postoperative analgesia is an important factor to facilitate sooner movement of the patient, better care of infants. The aim of this study was to determine the preventive effect of ilioinguinal nerve block on pain after cesarean section. Materials and Methods: In a randomized clinical trial study, 80 female candidates for cesarean section under general anesthesia were selected and divided into two groups. In the first group, ilioinguinal nerve was blocked and in the control group, ilioinguinal nerve block was not done. Finally, postoperative pain was compared between the two groups. Results: The mean pain intensity at 6 and 24 h after operation had no significant difference between two groups but in the rest of the times, it was different between two groups. Furthermore, in sitting position, except for 6 h, the pain intensity at the rest of the time had a significant difference between two groups. The pain intensity in 12 h after operation had a significant difference while in 24 h after operation; there was no difference between two groups. Doing repeated measures, ANOVA also indicated that the process of changes in the pain intensity in three positions of rest, sitting and walking had no significant difference up to 24 h after operation (P < 0.001). Conclusion: Control of pain after cesarean as one of the most common factors for abdominal surgery will lead to decrease the staying of the patient in hospital, reduce morbidity and lower use of narcotics and analgesics after surgery. PMID:26623404
Mandal, Pragnadyuti; Das, Anjan; Majumdar, Saikat; Bhattacharyya, Tapas; Mitra, Tapobrata; Kundu, Ratul
Background: Post-operative nausea and vomiting (PONV) frequently hampers implementation of ambulatory surgery in spite of so many costly antiemetic drugs and regimens. Objective: The study was carried out to compare the efficacy of ginger (Zingiber officinale) added to Ondansetron in preventing PONV after ambulatory surgery. Materials and Methods: It was a prospective, double blinded, and randomized controlled study. From March 2008 to July 2010, 100 adult patients of either sex, aged 20-45, of ASA physical status I and II, scheduled for day care surgery, were randomly allocated into Group A[(n = 50) receiving (IV) Ondansetron (4 mg) and two capsules of placebo] and Group B[(n = 50) receiving IV Ondansetron (4 mg) and two capsules of ginger] simultaneously one hour prior to induction of general anaesthesia (GA) in a double-blind manner. One ginger capsule contains 0.5 gm of ginger powder. Episodes of PONV were noted at 0.5h, 1h, 2h, 4h, 6h, 12h and 18h post- operatively. Statistical Analysis and Results: Statistically significant difference between groups A and B (P < 0.05), was found showing that ginger ondansetron combination was superior to plain Ondansetron as antiemetic regimen for both regarding frequency and severity. Conclusion: Prophylactic administration of ginger and ondansetron significantly reduced the incidence of postoperative nausea and vomiting compared to ondansetron alone in patients undergoing day care surgery under general anaesthesia. PMID:24497743
Wang, Min; Yu, LiNa; Yan, M.
Background Dezocine is considered to be an alternative medication for managing postoperative pain. The aim of this study was to assess the efficacy and safety of this drug in this regard. Methods Medline, EMBASE and the Cochrane Central Register of Control Trials (CENTRAL) were searched to identify all randomized controlled trials (RCTs) that compare dezocine with placebo or dezocine with morphine on postoperative pain. The data were extracted and pooled using Mantel-Haenszel random effects model. Heterogeneity was tested using the I2 statistic with values >50% and Chi2 test with P ≤ 0.05 indicating obvious heterogeneity between the studies. Results Seven trials evaluating 665 patients were included. The number of patients with at least 50% pain relief was increased (N = 234; RR 3.04, 95% CI 2.27 to 4.08) and physician (N = 465; RR 2.84, 95% CI 1.66 to 4.84) and patient satisfaction (N = 390; RR 2.81, 95% CI 1.85 to 4.26) were improved following the administration of dezocine compared with the placebo. The effects of dezocine were similar to those of morphine in terms of the number of patients reporting at least 50% pain relief within 2–6 h after surgery (N = 235; RR 1.29, 95% CI 1.15 to 1.46) and physician (N = 234; RR 1.18, 95% CI 0.93 to 1.49) and patient (N = 158; RR 1.33, 95% CI 0.93 to 1.92) satisfaction. While, the number of patients with at least 50% pain relief within 0–1 h after surgery increased following dezocine compared with morphine treatment (N = 79; RR 1.45, 95% CI 1.18 to 1.77). There was no difference in the incidence of postoperative nausea and vomiting (PONV) following dezocine treatment compared with the placebo (N = 391; RR 1.06, 95% CI 0.42 to 2.68) or morphine treatment (N = 235; RR 0.65, 95% CI 0.14 to 2.93). Conclusion Dezocine is a promising analgesic for preventing postoperative pain, but further studies are required to evaluate its safety. PMID:26287536
Nikeghbalian, Saman; Vafaei, Homeira; Moradian, Farid; Kazemi, Kourosh; Tanideh, Nader; Shayan, Leila; Nikeghbalian, Zahra
Objectives: To investigate the effects of intravenous infliximab in preventing the formation of peritoneal adhesions in an animal model of rat. Methods: This was an experimental study being performed in animal laboratory of Shiraz University of Medical Sciences during 2012. Sixty albino rats were randomly assigned in to three groups by Random Design Method. The first group received single infliximab injection (n=20), the second one received double infliximab injection (n=20) and the third received nothing (n=20), after receiving intra-peritoneal injection of talc for induction of peritoneal adhesions. All the animals were sacrificed after 6 weeks and the peritoneal adhesions were evaluated according to Nair classification. Results: We observed that the mean adhesion grade was lower in those who received double dose of infliximib when compared to single dose and controls. However the difference did not reach a significant value (p=0.178). The grade of peritoneal adhesion was also comparable between the three study groups (p=0.103). The mean number of 1st WBC count was also comparable between three study groups (p=0.382). We observed that 2nd WBC count was also comparable between two study groups (p=0.317). Conclusion: Administration of intravenous infliximab after intraabdominal surgicalprocedures would not prevent the formation of peritoneal adhesions in animal model of albino rat. PMID:27162911
Chen, Shih-Hsien; Chen, Chih-Hao; Fong, Yi Teng; Chen, Jyh-Ping
As one of the common complications after tendon injury and subsequent surgery, peritendinous adhesions could be minimized by directly placing a physical barrier between the injured site and the surrounding tissue. With the aim of solving the shortcomings of current biodegradable anti-adhesion barrier membranes, we propose the use of an electrospun chitosan-grafted polycaprolactone (PCL-g-CS) nanofibrous membrane (NFM) to prevent peritendinous adhesions. After introducing carboxyl groups on the surface by oxygen plasma treatment, the polycaprolactone (PCL) NFM was covalently grafted with chitosan (CS) molecules, with carbodiimide as the coupling agent. Compared with PCL NFM, PCL-g-CS NFM showed a similar fiber diameter, permeation coefficient for bovine serum albumin, ultimate tensile strain, reduced pore diameter, lower water contact angle, increased water sorption and tensile strength. With its submicrometer pore diameter (0.6-0.9μm), both NFMs could allow the diffusion of nutrients and waste while blocking fibroblast penetration to prevent adhesion formation after tendon surgery. Cell culture experiments verified that PCL-g-CS NFM can reduce fibroblast attachment while maintaining the biocompatibility of PCL NFM, implicating a synergistic anti-adhesion effect to raise the anti-adhesion efficacy. In vivo studies with a rabbit flexor digitorum profundus tendon surgery model confirmed that PCL-g-CS NFM effectively reduced peritendinous adhesion from gross observation, histology, joint flexion angle, gliding excursion and biomechanical evaluation. An injured tendon wrapped with PCL-g-CS NFM showed the same tensile strength as the naturally healed tendon, indicating that the anti-adhesion NFM will not compromise tendon healing. PMID:25192729
Angelidi, Maria; Pandazi, Aggeliki; Tzirogiannis, Konstantinos N.; Panoutsopoulos, Georgios I.; Kostopanagiotou, Georgia
Introduction Laparoscopic cholecystectomy is associated with a high incidence of postoperative nausea and vomiting. In this study we investigated comparatively the efficacy of combination therapy with ondansetron plus droperidol versus monotherapy with each agent alone in preventing postoperative nausea and vomiting following elective laparoscopic cholecystectomy. Material and methods One hundred twenty-seven patients who underwent elective laparoscopic cholecystectomy under general anesthesia were included in the study, and assigned to one of the following three groups according to the antiemetic drug given intravenously at the end of the surgery: droperidol 1.25 mg in group D, ondansetron 4 mg in group O, and a combination of droperidol and ondansetron at the doses mentioned above in group D + O. Incidence of postoperative nausea and vomiting, and doses of given rescue antiemetics were recorded during the first postoperative day. The total drug cost per patient spent for postoperative nausea and vomiting management (including prophylactic antiemetics plus rescue postoperative antiemetics) was calculated. Results Combination therapy significantly reduced postoperative nausea and vomiting at 30 min, 3 h and 6 h after surgery compared with group D (p < 0.01 for all time points) and O (p < 0.01 at 30 min, p < 0.05 at 3 h) and required less rescue antiemetic treatment (p < 0.01). Total antiemetic cost analyses revealed no significant differences among the three groups (p > 0.05). Conclusions Pretreatment with ondansetron plus droperidol is more effective than monotherapy in preventing postoperative nausea and vomiting following laparoscopic cholecystectomy, without increasing the cost comparatively. PMID:25995753
Hadani, M; Ram, Z; Horowitz, A; Shacked, I
An experimental study was designed to test the efficacy of a silicon barrier around a nerve root in order to prevent post operative epidural root scar adhesions. In 32 Sprague-Dawley rats a lumbar nerve root was microsurgically exposed bilaterally. In 16 animals a silicon tube, prepared with a longitudinal cut along half of its wall, was placed around one nerve root, while the contralateral side served as control. In another group of 12 animals, an autologous subcutaneous fat graft was placed on the exposed root. A group of 4 animals served as the control group which had not been operated upon. No post operative neurological deficit was observed in any of the animals. All animals were sacrificed 60 days after the operation and a block of tissue including the nerve roots were resected bilaterally without removal of the silicon or fat graft. Longitudinal and transverse cuts of the roots were stained with Haematoxilin and Eosin and with Masson's trichrome collagen stain. The roots in the "unoperated" control group were clean of any scar tissue. In 13 out of 16 animals, silicon prevented scar formation around the root as opposed to scar adhesions around control root on the contralateral side and as compared to unoperated roots. In the silicon group, adhesions penetrated only through the longitudinal narrow cut edge of the tube. Fat did not prevent adhesions in 11 out of 12 animals. We conclude that a silicon barrier is an effective method preventing post operative epidural root scarring in rats. PMID:8237494
Kang, Hyun; Chung, Yoon Sang; Kim, Sang Wook; Choi, Geun Joo; Kim, Beom Gyu; Park, Suk Won; Seok, Ju Won; Hong, Joonhwa
Objective We investigated the mobility of a temperature-sensitive poloxamer/Alginate/CaCl2 mixture (PACM) in relation to gravity and cardiac motion and the efficacy of PACM on the prevention of pericardial adhesion in a supine rabbit model. Methods A total of 50 rabbits were randomly divided into two groups according to materials applied after epicardial abrasion: PACM and dye mixture (group PD; n = 25) and saline as the control group (group CO; n = 25). In group PD, rabbits were maintained in a supine position with appropriate sedation, and location of mixture of PACM and dye was assessed by CT scan at the immediate postoperative period and 12 hours after surgery. The grade of adhesions was evaluated macroscopically and microscopically two weeks after surgery. Results In group PD, enhancement was localized in the anterior pericardial space, where PACM and dye mixture was applied, on immediate post-surgical CT scans. However, the volume of the enhancement was significantly decreased at the anterior pericardial space 12 hours later (P < .001). Two weeks after surgery, group PD had significantly lower macroscopic adhesion score (P = .002) and fibrosis score (P = .018) than did group CO. Inflammation score and expression of anti-macrophage antibody in group PD were lower than those in group CO, although the differences were not significant. Conclusions In a supine rabbit model study, the anti-adhesion effect was maintained at the area of PACM application, although PACM shifted with gravity and heart motion. For more potent pericardial adhesion prevention, further research and development on the maintenance of anti-adhesion material position are required. PMID:26580394
Antor, María A.; Uribe, Alberto A.; Erminy-Falcon, Natali; Werner, Joseph G.; Candiotti, Keith A.; Pergolizzi, Joseph V.; Bergese, Sergio D.
Postoperative nausea and vomiting (PONV) is one of the most common and undesirable complaints recorded in as many as 70–80% of high-risk surgical patients. The current prophylactic therapy recommendations for PONV management stated in the Society of Ambulatory Anesthesia (SAMBA) guidelines should start with monotherapy and patients at moderate to high risk, a combination of antiemetic medication should be considered. Consequently, if rescue medication is required, the antiemetic drug chosen should be from a different therapeutic class and administration mode than the drug used for prophylaxis. The guidelines restrict the use of dexamethasone, transdermal scopolamine, aprepitant, and palonosetron as rescue medication 6 h after surgery. In an effort to find a safer and reliable therapy for PONV, new drugs with antiemetic properties and minimal side effects are needed, and scopolamine may be considered an effective alternative. Scopolamine is a belladonna alkaloid, α-(hydroxymethyl) benzene acetic acid 9-methyl-3-oxa-9-azatricyclo non-7-yl ester, acting as a non-selective muscarinic antagonist and producing both peripheral antimuscarinic and central sedative, antiemetic, and amnestic effects. The empirical formula is C17H21NO4 and its structural formula is a tertiary amine L-(2)-scopolamine (tropic acid ester with scopine; MW = 303.4). Scopolamine became the first drug commercially available as a transdermal therapeutic system used for extended continuous drug delivery during 72 h. Clinical trials with transdermal scopolamine have consistently demonstrated its safety and efficacy in PONV. Thus, scopolamine is a promising candidate for the management of PONV in adults as a first line monotherapy or in combination with other drugs. In addition, transdermal scopolamine might be helpful in preventing postoperative discharge nausea and vomiting owing to its long-lasting clinical effects. PMID:24782768
Luu, Hoan-My Do; Chen, Angela; Isayeva, Irada S
The Intergel® ferric crosslinked hyaluronate (FeHA) adhesion prevention solution (APS) (FDA) is associated with serious post-operative complications (Henley, http://www.lawyersandsettlements.com/features/gynecare-intergel/intergel-timeline.html, 2007; FDA, 2003; Roman et al., Fertil Steril 2005, 83 Suppl 1:1113-1118; Tang et al., Ann Surg 2006;243(4):449-455; Wiseman, Fertil Steril 2006;86(3):771; Wiseman, Fertil Steril 2006;85(4):e7). This prompted us to examine the in situ stability of crosslinked HA materials to hyaluronidase lyase degradation. Variables such as ferric ionic crosslink density, HA concentration, gel geometry, and molecular weight (MW) of HA polymer were studied. Various formulations of the crosslinked "in house" [Isayeva et al., J Biomed Mater Res: Part B - Appl Biomater 2010, 95B (1):9-18] FeHA (0.5%, w/v; 30, 50, 90% crosslinked), the Intergel® FeHA (0.5%, w/v; 90%), and the non-crosslinked HA (0.05-0.5%, w/v) were degraded at a fixed activity of hyaluronidase lyase from Streptomyces hyalurolyticus (Hyase) at 37°C over time according to the method [Payan et al., J Chrom B: Biomed Sci Appl 1991;566(1):9-18]. Under our conditions, the data show that the crosslink density affects degradation the most, followed by HA concentration and then gel geometry. We found that MW has no effect. Our results are one possible explanation of the observations that the Intergel® FeHA APS (0.5%, w/v; 90%) material persisted an order of magnitude longer than expected [t1/2 = 500 hrs vs. t1/2 = 50 hrs (FDA; Johns et al., Fertil Steril 1997;68(1):37-42)]. These data also demonstrate the sensitivity of the in vitro hyaluronidase assay to predict the in situ stability of crosslinked HA medical products as previously reported [Sall et al., Polym Degrad Stabil 2007;92(5):915-919]. PMID:23559362
Kim, Jin Hak; Chang, Byung Kwon; Lee, Jae Il
Background Epidural hematoma is a rare but serious complication. According to previous studies, it is not prevented by suction drains. This study evaluated the following alternative hypothesis: the larger the diameter of a suction drain, the less the remaining epidural hematoma after spinal surgery. Methods This was a randomized prospective study. Patients who underwent posterior lumbar decompression and instrumented fusion were divided into two groups: the large drain (LD, 2.8-mm-diameter tube) and small drain (SD, 1.6-mm-diameter tube) groups according to the diameter of the suction drains. All patients were consecutive and allocated alternately according to the date of operations. Suction drains were removed on day 3 and magnetic resonance imaging was performed on day 7 postoperatively. The size of remaining hematomas was measured by the degree of thecal sac compression in cross section using the following 4-point numeric scale: G1, less than one quarter; G2, between one quarter and half; G3, more than half; and G4, more than subtotal obstruction. Results There were 39 patients with LDs and 38 with SDs. They did not differ significantly in terms of sex, number of fusion segments, revision or not, antiplatelet medication, intraoperative injection of tranexamic acid. However, patient age differed significantly between the two groups (LD, 63.3 years and < SD, 68.6 years; p = 0.007). The two groups did not differ significantly in terms of prothrombin time, activated partial thromboplastin time, platelet number, blood loss, or operation duration. However, platelet function analysis exhibited a significant difference (LD, 164.7 seconds and < SD, 222.3 seconds; p = 0.002). The two blinded readers showed high consistency (Kappa value = 0.740; p = 0.000). The results of reader 1 were as follows: LD and SD had 21 and 21 cases of G1, 9 and 11 cases of G2, 6 and 6 cases of G3, and 3 and 0 cases of G4, respectively. The results of reader 2 were as follows: LD and SD had 22
Martínez-Gómez, Aránzazu; Alvarez, Cristina; de Abajo, Javier; del Campo, Adolfo; Cortajarena, Aitziber L; Rodriguez-Hernandez, Juan
Preventing microbial adhesion onto membranes is a crucial issue that determines the durability of the membrane. In this Research Article, we prepared aromatic polyimides (extensively employed for the elaboration of ultrafiltration membranes) containing PEO branches. Four polyimide-g-PEO copolymers were prepared from 6F dianhydride and a novel aromatic diamine containing PEO-550 side groups. The copolymers were designed to have variable PEO content, and were characterized by their spectroscopic and physical properties. The Breath Figure technique was successfully applied to create an ordered surface topography, where the PEO chains were preferentially located on the surface of the micrometer size holes. These unique features were explored to reduce bacterial adhesion. It was established that surface modified polyimide membranes have a high resistance to biofouling against Staphylococcus aureus. In particular, we observed that an increase of the PEO the content in the copolymer produced a decrease in the bacterial adhesion. PMID:25909661
Andrievskikh, I A; Omel'ianiuk, M Iu
The authors studied peculiarities of the immune status in angiosurgical patients with systemic vasculitis, as well as possibilities of immunodiagnosis and immunocorrection in prevention of early coagulopathic and reparative complications after angiosurgical interventions in this cohort of patients. A total of 172 angiosurgical patients presenting with systemic vasculitis were subdivided into two groups depending on the preoperative preparation methods used. In Group One (Study Group) comprising 81 patients preoperative preparation was carried out using immunosuppressive therapy with hormones and cytostatics according to the rheumatologist's indications. In Group Two (n=91) hormones and/or cytostatics were replaced by the proposed four-component immunocorrection including various combinations of correcting the lifestyle, use of antioxidative-activity immunomodulators, plasmapheresis and intravenous administration of immunoglobulins. It was determined that using this method of correction made it possible to achieve a good anti-inflammatory effect in angiosurgical patients with systemic vasculitis, thus avoiding negative aftermaths of immunosuppression. The developed method of immunocorrection makes it possible to decrease the rate of early postoperative coagulopathic and reparative complications in angiosurgical patients as compared to therapy with hormones and/or cytostatics. PMID:26673291
Several studies demonstrated acute inflammatory response following traumatic injury. Inflammatory response during surgical interventions was verified by a significant increase of endotoxin plasma levels and a decrease of the endotoxin neutralizing capacity (ENC). However, the incidence of elevated endotoxin levels was significantly higher (89%) than detected bacterial translocation (35%). Thus parts or products of Gram-negative bacteria seem to translocate more easily into the blood circulation than whole bacteria. Along with the bacterial translocation, the inflammatory response correlated directly with the severity of the surgical intervention. In comparison after major and minor surgery Interleukin-6 (IL-6) and C-reactive protein (CRP) was also significantly different. Similar effects in mediator release were shown during endovascular stent graft placement and open surgery in infrarenal aortic aneurysm. Open surgery demonstrated a significant stronger endotoxin translocation and a decrease of ENC. Strategies to prevent translocation seem to be sensible. Colostrum is the first milk produced by the mammary glands within the first days after birth. It contains a complex system of immune factors and has a long history of use in traditional medicine. Placebo-controlled studies verified that prophylactic oral application of immunoglobulin-enriched colostrum milk preparation diminishes perioperative endotoxemia, prevents reduction of ENC and reduces postoperative CRP-levels, suggesting a stabilization of the gut barrier. This effect may be caused by immunoglobulin transportation by the neonatal receptor FcRn of the mucosal epithelium. In conclusion, there is an association of perioperative endotoxemia and the subsequent increase in mediators of the acute phase reaction in surgical patients. A prophylactic oral application of colostrum milk is likely to stabilize the gut barrier i.e. reduces the influx of lipopolysaccharides arising from Gram-negative bacterial
Orth, Klaus; Knoefel, Wolfram Trudo; van Griensven, Martijn; Matuschek, Christiane; Peiper, Matthias; Schrumpf, Holger; Gerber, Peter Arne; Budach, Wilfried; Bölke, Edwin; Buhren, Bettina Alexandra; Schauer, Matthias
Several studies demonstrated acute inflammatory response following traumatic injury. Inflammatory response during surgical interventions was verified by a significant increase of endotoxin plasma levels and a decrease of the endotoxin neutralizing capacity (ENC). However, the incidence of elevated endotoxin levels was significantly higher (89%) than detected bacterial translocation (35%). Thus parts or products of Gram-negative bacteria seem to translocate more easily into the blood circulation than whole bacteria. Along with the bacterial translocation, the inflammatory response correlated directly with the severity of the surgical intervention. In comparison after major and minor surgery Interleukin-6 (IL-6) and C-reactive protein (CRP) was also significantly different. Similar effects in mediator release were shown during endovascular stent graft placement and open surgery in infrarenal aortic aneurysm. Open surgery demonstrated a significant stronger endotoxin translocation and a decrease of ENC. Strategies to prevent translocation seem to be sensible. Colostrum is the first milk produced by the mammary glands within the first days after birth. It contains a complex system of immune factors and has a long history of use in traditional medicine. Placebo-controlled studies verified that prophylactic oral application of immunoglobulin-enriched colostrum milk preparation diminishes perioperative endotoxemia, prevents reduction of ENC and reduces postoperative CRP-levels, suggesting a stabilization of the gut barrier. This effect may be caused by immunoglobulin transportation by the neonatal receptor FcRn of the mucosal epithelium.In conclusion, there is an association of perioperative endotoxemia and the subsequent increase in mediators of the acute phase reaction in surgical patients. A prophylactic oral application of colostrum milk is likely to stabilize the gut barrier i.e. reduces the influx of lipopolysaccharides arising from Gram-negative bacterial pathogens
Zhang, Ning; Melo, Mary A. S.; Chen, Chen; Liu, Jason; Weir, Michael D.; Bai, Yuxing; Xu, Hockin H. K.
Objectives The objectives of this study were to: (1) develop a novel adhesive for prevention of tooth root caries and secondary caries by possessing a combination of protein-repellent, antibacterial, and remineralization capabilities for the first time; and (2) investigate the effects of 2-methacryloyloxyethyl phosphorylcholine (MPC), dimethylaminohexadecyl methacrylate (DMAHDM), and nanoparticles of amorphous calcium phosphate (NACP) on dentine bond strength, protein-repellent properties, and dental plaque microcosm biofilm response. Methods MPC, DMAHDM and NACP were added into Scotchbond Multi-Purpose primer and adhesive. Dentine shear bond strengths were measured. Adhesive coating thickness, surface texture and dentine-adhesive interfacial structure were examined. Protein adsorption onto adhesive resin surface was determined by the micro bicinchoninic acid method. A human saliva microcosm biofilm model was used to investigate biofilm metabolic activity, colony-forming unit (CFU) counts, and lactic acid production. Results The resin with 7.5% MPC + 5% DMAHDM + 30% NACP did not adversely affect dentine shear bond strength (p > 0.1). The resin with 7.5% MPC + 5% DMAHDM + 30% NACP produced a coating on root dentine with a thickness of approximately 70 μm and completely sealed all the dentinal tubules. The resin with 7.5% MPC + 5% DMAHDM + 30% NACP had 95% reduction in protein adsorption, compared to SBMP control (p < 0.05). The resin with 7.5% MPC + 5% DMAHDM + 30% NACP was strongly antibacterial, with biofilm CFU being four orders of magnitude lower than that of SBMP control. Significance The novel multifunctional adhesive with strong protein-repellent, antibacterial and remineralization properties is promising to coat tooth roots to prevent root caries and secondary caries. The combined use of MPC, DMAHDM and NACP may have wide applicability to bonding agents, cements, sealants and composites to inhibit caries. PMID:26187532
Tian, Fuming; Dou, Changwu; Qi, Songtao; Zhao, Liqun; Chen, Bo; Yan, Haicheng; Zhang, Li
Objective: This study aims to explore the preventive effect of dexamethasone gelatin sponge on the lumbosacral epidural adhesion in the laminectomy. Methods: A total of 36 Wista rats were divided into A, B, C and D groups randomly. Dexamethasone was not used in group A, Dexamethasone was used in group B, Dexamethasone was not used in group C but covered with gelatin sponge, dexamethasone gelatin sponge was used in group D. 3 rats in each group were sacrificed at 4, 8 and 12 weeks after operation respectively and the wound was opened to observe the dural scar formation and the dura adhesion. Immunohistochemical technique was used for histology observation. The expressions of VEGF and VEGFR2 in the epidural scar and surrounding tissues were detected with western blotting and immunohistochemical methods. Results: According to the Rydell score standard, there were different degree of adhesion formation in A, B and C groups while there was no obvious adhesion formation in D group. It was confirmed that the expressions of VEGF and VEGFR2 in group D were lower than that of the other groups. Conclusions: Dexamethasone gelatin sponge could significantly reduce the occurrence of epidural scar tissue hyperplasia and adhesion after laminectomy in rats, and its mechanism may be related to the decreased expression of VEGF and VEGFR2. PMID:26131126
Liang, Yuan; Sun, Yu; Li, Xiaolei; Yan, Lianqi; Wang, Jingcheng; Hu, Jinlong; Yu, Huan; Xiao, Haixiang; Chen, Hui; Sun, Zhongwei; Cai, Jun; Feng, Xinmin; Xiong, Chuanzhi; He, Jinshan
10-Hydroxycamptothecin could reduce intraarticular adhesion by inhibiting fibroblasts proliferation after knee surgery. However, the ideal concentration of hydroxycamptothecin have not been defined. This study was tried to verify the optimal concentration of 10-hydroxycamptothecin in preventing knee intraarticular adhesion. Sixty rabbits were randomly divided into five groups. Approximately 10 mm × 10 mm of the cortical bone was removed from both sides of the femoral condyle and the underneath cancellous bone was exposed. Various concentrations of hydroxycamptothecin (0.1 mg/ml, 0.5 mg/ml, 1.0 mg/ml, 2.0 mg/ml) or saline were applied to the decorticated areas for 10 minutes. After four weeks, the degree of inraarticular adhesion was assessed by macroscopic evaluation, biochemical analysis of hydroxyproline content and histological evaluation. The results demonstrated that the extent of knee inraarticular adhesion in 1.0 mg/ml group and 2.0 mg/ml hydroxycamptothecin group were significantly lower than those of 0.5 mg/ml group, 0.1 mg/ml hydroxycamptothecin group and control group. Moreover, there was no significant difference between 1.0 mg/ml group and 2.0 mg/ml hydroxycamptothecin group. In conclusion, topical application of 1.0 mg/ml hydroxycamptothecin may be the optimal concentration in reducing intraarticular adhesion after knee surgery in rabbits. PMID:24714729
Blount, L.H.; Thomas, B.J.; Tran, L.; Selch, M.T.; Sylvester, J.E.; Parker, R.G. )
Ninety-seven high risk hips were irradiated postoperatively for prevention of heterotopic bone (HTB) in the UCLA Department of Radiation Oncology from 1980 to 1988. Ninety-two hips in 82 patients were eligible for analysis with a minimum follow-up of 2 months and a median follow-up of 10 months. Forty-nine of the hips had porous coated ingrowth prostheses. From 1980 to 1986, 2 Gy fractions were used to deliver 20 Gy (8 hips), 12 Gy (1 hip), and 10 Gy (27 hips). Since December of 1986, 38 hips received 8 Gy in two increments and 18 hips received a single 7 Gy fraction. All porous ingrowth components were shielded with custom blocks. Six out of 92 hips developed clinically significant. There was one clinically significant failure in 78 hips (1.3%) when irradiation was initiated before post-operative day (POD) No.6 and shielding was properly placed. One clinical failure occurred in 38 hips which received 8 Gy in two increments. One clinical failure occurred out of the 18 hips treated with 7 Gy in one fraction. This failure could be related to block malposition. There were four clinical failures in the 36 hips treated with 2 Gy fractions to total doses of 10 Gy, 12 Gy, or 20 Gy. Three of these failures were associated with initiation of treatment after POD No.5, and the fourth was related to block malposition. Unshielded trochanteric osteotomies resulted in five migrations and seven fibrous unions for a total non-osseous union rate of 12/36 (33%). Shielding of the remaining 28 trochanteric osteotomies resulted in a non-osseous union rate of 7%. There were no failures of union of components, and the only side effects noted in the series were the five trochanteric migrations. In conclusion, the use of 8 Gy in two increments or 7 Gy in one fraction was found to be as efficacious as conventional 2 Gy fractionation schemes with no increase in side effects.
