Adhesive Bands Research Articles

Reduction of peritoneal adhesion bands by mycophenolate mofetil (CellCept) and prednisolone in rats

Aims: the purpose of this study was to assess the efficacy of prednisolone and cellcept in decreasing postoperative adhesion band formation in rats. Methods: sixty male rats were randomly divided into three equal groups. A standard midline incision was made on the abdomen of each rat, then 2 mL of 10% sterile solution talc was injected into intraperitoneal cavity in order to induce adhesion. Group 1 served as control group, while group 2 received oral cellcept (40 mg/kg/d) and group 3 received oral Prednisolone (5 mg/kg/d) for 4 weeks. results: the formation of adhesion bands in control group was significantly higher than the prednisolone and cellcept group (p <0.001). the amount of adhesion bands in the second group was similar to the third one. conclusion: Orally administered cellcept is as effective as oral prednisolone in declining chance of intraperitoneal adhesion band formation, although it causes fewer complications such as infection in rats.

Indenter Geometry Affecting Indentation Behaviors of the Zr-Based Bulk Metallic Glass

Indenter dependent indentation behaviors of the Zr-based bulk metallic glass, such as adhesion, serrated flows, shear bands, residual indent morphologies, were found and analyzed in this paper. An interesting phenomenon is presented that adhesion of the Zr-based bulk metallic glass appears during the indentation test using the cube-corner indenter but it’s not observed when using the Berkovich indenter. Corresponding to the adhesion behavior, “dirty” but new surfaces with the nano-scale dimple structure are formed by the cube-corner indenter while relatively smooth surfaces with few discrete shear bands are obtained by the Berkovich indenter. Indentation experiments indicate that the adhesion force between the cube-corner indenter and the Zr-based bulk metallic glass depends on the loading rate, the maximum penetration load and the cyclic loading number. These phenomena will enhance understanding of shear band formation, shear-induced softening, and adhesion of bulk metallic glasses. [doi:10.2320/matertrans.M2014136]

Acquired Ileal Atresia Induced by Adhesive Intestinal Obstruction

Three female infants, aged 13, 7 and 18mo respectively with acquired ileal atresia induced by adhesive small bowel obstruction are reported. Case 1 was diagnosed with urachal cyst and cyst excision was performed when she was 7-mo-old. Case 2 was diagnosed with mesenteric cyst and cyst excision was performed by laparoscopic-assisted procedure when she was 3-mo-old. Case 3 had no history of abdominal operation previously. At laparotomy ileal atresia induced by adhesive band was found.

Intraperitoneal Administration Of Activated Protein C Prevents Post-Surgical Adhesion Band Formation

Postoperative intraperitoneal adhesion bands are the most important causes of intestinal obstruction, pelvic pain and female infertility. Adhesion bands are induced by inflammatory responses elicited by injury following surgery. The objective of this study was to evaluate the effectiveness of activated protein C (APC), a natural anticoagulant and antiinflammatory serine protease in plasma, in preventing post-surgical intraperitoneal adhesion band formation. The protective effects of APC and the FDA approved agent, sodium hyaluronate/carboxymethylcellulose (HA/CMC, also called Seprafilm), were compared by administering the two drugs intraperitoneally into 30 male C57bl/6 mice. After 7 days, the pathological adhesion grades were scored by two scaling systems and the peritoneal fluid concentration of tissue plasminogen activator (tPA) as well as the concentrations of the proinflammatory cytokines, IL-1, IL-6, TNF-α, IFN-γ and TGF-β were evaluated. The inflammation scores of mice in all groups were also measured based on histological data obtained from peritoneal tissues. Relative to the HA/CMC group, intraperitoneal administration of APC led to a significantly higher reduction of adhesion band formation. Moreover, a markedly lower inflammation score was obtained in the adhesive tissues of the APC-treated group which correlated with significantly reduced peritoneal concentrations of IL-6, TNF-α, IFN-γ and TGF-β and elevated concentration of tPA in this group. These results suggest that in comparison to the FDA approved agent, Seprafilm, APC exhibits a markedly higher efficacy in preventing postoperative adhesion band formation. Thus, APC holds the potential to be therapeutically used as a novel anti-adhesive agent. Disclosures:No relevant conflicts of interest to declare.

Mandatory Resection of Strangulation Marks in Small Bowel Obstruction?

