Prevention Of Adhesion Formation Research Articles

More than an Uterotonic Agent: Oxytocin Prevents Peritoneal Adhesion

Prevention of postoperative adhesions (PPA) has become an important issue. The aim is to investigate the effect of Oxytocin (OT) on PPAs. A total of thirty female Wistar-albino rats were randomly divided into three groups (10 rats/group). The cecal peritone of Group I rats (controls) were scraped, to trigger adhesion formation, and no treatment were given. After cecal scrubbing, 1 mL saline solution was applied to each rat in Group II (i.p. saline treated group) and 80 IU/kg of OT (Pituisan®, Ege Vet, Turkey) to Group III (i.p. OT treated group) intraperitoneally. All animals were sacrificed 10 days after surgery and adhesions graded in terms of severity and histopathologic characteristics. The median scores for the extent, severity, and degree of adhesions in Group I and Group II were statistically significant and considerably higher than those scores for Group III (P<0.001). The inflammation, neovascularization, and fibrosis scores for Group III were statistically significant and considerably lower than those scores for Groups I and II (P<0.001, P<0.001 and P=0.002 respectively). OT, significantly prevented adhesion formation improving wound healing possibly by suppressing adhesion formation with anti-inflammatory and antioxidant properties. OT may be useful in the prevention of PPA in humans.

Cordycepin prevents postoperative formation of intra-abdominal adhesion in a rat model: An experimental study.

The aim of the present study was to investigate whether cordycepin prevented adhesion formation in a rat model. Rats were randomly assigned to 3 groups of 10 rats. The absence of adhesion was confirmed via laparotomy. Adhesion group: The cecum was removed from the abdomen and scraped with a dry gauze bandage until petechial hemorrhagic foci developed. Cordycepin group: The same surgical procedure was performed as in the adhesion group, and 10 mg/kg cordycepin was administered intraperitoneally. After 15 days, the rats were sacrificed humanely via cardiac blood withdrawal under anesthesia. The rats were then analyzed morphologically and histopathologically, and hydroxyproline (OH-p) and malondialdehyde (MDA) levels were measured. Macroscopic analysis revealed significantly less adhesion in the cordycepin group than in the adhesion group (p<0.01). Furthermore, significant histopathological improvement was also evident in the cordycepin group compared to the adhesion group (p<0.05). The levels of OH-p and MDA in blood and tissue were higher in the adhesion group than in the control group, and lower in the cordycepin group than the adhesion group. Interestingly, MDA level was significantly lower (blood: p<0.05; tissue: p<0.01) in the cordycepin group than in the adhesion group, whereas only tissue OH-p was significantly lower in the cordycepin group compared with the adhesion group (p<0.05). One rat in both adhesion group and cordycepin group died postoperatively. Results indicated that cordycepin effectively reduced adhesion in a rat abrasion model. Thus, this agent may be valuable to prevent postoperative adhesion.

The influences of thermally cross-linked gelatin film for intraperitoneal dissemination of tumor cells

