Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0021843 (bowel obstruction)
 9,927 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Due to increasing number of people treated surgically there is a rising a problem of peritoneal adhesions. They can cause pain, infertility of young women, technical problems during successive operations and--last but not least--adhesional bowel obstructions. Patients operated on due to mechanical small bowel obstruction in the 2nd Department of Surgery from 1st January 1987 to 30th June 2002 were included in the study. Diagnosis was set using clinical examination and imaging techniques such as X-ray and ultrasound and was confirmed during the operation. Strangulated hernia followed by peritoneal adhesions proved to be the most common causes of small bowel obstruction. Overall mortality rate in the group of adhesion-related obstructions reached 9.6%. In the group of 53 (39%) patients requiring small bowel resection mortality rate was 15.1%, and in the remaining patients, requiring only adhesiolysis--6.0%. There was markedly higher (18.4%) mortality rate noticed in the group of people older than 69 years as compared to younger patients (6.1%). More than twofold decrease in postoperative mortality rate observed throughout 15 years should be attributed to improvement of in-hospital care.
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PMID:[Peritoneal adhesions as cause of small bowel obstruction]. 1467 90

Postoperative peritoneal adhesions are common and serious complications of general abdominal and gynecological surgery that can lead to chronic abdominal pain, small-bowel obstruction and infertility. The specific pathophysiology of peritoneal adhesions remains elusive and current treatment is relegated to prevention through meticulous surgical technique and protective physical barriers, gels and solutions. We have reported that reactive oxygen species (ROS), generated by phagocytic cells at the site of tissue injury, serve as major signaling molecules regulating the expression of vascular endothelial growth factor (VEGF) and subsequent wound repair. We hypothesized that peritoneal adhesions are a product of over-healing surgical wounds and that, like in wound healing, ROS are implicated in their pathogenesis. We examined the presence of footprints of ROS and the ROS-inducible angiogenic factor VEGF in human adhesion tissue. An experimental model of peritoneal adhesion was established in rodents to study of the dynamics of ROS-induced gene expression during de novo adhesion tissue formation. Immunohistochemical analysis demonstrated presence of ROS/oxidant and macrophages in human peritoneal tissue. The presence of ROS and ROS-sensitive transcription factor EGR-1 was also evident in an experimental rodent peritoneal adhesion model. Along with ROS, VEGF, and a large number of mature and immature CD31/vWF positive blood vessels were present in the adhesion tissue. These observations are not consistent with the contention that adhesions are non-functional scar tissue. The newly developed rodent model of adhesion may present a useful approach to reproducibly and objectively study molecular mechanisms underlying the dynamic process of de novo adhesion tissue formation.
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PMID:Reactive oxygen species and EGR-1 gene expression in surgical postoperative peritoneal adhesions. 1496 Nov 85

Surgical adhesions are a common and often severe complication of abdominal or pelvic injury that cause pelvic pain, bowel obstruction, and infertility in women. Current treatments are of limited effectiveness because little is known about the cellular and subcellular processes underlying adhesiogenesis. Recently, we showed that Th1 alpha beta CD4(+) T cells mediate the pathogenesis of adhesion formation in a rodent model of this disease process. In this study, we demonstrate that in mice these T cells home directly to the site of surgically induced adhesions and control local chemokine production in a manner dependent on the CD28 T cell costimulatory pathway. Conversely, the inhibitory programmed death-1 pathway plays a central role in limiting adhesiogenesis, as programmed death-1 blockade was associated with increased T cell infiltration, chemokine production, and a concomitant exacerbation of disease. Our results reveal for the first time that the development of postsurgical fibrosis is under the tight control of positive and negative T cell costimulation, and suggest that targeting these pathways may provide promising therapies for the prevention of adhesion formation.
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PMID:Regulation of postsurgical fibrosis by the programmed death-1 inhibitory pathway. 1510 Mar 24

