Surgical Research; Surgical Audit and Safe Surgery

N. A.

Salicylic acid sans aspirin in animals and man: persistence in fasting and biosynthesis from benzoic acid.

Salicylic acid (SA), which is central to defense mechanisms in plants and the principal metabolite of aspirin, occurs naturally in man with higher levels of SA and its urinary metabolite salicyluric acid (SU) in vegetarians overlapping with levels in patients on low-dose aspirin regimens. SA is widely distributed in animal blood. Fasting for major colorectal surgery did not cause disappearance of SA from plasma, even in patients following total proctocolectomy. A (13)C(6) benzoic acid load ingested by six volunteers led, between 8 and 16 h, to a median 33.9% labeling of urinary salicyluric acid. The overall contribution of benzoic acid (and its salts) to the turnover of circulating SA thus requires further assessment. However, that SA appears to be, at least partially, an endogenous compound should lead to reassessment of its role in human (and animal) pathophysiology.

Peritoneal adhesions: pathogenesis, assessment and effects.

BACKGROUND: As modem surgery has evolved, there has been an increase in iatrogenic peritoneal adhesions. Most surgeons manage adhesions and their related complications on a regular basis. Studies in recent years have improved the understanding of the pathogenesis and impact of adhesions, which are discussed. METHODS: A systematic search of literature was performed to identify publications addressing the etiopathogenesis, clinical spectrum and effects of adhesions, using the following database: Medline (1966 to April 2005), Embase (1974 to April 2005), and the Cochrane controlled trials register. The reference lists of key publications so identified were in addition scrutinized for additional articles of relevance. RESULTS: Adhesions occur in more than three fourths of patients following laparotomy. Perironeal trauma results in a unique inflammatory process in which fibrin formation and fibrinolysis play a central role. The effects of adhesions are unpredictable but are wide ranging, causing a significant health care burden. Intestinal obstruction, infertility, problems at reoperative surgery and cumulative costs of care over many years are the key concerns. While adhesiolysis is beneficial in adhesive intestinal obstruction and infertility, its value in chronic pain is uncertain. CONCLUSION: Every violation of the peritoneum carries a potentially lifelong risk of a range of complications. Data available on the epidemiology and natural history of adhesions call for a wider acknowledgement of the problem in the planning of services and greater attention to preventive strategies.