Ji, Gyu Yeul; Oh, Chang Hyun; Moon, Byung Gwan; Yi, Seong; Han, In Bo; Heo, Dong Hwa; Kim, Ki-Tack; Kim, Keung Nyun
Objective Epidural injection of hyaluronic acid may prevent adhesion formation after spine surgery, but the compounds used to stabilize hyaluronidase could interfere with its anti-adhesion effects. The present study was conducted as a clinical trial to evaluate the efficacy and safety of an experimental medical gel in preventing adhesion formation. Methods This study was designed as a multicenter, randomized, double-blind, and comparative controlled clinical trial with an observation period of 6 weeks. Subjects were randomly assigned into two groups: group A with sodium hyaluronate + 1,4-butanediol diglycidyl ether (BDDE) and group B with sodium hyaluronate + sodium carboxymethylcellulose (CMC). Visual analogue scale (VAS) of back and leg pain and the Oswestry disability index (ODI) and scar score ratings were assessed after surgery. Results Mean scar grade was 2.37±1.13 in group A and 2.75±0.97 in group B, a statistically significant difference (p=0.012). VAS of back and leg pain and ODI scores decreased significantly from baseline to 3 and 6 weeks postoperatively in both groups (p<0.001). However, VAS and ODI scores were not statistically different between groups A and B at baseline or at 3 and 6 weeks after operation (p>0.3). The number of adverse reactions related to the anti-adhesion gels was not statistically different (p=0.569), but subsequent analysis of nervous adverse reactions showed group B was superior with a statistically difference (p=0.027). Conclusion Sodium hyaluronate with BDDE demonstrated similar anti-adhesion properties to sodium hyaluronate with CMC. But, care should be used to nervous adverse reactions by using sodium hyaluronate with BDDE. PMID:26217381
Kang, Shin-Ae; Hasan, Nafis; Mann, Aman P; Zheng, Wei; Zhao, Lichao; Morris, Lynsie; Zhu, Weizhu; Zhao, Yan D; Suh, K Stephen; Dooley, William C; Volk, David; Gorenstein, David G; Cristofanilli, Massimo; Rui, Hallgeir; Tanaka, Takemi
Shear-resistant adhesion and extravasation of disseminated cancer cells at the target organ is a crucial step in hematogenous metastasis. We found that the vascular adhesion molecule E-selectin preferentially promoted the shear-resistant adhesion and transendothelial migration of the estrogen receptor (ER)–/CD44+ hormone-independent breast cancer cells, but not of the ER+/CD44-/low hormone-dependent breast cancer cells. Coincidentally, CD44+ breast cancer cells were abundant in metastatic lung and brain lesions in ER– breast cancer, suggesting that E-selectin supports hematogenous metastasis of ER–/CD44+ breast cancer. In an attempt to prevent hematogenous metastasis through the inhibition of a shear-resistant adhesion of CD44+ cancer cells to E-selectin-expressing blood vessels on the premetastatic niche, an E-selectin targeted aptamer (ESTA) was developed. We demonstrated that a single intravenous injection of ESTA reduced metastases to a baseline level in both syngeneic and xenogeneic forced breast cancer metastasis models without relocating the site of metastasis. The effect of ESTA was absent in E-selectin knockout mice, suggesting that E-selectin is a molecular target of ESTA. Our data highlight the potential application of an E-selectin antagonist for the prevention of hematogenous metastasis of ER–/CD44+ breast cancer. PMID:25815697
Viani, Gustavo A. Stefano, Eduardo J.; Afonso, Sergio L.; De Fendi, Ligia I.
Purpose: The aim of this study was to evaluate the results of keloidectomy and strontium 90 brachytherapy in the prevention of keloid recurrence following excision and to identify outcome and the prognostic factors that predict keloid recurrence after irradiation. Methods and Materials: Data of 612 patients with 892 keloids treated between 1992 and 2006 were evaluated retrospectively. Brachytherapy was performed using a Sr-90Y surface applicator. Total dose was 20 Gy in 10 fractions. Results: With a median follow-up of 61 months, the overall recurrence-free response rate for all keloids was 87.6%. Multivariate analysis revealed the following prognostic factors for recurrence: keloid size > 5 cm (p < 0.0001), burn scars as the keloid etiology (p < 0.0001), and previous treatment (p < 0.0001). Outcome was not found to be significantly related to the interval between surgery and radiotherapy, sex, or age. Pruritus and skin reddening were the most common symptoms of keloids, but all signs and symptoms abated with time after treatment. Cosmetic results from the keloid treatment were considered good or excellent in 70.6% of the patients. Conclusion: Our study findings show that excision plus Sr-90 brachytherapy is effective in the eradication of keloids. Sr-90 radiotherapy (20 Gy in 10 fractions) achieved a similar local control rate, as have higher doses per fraction in other series. It also resulted in a good cosmetic rate and relief of symptoms. Our data further suggest that the initiation of postoperative irradiation within hours of surgical excision is not important to therapeutic outcome.
Jiang, Shichao; Yan, Hede; Fan, Dapeng; Song, Jialin; Fan, Cunyi
Defect of the tendon sheath after tendon injury is a main reason for tendon adhesions, but it is a daunting challenge for the biomimetic substitute of the tendon sheath after injury due to its multi-layer membrane-like structure and complex biologic functions. In this study, a multi-layer membrane with celecoxib-loaded poly(l-lactic acid)-polyethylene glycol (PELA) electrospun fibrous membrane as the outer layer, hyaluronic acid (HA) gel as middle layer, and PELA electrospun fibrous membrane as the inner layer was designed. The anti-adhesion efficacy of this multi-layer membrane was compared with a single-layer use in rabbit flexor digitorum profundus tendon model. The surface morphology showed that both PELA fibers and celecoxib-loaded PELA fibers in multi-layer membrane were uniform in size, randomly arrayed, very porous, and smooth without beads. Multi-layer membrane group had fewer peritendinous adhesions and better gliding than the PELA membrane group and control group in gross and histological observation. The similar mechanical characteristic and collagen expression of tendon repair site in the three groups indicated that the multi-layer membrane did not impair tendon healing. Taken together, our results demonstrated that such a biomimetic multi-layer sheath could be used as a potential strategy in clinics for promoting tendon gliding and preventing adhesion without poor tendon healing. PMID:25822877
Roubickova, A; Dudek, M; Comba, L; Housova, D; Bradna, P
The aim of this study was to determine the effect of peroxide bleaching on the marginal seal of composite restorations bonded with several adhesive systems. Combined cylindrical Class V cavities located half in enamel and half in dentin were prepared on the buccal and lingual surfaces of human molars. The cavities were bonded with the self-etch adhesives Clearfil SE-Bond (CLF), Adper Prompt (ADP), and iBond (IBO) and an etch-and-rinse adhesive Gluma Comfort Bond (GLU) and restored with a microhybrid composite Charisma. Experimental groups were treated 25 times for eight hours per day with a peroxide bleaching gel Opalescence PF 20, while the control groups were stored in distilled water for two months and then subjected to a microleakage test using a dye penetration method. Scanning electron microscopy was used to investigate the etching and penetration abilities of the adhesives and morphology of debonded restoration-enamel interfaces after the microleakage tests. Statistical analyses were performed using nonparametric Kruskal-Wallis, Mann-Whitney, and Wilcoxon tests at p=0.05. The microleakage of all GLU groups was low and not significantly affected by peroxide bleaching. Low microleakage was recorded for CLF control groups, but after bleaching, a small but significant increase in microleakage at the enamel margin indicated its sensitivity to peroxide bleaching. For ADP and IBO control groups, the microleakage at the enamel margins was significantly higher than for GLU and CLF and exceeded that at the dentin margins. Bleaching did not induce any significant changes in the microleakage. Electron microscopy analysis indicated that in our experimental setup, decreased adhesion and mechanical resistance of the ADP- and IBO-enamel interfaces could be more important than the chemical degradation effects induced by the peroxide bleaching gel. PMID:23570299
Whitlock, Elizabeth L.; Vannucci, Andrea; Avidan, Michael S.
Delirium is an unfortunately common complication seen during the postoperative course. Because of its significant association with physical and cognitive morbidity, clinicians should be aware of evidence-based practices relating to the diagnosis, treatment, and prevention of postoperative delirium. Here, we review selected recent literature pertaining to the epidemiology and impact of the condition, perioperative risk factors for its development and/or exacerbation, and strategies for management of delirium, with additional attention to the intensive care unit population. PMID:21483389
Cheong, Kah Bik; Zhang, Ji-ping; Huang, Yong; Zhang, Zhang-jin
Background Acupuncture therapy for preventive and treatment of postoperative nausea and vomiting(PONV), a condition which commonly present after anaesthesia and surgery is a subject of growing interest. Objective This paper included a systematic review and meta-analysis on the effect of different type of acupuncture and acupoint selection in PONV prevention and treatment. Methods Randomised controlled trials(RCTs) comparing acupuncture with non-acupuncture treatment were identified from databases PubMed, Cochrane, EBSCO, Ovid, CNKI and Wanfangdata. Meta-analysis on eligible studies was performed using fixed-effects model with RevMan 5.2. Results were expressed as RR for dichotomous data, with 95%CI. Results Thirty RCTs, 1276 patients (intervention) and 1258 patients (control) were identified. Meta-analysis showed that PC6 acupuncture significantly reduced the number of cases of early vomiting (postoperative 0-6h) (RR=0.36, 95%CI 0.19,0.71; P=0.003) and nausea (postoperative 0-24h) (RR=0.25, 95%CI 0.10,0.61; P=0.002), but not early nausea (postoperative 0-6h) (RR=0.64, 95%CI 0.34,1.19; P=0.150) and vomiting (postoperative 0-24h) (RR=0.82, 95%CI 0.48,1.38; P=0.450). PC6 acupressure significantly reduced the number of cases of nausea (RR=0.71, 95%CI 0.57,0.87; P=0.001) and vomiting (RR=0.62, 95%CI 0.49,0.80; P=0.000) at postoperative 0-24h. PC6 electro-acupoint stimulation significantly reduced the number of cases of nausea (RR=0.49, 95%CI 0.38,0.63; P<0.000) and vomiting (RR=0.50, 95%CI 0.36,0.70; P<0.000) at postoperative 0-24h. Stimulation of PC6 with other acupoint(s) significantly reduced the number of cases of nausea and vomiting (RR=0.29, 95%CI 0.17,0.49; P<0.000) at postoperative 0-24h. Stimulation of other acupoint(s)(non PC6) also significantly reduced the number of cases of nausea and vomiting (RR=0.63, 95%CI 0.49,0.81; P=0.000) at postoperative 0-24h. However, the quality of study was generally low in studies of PC6 combined with other acupoint(s) and
Zhu, Yang-Zi; Yao, Rui; Zhang, Zhe; Xu, Hui; Wang, Li-Wei
Abstract Background: Trial design neuroinflammation and postoperative pain after surgery are increasingly reported in association with postoperative cognitive dysfunction (POCD). Parecoxib, a selective cyclooxygenase (COX)-2 inhibitor, is used for postoperative analgesia for its potent anti-inflammatory and analgesic effects. This study aimed to evaluate parecoxib's effects on POCD in elderly patients undergoing total knee arthroplasty. Methods: Around 134 elderly patients undergoing total knee arthroplasty were randomly divided into parecoxib (group P) and control (group C) groups, and treated with parecoxib sodium and saline, respectively, shortly after induction of general anesthesia and 12-h postsurgery, respectively. Perioperative plasma IL-1β, IL-6, TNF-α, and C-reactive protein (CRP) 1evels were measured. Postoperative pain was assessed following surgery. Neuropsychological tests were performed before surgery, and 1 week and 3 months postoperation. Results: POCD incidence in group P was significantly lower compared with that of group C at 1 week after surgery (16.7% vs 33.9%; P < 0.05); no significant difference was found between groups C and P at 3-month follow-up (9.7% vs 6.7%). Compared with group C values, visual analog pain scale (VAS) scores at 3, 6, and 12 hours after surgery were significantly lower in group P(P < 0.05). Plasma IL-1β, IL-6, and TNF-α levels were lower in group P than in group C after the operation (P < 0.05). No significant difference in the plasma CRP level was found between groups P and C. Conclusions: Parecoxib sodium decreases POCD incidence after total knee arthroplasty in elderly patients and may explain how this drug suppresses inflammation and acute postoperative pain caused by surgical trauma. PMID:27428192
Tanaka, Kumi; Katoh, Takuro; Irimajiri, Junya; Taniguchi, Hiroko; Yokozeki, Hiroo
Tinea pedis is contagious and typically spreads from infected to non-infected persons. The purpose of this study was to evaluate the efficacy of footwear in preventing tinea pedis adhesion. Using the stamp culture method, we investigated the effectiveness of preventing dermatophyte passage by the wearing of stockings made of nylon, socks made of cotton and tabi (Japanese socks), as well as the effect of removing dermatophytes from these items by washing with soap, cold water and cold water after turning inside-out. For sandals, sneakers and boots, we also investigated the effect of dermatophyte removal by pouring cold water into the footwear, wiping with a wet towel, and pouring boiling water into the footwear. The wearing of socks or tabi was effective in preventing passage of dermatophytes. The stocking material proved to be too thin to prevent passage. On the inner side of socks (the side of the sole), all treatments were effective at removing dermatophytes, but on the outer side of socks (the side touching the surface of the sandals), the treatment of washing in cold water after turning inside-out resulted in significantly more dermatophytes as compared with the other treatments. Pouring cold water, wiping with a wet towel and pouring boiling water were all effective for removing dermatophytes from sandals and sneakers. However, for boots, the treatment of pouring cold water was less effective. To prevent the adhesion of dermatophytes to sandals, wearing socks or tabi was effective, and the treatments of washing socks in cold water after turning inside-out and of pouring cold water into the boots were less effective than the others. PMID:16923133
Maynard, E M; Fernandez, E; Normann, R A
Minimizing relative movements between neural tissues and arrays of microelectrodes chronically implanted into them is expected to greatly enhance the capacity of the microelectrodes to record from single cortical neurons on a long-term basis. We describe a new surgical technique to minimize the formation of adhesions between the dura and an implanted electrode array using a 12 microm (0.5 mil) thick sheet of Teflon film positioned between the array and the dura. A total of 15 cats were implanted using this technique. Gross examination of 12 implant sites at the time of sacrifice failed to find evidence of adhesions between the arrays and the dura when the Teflon(R) film remained in its initial position. In six implants from which recordings were made, an average of nine of the 11 (81%) connected electrodes in each array recorded evoked neural activity after 180 days post implantation. Further, on average, two separable units were identified on each of the implanted electrodes in these arrays. No significant change was found in the density of cell bodies around implanted electrodes of four of the implanted electrode arrays. However, histological evaluation of the implant sites revealed evidence of meningeal proliferation beneath the arrays. The technique described is shown to be effective at preventing adhesions between implanted electrode arrays and improve the characteristics of chronic recordings obtained with these structures. PMID:10788663
Venkat Kumar, Govindarajan; Su, Chia-Hung; Velusamy, Palaniyandi
Bacterial adhesion is a major problem that can lead to the infection of implanted urological stents. In this study, kanamycin-chitosan nanoparticles (KMCSNPs) were immobilized on the surface of a polyurethane ureteral stent (PUS) to prevent urinary bacterial infection. KMCSNPs were synthesized using the ionic gelation method. The synthesized KMCSNPs appeared spherical with a ζ-average particle size of 225 nm. KMCSNPs were immobilized on the PUS surface by covalent immobilization techniques. The surface-modified PUS was characterized using attenuated total reflectance Fourier transform infrared spectroscopy, field emission scanning electron microscopy, and energy dispersive X-ray spectroscopy. The surface-modified PUS showed significantly increased antibacterial activity against Escherichia coli MTCC 729 and Proteus mirabilis MTCC 425 relative to the surface of an unmodified PUS. These findings suggest that the KMCSNP-immobilized PUS has the potential to prevent bacterial infection in the human urinary tract. PMID:27436679
Jaworski, Radosław; Irga-Jaworska, Ninela; Haponiuk, Ireneusz; Jaśkiewicz, Janusz
Oesophagogastric anastomosis after oesophagus resection is commonly performed on the neck. Even though a few different techniques of oesophagogastric anastomosis have been previously detailed, both manual and mechanical procedures have been burdened with leakages and strictures. Our simple technique of oesophagogastric anastomosis is a modification of mechanical anastomosis with the use of a circular stapler in order to prevent postoperative leak and concomitant mediastinal complications. Since 2008, we have performed nine oesophagogastric anastomoses following oesophagus resection. The mean age of the operated patients was 54 years. There was no mortality among the operated patients in the early post-operative period. The mean follow-up period for the patients operated on in our department was 17 months until the time of the analysis. None of the patients showed any leakage or stricture, and no mediastinal complications were reported in the group. Following our own experience, mechanical anastomosis with the use of a circular stapler seems to decrease the time of the operation as well as significantly reducing the incidence of leakages from the anastomosis. This type of anastomosis may decrease the number of postoperative strictures and the most dangerous mediastinal infections. PMID:26855647
Artemiou, Panagiotis; Bilecova-Rabajdova, Miroslava; Sabol, Frantisek; Torok, Pavol; Kolarcik, Peter; Kolesar, Adrian
Introduction Post-cardiac surgery delirium is a severe complication. The circadian rhythm of melatonin secretion has been shown to be altered postoperatively. Aim of the study It was hypothesized that restoring normal sleeping patterns with a substance that is capable of resynchronizing circadian rhythm such as exogenous administration of melatonin may possibly reduce the incidence of postoperative delirium. Material and methods This paper represents a prospective clinical observational study. Two consecutive groups of 250 consecutive patients took part in the study. Group A was the control group and group B was the melatonin group. In group B, the patients received prophylactic melatonin treatment. The main objectives were to observe the incidence of delirium, to identify any predictors of delirium, and to compare the two groups based on the delirium incidence. Results The incidence of delirium was 8.4% in the melatonin group vs. 20.8% in the control group (p = 0.001). Predictors of delirium in the melatonin group were age (p = 0.001) and higher EuroSCORE II value (p = 0.001). In multivariate analysis, age and EuroSCORE II value (p = 0.014) were predictors of postoperative delirium. Comparing the groups, the main predictors of delirium were age (p = 0.001), EuroSCORE II value (p = 0.001), cardio-pulmonary bypass (CPB) time (p = 0.001), aortic cross-clamping (ACC) time (p = 0.008), sufentanil dose (p = 0.001) and mechanical ventilation (p = 0.033). Conclusions Administration of melatonin significantly decreases the incidence of postoperative delirium after cardiac surgery. Prophylactic treatment with melatonin should be considered in every patient scheduled for cardiac surgery. PMID:26336494
Zahr, Alisar; Alcaide, Pilar; Yang, Jinling; Jones, Alexander; Gregory, Meredith; dela Paz, Nathaniel G.; Patel-Hett, Sunita; Nevers, Tania; Koirala, Adarsha; Luscinskas, Francis W.; Saint-Geniez, Magali; Ksander, Bruce; D'Amore, Patricia A.; Argüeso, Pablo
Endomucin is a membrane-bound glycoprotein expressed luminally by endothelial cells that line postcapillary venules, a primary site of leukocyte recruitment during inflammation. Here we show that endomucin abrogation on quiescent endothelial cells enables neutrophils to adhere firmly, via LFA-1-mediated binding to ICAM-1 constitutively expressed by endothelial cells. Moreover, TNF-α stimulation downregulates cell surface expression of endomucin concurrent with increased expression of adhesion molecules. Adenovirus-mediated expression of endomucin under inflammatory conditions prevents neutrophil adhesion in vitro and reduces the infiltration of CD45+ and NIMP-R14+ cells in vivo. These results indicate that endomucin prevents leukocyte contact with adhesion molecules in non-inflamed tissues and that downregulation of endomucin is critical to facilitate adhesion of leukocytes into inflamed tissues. PMID:26831939
Zahr, Alisar; Alcaide, Pilar; Yang, Jinling; Jones, Alexander; Gregory, Meredith; dela Paz, Nathaniel G; Patel-Hett, Sunita; Nevers, Tania; Koirala, Adarsha; Luscinskas, Francis W; Saint-Geniez, Magali; Ksander, Bruce; D'Amore, Patricia A; Argüeso, Pablo
Endomucin is a membrane-bound glycoprotein expressed luminally by endothelial cells that line postcapillary venules, a primary site of leukocyte recruitment during inflammation. Here we show that endomucin abrogation on quiescent endothelial cells enables neutrophils to adhere firmly, via LFA-1-mediated binding to ICAM-1 constitutively expressed by endothelial cells. Moreover, TNF-α stimulation downregulates cell surface expression of endomucin concurrent with increased expression of adhesion molecules. Adenovirus-mediated expression of endomucin under inflammatory conditions prevents neutrophil adhesion in vitro and reduces the infiltration of CD45(+) and NIMP-R14(+) cells in vivo. These results indicate that endomucin prevents leukocyte contact with adhesion molecules in non-inflamed tissues and that downregulation of endomucin is critical to facilitate adhesion of leukocytes into inflamed tissues. PMID:26831939
Guo, Yong; Sun, Lulu; Zhang, Junfeng; Li, Qifang; Jiang, Hong; Jiang, Wei
This study analyzed the preventive effects of low-dose dexmedetomidine on postoperative cognitive function and recovery quality in elderly oral cancer patients by observing the perioperative kinetics of inflammatory cytokines, cortisol and melatonin.A total of 149 elderly oral cancer patients who had undergone tumor resection surgery were selected and randomly divided into 2 groups, Group D and Group S. After surgery, Group D was assigned to take intravenous dexmedetomidine at a dose of 0.2 μg/kg/h for 12 h, while Group S was administered physiological saline in the same manner. On the day of surgery and for the first three postoperative days, the patients were assessed with the Mini-Mental State Examination (MMSE) and a 40-item quality of recovery score questionnaire (QoR40) at 7:00 am every morning. Venous blood was harvested at the same time. Then, IL-6, CRP, cortisol and melatonin levels were measured. There were no significant between-group differences in the baseline characteristics. After surgery, the MMSE and QoR40 scores in Group D were better than those in Group S. No between-group differences were observed in the incidences of severe hypotension and bradycardia. Moreover, respiratory depression was not observed in the 2 groups. The peaks of IL-6, CRP and cortisol concentrations in Group D were lower than those in Group S. However, the melatonin levels did not differ between the 2 groups. In elderly patients, intravenous dexmedetomidine administered postoperatively for 12 h at a dose of 0.2 ug/kg/h could improve postoperative cognitive function and recovery quality by decreasing excessive inflammation and stress levels. PMID:26629132
Lehr, Hans-Anton; Frei, Balz; Arfors, Karl-E.
A common feature of cigarette-smoke (CS)-associated diseases such as atherosclerosis and pulmonary emphysema is the activation, aggregation, and adhesion of leukocytes to micro- and macrovascular endothelium. A previous study, using a skinfold chamber model for intravital fluorescence microscopy in awake hamsters, has shown that exposure of hamsters to the smoke generated by one research cigarette elicits the adhesion of fluorescently labeled leukocytes to the endothelium of arterioles and small venules. By the combined use of intravital microscopy and scanning electron microscopy, we now demonstrate in the same animal model that (i) CS-induced leukocyte adhesion is not confined to the microcirculation, but that leukocytes also adhere singly and in clusters to the aortic endothelium; (ii) CS induces the formation in the bloodstream of aggregates between leukocytes and platelets; and (iii) CS-induced leukocyte adhesion to micro- and macrovascular endothelium and leukocyte-platelet aggregate formation are almost entirely prevented by dietary or intravenous pretreatment with the water-soluble antioxidant vitamin C (venules, 21.4 ± 11.0 vs. 149.6 ± 38.7 leukocytes per mm^2, P < 0.01; arterioles, 8.5 ± 4.2 vs. 54.3 ± 21.6 leukocytes per mm^2, P < 0.01; aortas, 0.8 ± 0.4 vs. 12.4 ± 5.6 leukocytes per mm^2, P < 0.01; means ± SD of n = 7 animals, 15 min after CS exposure). No inhibitory effect was observed by pretreatment of the animals with the lipid-soluble antioxidants vitamin E or probucol. The protective effects of vitamin C on CS-induced leukocyte adhesion and aggregation were seen at vitamin C plasma levels (55.6 ± 22.2 μM, n = 7) that can easily be reached in humans by dietary means or supplementation, suggesting that vitamin C effectively contributes to protection from CS-associated cardiovascular and pulmonary diseases in humans.