No evidence is available on how to treat intraoperatively detected band-shaped strangulation marks of the bowel wall originating from an adhesive band or hernia ring. The authors prefer to resect these hazardous strangulation marks to avoid secondary small bowel perforation. This retrospective study investigated the prevalence of intraoperatively unrecognized ulceration and transmural necrosis at the site of the strangulation marks. From July 2003 to July 2011, a total of 31 of 461 patients with acute bowel obstruction underwent small bowel resection due to strangulation marks, exclusively. Seven patients had two strangulation marks, resulting in 38 strangulation marks to be analyzed. From 38 examined strangulation marks, 14 (36.8 %) exhibited deep ulceration or transmural necrosis. Four (10.5 %) necrotic lesions had already been recognized intraoperatively, while 7 (18.4 %) unsuspicious strangulation marks showed deep ulceration and 3 (7.9 %) showed transmural necrosis exclusively at final histopathologic examination. The number of strangulation marks that needed to be resected for prevention of one missed deep ulceration and/or transmural necrosis of the small bowel was 3.4. The presence of deep ulceration or transmural necrosis is associated with an obvious decrease in bowel diameter caudad to the strangulation mark. No anastomotic leak occurred. The severity of small bowel damage at the site of band-shaped strangulation marks may be underestimated by surgeons. The present series showed favorable results with a resection-per-principle policy for these strangulation marks. If an obvious decrease of bowel diameter aborally to the strangulation mark is present, resection or seromuscular invagination of the later is particularly recommended.

Bioactive components and preventive effect of green tea (Camellia sinensis) extract on post-laparotomy intra-abdominal adhesion in rats

BackgroundAdhesion formation is an important complication of abdomino-pelvic surgery. Green tea (Camellia sinensis) has anti-oxidant and anti-inflammatory effects which prevent production and accumulation of collagen and, thus, may reduce adhesion formation. The present study examined the effect of green tea alcoholic extract on intra-abdominal adhesion formation. Total phenolic, flavonoid and flavonol contents as well as anti-oxidant activity were also evaluated. MethodsThirty healthy male Wistar rats were randomly assigned to two equal groups of green tea (A) and distilled water (B). After anesthesia, the abdominal wall was opened and three shallow longitudinal and transverse incisions of 2 cm in length were made on the right side of the peritoneum by scalpel blade. A 2 × 2 cm square of the left abdominal wall peritoneum was removed by surgical scissors. Green tea extract or distilled water was introduced into the abdominal cavity of each rat. The rats were sacrificed two weeks post-laparotomy and adhesion bands were scored according to severity, extent and appearance. Fibrosis and inflammation were also scored via histopathological examination. ResultsThere was a significant difference in mean adhesion scores between the green tea and distilled water groups (3.2 ± 3.503 and 7.33 ± 0.51, respectively) (p = 0.001). In terms of fibrosis (p = 0.002) and inflammation (p = 0.003) a statistically significant difference was also seen between the two groups following histopathological examination. ConclusionGreen tea extract reduces intra-peritoneal adhesions in an animal model.

Molecular implication of ADAM-15 and 17 in intrauterine adhesions

ObjectivesTo investigate the regulation of the proteins ADAM-15 and ADAM-17 in intrauterine adhesions (IUA). Study design68 patients were found to have IUA in a study performed at our Department of Gynecology, and 18 control volunteer participants were recruited in the study. The patients with IUA were assigned to three groups according to the classification of March et al.: IUA-I (n=28), IUA-II (n=22), and IUA-III (n=18). All the volunteers were assigned to the control group (Con, n=18). The expression of ADAM-15 and ADAM-17 in the adhesive band tissue in patients and the endometrium in volunteers was detected by western blot, real-time PCR, and immunohistochemistry. ResultsThe expression of ADAM-15 and ADAM-17 was significantly upregulated in both protein level and transcript level in IUA patients compared to that in controls. ADAM-15 expression was significantly higher in IUA-III (4.59±0.15) compared to IUA-II (3.18±0.12) and IUA-I (2.11±0.17; P<0.01). ADAM-17 expression was also significantly higher in IUA-III (3.25±0.11) compared to IUA-II (2.21±0.15) and IUA-I (1.78±0.21; P<0.01). The transcript levels of ADAM-15 and ADAM-17 showed similar patterns, and were markedly higher in grade III IUA patients compared to grade II and grade I. The severity of IUA was positively correlated to the protein and transcript expression level of ADAM-15 and ADAM-17 in uterine tissue. ConclusionsThe development of IUA is associated with regulation of ADAM15 and ADAM-17, which may be potential biological markers for evaluating the severity of intrauterine adhesions.

