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Query: UMLS:C0001511 (Adhesion)
 5,955 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Peritoneal adhesions were created in rats by brisk scrubbing of the terminal part of the ileum. Adhesions were graded by total number and the presence of small bowel obstruction. Adhesion prophylaxis was evaluated using dexamethasone, methylprednisolone sodium succinate, promethazine hydrochloride, and human fibrinolysin (Thrombolysin) in various combinations, doses, and routes of administration. Methylprednisolone and dexamethasone, depending on the route of administration, modified the total number of adhesions but did not modify their severity when compared to control animals. Promethazine by itself modified peritoneal adhesions in the rat. Used together, methylprednisolone and promethazine also modified adhesions, but were not substantially better than the combination of dexamethasone and promethazine. Methylprednisolone, promethazine, and human fibrinolyzin, when used in combination intraperitoneally, virtually eliminated adhesion formation.
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PMID:Prevention of peritoneal adhesions in the rat. The effects of dexamethasone, methylprednisolone, promethazine, and human fibrinolysin. 12 75

Eosinophilic gastroenteritis, an idiopathic inflammation of the alimentary canal, is characterized by infiltration of the intestinal wall by eosinophils, massive submucosal edema, and peripheral eosinophilia. It is generally confined to the gastric antrum and proximal small intestine. A young woman had an eosinophilic infiltrate that involved the distal ileum and right colon only. Barium studies showed severe narrowing and shortening of the cecum and ascending colon. Symptoms of intestinal obstruction did not respond satisfactorily to conservative measures. Adhesions over the ileocecal area as well as thickening and induration of the terminal ileum and proximal right colon were found on hemicolectomy. The remaining intestine and the peritoneal cavity were felt to be normal. Histologic examination showed a cellular infiltrate with prominent eosinophils in the mucosa, submucosal edema and fibrosis. During a 40-month follow-up period after the hemicolectomy, the patient has not shown clear evidence of recurrence or extension of the disease to the stomach or proximal small intestine. It is concluded that idiopathic eosinophilic gastroenteritis may primarily involve the ileocecal area. In that location it must be specifically differentiated from intestinal tuberculosis, amebiasis, and Crohn's disease.
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PMID:Eosinophilic gastroenteritis involving the ileocecal area. 42 48

Thirteen horses and ponies were used to evaluate an anastomotic technique utilizing a modified Gambee suture pattern. The modified Gambee technique was compared with a single-row everting technique and a double-row inverting technique. The double-row inverting technique predisposed to intestinal obstruction and resulted in minimal adhesions. The everting technique predisposed to leakage of intestinal contents and subsequent peritonitis. Adhesions were formed at the site of the anastomosis to such an extent as to jeopardize the proper position of the bowel. The technique did not cause any luminal constriction initially, but the ensuing adhesions did tend to limit the expansibility of the bowel. The modified Gambee technique was associated with minimal constriction of the bowel lumen. Excessive adhesions and leakage were not found to be problems associated with the technique. It was concluded that, in Equidae, the modified Gambee technique for intestinal anastomosis results in near normal lumen diameter, minimal adhesions, and adequate strength, thus being safe and effective.
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PMID:Comparison of three techniques for intestinal anastomosis in Equidae. 78 Mar 29

One hundred severty-one cases of mechanical intestinal obstruction were studied. One hundred fifteen had small bowel obstruction and fifty-six had large bowel obstruction. Adhesion (32.8 per cent), hernia (21.6 per cent), and neoplasm (18.1 per cent) were the cause of obstruction in more than 70 per cent of all cases. More than 40 per cent of patients were older than 60 years and the average age was 52.7. The numbers of males and females were approximately equal. There were twice as many whites as blacks, and the mortality rate was higher among blacks. The overall uncorrected mortality rate was 18.7 per cent. Operation was performed in 105 patients (61.4 per cent), with a postoperative mortality of 19 per cent and corrected postoperative mortality of 4.5 per cent. Contributing factors that were significant were high incidence of metastatic diseases, elderly patients, and delay in admission.
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PMID:Intestinal obstruction. 115 23