Ding, Mingxia; Wang, Jiansong; Zuo, Yigang; Chen, Jian; Wang, Haifeng; Li, Ning; Liu, Jingyu; Wang, Wei; Li, Haihao
Objective To improve HoLEP surgical techniques of finding envelope, enucleation, hemostatic and comminution, and to treate the incontinence reason predictably, so as to reduce the complications of HoLEP surgery. Methods Technical improvements were performed in 272 patients who underwent HoLEP during January 2014 to December 2014. (I) The gland was enucleated in three lobes, not overall enucleation; (II) start with both sides of verumontanum to find envelope, the ‘three-lobe’ technique involves 5- and 7-o'clock position incisions with enucleation of the middle lobe and subsequent enucleation of one lateral lobe followed by the other lateral lobe; (III) we only lift the glands gently by lens body, using holmium laser blasting to peel glands, and abandon conventional mirror peeling method; (IV) if bleeding is encountered, the laser fibre can be defocused slightly from the bleeding point to achieve haemostasis; (V) we crushed glands vacantly with the status of bladder filling. The reason why postoperative urinary incontinence occurs may be thermal burns sphincter, mucosal retention inadequate, sphincter weiss at around 12:00, and sphincter injury caused by mirror body elevation, etc. Some precautions during the operation were as follows: (I) reducing laser ablation; (II) separation off the reserved side lobe mucosa before peeling; (III) avoid 12:00 distal mucosal tear; (IV) using blasting holmium laser energy not lens body to peel glands, which can avoid sphincter injury by mirror body elevation force. Results We identified 272 patients who underwent HoLEP. The median volume of enucleated adenomas was 92±24 g. The median IPSS before surgery was 23.3±6.1. Average (range) operation time was 86±21 minutes. Amount of bleeding was 56±14 mL. Postoperative patients of hospital stay was 32±5 h, average time of indwelling catheter time was 22±6 h. Patients were followed up for 6-28 months’ time, an average of 12.4 months. Postoperative patients with international
Li, Xiaolei; Sun, Yu; Chen, Hui; Zhu, Gengyao; Liang, Yuan; Wang, Qiang; Wang, Jingcheng; Yan, Lianqi
Hydroxycamptothecin (HCPT) has been proven to prevent intraarticular scar adhesion, but the mechanism is still unclear. ER stress is known to participate in many diseases, and the IRE-1 signal pathway has been reported in fibrotic diseases. The aim of this study was to illustrate the mechanism of HCPT-induced apoptosis in fibroblasts and the prevention of intraarticular scar adhesion. The effects of HCPT on fibroblasts were determined by CCK-8 assay, Hoechst staining and Western blot. The effect of HCPT on intraarticular scar adhesion was detected by macroscopic evaluation, hydroxyproline content, histological evaluation, fibroblast counting and immunohistochemical analysis. HCPT induced apoptosis of fibroblasts, according to CCK-8 assays, Hoechst staining and Western blot analysis. As the concentration of HCPT increased, the expressions of glucose-regulated protein 78 (GRP78), inositol-requiring kinase1 (IRE-1), C/EBP homologous protein (CHOP) and Bax were all increased, but the expression of Bcl-2 was decreased. Knockdown of IRE-1 alleviated the HCPT-induced apoptosis in our fibroblast model. HCPT could prevent intraarticular scar adhesion, according to the results of macroscopic evaluation, hydroxyproline content, histological evaluation and fibroblast counting in a rabbit model. Immunohistochemical analysis showed that IRE-1 expression increased as the concentration increased. The present study showed that the IRE-1 signal pathway might be involved in HCPT-induced apoptosis of fibroblast and might play a role in preventing intraarticular scar adhesion. PMID:27068147
Stock, M C; Downs, J B; Gauer, P K; Alster, J M; Imrey, P B
Continuous positive airway pressure (CPAP) administered at intervals with a mask and incentive spirometry (IS) were compared with a regimen of coughing and deep breathing (CDB) to determine which promoted the most rapid recovery of pulmonary function after upper abdominal operations in 65 adults. Postoperatively, FRC of patients in all groups was similar relative to preoperative values. However, mean FRC of patients who received CPAP increased more rapidly than did mean FRC of those receiving CDB when compared to the values obtained following operation (p less than 0.05). Incentive spirometry did not increase FRC to a greater extent than did CDB. Roentgenographic evidence of atelectasis 72 hours postoperatively was observed in 23 percent of CPAP patients (five of 22) and 42 percent and 41 percent of patients who received CDB (eight of 19) and IS (nine of 22). Two patients (3 percent) developed pneumonia. The low incidence of pneumonia regardless of the type of therapy may be attributable to vigorous, vigilant respiratory care in a population at high risk for developing pneumonia. Frequency and supervision of respiratory therapy may be more important than the type of therapy delivered after upper abdominal operations. Mask CPAP offers advantages because it requires no effort from the patient, and therapy is not painful. PMID:3881226
Joshipura, Ishan; Johnson, Alexander; Ayers, Hudson; Dickey, Michael
This work explores the wetting behavior of an oxide-coated liquid metal, eutectic alloy of gallium and indium (`EGaIn'), which remains a liquid at room temperature. Liquid metals uniquely combine fluidity with metallic properties. Combined, these properties enable soft, stretchable, and shape reconfigurable electronics with `softer than skin' interfaces. Ga forms spontaneously a thin surface oxide that alters its wetting behavior and makes it difficult to move across surfaces without leaving residue behind. We examine the effects of surface roughness (i.e., Cassie-Baxter state) and lubrication to minimize adhesion of Ga oxide to surfaces. Lubricated surfaces create a `slip-layer' of liquid between the metal and surface that also inhibits wetting. This slip layer allows the metal to move reversibly through microchannels by preventing adhesion of the oxide. The metal may be pumped or moved by using low voltages or pneumatic actuation. Optical microscopy confirms the importance of the slip-layer, which enables non-stick motion of the metal through capillaries. Finally, electrochemical impedance spectroscopy characterizes the electrohydrodynanic motion of EGaIn in capillary systems.
Background In line with the growing number of surgical procedures being performed worldwide, postoperative complications are also increasing proportionately. Prevention of these postoperative complications is a high medical priority. Preoperative education of patients, including provision of preparatory information about the correct behavior after surgery, could improve the postoperative outcome, but the evidence for this is inconclusive. The aim of the PEDUCAT trial is to evaluate the feasibility and the impact of preoperative patient education on postoperative morbidity, mortality and quality of life in patients scheduled for elective major visceral surgery. Methods/design PEDUCAT is designed as a cluster-randomized controlled pilot study. The experimental group will visit a standardized preoperative seminar to learn how best to behave after surgery in addition to being given a standard information brochure, whereas the control group will only receive the information brochure. Outcome measures such as postoperative morbidity, postoperative pain, postoperative anxiety and depression, patient satisfaction, quality of life, length of hospital stay and postoperative mortality will be evaluated. Statistical analysis will be based on the intention-to-treat population. Analysis of covariance will be applied for the intervention group comparison, adjusting for age, center and quality of life before surgery. This is a pilot study to show the feasibility of the concept. Nevertheless, the planned sample size of n = 204 is large enough to show an effect with power of 90% and a significance level of 5%. Trial registration German Clinical Trial Register number: DRKS00004226. PMID:23978275
Yin, Bing; Liu, Tao; Yin, Yansheng
A superhydrophobic coating composed of silver nanoparticles was developed on copper from fluorinated multilayered polyelectrolyte films to examine its performance in preventing microbial adhesion. Antibacterial and antibiofouling experiments for this novel coating were conducted with SRB. From the disk diffusion tests (for 48 h), it was found that, compared to the traditional coating composed of nanosilver, this novel coating significantly improved antibacterial performance and long-term effectiveness. The oxidation states of the immobilized silver in polyelectrolyte multilayer films were investigated with X-ray photoelectron spectroscopy (XPS), and the stability of the immobilized silver was evaluated through a leaching test. It was found that if silver was exposed to aqueous environments some ionic silver species would be produced and released. The ion release kinetics showed that the duration of sustained release of antibacterial Ag ions from the novel coatings was prolonged, which was why they had more long-term antibacterial performance. PMID:23137302
Han, Fanghai; Li, Hongming
Prevention of intraoperative incidental injuries during radical operation for rectal cancer and management of postoperative complication are associated with successful operation and prognosis of patients. This paper discusses how to prevent such intraoperative incidental injuries and how to manage postoperative complication. (1) Accurate clinical evaluation should be performed before operation and reasonable treatment decision should be made, including determination of the distance from transection to lower margin of the tumor, T and M staging evaluated by MRI, fascia invasion of mesorectum, metastasis of lateral lymph nodes, metastatic station of mesentery lymph node, association between levator ani muscle and anal sphincter, course and length of sigmoid observed by Barium enema, length assessment of pull-through bowel. Meanwhile individual factors of patients and tumors must be realized accurately. (2) Injury of pelvic visceral fascia should be avoided during operation. Negative low and circumference cutting edge must be ensured. Blood supply and adequate length of pull-down bowel must be also ensured. Urinary system injury, pelvic bleeding and intestinal damage should be avoided. Team cooperation and anesthesia procedure should be emphasized. Capacity of handling accident events should be cultivated for the team. (3) intraoperative incidental injuries during operation by instruments should be avoided, such as poor clarity of camera due to spray and smog, ineffective instruments resulted from repeated usage. (4) As to the prevention and management of postoperative complication of rectal cancer operation, prophylactic stoma should be regularly performed for rectal cancer patients undergoing anterior resection, while drainage tube placement does not decrease the morbidities of anastomosis and other complications. After sphincter-preserving surgery for rectal cancer, attentions must be paid to the occurrence of anastomotic bleeding, pelvic bleeding, anastomotic
Yousuf, Beena; Samad, Khalid; Ullah, Hameed; Hoda, Muhammad Q
Background: Postoperative shivering (POS) is a common and distressing experience occurring in up to 60% patients postoperatively. This study was designed to compare the efficacy of tramadol in preventing POS when used with two different induction agent, propofol or thiopentone. Materials and Methods: One hundred and twenty-four ASA I and II adult patients, aged between 18-60 years, undergoing general anesthesia of intermediate duration (60-240 min) for orthopedic, gynecological, and general surgical procedures were randomly divided to receive either thiopentone or propofol as induction agent. Each group was further subdivided (31 patients in each group) to receive either tramadol or saline 15 min before wound closure. Presence of POS after extubation till discharge from post anesthesia care unit (PACU) was recorded at six different time intervals. Results: The highest incidence of POS was observed in thiopentone-saline (TS) group 77.4%, while the lowest (12.9%) was in propofol-tramadol (PT) group (P > 0.001). Total number of shivering episodes was 122 out of which, 35 (28.7%) were of grade 2 and 3 (significant shivering) requiring treatment. The incidence of significant shivering was similar to the episodes of POS, highest in TS group and lowest being in PT group (P > 0.05). Conclusion: The prophylactic use of tramadol in a dose of 1 mg/kg with propofol as an induction agent significantly reduces the incidence of POS in patients recovering from general anesthesia of intermediate duration. PMID:24249991
Although laparoscopy has the potential to reduce peritoneal trauma and post-operative peritoneal adhesion formation, only one randomized controlled trial and a few comparative retrospective clinical studies have addressed this issue. Laparoscopy reduces de novo adhesion formation but has no efficacy in reducing adhesion reformation after adhesiolysis. Moreover, several studies have suggested that the reduction of de novo post-operative adhesions does not seem to have a significant clinical impact. Experimental data in animal models have suggested that CO2 pneumoperitoneum can cause acute peritoneal inflammation during laparoscopy depending on the insufflation pressure and the surgery duration. Broad peritoneal cavity protection by the insufflation of a low-temperature humidified gas mixture of CO2, N2O and O2 seems to represent the best approach for reducing peritoneal inflammation due to pneumoperitoneum. However, these experimental data have not had a significant impact on the modification of laparoscopic instrumentation. In contrast, surgeons should train themselves to perform laparoscopy quickly, and they should complete their learning curves before testing chemical anti-adhesive agents and anti-adhesion barriers. Chemical anti-adhesive agents have the potential to exert broad peritoneal cavity protection against adhesion formation, but when these agents are used alone, the concentrations needed to prevent adhesions are too high and could cause major post-operative side effects. Anti-adhesion barriers have been used mainly in open surgery, but some clinical data from laparoscopic surgeries are already available. Sprays, gels, and fluid barriers are easier to apply in laparoscopic surgery than solid barriers. Results have been encouraging with solid barriers, spray barriers, and gel barriers, but they have been ambiguous with fluid barriers. Moreover, when barriers have been used alone, the maximum protection against adhesion formation has been no greater than
Kramer, Axel; Assadian, Ojan; Frank, Matthias; Bender, Claudia; Hinz, Peter
After reviewing the literature about the microbial spectrum, the risk factors of post-operative infections, and the results of surgical interventions, the following recommendation can be made for the management of bite wounds: fresh, open wounds: surgical debridement, if appropriate, then an antiseptic lavage with a fluid consisting of povidone iodine and ethanol (e.g., Betaseptic®), no antibiotics, primary wound closure nearly closed fresh wounds (e.g., cat bites): surgical debridement, if appropriate, dressing with an antiseptic-soaked compress for ~60 minutes with repeated soaking (e.g., Betaseptic®), no antibiotics older wounds after ~4 hours: surgical debridement, if appropriate, dressing with an antiseptic-soaked compress or bandage for ~60 minutes with repeated soaking (e.g., Betaseptic®), at the same time intravenous or dose-adapted oral antibiotics (Amoxicillin and/or clavulanic acid) older wounds after ~24 hours: surgical debridement, then antiseptic lavage (Betaseptic®), in case of clinically apparent infection or inflammation surgical revision with opening of wound and treatment with antibiotics according to resistogram (empirical start with Amoxicillin and/or clavulanic acid). For each kind of bite wound, the patient’s tetanus immunization status as well as the risk of exposure to rabies have to be assessed. Similarly, the possibility of other infections, such as lues (Syphilis), hepatitis B (HBV), hepatitis C (HBC), hepatitis D (HDV) and HIV, in the rare case of a human bite wound, has to be taken into account. PMID:20941334
Watanabe, K; Taniguchi, H; Nishioka, K; Maruyama, R; Katoh, T
We studied the preventive effects of socks against dermatophyte infection. Wearing various socks (cotton socks, nylon stockings, wool socks and "tabi"), a healthy volunteer walked on a bath mat on which a patient with tinea pedis had stepped earlier. The volunteer pressed her right foot with socks onto large agar medium (Foot-press method), then, took off the socks and performed the Foot-press method again. The number of colonies of isolated dermatophytes on the medium was counted. The number of isolated colonies from the sole after taking off the nylon stockings was larger than that from the foot wearing the stockings. Dermatophytes were also isolated from the sole after taking off cotton socks. In contrast, few dermatophytes were isolated from the sole after taking off wool socks or "tabi". On microscopic observation, fibers of the nylon stockings and cotton socks were seen to be loose enough for dermatophytes to pass through. In contrast with those socks, fibers of wool socks and "tabi" were tight or fluffy. In conclusion, the nylon stockings and cotton socks are unsatisfactory in preventing the adhesion of dermatophytes. PMID:10938520
Azeke, John Imuetinyan-Jesu, Jr.
Abdominal adhesions are the aberrant result of peritoneal wound healing commonly associated with surgery and inflammation. A subject of a large number of studies since the first half of the last century, peritoneal adhesion prevention has, for the most part, evaded the scientific community and continues to cost Americans an estimated $2-4 billion annually. It is known that transforming growth factor-beta (TGF-beta) plays a key role in the wound healing cascade; however, suppression of this multifunctional growth factor's activity may have more harmful consequences than can be tolerated. As a result, much attention has fallen on connective tissue growth factor (CTGF), a downstream mediator of TGF-beta's fibrotic action. It has been demonstrated in several in vitro models, that the suppression of CTGF hinders fibroblast proliferation, a necessary condition for fibrosis. Furthermore, antisense oligonucleotides (antisense oligos, AO) to CTGF have been shown to knock down CTGF mRNA levels by specifically hindering the translation of CTGF protein. Antisense technologies have met with a great deal of excitement as a viable means of preventing diseases such as adhesions by hindering protein translation at the mRNA level. However, the great challenge associated with the use of these drugs lies in the short circulation time when administered "naked". Viral delivery systems, although excellent platforms in metabolic studies, are not ideal for diagnostic use because of the inherent danger associated with viral vectors. Microparticles made of biodegradable polymers have therefore presented themselves as a viable means of delivering these drugs to target cells over extended periods. Herein, we present two in vivo studies confirming the up-regulation of TGF-beta protein and CTGF mRNA following injury to the uterine tissues of female rats. We were able to selectively knockdown post-operative CTGF protein levels following surgery, however, our observations led us to conclude that
Robinson, Clifford G.; Polster, Joshua M.; Reddy, Chandana A.; Lyons, Janice A.; Evans, Peter J.; Lawton, Jeffrey N.; Graham, Thomas J.; Suh, John H.
Purpose: Heterotopic ossification (HO) about the elbow has been described after surgery, trauma, and burns. Even limited deposits can lead to significant functional deficits. Little data exist regarding outcomes of patients treated with radiation therapy (RT) after elbow surgery. We report here the Cleveland Clinic experience with single-fraction radiation following surgery to the elbow. The primary endpoint was the rate of new HO after RT. Secondary endpoints were range of motion, functional compromise, and toxicity. Methods and Materials: From May 1993 to July 2006, 36 patients underwent elbow surgery followed by single-fraction RT. Range of motion data were collected before and during surgery and at last follow-up. Radiographs were reviewed for persistent or new HO. Patient and treatment factors were analyzed for correlation with development of HO or functional compromise. Results: Median follow-up was 8.7 months, median age was 42 years, and 75% of patients were male. Twenty-six (72%) patients had HO prior to surgery. All patients had significant limitations in flexion/extension or pronation/supination at baseline. Thirty-one (86%) patients had prior elbow trauma, and 26 (72%) patients had prior surgery. RT was administered a median of 1 day postoperatively (range, 1-4 days). Thirty-four patients received 700 cGy, and 2 patients received 600 cGy. Three (8%) patients developed new HO after RT. All patients had improvement in range of motion from baseline. No patient or treatment factors were significantly associated with the development of HO or functional compromise. Conclusions: Single-fraction RT after surgery to the elbow is associated with favorable functional and radiographic outcomes.
Søreide, Kjetil; Labori, Knut Jørgen
Abstract Background: Pancreas surgery has developed into a fairly safe procedure in terms of mortality, but is still hampered by considerable morbidity. Among the most frequent and dreaded complications are the development of a post-operative pancreatic fistula (POPF). The prediction and prevention of POPF remains an area of debate with several questions yet to be firmly addressed with solid answers. Methods: A systematic review of systematic reviews/meta-analyses and randomized trials in the English literature (PubMed/MEDLINE, Cochrane library, EMBASE) covering January 2005 to December 2015 on risk factors and preventive strategies for POPF. Results: A total of 49 systematic reviews and meta-analyses over the past decade discussed patient, surgeon, pancreatic disease and intraoperative related factors of POPF. Non-modifiable factors (age, BMI, comorbidity) and pathology (histotype, gland texture, duct size) that indicates surgery are associated with POPF risk. Consideration of anastomotic technique and use of somatostatin-analogs may slightly modify the risk of fistula. Sealant products appear to have no effect. Perioperative bleeding and transfusion enhance risk, but is modifiable by focus on technique and training. Drains may not prevent fistulae, but may help in early detection. Early drain-amylase may aid in detection. Predictive scores lack uniform validation, but may have a role in patient information if reliable pre-operative risk factors can be obtained. Conclusions: Development of POPF occurs through several demonstrated risk factors. Anastomotic technique and use of somatostatin-analogs may slightly decrease risk. Drains may aid in early detection of leaks, but do not prevent POPF. PMID:27216233
Kitsmaniuk, Z D; DëmochkoVB; Popovich, V I
The efficacy of low-energy helium-neon and copper vapor lasers for prevention and treatment of postoperative and irradiation complications was assessed in 195 patients with locally advanced tumors of the head and neck. The control group included 118 patients. Intravenous laser irradiation of the blood was associated with a higher percentage of wound healing by first intention and better course of the postoperative period. Laser treatment of skin irradiation fields was shown to improve skin tolerance to the neutron beam. The study failed to establish tumor growth stimulation by the laser irradiation in terms of recurrence and metastasis development. The data obtained showed low-energy laser irradiation to offer promise for prevention and treatment of postoperative and irradiation complications. PMID:1300810
Lim, Chae Seong; Kim, Yoon-Hee; Park, Sang-Il; Kim, Jae-Kook; Kim, Myoung-Joong; Kim, Hyun-Joong
Background 5-HT3 receptor antagonist, dexamethasone and droperidol were used for the prevention of postoperative nausea and vomiting (PONV). Recently, neurokinin-1 (NK1) antagonist has been used for PONV. We evaluated the effect of oral aprepitant premedication in addition to ondansetron. Methods A total 90 patients scheduled for elective rhinolaryngological surgery were allocated to three groups (Control, Ap80, Ap125), each of 30 at random. Ondansetron 4 mg was injected intravenously to all patients just before the end of surgery. On the morning of surgery, 80 mg and 125 mg aprepitant were additionally administered into the Ap80 group and Ap125 group, respectively. The rhodes index of nausea, vomiting and retching (RINVR) was checked at 6 hr and 24 hr after surgery. Results Twelve patients who used steroids unexpectedly were excluded. Finally 78 patients (control : Ap80 : Ap125 = 24 : 28 : 26) were enrolled. Overall PONV occurrence rate of Ap125 group (1/26, 3.9%) was lower (P = 0.015) than the control group (7/24, 29.2%) at 6 hr after surgery. The nausea distress score of Ap125 group (0.04 ± 0.20) was lower (P = 0.032) than the control group (0.67 ± 1.24) at 6 hr after surgery. No evident side effect of aprepitant was observed. Conclusions Oral aprepitant 125 mg can be used as combination therapy for the prevention of PONV. PMID:23560185
Polati, E; Finco, G; Bartoloni, A; Gottin, L; Pinaroli, A M; Zanoni, L; Mazzetti, C; Fontanive, P
Postoperative nausea and vomiting (PONV) are among the most common complications in surgical patients. In this prospective, double blind, parallel group study we compare the prophylactic antiemetic efficacy of ondansetron versus placebo in 90 patients undergoing general balanced anaesthesia. The patients were stratified according to the kind of surgery and randomly allocated to three treatment groups: 30 patients (Group A) received ondansetron 4 mg i.v. 1 hour before the induction of anaesthesia and placebo 1 hour before the end of surgery; 30 patients (Group B) received placebo 1 hour before the end of anaesthesia and ondansetron 4 mg i.v. 1 hour before the end of surgery; 30 patients (Group C-control group) received placebo in both the administrations. Data were analyzed by Student t test and chi 2 test; significance was taken at p < 0.05. The three groups proved comparable with respect to demographic characteristics, duration of anaesthesia and fentanyl consumption. Analysis of the results showed that PONV had a significantly lower incidence in treated patients (Groups A and B) than in the control group patients (Group C): postoperative nausea occurred in 13%, 30% and 67% of patients in Group A, B and C respectively and it was associated with vomiting in 3%, 7% and 57% of patients in Group A, B and C respectively. Although the patients in Group A showed a lower incidence of PONV in comparison to the patients in Group B, such differences proved to be not statistically significant. No adverse effects in relation to drug administration were observed. We conclude that ondansetron 4 mg i.v. is safe and effective in preventing PONV in the surgical patients, particularly when administered before the induction of anaesthesia. PMID:8919833
Colombel, J; Rutgeerts, P; Malchow, H; Jacyna, M; Nielsen, O; Rask-Madsen, J; Van Deventer, S; Ferguson, A; Desreumaux, P; Forbes, A; Geboes, K; Melani, L; Cohard, M
BACKGROUND AND AIMS—New lesions of Crohn's disease occur early after ileal or ileocolonic resection and ileocolonic anastomosis. We performed a double blind controlled trial to evaluate the safety and tolerance of recombinant human interleukin 10 (IL-10; Tenovil) in subjects operated on for Crohn's disease. We also assessed the effect of Tenovil in preventing endoscopic recurrence 12 weeks after surgery. METHODS—Patients with Crohn's disease who underwent curative ileal or ileocolonic resection and primary anastomosis were randomised within two weeks after surgery to receive subcutaneous Tenovil 4 µg/kg once daily (QD) (n=22) or 8 µg/kg twice weekly (TIW) (n=21), or placebo (QD or TIW) (n=22). An ileocolonoscopy was performed after 12 weeks of treatment. RESULTS—Compliance was excellent. The most frequently observed adverse events were mild and moderate in severity and equally distributed across treatment groups. Thirty seven patients in the pooled Tenovil group and 21 patients in the pooled placebo group were evaluable by endoscopy. At 12 weeks, 11 of 21 patients (52%) in the placebo group had recurrent lesions compared with 17 of 37 patients (46%) in the Tenovil group (ns). The incidence of severe endoscopic recurrence was similar in both groups (9%). CONCLUSION—Tenovil treatment for 12 consecutive weeks in patients with Crohn's disease after intestinal resection was safe and well tolerated. No evidence of prevention of endoscopic recurrence of Crohn's disease by Tenovil was observed. Keywords: Crohn's disease; interleukin 10; endoscopic recurrence PMID:11413109
Wu, Jason H Y; Marchioli, Roberto; Silletta, Maria G; Masson, Serge; Sellke, Frank W; Libby, Peter; Milne, Ginger L; Brown, Nancy J; Lombardi, Federico; Damiano, Ralph J; Marsala, Joann; Rinaldi, Mauro; Domenech, Alberto; Simon, Caterina; Tavazzi, Luigi; Mozaffarian, Dariush
Background Animal study results point to oxidative stress as a key mechanism triggering postoperative atrial fibrillation (PoAF), yet the extent to which specific biomarkers of oxidative stress might relate to PoAF risk in humans remains speculative. Methods and Results We assessed the association of validated, fatty acid–derived oxidative stress biomarkers (F2-isoprostanes, isofurans, and F3-isoprostanes) in plasma and urine, with incident PoAF among 551 cardiac surgery patients. Biomarkers were measured at enrollment, the end of surgery, and postoperative day 2. PoAF lasting ≥30 seconds was confirmed with rhythm strip or electrocardiography and centrally adjudicated. Outcomes were assessed until hospital discharge or postoperative day 10, whichever occurred first. Urine level of each oxidative stress biomarker rose at the end of surgery (2- to 3-fold over baseline, P<0.001) and subsequently declined to concentrations comparable to baseline by postoperative day 2. In contrast, plasma concentrations remained relatively stable throughout the perioperative course. Urine F2-isoprostanes and isofurans at the end of surgery were 20% and 50% higher in subjects who developed PoAF (P≤0.009). While baseline biomarker levels did not associate significantly with PoAF, end of surgery and postoperative day 2 isoprostanes and isofurans demonstrated relatively linear associations with PoAF. For example, the end of surgery extreme quartile multivariate adjusted OR (95% CI) for urine isofurans and F3-isoprostanes were 1.95 (1.05 to 3.62; P for trend=0.01) and 2.10 (1.04 to 2.25, P for trend=0.04), respectively. The associations of biomarkers with PoAF varied little by demographics, surgery type, and medication use (P≥0.29 for each). Conclusions These novel results add to accumulating evidence supporting the likely key pathogenic role of elevated oxidative stress in PoAF. Clinical Trial Registration URL: Clinicaltrials.gov Unique identifier: NCT00970489. PMID:25994442
Heupel, Wolfgang-Moritz; Müller, Thomas; Efthymiadis, Athina; Schmidt, Enno; Drenckhahn, Detlev; Waschke, Jens
Pemphigus vulgaris (PV) autoantibodies directly inhibit desmoglein (Dsg) 3-mediated transinteraction. Because cellular signaling also seems to be required for PV pathogenesis, it is important to characterize the role of direct inhibition in pemphigus acantholysis to allow establishment of new therapeutic approaches. Therefore, we modeled the Dsg1 and Dsg3 sequences into resolved cadherin structures and predicted peptides targeting the adhesive interface of both Dsg3 and Dsg1. In atomic force microscopy single molecule experiments, the self-designed cyclic single peptide specifically blocked homophilic Dsg3 and Dsg1 transinteraction, whereas a tandem peptide (TP) consisting of two combined single peptides did not. TP did not directly block binding of pemphigus IgG to their target Dsg antigens but prevented PV-IgG-induced inhibition of Dsg3 transinteraction in cell-free (atomic force microscopy) and cell-based (laser tweezer) experiments, indicating stabilization of Dsg3 bonds. Similarly, PV-IgG-mediated acantholysis and disruption of Dsg3 localization in HaCaT keratinocytes was partially blocked by TP. This is the first evidence that direct inhibition of Dsg3 binding is important for PV pathogenesis and that peptidomimetics stabilizing Dsg transinteraction may provide a novel approach for PV treatment. PMID:19164289
Chen, Wenjun; Deng, Dunying; Cheng, Yuanrong; Xiao, Fei
The easy oxidation of copper is one critical obstacle to high-performance copper-filled isotropically conductive adhesives (ICAs). In this paper, a facile method to prepare highly reliable, highly conductive, and low-cost ICAs is reported. The copper fillers were treated by organic acids for oxidation prevention. Compared with ICA filled with untreated copper flakes, the ICA filled with copper flakes treated by different organic acids exhibited much lower bulk resistivity. The lowest bulk resistivity achieved was 4.5 × 10-5 Ω cm, which is comparable to that of commercially available Ag-filled ICA. After 500 h of 85°C/85% relative humidity (RH) aging, the treated ICAs showed quite stable bulk resistivity and relatively stable contact resistance. Through analyzing the results of x-ray diffraction, x-ray photoelectron spectroscopy, and thermogravimetric analysis, we found that, with the assistance of organic acids, the treated copper flakes exhibited resistance to oxidation, thus guaranteeing good performance.