Dyspareunia caused by a vaginal adhesion band following a transvaginal mesh repair

Surgery with synthetic mesh or graft materials has become increasingly popular over the past decade due to the excellent short-term success rate. However, concern about mesh-related complications still exists. Here we report a case experiencing sexual pain after a transvaginal mesh repair with a total Prolift procedure. Also, her husband experienced painful intercourses due to a vertical adhesion band between the anterior and posterior vaginal wall. Under local anesthesia, the adhesion band was dissected. She restarted her sexual life 3 weeks after the procedure without any further complaint. A postoperative vaginal adhesion band formation may occur during the healing process, which may cause postoperative sexual dysfunction. This rare complication may aid in preoperative counseling about the potential adverse events on postoperative sexual function.

Pilot study on binding of bovine salivary proteins to grit silicates and plant phytoliths.

Mostly fed with grass in fresh or conserved form, cattle and other livestock have to cope with silicate defence bodies from plants (phytoliths) and environmental silicates (grit), which abrade tooth enamel and could additionally interact with various salivary proteins. To detect potential candidates for silicate-binding proteins, bovine whole saliva was incubated with grass-derived phytoliths and silicates. Interactions of salivary proteins with pulverized bovine dental enamel and dentine were additionally analysed. After intense washing, the powder fractions were loaded onto 1D-polyacrylamide gels, most prominent adhesive protein bands were cut out and proteins were identified by mass spectrometry within three independent replicates. All materials were mainly bound by bovine odorant-binding protein, bovine salivary protein 30×10(3) and carbonic anhydrase VI. The phytolith/silicate fraction showed additional stronger interaction with haemoglobin β and lactoperoxidase. Conceivably, the binding of these proteins to the surfaces may contribute to biological processes occurring on them.

Small bowel volvulus secondary to post appendectomy adhesion band

Small bowel volvulus secondary to post appendectomy adhesion band

Intestinal torsion causing chylous ascites: a rare occurrence

Intestinal torsion and chylous ascites are very rarely associated. We present the case of a 19-year-old man who presented with acute abdomen. Computed tomography of his abdomen showed features suggestive of intestinal torsion. Chylous ascites was incidentally discovered on exploratory laparotomy. The chylous fluid was drained, the small bowel detorted and the coloduodenal adhesion band taken down. The patient's retroperitoneum was explored to exclude occult masses and malformations of the lymphatics. Post surgery, the patient recovered uneventfully. In this case, we postulate that intestinal malrotation had caused the obstruction of the lymphatic flow from the mesenteric lymphatic channels, leading to the exudation of chyle, which then resulted in the accumulation of chylous fluid in the peritoneal cavity. It is important to exclude the more common causes of atraumatic chylous ascites, such as enlarged retroperitoneal lymph nodes or lymphatic malformations.

Minimally Invasive Colostomy Revision for Palliation of Large Stomal Prolapse and an Adherent Sliding Peristomal Hernia

Minimally Invasive Colostomy Revision for Palliation of Large Stomal Prolapse and an Adherent Sliding Peristomal Hernia

Omentopexy for patch repair of diaphragmatic defect

There are many techniques in the reconstructive of congenital diaphragmatic hernia defect. In this study, we present our results from a prospective, randomised trial of using the omentum (omentopexy) for repair of large diaphragmatic defects. Twenty white, male, New Zealand rabbits were used to compare incidence and severity of adhesion bands formation in abdominal cavity with/without of omentopexy after repair of diaphragm defect with the non-absorbable patch (Dacron). They were divided in to two groups, GI (10 animals with omentopexy and repair) and GII (10 animals with repair, without omentopexy). On the 60 th day, animals were re-operated. In each case, adhesion band formation and its severity were recorded. The difference between the incidence of adhesion band formation among the two group was statistically significant (P = 0.019).The majority of rabbits in GII (60%) had substantial adhesion bands (Grade >2 or severe score), whereas, in GI, none of rabbits had substantial adhesion bands (P = 0.019). Our study showed that the use of omentopexy as a cover in repair of diaphragmatic defect is versatile technique with a good success for decreasing of adhesion band formations at short-term follow-up.

