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1.
Acta Chir Belg ; 103(5): 513-6, 2003 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-14653040

RESUMEN

More and more prosthetic materials are being used in the treatment of inguinal hernia. This report deals with some unusual but devastating complications, occurring after preperitoneal mesh implantation. A 56-year old male patient underwent a Stoppa-repair for a bilateral inguinal hernia. Two years postoperatively, a localized abdominal wall abscess was treated with antibiotics and drainage. A barium enema and a CT-scan of the abdomen were performed to rule out an enteric fistula; the CT-scan unexpectedly revealed a tumoral mass involving the sigmoid colon, and an explorative laparotomy was done. Peroperatively, part of the mesh was found to penetrate the bowel wall and a sigmoidectomy with removal of the mesh was performed. Two years later, ingrowth of the urinary bladder by the remains of the mesh was the unfortunate peroperative finding when the patient was operated on for an inflammatory mass, involving the bladder wall. The patient needed two more interventions for persisting wound fistulas. All the remains of the mesh have been removed and all fistulas have been widely excised. Nowadays, the patient is recovering well with complete healing of all wounds. Although infection of prostheses used in the treatment of hernias has been described, late and serious complications related to mesh implantation, such as perforation of the colon and the bladder, have seldom been reported.


Asunto(s)
Enfermedades del Colon/cirugía , Migración de Cuerpo Extraño/cirugía , Hernia Inguinal/cirugía , Mallas Quirúrgicas/efectos adversos , Procedimientos Quirúrgicos Operativos/efectos adversos , Enfermedades de la Vejiga Urinaria/cirugía , Materiales Biocompatibles/efectos adversos , Enfermedades del Colon/etiología , Enfermedades del Colon/fisiopatología , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Polipropilenos/efectos adversos , Procedimientos Quirúrgicos Operativos/métodos , Resultado del Tratamiento , Enfermedades de la Vejiga Urinaria/etiología , Enfermedades de la Vejiga Urinaria/fisiopatología
2.
Surg Endosc ; 13(10): 998-1000, 1999 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-10526035

RESUMEN

BACKGROUND: In order to investigate the effect of carbon dioxide (CO(2)) pneumoperitoneum on solid colon carcinomas, we used a colon anastomosis tumor model in 30 male syngeneic WAG rats, which were divided, at random into three groups. METHODS: In all rats, 10(6) CC531 S colon carcinoma cells were injected as an enema into the colon. Subsequently, a transection and a reanastomosis of the colon descendens was performed via laparotomy. After 2 weeks, group 1 (n = 10) was anesthetized as an anesthesia control group. Group 2 (n = 10) had a laparotomy that was closed after 20 min. In group 3 (n = 10), a CO(2) pneumoperitoneum of

Asunto(s)
Neoplasias del Colon/patología , Siembra Neoplásica , Neumoperitoneo Artificial , Animales , Dióxido de Carbono , Estudios de Evaluación como Asunto , Masculino , Metástasis de la Neoplasia , Distribución Aleatoria , Ratas , Ratas Endogámicas
3.
Eur J Surg ; 164(8): 617-21, 1998 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-9720939

RESUMEN

OBJECTIVE: To study the usefulness of gentamicin-containing sponges in the infected peritoneal cavity in rats. DESIGN: Controlled study. MATERIAL: 83 Male Wistar rats, 36 of which were treated by plain sponge, 36 by gentamicin-impregnated sponge, and 11 acted as controls. INTERVENTIONS: A standard model of intraperitoneal infection was developed by making a 1 cm long incision in the caecum. MAIN OUTCOME MEASURES: Postoperative mortality, macroscopic and microscopic features of infection, and bacterial concentrations in the abdomen on days 3, 6, and 9. RESULTS: In the respective groups 2, 3 and 2 animals died during operation and 4/34 (11%), 3/33 (9%); and 0/9 died before day 3. There were appreciable reductions in the number of animals with features of infection after 3 days but these were not significant at 6 or 9 days. CONCLUSION: Gentamicin-containing collagen sponges placed on a septic focus in the abdomen reduce local infection for at least 3 days.


