The European journal of surgery. Supplement. : = Acta chirurgica. Supplement最新文献

{"title":"Misdiagnosis of cancer due to multiple glove powder granulomas.","authors":"K E Giercksky","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A biologically absorbable powder, the cornstarch lubricant used in the production of gloves, is treated with epichlorohydrin, a cross-linking agent forming one to three diether glycerine groups to create a glove lubricating powder. This agent, together with chemicals used in glove fabrication is able to interfere with important biological diagnostic procedures, such as polymerase chain reaction (PCR) and enzyme immunoassay as well as to induce a granulomatous reaction in traumatised surgical tissue.</p>","PeriodicalId":77418,"journal":{"name":"The European journal of surgery. Supplement. : = Acta chirurgica. Supplement","volume":" 579","pages":"11-4"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20140971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biochemical events in peritoneal tissue repair.","authors":"G S diZerega","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The increased incidence of postoperative adhesions and their complications have refocused attention on our understanding of adhesions, their clinical consequences and prevention. Postsurgical adhesions have four major negative impacts on health care outcomes. First, adhesions cause significant morbidity, including intestinal obstruction, infertility and pelvic pain. Second, adhesions are associated with multiple surgical complications. Third, these complications lead to greater surgical workload and utilization of hospital and other health care resources. Fourth, all these negative impacts result in significant economic burden to society. The complexities of adhesion formation and limitations in their understanding and research have hampered the development of satisfactory preventive treatments. Adhesions are highly differentiated, formed through an intricate process and associated with a complex organ, the peritoneum. The surface lining of the peritoneum is the key site in adhesion formation and prevention. Two unique properties of the peritoneal surface play key roles in these processes: its delicacy and its uniform, relatively rapid rate of re-epithelialization, irrespective of the size of injury. A suitable barrier that separates damaged peritoneal surfaces for the entire five to seven days of re-epithelialization is likely to prove effective in reducing adhesion formation. Postsurgical peritoneal repair begins with coagulation, which releases a variety of chemical messengers that bring about a cascade of events. Some of the principal cellular elements in this cascade are leukocytes, including polymorphonuclear neutrophils and macrophages, mesothelial cells, and fibrin. Following surgical injury, macrophages exhibit increased phagocytic, respiratory burst and secretory activity, and after day 5, are the major component of the leukocyte population. Macrophages also recruit new mesothelial cells onto the surface of the injury. These cells form small islands throughout the injured area which proliferate into sheets of mesothelial cells and accomplish re-epithelialization, usually five to seven days after surgical injury. The progenitor to adhesions is the fibrin gel matrix which develops in several steps. These include the formation and insolubilization of fibrin polymer and its interaction with fibronectin and a series of amino acids. Protective fibrinolytic enzyme systems of the peritoneal mesothelium, such as the tissue plasminogen activator (tPA) system, can remove the fibrin gel matrix. However, surgery dramatically diminishes fibrinolytic activity. This occurs in at least two ways: first, by increasing levels of plasminogen activator inhibitors and second, by reducing tissue oxygenation. Peritoneal re-epithelialization and adhesion formation thus can be seen as alternative pathways following peritoneal injury. The pivotal events determining the pathway are the apposition of two damaged surfaces and the extent of fibrinolysis. Develop","PeriodicalId":77418,"journal":{"name":"The European journal of surgery. Supplement. : = Acta chirurgica. Supplement","volume":" 577","pages":"10-6"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20030978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The clinical significance of adhesions: focus on intestinal obstruction.","authors":"H Ellis","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Postoperative adhesions occur after almost every abdominal surgery and are the leading cause of intestinal obstruction, accounting for more than 40% of all cases and 60% to 70% of those involving the small bowel. This contrasts with earlier experience in the Western World and current practice in the Third World, where abdominal operations are infrequent, hernias remain untreated, and strangulated hernia is common. These are among the findings of prospective and retrospective studies on adhesions conducted at the Westminster Medical School, University of London, London, UK, and of other published studies on the clinical consequences of postoperative intra-abdominal adhesions and resultant intestinal obstruction. In an analysis of 210 patients who had undergone at least one previous abdominal operation, 92.9% had postsurgical adhesions. This is not surprising, given the extreme delicacy of the peritoneum and the fact that apposition of two injured surfaces nearly always results in adhesion formation. Problems resulting from postsurgical adhesions create a considerable workload. At Westminster Hospital over 24 years, intestinal obstruction accounted for 0.9% of all admissions, 3.3% of major laparotomies and 28.8% of cases of large or small bowel obstructions. A 1992 British survey reported an annual total of 12,000 to 14,400 cases of adhesive intestinal obstruction. In 1988 in the United States, admissions for adhesiolysis