Wang, Mei; Gao, Yun-Hai; Xu, Jie; Chi, Yuan; Wei, Xiao-Bing; Lewith, George; Liu, Jian-Ping
Summary Objective To evaluate the preventive effect of Zusanli (ST36) acupoint injections with various agents, for postoperative ileus (POI). Methods We searched electronic databases for randomized controlled trials from inception to 1st February 2015 evaluating ST36 acupoint injection for preventing POI. Revman 5.2.0 was used for data analysis with effect estimates presented as mean difference (MD) with 95% confidence interval (CI). Statistical heterogeneity was tested using I2 (defined as significant if I2 > 75%). We used a random effects model (REM) for pooling data with significant heterogeneity. Results Thirty trials involving 2967 participants were included. All trials were assessed as high risk of bias (poor methodological quality). For time to first flatus, meta-analysis favored ST36 acupoint injection of neostigmine (MD −20.70 h, 95% CI −25.53 to −15.87, 15 trials, I2 = 98%, REM), vitamin B1 (MD −11.22 h, 95% CI −17.01 to −5.43, 5 trials, I2 = 98%, REM), and metoclopramide (MD −15.65 h, 95% CI −24.77 to −6.53, 3 trials, I2 = 94%, REM) compared to usual care alone. Meta-analysis of vitamin B1 favored ST36 acupoint injection compared to intra-muscular injection (MD −17.21 h, 95% CI −21.05 to −13.36, 4 trials, I2 = 89%, REM). Similarly, for time to bowel sounds recovery and first defecation, ST36 acupoint injection also showed positive effects. Conclusions ST36 acupoint injections with various agents may have a preventive effect for POI. Safety is inconclusive as few of included trials reported adverse events. Due to the poor methodological quality and likely publication bias further robust clinical trials are required to arrive at a definitive conclusion. PMID:26051583
Schreinemacher, Marc H. F.; ten Broek, Richard P.; Bakkum, Erica A.; van Goor, Harry
Background Postoperative adhesions are the most frequent complication of abdominal surgery, leading to high morbidity, mortality, and costs. However, the problem seems to be neglected by surgeons for largely unknown reasons. Methods A survey assessing knowledge and personal opinion about the extent and impact of adhesions was sent to all Dutch surgeons and surgical trainees. The informed-consent process and application of antiadhesive agents were questioned in addition. Results The response rate was 34.4%. Two thirds of all respondents (67.7%) agreed that adhesions exert a clinically relevant, negative effect. A negative perception of adhesions correlated with a positive attitude regarding adhesion prevention (ρ = 0.182, p < 0.001). However, underestimation of the extent and impact of adhesions resulted in low knowledge scores (mean test score 37.6%). Lower scores correlated with more uncertainty about indications for antiadhesive agents which, in turn, correlated with never having used any of these agents (ρ = 0.140, p = 0.002; ρ = 0.095, p = 0.035; respectively). Four in 10 respondents (40.9%) indicated that they never inform patients on adhesions and only 9.8% informed patients routinely. A majority of surgeons (55.9%) used antiadhesive agents in the past, but only a minority (13.4%) did in the previous year. Of trainees, 82.1% foresaw an increase in the use of antiadhesive agents compared to 64.5% of surgeons (p < 0.001). Conclusions The magnitude of the problem of postoperative adhesions is underestimated and informed consent is provided inadequately by Dutch surgeons. Exerting adhesion prevention is related to the perception of and knowledge about adhesions. PMID:20814678
Sheshadri, Veena; Bharadwaj, Suparna; Chandramouli, BA
Background and Aims: Intra-operative identification and preservation of extraocular motor nerves is one of the main goals of surgeries for skull base tumours and this is done by monitoring the extraocular movement (EOM). Intra-operative electromyographic monitoring has been reported, but it is a complex and skilful process. Electrooculography (EOG) is a simple and reliable technique for monitoring EOMs. We aimed to assess the utility of EOG monitoring in preventing extraocular motor nerve dysfunction during skull base surgeries. Methods: In this retrospective cohort study, intra-operative EOG recordings were obtained using disposable needle electrodes placed on the periorbital skin and the polarity of the waves noted for interpretation. Triggered as well as continuous EOG responses were recorded after monopolar electrode stimulation of cranial nerve (CN) during tumour removal which helped the surgeon with careful dissection and avoiding potential nerve injuries. Results: Of the 11 cases monitored, oculomotor and abducent nerves were identified in all cases, but the trochlear nerve could not be definitively identified. Six patients had no pre- or post-operative extraocular motor nerve dysfunction. The other five patients had pre-existing deficits before surgery, which recovered completely in two, significantly in one, and did not improve in two patients at 3–6 months follow-up. Conclusions: EOG was found to be a simple and reliable method of monitoring extraocular motor nerves (CNs III and VI) intraoperatively. PMID:27601738
Serpa Neto, Ary; Schultz, Marcus J; Gama de Abreu, Marcelo
For many years, mechanical ventilation with high tidal volumes (V(T)) was common practice in operating theaters because this strategy recruits collapsed lung tissue, improves ventilation-perfusion mismatch, and thus decreases the need for high oxygen fractions. Positive end-expiratory pressure (PEEP) was seldom used because it could cause cardiac compromise. Increasing advances in the understanding of the mechanisms of ventilator-induced lung injury from animal studies and randomized controlled trials in patients with uninjured lungs in intensive care unit and operation room have pushed anesthesiologists to consider lung-protective strategies during intraoperative ventilation. These strategies at least include the use of low V(T), and perhaps also the use of PEEP, which when compared to high V(T) with low PEEP may prevent the occurrence of postoperative pulmonary complications (PPCs). Such protective effects, however, are likely ascribed to low V(T) rather than to PEEP. In fact, at least in nonobese patients undergoing open abdominal surgery, high PEEP does not protect against PPCs, and it can impair the hemodynamics. Further studies shall determine whether a strategy consisting of low V(T) combined with PEEP and recruitment maneuvers reduces PPCs in obese patients and other types of surgery (e.g., laparoscopic and thoracic), compared to low V(T) with low PEEP. Furthermore, the role of driving pressure for titrating ventilation settings in patients with uninjured lungs shall be investigated. PMID:26643098
Sanie, Mohammad Sadegh; Kalani, Navid; Ghobadifar, Mohamed Amin; Zabetian, Hassan; Hosseini, Mehdi
Background Postoperative shivering is a major problem in children undergoing general anesthesia. Objectives The aim of the present study was to investigate the role of low-dose intravenous ketamine for prevention of shivering after induction of general anesthesia in children who had undergone tonsillectomy. Patients and Methods This was a randomized, double-blinded, placebo-controlled trial including 80 children, of American society of anesthesiologists (ASA) physical status I or II, scheduled for tonsillectomy under general anesthesia who were randomly assigned to an intravenous ketamine (0.5 mg/kg, n = 40; group K) group or matched dose placebo (n = 40; group N) group. Surgical and demographic data, unexpected side effects, and the occurrence of shivering for each child were assessed by a blinded observer at the following time points: T0, in the recovery room; T10, at 10 minutes; T20, at 20 minutes; T30, and at 30 minutes. Results With regards to the demographic and surgical data, no significant differences between the two study groups were observed (P ≥ 0.05). Shivering intensity in children who had received ketamine was significantly lower than children who had not received ketamine, at T0, T10, T20, and T30 after arrival (P < 0.05). There were no significant differences in hallucination, nausea, vomiting, hemodynamic dysfunction, blurred vision, and seizure in the K group compared with the N group (P ≥ 0.05). Conclusions Administration of intravenous ketamine at a dosage of 0.5 mg/kg immediately after anesthesia induction had a preventive effect on shivering intensity without hemodynamic alterations in children undergoing general anesthesia for tonsillectomy.
Lazarou, George; Mondesir, Carlene; Wei, Kai; Khullar, Poonan; Ogden, Lorna
Objectives: To compare the potential for postoperative laparoscopic adhesion formation utilizing either monopolar cautery or ultrasonic energy and to determine whether there is added benefit with the addition of a suspension of hyaluronate/carboxymethylcellulose in saline versus saline alone. Methods: Injuries were induced in rabbits by using monopolar cautery on 1 uterine horn and adjacent sidewall and ultrasonic energy on the opposite. Hyaluronate/ carboxymethylcellulose or saline was added to every other animal. Autopsies were performed after 3 weeks. Clinical and pathologic scoring of adhesions was performed by blinded investigators. Results: A very significant difference occurred in pathologic adhesion scores favoring the ultrasonic scalpel when the animals were treated with saline. However, a borderline significant difference was found in pathologic scores favoring the ultrasonic scalpel compared to the monopolar cautery. There was no significant difference in clinical adhesion scores between the 2 modalities. No significant difference in either score was found with the addition of hyaluronate/carboxymethylcellulose or saline with either instrument. Conclusion: No benefit was found for adhesion prevention with hyaluronate/carboxymethylcellulose. Although no reduction was achieved in clinical adhesions, the ultrasonic scalpel resulted in fewer histologic signs of tissue inflammation in the early postoperative period, suggesting that further clinical adhesions might develop over time with cautery. PMID:21985723
Fu, Bingmei M.; Yang, Jinlin; Cai, Bin; Fan, Jie; Zhang, Lin; Zeng, Min
Tumor cell adhesion to the microvessel wall is a critical step during tumor metastasis. Vascular endothelial growth factor (VEGF), a secretion of tumor cells, can increase microvessel permeability and tumor cell adhesion in the microvessel. To test the hypothesis that inhibiting permeability increase can reduce tumor cell adhesion, we used in vivo fluorescence microscopy to measure both microvessel permeability and adhesion rates of human mammary carcinoma MDA-MB-231 cells in post-capillary venules of rat mesentery under the treatment of VEGF and a cAMP analog, 8-bromo-cAMP, which can decrease microvessel permeability. By immunostaining adherens junction proteins between endothelial cells forming the microvessel wall, we further investigated the structural mechanism by which cAMP abolishes VEGF-induced increase in microvessel permeability and tumor cell adhesion. Our results demonstrate that 1) Pretreatment of microvessels with cAMP can abolish VEGF-enhanced microvessel permeability and tumor cell adhesion; 2) Tumor cells prefer to adhere to the endothelial cell junctions instead of cell bodies; 3) VEGF increases microvessel permeability and tumor cell adhesion by compromising endothelial junctions while cAMP abolishes these effects of VEGF by reinforcing the junctions. These results suggest that strengthening the microvessel wall integrity can be a potential approach to inhibiting hematogenous tumor metastasis.
Chen, Guojing; Liu, Tao
The present preliminary study was to observe the feasibility of the use of polylactic acid gel (PLA-G) in modified radical mastectomy and the ability of the PLA-G in the prevention of flap adhesion after operation. Sixty-eight patients were diagnosed with breast cancer, and received modified radical mastectomy from Jan. 2004 to Dec. 2006. The patients were divided randomly into a treatment group and a control group (with 34 cases each). The PLA-G was used under the surface of the auxiliary operative wound in the treatment group, and nothing was used in the control group. The wound healing, the wound complication, the amount of drainage solution, the indwelling time of the drainage tube and the auxiliary skin adhesion were evaluated after operation in both groups. There were no statistical difference on wound healing between the first intension (29:27) and the second intention (5:7), and the wound dehiscence after taking the stitches out (0:0) between the two intensions, the hematoma (0:1) and the effusion of the wound (5:6), and the flap necrosis (1:2) between two groups. There were also no statistical difference on the amount of drainage solution per day (6 +/- 3) and indwelling time of the drainage tube (6 +/- 4) after operation between the two groups (P > 0.5). After the operation, the case load with no flap adhesion in the treatment group was significant higher compared with the control group (22:8). The case load with complete acquired skin flap adhesion in the treatment group was visibly lower than in the control group (3:19), which proved that there was a significant statistical difference between the two groups (P < 0.05). This study suggested that the using of PLA-G in the breast cancer modified radical mastectomy could prevent skin flap adhesion without any harmful effects in the wound healing. PMID:24645611
Yuan, Fang; Lin, Long-Xiang; Zhang, Hui-Hui; Huang, Dan; Sun, Yu-Long
Adhesions often occur after abdominal surgery. It could cause chronic pelvic pain, intestinal obstruction, and infertility. A hydrogel biomaterial, carbodiimide-derivatized hyaluronic acid gelatin (cd-HA gelatin), has been successfully used to reduce adhesion formation after flexor tendon grafting. This study investigated the efficacy of cd-HA gelatin in preventing postsurgical peritoneal adhesions in a rat model. The surgical traumas were created on the underlying muscle of the abdominal wall and the serosal layer of the cecum. The wounds were covered with or without cd-HA gelatin. Animals were euthanized at day 14 after surgery. Adhesion formation was assessed with adhesion degree and adhesion breaking strength. The healing of abdominal wall was evaluated with biomechanical testing and histological analysis. The adhesions occurred in all rats (n = 12) without cd-HA gelatin treatment. The application of cd-HA gelatin significantly reduced the adhesion rate from 100% to 58%. The decrease of adhesion breaking strength also manifested that cd-HA gelatin could reduce postsurgical intra-abdominal adhesion formation. Moreover, it was found that cd-HA gelatin was a safe material and could promote tissue healing. The cd-HA gelatin hydrogel could reduce the formation of intra-abdominal adhesions without adversely effects on wound healing. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 1175-1181, 2016. PMID:26749008
Munro, G H; Evans, P; Todryk, S; Buckett, P; Kelly, C G; Lehner, T
Attachment of Streptococcus mutans to the tooth surface involves a cell surface protein with an M(r) of 185,000, termed streptococcal antigen (SA) I/II. Four overlapping fragments of the gene encoding SA I/II were amplified by polymerase chain reaction, cloned, and expressed in Escherichia coli. The recombinant polypeptides were assayed for adhesion-binding activity to salivary receptors and for recognition by a panel of monoclonal antibodies (MAbs) raised against SA I/II. Two of the MAbs which are known to prevent colonization of S. mutans in vivo bound the recombinant polypeptide comprising residues 816 to 1161. In vitro adhesion of S. mutans to saliva-coated hydroxyapatite beads was also inhibited specifically by a polypeptide (residues 816 to 1213) encompassing the same region. The evidence from the MAbs preventing colonization of S. mutans and the adherence inhibition assay suggests that an adhesion-binding activity resides within the portion of SA I/II comprising residues 816 to 1213, which is highly conserved among oral streptococcal species. Images PMID:7691754
Kawashima, Tetsuo; Takeuchi, Shingo; Usuda, Jitsuo
Background Postoperative recurrent pneumothorax (PORP) can arise after surgery for primary spontaneous pneumothorax (PSP) that is recurrent or involves prolonged air leakage. In this study, which included 265 patients (279 cases) with PSP who underwent surgery at our department, the percentage of patients that did not experience PORP was compared between a group that underwent bullectomy alone (group A) and a group in which the staple line and the surrounding visceral pleura were covered with a PGA sheet after bullectomy (group B) in order to study the utility of PGA sheets for preventing PORP. Methods Among the patients with PSP who underwent surgery, the cases of 92 patients (98 cases) from Group A and 173 patients (181 cases) from Group B were reviewed retrospectively. The incidence rates of PORP in these two groups were statistically analyzed in addition to the associations between PORP and age, gender, the affected side, height, body weight, height/weight ratio, smoking habits, or the surgical procedure. Results In total, 96.7% of the patients in group B did not suffer PORP, which was significantly higher than the equivalent figure for group A (83.7%, log-rank test: P=0.0003). Moreover, among the examined parameters, only covering the staple line with a PGA sheet was found to be an independent prognostic factor (Cox regression: P=0.0003; HR =0.212; 95% CI, 0.082-0.547). Conclusions It was revealed that when bullectomy is performed in patients with PSP, wide coverage of the staple line and the surrounding visceral pleura with a PGA sheet significantly reduces the risk of PORP. PMID:26716036
Chung, Dominic W; Chen, Junmei; Ling, Minhua; Fu, Xiaoyun; Blevins, Teri; Parsons, Scott; Le, Jennie; Harris, Jeff; Martin, Thomas R; Konkle, Barbara A; Zheng, Ying; López, José A
The ability of von Willebrand factor (VWF) to initiate platelet adhesion depends on the number of monomers in individual VWF multimers and on the self-association of individual VWF multimers into larger structures. VWF self-association is accelerated by shear stress. We observed that VWF self-association occurs during adsorption of VWF onto surfaces, assembly of secreted VWF into hyperadhesive VWF strings on the endothelial surface, and incorporation of fluid-phase VWF into VWF fibers. VWF adsorption under static conditions increased with increased VWF purity and was prevented by a component of plasma. We identified that component as high-density lipoprotein (HDL) and its major apolipoprotein ApoA-I. HDL and ApoA-I also prevented VWF on the endothelium from self-associating into longer strands and inhibited the attachment of fluid-phase VWF onto vessel wall strands. Platelet adhesion to VWF fibers was reduced in proportion to the reduction in self-associated VWF. In a mouse model of thrombotic microangiopathy, HDL also largely prevented the thrombocytopenia induced by injection of high doses of human VWF. Finally, a potential role for ApoA-I in microvascular occlusion associated with thrombotic thrombocytopenic purpura and sepsis was revealed by the inverse relationship between the concentration of ApoA-I and that of hyperadhesive VWF. These results suggest that interference with VWF self-association would be a new approach to treating thrombotic disorders. PMID:26552698
Kavic, Suzanne M.
Background: Adhesions commonly result from abdominal and pelvic surgical procedures and may result in intestinal obstruction, infertility, chronic pain, or complicate subsequent operations. Laparoscopy produces less peritoneal trauma than does conventional laparotomy and may result in decreased adhesion formation. We present a review of the available data on laparoscopy and adhesion formation, as well as laparoscopic adhesiolysis. We also review current adjuvant techniques that may be used by practicing laparoscopists to prevent adhesion formation. Database: A Medline search using “adhesions,” “adhesiolysis,” and “laparoscopy” as key words was performed for English-language articles. Further references were obtained through cross-referencing the bibliography cited in each work. Discussion: The majority of studies indicate that laparoscopy may reduce postoperative adhesion formation relative to laparotomy. However, laparoscopy by itself does not appear to eliminate adhesions completely. A variety of adjuvant materials are available to surgeons, and the most recent investigation has demonstrated significant potential for intraperitoneal barriers. Newer technologies continue to evolve and should result in clinically relevant reductions in adhesion formation. PMID:12113430
Farias, David; Walter, Ricardo; Swift, Edward J
Postoperative sensitivity is characterized by short and sharp pain, and often experienced after cementation of indirect restorations. Factors associated with the occurrence of post-cementation sensitivity include type of cement, removal of smear layer by acid-etching, aggressive tooth preparation, inadequate provisional restorations, and patient's age. Its prevention is based on either interfering with mechanoreceptor activity or occluding the dentinal tubules. Regarding the latter, application of dentin desensitizers may be effective for blocking the tubules and significantly reducing dentin permeability and consequently postoperative sensitivity. This Critical Appraisal will present available clinical data where traditional materials such as zinc phosphate and glass ionomer cements (GIC) as well as self-adhesive resin-based cements were used. PMID:24761824
Ntourakis, Dimitrios; Katsimpoulas, Michail; Tanoglidi, Anna; Barbatis, Calypso; Karayannacos, Panayotis E; Sergentanis, Theodoros N; Kostomitsopoulos, Nikolaos; Machairas, Anastasios
Background Postoperative adhesions are the result of aberrant peritoneal healing. As they are the leading cause of postoperative bowel obstruction, anti-adherence barriers are advocated for their prevention. This study looks into the effect of these biomaterials on the healing of intestinal anastomoses. Materials and Methods Thirty-three New Zealand White rabbits underwent laparotomy, transection of the terminal ileum, and creation of an end-to-end anastomosis. Animals were randomized into 3 groups: the Control group (n = 11); the Icodextrin group, receiving icodextrin 4% intraperitonealy (n = 11); and the HA/CMC group, having the anastomosis wrapped with a hyaluronic acid/carboxymethylcellulose film (n = 11). All animals were sacrificed on the seventh postoperative day. Macroscopic adhesions were graded and anastomotic strength was tested by the burst pressure. Histological healing was assessed in a semiquantitative way for the presence of ulceration, reepithelization, granulation tissue, inflammation, eosinophilic infiltration, serosal inflammation, and microscopic adhesions. Univariate and multivariate analysis was used. Results are given as medians with interquartile range. Results The median adhesion scores were the following: Control 1 (0-3), Icodextrin 0 (0-1), HA/CMC 0 (0-0), P = .017. The burst pressure did not differ between the groups; however, all except one bowel segments tested burst away from the anastomosis. The macroscopic and histological anastomotic healing was comparable in all 3 groups. A poor histological anastomotic healing score was associated with a higher adhesion grade (odds ratio = 1.92; 95% confidence interval = 1.06-3.47; P = .032). Conclusion Adhesion formation was inhibited by the materials tested without direct detrimental effects on anastomotic healing. Poor anastomotic healing provokes adhesions even in the presence of anti-adhesion barriers. PMID:26474604
Lagares, David; Busnadiego, Oscar; García-Fernández, Rosa Ana; Kapoor, Mohit; Liu, Shangxi; Carter, David E.; Abraham, David; Shi-Wen, Xu; Carreira, Patricia; Fontaine T, Benjamin A; Shea, Barry S; Tager, Andrew M; Leask, Andrew; Lamas, Santiago; Rodríguez-Pascual, Fernando
Objective Enhanced adhesive signaling including activation of the focal adhesion kinase (FAK) is a hallmark of fibroblasts from lung fibrosis patients, and FAK has been therefore hypothesized to be a key mediator of this disease. This study was undertaken to characterize the contribution of FAK to the development of pulmonary fibrosis both in vivo and in vitro. Methods FAK expression and activity were analyzed in lung tissue samples from lung fibrosis patients by immunohistochemistry. Mice orally treated with the FAK inhibitor, PF-562,271, or with siRNA-mediated silencing of FAK, were exposed to intratracheally instilled bleomycin to induce lung fibrosis, and the lungs were harvested for histological and biochemical analysis. Using endothelin-1 (ET-1) as stimulus, cell adhesion and contraction, as well as profibrotic gene expression were studied in fibroblasts isolated from wild type and FAK-deficient mouse embryos. ET-1-mediated FAK activation and gene expression were studied in primary mouse lung fibroblasts, as well as in wild type and integrin β1-deficient fibroblasts. Results Increased FAK expression and activity are upregulated in fibroblast foci and remodeled vessels in lung fibrosis patients. Pharmacological or siRNA-mediated targeting of FAK resulted in marked abrogation of bleomycin-induced lung fibrosis. Loss of FAK impaired the acquisition of a profibrotic phenotype in response to ET-1. Profibrotic gene expression leading to myofibroblast differentiation required cell adhesion, and was driven by Jun N-terminal kinase activation through integrin β1/FAK signaling. Conclusion These results implicate FAK as a central mediator of fibrogenesis, and highlight this kinase as a potential therapeutic target in fibrotic diseases. PMID:22492165
Background Esophageal resection is associated with a high incidence of postoperative pneumonia. Respiratory complications account for almost half of the readmissions to the critical care unit. Postoperative complications can result in prolonged hospital stay and consequently increase healthcare costs. In cardiac surgery a preoperative inspiratory muscle training program has shown to prevent postoperative pneumonia and reduce length of hospital stay. While in some surgical centers inspiratory muscle training is already used in the preoperative phase in patients undergoing esophageal resection, the added value of this intervention on the reduction of pulmonary complications has not yet been investigated in large surgical populations other than cardiac surgery in a randomized and controlled study design. Methods/Design The effect of a preoperative inspiratory muscle training program on the incidence of postoperative pneumonia in patients undergoing esophageal resection will be studied in a single blind multicenter randomized controlled trial (the PREPARE study). In total 248 patients (age >18 years) undergoing esophageal resection for esophageal cancer will be included in this study. They are randomized to either usual care or usual care with an additional inspiratory muscle training intervention according to a high-intensity protocol which is performed with a tapered flow resistive inspiratory loading device. Patients have to complete 30 dynamic inspiratory efforts twice daily for 7 days a week until surgery with a minimum of 2 weeks. The starting training load will be aimed to be 60% of maximal inspiratory pressure and will be increased based on the rate of perceived exertion. The main study endpoint is the incidence of postoperative pneumonia. Secondary objectives are to evaluate the effect of preoperative inspiratory muscle training on length of hospital stay, duration of mechanical ventilation, incidence of other postoperative (pulmonary) complications
Brassard, J D; Sarkar, D K; Perron, J; Audibert-Hayet, A; Melot, D
Thin films of zinc have been deposited on steel substrates by electrodeposition process and further functionalized with ultra-thin films of commercial silicone rubber, in order to obtain superhydrophobic properties. Morphological feature, by scanning electron microscope (SEM), shows that the electrodeposited zinc films are composed of micro-nano rough patterns. Furthermore, chemical compositions of these films have been analyzed by X-ray diffraction (XRD) and infra-red (IRRAS). An optimum electrodeposition condition, based on electrical potential and deposition time, has been obtained which provides superhydrophobic properties with a water contact angle of 155±1°. The corrosion resistance properties, in artificial seawater, of the superhydrophobic zinc coated steel are found to be superior to bare steel. Similarly, the measured ice adhesion strength on superhydrophobic surfaces, using the centrifugal adhesion test (CAT), is found to be 6.3 times lower as compared to bare steel. This coating has promising applications in offshore environment, to mitigate corrosion and reduce ice adhesion. PMID:25529334
Jang, Kee W.; Buckwalter, Joseph A.; Martin, James A.