Event Abstract Back to Event The influences of thermally cross-linked gelatin film for intraperitoneal dissemination of tumor cells Hiroe Miyamoto1, Hiroyuki Tsujimoto1, Koki Yamanaka1, Han Pei1, Tsunehito Horii1, Hiroko Torii1, Yuki Ozamoto1 and Akeo Hagiwara1 1 Doshisha University, Department of Medical Life System, Japan Introduction: To prevent adhesion formation after abdominal surgery, we have developed a thermally cross-linked gelatin film and previously reported its superior anti-adhesive effects with excellent peritoneal regeneration[1]. However, it may act as a scaffold convenient for tumor cell growth, thereby accelerating peritoneal dissemination when used in surgery for abdominal tumors since the gelatin film is made from a degenerated product of collagen which is the most abundant extracellular matrix protein in mammals and has been used as a scaffold in the field of regeneration medicine. In this study, we tried to clarify this issue in in vitro and in vivo experiments using mouse B16 melanoma cells and its carcinomatous peritonitis model, compared with HA/CMC film which is an anti-adhesive material composed of polysaccharides and has been used clinically. Materials, Methods and Results: At first, we examined the influence of the gelatin film for in vitro tumor cell growth. B16 melanoma cells were cultured on the gelatin film, HA/CMC film or without any film. Each viable cell number was counted with time. As the result, B16 melanoma cells grew on the gelatin film and HA/CMC film significantly lower than those in the control group. Next, we examined the influence of the gelatin film for peritoneal dissemination using B16 melanoma carcinomatous peritonitis model. After laparotomy, small parts of bilateral parietal peritoneum were removed mechanically. The injured site were covered with the gelatin film, HA/CMC film or without any films (control). Then, each mouse was inoculated intraperitoneally with the B16 melanoma cells, which has intrinsic black melanin pigmentation. At 7 days after the inoculation, the tumor weight of B16 melanoma at the injured sites were measured. The result showed no significant differences of the tumor weight among three groups. Furthermore, there was also no significant differences of the mean survival time of the mice among three groups with the gelatin film, HA/CMC film or without any films. Discussion: In the in vitro experiment, the gelatin film as well as the HA/CMC inhibited the growth of B16 melanoma cells unexpectedly, compared with the control group. In the in vivo experiments using B16 melanoma carcinomatous peritonitis model, both films did not influence the tumor growth or the survival times of the mice inoculated with the tumors. These results suggests that the both types of films do not enhance the tumor growth at the injured sites at least. Conclusions: Thermally cross-linked gelatin film does not act as a scaffold convenient for tumor cell growth, thereby accelerating peritoneal dissemination, when used in surgery for abdominal tumors.

Primary Frozen Shoulder Syndrome: Arthroscopic Capsular Release

Idiopathic adhesive capsulitis, or primary frozen shoulder syndrome, is a fairly common orthopaedic problem characterized by shoulder pain and loss of motion. In most cases, conservative treatment (6-month physical therapy program and intra-articular steroid injections) improves symptoms and restores shoulder motion. In refractory cases, arthroscopic capsular release is indicated. This surgical procedure carries several advantages over other treatment modalities. First, it provides precise and controlled release of the capsule and ligaments, reducing the risk of traumatic complications observed after forceful shoulder manipulation. Second, release of the capsule and the involved structures with a radiofrequency device delays healing, which prevents adhesion formation. Third, the technique is straightforward, and an oral postoperative steroid program decreases pain and allows for a pleasant early rehabilitation program. Fourth, the procedure is performed with the patient fully awake under an interscalene block, which boosts the patient's confidence and adherence to the physical therapy protocol. In patients with refractory primary frozen shoulder syndrome, arthroscopic capsular release emerges as a suitable option that leads to a faster and long-lasting recovery.

Reduction of adhesions and antrostomy stenosis with topical vitamin A after endoscopic sinus surgery.

Prevention of adhesion formation and restoration of mucociliary mucosa are major determinants of the success of endoscopic sinus surgery (ESS). Vitamin A (VA) can promote mucociliary differentiation of respiratory epithelium. However, whether topical VA can promote sinonasal wound healing or reduce adhesion formation after ESS in humans remains unexplored. To investigate the effect of topical VA on sinonasal wound healing and adhesion formation after ESS. This is a within-subject control study. Patients with chronic rhinosinusitis were included. Each patient underwent ESS, and topical VA was applied over the sinonasal wound. Postoperative outcomes were assessed by using the Lund-Kennedy score, and the antrostomy size was measured. In vitro wound healing assay of fibroblasts with or without VA was evaluated. Restoration of ciliated epithelium was examined by using scanning electron microscopy. Thirty patients were enrolled. The mean (standard deviation {SD}) scores for scarring/adhesion in the VA-treated side at 3 and 12 months after surgery (0.20 ± 0.40 and 0.23 ± 0.42, respectively) were significantly lower than those in the controls (0.47 ± 0.50 and 0.53 ± 0.62, respectively). The mean (SD) antrostomy size in the VA treated side at 1, 3, and 12 months after surgery (0.85 ± 0.30 cm(2), 0.7 ± 0.30 cm(2), and 0.70 ± 0.27 cm(2), respectively) were significantly larger than those in the controls (0.79 ± 0.26 cm(2), 0.60 ± 0.25 cm(2), and 0.57 ± 0.24 cm(2), respectively). Wound healing assay revealed that VA significantly inhibited the proliferation and migration of fibroblasts. Scanning electron microscopy showed mature ciliated cells in the VA-treated side. Topical VA is a promising agent for sinonasal wound healing after ESS because it can promote mucociliary reepithelization, reduce adhesion, and prevent antrostomy stenosis.

