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The aim of the study was to evaluate the effects of 0.9% NaCl and other solutions suitable for peritoneal lavage on in vitro viability and fibrinolytic activity of human peritoneal mesothelial cells.Material and methods. Mesothelial cells were isolated from the intra-operatively collected greater omentum specimens and then cultured. Subsequently, eight cultures (n=8) were incubated for six hours with M199 culture medium (control group) or culture medium with the addition of 0.9% NaCl, PD fluid Gambrosol-Trio 10 or Hanks' solution. Immediately after exposure to the studied solutions, the amount of LDH released by the cultured cells was determined. Then, cultured cells were incubated for the next 24 hours; after this period their metabolism and fibrinolytic activity were determined by means of IL-6, t-PA and PAI-1 levels. Levels of these substances were compared to the amount of total cellular protein that was determined simultaneously.Results. Hanks' solution showed no significant influence on cellular culture architecture and mesothelium metabolism. PD fluid Gambrosol-Trio 10 damaged mesothelial cell structure and function as manifested by an increased release of LDH and enhanced t-PA synthesis, as well as decreased production of IL-6 and PAI-1. Exposure to 0.9% NaCl solution was found to cause a disturbance in cellular adhesion without significant structural damage (marked changes in cellular morphology without increased LDH release) and significant metabolism impairment as presented by reduced production of t-PA, IL-6 and PAI-1.Conclusions. Saline solution and PD fluids should not be used for peritoneal lavage. Further investigations are required to identify the least harmful solution for mesothelial cells suitable for application in intra-operative peritoneal lavage.
Bowel obstruction is a condition which has been known for many years. As time goes by, the problem is still often encountered at surgical emergency rooms. More than 20% of emergency surgical interventions are performed because of symptoms of digestive tract obstruction with the disease mostly situated in the small bowel. Rates of causative factors of the disease have changed over recent years and there have been increasingly more cases of small bowel obstruction caused by peritoneal adhesions, i.e., adhesive small bowel obstruction (ASBO). The aim of the study to analyse the reasons and incidence of adhesive small bowel obstruction during two periods of time (1990-1995 and 2005-2010). Material and methods. We performed a retrospective analysis of medical records of patients hospitalized at the 1st Department of General Surgery and Surgical Oncology of the Provincial Polyclinic Hospital in Płock between 1990 and 1995. The outcomes were compared with another period of 2005-2010. Results. We found that the incidence of adhesive small bowel obstruction increased from 58 cases in the first period to 215 cases in the second one, and the outcomes improved. The proportion of patients who underwent surgery diminished from 38% to 13%. The mean hospitalization time shortened and was 11.3 days and 6.95 days during 1990-1995 and 2005-2010 periods of time, respectively. In the first group, patients who had a surgery were hospitalized for 17.8 days and those who were treated conservatively for 8.08 days. In the second group, the mean hospital stay decreased to 15.6 days and 5.7 days in the case of surgical and conservative treatment, respectively. The age of onset declined from 56.63 years in the first period to 52.54 years in the other one. Conclusions. Analysed data show an increasing number of patients with adhesive small bowel obstruction. The highest risk of the disease was associated with operations on the large bowel and gynaecological procedures.
The aim of the study was to evaluate the influence of vitamin E administered intraperitoneally on the prevention of peritoneal adhesion formation in rats on the basis of macroscopic and microscopic assessment of the adhesions.Material and methods. Experimental studies were performed on 50 Sprague-Dawley male rats, which were randomly divided into 5 groups, 10 rats in a group. Experimental group I (EI) included 10 rats which had peritoneal adhesions provoked by scraping of the wall of cecum and parietal peritoneum followed by intraperitoneal administration of vitamin E in the dose of 100 mg/kg body weight. Experimental group II (EII) included 10 rats which had peritoneal adhesions provoked by surgery, without administration of vitamin E. Control Group I (CI) included 10 rats which had the abdominal cavity opened without provoking peritoneal adhesions, and vitamin E was administered. Control Group II (CII) included 10 rats which had peritoneal adhesions provoked by surgery, and then lipid based solution was administered intraperitoneally. Control Group III (CIII) included 10 rats which had the abdominal cavity only opened and closed.Groups EI, CI and CII were the subject of the drugs intraperitoneal re-injection in first, second and third day after surgery. The animals were killed during the 8th postoperative day. Macroscopic examination of peritoneal adhesions using the classification reported by Nair was performed and samples for microscopic examination were excised.Results. In group EI peritoneal adhesions were formed in 60% rats (40% weak and 20% solid). In group EII peritoneal adhesions were found in all animals (30% weak and 70% solid). Reduction of the inflammatory response and less severe fibrosis were observed in animals with intraperitoneal administration of vitamin E.Conclusion. In the study, vitamin E administered intraperitoneally to rats decreased the intensity and extensiveness of peritoneal adhesions, which was confirmed by macroscopic and microscopic examinations.
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