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Biomedical subjects

L Holmdahl

Publications and source records attributed to L Holmdahl.

48 records · Page 3Linked to original sources
PubMed1997

Mechanisms of adhesion development and effects on wound healing.

This paper reviews the evidence that glove powder plays an important role in adhesion formation and has adverse effects on the healing of abdominal incisional wounds. The underlying mechanisms leading to these adverse effects are beginning to be revealed. By affecting the mesothelial cell function, powder contamination disrupts the delicate balance of fibrin deposition and degradation, provoking adhesion formation, and interfering with wound healing. Studies are described showing that starch impairs incisional wound healing by its effect on the T cell-mediated immune system. Furthermore starch powder may act as a vector for endotoxin. This paper concludes that starch powder is harmful and its use in a hospital setting can no longer be supported.

Abdomen↗
PubMed1997

Cost of bowel obstruction resulting from adhesions.

OBJECTIVE: To assess the direct costs associated with bowel obstruction resulting from adhesions. DESIGN: Prospective study. SETTING: University Hospital, Sweden. SUBJECTS: 57 patients aged 16 years or older who fulfilled the clinical and radiological criteria of bowel obstruction. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Course of, and direct costs associated with, the illness. RESULTS: In 34 of the 57 patients (60%) bowel obstruction was caused by adhesions, and in all 34 the small bowel was obstructed (85% of all cases of small bowel obstruction). 22 of the 42 patients who required a hospital stay of more than 24 hours (52%) had adhesive obstruction, and 10 of these (45%) had to be operated on, 2 of them twice. Major complications occurred in 6 (60%) and one died. In a national perspective, adhesive bowel obstruction may cause 2330 hospital admissions annually, which is associated with an estimated direct cost of about US$13 million. CONCLUSIONS: Adhesions are a serious, common, and costly complication of surgery. Efforts have to be undertaken to control their formation.

Adult↗
PubMed1996

Fibrinolysis in human peritoneum during operation.

BACKGROUND: A reduced local fibrinolysis seems to be an important mechanism in the formation of adhesions. Peritonitis may cause adhesions, and the aim of the present study was to determine peritoneal fibrinolytic capacity in inflamed and normal peritoneum. METHODS: Biopsy specimens from normal and inflamed human peritoneum were taken at the beginning and end of operation. After extraction plasminogen activator activity (PAA) was determined by using a chromogenic substrate assay in the presence or absence of inhibitory antibodies against tissue-type plasminogen activator (t-PA), urokinase or plasminogen activator inhibitor-1. RESULTS: t-PA exerted 95% of the PAA. PAA was significantly reduced (p < 0.01) during peritonitis (3.0 IU/micrograms protein; range, 0.3 to 4.2) compared with normal peritoneum (7.1 IU/micrograms protein; range, 0.6 to 18.1). A significant reduction (p < 0.05) in PAA occurred during operation both in normal peritoneum (3.8 IU/micrograms protein; range, 0.8 to 8.6) and in peritonitis (0.6 IU/micrograms protein; range, 0.16 to 2.1). Values are given as medians. CONCLUSIONS: The main PAA in human peritoneum was t-PA. The activity was decreasing during operation and reduced in peritonitis. This reduction in PAA might be a local response to inflammation.

Abdomen↗
PubMed1996

Foreign material in postoperative adhesions.

OBJECTIVE: The authors determined the prevalence of foreign body granulomas in intra-abdominal adhesions in patients with a history of abdominal surgery. PATIENTS AND METHODS: In a cross-sectional, multicenter, multinational study, adult patients with a history of one or more previous abdominal operations and scheduled for laparotomy between 1991 and 1993 were examined during surgery. Patients in whom adhesions were present were selected for study. Quantity, distribution, and quality of adhesions were scored, and adhesion samples were taken for histologic examination. RESULTS: In 448 studied patients, the adhesions were most frequently attached to the omentum (68%) and the small bowel (67%). The amount of adhesions was significantly smaller in patients with a history of only one minor operation or one major operation, compared with those with multiple laparotomies (p < 0.001). Significantly more adhesions were found in patients with a history of adhesions at previous laparotomy (p < 0.001), with presence of abdominal abscess, hematoma, and intestinal leakage as complications after former surgery (p = 0.01, p = 0.002, and p < 0.001, respectively), and with a history of an unoperated inflammatory process (p = 0.04). Granulomas were found in 26% of all patients. Suture granulomas were found in 25% of the patients. Starch granulomas were present in 5% of the operated patients whose surgeons wore starch-containing gloves. When suture granulomas were present, the median interval between the present and the most recent previous laparotomy was 13 months. When suture granulomas were absent, this interval was significantly longer--i.e., 30 months (p = 0.002). The percentage of patients with suture granulomas decreased gradually from 37% if the previous laparotomy had occurred up to 6 months before the present operation, to 18% if the previous laparotomy had occurred more than 2 years ago (p < 0.001). CONCLUSIONS: The number of adhesions found at laparotomy was significantly larger in patients with a history of multiple laparotomies, unoperated intra-abdominal inflammatory disease, and previous postoperative intra-abdominal complications, and when adhesions were already present at previous laparotomy. In recent adhesions, suture granulomas occurred in a large percentage. This suggests that the intra-abdominal presence of foreign material is an important cause of adhesion formation. Therefore intra-abdominal contamination with foreign material should be minimized.