Intraperitoneal lidocaine hydrochloride for prevention of intraperitoneal adhesions following laparoscopic genitourinary tract surgery in ewes

Adhesion formation involving the genitourinary tract is common following laparoscopic procedures. To evaluate the effectiveness of intraperitoneal lidocaine hydrochloride 1% solution for the prevention of abdominal adhesions, twenty four Santa Ines ewes submitted to laparoscopic ovum pick-up, uterine puncture and local rinsing, were randomly distributed into two groups of 12 animals, according to rinsing solution: normal saline (SG) or 1% lidocaine hydrochloride solution (LG). Laparoscopy for manipulation of the reproductive tract (uterine puncture trauma model and ovum pick-up) was applied. A standard laparoscopic approach using three ports in triangulation was employed. The uterus and ovaries were rinsed at the end of the procedure (using either saline or lidocaine hydrochloride) for removal of blood clots from the ovaries and uterine horn surfaces. Inflammation was assessed postoperatively by plasma fibrinogen, and all animals underwent a second laparoscopic procedure 21days after surgery for macroscopic assessment of adhesion formation. Four cases of adhesion were observed in each group. The plasma fibrinogen did not differ between groups and among different time points, indicating an absence of systemic inflammation following laparoscopic procedures. There were no significant differences between treatments. Both normal saline and 1% lidocaine hydrochloride were similarly effective in the prevention of adhesion formation.

Postoperative Urinary Retention With Gross Vulvar Edema After Use of 4% Icodextrin

4% icodextrin is a fluid that can be instilled laparoscopically to prevent adhesion formation. There are few complications reported in the literature associated with its use. A 38-year-old woman, gravida 2, para 0, abortus 2 underwent laparoscopic salpingectomy. 4% icodextrin was instilled in an effort to prevent adhesion formation. Postoperatively, the patient experienced urinary retention and gross vulvar edema that required foley catheter use until the 4% icodextrin solution had absorbed. Postoperative complications that may be associated with the use of 4% icodextrin include urinary retention and vulvar edema.

Soybean oil prevents peritoneal adhesions without impairing colonic anastomotic healing

AimAdhesion formation could potentially result in significant morbidity and mortality. In the present study, we investigated the role of soybean oil in the prevention of peritoneal adhesions and its effect on the anastomotic healing process.Patients and MethodsA total of 40 male Wistar Albino rats were randomly assigned to four groups: group A, adhesion induction method; group B, adhesion induction method with administration of soybean oil; group C, colonic anastomosis method; and group D, colonic anastomosis method with administration of soybean oil. Adhesions were scored on postoperative day 7. Anastomotic healing was assessed by determining anastomotic bursting pressure (ABP), tissue hydroxyproline content and the histopathological examination. The serum malondialdehyde (MDA), nitric oxide (NO) and myeloperoxidase (MPO) levels were determined to evaluate cellular response to injury.ResultsThe difference in mean values between saline‐ and soybean oil‐treated groups, using both the adhesion method and colonic anastomosis method, were statistically significant (P = 0.0003, P = 0.009). Soybean oil administration resulted in no significant difference in terms of ABP and histopathological scores (P = 0.694 and P = 0.246, respectively). Tissue hydroxyproline content was increased significantly with soybean oil administration (P = 0.001). Mean MDA, NO and MPO levels were significantly decreased in the soybean‐administered colonic anastomosis group (P = 0.001, P = 0.001, P = 0.002, and respectively). In the soybean‐administered adhesion group, mean MDA, NO and MPO levels were lower than in the control group, but the differences were not significant (P = 0.113, P = 0.958, and P = 0.597, respectively).ConclusionSoybean oil administration intraperitoneally has been shown to prevent adhesion formation effectively without impairing the colonic anastomotic healing process.

