|
| ||
|
|
||
Abdominal Incision (abdominal + incision)
Selected AbstractsEffect of ,-trinositol on secretion induced by Escherichia coli ST-toxin in rat jejunumACTA PHYSIOLOGICA, Issue 4 2003A.-M. Lahti Abstract Aim:,d -myo-inositol-1,2,6-trisphosphate (, -trinositol, PP56), is a synthetic isomer of the intracellular second messenger, d -myo-inositol-1,4,5-trisphospahate. The pharmacological actions of , -trinositol include potent anti-inflammatory properties and inhibition of the secretion induced by cholera toxin and obstructive ileus. In the present study, we investigated whether , -trinositol was able to influence the secretion induced by heat-stable ST-toxin from Escherichia coli in the rat jejunum. Methods:, A midline abdominal incision was performed in anaesthetized male Sprague,Dawley rats and a 6,7 cm long jejunal segment was isolated with intact vascular supply and placed in a chamber suspended from a force displacement transducer connected to a Grass® polygraph. Intestinal net fluid transport was continuously monitored gravimetrically. Crystalline ST-toxin (120 mouse units) was introduced into the intestinal lumen and left there for the rest of the experiment. When a stable secretion was observed, , -trinositol (60 mg kg,1 h,1) or saline were infused during 2 h, followed by a 2-h control period. Results:, , -Trinositol induced a significant (P < 0.001) inhibition of ST-toxin secretion within 30 min, lasting until 2 h after infusion had stopped. The agent also moderately increased (P < 0.05) net fluid absorption in normal jejunum. Mean arterial pressure (P < 0.001) and heart rate (P < 0.001) were reduced by , -trinositol. Conclusion:, The inhibition by , -trinositol of ST-toxin induced intestinal secretion is primarily secondary to inhibition of secretory mechanisms and only to lesser extent due to increased absorption. The detailed mechanisms of action have not been clarified but may involve suppression of inflammation possibly by means of cellular signal transduction. [source] The transversus abdominis plane block: a valuable option for postoperative analgesia?ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2010A topical review The transversus abdominis plane (TAP) block is a newly described peripheral block involving the nerves of the anterior abdominal wall. The block has been developed for post-operative pain control after gynaecologic and abdominal surgery. The initial technique described the lumbar triangle of Petit as the landmark used to access the TAP in order to facilitate the deposition of local anaesthetic solution in the neurovascular plane. Other techniques include ultrasound-guided access to the neurovascular plane via the mid-axillary line between the iliac crest and the costal margin, and a subcostal access termed the ,oblique subcostal' access. A systematic search of the literature identified a total of seven randomized clinical trials investigating the effect of TAP block on post-operative pain, including a total of 364 patients, of whom 180 received TAP blockade. The surgical procedures included large bowel resection with a midline abdominal incision, caesarean delivery via the Pfannenstiel incision, abdominal hysterectomy via a transverse lower abdominal wall incision, open appendectomy and laparoscopic cholecystectomy. Overall, the results are encouraging and most studies have demonstrated clinically significant reductions of post-operative opioid requirements and pain, as well as some effects on opioid-related side effects (sedation and post-operative nausea and vomiting). Further studies are warranted to support the findings of the primary published trials and to establish general recommendations for the use of a TAP block. [source] Prolonged activated partial thromboplastin time in thromboprophylaxis with unfractionated heparin in patients undergoing cesarean sectionJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 1 2010Shigeki Matsubara Abstract Aim:, Hemorrhage is an important complication of heparin-thromboprophylaxis after surgery. We attempted to clarify the incidence rate of prolonged activated partial thromboplastin time (APTT), representative of hemorrhagic tendency, in Japanese women who received thromboprophylaxis with unfractionated subcutaneous heparin administration after cesarean section (CS). We also determined factors which affected postoperative APTT. Methods:, We studied 280 women who were administered thromboprophylaxis with unfractionated subcutaneous heparin 5000 IU two times per day after CS. Postoperative APTT under heparin was measured and the incidence of its prolongation was determined. Preoperative APTT, blood loss during surgery, postoperative hematocrit, postoperative serum total protein level, and postpartum body weight were measured, and their correlation with postoperative APTT was determined. Results:, Preoperative and postoperative APTT values were 28.3 (26.7,30.3) and 33.8 (31.0,37.5) seconds for median (interquartile range), respectively. Overall, 7.1% of patients showed ,45 s postoperative APTT. Two patients (0.7%) showed ,60 s APTT, one of whom suffered subcutaneous hemorrhage around the abdominal incision with complete healing. There were no other hemorrhagic complications. Preoperative APTT positively, and postpartum body weight inversely, correlated with postoperative APTT. The amount of blood loss, postoperative hematocrit, and postoperative serum total protein level did not correlate with postoperative APTT. No discernible deep vein thrombosis or pulmonary embolism occurred. Conclusion:, Although 7.1% of women under heparin-thromboprophylaxis showed a prolonged APTT that was 150% of the preoperative APTT, serious side effects were not observed. Subcutaneous administration of unfractionated heparin, if checking APTT prolongation 1 day after surgery, may be safe method of thromboprophylaxis after CS. [source] Upper midline incision for living donor right hepatectomyLIVER TRANSPLANTATION, Issue 2 2009Seong Hoon Kim Innovations and refinements in the techniques of