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

{"title":"Local treatment of bone and soft tissue infections with the collagen-gentamicin sponge.","authors":"A Stemberger, H Grimm, F Bader, H D Rahn, R Ascherl","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77418,"journal":{"name":"The European journal of surgery. Supplement. : = Acta chirurgica. Supplement","volume":" 578","pages":"17-26"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20114453","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":"Cost implications of adhesions as highlighted in a European study.","authors":"H Jeekel","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>For a hospital, the medical costs of dealing with post-operative adhesions can be very high. Studies to determine the extent of these costs are described, together with a suggested strategy by which surgeons may help avoid future cases of adhesion formation.</p>","PeriodicalId":77418,"journal":{"name":"The European journal of surgery. Supplement. : = Acta chirurgica. Supplement","volume":" 579","pages":"43-5"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20140334","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":"Mechanisms of adhesion development and effects on wound healing.","authors":"L Holmdahl","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This paper reviews the evidence that glove powder plays an important role in adhesion formation and has adverse effects on the healing of abdominal incisional wounds. The underlying mechanisms leading to these adverse effects are beginning to be revealed. By affecting the mesothelial cell function, powder contamination disrupts the delicate balance of fibrin deposition and degradation, provoking adhesion formation, and interfering with wound healing. Studies are described showing that starch impairs incisional wound healing by its effect on the T cell-mediated immune system. Furthermore starch powder may act as a vector for endotoxin. This paper concludes that starch powder is harmful and its use in a hospital setting can no longer be supported.</p>","PeriodicalId":77418,"journal":{"name":"The European journal of surgery. Supplement. : = Acta chirurgica. Supplement","volume":" 579","pages":"7-9"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20140970","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":"Setting standards for product selection: allergy prevention.","authors":"I R White","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>It is axiomatic to state that if products made of natural rubber latex were not used in health care settings then there would be no problems of acquired hypersensitivity from such products. Although synthetic materials are available they do not currently possess the same technical qualities of elasticity and comfort, nor do they deliver the desired degree of protection against biological agents as gloves made out of natural rubber latex. Selection of gloves either for non-sterile procedures or sterile surgical use should be based on this understanding, and gloves with minimal levels of extractable latex proteins should be used.</p>","PeriodicalId":77418,"journal":{"name":"The European journal of surgery. Supplement. : = Acta chirurgica. Supplement","volume":" 579","pages":"27-8"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20140975","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 role of Seprafilm bioresorbable membrane in adhesion prevention.","authors":"D E Beck","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate, the safety and efficacy of Seprafilm, a novel bioresorbable membrane of chemically modified hyaluronic acid and carboxymethylcellulose, in preventing and reducing postoperative adhesion formation.</p><p><strong>Design: </strong>Randomized, controlled, blinded, prospective multicenter study.</p><p><strong>Setting: </strong>Major academic surgical centers.</p><p><strong>Subjects: </strong>183 (treatment, n = 91; control, n = 92) patients with ulcerative colitis or familial polyposis.</p><p><strong>Interventions: </strong>Restorative proctocolectomy and ileal J-pouch anastomosis with diverting ileostomy followed by second-stage laparoscopy for ileostomy closure and direct visual assessment of the peritoneal cavity. Before abdominal closure in treated patients, Seprafilm, averaging 406.9 cm2 per patient, was applied without suturing between the midline incision and underlying tissues and organs.</p><p><strong>Main outcome measures: </strong>Determination of the incidence, extent (mean percentage of midline incision associated with adhesions), severity (grade 1, least severe; grade 2, moderately severe; grade 3, very severe), and distribution of adhesions.</p><p><strong>Results: </strong>In 175 (treatment, n = 90) evaluable patients, Seprafilm significantly reduced the incidence (49% and 94%, respectively, p < 0.0001), extent (23% and 63%, respectively, p < 0.0001), and severity (15% versus 58% grade 3 severity, respectively, p < 0.0001) of postoperative adhesions. Seprafilm decreased the rate of adhesion formation by nearly 50%. More than half (51%) of Seprafilm recipients were adhesion-free, versus only 6% of untreated patients. Thus treated patients were eight times more likely to be free of adhesions than untreated controls. The incidence of incisional adhesions associated with the omentum, small bowel, left sidewall, bladder, ileostomy, and stomach was significantly reduced in the Seprafilm patients. Effects on vital signs and laboratory parameters were comparable in the two groups and were attributable to the operative procedure, concomitant therapy, or comorbid disease. All reported adverse events were associated with the surgical procedure and/or comorbid disease and did not differ significantly between the two groups (p > 0.05).</p><p><strong>Conclusion: </strong>Seprafilm is safe and significantly reduces the incidence, extent, and severity of postoperative adhesions to the midline incision compared with no treatment, the current standard of surgical care.