Glove reinforcement: an alternative to double gloving.

Gloves, worn by the surgical team to prevent transmission of infections from and to patients, are prone to tears and perforations. This study was done to determine the frequency and sites of unrecognized glove perforation during surgical procedures. The percentage of glove perforation was 14%. Of the punctures, 73% occurred in one of four contiguous locations on the glove. We recommend glove reinforcement at these locations to provide better protection, as well as to reduce the burden of double gloving.

A cytokine analysis of the effect of cell saver on blood in coronary bypass surgery.

BACKGROUND: Increasing concern about the transmission of viral disease has generated greater interest in the use of salvaged blood as a means of alleviating the demand for homologous blood and expediting resuscitation during massive hemorrhage. Autologous blood processed by autotransfusion devices has become increasingly common in major surgery and is now largely viewed as safe and efficacious. However, there may be serious complications and sequelae associated with the use of processed blood, such as adult respiratory distress syndrome (ARDS) and renal failure. Complement cascade activation resulting from blood coming into contact with autotransfusion equipment leads to enrollment of leukocytes and release of large concentrations of cytokines, which may contribute to the development of organ failure. Our study evaluated cytokine release during cell saver (CS) blood salvage in the course of coronary artery bypass grafting (CABG) surgery. MATERIALS AND METHODS: Forty-five patients randomly selected for CABG were evaluated. All had received at least one unit of autotransfused blood by means of the Haemonetics Cell Saver System 5 (Haemonetics Corp., Braintree, MA). Each patient had four blood samples taken (pre-operative, CS container, autotransfusion from the blood bag, and one hour post-transfusion). These samples were then centrifuged and the sera were collected. An enzyme linked immunosorbent assay (ELISA) test, using the Biosource Cytoscreen solid phase "sandwich" ELISA kit (Biosource International, Camarillo, CA) was conducted to determine levels of the cytokines Interleukin (IL) 1, 2, 4, 6, 8, and 10, tumor necrosis factor (TNF), intracellular adhesion molecule (ICAM), and vascular cell adhesion molecule (VCAM). RESULTS: Significantly increased concentrations of the pro-inflammatory cytokines IL-1, 2, 4, 6, and 8, TNF, ICAM, and VCAM were noted throughout all time periods studied. The same effect was observed for the anti-inflammatory cytokine IL-10. CONCLUSION: Statistically significant increases in both the circulating levels of the pro-inflammatory and anti-inflammatory cytokines studied were recorded. It is our contention that the presence of IL-10, a down-regulator of inflammation, is responsible for attenuating the possible deleterious effects of the pro-inflammatory cytokines observed. However, morbidity and mortality, as well as the future patency of the bypass grafts, have not been correlated with the use of the autologous method of transfusion.

Interleukin-1, interleukin-2 and interleukin-10 expression in different techniques of saphenous vein harvesting.

BACKGROUND: Levels of the cytokines Interleukin-1 (IL-1), IL-2, and IL-10 are sensitive to the traumatic effect of saphenous vein harvesting. Their levels are compared between the endoscopic and traditional open techniques of harvesting. METHODS: Samples of human saphenous veins were harvested from 90 randomly selected patients undergoing coronary artery bypass surgery (CABG), using the open or endoscopic techniques. Endothelial cells collected from the vein samples retrieved through both techniques were cultured for 72 hours. Pre and postoperative sera, in addition to the supernatants from the cultures, were analyzed for IL-1, IL-2, and IL-10 using ELISA. RESULTS: Mean preoperative concentrations of IL-1, Il-2, and IL-10 were 0.11+/- 0.04, 0.09 +/- 0.04, and 0.09 +/- 0.04 pg/ml, respectively. Corresponding values for postoperative sera were 0.13 +/- 0.08, 0.12 +/- 0.10, 0.14 +/- 0.17 pg/ml, respectively. The differences between pre and postoperative means for each cytokine were not statistically significant (p = 0.13, 0.18, 0.05, respectively). Mean IL-1, IL-2, and IL-10 concentrations for endothelial cell culture supernatants did not differ significantly between the endoscopic (0.17 +/- 0.11, 0.11 +/- 0.05, and 0.32 +/- 0.40 pg/ml, respectively) and the open method (0.19 +/- 0.16, 0.11 +/- 0.05, and 0.46 +/- 0.80 pg/ml, respectively) (p = 0.48, 0.81, 0.30, respectively). CONCLUSION: Since endoscopic and open saphenectomies are technically comparable with respect to their effects on IL-1, Il-2, and IL-10 levels, we recommend the endoscopic method for its lower morbidity and the potential for earlier hospital discharge.