The Effect of Negative Pressure in the Abdominal Cavity With Suprasorb CNP on Abdominal Organs-An Experimental Study.

Since the introduction of negative pressure therapy of the abdomen, care has been taken to protect the intestine from the effects of negative pressure in order to avoid impairments of abdominal organs. As an alternative to the widespread AB-TheraR system (KCI, San Antonio, Texas, USA), the different concept of Suprasorb CNPR (Lohmann & Rauscher, Austria-Germany) was introduced by the producer with the premise of achieving a better therapeutic effect. Due to numerous pores of the film, the effects of the negative pressure are brought to the surface of the intestinal organs and these effects were tested on seven experimental animals. Particular attention was paid to the small intestine, colon, liver, and pancreas. Over 8 h continuously, three animals were tested with -80 mmHg, 4 with -60 mmHg. The results showed no macroscopic pathological changes. The histological results showed borderline changes in the small intestine and colon with -80 mmHg application, minimal or none with -60 mmHg. The liver and pancreas were found free of pathological changes. For use on human organs, the intra-abdominal application of -60 mmHg for the Suprasorb CNP system is proposed as the standard.

Decision making in the source control of intra-abdominal infection / 中华消化外科杂志

Source control should be performed as soon as possible once the diagnosis of intra-abdominal infection made. Surgical intervention should be considered when resuscitating the intra-abdominal infection with sepsis or septic shock and percutaneous abscess drainage, laparotomy or open abdominal therapy could be considered according to the sepsis severity. Treatment failure may be diagnosed if there is no any improvement in the systematic inflammatory reaction and multiple organ dysfunction. Interleukin 6 and procalcitonin combined with blood white cell count and C-reactive protein could reflect the systematic inflammatory reaction and Sequential Organ Failure Assessment can evaluate if there is any improvement of organ function. Bilirubin is a sensitive indicator of liver function in intra-abdominal infection and its persistent increasing usually means the deterioration of liver function. Once the treatment failure is made, the re-intervention should be performed as soon as possible and B ultrasound or CT should be done before operation to define the precise infected focus. The bacteria information should be retrieved before or during the intervention to guide the postoperative antibiotics usage.

Decision making in the source control of intra-abdominal infection / 中华消化外科杂志

Source control should be performed as soon as possible once the diagnosis of intra-abdominal infection made.Surgical intervention should be considered when resuscitating the intra-abdominal infection with sepsis or septic shock and percutaneous abscess drainage,laparotomy or open abdominal therapy could be considered according to the sepsis severity.Treatment failure may be diagnosed if there is no any improvement in the systematic inflammatory reaction and multiple organ dysfunction.Interleukin 6 and procalcitonin combined with blood white cell count and C-reactive protein could reflect the systematic inflammatory reaction and Sequential Organ Failure Assessment can evaluate if there is any improvement of organ function.Bilirubin is a sensitive indicator of liver function in intra-abdominal infection and its persistent increasing usually means the deterioration of liver function.Once the treatment failure is made,the re-intervention should be performed as soon as possible and B ultrasound or CT should be done before operation to define the precise infected focus.The bacteria information should be retrieved before or during the intervention to guide the postoperative antibiotics usage.

Uso combinado de endoprótese GORE TAG® e Gore Exculder® para tratamento de aneurisma de aorta abdominal com angulação extrema / Combined use of GORE TAG® and Gore Exculder® endografts for treatment of abdominal aortic aneurysm with severe angulation

O avanço tecnológico da cirurgia endovascular no tratamento de aneurismas de aorta vem permitindo que uma maior quantidade de pacientes, antes considerados inaptos para essa abordagem, beneficie-se dessa modalidade terapêutica. Apesar da atual disponibilidade de endopróteses com alta conformabilidade, casos com anatomia desfavorável permanecem um desafio para os cirurgiões. Descrevemos um caso anatomicamente desfavorável, resolvido com sucesso pela técnica endovascular, utilizando-se uma manobra não convencional.

The advances in endovascular surgery for treatment of aortic aneurysms have allowed a greater number of patients, who were previously considered unsuitable for the approach, to benefit from this therapeutic modality. Despite the current availability of highly comfortable endografts, cases with unfavorable anatomy remain a challenge for surgeons. We report a case with difficult anatomy that was successfully managed using an unconventional endovascular technique.