Conservative management of major abdominal wound dehiscence in premature babies - a seven-year experience.

AIM: The aim of the study was to analyse our experience of managing complete abdominal wound dehiscence in preterm neonates non operatively, when primary closure was not possible. We used intrasite gel (a carboxymethyl cellulose polymer which helps in wound debridement and healing) and occlusive duoderme dressings. MATERIALS AND METHODS: There were seven neonates who developed abdominal dehiscence following laparotomy between January 2000 and December 2006. All had complete abdominal dehiscence with visible intestines. The defect was allowed to granulate and epithelialise by the application of intrasite gel and duoderme dressings. Dressings were changed every 3 days, or earlier, if necessary. RESULTS: All babies responded well, i.e. their wounds healed without the need for immediate surgery. One patient actually had a stoma in the middle of the wound which was managed with stoma bags during the same period. The period of total epithelialisation ranged from 21 to 108 days. Two patients developed adhesive intestinal obstruction requiring surgery, at 2 and 3 months after the start of treatment. On follow-up, 2/7 patients had developed an incisional hernia. CONCLUSION: Abdominal wound dehiscence can be successfully managed conservatively with intrasite gel and duoderme dressings, even if bowel is visible. This is potentially lifesaving in severely premature and septic babies in whom primary closure is not desirable. However, some patients do develop adhesive intestinal obstruction or a faecal fistula, either as a result of their primary illness or of this treatment. We believe that this series is the first of its kind to be reported in the world literature.

Reducing micropollutants with source control: substance flow analysis of 212 pharmaceuticals in faeces and urine.

Pharmaceuticals in the aquatic environment are raising concern. It is expected that many anthropogenic pharmaceuticals are largely excreted via urine; a popular argument for introducing urine source separation. However, to date, this assumption lacks verification. We close this gap with quantitative screening of official pharmaceutical data. We analysed the excretion pathways of 212 pharmaceuticals' active ingredients (AI), equalling 1,409 products. On average, 64% (+/-27%) of each AI was excreted via urine, and 35% (+/-26%) via faeces. In urine, 42% (+/-28%) of each AI was excreted as metabolites. However, these numbers need cautious interpretation. We found an extreme variability (1) between different therapeutic groups, (2) within some groups and (3) sometimes even between products of the same AI. We discuss various therapeutic groups and include Swiss sales' quantities. For instance, urine source separation could very effectively remove the highly sold and non-degradable x-ray contrast media: 94% (+/-4%) are excreted via urine. However, for different pharmaceuticals belonging to cytostatics, excretion via urine was 6-98%. Because of such large variability we advise caution to introduce the still imperfect urine separation technology solely because of pharmaceuticals. Nonetheless, together with other good arguments for this innovation, removal of pharmaceuticals is a welcome side effect.