Adult↗
PubMed1994

Experimental models for quantitative studies on adhesion formation in rats and rabbits.

Postoperative formation of adhesions is a common complication in abdominal surgery. The aim of the present study was to develop standardized experimental models for quantitative studies of the formation of adhesions in rats and rabbits. In rats the suturing of a peritoneal wound increased adhesion formation significantly compared to leaving it open, 77.9 +/- 4.8 and 5.3 +/- 2.8%, respectively (p < 0.001). The suturing technique, when comparing the interrupted and continuous method after 1 week, had no influence, 84.5 +/- 6.3% and 73.1 +/- 11.2%, respectively (p > 0.05). Different types of trauma resulted in differences in adhesion formation to noninjured parts in the abdominal cavity, adhesions in 17.5 and 2.5% of the animals, respectively (p < 0.05). In rabbits adhesions formed more frequently (p < 0.001) to visceral peritoneum (59.3 +/- 3.7%) than to the parietal one (22.3 +/- 1.6%) indicating a different propensity of tissues to have adhesions. These models enable detailed quantitative studies on experimental formation of adhesions.

Animals↗
PubMedDate not supplied

Cellular distribution of 5-lipoxygenase and leukotriene receptors in postsurgical peritoneal wound repair.

Products of the eicosanoid pathways, namely prostaglandins and leukotrienes, are known to play a key role in inflammatory and immune responses, as well as other wound cellular activities of wounded tissue. The objective of this study was to determine whether surgically induced intraperitoneal and incisional wounds in the rat express 5-lipoxygenase and contain binding sites for leukotrienes and whether their levels change during the course of healing. With the use of a specific monoclonal antibody generated against 5-lipoxygenase, the enzyme was immunohistochemically localized in various wound cells during postsurgical days 2 to 35. The inflammatory cells within the wound were the major cell types containing 5-lipoxygenase immunoreactive protein, followed by fibroblasts in the incisional and peritoneal fibrous adhesions, striated muscle, and the vasculature. The greatest level of immunostaining was observed during the first 2 weeks after surgery, which decreased to near unwounded levels by day 35. Light microscope autoradiographic binding studies using (3)H-leukotrienes indicated that the peritoneal/incisional wounds and unwounded tissues contain specific (3)H-leukotriene C(4) and (3)H-leukotriene D(4) but not (3)H-leukotriene B(4) binding sites. Quantitative grain analysis (net grain density/100 microm(2)), representing specific (3)H-leukotriene C(4) and (3)H-leukotriene D(4) binding sites calculated for different cell types in the wound and unwounded regions showed that (3)H-leukotriene C(4) binding was highest over the striated muscle proximal to the injury and incisional and peritoneal granulation tissue fibroblasts. The net grain density over these cells increased by 3-, 2.5-, and 2-fold by day 14, respectively, and declined to the control values by day 21 after injury (p < 0.05). The pattern of (3)H-leukotriene D(4) binding was similar to that observed for (3)H-leukotriene C(4), but with a lower density. The grain density for (3)H-leukotriene C(4) and (3)H-leukotriene D(4) in arteriolar endothelial and smooth muscle cells remained unchanged. These data suggest that the products of the lipoxygenase pathway through the presence of their specific receptors may play an important role in peritoneal wound repair and adhesion formation.

Journal Article↗
PubMedDate not supplied

Alteration of type I and III collagen expression in human peritoneal mesothelial cells in response to hypoxia and transforming growth factor-beta1.

Overexpression and accumulation of extracellular matrix is central to peritoneal adhesion formation following surgically induced tissue trauma. Transforming growth factor-beta1 and hypoxia have been implicated in tissue fibrosis and postoperative adhesion formation. To extend this observation we examined whether transforming growth factor-beta1 and/or hypoxia regulate the expression of type I and III collagen in human peritoneal mesothelial cells. Cultured human mesothelial cells were maintained under hypoxia (2% oxygen), or treated with transforming growth factor-beta1 (1 ng/ml) or a combination of hypoxia and transforming growth factor-beta1. Total cellular RNA from treated and untreated cells were collected and subjected to multiplex reverse transcription/polymerase chain reaction to quantitate collagen I and III mRNA levels in response to these treatments. The results indicate that 6 hours of hypoxia increased collagen III mRNA by 7.2 fold which was further increased to 9.4 fold following transforming growth factor-beta1 treatment; in contrast collagen I mRNA decreased by 0.42 fold which was further decreased by 0.3 fold following transforming growth factor-beta1 treatment. Transforming growth factor-beta1 treatment under normal conditions resulted in an 8.4-fold increase and a 0.3-fold decrease in collagen III and I mRNA levels, respectively. Hypoxia treatment also resulted in a 1.9-fold increase in transforming growth factor-beta1 mRNA level compared with control. The ratio of type III/I collagen was increased in response to transforming growth factor-beta1 treatment under hypoxic condition. In conclusion, the data suggest that hypoxia may modulate extracellular matrix production by human mesothelial cells via a transforming growth factor-beta1 dependent mechanism.

Cell Hypoxia↗