The publication data currently available has been vetted by Vanderbilt faculty, staff, administrators and trainees. The data itself is retrieved directly from NCBI's PubMed and is automatically updated on a weekly basis to ensure accuracy and completeness.
If you have any questions or comments, please contact us.
OBJECTIVE - To examine the impact of a recent surgery on development of endometriosis-related adhesions in a chimeric model and to determine the therapeutic efficacy of pioglitazone (PIO).
DESIGN - Human endometrial biopsies were maintained in E(2) with or without PIO for 24 h before intraperitoneal injection into immunocompromised mice also treated with or without PIO at multiple time points after peritoneal surgery. The presence and extent of adhesions were examined in animals relative to the initial establishment of experimental endometriosis.
SETTING - Medical school research center.
PATIENT(S) - Endometrial biopsies for experimental studies were provided by normally cycling women without a medical history indicative of endometriosis or adhesions.
INTERVENTION(S) - None.
MAIN OUTCOME MEASURE(S) - Examination of the development of endometriosis-related adhesions in an experimental model.
RESULT(S) - Without therapeutic intervention, injection of E(2)-treated human endometrial tissue into mice near the time of peritoneal surgery resulted in multiple adhesions and extensive endometriotic-like disease. In contrast, PIO treatment reduced adhesive disease and experimental endometriosis related to surgical injury.
CONCLUSION(S) - The presence of human endometrial tissue fragments in the peritoneal cavity of mice with a recent surgical injury promoted development of both adhesive disease and experimental endometriosis. Targeting inflammation and angiogenesis with PIO therapy limited the development of postsurgical adhesions associated with ectopic endometrial growth.
Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Small bowel obstruction after intra-abdominal surgery is a common cause of morbidity necessitating reoperation. The aim of this study was to determine the feasibility of and indications for laparoscopic surgery for acute adhesive small bowel obstruction (AASBO). We conducted a retrospective review of all patients with AASBO who underwent laparoscopic adhesiolysis at a major university medical center. Laparoscopic treatment was performed successfully in 16 patients, and conventional treatment was performed in 13 patients. The rate of conversion from laparoscopic to open was 16.7 per cent. In 15 of 16 total patients who underwent laparoscopic surgery, laparoscopic bandlysis was performed and one patient underwent laparoscopic adhesiolysis. Laparoscopic surgery was performed successfully in nine who had a single adhesive band demonstrated on an abdominal CT, and conventional surgery was performed in all 10 patients without a single adhesive band identified radiographically. Abdominal CT scans facilitate the selection of operative approach for AASBO based on preoperative identification of the obstruction site. Laparoscopic adhesiolysis is a safe and effective treatment modality for patients with AASBO with a single band or single transition zone identified by preoperative imaging.
OBJECTIVE - The purpose of this study was to determine the test characteristics of preoperative abdominal ultrasound in predicting infraumbilical adhesions in women.
STUDY DESIGN - This was a diagnostic test study of 60 women at risk for intra-abdominal adhesions undergoing laparoscopy or vertical laparotomy. Participants underwent periumbilical sonographic measurement of visceral slide (longitudinal movement of the viscera during a cycle of respiration).
RESULTS - Prevalence of infraumbilical bowel adhesions was 12%. A visceral slide threshold <1 cm to predict adhesions had sensitivity = 86%, specificity = 91%, positive predictive value = 55%, and negative predictive value = 98%. On stratifying visceral slide (<0.8 cm, > or =0.8 and <1 cm, and > or =1 cm), the likelihood ratios for detecting adhesions were 15.1, 5.0, and 0.2, respectively.
CONCLUSION - Measuring visceral slide improves preoperative prediction of both presence and absence of bowel adhesions in patients with previous abdominal operations or infection; this technique may assist in avoiding iatrogenic bowel injury.
BACKGROUND - Adhesion formation after abdominal operations causes significant morbidity.
METHODS - Adhesion formation in pigs was compared after placement of prosthetic mesh during celiotomy (group 1), laparoscopy with large incision (group 2), and laparoscopy (group 3). After peritoneum was excised, polypropylene mesh was fixed to the abdominal wall, then to the opposite abdominal wall in the preperitoneal space followed by peritoneal closure. Adhesion area, grade, and vascularity were measured.
RESULTS - More adhesions (p < 0.02) covered intraperitoneal mesh (7.57 +/- 1.89 cm2) than covered reperitonealized mesh (2.16 +/- 1.13 cm2), and adhesion grade was significantly greater (p < 0.02). Adhesion areas were significantly greater in groups 1 and 2 than in group 3 (p = 0.001 and 0.03, respectively). Adhesion grade was significantly greater in groups 1 and 2 than in group 3 (p = 0.02 and p = 0.04, respectively). Groups 1 and 2 had more vascular adhesions than group 3 (p < 0.01 and p = 0.02, respectively)
CONCLUSIONS - A foreign body within the peritoneum stimulates more numerous and denser adhesions. Tissue trauma distant from the site of adhesions increases their formation. A major advantage of laparoscopic surgery is decreased adhesion formation.
Multiple, linked interactions between the platelet surface and collagen fibers have been implicated in the initiation of platelet secretion and subsequent aggregation. The formation of such multiple simultaneous interactions could give rise to high affinity adhesion of platelets to collagen even though the affinity of the individual interactions may be much weaker. This concept has been tested by measuring the adhesion of platelets to collagen under conditions which could effect the formation of multiple interactions. Adhesion is markedly diminished at 4 degrees C but not at 23 or 37 degrees C. Metabolic inhibitors such as 2-deoxyglucose and Antimycin A do not inhibit adhesion although they virtually abolish subsequent aggregation. Brief formaldehyde fixation of platelets greatly reduces adhesion. These results are consistent with the concept that the formation of multiple linked interactions between the platelet surface and collagen are important in platelet-collagen adhesion and that mobility of platelet membrane components is required for the clustering of these interactions in focussed regions on the platelet surface.
Von Willebrand factor is adsorbed from plasma by fibrillar collagen in a manner which is dependent upon the time of incubation and collagen concentration. The adsorption does not require divalent cations and is temperature independent. As purified von Willebrand factor is also adsorbed by fibrillar collagen it is unlikely that the adsorption is mediated by other plasma proteins. Denatured collagen has no effect on von Willebrand factor activity and does not inherit the adsorption of the factor by native fibrillar collagen. The adsorbed von Willebrand factor can be eluted from fibrillar collagen with 1M NaCl. The similarities between the adhesion of platelets to collagen and the adsorption of von Willebrand factor by collagen suggest that von Willebrand factor may have a role in collagen-platelet adhesion. The observed inhibition of platelet adhesion to collagen by antiserum to von Willebrand factor is consistent with this hypothesis.