fibrin and Intestinal-Obstruction

Topics: Adolescent; Female; Fibrin; Humans; Intestinal Obstruction; Intestine, Small; Tissue Adhesions; Tomography, X-Ray Computed

This literature review attempts to enumerate possible etiologies of postoperative peritoneal adhesions as well as to suggest preventitive measures. The theory that the cause of adhesions was development of fibrous tissue resulting from the destruction of serosa at surgery is discussed, but the author points out that numerous experimental and clinical experiences point to a more complicated etiology. Serosal defects do heal, and not necessarily through adhesion formation, as shown in experimental animals; therefore a new notion of the process of peritoneal repair was advanced which, simply stated, sees free-floating macrophages as the principal source of new serosa. So other areas and tissue types are probably the source of adhesions. The discussion of these other etiological factors include ischemic tissue as a source of adhesions and foreign body causes of granuloma and adhesions (primarily surgical glove powder). In terms of adhesion prevention, many approaches have been tried from using prophylactic agents to inhibit the formation of fibrin in peritoneal exudate (agents such as sodium citrate, heparin, and anticoagulants), use of enzymes and fibrinolytic agents, such as streptokinase and hyaluronidase, to introduction of inert polysiloxanes for prevention at the time of surgery. The use of cortisone, which has been reported to have good results, is also discussed. Finally, the control of distribution of adhesions by plicative techniques is enumerated. With the up-to-date knowledge that adhesions which develop after abdominal operations represent a vascular response by surrounding structures to the stimulus of ischemic tissue or foreign material within the peritoneal cavity, rather than a healing mechanism for serosal defects, a rational approach toward operating on adhesions is presented; this technique requires scrupulous surgical procedure, freedom from foreign body intrusion, the leaving open of serosal defects (rather than pulling together under tension), and, frequently, attempts to surgically ensure that the inevitable adhesion formation occurs in areas which are innocuous to adjacent structures.

Topics: Abdomen; Enzyme Therapy; Exudates and Transudates; Fibrin; Fibrinolytic Agents; Histamine H1 Antagonists; Humans; Hyaluronoglucosaminidase; Intestinal Obstruction; Ischemia; Peritoneal Diseases; Peritoneum; Postoperative Complications; Tissue Adhesions; Wound Healing

From 1975 to 1987, 44 of 230 patients with cystic fibrosis under our care underwent a total of 66 operations. There were no direct intra- or postoperative complications. If an optimal and aggressive adjuvant treatment is given postoperatively, there are no increased risks associated with surgical procedures in cystic fibrosis patients. Treatment of spontaneous pneumothorax remains a problem. An alternative treatment for pneumothorax using transcutaneous fibrin pleurodesis is presented.

Topics: Child; Child, Preschool; Cystic Fibrosis; Drainage; Fibrin; Humans; Infant; Infant, Newborn; Intestinal Obstruction; Intraoperative Complications; Pneumothorax; Recurrence

Our experience with the subcutaneous absorbable bridge for constructing a temporary loop ileostomy and loop colostomy is described. The use of this subcutaneous absorbable bridge in 15 patients - 6 with loop ileostomy and 9 with loop colostomy - was almost without complications. The absorbable bridge is a progress for maturation of the stoma and for immediate postoperative as prospective fitting of a watertight appliance. The actual trend substituting the temporary loop colostomy by the loop ileostomy may be advanced by the unlimited use of the subcutaneous absorbable bridge for constructing a temporary loop ileostomy.

Topics: Adult; Aged; Colonic Diseases; Colonic Neoplasms; Colostomy; Female; Fibrin; Glycerol; Humans; Ileostomy; Intestinal Obstruction; Male; Middle Aged; Ovarian Neoplasms; Prostheses and Implants; Sutures

Sclerosing peritonitis is a severe complication after CAPD treatment. The visceral peritoneum is thickened and interenteric adhesive parts are found. Myofibroblasts are proliferated and the collageneous tissue is hyperplastic. The mean clinical symptom is the mechanical obstruction of the small bowel. We observed this illness in three out of sixty patients under CAPD. These patients had higher incidence of bacterial peritonitis. In the ascites high concentrations of PG E2 and Thromboxan B2 were observed. After treatment of the infection the concentrations fell down to normal values. Electronoptical observations from peritoneal biopsies showed a proliferation of myofibroblasts and extracellular lysosomes. It is known from these lysosomes that they are able to set free proteasis. These lead to degredation of fibrin and fibrinogen. These splits are mitogen to myofibroblasts. release from HIT cells could also be evoked by the sulphonylureas glibenclamide and tolbutamide and by an increase in concentration of extracellular K+ to 40 mmol/l. The content of cyclic AMP in HIT cells was increased modestly by glucose but not by an increase in extracellular K+. Forskolin elicited a 4-fold increase in cyclic AMP content. We conclude that HIT cells retain the essential features of the insulin secretory response of normal B cells and represent an important tool for further biochemical characterisation of the secretory system.

Topics: Adult; Bacterial Infections; Dinoprostone; Female; Fibrin; Humans; Intestinal Obstruction; Intestine, Small; Male; Peritoneal Dialysis, Continuous Ambulatory; Peritoneum; Peritonitis; Prostaglandins E; Sclerosis; Thromboxane B2

Twenty cases of ischemic bowel disease were analysed to determine the frequency and significance of fibrin thrombi in this condition. Fibrin thrombi were present in all 10 patients with occlusive ischemic bowel disease and in 7 of the 10 patients with nonocclusive ischemic bowel disease. In addition, fibrin thrombi were noted in a wide variety of specific and nonspecific inflammatory bowel diseases and in acute appendicitis. We conclude that fibrin thrombi are a nonspecific feature of tissue necrosis and that their mere presence in the bowel should not be regarded as an expression of disseminated intravascular coagulation.

Topics: Appendicitis; Colitis, Ulcerative; Crohn Disease; Fibrin; Humans; Intestinal Diseases; Intestinal Obstruction; Intestines; Ischemia; Necrosis; Thrombosis

Ninety-three postoperative patients 1 day to 13 years of age had blood cultures, limulus lysate assay, determination of fibrin degradation products, white blood cell and platelet counts. Seven groups were studied. The limulus lysate assay was often positive (64%) in the presence of gram negative septicemia but there were false positives and negatives. The tests for fibrin degradation products were inconsistent. The white blood cell count was low in babies with gram negative septicemia. One hundred per cent of the infants with gram negative septicemia had a platelet count below 150,000; 71% below 100,000 (average 67,000 septic babies, 257,000 non-septic babies). The drop in platelet count with gram negative septicemia was abrupt---as much as 222,000 in 24 hours. Platelets increased when therapy was effective. Two children with gram negative septicemia had platelet counts of 50,000 and 20,000. The platelet count for patients with gram positive septicemia was 299,000, and above 150,000 in all children with ruptured and non-ruptured appendicitis and major surgery without gram negative septicemia. It was concluded that serial measurements of platelet count in the postoperative infant and child was a rapid and reliable method for early detection of gram negative septicemia and changes in platelet count in response to treatment was an indicator of the effectiveness of therapy.

Topics: Abdominal Muscles; Adolescent; Appendicitis; Bacteria; Bacterial Infections; Blood Cell Count; Blood Platelets; Child; Child, Preschool; Enterocolitis, Pseudomembranous; Escherichia coli Infections; Fibrin; Gangrene; Humans; Infant; Infant, Newborn; Intestinal Obstruction; Klebsiella Infections; Leukocyte Count; Liver Neoplasms; Platelet Aggregation; Postoperative Complications; Pseudomonas Infections; Sepsis; Time Factors