povidone-iodine and Rectal-Neoplasms

Twenty-three patients who underwent abdominoperineal resection for rectal adenocarcinoma were entered into a prospective study to determine the efficacy of periodic instillation of Betadine into the urinary drainage system as a prophylactic measure for catheter-associated urinary tract infections. We decided to use a control group of 33 consecutive patients done in the period just preceding the starting of this prospective study. In both groups the mean duration of the Foley catheter drainage was similar. Eight of eight female patients in the treatment group and six of seven patients in the control group developed a urinary tract infection. However, only five of 15 male patients (33%) in the treatment group whereas 16 of 26 males in the control group (61%) developed a urinary tract infection. Thus, the addition of Betadine in the drainage system of urinary indwelling catheters was associated with a 50% decrease in the incidence of urinary tract infections in males.

Topics: Abdomen; Adult; Aged; Aged, 80 and over; Catheters, Indwelling; Equipment Contamination; Female; Humans; Male; Middle Aged; Perineum; Povidone; Povidone-Iodine; Rectal Neoplasms; Urinary Catheterization; Urinary Tract Infections

Fifty-six patients undergoing abdomino-perineal excision of the rectum for carcinoma were randomized to receive twice daily irrigation of the perineal wound with either 1% povidone-iodine (PVP-I) or normal saline for 5 days following surgery. The incidence of perineal wound infection, primary and delayed wound healing and persistent sinus formation was recorded. There was a highly significant reduction in perineal wound infection in the PVP-I group (P less than 0.01) and this was true even if perineal wound contamination had occurred during operation (P less than 0.05). Primary wound healing was significantly improved in the treatment group (P less than 0.02) and this was found also in the presence of contamination (P less than 0.005). There was no significant difference between the treated and control group in the incidence of delayed wound healing and persistent sinus formation.

Topics: Aged; Anti-Infective Agents, Local; Female; Humans; Male; Middle Aged; Perineum; Postoperative Care; Povidone; Povidone-Iodine; Rectal Neoplasms; Surgical Wound Infection; Therapeutic Irrigation; Wound Healing

Preoperative mechanical bowel preparation, peroperative topical antiseptic measures, and postoperative antibiotic therapy have all been shown to reduce infection after colorectal surgery. We report the results of a randomised trial of preoperative irrigation with a 10% aqueous solution of povidone-iodine (Betadine) versus water in patients undergoing major resection for large bowel carcinoma. All patients had mechanical bowel preparation, preoperative topical povidone-iodine and per and postoperative antibiotics. Of 22 study patients only one (4.6%) developed abdominal wound infection, whereas in 23 controls nine (39.1%) did so (P less than 0.01). In three of the study patients cultures of swabs taken at operation from the transected bowel ends showed no bacterial growth. Arguably the bacterial population would have been markedly reduced in other patients. These results suggest that povidone-iodine irrigation before large bowel resection reduces wound sepsis.

Topics: Aged; Bacteria; Colonic Neoplasms; Female; Humans; Intestines; Male; Povidone; Povidone-Iodine; Premedication; Rectal Neoplasms; Surgical Wound Infection; Therapeutic Irrigation

Over the past 3 years, colorectal surgeons have begun to adapt the technique of transanal total mesorectal excision. As international experience has been quickly forged, an improved recognition of the pitfalls and the practical details of this disruptive technique have been realized. The purpose of this technical note was to express the various nuances of transanal total mesorectal excision as learned during the course of its clinical application and international teaching, so as to rapidly communicate and share important insights with other surgeons who are in the early adoption phase of this approach. The technical points specific to transanal total mesorectal excision are addressed herein. When correctly applied, these will likely improve the quality of surgery and decrease morbidity attributable to inexperience with the transanal approach to total mesorectal excision.