Postoperative adhesions (PAs) are usually clinically asymptomatic. Symptomatic cases, however, may present with chronic abdominal and pelvic pain, infertility, and intestinal obstruction; and they may require intensive, costly therapeutic modalities. Various agents have been used to prevent PAs, but the results indicate general suboptimal effectiveness. Our objective was to evaluate the comparative effectiveness of two pharmacologic agents for preventing PA: nadroparine calcium (low-molecular-weight heparin, or LMWH) and aprotinin, as well as a barrier agent, sodium hyaluronate/carboxymethycellulose (SCMC). Our subjects were 40 male Wistar-Albino rats divided into four groups, each consisting of 10 rats, which underwent standard cecal abrasion preceding midline laparotomy. In the control group (group 1) 1 ml of 0.9% NaCl was administered intraperitoneally before abdominal closure. In the three preventive groups, 100 U AXa (anti factor X activity) LMWH, 1800 IU aprotinin, and SCMC were administered intraperitoneally to groups 2, 3, and 4, respectively. Relaparotomy was performed on the 14th postoperative day. Visceral and abdominal wall adhesions were scored in a blinded fashion. The adhesion scores (mean +/- SD) for groups 1, 2, 3, and 4 were 2.00 +/- 0.67, 0.6.00 +/- 0.84, 1.10 +/- 0.74, and 0.20 +/- 0.42, respectively. The differences in the adhesion scores among all three preventive groups (groups 2, 3, 4) were statistically significant when compared with the control group ( p < 0.001, p = 0.017, p < 0.001, respectively). Intraperitoneal SCMC and administration of LMWH were more effective than giving aprotinin.
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PMID:Comparative effectiveness of several agents for preventing postoperative adhesions. 1518 99

Postoperative intra-abdominal adhesions are an almost invariable consequence of abdominal and pelvic surgery. Most patients are unaware of their presence, but they may result in morbidity such as acute intestinal obstruction, female infertility and dyspareunia. Claims made against surgeons and gynaecologists in the UK are reviewed, and lessons are highlighted.
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PMID:Medicolegal consequences of adhesions. 1522 10

The abnormal joining of anatomic structures after abdominal and pelvic surgery can lead to such major complications as bowel obstruction or infertility. Poly(vinyl alcohol) (PVA) membranes and hydrogels were placed over the injured tissue to act as a physical barrier and prevent such adhesions from occurring in a rabbit sidewall model. The membranes were sutured into place to prevent their slipping or curling on the moist tissue. Various in vitro experiments (including testing for swelling and mechanical strength) were conducted in order to better understand the behavior of these membranes in the wound. The results showed that both the PVA membranes and PVA hydrogels significantly reduced the number and severity of adhesions in the rabbit sidewall model, and even indicated a distinct improvement over SEPRAFILM as antiadhesion barriers. Contact-angle measurements were taken in order to evaluate the surface properties of the membranes and hydrogels. Three approaches were taken to render the membranes more bioadhesive, and forego the need for future additional suturing: imprinting a texture onto the membrane, coating the membrane with carboxy methyl cellulose (CMC), and producing bi-layered, porous PVA membranes through a process of lyophilization. Though the surface of the PVA hydrogels is more hydrophilic than the surface of the PVA membranes, neither would adhere untreated to moist tissue. However, all three approaches aimed at improving their bioadhesion yielded excellent results and demonstrated that PVA could indeed be considered a viable method of adhesion prevention.
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PMID:Poly(vinyl alcohol) membranes for adhesion prevention. 1526

Postoperative adhesion development remains a very frequent occurrence, which is often unrecognized by surgeons because of limited ability to conduct early second-look laparoscopies. The consequences include infertility, pelvic pain, bowel obstruction, and difficult reoperative procedures. To date, approaches to limit adhesions primarily have involved barriers to separate tissue during reepithelization. Future progress in regulating adhesion development and tissue fibrosis likely will require an improved understanding of the molecular processes involved in normal peritoneal repair and its aberrations leading to adhesion development. We hypothesize that tissue hypoxia (in part resulting from tissue incision, fulguration, suture ligation, etc.) is the major inciting event, which leads to a coordinated series of molecular events that promote an inflammatory response leading to enhanced tissue fibrosis. These events are reduced plasminogen activator activity, extracellular matrix deposition, increased cytokine production, increased angiogenesis, and reduced apoptosis (programmed cell death). Improved understanding of these events and their regulation will provide the opportunity to regulate better postoperative adhesion development and tissue fibrosis, thereby reducing the morbidity and mortality they cause.
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PMID:Molecular characterization of postoperative adhesions: the adhesion phenotype. 1555 39