A Prospective Study on the Gastrografin Contrast Radiology in the Management of Small Bowel Obstruction

Objective: To investigate the value of the hyperosmolar water-soluble contrast medium Gastrografin® in choosing which patients with small-intestine obstruction, caused by post-operative adhesions, to treat conservatively. Summary Background Data: Post-operative abdominal adhesions represent the main aetiological factor for intestinal obstruction. The mortality rate from intestinal obstruction has been quoted at 5 – 10% . The most effective way to reduce the morbidity and mortality caused by post-operative adhesions is, therefore, through early diagnosis and appropriate treatment. Methods: A prospective Gastrografin® study was performed in patients with small-intestine obstruction from June 2010 to June 2011. Results: Fifty-eight patients with adhesive intestinal obstruction received Gastrografin® via a nasogastric tube. Direct abdominal radiographs were taken after 4 and 8 h. Thirty-nine patients (67.2%) had Gastrografin® in the right colon within 8 h and were considered to have partial obstruction. These patients commenced oral feeding even though abdominal radiographs revealed gas–fluid levels. In the remaining 19 patients (32.7%), Gastrografin® was not observed in the right colon within 8 h: five of the 19 patients (26.3%) were successfully treated conservatively; 14 of the 19 patients (73.7%) developed toxic signs and underwent surgery, with obstruction resulting from adhesive bands being confirmed at operation. Conclusions: Conservative treatment can be recommended for patients in whom contrast medium is observed in the right colon within 8 h following administration, regardless of the presence of obstruction signs. Absence of contrast medium in the right colon within 8 h cannot, however, be considered an indication for surgery.

Herniated mobile descending colon

Persistent descending mesocolon is a congenital anomaly that has been shown, in most cases, to be asymptomatic because of its short length. To the best of our literature review and knowledge, no case of internal herniation of the mobile descending colon into either gastrocolic or splenocolic recesses have been reported. We therefore wish to report a case of herniated mobile descending colon in a middle-aged woman. HA was a 54-year-old female with a 2-year history of recurrent episodes of left upper quadrant pain of the abdomen. The pain, which was initially dull aching, suddenly became sharp in nature and so severe that it precluded her from doing her domestic activities. She had undergone clinical evaluation and work up previously but no etiology for her pain was found. After resuscitation, she consented to exploratory laparatomy for an acute on-chronic abdominal pain of unknown etiology. The intraoperative findings were a portion of the wall of the left colon seen to have herniated into a small band of tissue on the left posterior wall. The whole descending colon was unattached to the posterior peritoneum. The trapped portion (4 cm in length) of the wall of the colon was released and a warm pack was applied to the segment of large bowel so released. Following this maneuver, the portion was found to be viable and so a left colopexy was performed and the adhesion band that was placed obliquely from the spleen toward the midline was excised. Postoperative period was uneventful and since then the patient's abdominal pain has been abated over the past 1 year. The morbidity of a mobile descending colon includes internal herniation. Therefore, early detection and colopexy is necessary.

MANAGEMENT OF VERTICAL TOOTH FRACTURE WITH BANDING - A CASE REPORT

ABSTRACT Aim To present a case of vertical tooth fracture treated by adhesive bonding and banding before root canal treatment. Method In this case, a vertically fractured maxillary premolar was stabilized by adhesive resin and orthodontic stainless steel band followed by root canal treatment. Conclusion The prognosis of teeth with cracks depends on the location and extent of the crack. Early recognition and treatment is the key to proper management.

自然気胸における肺尖部索状癒着のCTによる検出能評価―新しい手術適応の提案

【目的】自然気胸における肺尖部の索状癒着は血気胸を生じる危険性がある．これをCTでどれほど検出できるか検討した．【対象と方法】2005年1月から2012年12月まで，当院で胸腔鏡手術を行った本人申告初発自然気胸154例に対し，MPRも併用し，胸部CTによる索状癒着の検出を試みた．【結果】154例中，索状癒着が指摘された症例は31例で，全例胸腔鏡でも索状癒着を確認した．一方，残る123例は指摘出来なかったが，その内4例に術中に索状癒着を確認した．結局，154例中35例（22.7%）に索状癒着が存在し，その35例中31例（88.6%）はCTで検出可能であった．【結語】肺尖部索状癒着は血気胸の原因となるため，これを認める症例は初発再発に関係なく手術適応としても良いと考える．CTはそのようなリスクを有する症例の約90%を検出でき有用であった．

Spreading dynamics of cellular aggregates confined to adhesive bands

We examine the spreading of cellular aggregates deposited on adhesive striated glass surfaces consisting of 100 μm large bands alternatively coated with fibronectin and with PolyEthyleneGlycol-Poly-L-lysine (PEG-PLL). The aggregates spread confined to the adhesive fibronectin bands. A front of cells expands from the aggregate at constant velocity. In comparison, the radial spreading of an aggregate on the uniform fibronectin coated glass surface obeys a diffusive law. We develop a common theoretical model in agreement with our experimental observations to describe the apparently disparate spreading kinetics of cellular aggregates. These results demonstrate the dominant role of the permeation in the expansion of the precursor film of cells around the aggregate.

