Pathophysiology and prevention of postoperative peritoneal adhesions

Peritoneal adhesions represent an important clinical challenge in gastrointestinal surgery. Peritoneal adhesions are a consequence of peritoneal irritation by infection or surgical trauma, and may be considered as the pathological part of healing following any peritoneal injury, particularly due to abdominal surgery. The balance between fi brin deposition and degradation is critical in determining normal peritoneal healing or adhesion formation. Postoperative peritoneal adhesions are a major cause of morbidity resulting in multiple complications, many of which may manifest several years after the initial surgical procedure. In addition to acute small bowel obstruction, peritoneal adhesions may cause pelvic or abdominal pain, and infertility. In this paper, the authors reviewed the epidemiology, pathogenesis and various prevention strategies of adhesion formation, using Medline and PubMed search. Several preventive agents against postoperative peri-toneal adhesions have been investigated. Their role aims in activating fi brinolysis, hampering coagulation, diminishing the inflammatory response, inhibiting col-lagen synthesis or creating a barrier between adjacentwound surfaces. Their results are encouraging but most of them are contradictory and achieved mostly in animal model. Until additional fi ndings from future clinical researches, only a meticulous surgery can be recommended to reduce unnecessary morbidity and mortality rates from these untoward effects of surgery. In the current state of knowledge, pre-clinical or clini-cal studies are still necessary to evaluate the effective-ness of the several proposed prevention strategies of postoperative peritoneal adhesions.

Relationship between expression of hepatocyte grow factor and apoptosis of trophoblasts in hypertensive disorder complicating pregnancy

The aim of this study was to investigate the expression of hepatocyte growth factor(HGF)and Fas in placentas of uncomplicated pregnant women and those with hypertensive disorder complicating pregnancy(HDCP),and elucidate the possible relationship between HGF and apopto-sis of trophoblasts.Reverse transcription-polymerase chain reaction(RT-PCR)was undertaken to examine the concentra-tion of HGF mRNA and Fas mRNA obtained from 34 cases of HDCP and 30 cases of uncomplicated pregnancy.The expression of HGF mRNA in mild preeclampsia,severe preeclampsia and eclampsia cases was significantly lower than that in the uncomplicated cases(0.43P0.12,0.38P0.09,0.19P0.17 versus 0.67P0.19,P<0.05),while the expres-sion of Fas mRNAin mild preeclampsia,severe preeclampsia and eclampisa cases was significantly higher than that in the uncomplicated cases(1.58P0.26,2.96P0.14,5.98P1.17 versus 1.01P0.36,P<0.05).For HGF mRNA and Fas mRNA,there was no difference between gestational hyper-tension cases and control cases.Decreased HGF mRNA or increased Fas mRNA was found along with the progress of HDCP.Negative correlation was found between the expressions of HGF and Fas.These results indicate that HGF inhibits the apoptosis mediated by Fas,and the reduced expression of HGF in HDCP may be responsible for the apoptosis of trophoblasts.

Role of stair-climbing test in predicting postoperativecardiopulmonary complications in elderly patients with biliarydiseases

One hundred and twenty-six patients above 80 years old with biliary diseases undergoing operations in Shaoxing People’s Hospital from Jan.2002 to Jan.2007 were analyzed retrospectively.All patients performed a preoperative stair-climbing test,and the risks for cardio-pulmonary complications were evaluated with pair-matching and linear correlations analysis between stair-climbing height(h)and left ventricular ejective factor(EF),forced vital capacity(FVC)and forced expiratory volume in one second(FEV1).There was a significant difference in the incidence of cardiopulmonary complications among different stair-climbing heights.Stair-climbing heights were positively related with EF,FVC and FEV1.This suggests that the stair-climbing test is an effective and simple method for predicting cardiopulmonary complica-tions in elderly patients with biliary diseases.