Randomised trial of intraperitoneal irrigation with low molecular weight povidone-iodine solution to reduce intra-abdominal infectious complications.

A prospective randomized trial was performed comparing the efficacy of intraperitoneal irrigation with low molecular weight povidone-iodine solution ('Betadine LMW') (PVP-I LMW) in reducing the risk of intra-abdominal infectious complications. Seventy-five patients who were undergoing surgical procedures in the face of bacterial contamination were studied. Patients were intra-operatively randomized to receive intraperitoneal irrigation prior to abdominal closure with PVP-I LMW or with saline. Patients were maintained on peri-operative systemic antibiotics, and surgical incisions were drained and were closed primarily or left open according to the practice of the surgeon responsible. If incisions were closed, the subcutaneous tissue was irrigated prior to skin closure with the same irrigant as used intraperitoneally, PVP-I LMW or saline. Patients were followed for abnormal wound healing, peritonitis, intra-abdominal abscesses, or other infectious complications. Serum iodine levels were monitored in some patients. Intra-abdominal infectious complications developed in two of 37 patients receiving PVP-I LMW irrigation as compared to complications in nine of 38 patients receiving saline irrigation (P less than 0.05). When infectious complications were excluded that were possibly due to surgical technical failures (such as anastomotic leakage), peritonitis or intra-abdominal abscesses were observed in one of 37 PVP-I LMW patients and in seven of 38 saline control patients (P less than 0.05). Wound infections developed in one of 37 PVP-I LMW patients and in three of 38 control patients. A broad range of serum iodine levels were observed in control patients preoperatively and at 24 h and 7 days postoperatively. Serum iodine levels in 'Betadine LMW' patients rose approximately nine-fold by 24 h postoperatively and returned to pre-operative levels by 7 days. It was concluded that PVP-I LMW solution can reduce the incidence of intra-abdominal infectious complications when used as an intraperitoneal irrigant in patients undergoing bacterially-contaminated surgical procedures.

Effects of intraoperative electron irradiation in the dog on cell turnover in intact and surgically-anastomosed aorta and intestine.

Adult dogs were subjected to laparotomy and intraoperative electron irradiation after division and reanastomosis of aorta or after construction of a blind loop of small intestine having a transverse suture line and an end-to-side anastomosis. Dogs received intraoperative irradiation of both intact and anastomosed aorta or intestine in doses of 0, 2000, 3000, or 4500 rad. Animals were sacrificed at seven days or three months following treatment. At 24 hours prior to sacrifice, dogs received 5 mCi tritiated thymidine intravenously. Irradiated and non-irradiated segments of aorta and small intestine, including intact and anastomotic regions, were analyzed for tritiated thymidine incorporation and were subjected to autoradiography. Incorporation studies showed diminution in tritiated thymidine uptake by irradiated portions of aorta and small intestine, in both intact and anastomotic regions. Autoradiograms revealed that irradiated areas of intact or anastomotic aorta or intestine had diminished labeling of stromal cells, suggesting a lowered cell proliferative capacity of irradiated tissue compared to non-irradiated portions. Inflammatory cells showed similar labeling indices in irradiated and non-irradiated tissues, both intact and surgically-manipulated, suggesting that irradiation does not significantly affect a subsequent local inflammatory response. Radiation-induced decreases in tritiated thymidine incorporation in irradiated aorta and small intestine were generally more marked at seven days than at three months following irradiation, suggesting that radiation-induced depression of cell turnover rates decreases with time. The presence of tritiated thymidine uptake after irradiation demonstrates the ability of intact and surgically-manipulated aorta and intestine to recover from radiation-induced damage.