Asunto(s)
Antibacterianos/administración & dosificación , Infecciones Bacterianas/tratamiento farmacológico , Colágeno/administración & dosificación , Gentamicinas/administración & dosificación , Enfermedades Peritoneales/tratamiento farmacológico , Animales , Infecciones Bacterianas/microbiología , Distribución de Chi-Cuadrado , Modelos Animales de Enfermedad , Evaluación Preclínica de Medicamentos , Masculino , Enfermedades Peritoneales/microbiología , Ratas , Ratas Wistar , Factores de Tiempo
4.
J Clin Endocrinol Metab ; 83(2): 309-19, 1998 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-9467533

RESUMEN

The catabolic state of prolonged critical illness is associated with a low activity of the thyrotropic and the somatotropic axes. The neuroendocrine component in the pathogenesis of these low activity states was assessed by investigating the effects of continuous intravenous infusions of TRH, GH-releasing peptide-2 (GHRP-2), and GHRH. Twenty adult patients, critically ill for several weeks, were studied during two consecutive nights. They had been randomly allocated to one of three combinations of peptide infusions, each administered in random order: TRH (one night) and placebo (other night), TRH + GHRP-2 (one night) and GHRP-2 (other night), or TRH + GHRH + GHRP-2 (one night) and GHRH + GHRP-2 (other night). The peptide infusions were started after a 1-microgram/kg bolus and infused (1 microgram/kg per h) until 0600 h. Blood sampling was performed every 20 min, and pituitary hormone secretion was quantified by deconvolution analysis. Reduced pulsatile fraction of TSH, GH, and PRL secretion and low serum concentrations of T4, T3, insulin growth factor-I (IGF-I), IGF-binding protein-3 (IGFBP-3), and the acid-labile subunit (ALS) were documented in the untreated state. Infusion of TRH alone or in combination with GH secretagogues augmented nonpulsatile TSH release 2- to 5-fold; only TRH + GHRP-2 increased pulsatile TSH secretion (4-fold). Average rises in T4 (40-54%) and in T3 (52-116%) were obtained with all three combinations, whereas reverse T3 levels did not increase, except when TRH was infused alone. Pulsatile GH secretion was amplified > 6- and > 10-fold, respectively, by GHRP-2 and GHRH + GHRP-2 infusions, generating mean increases of serum IGF-I (66% and 106%), IGFBP-3 (50% and 56%), and ALS (65% and 97%) within 45 h. The addition of TRH did not alter the GH secretory patterns. TRH infusion increased PRL release only when combined with GH secretagogues. No effects on serum cortisol were detected. In conclusion, the pathogenesis of the low activity state of the thyrotropic and somatotropic axes in prolonged critical illness appears to have a neuroendocrine component, because these axes are both readily activated by coinfusion of TRH and GH secretagogues.


Asunto(s)
Enfermedad Crítica , Hormona Liberadora de Hormona del Crecimiento , Hipotálamo/fisiopatología , Oligopéptidos , Hipófisis/fisiopatología , Hormona Liberadora de Tirotropina , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hormona Liberadora de Hormona del Crecimiento/administración & dosificación , Hormona de Crecimiento Humana/metabolismo , Humanos , Proteína 3 de Unión a Factor de Crecimiento Similar a la Insulina/sangre , Factor I del Crecimiento Similar a la Insulina/metabolismo , Masculino , Persona de Mediana Edad , Oligopéptidos/administración & dosificación , Periodicidad , Prolactina/metabolismo , Tirotropina/metabolismo , Hormona Liberadora de Tirotropina/administración & dosificación , Tiroxina/sangre , Triyodotironina/sangre , Triyodotironina Inversa/sangre
5.
Clin Endocrinol (Oxf) ; 45(3): 341-51, 1996 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-8949573