accounted for nearly 950,000 days of inpatient care. Risk factors, such as type of surgery and site of adhesions, as well as timing and recurrence rate of adhesive obstruction, remain unpredictable or poorly understood. The type of surgery most frequently leading to adhesive obstruction includes colonic, and especially rectal surgery, appendicectomy, and gynecological procedures. Laparoscopy does not seem to eliminate the risk of adhesions and adhesive obstruction. Adhesions involving the small intestine occur less frequently than those involving the omentum, but are more likely to become obstructive. Follow-up of over 2,000 laparotomies at the Westminster Hospital demonstrated that 1% of patients developed adhesive obstruction within one year of surgery, and half of these occurred within the first postoperative month. However, obstruction may occur at any time, and some 20% of cases appeared more than 10 years later. Recurrent obstruction following adhesiolysis is common, but actuarial tables still need to be constructed. Adhesive obstruction is clinically challenging, since there is no simple way to differentiate between adhesive and strangulated obstructions. Mortality rates escalate from 3% for simple obstructions to 30% when the bowel becomes necrotic or perforated.</p>","PeriodicalId":77418,"journal":{"name":"The European journal of surgery. Supplement. : = Acta chirurgica. Supplement","volume":" 577","pages":"5-9"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20030977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preclinical evaluation of Seprafilm bioresorbable membrane.","authors":"J W Burns,&nbsp;M J Colt,&nbsp;L S Burgees,&nbsp;K C Skinner","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To characterize Seprafilm bioresorbable membrane and assess its efficacy and safety in reducing adhesions.</p><p><strong>Design: </strong>In vitro and animal studies designed to provide precise control of tissue trauma and closely approximate clinically relevant conditions in abdominal surgery.</p><p><strong>Setting: </strong>Experimental laboratories, USA.</p><p><strong>Subjects: </strong>Experimental animals, principally rats and rabbits.</p><p><strong>Interventions: </strong>The rat cecal abrasion or sidewall injury model evaluated the efficacy of seprafilm in the presence of blood and irrigation solutions, in multiple layers, under ischemic conditions, and in adhesion reformation. A rabbit anastomosis model tested the effect of the membrane on wound healing, and a series of challenge tests determined its toxicology, immunogenicity, and biocompatibility.</p><p><strong>Main outcome measures: </strong>Incidence and severity of adhesions; mutagenicity; pyrogenicity; irritation effects; systemic toxicity.</p><p><strong>Results: </strong>Seprafilm significantly reduced the number of cecal adhesions (p < 0.001) and the number of animals with severe adhesions (p < 0.001) when compared with nontreated controls, even in the presence of bleeding. The membrane also significantly decreased the number of animals with any adhesions (p < 0.001). Seprafilm maintains efficacy when used with excess irrigation solutions, when layered, and under ischemic conditions. Among rats tested for adhesion reformation, the treated group had a significantly larger proportion of adhesion-free animals than the untreated group, 72% versus 28%, (p = 0.007). Seprafilm did not impair wound healing in anastomosis and is nontoxic, nonmutagenic, nonimmunogenic, nonpyrogenic, nonirritating, and biocompatible.</p><p><strong>Conclusion: </strong>Preclinical studies have shown that Seprafilm is safe and effective in reducing postsurgical adhesions. Seprafilm meets the requirements of an ideal barrier and can be a useful adjuvant in abdominal and pelvic surgery.</p>","PeriodicalId":77418,"journal":{"name":"The European journal of surgery. Supplement. : = Acta chirurgica. Supplement","volume":" 577","pages":"40-8"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20030892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adhesions: preventive strategies.","authors":"B Risberg","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Adhesions, which occur after 67% to 93% of abdominal operations, represent a major clinical problem, resulting in intestinal obstruction, infertility, and pain and incurring considerable economic costs. The magnitude and seriousness of the problem of adhesions have been underappreciated. Moreover, efforts to prevent or reduce adhesions largely have been unsuccessful, hindered by their empirical basis, the lack of good predictive animal models, and the biochemical complexities of adhesiogenesis. The two major strategies for adhesion prevention or reduction are adjusting surgical technique and applying adjuvants. Modifications in technique that all surgeons should implement include minimizing the invasiveness of surgery, minimizing surgical trauma, such as ischemia from peritoneal suturing, and avoiding the introduction of foreign material, e.g., starch glove powder, into the body. Given the adhesiogenic nature of peritoneal repair, however, improvements in surgical technique alone will help decrease but not prevent adhesion formation. Adjuvant therapy is necessary. Adjuvants fall into two main categories, drugs and barriers. Nonsteroidal anti-inflammatory drugs have shown questionable clinical efficacy, possibly because of difficulties in drug delivery. Corticosteroids, alone or with antihistamines, also have had equivocal clinical results and may be immunosuppressive and delay wound healing. Experimentally, fibrinolytics such as tissue plasminogen activator (tPA), administered systemically or intraperitoneally (i.p.), have demonstrated conflicting results and hemorrhagic complications. However, recently, tPA, administered topically in a carboxymethylcellulose (CMC) gel, has been effective in reducing and preventing adhesions in rabbits. Phosphatidylcholine, given