Focal adhesions are transmembrane protein complexes that attach chondrocytes to the pericellular cartilage matrix and in turn, are linked to intracellular organelles via cytoskeleton. We previously found that excessive compression of articular cartilage leads to cytoskeleton-dependent chondrocyte death. Here we tested the hypothesis that this process also requires integrin activation and signaling via focal adhesion kinase (FAK) and Src family kinase (SFK). Osteochondral explants were treated with FAK and SFK inhibitors (FAKi, SFKi respectively) for 2 hours and then subjected to a death-inducing impact load. Chondrocyte viability was assessed by confocal microscopy immediately and at 24 hours post-impact. With no treatment immediate post-impact viability was 59%. Treatment with 10μM SFKi, 10μM or 100μM FAKi improved viability to 80%, 77%, and 82% respectively (p<0.05). After 24 hours viability declined to 34% in controls, 48% with 10μM SFKi, 45% with 10μM FAKi, and 56% with 100μM FAKi (p<0.01) treatment. These results confirmed that most of the acute chondrocyte mortality was FAK- and SFK-dependent, which implicates integrin-cytoskeleton interactions in the death signaling pathway. Together with previous findings, these data support the hypothesis that the excessive tissue strains accompanying impact loading induce death via a pathway initiated by strain on cell adhesion receptors. PMID:24249698
Pawar, Abhijit Yuvaraj; Biswas, Samar Kumar
Postoperative spinal wound infection increases the morbidity of the patient and the cost of healthcare. Despite the development of prophylactic antibiotics and advances in surgical technique and postoperative care, wound infection continues to compromise patient outcome after spinal surgery. Spinal instrumentation also has an important role in the development of postoperative infections. This review analyses the risk factors that influence the development of postoperative infection. Classification and diagnosis of postoperative spinal infection is also discussed to facilitate the choice of treatment on the basis of infection severity. Preventive measures to avoid surgical site (SS) infection in spine surgery and methods for reduction of all the changeable risk factors are discussed in brief. Management protocols to manage SS infections in spine surgery are also reviewed. PMID:26949475
Biswas, Samar Kumar
Postoperative spinal wound infection increases the morbidity of the patient and the cost of healthcare. Despite the development of prophylactic antibiotics and advances in surgical technique and postoperative care, wound infection continues to compromise patient outcome after spinal surgery. Spinal instrumentation also has an important role in the development of postoperative infections. This review analyses the risk factors that influence the development of postoperative infection. Classification and diagnosis of postoperative spinal infection is also discussed to facilitate the choice of treatment on the basis of infection severity. Preventive measures to avoid surgical site (SS) infection in spine surgery and methods for reduction of all the changeable risk factors are discussed in brief. Management protocols to manage SS infections in spine surgery are also reviewed. PMID:26949475
MacLennan, I.; Keys, H.M.; Evarts, C.M.; Rubin, P.
Heterotopic ossification is a complication of total hip arthroplasty in 14 to 30% of patients. Significant functional impairment will occur in up to 28% of patients with ectopic bone. The high risk group includes those with preexisting heterotopic bone in either hip, those suffering from hypertrophic osteoarthritis or ankylosing spondylitis and patients who have had multiple procedures on the hip. Fifty-eight patients (67 hips) were irradiated after surgical removal of ectopic bone (53 hips) or received radiation prophylaxis of heterotopic ossification (14 hips). Ninety-five percent of patients had either no bone visible or insignificant amounts of ectopic bone visible on postoperative hip X-rays. Only 5% of patients showed significant persistence of ectopic bone. Postoperative hip function was dramatically improved compared to preoperative function in all patients treated. The importance of early commencement of irradiation is emphasized.
Larsen, K R; Ingwersen, U; Bertelsen, M T; Kiil-Nielsen, K; Laub, M S; Bach, K S; Hansen, K H; Sandermann, J
The object of the investigation was to compare the effect of three different physiotherapy masks on the incidence of postoperative complications after thoracic surgery. It was carried out as a prospective, consecutive, randomized comparison at a Department of Thoracic and Heart Surgery at a University Hospital. The therapy was performed by experienced and specially trained physiotherapists. One hundred and sixty patients were evaluated; 60 patients undergoing heart surgery, 59 patients having pulmonary resection, and 41 patients with exploratory thoracotomy. In each operative category the patients were treated with one of three face mask systems used in addition to routine chest physiotherapy. These were either continuous positive airway pressure (CPAP), positive expiratory pressure (PEP), or inspiratory resistance--positive expiratory pressure (IR-PEP). Postoperative pulmonary complications were assessed by forced vital capacity (FVC), arterial oxygen tension (PaO2), and chest X-ray examination, all parameters were measured preoperatively and on the fourth and ninth postoperative day. The patients filled in a questionnaire concerning their opinions about their mask treatment. IR-PEP showed a lesser decrease in PaO2 on day nine. Otherwise there was an equal decrease in FVC and PaO2, and equal frequency of atelectasis in the three mask treatments. It is therefore concluded that any of the three therapies: continuous positive airway pressure (CPAP), positive expiratory pressure (PEP), and inspiratory resistance--positive expiratory pressure (IR-PEP) may be used as supplement to standard chest physiotherapy. PMID:7985254
Shin, Yong Cheol; Yang, Won Jun; Lee, Jong Ho; Oh, Jin-Woo; Kim, Tai Wan; Park, Jong-Chul; Hyon, Suong-Hyu; Han, Dong-Wook
This study concentrates on the development of biodegradable nanofiber membranes with controlled drug release to ensure reduced tissue adhesion and accelerated healing. Nanofibers of poly(lactic-co-glycolic acid) (PLGA) loaded with epigallocatechin-3-O-gallate (EGCG), the most bioactive polyphenolic compound in green tea, were electrospun. The physicochemical and biomechanical properties of EGCG-releasing PLGA (E-PLGA) nanofiber membranes were characterized by atomic force microscopy, EGCG release and degradation profiles, and tensile testing. In vitro antioxidant activity and hemocompatibility were evaluated by measuring scavenged reactive oxygen species levels and activated partial thromboplastin time, respectively. In vivo antiadhesion efficacy was examined on the rat peritonea with a surgical incision. The average fiber diameter of E-PLGA membranes was approximately 300–500 nm, which was almost similar to that of pure PLGA equivalents. E-PLGA membranes showed sustained EGCG release mediated by controlled diffusion and PLGA degradation over 28 days. EGCG did not adversely affect the tensile strength of PLGA membranes, whereas it significantly decreased the elastic modulus and increased the strain at break. E-PLGA membranes were significantly effective in both scavenging reactive oxygen species and extending activated partial thromboplastin time. Macroscopic observation after 1 week of surgical treatment revealed that the antiadhesion efficacy of E-PLGA nanofiber membranes was significantly superior to those of untreated controls and pure PLGA equivalents, which was comparable to that of a commercial tissue-adhesion barrier. In conclusion, the E-PLGA hybrid nanofiber can be exploited to craft strategies for the prevention of postsurgical adhesions. PMID:25187710
Finke, B.; Testrich, H.; Rebl, H.; Walschus, U.; Schlosser, M.; Zietz, C.; Staehlke, S.; Nebe, J. B.; Weltmann, K. D.; Meichsner, J.; Polak, M.
The design of a titanium implant surface should ideally support its later application in clinical use. Temporarily used implants have to fulfil requirements different from permanent implants: they should ensure the mechanical stabilization of the bone stock but in trauma surgery they should not be integrated into the bone because they will be removed after fracture healing. Finishing of the implant surface by a plasma-fluorocarbon-polymer (PFP) coating is a possible approach for preventing cell adhesion of osteoblasts. Two different low pressure gas-discharge plasma processes, microwave (MW 2.45 GHz) and capacitively coupled radio frequency (RF 13.56 MHz) plasma, were applied for the deposition of the PFP film using a mixture of the precursor octafluoropropane (C3F8) and hydrogen (H2). The thin films were characterized by x-ray photoelectron spectroscopy, Fourier transform infrared reflection absorption spectroscopy, and water contact angle measurements. Cell culture experiments show that cell adhesion and spreading of MG-63 osteoblasts were clearly reduced or nonexistent on these surfaces, also after 24 h of storage in the cell culture medium. In vivo data demonstrated that the local inflammatory tissue response for the PFP films deposited in MW and RF plasma were comparable to uncoated controls.
Totani, Masayasu; Terada, Kayo; Terashima, Takaya; Kim, Ill Yong; Ohtsuki, Chikara; Xi, Chuanwu; Tanihara, Masao
We demonstrate utilization of star-shaped polymers as high-density polymer brush coatings and their effectiveness to inhibit the adhesion of platelets and bacteria. Star polymers consisting of poly(2-hydroxyethyl methacrylate) (PHEMA) and/or poly(methyl methacrylate) (PMMA), were synthesized using living radical polymerization with a ruthenium catalyst. The polymer coatings were prepared by simple drop casting of the polymer solution onto poly(ethylene terephthalate) (PET) surfaces and then dried. Among the star polymers prepared in this study, the PHEMA star polymer (star-PHEMA) and the PHEMA/PMMA (mol. ratio of 71/29) heteroarm star polymer (star-H71M29) coatings showed the highest percentage of inhibition against platelet adhesion (78–88% relative to noncoated PET surface) and Escherichia coli (94–97%). These coatings also showed anti-adhesion activity against platelets after incubation in Dulbecco's phosphate buffered saline or surfactant solution for 7 days. In addition, the PMMA component of the star polymers increased the scratch resistance of the coating. These results indicate that the star-polymer architecture provides high polymer chain density on PET surfaces to prevent adhesion of platelets and bacteria, as well as coating stability and physical durability to prevent exposure of bare PET surfaces. The star polymers provide a simple and effective approach to preparing anti-adhesion polymer coatings on biomedical materials against the adhesion of platelets and bacteria. PMID:25485105
Totani, Masayasu; Ando, Tsuyoshi; Terada, Kayo; Terashima, Takaya; Kim, Ill Yong; Ohtsuki, Chikara; Xi, Chuanwu; Kuroda, Kenichi; Tanihara, Masao
We demonstrate utilization of star-shaped polymers as high-density polymer brush coatings and their effectiveness to inhibit the adhesion of platelets and bacteria. Star polymers consisting of poly(2-hydroxyethyl methacrylate) (PHEMA) and/or poly(methyl methacrylate) (PMMA), were synthesized using living radical polymerization with a ruthenium catalyst. The polymer coatings were prepared by simple drop casting of the polymer solution onto poly(ethylene terephthalate) (PET) surfaces and then dried. Among the star polymers prepared in this study, the PHEMA star polymer (star-PHEMA) and the PHEMA/PMMA (mol. ratio of 71/29) heteroarm star polymer (star-H71M29) coatings showed the highest percentage of inhibition against platelet adhesion (78-88% relative to noncoated PET surface) and Escherichia coli (94-97%). These coatings also showed anti-adhesion activity against platelets after incubation in Dulbecco's phosphate buffered saline or surfactant solution for 7 days. In addition, the PMMA component of the star polymers increased the scratch resistance of the coating. These results indicate that the star-polymer architecture provides high polymer chain density on PET surfaces to prevent adhesion of platelets and bacteria, as well as coating stability and physical durability to prevent exposure of bare PET surfaces. The star polymers provide a simple and effective approach to preparing anti-adhesion polymer coatings on biomedical materials against the adhesion of platelets and bacteria. PMID:25485105
Moon, Soo Yeong; Song, Dong Un; Lee, Ki Hyun; Song, Jae Wook; Kwon, Young Eun
Background Postoperative nausea and vomiting (PONV) are common complications after anesthesia and surgery. This study was designed to compare the effects of palonosetron and ondansetron in preventing PONV in high-risk patients receiving intravenous opioid-based patient-controlled analgesia (IV-PCA) after gynecological laparoscopic surgery. Methods One hundred non-smoking female patients scheduled for gynecological laparoscopic surgery were randomly assigned into the palonosetron group (n = 50) or the ondansetron group (n = 50). Palonosetron 0.075 mg was injected as a bolus in the palonosetron group. Ondansetron 8 mg was injected as a bolus and 16 mg was added to the IV-PCA in the ondansetron group. The incidences of nausea, vomiting and side effects was recorded at 2 h, 24 h, 48 h and 72 h, postoperatively. Results There were no significant differences between the groups in the incidence of PONV during 72 h after operation. However, the incidence of vomiting was lower in the palonosetron group than in the ondansetron group (18% vs. 4%, P = 0.025). No differences were observed in use of antiemetics and the side effects between the groups. Conclusions The effects of palonosetron and ondansetron in preventing PONV were similar in high-risk patients undergoing gynecological laparoscopic surgery and receiving opioid-based IV-PCA. PMID:23459499
Shende, Dilip; Kumar, Neeraj; Ray, Bikash Ranjan; Mohan, Virender Kumar
Aim. Efficacy of granisetron and combination of granisetron and dexamethasone was evaluated for prevention of postoperative nausea and vomiting (PONV) in children undergoing elective strabismus surgery. Methods. A total of 136 children (1–15 years) were included. Children received either granisetron (40 mcg/kg) [group G] or combination of granisetron (40 mcg/kg) and dexamethasone (150 mcg/kg) [group GD]. Intraoperative fentanyl requirement and incidence and severity of oculocardiac reflex were assessed. PONV severity was assessed for first 24 hours and if score was >2, it was treated with metoclopramide. Postoperative analgesia was administered with intravenous fentanyl and ibuprofen. Results. The demographic profile, muscles operated, and fentanyl requirement were comparable. Complete response to PONV in first 24 hours was observed in 75% (51/68) of children in group G and 76.9% (50/65) of children in group GD, which was comparable statistically (p = 0.96, Fisher exact test; OR 1.11, 95% CI 0.50, 2.46). Incidence of PONV between 0 and 24 hours was comparable. One child in group G required rescue antiemetic in first 24 hours and none of the children had severe PONV in group GD. There was no significant difference in incidence or severity of oculocardiac reflex. Conclusion. Dexamethasone did not increase efficacy of granisetron for prevention of PONV in elective pediatric strabismus surgery. Registration number of clinical trial was CTRI/2009/091/001000. PMID:26925101
Park, Seong Yong; Lee, Hyun-Sung; Jang, Hee-Jin; Joo, Jungnam; Zo, Jae Ill
OBJECTIVES Respiratory failure from acute lung injury (ALI), acute respiratory distress syndrome (ARDS) and pneumonia are the major cause of morbidity and mortality following an oesophagectomy for oesophageal cancer. This study was performed to investigate whether an intraoperative corticosteroid can attenuate postoperative respiratory failure. METHODS Between November 2005 and December 2008, 234 consecutive patients who underwent an oesophagectomy for oesophageal cancer were reviewed. A 125-mg dose of methylprednisolone was administered after performing the anastomosis. ALI, ARDS and pneumonia occurring before postoperative day (POD) 7 were regarded as acute respiratory failure. RESULT The mean age was 64.2 ± 8.7 years. One hundred and fifty-one patients were in the control group and 83 patients in the steroid group. Patients' characteristics were comparable. The incidence of acute respiratory failure was lower in the steroid group (P = 0.037). The incidences of anastomotic leakage and wound dehiscence were not different (P = 0.57 and P = 1.0). The C-reactive protein level on POD 2 was lower in the steroid group (P < 0.005). Multivariate analysis indicates that the intraoperative steroid was a protective factor against acute respiratory failure (P = 0.046, OR = 0.206). CONCLUSIONS Intraoperative corticosteroid administration was associated with a decreased risk of acute respiratory failure following an oesophagectomy. The laboratory data suggest that corticosteroids may attenuate the stress-induced inflammatory responses after surgery. PMID:22745302
Bopp, Eric J; Estrada, T Jose L; Kilday, Jeremy M; Spradling, James C; Daniel, Carole; Pellegrini, Joseph E
The purpose of this study was to determine if giving 50 mg of meclizine the night before and on the day of surgery would effectively reduce postoperative nausea and vomiting (PONV) for the entire 24 hours after surgery in patients identified as being at high risk for PONV Subjects were randomly assigned to receive either 50 mg of oral meclizine (experimental group) or a placebo (control group) the night before and the day of surgery. All subjects were intravenously administered 4 mg of ondansetron before the conclusion of surgery. Seventy subjects (35 control; 35 experimental) were included in analysis. postoperaIn the placebo group we noted higher verbal numeric rating scale scores for nausea, a higher incidence oftive nausea and vomiting (PONV) continues to be a common complication after general anesthesia, with the incidence ranging from 17% to 87%.15 It has been reported that PONV increased antiemetic requirements, and lower overall anesthesia satisfaction scores at all time intervals measured, compared with the experimental group, but the differences were not statistically significant until analyzed by postoperative setting. No difference in sedation or side effects was noted between groups. Based on these results, we recommend that the administration of 50 mg of oral meclizine the night before and on the day of surgery be considered effective antiemetic prophylaxis in patients identified as having a high risk for PONV. PMID:20977130
Dai, Zhaoxing; Yu, Xiaobo; Hong, Jiaxu; Liu, Xi; Sun, Jianguo; Sun, Xinghuai
The formation of a scar after glaucoma surgery often leads to unsuccessful control of intraocular pressure, and should be prevented by using a variety of methods. We designed and developed a novel drug delivery system (DDS) comprising cyclosporine A (CsA) and poly(lactic-co-glycolic acid) (PLGA) based on a glaucoma drainage device (GDD) that can continuously release CsA to prevent postoperative fibrosis following glaucoma surgery. The CsA@PLGA@GDD DDS was observed by field emission scanning electron microscopy and revealed an asymmetric pore structure. Thermogravimetric analysis was performed to measure the weight loss and evaluate the thermal stability of the CsA@PLGA@GDD DDS. The in vitro drug release profile of the DDS was studied using high performance liquid chromatography, which confirmed that the DDS released CsA at a stable rate and maintained adequate CsA concentrations for a relatively long time. The biocompatibility of the DDS and the inhibitory effects on the postoperative fibrosis were investigated in vitro using rabbit Tenon's fibroblasts. The in vivo safety and efficacy of the DDS were examined by implanting the DDS into Tenon's capsules in New Zealand rabbits. Bleb morphology, intraocular pressure, anterior chamber reactions, and anterior chamber angiography were studied at a series of set times. The DDS kept the filtration pathway unblocked for a longer time compared with the control GDD. The results indicate that the CsA@PLGA@GDD DDS represents a safe and effective strategy for preventing scar formation after glaucoma surgery. PMID:27207056
Odeny, Thomas A.; Bailey, Robert C.; Bukusi, Elizabeth A.; Simoni, Jane M.; Tapia, Kenneth A.; Yuhas, Krista; Holmes, King K.; McClelland, R. Scott
Background Following male circumcision for HIV prevention, a high proportion of men fail to return for their scheduled seven-day post-operative visit. We evaluated the effect of short message service (SMS) text messages on attendance at this important visit. Methodology We enrolled 1200 participants >18 years old in a two-arm, parallel, randomized controlled trial at 12 sites in Nyanza province, Kenya. Participants received daily SMS text messages for seven days (n = 600) or usual care (n = 600). The primary outcome was attendance at the scheduled seven-day post-operative visit. The primary analysis was by intention-to-treat. Principal Findings Of participants receiving SMS, 387/592 (65.4%) returned, compared to 356/596 (59.7%) in the control group (relative risk [RR] = 1.09, 95% confidence interval [CI] 1.00–1.20; p = 0.04). Men who paid more than US$1.25 to travel to clinic were at higher risk for failure to return compared to those who spent ≤US$1.25 (adjusted relative risk [aRR] 1.35, 95% CI 1.15–1.58; p<0.001). Men with secondary or higher education had a lower risk of failure to return compared to those with primary or less education (aRR 0.87, 95% CI 0.74–1.01; p = 0.07). Conclusions Text messaging resulted in a modest improvement in attendance at the 7-day post-operative clinic visit following adult male circumcision. Factors associated with failure to return were mainly structural, and included transportation costs and low educational level. Trial Registration ClinicalTrials.gov NCT01186575 PMID:22957034
Konski, A.; Weiss, C.; Rosier, R.; Poulter, C.; Pelligrini, V.; Anthony, P.; Evarts, C.M.; Richardson, M.; Henzler, M.; Rubin, P. )
Radiation has been shown to be effective in the prevention of heterotopic bone. The exact etiology of heterotopic bone is unknown. Total hip prosthetic devices that do not depend upon bone cement for fixation have become increasingly popular. The mechanism by which the bone forms around the prosthesis is similar to the process by which fractures heal which has been shown to be sensitive to irradiation. Using a rabbit model we have undertaken a study to investigate the effect of irradiation on the bony ingrowth on porous coated implants. Forty-five rabbits had porous coated implants surgically placed in the tibiae bilaterally. Each rabbit had one tibia randomly irradiated with 1,000 cGy in 5 fractions starting on the first post-operative day. Animals were sacrificed weekly starting 2 weeks post-operatively and the tibae were sent for pullout studies. The amount of force necessary to pullout the treated tibae was statistically less than the amount of force necessary to remove the untreated tibae at 2 weeks. From 3 weeks on there was no difference in the force necessary to remove the prosthesis from the untreated or treated tibae. Histologically, the untreated tibae showed bone formation while the treated tibae did not. Because of these results, it is suggested that the treatment of patients at risk for development of heterotopic bone be modified to only include the area between the femur and pelvis avoiding treatment of the prosthetic device.
