Encapsulating Peritoneal Sclerosis 43 Years after Distal Gastrectomy for Early Gastric Cancer.

We herein report a case of encapsulating peritoneal sclerosis (EPS) in a patient without chronic kidney disease after gastrectomy. A 69-year-old man underwent distal gastrectomy for early gastric cancer at 25 years old. After 43 years, he developed bowel obstruction and underwent enterolysis of the encapsulated small intestine. A pathological examination of the capsular membranes revealed inflammation, foam, and giant cells that destroyed foreign substances. The patient was discharged 1.5 months later. Foreign body reactions to surgical instruments used in gastrectomy are considered a cause of EPS. EPS due to foreign body reactions to surgical instruments should also be considered in such cases.

Enriched Graphene Oxide-Polypropylene Suture Threads Buttons Modulate the Inflammatory Pathway Induced by Escherichia coli Lipopolysaccharide.

Graphene oxide (GO), derived from graphene, has remarkable chemical-physical properties such as stability, strength, and thermal or electric conductivity and additionally shows antibacterial and anti-inflammatory properties. The present study aimed to evaluate the anti-inflammatory effects of polypropylene suture threads buttons (PPSTBs), enriched with two different concentrations of GO, in the modulation of the inflammatory pathway TLR4/MyD 88/NFκB p65/NLRP3 induced by the Escherichia coli (E. coli) lipopolysaccharide (LPS-E). The gene and the protein expression of inflammatory markers were evaluated in an in vitro model of primary human gingival fibroblasts (hGFs) by real-time PCR, western blotting, and immunofluorescence analysis. Both GO concentrations used in the polypropylene suture threads buttons-GO constructs (PPSTBs-GO) decreased the expression of inflammatory markers in hGFs treated with LPS-E. The hGFs morphology and adhesion on the PPSTBs-GO constructs were also visualized by inverted light microscopy, scanning electron microscopy (SEM), and real-time PCR. Together, these results suggest that enriched PPSTBs-GO modulates the inflammatory process through TLR4/MyD 88/NFκB p65/NLRP3 pathway.

Composite membranes of alginate and chitosan reinforced with cotton or linen fibers incorporating epidermal growth factor.

Suture threads of cotton or linen, in crossed and random orientation, were added to alginate-chitosan membranes intended to wound coatings application to improve the mechanical properties. The elongation at break increased to about 5 and 8 times for membranes with linen and cotton, respectively, both in the crossed orientation. The addition of the threads increased roughness and opacity of the membranes and reduced the liquid absorption capacity and water vapor transmission rate. The lowest toxicity to human fibroblasts was observed for extracts of membranes produced with linen, and incorporation in them of epidermal growth factor was able to slightly increase cell proliferation.

Uso exclusivo de fios absorvíveis em fendas labiopalatais / Exclusive use of absorbable suture threads in cleft lip and palate

INTRODUÇÃO: O tratamento de fendas labiopalatais tem etapas que podem trazer traumas psicológicos consideráveis aos pacientes e familiares. O uso de fios absorvíveis pode eliminar um destes momentos desconfortáveis. Contudo, a utilização exclusiva deste tipo de material de síntese ainda não é a preferência de todos os cirurgiões, principalmente em planos musculares. MÉTODOS: Levantados os dados dos pacientes operados no Hospital Universitário da Universidade Federal do Rio de Janeiro, submetidos à correção de fendas labiais ou palatais, nas quais foram utilizados somente fios absorvíveis (poliglecaprona 25 - Monocryl® ou poliglactina 910 - Vicryl Rapide®) em todos os panos de sutura (mucosa, músculo, pele). O período avaliado foi de 2007 a 2014. RESULTADOS: Encontramos 360 pacientes que se enquadraram no estudo. Não observamos diferenças quanto ao aspecto local das feridas durante o processo de absorção dos fios. A incidência de deiscências ou fístulas se manteve abaixo de 1% e não houve complicações relacionadas ao objetivo do estudo. As cicatrizes não se mostraram, a longo prazo, diferentes das obtidas com o uso de fios inabsorvíveis, utilizados em outros tipos de cirurgias. CONCLUSÕES: O uso exclusivo destes fios absorvíveis se mostrou uma opção eficaz e segura. Proporcionou cicatrizes de boa qualidade, força tênsil adequada (mesmo em planos musculares) e não observamos complicações relacionadas ao processo de absorção dos materiais empregados.