We retrospectively compared the CT findings in patients with and without surgically proved small-bowel obstruction to evaluate the role of CT in diagnosing the presence and cause of obstruction. In the patients with obstruction, we compared the CT findings with findings on plain abdominal radiographs and contrast studies of the small intestine. CT criteria used for the diagnosis of obstruction were dilated small-bowel loops proximal to the suspected site of obstruction and collapsed or normal-appearing loops of small bowel distal to the obstruction. Receiver-operating-characteristic analysis suggested the optimum balance of sensitivity and specificity was achieved when 2.5 cm was used to indicate dilatation of the small bowel. On the basis of these criteria, the presence of obstruction was correctly diagnosed in 27 (90%) of 30 patients with proved obstruction, and obstruction was not diagnosed in the patients without obstruction. The cause of the obstruction was evident on CT in 14 of the 30 obstructed patients: abscess (five), neoplastic lesion (three), peritoneal carcinomatosis (three), and other (three). Adhesions were responsible for the obstruction in 13 of 15 patients in whom the cause was not shown on CT. In six patients in whom findings on plain abdominal radiographs were normal, the CT scan was positive for obstruction. However, in the three patients whose CT scans were falsely negative for obstruction, findings suggesting obstruction were seen on plain films. Of 15 patients who had both CT and contrast studies of the small intestine, CT offered more information concerning the cause of obstruction in six (40%), primarily by demonstrating significant extraluminal abnormalities. CT and gastrointestinal contrast studies gave concordant results in eight patients with obstruction. In only one patient did the gastrointestinal contrast study give more diagnostic information. We conclude that CT scanning demonstrates accurately the presence of high-grade small-bowel obstruction and may be the technique of choice when extraluminal abnormalities are suspected or when prompt, efficient, and comprehensive evaluation is required.
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PMID:CT diagnosis of small-bowel obstruction: efficacy in 60 patients. 154 91

Radical pelvic surgery has well-defined side effects, many of which may be related to the formation of pelvic adhesions. The effectiveness of different agents at limiting the formation of postradical pelvic surgery adhesions (PRPSA) has been variable to date. Use of a barrier could be beneficial not only by limiting adhesion formation but by acting as a "pelvic lid" to elevate the bowel out of a radiation treatment field and therefore limit subsequent radiation injury and associated fistula formation. We investigated the ability of the Gore-Tex Surgical Membrane (Gore-SM) to inhibit PRPSA in 20 adult female hogs undergoing radical hysterectomy, bilateral salpingo-oophorectomy, and resection of pelvic peritoneum. After completion of the radical resection, animals were randomized to either no attempt at covering the peritoneal defect or covering it and a 1-cm margin of intact peritoneum with a tailored sheet of Gore-SM. The membrane was secured in place using a continuous running 4-O Prolene suture around the perimeter. No intraoperative deaths occurred. No animal evidenced signs of bleeding, infection, bowel obstruction, or abscess formation. Four weeks after the initial surgery, the animals were again anesthetized, exploratory celiotomy was performed, and adhesions were quantified with specific note being made of any segments of small bowel that were adherent into the pelvis. Animals were then sacrificed. Adhesion scores for the Gore-SM-treated animals (n = 10; mean, 0.14 +/- 0.12; median, 0.21) were significantly less than those of animals with the noncovered pelvis (n = 10; mean, 1.33 +/- 0.41; median, 1.42; P less than 0.001). Similarly, significantly fewer animals treated with Gore-SM had small bowel loops adherent in the pelvis when compared to control animals (10% vs 70%; P less than 0.01). In this model, meticulously suturing the membrane in place with continuous permanent suture, the Gore-SM was an effective barrier for postoperative adhesion prophylaxis and successfully limited small bowel adherence into the pelvis.
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PMID:The Gore-Tex Surgical Membrane: effectiveness as a barrier to inhibit postradical pelvic surgery adhesions in a porcine model. 161 6