i.p. or orally, also has shown promise in animal studies. Barriers, by separating traumatized surfaces for the critical first five to seven days of peritoneal re-epithelialization, are useful adjuvants, and include macromolecular solutions and mechanical devices. Dextran, a macromolecular solution, has been studied widely, but has not demonstrated consistent clinical efficacy and has been largely abandoned as an anti-adhesion barrier. A newly developed hyaluronic acid-phosphate-buffered saline solution applied intraoperatively to protect peritoneal surfaces from indirect surgical trauma effectively and safely reduced adhesions in a large multicenter study of women undergoing gynecological laparotomy. Three recently developed mechanical barriers also have demonstrated clinical progress in adhesion prevention. A bioresorbable membrane consisting of hyaluronic acid and CMC has gained regulatory approval for clinical use in both general and gynecological surgery following demonstration of efficacy and safety in reducing adhesions. A barrier made of expanded polytetrafluoroethylene and another developed from oxidized regenerated cellulose are currently available for gynecological surger","PeriodicalId":77418,"journal":{"name":"The European journal of surgery. Supplement. : = Acta chirurgica. Supplement","volume":" 577","pages":"32-9"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20030891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glove powder--a risk factor for the development of latex allergy?","authors":"R Brehler,&nbsp;R Kolling,&nbsp;M Webb,&nbsp;C Wastell","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Studies are described which compare the prevalence of sensitisation against latex proteins in medical personnel in different hospitals. The objective of these studies was to find out whether the use of powdered or unpowdered gloves could be related to the prevalence of latex allergy. Employees of one of the investigated hospitals (Germany) were using only powdered latex gloves, and in the other two hospitals (Great Britain) low protein powder-free latex gloves were used. Methods by which latex allergy can be avoided are suggested.</p>","PeriodicalId":77418,"journal":{"name":"The European journal of surgery. Supplement. : = Acta chirurgica. Supplement","volume":" 579","pages":"23-5"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20140974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of powder on infection risks and associated mechanisms.","authors":"H Renz,&nbsp;D Gemsa","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This paper examines the release of Tumour necrosis factor alpha, (TNFa) interleukin 1, eicosanoids, and hydrogen peroxide from macrophages exposed to glove starch particles. Studies are described which show that T-cell responses are potently activated by glove powder products leading to the release and formation of high amounts of pro-inflammatory mediators, ultimately resulting in adverse clinical consequences such as starch peritonitis or adhesions.</p>","PeriodicalId":77418,"journal":{"name":"The European journal of surgery. Supplement. : = Acta chirurgica. Supplement","volume":" 579","pages":"35-8"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20140977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glove Powder--The Hazards which Demand a Ban. Proceedings of a meeting. London, United Kingdom, May 1996.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77418,"journal":{"name":"The European journal of surgery. Supplement. : = Acta chirurgica. Supplement","volume":" 579","pages":"4-55"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20187887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical infection: current concerns.","authors":"E W Taylor","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77418,"journal":{"name":"The European journal of surgery. Supplement. : = Acta chirurgica. Supplement","volume":" 578","pages":"5-9"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20114451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention of wound infection in elective colorectal surgery by local application of a gentamicin-containing collagen sponge.","authors":"H J Rutten,&nbsp;P H Nijhuis","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Preoperative antibiotic prophylaxis is known to significantly reduce the incidence of postoperative wound infection in elective colorectal surgery, and is a recognized part of surgical management. Antibiotics are usually given systemically or orally, or by a combination of the two routes. Local antibiotic delivery to the wound site using an implanted, reabsorbable, gentamicin-containing collagen sponge is a novel concept. We compared postoperative wound infection rates in 221 colorectal surgery patients randomized to receive systemic gentamicin/metronidazole with (Group I, n = 107) or without (Group II, n = 114) the gentamicin-collagen sponge. The two patient groups were identical on the basis of demographics and operations undergone. The postoperative wound infection rate was significantly lower in Group I patients than Group II 5.6% (6/107) and 18.4% (21/ 114), respectively (p < 0.01). The mean duration of hospital stay was 13.8 days in Group I and 16.3 days in Group II, which did not represent a statistically significant difference. The gentamicin collagen sponge was well tolerated and no adverse events were reported that were attributable to its use. This new method for delivering gentamicin directly to the operative site may represent a significant method for reducing postoperative wound infection rates to levels lower than those currently achieved with systemic antibiotics alone.</p>","PeriodicalId":77418,"journal":{"name":"The European journal of surgery. Supplement. : = Acta chirurgica. Supplement","volume":" 578","pages":"31-5"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20114455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}