Laparostomía contenida en las emergencias abdominales / Contained laparostomy in the abdominales emergencies

Se estudian 35 pacientes afectados por emergencias abdominales graves con laparostomía contenida. La mortalidad fue del 34,28%, la edad media de los fallecidos fue de 81 años y de la serie total de 62 años. En 2 pacientes se usó como elemento de contención la malla de polipropileno, en 3 de poliglactina, en 2 tul de novia, en 11 microtul de nylon y en 18 poliuretano. En el momento actual la malla de poliuretano acompañada de recambios y de lavados programados cada 24 ó 48 horas, es la que mejor se adapta a nuestras necesidades y posibilidades. Las indicaciones del procedimiento no están totalmente delimitadas. Se aplica de necesidad en destrucciones sépticas de la pared abdominal, en graves evisceraciones, en pacientes distendidos con insuficiencia respiratoria y ante el fracaso de procedimientos cerrados. Son indicaciones de elección la peritonitis fecal, la purulenta evolucionada, la secundaria a disrupción anastomótica y la necrosis visceral, el procedimiento es útil en estas emergencias abdominales muy graves y se recomienda su uso en forma primaria. (AU)

Laparostomía contenida en las emergencias abdominales / Contained laparostomy in the abdominales emergencies

Se estudian 35 pacientes afectados por emergencias abdominales graves con laparostomía contenida. La mortalidad fue del 34,28%, la edad media de los fallecidos fue de 81 años y de la serie total de 62 años. En 2 pacientes se usó como elemento de contención la malla de polipropileno, en 3 de poliglactina, en 2 tul de novia, en 11 microtul de nylon y en 18 poliuretano. En el momento actual la malla de poliuretano acompañada de recambios y de lavados programados cada 24 ó 48 horas, es la que mejor se adapta a nuestras necesidades y posibilidades. Las indicaciones del procedimiento no están totalmente delimitadas. Se aplica de necesidad en destrucciones sépticas de la pared abdominal, en graves evisceraciones, en pacientes distendidos con insuficiencia respiratoria y ante el fracaso de procedimientos cerrados. Son indicaciones de elección la peritonitis fecal, la purulenta evolucionada, la secundaria a disrupción anastomótica y la necrosis visceral, el procedimiento es útil en estas emergencias abdominales muy graves y se recomienda su uso en forma primaria.

Flexor tendon pulley reconstructions--a histological and ultrastructural study in non-human primates.

The feasibility of A2 pulley reconstructions using expanded polytetrafluoroethylene (PTFE), woven nylon, and fascia lata was assessed in a non-human primate model and evaluated by light and scanning electron microscopy 18 weeks after implantation. No adhesions were found between reconstructed pulleys and flexor tendons. All types of pulley were intact and incorporated by host tissues, without evidence of a foreign body reaction. The inner surfaces of the fascial and PTFE pulleys, apposed to the gliding flexor tendons, were smooth and covered by a fibrous layer of tissue on microscopic and ultrastructural examination. The apposed visceral synovial surfaces of the F.D.P. tendon were indistinguishable from those from unoperated digits. The FDP tenosynovium apposed to woven nylon pulleys was more fibrillar and granular. Based on the results of the present study and on previous biomechanical data, expanded PTFE should be considered as a material for pulley reconstruction; it is incorporated by host tissues, elicits no foreign body reaction and causes no adhesions or traumatic changes to underlying flexor tendons. It is not yet known whether it has sufficient breaking strength to meet the functional demands of human pulleys.

[Antimicrobial polymers in surgery of the lungs]. / Antimikrobnye polimery v khirurgii legkikh.

Approved in the experiment and employed in 60 patients in atypical resection of a lung were the antimicrobial biocompatible absorbable polymers--"Capromed DC threads and ESBADCh film--in combination with MK-7 cyanoacrylate++ glue for formation of hermetic pulmonary suture. This facilitated good smoothing out of the lung remainder, sharp decrease of microbial colonization at the site, where the mentioned polymers were used.

Therapeutic effects of silver nylon dressings with weak direct current on Pseudomonas aeruginosa-infected burn wounds.

The therapeutic and prophylactic effects of nylon dressings coated with metallic silver in a direct current circuit have been examined in a rat model of fatal burn wound sepsis. Male Sprague-Dawley rats weighing 325 +/- 25 grams with 20% full-thickness scald injuries were used. Therapeutic effects were examined at 4 or 24 hours after surface inoculation with a lethal dose of Pseudomonas aeruginosa (Strain 59-1244). When used as a surface anode with an implanted silver needle cathode, the silver nylon was therapeutic at currents between 0.4 and 40 microA when applied at either test time and continued for 5 days (p less than 0.001). When used as a cathode, silver nylon was not effective. Nylon cloth without a silver metal coating was not effective without applied current or when used as an anode. Silver nylon dressings placed at 4 hours after inoculation but without applied current showed significant effectiveness (p less than 0.01). This effect, however, was significantly less than that seen with silver nylon used as an anode (p less than 0.001). Barrier prophylactic effects were examined by placing silver nylon or uncoated nylon on burn wounds before inoculation with Pseudomonas aeruginosa. The uncoated nylon had no barrier effect. Silver nylon was found protective but applied current was not required for significant (p less than 0.001) barrier effect. These results indicate silver nylon dressings may be a valuable antimicrobial burn wound covering device.

Silver nylon cloth: in vitro and in vivo evaluation of antimicrobial activity.

The topical agents used in burn care today, although beneficial, do have limitations, the most important of which is the failure to prevent or treat burn wound infections in patients with extensive injuries. Therefore, we evaluated the antimicrobial activity of two silver nylon fabrics (SN and HRS) on the growth of S. aureus, P. aeruginosa, and C. albicans. The theoretical advantages of these nylon fabrics over presently available silver compounds is their ability to continuously release silver ions into the burn wound as long as the material is in contact with the wound. Additionally, the release of silver from these fabrics can be augmented electrolytically. The results of these experiments indicated that both materials were microbicidal in vitro for all three test organisms. Furthermore, the antimicrobial activity could be significantly augmented by passing a weak DC current through the material, which increased the rate of release of silver ions from the fabrics. In vivo, HRS was as effective as silver sulfadiazine in preventing colonization of the burn wound. The use of silver nylon fabrics thus appears to be a promising way of delivering large quantities of silver ions into the burn wound without the potential side effects of a carrier molecule or cream.

Results of nylon repairs in inguinal hernias (abstract only)

Three hundred and forty eight inguinal hernias were repaired by nylon darn technique and the patients followed for a period of 1 to 10 years. There were 7 method failures, namely 4 recurrences and 3 nylon sinuses, all requiring further operation. There were 7 imperfections namely 5 bulges and 2 indurations, none requiring further operation (AU)