We investigated the ability of recombinant tissue plasminogen activator to inhibit post-radical pelvic surgery adhesions formation in 40 adult female canines undergoing radical hysterectomy, bilateral salpingo-oophorectomy, omentectomy, resection of pelvic and abdominal peritoneum, and placement of a peritoneal access catheter. Immediately after operation one half of animals received either recombinant tissue plasminogen activator, 1 mg/kg weight, diluted in 9 ml sterile normal saline solution per milligram of the plasminogen activator or 10 ml vehicle per kilogram intraperitoneally every 12 hours for a total of 10 doses. A single control animal died postoperatively of complications of intestinal obstruction. No bleeding abnormalities were noted in either group of animals. Four weeks after surgery, animals underwent reexploration and adhesions were quantified. Adhesion scores for the animals treated with recombinant tissue plasminogen activator (n = 20; mean score, 1.29 +/- 1.97; median, 0.6) were significantly less than for control animals (n = 19; mean score, 4.64 +/- 3.71; median, 3.86; p = 0.03). Whereas recombinant tissue plasminogen activator appears to effectively prevent post-radical pelvic surgery adhesions in this canine model, phase I and II trials in humans will be required to determine safety and clinical benefit.
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PMID:The ability of recombinant tissue plasminogen activator to inhibit post-radical pelvic surgery adhesions in the dog model. 195 91

Adhesions are the most common cause of intestinal obstruction. Medical treatment for those patients with no signs of vascular involvement has been successful in many cases. We reviewed the clinical records of 87 patients with intestinal obstruction due to adhesions, having a total of 122 episodes. Satisfactory follow up was obtained in 76% of patients for a mean of 29.6 months. 47% of episodes resolved without need for surgical intervention. Volume entrapment during the first hours was correlated with need for surgical treatment (p < 0.01). Recurrences were not different between medical and surgical patients (p = 0.28). Thus, medical treatment of this type of intestinal obstruction may be attempted in most patients, not only those who are poor surgical risks.
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PMID:[The medical treatment of intestinal obstruction due to adhesions and adherences]. 215 24

Adhesions are the leading cause of small bowel obstruction and a frequent cause of failure of infertility operations. Fibrinolysis is involved in the formation and resolution of adhesions. Although intravenous dextran (Macrodex) is known to augment intravascular fibrinolysis, the effects of intraperitoneal dextran (Hyskon) on fibrinolysis have not been extensively studied. A fibrin plate assay system was used to assess plasminogen activator activity of rabbit peritoneum and plasma after treatment with intraperitoneal or intravenous dextran 70. Hyskon significantly reduced the ability of severe trauma to depress plasminogen activator activity of visceral peritoneum and was capable of direct plasminogen activation. Untraumatized or minimally traumatized peritoneum was not affected, nor was plasminogen activator activity of plasma. Pulmonary effusions and perioperative deaths were significantly associated with the use of Hyskon.
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PMID:Intravenous versus intraperitoneal administration of dextran in the rabbit: effects on fibrinolysis. 242 47

We present a retrospective analysis of 105 instances of small bowel obstruction (SBO) in 80 patients admitted to our hospital over a ten year period. Adhesions accounted for 73% of the cases and secondary involvement by malignancy for 13%. Appendectomy, colorectal and other pelvic procedures were the most frequent surgical antecedents responsible for the adhesions. In the 86% of cases with a temperature over 100 degrees F there was significant morbidity, mortality and/or strangulation, and this sign also foretold a prolonged hospital stay. Leukocytosis, when present along with abdominal tenderness also predicted a prolonged hospital stay. Strangulation occurred in 4.7% of the instances and was accompanied by at least one of the "classical symptoms". Fourty-five percent of the instances were successfully managed by conservative measures alone, whereas 55% had had surgical treatment. The mean hospital stay for all cases was 15.3 days. The morbidity rate for this series was 21% with a mortality of 3.8%. The largest single cause of death was related to malignant disease (three of four cases). When post-operative adhesions were the etiology, the hospital stay was 8.5 +/- 1.3 days for those treated with conservative measures compared with 16.5 +/- 1.8 days for those in whom a surgical procedure was performed (p less than 0.0001). This latter group also has a higher morbidity (32% compared to 5% for the non-operative group).
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PMID:Small bowel obstruction and its management. 265 44


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