ABSTRACT
Following laparotomy, almost 95% of patients develop adhesions. To prevent adhesion formation, peritoneal lavage has been investigated and many different lavage solutions have been proposed. In this study, different peritoneal lavage solutions were evaluated, testing their ability to prevent adhesion formation. Three consecutive steps were followed: (1) The lethal dose of Eschericia coli injected in the rat peritoneal cavity was determined, (2) the morbidity and mortality rates of different solutions for peritoneal lavage (i.e., saline, twice-distilled water, antiseptics, and antibiotics solutions) was investigated, and (3) the capability of the different lavage solutions to prevent adhesion formation was tested. Two hundred and ninety-eight rats were employed in this study. After intraperitoneal injection of E. coli, infection (clinical signs and animal vitality), adhesion formation (explorative laparoscopy, peritoneumgraphy and Zühlke scale grading), and animal performance status were investigated. All differences were evaluated by chi-square and analysis of variance (ANOVA) tests. Saline solution showed a low morbidity rate with no deaths. Twice-distilled water was associated with 100% mortality rate, as opposed to 45-75% for antiseptics, and 0-3% mortality for antibiotics. Antibiotics determined higher adhesion formation by Zühlke score as compared to saline solution (p < .001), while no difference was observed between antiseptics and saline (p = NS). Peritoneal lavage with 37 degrees C saline solution was associated with low adhesion formation and high survival rate as compared to twice-distilled water and antiseptics. Antibiotics solutions had high survival rate and high adhesion formation. Twice-distilled water and antisepsis should be avoided when based on the data obtained in this work.
Subject(s)
Peritoneal Lavage/methods , Postoperative Complications/prevention & control , Tissue Adhesions/prevention & control , Animals , Anti-Bacterial Agents/administration & dosage , Anti-Infective Agents, Local/administration & dosage , Disease Models, Animal , Escherichia coli Infections/complications , Laparoscopy , Male , Peritonitis/drug therapy , Peritonitis/mortality , Peritonitis/pathology , Postoperative Complications/pathology , Rats , Rats, Wistar , Sodium Chloride/administration & dosage , Survival Rate , Tissue Adhesions/pathology , Water/administration & dosageABSTRACT
BACKGROUND: Our aim was to evaluate the best intrathoracoscopic localization technique in patients with single pulmonary nodule and a history of malignancy. METHODS: We divided 50 patients in two groups, well matched for diameter and depth of the pulmonary lesion. In 25 patients we performed intrathoracoscopic ultrasound to locate the pulmonary nodule (group A), whereas in the other 25 patients the radio-guided technique was adopted (group B). In both group A and group B, the localization techniques were compared with finger palpation. In group A, 12 nodules were in the left lung and 13 in the right one; in group B, 11 lesions were in the left and 14 in the right lung. In both groups, the distance of the nodule from the pleural surface was 2.6 +/- 0.5 cm (2 to 2.5 cm in 14 patients, and >2.5 cm for the remaining 11). The diameter of the nodule was 1.26 +/- 0.22 (< or =1 cm in 10 patients, and 1 to 1.5 cm in 15) in both groups. All patients underwent thoracoscopic wedge resection, and 10 patients with a primary pulmonary lesion underwent posterior-lateral thoracotomy for lobectomy and mediastinal lymphadenectomy. RESULTS: In group A, ultrasound localized the nodule in 24 of 25 patients (96%) whereas finger palpation localized it in 19 of 25 (76%; not significant). In group B, both the radio-guided and finger palpation techniques localized the nodule in 20 of 25 patients (80%; not significant). No complications were recorded with the ultrasound technique; however, 10 cases of pneumothorax were detected after the radio-guided technique (p < 0.01). CONCLUSIONS: Both the ultrasound and radio-guided techniques are accurate to detect solitary pulmonary nodules, but the radio-guided method yields complications as compared with the ultrasound.
Subject(s)
Adenocarcinoma/diagnosis , Adenocarcinoma/secondary , Lung Diseases/diagnosis , Lung Neoplasms/diagnosis , Lung Neoplasms/secondary , Radiography, Interventional , Solitary Pulmonary Nodule/diagnostic imaging , Thoracoscopy , Ultrasonography, Interventional , Adenocarcinoma/diagnostic imaging , Adenocarcinoma/surgery , Adult , Aged , Aged, 80 and over , Breast Neoplasms , Carcinoma/diagnostic imaging , Carcinoma/secondary , Carcinoma/surgery , Colonic Neoplasms , Diagnosis, Differential , Female , Follow-Up Studies , Hamartoma/diagnosis , Hamartoma/diagnostic imaging , Hamartoma/surgery , Humans , Lung Diseases/diagnostic imaging , Lung Diseases/surgery , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/surgery , Lymph Node Excision , Male , Melanoma/diagnostic imaging , Melanoma/secondary , Melanoma/surgery , Middle Aged , Palpation , Plasma Cell Granuloma, Pulmonary/diagnosis , Plasma Cell Granuloma, Pulmonary/diagnostic imaging , Plasma Cell Granuloma, Pulmonary/pathology , Plasma Cell Granuloma, Pulmonary/surgery , Pneumonectomy/methods , Pneumonia/diagnosis , Pneumonia/diagnostic imaging , Pneumonia/surgery , Sensitivity and Specificity , Solitary Pulmonary Nodule/pathology , Solitary Pulmonary Nodule/surgery , Tomography, X-Ray Computed , Ultrasonography, Interventional/adverse effectsABSTRACT
INTRODUCTION: Our aim was to evaluate the best intrathoracoscopic localization technique in patients with a single pulmonary nodule and a history of malignancy. METHOD: We divided 30 patients into two groups, well matched for diameter and depth of the pulmonary lesion. In 15 patients (group A) we performed intrathoracoscopic ultrasound (US) to locate the pulmonary nodule, while in the other 15 patients (group B) intrathoracoscopic radioguided occult lesion localization (ROLL) was used. In both groups, the localization technique was compared to finger palpation. In group A, 6 nodules were in the left lung and 9 in the right; in group B, 7 lesions were in the left and 8 in the right lung. In each group, the distance of the nodule from the pleural surface was 2-2.5 cm in 8 patients, and > 2.5 cm in the remaining 7. In both groups, the diameter of the nodule was