Pofahl, Walter E; Ramsey, Keith M; Nobles, Delores L; Cochran, M Kathy; Goettler, Claudia
Although infrequent, postoperative methicillin-resistant Staphylococcus aureus (MRSA) surgical site infection (SSI) is associated with significant morbidity and cost. Previous studies have identified the importance of MRSA screening to diminish the risk of postoperative MRSA SSI. The current study quantifies the importance of eradication of the MRSA carrier state to prevent MRSA SSI. Beginning February 2007, all admissions to an 800-bed tertiary care hospital were screened for MRSA by nasal swab using rapid polymerase chain reaction-based testing. Patients found to be nasal carriers of MRSA were treated with 2 per cent mupirocin nasal ointment and 4 per cent chlorhexidine soap before surgery. The subset of patients undergoing procedures that are part of the Surgical Care Improvement Project (SCIP) were followed for MRSA SSI (n = 8980). The results of preoperative MRSA screening and eradication of the carrier state were analyzed. Since the initiation of universal MRSA screening, 11 patients undergoing SCIP procedures have developed MRSA SSI (0.12%). Of these, six patients (55%) had negative preoperative screens. Of the five patients with positive preoperative screens, only one received treatment to eradicate the carrier state. In patients who develop MRSA SSI, failure to treat the carrier state before surgery results in MRSA SSI. PMID:21396301
Tsutsumi, Yasuo M.; Soga, Tomohiro; Hamaguchi, Eisuke; Tanaka, Katsuya
The incidence of postoperative nausea and vomiting (PONV) is 30–50% after surgery. PONV occurs frequently, especially after craniotomy. In this study, we investigated the preventive effects on PONV in a randomized study by comparing patients who had been administered fosaprepitant, a neurokinin-1 (NK1) receptor antagonist, or ondansetron intravenously. Sixty-four patients undergoing craniotomy were randomly allocated to receive fosaprepitant 150 mg i.v. (NK1 group, n = 32) or ondansetron 4 mg i.v. (ONS group, n = 32) before anesthesia. The incidence of vomiting was significantly less in the NK1 group, where 2 of 32 (6%) patients experienced vomiting compared to 16 of 32 (50%) patients in the ONS group during the first 24 and 48 hours following surgery. Additionally, the incidence of complete response (no vomiting and no rescue antiemetic use) was significantly higher in the NK1 group than in the ONS group, and was 66% versus 41%, respectively, during the first 24 hours, and 63% versus 38%, respectively, during the first 48 hours. In patients undergoing craniotomy, fosaprepitant is more effective than ondansetron in increasing the rate of complete response and decreasing the incidence of vomiting at 24 and 48 hours postoperatively. PMID:25050340
Muto, Jun; Mano, Yohei; Harada, Noboru; Uchiyama, Hideaki; Yoshizumi, Tomoharu; Taketomi, Akinobu; Shirabe, Ken; Maehara, Yoshihiko
Portal annular pancreas (PAP) is a rare variant in which the uncinate process of the pancreas extends to the dorsal surface of the pancreas body and surrounds the portal vein or superior mesenteric vein. Upon pancreaticoduodenectomy (PD), when the pancreas is cut at the neck, two cut surfaces are created. Thus, the cut surface of the pancreas becomes larger than usual and the dorsal cut surface is behind the portal vein, therefore pancreatic fistula after PD has been reported frequently. We planned subtotal stomach-preserving PD in a 45-year-old woman with underlying insulinoma of the pancreas head. When the pancreas head was dissected, the uncinate process was extended and fused to the dorsal surface of the pancreas body. Additional resection of the pancreas body 1 cm distal to the pancreas tail to the left side of the original resection line was performed. The new cut surface became one and pancreaticojejunostomy was performed as usual. No postoperative complications such as pancreatic fistula occurred. Additional resection of the pancreas body may be a standardized procedure in patients with PAP in cases of pancreas cut surface reconstruction. PMID:22532811
Forrester, Carrie M; Benfield, Dennis A; Matern, Christina E; Kelly, Joseph A; Pellegrini, Joseph E
Postoperative nausea and vomiting (PONV) is prevalent in surgical patients with known risk factors: general anesthesia, female, nonsmoker, motion sickness history, and PONV history. Common treatment involves ondansetron; however, the effects are short-lived, and supplemental medication may be required. Meclizine, a long-acting drug with a low side-effect profile, may be ideal in combination with ondansetron for at-risk patients. We randomized 77 subjects scheduled for general anesthesia and screened for 4 of 5 PONV risk factors for experimental or control group assignment. Severity of PONV was measured using a 0 to 10 verbal numeric rating scale (VNRS). Other measured variables included time to onset and incidence of PONV and total antiemetic requirements. No significant differences in demographics (excluding weight), surgical or anesthesia time, analgesic requirements, or nausea incidence in the postanesthesia care unit (PACU) and same-day surgery unit were noted. The meclizine group had lower VNRS scores in the PACU at 15 (P = .013) and 45 (P = .006) minutes following rescue treatment. The incidence of nausea was lower in the meclizine vs. placebo group (10% vs. 29%) following discharge (P = .038). Prophylactic meclizine resulted in lower incidence and severity of PONV in a high-risk population, especially after rescue treatment. PMID:17304780
Korell, Matthias; Ziegler, Nicole; De Wilde, Rudy Leon
Purpose. This study evaluates both scopes of 4DryField PH, certified for adhesion prevention and hemostasis, in patients undergoing surgery for various and severe gynecological disorders. Methods. This is a two-institutional study. Adhesion prevention efficacy was evaluated using video documentation of first-look laparoscopies (FLL) and second-look laparoscopies (SLL); other patient data were analyzed retrospectively. Twenty patients with various disorders were evaluated, 4 assigned to a uterus pathology, 10 to endometriosis, and 6 to an adhesion disease group. Nine patients received 4DryField primarily for hemostasis and 11 solely for adhesion prevention. Nineteen patients had SLL after 5 to 12 weeks and one after 13 months. Results. At FLL with 4DryField, immediate hemostasis could be achieved in diffuse bleeding. At SLL, effective adhesion prevention was observed in 18 of all 20 women, with only 2 revealing major adhesions. In particular, only 1 of the 6 women with adhesion disease as predominant disorder showed major adhesions at SLL. Conclusions. Modified polysaccharide 4DryField is not only effective in diffuse bleeding. In this cohort with extensive surgery for various gynecological pathologies, 4DryField showed effective adhesion prevention as confirmed at SLL, too. Its use as premixed gel is a convenient variant for treatment of large peritoneal wounds. PMID:26904672
Korell, Matthias; Ziegler, Nicole; De Wilde, Rudy Leon
Purpose. This study evaluates both scopes of 4DryField PH, certified for adhesion prevention and hemostasis, in patients undergoing surgery for various and severe gynecological disorders. Methods. This is a two-institutional study. Adhesion prevention efficacy was evaluated using video documentation of first-look laparoscopies (FLL) and second-look laparoscopies (SLL); other patient data were analyzed retrospectively. Twenty patients with various disorders were evaluated, 4 assigned to a uterus pathology, 10 to endometriosis, and 6 to an adhesion disease group. Nine patients received 4DryField primarily for hemostasis and 11 solely for adhesion prevention. Nineteen patients had SLL after 5 to 12 weeks and one after 13 months. Results. At FLL with 4DryField, immediate hemostasis could be achieved in diffuse bleeding. At SLL, effective adhesion prevention was observed in 18 of all 20 women, with only 2 revealing major adhesions. In particular, only 1 of the 6 women with adhesion disease as predominant disorder showed major adhesions at SLL. Conclusions. Modified polysaccharide 4DryField is not only effective in diffuse bleeding. In this cohort with extensive surgery for various gynecological pathologies, 4DryField showed effective adhesion prevention as confirmed at SLL, too. Its use as premixed gel is a convenient variant for treatment of large peritoneal wounds. PMID:26904672
Agarkar, Sandip; Chatterjee, Aparna S
Background and Aims: Post-operative nausea and vomiting (PONV) has an 80% incidence in high-risk patients. This is despite the availability of several antiemetic drugs. Selective 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists are considered first-line for prophylaxis, ondansetron being the most commonly used agent. Ramosetron, another selective 5-HT3 receptor antagonist, is more potent and longer acting than ondansetron. This study was conducted to evaluate the antiemetic efficacy of ramosetron in comparison with ondansetron in patients at a high risk of PONV. Methods: This was a prospective randomised double-blind study carried out over a 6-month period in which 206 patients with at least two risk factors for PONV were randomised to receive ramosetron 0.3 mg or ondansetron 8 mg, 30 min before the end of surgery. The incidence of PONV, severity of nausea and need for rescue antiemetic were recorded over the next 24 h. Primary outcome was the incidence of PONV. Secondary outcomes included severity of nausea and need for rescue. The data were analysed using the Predictive Analytics Software (PASW, version 18: Chicago, IL, USA). Results: The incidence of PONV was found to be 35% in the ramosetron group as opposed to 43.7% in the ondansetron group (P = 0.199). Need for rescue antiemetic was 23.3% in the ramosetron group and 32% in the ondansetron group (P = 0.156) in the 24 h following surgery. Conclusion: Ramosetron 0.3 mg and ondansetron 8 mg were equally effective in reducing the incidence of PONV in high risk patients. PMID:25937648
Chang, Chul; Hong, Sung-Moon; Cho, Jin-Hee; Shim, Sang Yul; Cho, Jung-Sun
Objectives Recurrent mucosal disease and anatomic obstruction are commonly cited causes of failed endoscopic sinus surgery (ESS). Hyaluronic acid (HA) has been reported to reduce scarring and to promote wound healing in sinonasal surgery. HyFence is HA stabilized by 1, 4-butandiol diglycidyl ether, which makes it less-water-soluble and highly viscoelastic. The purpose of this study is to examine the anti-adhesion effect of HyFence after ESS compared to that of HA-CMC (Guardix-Sol). Methods Seventy-four patients with chronic rhinosinusitis who underwent ESS were included in the study. After the ESS procedure, Merocel was placed in the ethmoidectomized areas of the both sides. Five milliliters of Guardix-Sol was then applied to the Merocel of one side and HyFence LV was applied to the other side. The effect of the agents was evaluated at one, two, and four weeks after surgery by endoscopic examination. The severity of adhesion, edema, infection and complications were evaluated. Results There was no significant difference in the incidence of postoperative adhesion between the HyFence group and the Guardix-Sol group (P>0.05). Mean postoperative grades of edema and infection showed no significant difference between groups (P>0.05). There was no significant postoperative complications associated with either anti-adhesion agent (P>0.05). Conclusion HyFence has equivalent anti-adhesion effect compared to Guardix-Sol following ESS. PMID:24587878
Tang, Ningfeng; Bamford, Penny; Jones, Jace; He, Min; Kane, Maureen A.; Mooney, Sandra M.; Bearer, Cynthia F.
Background Fetal Alcohol Spectrum Disorder, the leading known cause of mental retardation, is caused by alcohol exposure during pregnancy. One mechanism of ethanol teratogenicity is the disruption of the function of L1 cell adhesion molecule (L1). These functions include enhancement of neurite outgrowth, trafficking through lipid rafts, and signal transduction. Recent data have shown that choline supplementation of rat pups reduces the effects of ethanol on neurobehavior. We sought to determine if choline could prevent the effect of ethanol on L1 function using a simple experimental system. Methods Cerebellar granule neurons (CGN) from postnatal day 6 rat pups were cultured with and without supplemental choline, and the effects on L1 signaling, lipid raft distribution and neurite outgrowth were measured in the presence or absence of ethanol. Results Choline significantly reduced the effect of ethanol on L1 signaling, the distribution of L1 in lipid rafts and L1 mediated neurite outgrowth. However, choline supplemented ethanol exposed cultures remained significantly different than controls. Conclusions Choline pretreatment of CGN significantly reduces the disruption of L1 function by ethanol, but does not completely return L1 function to baseline. This experimental system will enable discovery of the mechanism of the neuroprotective effect of choline. PMID:25421509
Ward, Kristy K.; Tancioni, Isabelle; Lawson, Christine; Miller, Nichol L.G.; Jean, Christine; Chen, Xiao Lei; Uryu, Sean; Kim, Josephine; Tarin, David; Stupack, Dwayne G.; Plaxe, Steven C.; Schlaepfer, David D.
Recurrence and spread of ovarian cancer is the 5th leading cause of death for women in the United States. Focal adhesion kinase (FAK) is a cytoplasmic protein-tyrosine kinase located on chromosome 8q24.3 (gene is Ptk2), a site commonly amplified in serous ovarian cancer. Elevated FAK mRNA levels in serous ovarian carcinoma are associated with decreased (logrank P = 0.0007, hazard ratio 1.43) patient overall survival, but how FAK functions in tumor progression remains undefined. We have isolated aggressive ovarian carcinoma cells termed ID8-IP after intraperitoneal (IP) growth of murine ID8 cells in C57Bl6 mice. Upon orthotopic implantation within the periovarian bursa space, ID8-IP cells exhibit greater tumor growth, local and distant metastasis, and elevated numbers of ascites-associated cells compared to parental ID8 cells. ID8-IP cells exhibit enhanced growth under non-adherent conditions with elevated FAK and c-Src tyrosine kinase activation compared to parental ID8 cells. In vitro, the small molecule FAK inhibitor (Pfizer, PF562,271, PF-271) at 0.1 uM selectively prevented anchorage-independent ID8-IP cell growth with the inhibition of FAK tyrosine (Y)397 but not c-Src Y416 phosphorylation. Oral PF-271 administration (30 mg/kg, twice daily) blocked FAK but not c-Src tyrosine phosphorylation in ID8-IP tumors. This was associated with decreased tumor size, prevention of peritoneal metastasis, reduced tumor-associated endothelial cell number, and increased tumor cell-associated apoptosis. FAK knockdown and re-expression assays showed that FAK activity selectively promoted anchorage-independent ID8-IP cell survival. These results support the continued evaluation of FAK inhibitors as a promising clinical treatment for ovarian cancer. PMID:23275034
Evangelisti, Gisberto; Andreani, Lorenzo; Girardi, Federico; Darren, Lebl; Sama, Andrew; Lisanti, Michele
Postoperative spinal wound infection is a potentially devastating complication after operative spinal procedures. Despite the utilization of perioperative prophylactic antibiotics in recent years and improvements in surgical technique and postoperative care, wound infection continues to compromise patients’ outcome after spinal surgery. In the modern era of pending health care reform with increasing financial constraints, the financial burden of post-operative spinal infections also deserves consideration. The aim of our work is to give to the reader an updated review of the latest achievements in prevention, risk factors, diagnosis, microbiology and treatment of postoperative spinal wound infections. A review of the scientific literature was carried out using electronic medical databases Pubmed, Google Scholar, Web of Science and Scopus for the years 1973-2012 to obtain access to all publications involving the incidence, risk factors, prevention, diagnosis, treatment of postoperative spinal wound infections. We initially identified 119 studies; of these 60 were selected. Despite all the measures intended to reduce the incidence of surgical site infections in spine surgery, these remain a common and potentially dangerous complication. PMID:26605028
Huber, Bruno C.; Ransohoff, Julia D.; Ransohoff, Katherine J.; Riegler, Johannes; Ebert, Antje; Kodo, Kazuki; Gong, Yongquan; Sanchez-Freire, Veronica; Dey, Devaveena; Kooreman, Nigel G.; Diecke, Sebastian; Zhang, Wendy Y.; Odegaard, Justin; Hu, Shijun; Gold, Joseph D.; Robbins, Robert C.; Wu, Joseph C.
Rationale Human embryonic stem cell (hESC) derivatives are attractive candidates for therapeutic use. The engraftment and survival of hESC derivatives as xenografts or allografts require effective immunosuppression to prevent immune cell infiltration and graft destruction. Objective To test the hypothesis that a short-course, dual-agent regimen of two costimulation-adhesion blockade agents can induce better engraftment of hESC derivatives compared to current immunosuppressive agents. Methods and Results We transduced hESCs with a double fusion reporter gene construct expressing firefly luciferase (Fluc) and enhanced green fluorescent protein (eGFP), and differentiated these cells to endothelial cells (hESC-ECs). Reporter gene expression enabled longitudinal assessment of cell engraftment by bioluminescence imaging (BLI). Costimulation-adhesion therapy resulted in superior hESC-EC and mouse EC engraftment compared to cyclosporine therapy in a hindlimb model. Costimulation-adhesion therapy also promoted robust hESC-EC and hESC-derived cardiomyocyte (hESC-CM) survival in an ischemic myocardial injury model. Improved hESC-EC engraftment had a cardioprotective effect after myocardial injury, as assessed by magnetic resonance imaging (MRI). Mechanistically, costimulation-adhesion therapy is associated with systemic and intra-graft upregulation of T cell immunoglobulin and mucin domain 3 (TIM3) and a reduced pro-inflammatory cytokine profile. Conclusions Costimulation-adhesion therapy is a superior alternative to current clinical immunosuppressive strategies for preventing the post-transplant rejection of hESC derivatives. By extending the window for cellular engraftment, costimulation-adhesion therapy enhances functional preservation following ischemic injury. This regimen may function through a TIM3-dependent mechanism. PMID:24038578
Dolasetron for the prevention of postoperative nausea and vomiting following outpatient surgery with general anaesthesia: a randomized, placebo-controlled study. The Dolasetron PONV Prevention Study Group.
Philip, B K; Pearman, M H; Kovac, A L; Chelly, J E; Wetchler, B V; McKenzie, R; Monk, T G; Dershwitz, M; Mingus, M; Sung, Y F; Hahne, W F; Brown, R A
In a multicentre, randomized, double-blind, placebo-controlled dose-ranging study, 1030 patients undergoing outpatient surgery with general anaesthesia received i.v. dolasetron mesylate (12.5, 25, 50, or 100 mg) or placebo. The principal outcome measure was the proportion of patients who were free of emesis or rescue medication for the 24-h period after the study drug was given; the subsidiary outcome measure was survival time without rescue medication. Effects on nausea were quantified using a visual analogue scale. Compared with placebo, a complete response was significantly higher when all four dolasetron doses were combined (49% vs. 58%, P =0.025). In females, dolasetron, 12.5-mg, dolasetron provided maximum clinical benefit (effectiveness compared with adverse events), with no additional benefit in complete response rates or nausea visual analogue scale scores at higher doses. No significant differences were observed in complete response for any dolasetron dose in males compared with placebo. The majority of adverse events reported were mild or moderate. Dolasetron provided well-tolerated, safe, and effective prophylaxis for post-operative nausea and vomiting with maximum effectiveness observed at a dose of 12.5 mg. PMID:10758440
Holly, Cheryl; Rittenmeyer, Leslie; Weeks, Susan Mace
Delirium is a frequent, yet often unrecognized, occurrence in elderly hospitalized patients. In patients with hip fracture, the incidence of delirium is reported to be as high as 62% and even greater if over 65 years of age. One approach to the prevention and management of postoperative delirium in elderly patients with hip fracture is the clinical audit. A clinical audit is a retrospective assessment of clinical care of patients and is guided by criteria that are evidence-based statements of best practice. The use of measurable, objective criterion, with an agreed standard of performance is the hallmark of an audit. The clinical audit criteria presented in this article for the prevention and management of delirium in hospitalized elderly with hip fracture were determined by a compilation of systematic reviews and existing evidence-based clinical guidelines. The following 5 audit criteria are discussed: (1) All elderly patients with a hip fracture are assessed for risk factors for developing delirium daily using a valid and reliable tool; (2) the environment of the patient with hip fracture is assessed daily for conduciveness to maintaining sensory orientation; (3) all patients with hip fracture receive essential nursing care; (4) appropriate clinical criteria are applied to confirm a diagnosis of delirium in patients with hip fracture; and (5) nonpharmacologic interventions are employed before pharmacologic interventions in patients with hip fracture with a diagnosis of delirium. PMID:24457386
Naghibi, Khosrou; Kashefi, Parviz; Azarnoush, Hamed; Zabihi, Parisa
Background: Postoperative nausea and vomiting (PONV) is a common complication after general anesthesia in patients undergoing elective lower abdominal surgery. We aimed to compare the effect of a sub hypnotic dose of Propofol in the prevention of PONV after lower abdominal surgery with that of the conventional antiemetic drug Metoclopramide. Materials and Methods: In this prospective, randomized, double-blind, placebo-controlled study, 104 patients with American Society of Anesthesiologists (ASA) class I or II status, aged 18–65 years, and undergoing elective lower abdominal surgery were randomized to one of four groups (n = 26 each). The patients in the four groups were administered intravenously Propofol 20 mg (G1), Propofol 30 mg (G2), Metoclopramide 10 mg (G3), and placebo (G4), 15 min before skin closure. All episodes of PONV during the first 24 h after anesthesia were recorded by an investigator who was blinded to treatment assignment. Results: There were no significant differences between the treatment groups with regard to their gender, age, ASA class, duration of surgery, duration of recovery time and hospital stay, and also body mass index (BMI) (P > 0.05). The prevalence of PONV 0-6 h after anesthesia was 23.08% with Propofol 20 mg (P = 0.005), 15.38% with Propofol 30 mg (P = 0.016), 15.38% with Metoclopramide 10 mg (P = 0.016), compared to 30.77% with placebo (P = 0.005). Conclusions: Administration of a subhypnotic dose of Propofol (30 mg) was found to be as effective as 10 mg Metoclopramide in reducing the incidence and severity of PONV in adult patients undergoing elective lower abdominal surgeries under Isoflurane-based anesthesia in the early postoperative period. PMID:25789261
Ahn, Sung Yul; Park, Hyang Joon; Kim, Jong Pill; Park, Tae Hwan
Facial paralysis resulting from leprosy has a serious impact on the entire face especially in the areas innervated by the facial nerves. In particular, lagophthalmos in patients with leprosy causes exposure keratitis, corneal, and conjunctival dryness, which can progress to blindness and disfigurement. Recently, we conducted 4 different temporalis muscle transfer (TMT) methods over the last 4 years to reduce ptosis. The methods used included Brown-McDowell, McCord-Codner, modified Gillies-Anderson, and modified Gillies. Seventy-five TMT operations in 60 patients were performed between 2011 and 2014. The mean age was 70.1. Fifteen patients had bilateral TMT procedures. As a result, ptosis appeared in 14(18.7%) of 75 TMT procedures for 4 years. To prevent or correct this complication, the following 4 technical refinements have simplified the surgery and yield better surgical outcomes. First, an increase in the length of the temporalis muscle flap to approximately 8 cm with a parallel course to the lateral canthus will reduce oblique pull. Second, the width of the fascia sling in the upper eyelid is narrowed (3-4 mm) to reduce weight on the eyelid. Third, the fascia sling in the upper lid should not be located along the full length of the upper lid but terminate 3.5 cm medial to lateral canthal tendon and in other words, should not be tied at the medial canthal tendon to reduce tension and weight. Lastly, the fascia sling in the eyelid should be located shallow (probably in subdermal layer) and as near as possible to the lid margin to prevent any functional disturbance in levator aponeurosis. PMID:26674897
Nallasamy, Palanisamy; Si, Hongwei; Babu, Pon Velayutham Anandh; Pan, Dengke; Fu, Yu; Brooke, Elizabeth A S; Shah, Halley; Zhen, Wei; Zhu, Hong; Liu, Dongmin; Li, Yunbo; Jia, Zhenquan
Sulforaphane, a naturally occurring isothiocyanate present in cruciferous vegetables, has received wide attention for its potential to improve vascular function in vitro. However, its effect in vivo and the molecular mechanism of sulforaphane at physiological concentrations remain unclear. Here, we report that a sulforaphane concentration as low as 0.5 μM significantly inhibited tumor necrosis factor-α (TNF-α)-induced adhesion of monocytes to human umbilical vein endothelial cells, a key event in the pathogenesis of atherosclerosis both in static and under flow conditions. Such physiological concentrations of sulforaphane also significantly suppressed TNF-α-induced production of monocyte chemotactic protein-1 and adhesion molecules including soluble vascular adhesion molecule-1 and soluble E-selectin, key mediators in the regulation of enhanced endothelial cell-monocyte interaction. Furthermore, sulforaphane inhibited TNF-α-induced nuclear factor (NF)-κB transcriptional activity, Inhibitor of NF-κB alpha (IκBα) degradation and subsequent NF-κB p65 nuclear translocation in endothelial cells, suggesting that sulforaphane can inhibit inflammation by suppressing NF-κB signaling. In an animal study, sulforaphane (300 ppm) in a mouse diet significantly abolished TNF-α-increased ex vivo monocyte adhesion and circulating adhesion molecules and chemokines in C57BL/6 mice. Histology showed that sulforaphane treatment significantly prevented the eruption of endothelial lining in the intima layer of the aorta and preserved elastin fibers' delicate organization, as shown by Verhoeff-van Gieson staining. Immunohistochemistry studies showed that sulforaphane treatment also reduced vascular adhesion molecule-1 and monocyte-derived F4/80-positive macrophages in the aorta of TNF-α-treated mice. In conclusion, sulforaphane at physiological concentrations protects against TNF-α-induced vascular endothelial inflammation, in both in vitro and in vivo models. This anti
Bortoluzzi, Marcelo Carlos; Capella, Diogo Lenzi; Barbieri, Tharzon; Pagliarini, Micheli; Cavalieri, Talita; Manfro, Rafael
Background The aim of this study was to assess the efficacy of a single prophylactic dose of amoxicillin and/or dexamethasone in preventing postoperative complications (PC) after a surgical removal of a single mandibular third molar (M3). Methods This study is a randomized, placebo controlled clinical trial. Four groups were included: Group 1 (G1) included a prophylactic dose of 2 g of amoxicillin and 8 mg of dexamethasone; Group 2 (G2) included a prophylactic dose of 2 g of amoxicillin and 8 mg of placebo; Group 3 (G3) included a prophylactic dose of 8 mg of dexamethasone and 2 g of placebo and; Group 4 (G4) placebo. Results Fifty patients were included. It was observed one case of alveolar infection (2%) and two of alveolar osteitis (4%) resulting in three PC (6%). No statistical differences were observed between therapeutic groups for development of PC, trismus, pain and edema. The use of antibiotics showed an absolute risk reduction (ARR) for PC development of 3.52% and the number needed to treat (NNT) was 29. Conclusion Prophylactic antibiotics and corticoid in a single dose regimen did not bring any benefit on M3 surgeries. PMID:23390473
Heidari, Morteza; Honarmand, Azim; Safavi, Mohammadreza; Chitsazi, Mohsen; Khalighinejad, Farnaz
Background: The incidence of postoperative nausea and vomiting (PONV) after middle ear surgery is high. In this study we want to compare the effects of intravenous granisetron and oral gabapentin as a premedication before surgery on the incidence and severity of PONV after middle ear surgery in adult patents. Materials and Methods: We enrolled 90 patients that were randomly divided into the three groups of 30 in each. Group I received granisetron 3 mg iv 2 minutes before induction of anesthesia; Group II received oral gabapentin 300 mg 1 hour before anesthesia and Group III received placebo. The incidence and severity of PONV were recorded each 15 minutes in the post-anesthesia care unit (PACU) and each 8 hours until 24 hours after discharge from the PACU. Result: The incidence and severity of nausea and vomiting at different time intervals in Groups I and Group II was significantly lower compared with Group III (P < 0.05). There was no significant difference in the incidence of side effects of study drug administration including respiratory depression, apnea, extra pyramidal disorders, drowsiness, dizziness, vertigo and headache in three groups. Conclusion: The study was shown that using gabapentin and granisetron have equal anti-emetic effects, but significant differences were seen between these two groups compared to the control group. These submit the efficiency of these drugs in preventing PONV. PMID:25709987
Kundu, Riddhi; Baidya, Dalim K; Arora, Mahesh Kumar; Maitra, Souvik; Darlong, Vanlal; Goswami, Devalina; Mohanaselvi, S; Bajpai, Minu
The use of a caudal block in laparoscopic surgery in children is limited to minor procedures like inguinal hernia repair, and intravenous opioids remain the analgesic modality of choice in major laparoscopic surgery. However, a caudal block is frequently performed at our institute even for laparoscopic surgery. Therefore, we planned to evaluate the analgesic efficacy of caudal bupivacaine and morphine in major laparoscopic surgery as compared to intravenous opioids. Our hypothesis was that a single-shot caudal block would increase the duration of analgesia and minimize the hemodynamic response to pneumoperitoneum. After institutional ethics committee clearance, data were collected for 65 ASA I-II children aged 6 months to 12 years who underwent laparoscopic surgery in the last 14 months. Demographic, surgical, and perioperative anesthetic and analgesic data were noted and analyzed. Twenty-four children received a caudal block with 0.25 % bupivacaine (1-1.25 ml/kg) with morphine (30-50 mcg/kg). In the caudal group, the time to first analgesic request was increased (165 vs. 45 min; p = 0.00) and tachycardia response to port site incision was less observed (33 vs. 63 % children; p = 0.019). Hemodynamic response to pneumoperitoneum was equal in both of the groups. Single-shot caudal injection of local anesthetic with morphine reduces port site skin incision response and increases the duration of postoperative analgesia but fails to prevent hemodynamic response to pneumoperitoneum. PMID:25686563
The effect of combination treatment using palonosetron and dexamethasone for the prevention of postoperative nausea and vomiting versus dexamethasone alone in women receiving intravenous patient-controlled analgesia
Ryoo, Seung-hwa; Yoo, Jae Hwa; Kim, Mun Gyu; Lee, Ki Hoon
Background The purpose of this study was to evaluate the effect of palonosetron combined with dexamethasone for the prevention of PONV compared to dexamethasone alone in women who received intravenous patient-controlled analgesia (IV-PCA) using fentanyl. Methods In this randomized, double-blinded, placebo-controlled study, 204 healthy female patients who were scheduled to undergo elective surgery under general anesthesia followed by IV-PCA for postoperative pain control were enrolled. Patients were divided into two groups: the PD group (palonosetron 0.075 mg and dexamethasone 5 mg IV; n = 102) and the D group (dexamethasone 5 mg IV; n = 102). The treatments were given after the induction of anesthesia. The incidence of nausea, vomiting, severity of nausea, and the use of rescue anti-emetics during the first 48 hours after surgery were evaluated. Results The incidence of PONV was significantly lower in the PD group compared with the D group during the 0-24 hours (43 vs. 59%) and 0-48 hours after surgery (45 vs. 63%) (P < 0.05). The severity of nausea during the 6-24 hours after surgery was significantly less in the PD group compared with the D group (P < 0.05). The incidence of rescue antiemetic used was significantly lower in the PD group than in the D group during the 0-6 hours after surgery (13.1 vs. 24.5%) (P < 0.05). Conclusions Palonosetron combined with dexamethasone was more effective in preventing PONV compared to dexamethasone alone in women receiving IV-PCA using fentanyl. PMID:26045930
Xie, Jingjing; Zhao, Rongli; Gu, Songen; Dong, Haiyan; Wang, Jichuang; Lu, Yusheng; Sinko, Patrick J.; Yu, Ting; Xie, Fangwei; Wang, Lie; Shao, Jingwei; Jia, Lee
Dissemination of circulating tumor cells (CTCs) in blood and their hetero-adhesion to vascular endothelial bed of distant metastatic secondary organs are the critical steps to initiate cancer metastasis. The rarity of CTCs made their in vivo capture technically challenging. Current techniques by virtue of nanostructured scaffolds monovalently conjugated with a single antibody and/or drug seem less efficient and specific in capturing CTCs. Here, we report a novel platform developed to re-engineer nanoscale dendrimers for capturing CTCs in blood and interfering their adhesion to vascular endothelial bed to form micrometastatic foci. The nanoscale dendrimers were spatiotemporally accommodated with dual antibodies to target two surface biomarkers of colorectal CTCs. Physiochemical characterization, including spectra, fluorescence, electron microscope, dynamic light scattering, electrophoresis, and chromatography analyses, was conducted to demonstrate the successful conjugation of dual antibodies to dendrimer surface. The dual antibody conjugates were able to specifically recognize and bind CTCs, moderately down-regulate the activity of the captured CTCs by arresting them in S phase. The related adhesion assay displayed that the dual antibody conjugates interfered the hetero-adhesion of CTCs to fibronectin (Fn)-coated substrates and human umbilical vein endothelial cells (HUVECs). The dual antibody conjugates also showed the enhanced specificity and efficiency in vitro and in vivo in restraining CTCs in comparison with their single antibody counterparts. The present study showed a novel means to effectively prevent cancer metastatic initiation by binding, restraining CTCs and inhibiting their hetero-adhesion to blood vessels, not by traditional cytotoxic-killing of cancer cells. PMID:25285173
Alonso, Juliana de Moura; Alves, Ana Liz Garcia; Watanabe, Marcos Jun; Rodrigues, Celso Antonio; Hussni, Carlos Alberto
Intra-abdominal adhesions constitute a significant clinical and surgical problem that can lead to complications such as pain and bowel occlusion or subocclusion. These adhesions are frustrating and potentially fatal, representing a major postoperative complication in abdominal surgery. It is estimated that 32% of horses undergoing laparotomy will present clinical symptoms due to adhesions, but the true prevalence is not known because a large proportion of animals with postoperative recurrent colics are medically treated or submitted to euthanasia without necropsy. Adhesions are highly cellular, vascularized, dynamic structures that are influenced by complex signaling mechanisms. Understanding their pathogenesis could assist in applying better therapeutic strategies and in developing more effective antiadhesion products. Currently, there are no definitive strategies that prevent adhesion formation, and it is difficult to interpret the results of existing studies due to nonstandardization of an induction model and evaluation of their severity. The best clinical results have been obtained from using minimally traumatic surgical techniques, anti-inflammatory agents, antimicrobials, anticoagulants, and mechanical separation of serosal surfaces by viscous intraperitoneal solutions or physical barriers. This paper aims to review adhesion formation pathogenesis, guide the understanding of major products and drugs used to inhibit adhesion formation, and address their effectiveness in the equine species. PMID:24587939
Buck, Maren E.; Breitbach, Anthony S.; Belgrade, Sonja K.; Blackwell, Helen E.; Lynn, David M.