INTRODUCTION: The treatment of orofacial clefts comprises steps that may result in considerable psychological trauma for patients and their caregivers. The use of absorbable sutures may help to eliminate these uncomfortable situations. However, the exclusive use of this synthetic material is still not preferred by surgeons, particularly in the muscle planes. METHODS: Data from patients who underwent surgery at the University Hospital of the Federal University of Rio de Janeiro from 2007 to 2014 were used. The patients underwent correction of cleft lip or palate, using only absorbable sutures (poliglecaprone 25 - Monocryl® or polyglactin 910 - Vicryl Rapide®) in all suture planes (mucosa, muscle, skin). RESULTS: We found 360 patients who met the inclusion criteria for this study. We did not observe differences in terms of the local appearance of the wounds during the suture absorption process. The incidence of dehiscence or fistula cases was below 1%, and there were no complications regarding the objectives of the study. In the long term, the scars did not differ from those obtained with non-absorbable sutures used in other types of surgeries. CONCLUSIONS: The exclusive use of absorbable sutures was shown to be an efficient and safe option. These resulted in good quality scars and adequate tensile strength (even in muscle planes), and we did not observe complications related to the absorption process of the material used.

Materiales de sutura quirúrgico / Surgical suture materials

Se realizó una revisión bibliográfica sobre el tema Materiales de sutura quirúrgica, tanto nacional como internacionalmente, tratando de encontrar la información más actualizada posible, tomando como base un trabajo publicado en una revista nacional en el año 1990 y una revisión bibliográfica nuestra presentada en el hospital Amalia Simoni en 1995. Se revisaron los materiales informativos de algunas casas comerciales y a partir de aquí, se expusieron las clasificaciones conocidas con los productos que la conforman y se ofrecieron las características del producto comercial y del fabricante. Se señalaron las ventajas de los materiales de sutura de origen sintético sobre los naturales que van siendo desplazados en su utilización y preferencia. Existe el interés de ayudar a mejorar el conocimiento sobre este tema a los profesionales de la salud, personal paramédico y en formación al igual que a médicos veterinarios.

A bibliographical review on the topic of surgical suture material, so much national as internationally, trying to find the most up-to-date possible information, taking as base a work published in a national magazine in the year 1990 and a bibliographical review of ours presented in Amalia Simoni hospital in 1995. The informative materials of some business houses are reviewed and starting from here, the well-known classifications are exposed with the products that compose it and offering the characteristics of the commercial product and the manufacturer. The advantages of the suture materials of synthetic origin are pointed out on the natural ones that are displaced in their use and preference. It encourages us the interest of helping to improve the knowledge on this topic to the health professionals and in formation, paramedic personnel as well as to veterinary doctors.

An innovative method to evaluate the suture compliance in sealing the surgical wound lips.

BACKGROUND AND AIM: The increasing number of surgical procedures performed with local anesthesia, followed by immediate patient discharge from the hospital, emphasizes the need for a tight waterproof suture that is capable of maintaining its tensile strength in the postoperative phase when the wound tumescence, edema due to the anesthetic drug, and surgical trauma disappear. Moreover, the issue of having an accurate surgical wound closure is very relevant in vivo in order to prevent hemorrhage and exogenous microbial infections. This study aimed at designing a new a lab technique that could be used for evaluating the best surgical material. Using such a technique, we compared the wound-lip-sealing properties of three commonly-used suture threads, namely polyurethane, polypropylene, and polyamide. MATERIALS AND METHODS: The mechanical properties of same-size suture threads made from polyurethane, polypropylene, and polyamide, were compared in order to define the one that possess the best elastic properties by being able to counteract the tension-relaxation process in the first 12 hours following surgery. The tension holding capacity of the suture materials was measured in both in vivo and in vitro experiments. The surface area of the scar associated with the three different suture threads was measured and compared, and the permeability of the three different suture threads was assessed at 0 minute, 2 minute, 4 minute, 6 minute, and 8 minute- interval. RESULTS: Results showed that polyurethane suture threads had significantly (P < 0.05) better tensile strength, elongation endurance before breakage, and better elasticity coefficient as compared to polypropylene and polyamide suture threads. Moreover, polyurethane suture threads were significantly (P < 0.05) more impermeable as compared to the other two suture thread types (polypropylene and polyamide). This impermeability was also associated with a tighter wound-lip-sealing ability, and with significantly (P < 0.05) less scar formation. CONCLUSION: Among the main concerns that surgeons, physicians, and patients often have is the development infection, oozing, and scar at the incision site following suturing. This always raises the question about which suture to use to avoid the above problems. This study provides evidence that the new technique developed in our lab could be used to compare the wound-lip sealing properties of different surgical suture threads. Using such a technique, the results show that polyurethane is significantly better than other commonly-used suture threads, like polypropylene and polyamide, in relation to wound sealing and scar formation.

