Preoperative administration of antibodies against tumor necrosis factor-alpha (TNF-alpha) and interleukin-1 (IL-1) and their impact on peritoneal adhesion formation.

This study investigates the effects of preoperative intravenous administration of antibodies against TNF-alpha and IL-1 on peritoneal adhesion formation. Fifty-six Sprague-Dawley rats (350-400 gm) were used in this study. Eight rats were used to empirically determine the amount of anti TNF-alpha and anti IL-1 needed for complete in vivo neutralization. This amount was used for preoperative treatment of selected groups. Forty-eight rats were divided into four equal groups (n = 12). All rats underwent a midline laparotomy. Ten cm square of cecal serosa was abraded, the peritoneal cavity was irrigated with normal saline, and the incision was closed in layers. Cultures were obtained intraoperatively and rats with positive cultures were excluded. Rats in Group 1 were not treated (control), while rats in Groups 2, 3, and 4 were treated with anti TNF-alpha, anti IL-1, and a combination of anti TNF-alpha and IL-1 respectively. All rats were killed at 3 weeks, and peritoneal adhesions were graded using a scale of 0 (none) to 3 (extensive, dense). Rats treated with anti IL-1 (Group 3) and those treated with a combination of anti TNF-alpha and anti IL-1 (Group 4) had significantly fewer adhesions when compared with Group 1 (control) (P < 0.01 and < 0.005, respectively). Least adhesion formation was associated with Group 4 rats. In conclusion, selective immunosuppression, at a molecular level, appears to have a significant impact on rates of postoperative peritoneal adhesion formation.

Tumor necrosis factor-alpha: a marker for peritoneal adhesion formation.

This study investigates the possible correlation between higher levels of tumor necrosis factor-alpha (TNF-alpha) and higher rates of adhesion formation following standard bowel injury. Forty-five Sprague-Dawley rats were divided into three equal groups. Blood was obtained from all rats preoperatively. All rats were subjected to a laparotomy. In group 1 the peritoneal cavity was irrigated with normal saline. In group 2 the cecal serosa was abraded, while rats in group 3 had 2 cm of their small bowel resected. A peritoneal catheter was placed in all rats prior to closure. Blood samples were obtained at 30, 90, and 180 min following injury. Peritoneal exudate (PE) was collected and the catheter removed in 3 hr. Blood samples and peritoneal exudate were processed and levels of TNF-alpha were determined. The severity of adhesions was graded 3 weeks postoperatively using a score of 0 (absent) to III (extensive, dense). Histological evaluation for collagen deposition and fibroblasts was carried out. Rats in group 1 had significantly lower adhesion grades when compared to groups 2 and 3 (grade 0; P < 0.0001). Postoperatively, groups 2 and 3 had higher serum and PE TNF-alpha levels when compared with group 1 (P < 0.01). There was a significant correlation between higher grades of adhesions and higher levels of serum and PE at 30, 90, and 180 min following operation (P < 0.01 and < 0.05, respectively). TNF-alpha, a proinflammatory cytokine, appears to be a good biological marker for postoperative intraabdominal adhesion formation.

Hemostasis and healing of superficial splenic injuries using Nd:YAG laser and nonsuture techniques: preliminary report.

This study was designed to compare Nd:YAG laser to fibrin glue, electrocautery, and avitene in the management of superficial splenic injury. Six dogs were submitted to laparotomy. A #11 blade scalpel was used to sharply excise the splenic capsule inflicting four 1" x 1" superficial injuries on each spleen. The lesions were treated. All animals had a second laparotomy ("first relaparotomy"); 2 dogs each were reexplored on postop days 3, 7, and 14. Morphologic and histologic observations were made. A third and final relaparotomy was performed on all dogs at 21 days with repeated morphologic and histologic assessments. Hemostatic times, grades of adhesions, and microscopic changes were not significantly different among the various treatments (P > 0.25). Capsular plaque formations were significantly different at the first relaparotomy (P < 0.01) and at final relaparotomy (P < 0.05). Both adhesions and capsular plaque formation were least at fibrin glue-treated sites, whereas Nd:YAG (1.06 microns) was most effective for average hemostatic time (mean = 109.67 s). Electrocautery produced the greatest necrosis at treatment sites. We conclude that all modalities are effective in controlling hemorrhage.

[Naso-intestinal endoscopic intubation in the complex treatment of postoperative intestinal obstruction]. / Nazointestinal'naia éndoskopicheskaia intubatsiia v kompleksnom lechenii posleoperatsionnoi kishechnoi neprokhodimosti.

The long-tube decompression was used for treatment of 54 selected patients with diagnosis of early postoperative intestinal obstruction. For this purpose a silicon double-lumen wire-guided tube has been endoscopically introduced into the proximal portion of the small intestine. In 40 cases continuous decompression of the small bowel brought about a successful resolution of intestinal obstruction by nonoperative therapy. Failure of the conservative treatment within the first 48 hours after intubation has led to operation in 14 cases. Six patients died in this series (4 patients died of multiple organ failure, 2--of thromboembolism). The study has shown that the method can be successfully used.

[Subtotal colectomy in the treatment of intestinal obstruction in cancer of the left half of the colon]. / Subtotal'naia kolektomiia v lechenii obturatsionnoi neprokhodimosti kishechnika pri rake levoi poloviny obodochnoi kishki.

Eleven cases of acute obstructing carcinoma of the left colon were treated by emergency subtotal colectomy with immediate ileocolorectal anastomosis. The procedure of on-table closed antegrade preparation of the small bowel has been developed by the authors preventing the anastomosis incompetence. In all cases during postoperative treatment the long-tube decompression, enteral tube feeding and HBO were used. Two patients died. In five cases non-fatal postoperative complications have developed. Further research is recommended for more careful selection of patients for the procedure.

[Effectiveness of hyperbaric oxygenation after operations for acute intestinal obstruction]. / Effektivnost' giperbaricheskoi oksigenatsii posle operatsii po povodu ostoi kishechnoi neprokhodimosti.

Positive effects of HBO sessions on indices of central hemodynamics is shown in 34 patients with different forms of acute intestinal obstruction.