Reducing the Oxidation Level of Dextran Aldehyde in a Chitosan/Dextran-Based Surgical Hydrogel Increases Biocompatibility and Decreases Antimicrobial Efficacy.

A highly oxidized form of a chitosan/dextran-based hydrogel (CD-100) containing 80% oxidized dextran aldehyde (DA-100) was developed as a post-operative aid, and found to significantly prevent adhesion formation in endoscopic sinus surgery (ESS). However, the CD-100 hydrogel showed moderate in vitro cytotoxicity to mammalian cell lines, with the DA-100 found to be the cytotoxic component. In order to extend the use of the hydrogel to abdominal surgeries, reformulation using a lower oxidized DA (DA-25) was pursued. The aim of the present study was to compare the antimicrobial efficacy, in vitro biocompatibility and wound healing capacity of the highly oxidized CD-100 hydrogel with the CD-25 hydrogel. Antimicrobial studies were performed against a range of clinically relevant abdominal microorganisms using the micro-broth dilution method. Biocompatibility testing using human dermal fibroblasts was assessed via a tetrazolium reduction assay (MTT) and a wound healing model. In contrast to the original DA-100 formulation, DA-25 was found to be non-cytotoxic, and showed no overall impairment of cell migration, with wound closure occurring at 72 h. However, the lower oxidation level negatively affected the antimicrobial efficacy of the hydrogel (CD-25). Although the CD-25 hydrogel’s antimicrobial efficacy and anti-fibroblast activity is decreased when compared to the original CD-100 hydrogel formulation, previous in vivo studies show that the CD-25 hydrogel remains an effective, biocompatible barrier agent in the prevention of postoperative adhesions.

Inhibition of cyclooxygenase-2 prevents intra-abdominal adhesions by decreasing activity of peritoneal fibroblasts.

BackgroundPostoperative intra-abdominal adhesions are common complications after abdominal surgery. The exact molecular mechanisms that are responsible for these complications remain unclear, and there are no effective methods for preventing adhesion formation or reformation. The aim of the study reported here was to investigate the preventive effects and underlying potential molecular mechanisms of selective cyclooxygenase-2 (COX-2) inhibitors in a rodent model of postoperative intra-abdominal adhesions.Materials and methodsThe expression of COX-2 in postoperative intra-abdominal adhe-sions and normal peritoneal tissue was examined by immunohistochemistry and Western blot analysis. Assays were performed to elucidate the effect of COX-2 inhibition on hypoxia-induced fibroblast activity in vitro and on intra-abdominal adhesion formation in vivo.ResultsHypoxia-induced COX-2 expression in peritoneal fibroblasts was increased in postoperative intra-abdominal adhesions. Inhibition of COX-2 attenuated the activating effect of hypoxia on normal peritoneal fibroblasts in vitro. Data indicate that selective COX-2 inhibitor prevents in vivo intra-abdominal adhesion by inhibition of basic fibroblast growth factor and transforming growth factor-beta expression, but not through an antiangiogenic mechanism. Furthermore, using selective COX-2 inhibitors to prevent intra-abdominal adhesions did not adversely affect the weight, bowel motility, or healing of intestinal anastomoses in a rat model.ConclusionThese results show that hypoxia-induced COX-2 expression in peritoneal fibroblasts is involved in the formation of intra-abdominal adhesions. Inhibition of COX-2 prevents postoperative intra-abdominal adhesions through suppression of inflammatory cytokines.

Clearance Rates of Ringer's Lactate and Adept and the Effect of Full Conditioning: A Randomized Controlled Trial