RESUMEN

OBJECTIVE: Protein hypercatabolism and preservation of fat depots are hallmarks of critical illness, which is associated with blunted pulsatile GH secretion and low circulating IGF-I, TSH, T4 and T3. Repetitive TRH administration is known to reactivate the pituitary-thyroid axis and to evoke paradoxical GH release in critical illness. We further explored the hypothalamic-pituitary function in critical illness by examining the effects of GH-releasing hormone (GHRH) and/or GH-releasing peptide-2 (GHRP-2) and TRH administration. PATIENTS AND DESIGN: Critically ill adults (n = 40; mean age 55 years) received two i.v. boluses with a 6-hour interval (0900 and 1500 h) within a cross-over design. Patients were randomized to receive consecutively placebo and GHRP-2 (n = 10), GHRH and GHRP-2 (n = 10), GHRP-2 and GHRH+GHRP-2 (n = 10), GHRH+GHRP-2 and GHRH+GHRP-2 + TRH (n = 10). The GHRH and GHRP-2 doses were 1 microgram/kg and the TRH dose was 200 micrograms. Blood samples were obtained before and 20, 40, 60 and 120 minutes after each injection. MEASUREMENTS: Serum concentrations of GH, T4, T3, rT3, thyroid hormone binding globulin (TBG), IGF-I, insulin and cortisol were measured by RIA; PRL and TSH concentrations were determined by IRMA. RESULTS: Critically ill patients presented a striking GH response to GHRP-2 (mean +/- SEM peak GH 51 +/- 9 micrograms/l in older patients and 102 +/- 26 micrograms/l in younger patients; P = 0.005 vs placebo). The mean GH response to GHRP-2 was more than fourfold higher than to GHRH (P = 0.007). In turn, the mean GH response to GHRH+GHRP-2 was 2.5-fold higher than to GHRP-2 alone (P = 0.01), indicating synergism. Adding TRH to the GHRH+GHRP-2 combination slightly blunted this mean response by 18% (P = 0.01). GHRP-2 had no effect on serum TSH concentrations whereas both GHRH and GHRH+GHRP-2 evoked an increase in peak TSH levels of 53 and 32% respectively. The addition of TRH further increased this TSH response > ninefold (P = 0.005), elicited a 60% rise in serum T3 (P = 0.01) and an 18% increase in T4 (P = 0.005) levels, without altering rT3 or TBG levels. GHRH and/or GHRP-2 induced a small increase in serum PRL levels. The addition of TRH magnified the PRL response 2.4-fold (P = 0.007). GHRP-2 increased basal serum cortisol levels (531 +/- 29 nmol/l) by 35% (P = 0.02); GHRH provoked no additional response, but adding TRH further increased the cortisol response by 20% (P = 0.05). CONCLUSIONS: The specific character of hypothalamic-pituitary function in critical illness is herewith extended to the responsiveness to GHRH and/or GHRP-2 and TRH. The observation of striking bursts of GH secretion elicited by GHRP-2 and particularly by GHRH+GHRP-2 in patients with low spontaneous GH peaks opens the possibility of therapeutic perspectives for GH secretagogues in critical care medicine.


Asunto(s)
Enfermedad Crítica , Hormona Liberadora de Hormona del Crecimiento/uso terapéutico , Oligopéptidos/uso terapéutico , Hipófisis/efectos de los fármacos , Hormona Liberadora de Tirotropina/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Sinergismo Farmacológico , Quimioterapia Combinada , Femenino , Hormona del Crecimiento/sangre , Hormona del Crecimiento/metabolismo , Hormonas/uso terapéutico , Humanos , Hidrocortisona/sangre , Hidrocortisona/metabolismo , Hipotálamo/efectos de los fármacos , Hipotálamo/metabolismo , Masculino , Persona de Mediana Edad , Hipófisis/metabolismo , Prolactina/sangre , Prolactina/metabolismo , Estimulación Química , Hormonas Tiroideas/sangre , Hormonas Tiroideas/metabolismo , Tirotropina/sangre , Tirotropina/metabolismo
6.
Acta Chir Belg ; 86(2): 118-22, 1986.
Artículo en Inglés | MEDLINE | ID: mdl-3716720

RESUMEN

Between 1970 and 1984 the diagnosis of acute, massive lung embolism was made 30 times in our department. In 29 patients the clinical diagnosis was correct and a Trendelenburg operation under extra-corporeal circulation was performed. In 18 cases there was an operation in the immediate preoperative course. In 1 case there was a combination of operation and the use of contraceptives. 3 cases were immobilized by a plaster of Paris cast. In 4 cases the use of oral contraceptives and in 3 patients the history of chronic recurrent lung embolism were evident. The mean immobilisation time was 15 days. In 24 cases the diagnosis was made only on the base of the clinical anamnesis, and examination, E.C.G. and chest radiography. In 4 cases angiography and in 1 patient the scintigraphy confirmed the diagnosis. Preoperatively 28 patients were in severe shock. One patient was operated electively. 14 patients needed external cardiac massage. In all cases clots were found in the left pulmonary artery, 28 in the right pulmonary artery, in 3 cases clots in the right atrium, 3 in the right ventricle and three in the inferior caval vein. Nine De Weese caval vein clips were inserted and one Mobin-Uddin filter. Postoperatively 18 patients were alive and well without sequelae. Two patients developed a cerebro-vascular accident (CVA) with one complete recovery. Ten patients died. Postoperative treatment consisted of I.V. heparin administration immediately after surgery and 6 months of oral anticoagulants. Except for chronic recurrent lung embolism the pulmonary function tests were excellent postoperatively without recurrence of the disease.


Asunto(s)
Embolia Pulmonar/cirugía , Enfermedad Aguda , Adulto , Anticoagulantes/uso terapéutico , Reposo en Cama/efectos adversos , Anticonceptivos Orales/efectos adversos , Circulación Extracorporea , Femenino , Fracturas Óseas/complicaciones , Heparina/administración & dosificación , Heparina/uso terapéutico , Humanos , Infusiones Parenterales , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/cirugía , Embolia Pulmonar/etiología , Recurrencia
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