We report an approach to the design of reactive polymer films that can be functionalized post-fabrication to either prevent or promote the attachment and growth of cells. Our approach is based on the reactive layer-by-layer assembly of covalently crosslinked thin films using a synthetic polyamine and a polymer containing reactive azlactone functionality. Our results demonstrate (i) that the residual azlactone functionality in these films can be exploited to immobilize amine-functionalized chemical motifs similar to those that promote or prevent cell and protein adhesion when assembled as self-assembled monolayers on gold-coated surfaces, and (ii) that the immobilization of these motifs changes significantly the behaviors and interactions of cells with the surfaces of these polymer films. We demonstrate that films treated with the hydrophobic molecule decylamine support the attachment and growth of mammalian cells in vitro. In contrast, films treated with the hydrophilic carbohydrate D-glucamine prevent cell adhesion and growth almost completely. The results of additional experiments suggest that these large differences in cell behavior can be understood, at least in part, in terms of differences in the abilities of these two different chemical motifs to promote or prevent the adsorption of protein onto film coated surfaces. We demonstrate further that this approach can be used to pattern regions of these reactive films that resist the initial attachment and subsequent invasion of mammalian cells for periods of at least one month in the presence of serum-containing cell culture media. Finally, we report that films that prevent the adhesion and growth of mammalian cells also prevent the initial formation of bacterial biofilms when incubated in the presence of the clinically relevant pathogen Pseudomonas aeruginosa. The results of these studies, collectively, suggest the basis of general approaches to the fabrication and functionalization of thin films that prevent
Intraoperative protective mechanical ventilation for prevention of postoperative pulmonary complications: a comprehensive review of the role of tidal volume, positive end-expiratory pressure, and lung recruitment maneuvers.
Güldner, Andreas; Kiss, Thomas; Serpa Neto, Ary; Hemmes, Sabrine N T; Canet, Jaume; Spieth, Peter M; Rocco, Patricia R M; Schultz, Marcus J; Pelosi, Paolo; Gama de Abreu, Marcelo
Postoperative pulmonary complications are associated with increased morbidity, length of hospital stay, and mortality after major surgery. Intraoperative lung-protective mechanical ventilation has the potential to reduce the incidence of postoperative pulmonary complications. This review discusses the relevant literature on definition and methods to predict the occurrence of postoperative pulmonary complication, the pathophysiology of ventilator-induced lung injury with emphasis on the noninjured lung, and protective ventilation strategies, including the respective roles of tidal volumes, positive end-expiratory pressure, and recruitment maneuvers. The authors propose an algorithm for protective intraoperative mechanical ventilation based on evidence from recent randomized controlled trials. PMID:26120769
De Potter, C. R.; Schelfhout, A. M.; De Smet, F. H.; Van Damme, S.; de Ridder, L.; Dhont, E.; van Emmelo, J.
It was the aim of this study to design mouse monoclonal antibodies (MAbs) that can inhibit the invasion of breast cancer cells in the host tissue. Therefore, MAbs were raised against epitopes on the extracellular domain of SK-BR-3 human breast cancer cells, and biological assays were performed to test the capability of the MAbs to inhibit cell substrate adhesion. MAb 14C5 bound an extracellular plasma membrane antigen of SK-BR-3 and MCF-7 human breast cancer cells and inhibited the cell substrate adhesion of these cells in vitro. The MAb delayed the adhesion of MCF-7 and SK-BR-3 cells on precultured embryonic heart fragments (PHFS). It inhibited the destruction of the PHF by MCF-7 cells and the invasion of the PHF by SK-BR-3 cells. The MAb reacted with an epitope on the cell membrane of in situ and invasive ductal carcinomas of the breast in immunohistochemistry. Poorly differentiated, highly invasive ductal carcinomas show extensive staining of long plasma membrane extensions. Normal multilayered epithelia, normal connective tissue, and tumors derived from these tissues as well as normal breast tissue were negative. From both cell lines a protein complex consisting of two subunits with molecular weight of 50 and 90 kd, respectively, was immunoprecipitated. It is concluded that the 14C5 antigen plays a role in cell substrate adhesion and subsequently also in invasion of breast cancer cells. The 14C5 MAb was able to inhibit cell substrate adhesion and invasion in vitro of breast cancer cells. Images Figure 3 Figure 4 Figure 5 PMID:8291615
Voigt, Dagmar; Gorb, Stanislav
The glandular trichomes of the plant Roridula gorgonias release an extremely adhesive, visco-elastic, resinous secretion that traps a variety of insects, including those having a considerable body size. However, the specialized mutualistic mirid bug Pameridea roridulae lives and walks on this sticky plant surface without being trapped. We have sought to reveal the mechanism underlying the apparent non-sticky nature of the cuticle of this bug. In this study, we have visualized intact plant and insect surfaces using cryo-scanning electron microscopy and measured the adhesive properties of the plant secretion on different surfaces. We present a combination of structural and experimental results that suggest that a thick and cohesively weak film of an outermost, epicuticular greasy secretion acts as a ;sloughing-off' layer, preventing the formation of contacts between the sticky plant secretion and the solid insect cuticle. In a comparative study of fresh cuticle fractures of flies representing a typical prey of R. gorgonias, a thin, fragmentary layer of epicuticular grease was revealed. These results indicate that, when trapping prey, the plant adhesive might form proper contact with solid islands of the insect cuticle that are free of epicuticular grease. PMID:18689418
Nallasamy, Palanisamy; Si, Hongwei; Babu, Pon Velayutham Anandh; Pan, Dengke; Fu, Yu; Brooke, Elizabeth A.S.; Shah, Halley; Zhen, Wei; Zhu, Hong; Liu, Dongmin; Li, Yunbo; Jia, Zhenquan
Sulforaphane, a naturally-occurring isothiocyanate present in cruciferous vegetables, has received wide attention for its potential to improve vascular function in vitro. However, its effect in vivo and the molecular mechanism of sulforaphane at physiological concentrations remain unclear. Here, we report that a sulforaphane concentration as low as 0.5 μM significantly inhibited TNF-α-induced adhesion of monocytes to human umbilical vein endothelial cells (HUVECs), a key event in the pathogenesis of atherosclerosis both in static and under flow conditions. Such physiological concentrations of sulforaphane also significantly suppressed TNF-α-induced production of monocyte chemotactic protein-1 (MCP-1), adhesion molecule sVCAM-1 and sE-Selectin, key mediators in the regulation of enhanced endothelial cell-monocyte interaction. Furthermore, sulforaphane inhibited TNF-α-induced NF-κB transcriptional activity, IκBα degradation and subsequent NF-κB p65 nuclear translocation in endothelial cells, suggesting that sulforaphane can inhibit inflammation by suppressing NF-κB signaling. In an animal study, sulforaphane (300 ppm) in a mouse diet significantly abolished TNF-α-increased ex vivo monocyte adhesion and circulating adhesion molecules and chemokines in C57BL/6 mice. Histology showed that sulforaphane treatment significantly prevented the eruption of endothelial lining in the intima layer of the aorta and preserved elastin fibers’ delicate organization as shown by Verhoeff-van Gieson staining. Immunohistochemistry studies showed that sulforaphane treatment also reduced VCAM-1 and monocytes-derived F4/80-positive macrophages in the aorta of TNF-α-treated mice. In conclusion, sulforaphane at physiological concentrations protects against TNF-α-induced vascular endothelial inflammation, in both in vitro and in vivo models. This anti-inflammatory effect of sulforaphane may be, at least in part, associated with interfering with the NF-κB pathway. PMID:24880493
Timmons, S.; Grabarek, J.; Kloczewiak, M.; Hawiger, J.
Thrombocytopenia often accompanies sepsis due to endotoxin producing gram-negative bacteria. The authors have observed that mutant Re595 of S. minnesota induced aggregation of human platelets separated from plasma fibrinogen (Theta) and other proteins. This aggregation is dependent on ADP secreted from storage granules in response to mutant Re595. Platelet aggregation induced by mutant Re595 was prevented by simultaneously added EDTA and EGTA (5mM), whereas secretion of /sup 14/C-serotonin was maintained. Preincubation of platelets with chelators (1 hr, 37/sup 0/C), known to dissociate irreversibly the platelet membrane glycoprotein IIb x IIIa complex, abolished aggregation while serotonin secretion was decreased by only one fourth. Since the GPIIb x IIIa complex constitutes the receptor for Theta, its role was examined using synthetic peptide analogs of sites on gamma and alpha chains of Theta. Gamma 400-411 (225 ..mu..M) inhibited platelet aggregation induced by mutant Re595 while serotonin secretion was unaffected. Alpha 572-575 (RGDS; 100 ..mu..M), analogous to cell adhesion site of fibronectin, also prevented aggregation induced by mutant Re595. Thus, mutant Re595 causes platelet aggregation which is divalent cation-dependent and proceeds via receptor pathway for secreted adhesive macromolecules.
Laspas, Panagiotis; Culmann, Philipp David; Grus, Franz Hermann; Prokosch-Willing, Verena; Poplawksi, Alicia; Pfeiffer, Norbert; Hoffmann, Esther Maria
Purpose A simple needling procedure is the standard method for restoring the function of an encapsulated bleb after trabeculectomy. However, postoperative hypotony represents a possible hazard. This study describes a new surgical approach for treating encapsulated blebs with reduced risk of early postoperative hypotony: bleb needling combined with transconjunctival sutures tightening the scleral flap directly. Methods The study included two groups of 23 patients with failing bleb following trabeculectomy: “Group 1” underwent simple needling revision of the filtering bleb and served as a control group, while “Group 2” received needling revision with additional transconjunctival scleral flap sutures, if intraoperatively the intraocular pressure was estimated to be very low. Intraocular pressure (IOP), postoperative management and complications were analyzed over a follow-up period of 4 weeks postoperatively. Results were compared using t-test or Mann-Whitney U-tests. Results Adverse effects occurred with a higher frequency after sole needling of the bleb (5 cases of choroidal effusion and 1 case of choroidal hemorrhage) than after the combined method with additional scleral sutures (1 case of choroidal effusion). The IOP on the first postoperative day was significantly lower in group 1, with 9.43 ± 9.01 mm Hg vs. 16.43 ± 8.35 mm Hg in group 2 (P = 0.01). Ten patients with ocular hypotony (IOD of 5 mmHg or lower) were found in group 1 and only two in group 2. One week and one month after surgery the intraocular pressure was similar in both groups (P>0.05). Conclusions This new needling technique with additional transconjunctival scleral flap sutures appears to reduce postoperative hypotony, and may thus protect from further complications, such as subchoroidal hemorrhage. PMID:27314495
Ayach, Taha; Nappo, Robert W; Paugh-Miller, Jennifer L; Ross, Edward A
Hyperkalemia occurs frequently in hospitalized patients and is of particular concern for those who have undergone surgery, with postoperative care provided by clinicians of many disciplines. This review describes the normal physiology and how multiple perioperative factors can disrupt potassium homeostasis and lead to severe elevations in plasma potassium concentration. The pathophysiologic basis of diverse causes of hyperkalemia was used to broadly classify etiologies into those with altered potassium distribution (e.g. increased potassium release from cells or other transcellular shifts), reduced urinary excretion (e.g. reduced sodium delivery, volume depletion, and hypoaldosteronism), or an exogenous potassium load (e.g. blood transfusions). Surgical conditions of particular concern involve: rhabdomyolysis from malpositioning, trauma or medications; bariatric surgery; vascular procedures with tissue ischemia; acidosis; hypovolemia; and volume or blood product resuscitation. Certain acute conditions and chronic co-morbidities present particular risk. These include chronic kidney disease, diabetes mellitus, many outpatient preoperative medications (e.g. beta blockers, salt substitutes), and inpatient agents (e.g. succinylcholine, hyperosmolar volume expanders). Clinicians need to be aware of these pathophysiologic mechanisms for developing perioperative hyperkalemia as many of the risks can be minimized or avoided. PMID:25698564
Kobayashi, K; Matsumoto, S; Morishima, T; Kawabe, T; Okamoto, T
Although the beneficial effect of cimetidine on survival in cancer has been clinically demonstrated in colorectal cancer patients, the mode of action of cimetidine has not been elucidated. In this report, we have demonstrated for the first time that cimetidine can block the adhesion of a colorectal tumor cell line to the endothelial cell monolayer in cell culture and that it can suppress the metastasis of the tumor cell in a nude mouse model. We also demonstrated that these antimetastasis effects of cimetidine might occur through down-regulation of the cell surface expression of E-selectin on endothelial cells, a ligand for sialyl Lewis antigens on tumor cells. We found that the cimetidine-mediated down-regulation of E-selectin did not involve down-regulation of E-selectin mRNA or blocking of the nuclear translocation of nuclear factor kappaB, a transcriptional activator of E-selectin gene expression. Because two other histamine type 2 receptor antagonists, famotidine and ranitidine, did not show any similar effect, these actions of cimetidine probably do not occur via blocking of the histamine receptor. These observations support the idea that cancer metastasis can be blocked by cimetidine administration through blocking the adhesion of tumor cells to the endothelium when an interaction between E-selectin and sialyl-Lewis antigens plays a role. PMID:10919677
Chen, Wei-Zhe; Liu, Shu; Chen, Fan-Feng; Zhou, Chong-Jun; Yu, Jian; Zhuang, Cheng-Le; Shen, Xian; Chen, Bi-Cheng; Yu, Zhen
Postoperative fatigue syndrome (POFS) is a common complication which decelerates recovery after surgery. The present study investigated the anti-fatigue effect of ginsenoside Rb1 (GRb1) through the inflammatory cytokine-mediated N-methyl-D-aspartate (NMDA) receptor pathway. A POFS rat model was created by major small intestinal resection and assessed with an open field test. Real-time quantitative polymerase chain reaction, western blot analysis, high performance liquid chromatography and a transmission electron microscopic analysis were used to determine typical biochemical parameters in the hippocampus. Our results showed that POFS rats exhibited fatigue associated with an increased expression of inflammatory cytokines and NMDA receptor 1, higher (kynurenine)/(tryptophan) and (kynurenine)/(kynurenic acid) on postoperative days 1 and 3, and an increased expression of indoleamine 2,3-dioxygenase (IDO) on postoperative day 1. Degenerated neurons were found in the hippocampus of POFS rats. The NMDA receptor antagonist MK801 had a significant effect on central fatigue on postoperative day 1. GRb1 had no effect on IDO or tryptophan metabolism, but exhibited a significant effect on POFS by inhibiting the expression of inflammatory cytokines and NMDA receptor 1. These data suggested that inflammatory cytokines could activate tryptophan metabolism to cause POFS through the NMDA receptor pathway. GRb1 had an anti-fatigue effect on POFS by reducing inflammatory cytokines and NMDA receptors. PMID:25747983
Wang, Guoqi; Zhang, Licheng; Lou, Shenghan; Chen, Yuxiang; Cao, Yanxiang; Wang, Ruirui; Zhang, Lihai; Tang, Peifu
Dexmedetomidine (DEX) has been used extensively for patients during surgery. Some studies found that DEX could reduce the incidence of postoperative side effects in laparoscopic surgical patients. However, no firm conclusions were made about it.The authors searched for randomized controlled trials (RCTs) in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials testing DEX administrated in laparoscopic surgical patients and reporting on postoperative nausea, vomiting, shivering, heart rate, mean arterial pressure (MAP), or extubation time after surgery or within 1 hour in postoperative care unit. Trial sequential analysis (TSA) was used for RCTs comparing DEX with placebo or no treatment in laparoscopic surgery patients. A protocol for this meta-analysis has been registered on PROSPERO (http://www.crd.york.ac.uk/prospero) and the registration number is CRD42015020226.Fifteen studies (899 patients) were included. DEX could significantly reduce the incidence of postoperative nausea (risk ratio [RR] and 95% confidence interval [CI], 0.43 [0.28, 0.66], P < 0.0001), vomiting (RR and 95% CI, 0.36 [0.18, 0.72], P = 0.004), shivering (RR and 95% CI, 0.19 [0.11, 0.35], P < 0.00001), rescue antiemetic (RR and 95% CI, 0.18 [0.07, 0.47], P = 0.0006), and increase the incidence of dry mouth (RR and 95% CI, 7.40 [2.07, 26.48], P = 0.002) comparing with the control group. In addition, firm conclusions can be made on the results of postoperative nausea according to the TSA. Meta-analysis showed that DEX group had a significantly lower heart rate (mean difference [MD] and 95% CI, -14.21 [-18.85, -9.57], P < 0.00001) and MAP (MD and 95% CI, -12.35 [-15.28, -9.42], P < 0.00001) than the control group, and firm conclusions can be made according to the TSA. No significance was observed on extubation time between 2 groups (MD and 95% CI, 0.70 [-0.89, 2.28], P = 0.39).The results from this meta-analysis indicated that perioperative DEX
Chou, Hsin-I; Chen, Kuan-Sheng; Wang, Hsien-Chi; Lee, Wei-Ming
OBJECTIVE To determine effects of cranberry extract on development of urinary tract infection (UTI) in dogs and on adherence of Escherichia coli to Madin-Darby canine kidney (MDCK) cells. ANIMALS 12 client-owned dogs (in vivo experiment) and 6 client-owned dogs (in vitro experiment). PROCEDURES 12 dogs with a history of recurrent UTI received an antimicrobial (n = 6) or cranberry extract (6) orally for 6 months. Dogs were monitored for a UTI. For the in vitro experiment, cranberry extract was orally administered to 6 dogs for 60 days. Voided urine samples were collected from each dog before and 30 and 60 days after onset of extract administration. Urine was evaluated by use of a bacteriostasis assay. An antiadhesion assay and microscopic examination were used to determine inhibition of bacterial adherence to MDCK cells. RESULTS None of the 12 dogs developed a UTI. The bacteriostasis assay revealed no zone of inhibition for any urine samples. Bacterial adhesion was significantly reduced after culture with urine samples obtained at 30 and 60 days, compared with results for urine samples obtained before extract administration. Microscopic examination revealed that bacterial adherence to MDCK cells was significantly reduced after culture with urine samples obtained at 30 and 60 days, compared with results after culture with urine samples obtained before extract administration. CONCLUSIONS AND CLINICAL RELEVANCE Oral administration of cranberry extract prevented development of a UTI and prevented E coli adherence to MDCK cells, which may indicate it has benefit for preventing UTIs in dogs. PMID:27027843
Mottura, A Aldo
measures which prevent extensive edemas are: avoiding transection of the temporal pedicle, or to realizing platysma plication too tight by using strong aspirative drainage instead of elastic bandages. In the post-op, the manual lymphatic drainage is initiated on the third or fifth day, but must be done by a trained professional, in a method contrary to that specified in the books for non-operated individuals. An aesthetician washes the hair and applies decongestive cold tea on the face the second day, and on the fifth, moisturizes the skin and cosmetically conceals any signs of bruising. The psychological support provided by the staff keeps the patient calm and relaxed. Five years experience with this protocol has enabled us to minimize post-op pain. The edema can be predicted with certain consistency (in which surgery there will be more or less edema) and the proper technique can be selected, permitting the patient to choose the best moment for a FL while the surgeon can avoid intra and postoperative measures that increase the edema. After surgery, the patient receives the daily assistance of the staff, which rapidly and efficiently improves this condition. We can predict and control the post-op recovery and the patient feels fine, unlike the past when recovery was abandoned to its natural evolution. If the patient perceived an intensive, positive support on behalf of the entire staff that kept him or her content, then we have succeeded in doing an excellent marketing. This may encourage others to undergo aesthetic surgery, especially those who are convinced that after surgery they might have to endure considerable suffering. PMID:12140694
Nithya Deva Krupa, A.
Marine biofilms formed due to adhesion of bacteria and other microorganisms on submerged surfaces are generally considered to be a major form of microfouling. Subsequent attachment of larvae of higher organisms like barnacles, mussels, and so forth, on marine biofilms, causes macrofouling. Several approaches have been used to prevent micro- and macrofouling. Silver nanoparticles (AgNPs) are known to exhibit strong inhibitory and antimicrobial activity. Biological synthesis of AgNPs is rapidly gaining importance due to its growing success. Hence, the present study is focused on the biosynthesis of AgNPs using fruit extract of Aegle marmelos and its characterization through UV-Vis spectrophotometer, X-ray diffractometer (XRD), Fourier transform infrared spectroscopy (FTIR), and atomic force microscopy (AFM). Further isolation and identification of marine biofilm forming bacteria were carried out through 16S rDNA analysis. The antimicrofouling effect of the biosynthesized AgNPs was tested against marine biofilm forming bacteria and the results suggested that it could effectively inhibit biofilm formation. This preliminary study has proved that AgNPs may be used as antimicrofouling agent for the prevention of biofouling in the early stages. PMID:25258620
Prüll, Kathrin; Weninger, Ernst; Mansmann, Ulrich; Küchenhoff, Helmut; Jovanovic, Alexander; Pollwein, Bernhard; Chappell, Daniel; Zwissler, Bernhard; von Dossow, Vera
Background Postoperative nausea and vomiting (PONV) is one of the most common and distressing complications after general anesthesia and surgery, with young non-smoking females receiving postoperative opioids being high-risk patients. This register-based study aims to evaluate the effect of low-dose haloperidol (0.5 mg intravenously) directly after induction of general anesthesia to reduce the incidence of PONV in the postoperative anesthesiological care unit (PACU). Methods Multivariable regression models were used to investigate the association between low-dose haloperidol and the occurrence of PONV using a patient registry containing 2,617 surgical procedures carried out at an university hospital. Results Haloperidol 0.5 mg is associated with a reduced risk of PONV in the total collective (adjusted odds ratio = 0.75, 95% confidence interval: [0.56, 0.99], p = 0.05). The results indicate that there is a reduced risk in male patients (adjusted odds ratio = 0.45, 95% confidence interval: [0.28, 0.73], p = 0.001) if a dose of 0.5 mg haloperidol was administered while there seems to be no effect in females (adjusted odds ratio = 1.02, 95% confidence interval: [0.71, 1.46], p = 0.93). Currently known risk factors for PONV such as female gender, duration of anesthesia and the use of opioids were confirmed in our analysis. Conclusion This study suggests that low-dose haloperidol has an antiemetic effect in male patients but has no effect in female patients. A confirmation of the gender-specific effects we have observed in this register-based cohort study might have major implications on clinical daily routine. PMID:26751066
... Abdominal Adhesions 1 Ward BC, Panitch A. Abdominal adhesions: current and novel therapies. Journal of Surgical Research. 2011;165(1):91– ... are abdominal adhesions and intestinal obstructions ... generally do not require treatment. Surgery is the only way to treat abdominal ...