Background: Instillation of crystalloid flotation agents, such as Ringer's lactate has been suggested for preventing adhesion formation after abdominal surgery, but the efficacy of this approach remains controversial. Objective: The aim of this pilot study was to evaluate the resorption rates of Ringer's lactate and icodextrin 4% following a pneumoperitoneum with CO2 and humidification (control) in comparison with a pneumoperitoneum with 86%CO2+10%N2O+4%O2 together with cooling and humidification (full conditioning). Materials and Methods: Twenty women undergoing laparoscopic hysterectomy were prospectively randomized to have during surgery with a control or a full-conditioned pneumoperitoneum as well as the instillation of 1000 mL of Ringer's lactate or icodextrin 4% at the end of surgery. Fluid volumes remaining after 24, 48, and 72 hours were measured by ultrasound testing. Results: The peritoneal volumes of Ringer's lactate and icodextrin 4% both decreased exponentially over time. Following a pneumoperitoneum with CO2, the resorption rate of Ringer's lactate was faster than for icodextrin 4%. After 24, 48, and 72 hours 11.7±1.0% versus 38.2±9.5% (p=0.009), 5.3±0.6% versus 14.9±4.8% (NS), and 4.2±0.7% versus 12.1±4% (p=0.03), respectively of the initial 1 L remained. Conditioning decreased the resorption rate of Ringer's lactate and after 24, 48, and 72 hours 25.2±3.4, 13.2±1.3 and 6.0±0.5% remained (p=0.03, 0.009, and NS versus the control group), respectively Conditioning did not affect the resorption rate of icodextrin. Conclusions: The absorption of both Ringer's lactate and of icodextrin 4% from the peritoneal cavity was fast and exponential in this pilot study. In the control group, the resorption rate of icodextrin 4% was slightly slower than that of Ringer's lactate. After conditioning, the resorption rate of Ringer's was slower and became comparable to that of icodextrin 4%. (J GYNECOL SURG 31:139)

Tamoxifen for the prevention of postoperative intra-abdominal adhesions

Postoperative intra-abdominal adhesion (PIAA) is a common complication following abdominal surgeries. Up to now, no practical method or device has been proven to be the gold standard in PIAA formation prevention. This study was designed to evaluate the effects of oral and intraperitoneal tamoxifen citrate on PIAA formation prevention. A total of 48 guinea pigs weighing 300–350 g were included in four groups (12 pigs in each group). Under general anesthesia, laparotomy was performed, and a part of small bowel was abraded using wet gauze so that serosal petechiae developed on the intestinal surface for induction of peritoneal adhesion. In group 1 (control), only this adhesion induction was performed with no treatment. In the second group, 2.5 mg/kg/day tamoxifen citrate was administered by orogastric gavage postoperatively. Group 3 underwent adhesion induction and then intraperitoneal administration of 2.5 mg/kg tamoxifen citrate diluted in 10 ml of aquapura. Group 4, underwent adhesion induction and intraperitoneal administration of 2.5 mg/kg tamoxifen citrate diluted in 10 ml aquapura and then 2.5 mg/kg/day tamoxifen citrate was administered by orogastric gavage postoperatively. Pigs underwent laparotomy on the eighth postoperative day, and grading of adhesions was performed according to the Adhesion Characteristic and Adhesion Tenacity scoring system. Data were analyzed using SPSS for Windows version 16. The control group was significantly different from other groups (p < 0.008), which means usage of tamoxifen (oral or intraperitoneal or both) significantly reduced adhesion formation after laparotomy. Intraperitoneal tamoxifen (group 3) was more effective in prevention of adhesion formation than oral tamoxifen application (group 2; p = 0.006). Also, administration of both oral and intraperitoneal tamoxifen (group 4) reduced adhesions significantly (p = 0.002) in comparison with just oral one (group 2), but it made no difference (p = 0.625) with only intraperitoneal tamoxifen (group 3). This study indicated that tamoxifen significantly reduces PIAAs, and intraperitoneal application is more effective than oral administration. This study shows that preventive effects of intraperitoneal application of tamoxifen will not improve when oral tamoxifen is added postoperatively. More studies with focus on evaluation of probable side effects and also performing clinical trials for evaluating tamoxifen for preventing PIAAs are strongly suggested.

Dexamethasone and sodium carboxymethyl cellulose prevent postoperative intraperitoneal adhesions in rats.