</p>","PeriodicalId":77418,"journal":{"name":"The European journal of surgery. Supplement. : = Acta chirurgica. Supplement","volume":" 577","pages":"49-55"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20030893","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 role of growth factors in peritoneal healing: transforming growth factor beta (TGF-beta).","authors":"N Chegini","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Processes that result in either normal peritoneal tissue repair of fibrous adhesion formation have until recently been largely unexplored at the molecular level. Our group is investigating the molecular events underlying peritoneal healing and hypothesizes that peptide growth factors, cytokines, and their receptors, which are expressed by various cell types at the site of injury and are present in the peritoneal fluid, play key roles in regulating tissue repair processes. This regulation is highly complex, involving the individual action of and/or synergistic interactions among many substances. These include various members of the growth factor family, such as transforming growth factors alpha and beta (TGF-alpha and TGF-beta), and of the cytokine family. These growth factors and cytokines are synthesized and released by activated macrophages in the peritoneal fluid and in the wound and by other major cell types in the wound, suggesting that they have a role in an autocrine/paracrine mechanism. For normal peritoneal healing to occur, the availability of these signaling substances must be optimal, precise, and synchronized. Inhibition, interruption, or excess expression of these signals seems to be responsible for failure in normal healing, either impairment (nonhealing) or excess tissue formation (adhesion development). Evidence of the key role of TGF-beta in peritoneal healing and adhesiogenesis falls into four main categories: 1) the characteristics of TGF-beta in other settings; 2) the presence and 3) activity of TGF-beta and/or its receptors in peritoneal wounds and fluid; and 4) the effects of the application of excess TGF-beta and anti-TGF-beta antibody on adhesion formation. TGF-betas are chemotactic for fibroblasts and inflammatory cells and promote cell proliferation and differentiation and angiogenesis. They also regulate the expression of various components of extracellular matrix. In mice, subcutaneous TGF-beta induces the formation of granulation tissue, and in several animal models and in humans, excess TGF-beta activity has been linked to the development of kidney and liver fibrosis. TGF-betas and their receptors are expressed by various cells in peritoneal wounds and fluid and are present at higher levels in injured compared with uninjured tissues. In vitro studies in peritoneal wounds and fluid show that TGF-beta 1 significantly upregulates its own expression and the expression of several extracellular matrix components and of tissue inhibitors of matrix metalloproteinases (TIMPs) but downregulates the expression of matrix metalloproteinases (MMPs). Following uterine horn injury, rats given TGF-beta daily for five days developed adhesions in significantly greater number and severity than did untreated controls. Although anti-TGF-beta neutralizing antibody in rats failed to significantly reduce adhesion formation, it did reduce cellularity of fibrous tissue. Antisense oligonucleotides to TGF-beta effectively blocked macropha","PeriodicalId":77418,"journal":{"name":"The European journal of surgery. Supplement. : = Acta chirurgica. Supplement","volume":" 577","pages":"17-23"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20030979","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":"Microbiology of intraabdominal infection and contamination.","authors":"R E Condon","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The processes involved in the genesis of an intraabdominal infection include bacterial contamination, selection, growth, invasion, localisation, and cure or failure. The four flora of abdominal infection (exogenous, gastric, biliary and faecal) are detailed. The author's choice of antibiotic agents for prophylaxis and treatment, and recommendations concerning the duration of treatment are outlined.</p>","PeriodicalId":77418,"journal":{"name":"The European journal of surgery. Supplement. : = Acta chirurgica. Supplement","volume":" 576","pages":"9-12"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19873089","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":"Duration of antibiotic treatment in surgical infections of the abdomen. The role of shock.","authors":"J M Bergstein","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Emergency laparotomy requiring perioperative antibiotics is often accompanied by shock. Whether the shock is the result of haemorrhage, sepsis, cardiac disease, or vasodilatation, it represents a profound metabolic alteration which impairs cellular metabolism, causes immunosuppression, and alters pharmacokinetics. These changes lead to an increased risk of infection, which can be overcome, at least in part, by increasing the dose and (probably) the duration of perioperative antibiotics.</p>","PeriodicalId":77418,"journal":{"name":"The European journal of surgery. Supplement. : = Acta chirurgica. Supplement","volume":" 576","pages":"16-8"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19873091","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":"Upper gastrointestinal surgery and the appendix.","authors":"R Heemken,&nbsp;T Hau","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In healthy humans the stomach, duodenum and proximal small bowel are almost sterile. Under pathological conditions, however, bacterial overgrowth occurs. The need for and duration of postoperative antibiotic treatment is based on the time from perforation to operation, and the degree of contamination or infection. Our recommendation ranges from no antibiotic in early cases with minimal contamination to 5 days of treatment when established peritonitis is encountered. The duration of treatment following appendectomy for acute appendicitis depends on the intraoperative findings: simple appendicitis: no postoperative antibiotics; phlegmonous or gangrenous appendicitis: 3 day course; perforated appendicitis with peritonitis or abscess formation: 3- to 5-day therapy.</p>","PeriodicalId":77418,"journal":{"name":"The European journal of surgery. Supplement. : = Acta chirurgica. Supplement","volume":" 576","pages":"61-2"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19872826","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":"Duration of antibiotic treatment in surgical infections of the abdomen. Choice of antibiotics in two French hospitals.","authors":"A Fingerhut,&nbsp;J P Terville,&nbsp;J M Hay,&nbsp;G Parmentier","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77418,"journal":{"name":"The European journal of surgery. Supplement. : = Acta chirurgica. Supplement","volume":" 576","pages":"63-4; discussion 64-5"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19872827","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}