Acute Gastric Outlet Obstruction After Left Hemicolectomy

Question: A 68-year-old man presented with nausea and vomiting. He had been healthy until 3 weeks before, when he was diagnosed with stage T3N0M0 sigmoidal adenocarcinoma and underwent left hemicolectomy. The course of recovery was smooth and he had been discharged 7 days previously. He experienced dysphagia and fullness 4 days after discharge, and developed nausea and vomiting the next day; he visited our emergency room after 2 days and was readmitted. Physical examination revealed epigastric tenderness and distension, but no rebounding pain. The surgical wound was clean and healing well. Laboratory tests revealed leukocytosis with a shift to the left. Upper gastrointestinal (UGI) endoscopy revealed gastric distension and a convergent fold over the antrum (Figure A) , but the scope could not pass into the duodenum. Computed tomography also demonstrated gastric distension and a shift of the gastric outlet to the left side with near obstruction (Figure B, C ). An UGI series with guided wire revealed that the axis turned from the left to the right side and then passed into the duodenum (Figure D ). The patient then underwent emergency surgery. What was the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. The surgical findings revealed an adhesive band from the antrum to the left side of the abdominal wall with twisting of the stomach (Figure E, arrow). After lysis of the adhesive band, the stomach returned to a normal position and the gastric outlet obstruction was relieved. The patient was discharged 1 week later. Acute gastric volvulus is rare and involves an abnormal rotation of the stomach by more than 180°, creating a closed loop obstruction. Acute gastric volvulus usually presents with acute abdominal conditions, radiography shows gastric distension and obstruction, and a nasogastric tube cannot be passed through in typical cases.1Cardile A.P. Heppner D.S. Gastric volvulus, Borchardt's triad, and endoscopy: a rare twist.Hawai'i Med J. 2011; 70: 80-82PubMed Google Scholar Our case had acute gastric distension but easy insertion of a nasogastric tube to the stomach because he had no paraesophageal hernia. The indications for UGI endoscopy in the diagnosis of acute gastric volvulus are tortuous stomach, paraesophageal hernia, and inability to locate and pass the scope through the pylorus in typical cases.2Ajao O.G. Gastric volvulus: a case report and a review of literature.J Natl Med Assoc. 1980; 72: 520-522PubMed Google Scholar Our case presented other aspects, including easy passage through to the antrum in the absence of a paraesophageal hernia, and showed gastric distension with a convergent fold in the antrum, resulting in complete obstruction and inability to insert the scope into the duodenum. Abdominal CT for diagnosis of acute gastric volvulus revealed gastric distension, a shift of the outlet to the left side, and twisting of the stomach. Based on our experience with this case, the findings of the UGI endoscopy, abdominal CT, and UGI series with a guided wire were highly suggestive of an atypical gastric volvulus caused by an adhesive band. Surgical treatment normally comprises de-rotation and anterior gastropexy, in which the greater curve of the stomach is fixed to the anterior abdominal wall. In our case, however, lysis of the adhesive band returned the stomach to a normal position without any fixation.

Multidetector CT appearance of adhesion-induced small bowel obstructions: matted adhesions versus single adhesive bands

Adhesive small bowel obstruction (SBO) is a common cause of abdominal pain after surgery or peritonitis. The role of computed tomography (CT) in the evaluation of SBO has expanded. Diagnosis of adhesive SBO, however, remains challenging. Adhesions causing SBO are classified as either matted adhesions or single adhesive bands, and both types have different mechanisms that lead to SBO. In patients with matted adhesions, SBO results from angulation and kinking or from torsion of the intestines. In patients with adhesive bands, SBO results from compression of the intestine caused by the band itself. Recent advances in spatial resolution using multidetector CT (MDCT) have enabled detailed assessment of the configuration of the SBO site. Presented in this pictorial essay are characteristic MDCT findings regarding the mechanism of the obstruction process of adhesive SBO.