We aimed to evaluate the effects of the barrier agent sodium carboxymethyl cellulose (SCMC) with and without dexamethasone for the prevention of postoperative adhesion formation in a rat model of postoperative peritoneal adhesion. A total of 160 three-month old male and female Wistar rats underwent a laparotomy, and adhesions were induced by ileocecal abrasion. Rats were randomly assigned to 4 groups (n=40 each): group A, untreated; group B, treated with SCMC only; group C1, treated with SCMC + 3 mg dexamethasone, and group C2, treated with SCMC + 8 mg dexamethasone. After 12 days, adhesion formation and histopathological changes were compared. In groups A, B, C1, and C2, the mortality rates were 10, 5, 5, and 5%, respectively. In groups C1 and C2, the adhesions were filmy and easy to dissect and were milder compared with those in groups A and B. The total adhesion score in group C1 (3.38±0.49) was significantly lower than that of group B (6.01±0.57; P<0.01) or group A (8.01±0.67; P<0.05). There was no significant difference in adhesion formation between groups C1 and C2. Compared with groups A and B, groups C1 and C2 exhibited milder histopathological changes. SCMC in combination with dexamethasone can prevent adhesion formation and is a better barrier agent than SCMC alone. The safety and feasibility of SCMC in combination with dexamethasone to prevent adhesion formation after abdominal surgery warrants further clinical study.

Efficacy and Safety of Sodium Hyaluronate with 1,4-Butanediol Diglycidyl Ether Compared to Sodium Carboxymethylcellulose in Preventing Adhesion Formation after Lumbar Discectomy.

ObjectiveEpidural injection of hyaluronic acid may prevent adhesion formation after spine surgery, but the compounds used to stabilize hyaluronidase could interfere with its anti-adhesion effects. The present study was conducted as a clinical trial to evaluate the efficacy and safety of an experimental medical gel in preventing adhesion formation.MethodsThis study was designed as a multicenter, randomized, double-blind, and comparative controlled clinical trial with an observation period of 6 weeks. Subjects were randomly assigned into two groups: group A with sodium hyaluronate + 1,4-butanediol diglycidyl ether (BDDE) and group B with sodium hyaluronate + sodium carboxymethylcellulose (CMC). Visual analogue scale (VAS) of back and leg pain and the Oswestry disability index (ODI) and scar score ratings were assessed after surgery.ResultsMean scar grade was 2.37±1.13 in group A and 2.75±0.97 in group B, a statistically significant difference (p=0.012). VAS of back and leg pain and ODI scores decreased significantly from baseline to 3 and 6 weeks postoperatively in both groups (p<0.001). However, VAS and ODI scores were not statistically different between groups A and B at baseline or at 3 and 6 weeks after operation (p>0.3). The number of adverse reactions related to the anti-adhesion gels was not statistically different (p=0.569), but subsequent analysis of nervous adverse reactions showed group B was superior with a statistically difference (p=0.027).ConclusionSodium hyaluronate with BDDE demonstrated similar anti-adhesion properties to sodium hyaluronate with CMC. But, care should be used to nervous adverse reactions by using sodium hyaluronate with BDDE.

Postoperative adhesion formation in a rabbit model: monopolar electrosurgery versus ultrasonic scalpel.

Background and Objectives:To determine if surgery using ultrasonic energy for dissection results in less adhesion formation than monopolar electrosurgical energy in the late (8 weeks) postoperative period.Methods:Injuries were induced in rabbits by using ultrasonic energy on one uterine horn and the adjacent pelvic sidewall and using monopolar energy on the opposite side. Eight weeks postoperatively, the rabbits underwent autopsy and clinical and pathologic scoring of adhesions was performed by blinded investigators.Results:There was no significant difference in clinical adhesion scores between the two modalities. The mean clinical score for monopolar cautery was 1.00 versus 0.88 for the Harmonic device (Ethicon Endo-Surgery, Cincinnati, Ohio) (P = .71). Furthermore, there was no significant difference found in the pathologic adhesion scores between the ultrasonic scalpel and monopolar energy. The mean pathologic score for monopolar electrosurgery was 4.35 versus 3.65 for the Harmonic scalpel (P = .30).Conclusion:Neither monopolar electrosurgery nor ultrasonic dissection is superior in the prevention of adhesion formation in the late postoperative period.

To Investigate the Effect of Colchicine in Prevention of Adhesions Caused by Serosal Damage in Rats.