Os fios de sutura cirúrgica e a enfermeira de Centro Cirúrgico: critérios de previsão e provisão segundo a natureza pública ou privada das instituições hospitalares / The sutures and the operation room nurse: criteria in forecasting the need for sutures threads provisioning according to the public or private nature of the hospital institution

Este estudo teve como propósito identificar e analisar os critérios adotados pelas enfermeiras na previsão de fios de sutura cirúrgica para a provisão da Unidade de Centro Cirúrgico, segundo a natureza pública ou privada das instituições hospitalares. As enfermeiras são responsáveis pela previsão, provisão, organização e controle dos materiais em suas unidades de trabalho. Os fios de sutura cirúrgica são considerados insumos duráveis, não reutilizáveis, consumidos durante cirurgias e fazem parte da lógica de programação das instituições hospitalares. A enfermeira da Unidade de Centro Cirúrgico interage com a administração, que efetua a compra do material e com o cirurgião que é seu usuário final. Para tanto, ela necessita conhecer suas aplicações e também os processos internos aos quais está submetido, de acordo com as normas e características da instituição. Observamos que fio de sutura cirúrgica é um tema pouco abordado em eventos de enfermagem, além da bibliografia ser escassa. Os dados foram coletados por meio de entrevista estruturada em 74 hospitais do município de São Paulo. Dentre eles, a maioria (68%) é privada, de porte médio, com Unidades de Centro Cirúrgico geral, movimento de até 500 procedimentos anestésico-cirúrgicos por mês e os fios são adquiridos por contrato direto com fornecedores. Das enfermeiras, a maioria (84%) tem mais de 5 anos de formada, curso de pós-graduação senso lato (78%), estão entre 2 a 5 anos como responsáveis pela Unidade de Centro Cirúrgico (51%) e aproximadamente metade é sócia de sociedade de especialista com predomínio absoluto da Sociedade Brasileira de Enfermeiros e Centro Cirúrgico (SOBECC). Sobre os fios de sutura cirúrgica, os aspectos que mais interessam às enfermeiras estão relacionadas à aplicação/indicação, características de cada um e critérios de substituição. Quase a totalidade das enfermeiras (96%) declarou ter adquirido a maior parte dos conhecimentos ) sobre fios na prática diária, isoladamente ou acrescido de outros meios. Com relação aos fios propriamente, 64% deles são padronizados por solicitação do cirurgião. Quanto a provisão na sala de operações, 40% dos fios são escolhidos no momento da cirurgia, enquanto 32% são disponibilizados em kits por especialidade. No hospital, 46% são adquiridos do fornecedor - hospitais privados - 32% através de concorrência pública - hospitais públicos. O estoque é reposto segundo cota estabelecida, em 58% dos hospitais, o que mantém relação com a natureza privada da instituição. Nos hospitais públicos predomina a provisão por meio de contagem de estoque com tempo pré-estabelecido, seguido de reposição (38%). A variedade dos fios também está relacionada à natureza, havendo maior variedade de fios em hospitais privados e uma inconstância no públicos. Tendo descrito os principais conceitos que envolvem fios de sutura cirúrgica e as características dos processos de previsão e provisão que envolvem esse material, esperamos contribuir para a tarefa de disponibilizar fios de sutura cirúrgica, uma das várias atribuições das enfermeiras de Centro Cirúrgico.

The present study aims at the indentification and analysis of the criteria adopted by nurses in forecasting the need for suture threads in Surgical Center Unit provisioning, according to the public or private nature of the hospital institution. Nurses are the responsible for the forecast, provision, organization and control of the materials in their work units. Surgical suture threads are considered as permanently needed non-reusable materials, daily consumed in surgeries and therefore part and parcel of the hospital programming logic. The Surgical Center Unit nurse interacts with the administration and with the surgeon, the former purchases the material and the later is its final user. Thus, nurses need to be acquainted with the materials in view, their applications and also the processes to which they are submitted in the institution. Notwithstanding, we have observed that surgical suture threads are rarely approached to, as a theme in nursing events, and that the bibliography concerning them is scarce. The data analyzed were collected by means of structured interviews in 74 São Paulo city hospitals which agreed to participate and filled out certain requirements. Most of them (68%) are middle-sized private institutions, counting with a general Surgical Center Unit that realizes up to 500 anesthetic-surgical procedures a mounth, the threads being acquired by direct contract with suppliers. The majority of the nurses that participated in this research have been graduated for 5 years (84%) and have concluded a post-graduation course (78%), 51% of them are in charge of the respective Unit of Surgical Center for 2 to 5 years and approximately half of them are members of specialist's society, such as the SOBECC (Sociedade Brasileira de Enfermeiros em Centro Cirúrgico, Brazilian Surgical Center Nursing Society). The most interesting aspects for nurses are those related to the application / indication of the threads, characteristics of each thread type and substitution criteria. Almost all the nurses (96%) declared to have acquired knowledge on threads in daily practice. Regarding the threads properly, 64% of them are standardized by surgeon's request, 40% are chosen in the moment of the surgery, while 32% are made available in kits divided by specialty. In the hospital, 46% are acquired from the supplier - private hospitals - 32% through public bid - public hospitals. The stock is restored by established quotes in 58% of the hospitals, a fact related to the private nature of the institutions. In the public hospitals the provision prevails through counting the stock at pre-established times, followed by replacement (38%). The variety of threads differs with the nature of the institution, with a larger variety in the private and an inconstant one in the public hospitals, significant at the level of 5%. By describing the main concepts related with surgical suture threads as well as the forecasting and provisioning characteristics involved, we hope to contribute toward making surgical suture threads available, one of the Surgical Center nurses several attributions.