living donor right hepatectomy (LDRH) have been made over the past decades, but the type and size of abdominal incision have been at a standstill since its inception. We introduce herein the upper midline incision for LDRH using the standard open technique. A prospective case-matched study was conducted on 23 consecutive donors who underwent LDRH under a supraumbilical upper midline incision (I group) from February to May 2008. These donors were matched 1:1 to 23 right liver donors with a conventional J-shaped incision (J group) according to age, gender, and body mass index. Under the mean incision length of 13.5 cm, LDRH was successfully completed in all 23 donors without extension of the incision, with a mean operative time of 232.3 ± 29.2 minutes. No donors required blood transfusion during surgery. There were 2 cases of postoperative bleeding immediately controlled under the same incision and a case of pleural effusion. All donors fully recovered and returned to their previous activities. All grafts have been functioning well. Compared with the J group, the I group had a shorter operative time, a shorter period of analgesic use, and, after discharge, infrequent complaints of wound pain. This upper midline incision, even without laparoscopic assistance, can be used for LDRH with less pain and without impairing safety, reproducibility, or effectivity, allowing the seemingly insufficient incision to be recommended to the transplant centers that are practicing living donor liver transplantation. Liver Transpl 15:193,198, 2009. © 2009 AASLD. [source] Smoking is a major risk factor for wound dehiscence after midline abdominal incision; case,control studyANZ JOURNAL OF SURGERY, Issue 4 2009Saleh M. Abbas Abstract Background:, The incidence of acute fascial wound dehiscence (AFWD) after major abdominal operations is as high as 3%. AFWD is associated with mortality rates of 15,20%. Male gender, advanced age and numerous systemic factors including malignancy hypoproteinemia and steroid use have been associated with increased risk. The aim of the present study was to investigate the association between smoking prevalence and AFWD. Methods:, Middlemore Hospital records were retrieved from the 1997,2006 period for patients who had undergone midline abdominal surgery and developed AFWD. A return to the operating theatre for closure of the fascial dehiscence was required for study group inclusion. Each patient in the study group was matched to two control patients who had been admitted in the same year for surgery and who had a similar initial surgical intervention. Conditional logistic regression was used to calculate odds ratios with 95% confidence intervals, representing the risk of developing fascial wound dehiscence in smokers compared with the non-smoking group. Results:, There were 52 patients (32 male, 20 female) and 104 controls (64 male, 40 female). Median age for both groups was 63 years. A history of heavy tobacco use (,20 pack-years) was more prevalent in those who had AFWD (46%) compared with the control group (16%; P = 0.0002; odds ratio 3.7). Conclusions:, Smoking is associated with an increased incidence of acute fascial wound dehiscence following laparotomy. It is not known whether smoking is a causal or a surrogate factor. [source] Causative factors, surgical treatment and outcome of incisional hernia after liver transplantationBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 8 2002Dr H. Janßen Background: Little is known about the incidence and causes of herniation, and the results of hernia repair in patients undergoing liver transplantation. Likewise, nothing is known about the best surgical approach for hernia repair. Methods: A retrospective analysis was conducted of the occurrence of incisional hernia in 290 patients who had liver transplantation between 1990 and 2000, and survived more than 6 months. Follow-up data were obtained from medical records and the outpatient service. Patients were evaluated for various clinical and surgical factors. Hernias were analysed with respect to localization, type of surgical repair and recurrence rate. Results: Some 17 per cent of the transplanted patients experienced an incisional hernia. Risk factors were acute rejection with affiliated steroid bolus therapy (P = 0·025), a low platelet count after transplantation (P = 0·048), and a transverse abdominal incision with upper midline approach (P = 0·04). Hernias were mainly located at the junction of the transverse and midline incision (P < 0·001) and the recurrence rate was highest here (P = 0·007). Prosthetic hernia repair achieved the lowest rate of recurrence and did not increase the incidence of infectious complications. Conclusion: Improved immunosuppression should avoid early steroid bolus therapy after transplantation. A low platelet count promotes herniation. Transverse abdominal incision seems to be the best approach for liver transplantation. Prosthetic hernia repair does not increase the complication rate. © 2002 British Journal of Surgery Society Ltd [source] NOTES: new dimension of minimally invasive surgeryANZ JOURNAL OF SURGERY, Issue 5 2009Song-Ling Yan Natural orifice transluminal endoscopic surgery (NOTES) is an emerging experimental alternative to conventional surgery. NOTES eliminates abdominal incisions and incision-related complications by combining endoscopic and laparoscopic techniques to diagnose and treat abdominal pathology. Since the first NOTES was reported by Kalloo et al. in 2004, significant achievements in the laboratory have occurred. Clinical use in humans has been limited, but several cases and one small clinical trial were published recently. As a further technical revolution in minimally invasive surgery, NOTES has the promising potential to be safer, less invasive, provide better cosmesis and possibly be more cost-effective. The purpose of the present article was to review the development and current status of NOTES and highlight important advances associated with this innovative approach. [source] | ||||||||||