Introduction and Aim. Adhesion formation is a process which starts with an inflammation caused by a number of factors and eventually results in fibrosis. Colchicine prevents adhesion formation which is antifibrous process. The effectivity of colchicine in the prevention of adhesions was investigated. Materials and Methods. A total of 36 rats were equally divided into three groups: (I) control group 1 (n = 12), (II) abrasion group 2 (n = 12), and (III) abrasion + colchicine group 3 (n = 12). Group 1 underwent laparotomy and was orally given physiological serum 2 cc/day for 10 days. In Group 2, injury was created in the cecum serosa following laparotomy and they were orally given physiological serum 2 cc/day for 10 days. In Group 3, injury was created in the cecum serosa following laparotomy and the rats were orally given colchicine 50 mcg kg/day mixed with physiological serum 2 cc/day for 10 days. Laparotomy was performed and adhesions were examined both macroscopically and microscopically. Both macroscopic and microscopic examinations were performed using Zühlke's score. Results. A significant difference was observed among the adhesion scores of the groups both macroscopically and microscopically. Macroscopic score was lower in group 3 than group 2. Microscopic score was lower in group 3 than group 2. Conclusion. Oral administration of colchicine is effective in the prevention of adhesions.

Subacromial Tenoxicam Injection in the Treatment of Impingement Syndrome

Objectives:As subacromial bursa injection is widely used for pain relief and functional improvements in patients with periarticular shoulder disorder, we aimed to present our results of subacromial tenoxicam injection in the treatment of impingement syndrome.Methods:Patients presented to the Department of Orthopaedics and Traumatology, Istanbul Medipol University with the primary complaints of shoulder pain from January 2012 to June 2013 were selected. Those who met the following inclusion criteria were finally considered: 1) who had a clinical sign of a painful arc and positive in Hawkins test and/or Neer impingement sign; 2) who had a precise rotator cuff injury including partial cuff tears, or subacromial bursitis detected during ultrasonography or MRI. The exclusion criteria were as follows: 1) who underwent shoulder surgery; 2) who had full thickness rotator cuff rupture; 3) who had hemiplegic shoulder pain; and 4) who displayed any suspected fracture on X-ray or had a recent shoulder trauma; 5) who showed limited active ROM and stiffness due to adhesive capsulitis. Thirty one shoulders out of thirty patients were treated with subacromial tenoxicam injection. Ten of them were left shoulders. Fifteen of the patients were women.. Patients had a mean age of 51.6 (30-73). Patients were evaluated 4 times. Before the first injection, 1 week after the first injection, 2 weeks after the second injection and 3 weeks after the third injection. In every injection 20 mg tenoxicam was performed.Results:In order to relieve the pain; two patients were given only one injection, thirteen patients were given two injections and “3 injections protocol” were done to fifteen patients. The mean pre- and posttreatment VAS scores were 7.9 (between, 7-9) and 2.7 (between, 2-4) points respectively. The average pre and posttreatment DASH scores were 59.41 (between, 45-80) and 14 (between, 8.3-25.8) points respectively. The mean pre and posttreatment range of motion were 106.1 (between, 80-130 and 170i7 (between, 140-180) degrees respectively. Differences between all pre- and post-treatment parameters were statistically significant (p<0.05).Conclusion:Tenoxicam is a cheap NSAID and an analgesic of the oxicam class, is closely related to proxicam, and has a long half-life, which enables it to be administrated once daily. It also readily penetrates the synovial fluid and intraarticular intravenous administration provides superior postoperative analgesic benefits. Tenoxicam also has the ability to prevent adhesion formation. Besides it has no detrimental effect on cartilage structure. It can be safely administrated intraarticularly. Given the positive therapeutic effects of subacromial tenoxicam injection, it can be used as an alternative treatment option.