Adhesion formation is of major concern to the pelvic surgeon. Most patients develop postoperative adhesions regardless of whether the mode of access to the abdominal cavity is by laparoscopy or laparotomy. Infertility is related to adhesions in the pelvis in 15-20% of cases. Peritoneal adhesions are the main cause of mechanical bowel obstruction in 65-80% of cases and contribute to a large extent to health-care expenditures. To prevent the formation of postoperative adhesions, a variety of medications have been studied such as glucocorticoids, heparin, dextran 70, saline solution, antibiotics, promethazine, antihistamines, prostaglandin synthesis inhibitors, Ringer's lactate solution, calcium-channel blockers and barriers such as Interseed and Gore-Tex. Such adhesions can be induced when operating on myomas and endometriosis. Experimental and clinical studies have demonstrated various mechanisms of action to be involved in adhesion prevention when gonadotropin-releasing hormone agonists (GnRH-a) are used for treatment. The following have been demonstrated and suggested: (1) Hypoestrogenic condition was found in rats to be associated with decreased adhesion formation. This could be related to the influence on estrogen-dependent growth factors and growth modulators by reliable and constant inhibition of ovarian estradiol biosynthesis and secretion, but also non-competitive estrogen antagonism seems to play a role. (2) Treatment with GnRH-a reduces the growth hormone release stimulated by growth hormone-releasing hormone. (3) GnRH-a treatment influences neoangiogenesis by affecting vascular endothelial growth factor and basic fibroblastic growth factor. (4) GnRH-a reduce the basal rate of coagulatory processes. The frequency and extent of fibrin-generating and degrading processes are reduced. Activity of the plasminogen activating inhibitor is reduced, suggesting an improvement infibrinolytic reactivity. (5) GnRH-a use alters the vascular resistance index, pulsatility index and vascular peak velocity, and possible immune response. (6) Avoidance of bleeding can reduce fibrin and therefore decreases the matrix for invasion by fibroblasts. (7) GnRH-a reduce the degree of inflammation postoperatively. Adhesion prevention seems to be at its best when pre- and postoperative GnRH-a treatment is administered. At present, there are trends to operate without prior treatment with GnRH-a. Based upon the data available, it seems worthwhile to consider preoperative and also postoperative treatment with GnRH-a: pretreatment for at least 2-3 months seems to be indicated, and a similar time after operation, to block the events associated with adhesion formation.
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PMID:Gonadotropin-releasing hormone agonists for prevention of postoperative adhesions: an overview. 1562 74

Postoperative intraperitoneal adhesion formation is a major cause of intestinal obstruction, pain and infertility. This experimental study was designed to evaluate the degree of adhesion formation and peritoneal tissue levels of malondialdehyde (MDA), reduced glutathione (GSH) and total nitrite and nitrate (NO) and the effect of aminoguanidine (AG) on these metabolite values after postoperative intraperitoneal adhesion formation in rats. A total of 21 adult male Wistar albino rats were randomly divided into three groups. Control rats were untreated; the AG group received AG 200 mg kg(-1) i.p. for 10 consecutive days intraperitoneally after surgery. The sham group was given 0.9% NaCl. The rats were killed on postoperative day 10. The peritoneal tissues were harvested to determine the tissue levels of MDA, GSH, and NO activity. For light microscopic evaluation, the cecum was removed. Adhesion formation scores in the AG group were significantly lower than those of the control and sham groups (p < 0.017, p < 0.026 respectively). In the AG-treated rats, tissue levels of MDA and NO were significantly lower than in the control group (p < 0.017). The levels of GSH in aminoguanidine-treated rats were significantly higher than those of the control group (p < 0.01). The severity of the inflammation was more prominent in the control group compared with the AG-injected rats. The results demonstrate that in this experimental model, intraperitoneal administration of aminoguanidine decreases the incidence and extent of peritoneal adhesions and causes a decrease in MDA and NO and an increase in GSH values.
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PMID:Protective effect of aminoguanidine against oxidative stress in an experimental peritoneal adhesion model in rats. 1599 Dec 62

Infertility and intestinal obstruction are well-known complications, arising from adhesion formation after intra-abdominal operations. Basic principles of adhesion formation have been found through animal studies. In addition, examination of agents for the prevention of adhesions can be easily made using experimental studies. However, lack of uniformity in study design makes assessment of the efficacy of any prophylactic regimen difficult. In this review, the material and methods used in experimental studies designed for adhesion formation or prevention were evaluated in detail, with experimental studies published in the literature from 1960 to 2003 being evaluated. Several methods for adhesion induction have been described in the literature. Severity of the adhesion varies from method to method, with the main problem being the lack of uniform expression of study results. Extensive use of complex adhesion classification systems should be used to resolve this discordance between experimental studies.
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PMID:Induction and assessment methods used in experimental adhesion studies. 1600 24


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