Bolat, Elif; Kocamaz, Erdoğan; Kulahcilar, Zeki; Yilmaz, Ali; Topcu, Abdullah; Coskun, Mehmet Erdal
Study Design A retrospective study. Purpose The aim of this study was to evalute the effects of mitomycin-C, sodium hyaluronate and human amniotic fluid on preventing spinal epidural fibrosis. Overview of Literature The role of scar tissue in pain formation is not exactly known, but it is reported that scar tissue causes adhesions between anatomic structures. Intensive fibrotic tissue compresses on anatomic structures and increases the sensitivity of the nerve root for recurrent herniation and lateral spinal stenosis via limiting movements of the root. Also, neuronal atrophy and axonal degeneration occur under scar tissue. Methods The study design included 4 groups of rats: group 1 was the control group, groups 2, 3, and 4 receieved antifibrotic agents, mitomycin-C (group 2), sodium hyaluronate (group 3), and human amniotic fluid (group 4). Midline incision for all animals were done on L5 for total laminectomy. Four weeks after the surgery, the rats were sacrificed and specimens were stained with hematoxylin-eosin and photos of the slides were taken for quantitive assesment of the scar tissue. Results There was no significant scar tissue in the experimental animals of groups 2, 3, and 4. It was found that there was no significant difference between drug groups, but there was a statistically significant difference between the drug groups and the control group. Conclusions This experimental study shows that implantation of mitomycin-C, sodium hyaluronate and human amniotic fluid reduces epidural fibrosis and adhesions after spinal laminectomy in rat models. Further studies in humans are needed to determine the complications of the agents researched. PMID:24353840
Sveinsson, I S
One hundred heart surgery patients were followed throughout their postoperative periods to assess the incidence and etiology of postcardiotomy delirium. Factors evaluated were: age, sex, history of previous psychiatric illness, history of cerebrovascular disease, cardiac diagnosis and operation, time of anesthesia, time of bypass, time spent in the intensive-care unit, and amount of sleep during the postoperative period. Six patients developed delirium, five of whom had a lucid postoperative interval; four patients had perceptual disturbances only, without loss of contact with reality; three had neurological symptoms with mild confusion; 87 kept a clear mental state. The following factors tended to be related to the occurrence of delirium and perceptual disturbances: history of preoperative psychiatric illness, advanced age, severity of preoperative and postoperative illness, and time spent in the intensive-care unit. Sleep deprivation consistently preceded onset of these symptoms with one exception. Operative factors did not seem to be of major importance. While postoperative delirium probably has multidetermined causes, the author believes that sleep deprivation superimposed on the other contributory condition is a common precipitating factor. Suggestions about the prevention and treatment of delirium are made. PMID:1177486
Dal-Secco, Daniela; Cunha, Thiago M; Freitas, Andressa; Alves-Filho, José Carlos; Souto, Fabrício O; Fukada, Sandra Y; Grespan, Renata; Alencar, Nylane M N; Neto, Alberto F; Rossi, Marcos A; Ferreira, Sérgio H; Hothersall, John S; Cunha, Fernando Q
In this study, we have addressed the role of H(2)S in modulating neutrophil migration in either innate (LPS-challenged naive mice) or adaptive (methylated BSA (mBSA)-challenged immunized mice) immune responses. Treatment of mice with H(2)S synthesis inhibitors, dl-propargylglycine (PAG) or beta-cyanoalanine, reduced neutrophil migration induced by LPS or methylated BSA (mBSA) into the peritoneal cavity and by mBSA into the femur/tibial joint of immunized mice. This effect was associated with decreased leukocyte rolling, adhesion, and P-selectin and ICAM-1 expression on endothelium. Predictably, treatment of animals with the H(2)S donors, NaHS or Lawesson's reagent, enhanced these parameters. Moreover, the NaHS enhancement of neutrophil migration was not observed in ICAM-1-deficient mice. Neither PAG nor NaHS treatment changed LPS-induced CD18 expression on neutrophils, nor did the LPS- and mBSA-induced release of neutrophil chemoattractant mediators TNF-alpha, keratinocyte-derived chemokine, and LTB(4). Furthermore, in vitro MIP-2-induced neutrophil chemotaxis was inhibited by PAG and enhanced by NaHS treatments. Accordingly, MIP-2-induced CXCR2 internalization was enhanced by PAG and inhibited by NaHS treatments. Moreover, NaHS prevented MIP-2-induced CXCR2 desensitization. The PAG and NaHS effects correlated, respectively, with the enhancement and inhibition of MIP-2-induced G protein-coupled receptor kinase 2 expression. The effects of NaHS on neutrophil migration both in vivo and in vitro, together with CXCR2 internalization and G protein-coupled receptor kinase 2 expression were prevented by the ATP-sensitive potassium (K(ATP)(+)) channel blocker, glybenclamide. Conversely, diazoxide, a K(ATP)(+) channel opener, increased neutrophil migration in vivo. Together, our data suggest that during the inflammatory response, H(2)S augments neutrophil adhesion and locomotion, by a mechanism dependent on K(ATP)(+) channels. PMID:18768887
McNicol, E D; Tzortzopoulou, A; Cepeda, M S; Francia, M B D; Farhat, T; Schumann, R
Paracetamol is the most commonly prescribed analgesic for the treatment of acute pain. The efficacy and safety of i.v. formulations of paracetamol is unclear. We performed a systematic search (multiple databases, bibliographies, any language, to May 2010) for single-dose, randomized, controlled clinical trials of propacetamol or i.v. paracetamol for acute postoperative pain in adults or children. Thirty-six studies involving 3896 patients were included. For the primary outcome, 37% of patients (240/367) receiving propacetamol or i.v. paracetamol experienced at least 50% pain relief over 4 h compared with 16% (68/527) receiving placebo (number needed to treat=4.0; 95% confidence interval, 3.5-4.8). The proportion of patients in propacetamol or i.v. paracetamol groups experiencing at least 50% pain relief diminished over 6 h. Patients receiving propacetamol or paracetamol required 30% less opioid over 4 h and 16% less opioid over 6 h than those receiving placebo. However, this did not translate to a reduction in opioid-induced adverse events (AEs). Similar comparisons between propacetamol or i.v. paracetamol and active comparators were either not statistically significant, not clinically significant, or both. AEs occurred at similar rates with propacetamol or i.v. paracetamol and placebo. However, pain on infusion occurred more frequently in those receiving propacetamol compared with placebo (23% vs 1%). A single dose of either propacetamol or i.v. paracetamol provides around 4 h of effective analgesia for about 37% of patients with acute postoperative pain. Both formulations are associated with few AEs, although patients receiving propacetamol have a higher incidence of pain on infusion. PMID:21558067
... our e-newsletter! Aging & Health A to Z Prevention Basic Facts & Information Some factors that affect your ... control of the things that you can change. Preventive Recommendations for Adults Aged 65 and Older The ...
Shimmura-Tomita, Machiko; Shimmura, Shigeto; Satake, Yoshiyuki; Shimazaki-Den, Seika; Omoto, Masahiro; Tsubota, Kazuo; Shimazaki, Jun
Immunosuppressive therapy is the main postoperative treatment for keratoplasty, but there are considerable differences in protocols for the use of steroids and other immunosuppressants. Therefore, we conducted 2 prospective randomized clinical trials and 1 prospective nonrandomized clinical trial on keratoplasty postoperative treatment. One study evaluated the efficacy and safety of long-term topical corticosteroids after a penetrating keratoplasty was performed. Patients who underwent keratoplasty and maintained graft clarity for >1 year were randomly assigned to either a steroid or a no-steroid group. At the 12-month follow-up, the no-steroid group developed significantly more endothelial rejection than did the steroid group. A second study elucidated the effectiveness and safety of systemic cyclosporine in high-risk corneal transplantation. The patients were assigned to a systemic cyclosporine or control group. At a mean follow-up of 42.7 months, no difference was observed in the endothelial rejection rates and graft clarity loss between the 2 groups. A third study elucidated the effectiveness and the safety of systemic tacrolimus in high-risk corneal transplantation. Of 11 consecutive eyes decompensated despite systemic cyclosporine treatment, there was no irreversible rejection in eyes treated with tacrolimus, which was significantly better than in previous penetrating keratoplasty with systemic cyclosporine treatment. Prognosis after keratoplasty in patients with keratoconus is relatively good, but special attention is required for patients with atopic dermatitis. Postkeratoplasty atopic sclerokeratitis (PKAS) is a severe form of sclerokeratitis after keratoplasty in atopic patients. Our retrospective study showed that 35 eyes of 29 patients from a total of 247 keratoconus eyes undergoing keratoplasty were associated with atopic dermatitis, of which 6 eyes of 5 patients developed PKAS. Eyes with PKAS had a significantly higher incidence of atopic blepharitis
... Adhesions 1 Ward BC, Panitch A. Abdominal adhesions: current and novel therapies. Journal of Surgical Research. 2011;165(1):91–111. Seek Help for ... and how to participate, visit the NIH Clinical Research Trials and You website ... Foundation for Functional Gastrointestinal Disorders 700 West Virginia ...
Kutun, Suat; Ulucanlar, Haluk; Tarcan, Oguz; Demir, Abdullah; Cetin, Abdullah
Purpose This study aimed to examine extended postoperative ileus and its risk factors in patients who have undergone abdominal surgery, and discuss the techniques of prevention and management thereof the light of related risk factors connected with our study. Methods This prospective study involved 103 patients who had undergone abdominal surgery. The effects of age, gender, diagnosis, surgical operation conducted, excessive small intestine manipulation, opioid analgesic usage time, and systemic inflammation on the time required for the restoration of intestinal motility were investigated. The parameters were investigated prospectively. Results Regarding the factors that affected the restoration of gastrointestinal motility, resection operation type, longer operation period, longer opioid analgesics use period, longer nasogastric catheter use period, and the presence of systemic inflammation were shown to retard bowel motility for 3 days or more. Conclusion Our study confirmed that unnecessary analgesics use in patients with pain tolerance with non-steroid anti-inflammatory drugs, excessive small bowel manipulation, prolonged nasogastric catheter use have a direct negative effect on gastrointestinal motility. Considering that an exact treatment for postoperative ileus has not yet been established, and in light of the risk factors mentioned above, we regard that prevention of postoperative ileus is the most effective way of coping with intestinal dysmotility. PMID:22111079
Wade, Ros; Paton, Fiona; Rice, Stephen; Stansby, Gerard; Millner, Peter; Flavell, Hayley; Fox, Dave; Woolacott, Nerys
Objectives To assess the clinical effectiveness of thigh length versus knee length antiembolism stockings for the prevention of deep vein thrombosis (DVT) in surgical patients. Design Systematic review and meta-analysis using direct methods and network meta-analysis. Methods Previous systematic reviews and electronic databases were searched to February 2014 for randomised controlled trials (RCTs) of thigh length or knee length antiembolism stockings in surgical patients. Study quality was assessed using the Cochrane Risk of Bias Tool. The primary outcome was incidence of DVT. Analysis of the DVT data was performed using ORs along with 95% CIs. The I2 statistic was used to quantify statistical heterogeneity. Results 23 RCTs were included; there was substantial variation between the trials and many were poorly reported with an unclear risk of bias. Five RCTs directly comparing thigh length versus knee length stockings were pooled and the summary estimate of effect favouring thigh length stockings was not statistically significant (OR 1.48, 95% CI 0.80 to 2.73). 13 RCTs were included in the network meta-analysis; thigh length stockings with pharmacological prophylaxis were more effective than knee length stockings with pharmacological prophylaxis, but again results were not statistically significant (OR 1.76, 95% credible intervals 0.82 to 3.53). Conclusions Thigh length stockings may be more effective than knee length stockings, but results did not reach statistical significance and the evidence base is weak. Further research to confirm this finding is unlikely to be worthwhile. While thigh length stockings appear to have superior efficacy, practical issues such as patient acceptability may prevent their wide use in clinical practice. Systematic review registration number CRD42014007202. PMID:26883236
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Trzpis, Monika; McLaughlin, Pamela M.J.; de Leij, Lou M.F.H.; Harmsen, Martin C.
The epithelial cell adhesion molecule (EpCAM, CD326) is a glycoprotein of ∼40 kd that was originally identified as a marker for carcinoma, attributable to its high expression on rapidly proliferating tumors of epithelial origin. Normal epithelia express EpCAM at a variable but generally lower level than carcinoma cells. In early studies, EpCAM was proposed to be a cell-cell adhesion molecule. However, recent insights revealed a more versatile role for EpCAM that is not limited only to cell adhesion but includes diverse processes such as signaling, cell migration, proliferation, and differentiation. Cell surface expression of EpCAM may actually prevent cell-cell adhesion. Here, we provide a comprehensive review of the current knowledge on EpCAM biology in relation to other cell adhesion molecules. We discuss the implications of the newly identified functions of EpCAM in view of its prognostic relevance in carcinoma, inflammatory pathophysiology, and tissue development and regeneration as well as its role in normal epithelial homeostasis. PMID:17600130
Ren, Chang; Zhao, Dachun; Zhu, Lan
In previous studies, N,O-carboxymethyl chitosan has been shown to decrease the incidence and intensity of abdominal adhesions. In the present study, adhesions were induced in 220 rabbits using a double uterine horn model. Rabbits were randomized to receive an operation only or an operation+medical chitosan intraperitoneally. Twenty-two rabbits from each group were euthanized at one of five different times (Day 3, 7, 14, 28, or 42), and adhesion formation was given gross and histopathological scores. Reductions were observed in adhesion extent (P=0.0337) and tenacity (P=0.0271) as well as inflammation (P<0.0001) on Day 3 when medical chitosan was applied. Prior to Day 14, fibrosis was less obvious in the medical chitosan group (P< 0.0005). The tenacity scores were significantly lower in the medical chitosan group following Day 14 (P<.05), while the type scores were lower in the medical chitosan group following Day 28 (P<.03). Thus, medical chitosan decreased both the gross and the histopathological scores of the induced adhesions. PMID:26842129
Renner, Stefan P.; Strissel, Pamela L.; Beckmann, Matthias W.; Lermann, Johannes; Hackl, Janina; Fasching, Peter A.
Endometriosis is a chronic disease of women in the reproductive age, defined as endometrial cells growing outside of the uterine cavity and associated with relapses. Relapses are hypothesized to correlate with incomplete surgical excision or result from nonrandom implantation of new endometrial implants in adjacent peritoneum. Thus, surgical excision could lead to free endometriotic cells or tissue residues, which readhere, grow, and invade into recurrent lesions. Barrier agents are frequently used to prevent postoperative adhesions. We tested if the absorbable cell adhesion barrier gel Intercoat consisting of polyethylene oxide and sodium carboxymethyl cellulose could inhibit cellular adhesion, proliferation, and invasion of primary endometriosis and endometrial cells. Due to an association of endometriosis with ovarian carcinoma, we tested two ovarian carcinoma cell lines. Prior to cell seeding, a drop of the barrier gel was placed in cell culture wells in order to test inhibition of adherence and proliferation or coated over a polymerized collagen gel to assay for prevention of invasion. Results showed that the barrier gel significantly inhibited cell adherence, proliferation, and invasion of endometriosis and endometrial stromal cells as well as ovarian carcinoma cells in culture. Our findings could help to prevent local cell growth/invasion and possible consequent recurrences. PMID:25785270
Shirey, Ray A.
Apparatus for coating selected portions of the troughs of a corrugated pipe within an adhesive includes a support disposed within the pipe with a reservoir containing the adhesive disposed on the support. A pump, including a spout, is utilized for supplying the adhesive from the reservoir to a trough of the pipe. A rotatable applicator is supported on the support and contacts the trough of the pipe. The applicator itself is sized so as to fit within the trough, and contacts the adhesive in the trough and spreads the adhesive in the trough upon rotation. A trough shield, supported by the support and disposed in the path of rotation of the applicator, is utilized to prevent the applicator from contacting selected portions of the trough. A locator head is also disposed on the support and provides a way for aligning the spout, the applicator, and the trough shield with the trough.
Apparatus for coating selected portions of the troughs of a corrugated pipe with an adhesive includes a support disposed within the pipe with a reservoir containing the adhesive disposed on the support. A pump, including a spout, is utilized for supplying the adhesive from the reservoir to a trough of the pipe. A rotatable applicator is supported on the support and contacts the trough of the pipe. The applicator itself is sized so as to fit within the trough, and contacts the adhesive in the trough and spreads the adhesive in the trough upon rotation. A trough shield, supported by the support and disposed in the path of rotation of the applicator, is utilized to prevent the applicator from contacting selected portions of the trough. A locator head is also disposed on the support and provides a way for aligning the spout, the applicator, and the trough shield with the trough. 4 figs.
Park, Jeong Woo; Cho, Tae Koo; Chun, Hyoung-Joon; Ryu, Je Il
Objective A common cause of failure in laminectomy surgery is when epidural, peridural, or perineural adhesion occurs postoperatively. The purpose of this study is to examine the efficacy of a temperature-sensitive, anti-adhesive agent (TSAA agent), Guardix-SG®, as a mechanical barrier for the prevention or reduction of peridural scar adhesion in a rabbit laminectomy model. Methods Twenty-six mature rabbits were used for this study. Each rabbit underwent two separate laminectomies at lumbar vertebrae L3 and L6, left empty (the control group) and applied 2 mL of the TSAA agent (the experimental group), respectively. Invasive scar formation or inflammation after laminectomy was quantitatively evaluated by measuring the thickness of the dura, the distance from the surface of dura to the scar tissues, the number of inflammatory cells in the scar tissues at the laminectomy site, and the concentration of collagen in histological sections. Results At 6 weeks postsurgery, the dura was significantly thinner and the distance from the surface of dura to the scar tissues was greater in the experimental group than in the control group (p=0.04 and p=0.01). The number of inflammatory cells was not significantly different in the two groups (p=0.08), although the mean number of inflammatory cells was relatively lower in the experimental group than in the control group. Conclusion The current study suggests that the TSAA agent, Guardix-SG®, could be useful as an interpositional physical barrier after laminectomy for the prevention or reduction of adhesion. PMID:27226857
Progar, D. J.; Bell, V. L.; Saintclair, T. L. (Inventor)
A process of preparing aromatic polyamide-acids for use as adhesives is described. An equimolar quantity of an aromatic dianhydride is added to a stirred solution of an aromatic diamine in a water or alcohol-miscible ether solvent to obtain a viscous polymer solution. The polymeric-acid intermediate polymer does not become insoluble but directly forms a smooth viscous polymer solution. These polyamic-acid polymers are converted, by heating in the range of 200-300 C and with pressure, to form polyimides with excellent adhesive properties.
Smith, Trent; Prince, Michael; DwWeese, Charles; Curtis, Leslie
The Shuttle Ice Liberation Coating (SILC) has been developed to reduce the adhesion of ice to surfaces on the space shuttle. SILC, when coated on a surface (foam, metal, epoxy primer, polymer surfaces), will reduce the adhesion of ice by as much as 90 percent as compared to the corresponding uncoated surface. This innovation is a durable coating that can withstand several cycles of ice growth and removal without loss of anti-adhesion properties. SILC is made of a binder composed of varying weight percents of siloxane(s), ethyl alcohol, ethyl sulfate, isopropyl alcohol, and of fine-particle polytetrafluoroethylene (PTFE). The combination of these components produces a coating with significantly improved weathering characteristics over the siloxane system alone. In some cases, the coating will delay ice formation and can reduce the amount of ice formed. SILC is not an ice prevention coating, but the very high water contact angle (greater than 140 ) causes water to readily run off the surface. This coating was designed for use at temperatures near -170 F (-112 C). Ice adhesion tests performed at temperatures from -170 to 20 F (-112 to -7 C) show that SILC is a very effective ice release coating. SILC can be left as applied (opaque) or buffed off until the surface appears clear. Energy dispersive spectroscopy (EDS) and x-ray photoelectron spectroscopy (XPS) data show that the coating is still present after buffing to transparency. This means SILC can be used to prevent ice adhesion even when coating windows or other objects, or items that require transmission of optical light. Car windshields are kept cleaner and SILC effectively mitigates rain and snow under driving conditions.
Stewart, Russell J.; Ransom, Todd C.; Hlady, Vladimir
The general topic of this review is protein-based underwater adhesives produced by aquatic organisms. The focus is on mechanisms of interfacial adhesion to native surfaces and controlled underwater solidification of natural water-borne adhesives. Four genera that exemplify the broad range of function, general mechanistic features, and unique adaptations are discussed in detail: blue mussels, acorn barnacles, sandcastle worms, and freshwater caddisfly larva. Aquatic surfaces in nature are charged and in equilibrium with their environment, populated by an electrical double layer of ions as well as adsorbed natural polyelectrolytes and microbial biofilms. Surface adsorption of underwater bioadhesives likely occurs by exchange of surface bound ligands by amino acid sidechains, driven primarily by relative affinities and effective concentrations of polymeric functional groups. Most aquatic organisms exploit modified amino acid sidechains, in particular phosphorylated serines and hydroxylated tyrosines (dopa), with high-surface affinity that form coordinative surface complexes. After delivery to the surfaces as a fluid, permanent natural adhesives solidify to bear sustained loads. Mussel plaques are assembled in a manner superficially reminiscent of in vitro layer-by-layer strategies, with sequentially delivered layers associated through Fe(dopa)3 coordination bonds. The adhesives of sandcastle worms, caddisfly larva, and barnacles may be delivered in a form somewhat similar to in vitro complex coacervation. Marine adhesives are secreted, or excreted, into seawater that has a significantly higher pH and ionic strength than the internal environment. Empirical evidence suggests these environment triggers could provide minimalistic, fail-safe timing mechanisms to prevent premature solidification (insolubilization) of the glue within the secretory system, yet allow rapid solidification after secretion. Underwater bioadhesives are further strengthened by secondary covalent
Javedan, Houman; Tulebaev, Samir
Delirium is a common postoperative surgical complication associated with poor outcomes. The complexity of delirium demands that each patient be assessed individually and a tailored prevention and treatment regimen be put in place. Nonpharmacologic and pharmacologic strategies are available to achieve this goal. PMID:24721366
Nett, Michael P
Although the long-term results following traditional total joint arthroplasty are excellent, postoperative pain management has been suboptimal. Under-treatment of pain is a focus of growing concern to the orthopedic community. Poorly controlled postoperative pain leads to undesirable outcomes, including immobility, stiffness, myocardial ischemia, atelectasis, pneumonia, deep venous thrombosis, anxiety, depression, and chronic pain. Over the past decade, the attempt to minimize postoperative complications, combined with the move toward minimally invasive surgery and early postoperative mobilization, has made pain management a critical aspect of joint replacement surgery. Effective protocols are currently available; all include a multimodal approach. Debate continues regarding the ideal approach; however, reliance on narcotic analgesia alone is suboptimal. PMID:20839719
Lui, Tun Hing
Tendon adhesion is one of the most common causes of disability following tendon surgery. A case of extensive peritendinous adhesions of the Achilles tendon and tibialis posterior tendon after compound rupture of the tendons was reported. This was managed by endoscopic adhesiolysis of both tendons. The endoscopic approach allows early postoperative mobilisation which can relieve the tendon adhesion. PMID:24045762
Konjic, Ferid; Idrizovic, Enes; Hasukic, Ismar; Jahic, Alen
Introduction: Adhesions are the reason for bowel obstruction in 80% of the cases. In well selected patients the adhesive ileus laparoscopic treatment has multiple advantages which include the shorter hospitalization period, earlier food taking, and less postoperative morbidity rate. Case report: Here we have a patient in the age of 35 hospitalized at the clinic due to occlusive symptoms. Two years before an opened appendectomy had been performed on him. He underwent the treatment of exploration laparoscopy and laparoscopic adhesiolysis. Dilated small bowel loops connected with the anterior abdominal wall in the ileocecal region by adhesions were found intraoperatively and then resected harmonically with scalpel. One strangulation around which a small bowel loop was wrapped around was found and dissected. Postoperative course was normal. PMID:27041815
Bhatta, N; Isaacson, K; Flotte, T; Schiff, I; Anderson, R R
The purpose of this study is to determine the role of bleeding, acute thermal damage, and charring in adhesion formation. Postoperative adhesions were compared following ovarian wedge resection in 48 rabbits using different lasers, electrosurgery, and scalpel. Twelve ovaries were sectioned per modality, in randomized pairs. Acute thermal injury as assessed by histology, bleeding, and charring differed among the modalities used. Adhesions were assessed 4 weeks later, by an investigator completely blinded of the treatment protocol. The adhesion scores were 11.6 +/- 8.0 with pulsed Er:YAG laser; 11.9 +/- 7.5 with scalpel; 8.3 +/- 9.3 with electrocautery; 6.7 +/- 8.8 with a continuous (c.w.) Nd:YAG laser; 5.3 +/- 4.8 with c.w. CO2 laser; 3.1 +/- 2.7 with pulsed CO2 laser; 1.7 +/- 1.8 with pulsed Ho:YAG laser; and 0.8 +/- 1.5 in the control (no resection) group. Ho:YAG, Nd:YAG, and electrocautery were completely hemostatic. Bleeding was minimal with the CO2 lasers. Er:YAG and scalpel caused maximum bleeding, requiring hemostatic measures to prevent exsanguination. Charring occurred with electrocautery, CO2 laser, and Nd:YAG laser. Bleeding and charring correlated with adhesion formation, but the histological depth of thermal damage did not. The Ho:YAG laser is a hemostatic, fiber-optic compatible laser causing significantly fewer adhesions (P < 0.04) than scalpel, electrocautery, Nd:YAG, Er:YAG, and c.w. CO2 lasers. Clinical use of the Ho:YAG laser, and the role of carbonization in promoting adhesions, deserve further study. PMID:8515673
Wei, Guoqian; Zhang, Xueyan; Su, Zhendong; Li, Xueqi
Highlights: • GA inhibited TNF-α-induced binding of monocytes to endothelial cells. • GA inhibited the induction of adhesion molecules MCP-1, VCAM-1 and E-selectin. • GA inhibits NF-κB p65 nuclear translocation and transcriptional activity. • GA inhibits TNF-α-induced IκBα degradation. - Abstract: Pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α) is considered to be the major one contributing to the process of development of endothelial dysfunction. Exposure to TNF-α induces the expression of a number of proinflammatory chemokines, such as monocyte chemotactic protein-1 (MCP-1), and adhesion molecules, including vascular adhesion molecule-1 (VCAM-1) and E-selectin, which mediate the interaction of invading monocytes with vascular endothelial cells. Glatiramer acetate (GA) is a licensed clinical drug for treating patients suffering from multiple sclerosis (MS). The effects of GA in vascular disease have not shown before. In this study, we found that GA significantly inhibited TNF-α-induced binding of monocytes to endothelial cells. Mechanistically, we found that GA ameliorated the upregulation of MCP-1, VCAM-1, and E-selectin induced by TNF-α. Notably, this process is mediated by inhibiting the nuclear translocation and activation of NF-κB. Our results also indicate that GA pretreatment attenuates the up-regulation of COX-2 and iNOS. These data suggest that GA might have a potential benefit in therapeutic endothelial dysfunction related diseases.
Barkmeier, W W; Cooley, R L
Adhesive bonding of resin materials to acid-conditioned enamel is a clinically proven technique in preventative, restorative, and orthodontic procedures. Laboratory evaluations of etched-enamel resin bonding have shown excellent bond strengths and the virtual elimination of marginal microleakage. Adhesion to dentin has been more of a challenge. Earlier-generation dentin bonding systems did not yield high bond strengths in the laboratory or prevent marginal microleakage. Newer-generation adhesive systems generally use a dentin conditioner to modify or remove the smear layer and a subsequent application of an adhesive resin bonding agent. Laboratory evaluations of newer systems have shown bond strengths that approach or actually exceed that of etched enamel resin bonding. Bond strengths have improved with the evolution of dentin bonding systems, and microleakage from the cementum/dentin margin has been significantly reduced or prevented with the newer systems. Although laboratory testing of adhesive systems provides a mechanism to screen and compare newly developed systems, clinical trials are essential to document long-term clinical performance. PMID:1470553
Vadivelu, Nalini; Mitra, Sukanya; Narayan, Deepak
Good pain control after surgery is important to prevent negative outcomes such as tachycardia, hypertension, myocardial ischemia, decrease in alveolar ventilation, and poor wound healing. Exacerbations of acute pain can lead to neural sensitization and release of mediators both peripherally and centrally. Clinical wind up occurs from the processes of N-Methyl D-Aspartate (NMDA) activation, wind up central sensitization, long-term potentiation of pain (LTP), and transcription-dependent sensitization. Advances in the knowledge of molecular mechanisms have led to the development of multimodal analgesia and new pharmaceutical products to treat postoperative pain. The new pharmacological products to treat postoperative pain include extended-release epidural morphine and analgesic adjuvants such as capsaicin, ketamine, gabapentin, pregabalin dexmetomidine, and tapentadol. Newer postoperative patient-controlled analgesia (PCA) in modes such as intranasal, regional, transdermal, and pulmonary presents another interesting avenue of development. PMID:20351978
Buckley, Jack C.; Brown, Adam P.; Shin, John S.; Rogers, Kirsten M.
a high extubation risk (endotracheal tube movement >4 cm) when the endotracheal tube was secured with tape versus 0% (0/30) when secured with the Haider Tube-Guard (P = 0.004). Six patients with taped endotracheal tubes required the traction to be aborted before 15 N of force was achieved to prevent potential extubation as the tape either separated from the face or stretched to allow excessive endotracheal tube movement. None of the patients appeared to sustain any injury from the Haider Tube-Guard device. CONCLUSIONS: The Haider Tube-Guard significantly reduced the mobility of the endotracheal tube when compared with adhesive tape and was well tolerated in our observations. PMID:26983051