Prevention of peritendinous adhesions with electrospun chitosan-grafted polycaprolactone nanofibrous membranes

As one of the common complications after tendon injury and subsequent surgery, peritendinous adhesions could be minimized by directly placing a physical barrier between the injured site and the surrounding tissue. With the aim of solving the shortcomings of current biodegradable anti-adhesion barrier membranes, we propose the use of an electrospun chitosan-grafted polycaprolactone (PCL-g-CS) nanofibrous membrane (NFM) to prevent peritendinous adhesions. After introducing carboxyl groups on the surface by oxygen plasma treatment, the polycaprolactone (PCL) NFM was covalently grafted with chitosan (CS) molecules, with carbodiimide as the coupling agent. Compared with PCL NFM, PCL-g-CS NFM showed a similar fiber diameter, permeation coefficient for bovine serum albumin, ultimate tensile strain, reduced pore diameter, lower water contact angle, increased water sorption and tensile strength. With its submicrometer pore diameter (0.6–0.9μm), both NFMs could allow the diffusion of nutrients and waste while blocking fibroblast penetration to prevent adhesion formation after tendon surgery. Cell culture experiments verified that PCL-g-CS NFM can reduce fibroblast attachment while maintaining the biocompatibility of PCL NFM, implicating a synergistic anti-adhesion effect to raise the anti-adhesion efficacy. In vivo studies with a rabbit flexor digitorum profundus tendon surgery model confirmed that PCL-g-CS NFM effectively reduced peritendinous adhesion from gross observation, histology, joint flexion angle, gliding excursion and biomechanical evaluation. An injured tendon wrapped with PCL-g-CS NFM showed the same tensile strength as the naturally healed tendon, indicating that the anti-adhesion NFM will not compromise tendon healing.

Role of IL-17 and TGF-β in peritoneal adhesion formation after surgical trauma.

Peritoneal adhesions are fibrous tissues formed after surgery. Both cytokines and transforming growth factors (TGFs) are involved in this process. The objective of this study was to investigate the cross talk between these entities. Peritoneal drainage fluid after surgery from patients and rodent models was examined by enzyme-linked immunosorbent assay and fluorescence-activated cell sorter. Data showed that the concentrations of interferon (IFN)-γ and interleukin (IL)-17 reached their peaks 6-12 hours after surgery, whereas TGF-β1 concentrations showed two postoperative peak time points at 2 and 72-96 hours. By neutralizing IFN-γ, IL-17 6-12 hours, and TGF-β1 72-96 hours after surgery, the degree of adhesion reduced significantly. However, neutralizing TGF-β1 2 hours after surgery did not affect adhesion formation. Furthermore, in vitro studies showed that compared with the fibroblasts that were directly stimulated with TGF-β1, the prestimulation of IL-17 promoted plasminogen activator inhibitor-1 production while inhibiting tissue-type plasminogen activator production. Moreover, additional stimulation with IFN-γ enhanced this effect. Together, these data indicate that IL-17 may promote adhesion formation by increasing the reaction of fibroblasts against TGF-β1. Blocking IL-17 might have a therapeutic potential in preventing adhesion formation after surgery.

A randomized controlled study of the efficacy of misoprostol and hyaluronic acid in preventing adhesion formation after gynecological surgery: a rat uterine horn model

ObjectiveTo investigate the effect of misoprostol in the reduction of adhesion formation after gynecological surgery. Study designA double blind, randomized controlled experimental study was designed. Twenty-one female Wistar Hannover rats were divided into three groups as control, misoprostol and Hyalobarrier® groups. A uterine horn adhesion model was created. After anesthesia induction, 1.5–2cm injuries were made to the each uterine horn by cautery. The control group received no special medications except for the standard surgical procedure. The misoprostol group received 10μcg/kg misoprostol in addition to the standard surgical procedure, and the Hyalobarrier® group received 1cm3 ready-for-use Hyalobarrier® gel intraperitoneally in addition to the standard surgical procedure. After 14 days from the first surgical procedure, adhesion scores were evaluated. ResultsThe extent (p<0.001), severity (p<0.001), degree (p<0.001) and total adhesion score (p<0.001) values of the control group were statistically higher than the values of misoprostol and Hyalobarrier® groups. The inflammation score value of misoprostol group was statistically lower than control and Hyalobarrier® groups (p<0.001). ConclusionIn this study, we have found a new therapeutic potential of misoprostol that may be useful in preventing pelvic adhesion and reducing inflammation scores.