Topics: Administration, Rectal; Anal Canal; Anastomosis, Surgical; Anatomic Landmarks; Anti-Infective Agents, Local; Antineoplastic Agents; Autonomic Pathways; Dissection; Fascia; Humans; Insufflation; Intraoperative Complications; Magnetic Resonance Imaging; Patient Selection; Povidone-Iodine; Rectal Neoplasms; Rectum; Specimen Handling; Suture Techniques; Therapeutic Irrigation; Transanal Endoscopic Surgery; Urethra

Exfoliated or soiled free malignant cells have serious consequences in patients undergoing gastrointestinal cancer surgery. The present study evaluates the toxicity and efficacy of cytotoxic agents in the prevention of cell seeding and tumor growth in the peritoneal cavity in an experimental model.. Mtln3 adenocarcinoma cell viability was tested in vitro using the trypan blue exclusion test after incubation with povidone-iodine or chlorhexidine. In vivo, Fischer rats were inoculated with 10(5) or 10(6) cells followed by peritoneal lavage with physiological saline, chlorhexidine 0.02 percent, povidone-iodine low molecular weight 1 percent or povidone-iodine high molecular weight 1 and 2 percent in different quantities and incubation times.. Chlorhexidine 0.02 percent and povidone-iodine low molecular weight 1 percent or high molecular weight 2 percent, killed over 98 percent of 10(5) or 10(6) tumor cells in vitro. Povidone-iodine low molecular weight 1 percent and high molecular weight 2 percent were toxic and lethal when 5 ml were applied in the peritoneal cavity three times for five minutes. Chlorhexidine 0.02 percent applied after inoculation of 10(5) or 10(6) cells, reduced the tumor development only to 70 and 80 percent. Application of 5 ml povidone-iodine 1 percent low molecular weight or high molecular weight, three times for one and five minutes, after inoculation of 10(6) cells did not change the tumor take. However, inhibition of Mtln3 cells to form metastases was observed. When povidone-iodine low molecular weight 1 percent was used three times for one minute after 10(5) tumor cells were "soiled", no toxicity was observed and the tumor take was reduced to 30 percent (P < 0.05).. Povidone-iodine toxicity proved to be a major issue in vivo. However, povidone-iodine low molecular weight 1 percent was safe when used for short periods and very effective when a limited number of tumor cells was inoculated. The use of cytotoxic agents to prevent recurrent disease caused by tumor cell seeding in patients seems to make sense only when the "inoculum size" of exfoliated or soiled cancer cells is limited.

Topics: Adenocarcinoma; Animals; Chlorhexidine; Disease Models, Animal; Female; Male; Neoplasm Recurrence, Local; Neoplasm Seeding; Neoplasms, Experimental; Peritoneal Lavage; Povidone-Iodine; Rats; Rats, Inbred F344; Rectal Neoplasms; Sensitivity and Specificity; Treatment Outcome

Forty-eight of 72 surgeons canvassed in the South West of England (67%) routinely use an intraluminal cytotoxic agent to prevent suture-line recurrence following partial resection of the large bowel for cancer. The most popular agents are chlorhexidine-cetrimide preparations (n = 14), mercuric perchloride (12), povidone-iodine (7) and water (12); noxythiolin, sodium hypochlorite and silver nitrate are used occasionally. The mean duration of treatment is 2 minutes. When assayed for cytotoxity against tumour cells freshly prepared from human colorectal carcinomas (n = 10), both chlorhexidine-cetrimide and povidone-iodine were rapidly lethal at a wide range of concentrations (5-100%). Mercuric perchloride (0.2%) was similarly effective, but up to 20% of tumour cells remained viable after exposure to noxythiolin and nearly 30% with water alone. Chlorhexidine-cetrimide and povidone-iodine are the agents of choice to kill malignant cells exfoliated into the colorectal lumen.

Topics: Anti-Infective Agents, Local; Cell Survival; Cetrimonium; Cetrimonium Compounds; Chlorhexidine; Colonic Neoplasms; Humans; Mercuric Chloride; Mercury; Neoplasm Metastasis; Neoplasm Recurrence, Local; Noxythiolin; Postoperative Complications; Povidone-Iodine; Rectal Neoplasms; Water