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Biomedical subjects

U Klinge

Publications and source records attributed to U Klinge.

99 records · Page 6Linked to original sources
PubMed1989

[Continuous 2-layer suture of the femoral hernia. Initial clinical results with 31 patients].

In a retrospective study the two-lined continuous suture for the repair of femoral hernia was examined. From 1.12. 1985 till 31.5. 1988 the femoral defect was closed by a continuous two-lined suture 33 times in 31 patients. In almost 50% (16 cases) the hernia was incarcerated, in total 10 surgeons took part. Postoperatively occurred one wound infection and one serom. During a postoperative observation time of 1-28 months up to now no recurrence has been seen. Thus the two-lined continuous suture of femoral hernia seems to use a sure, simple and practical operation technique, that can be used very well in the every-day-practice, also in case of incarcerated hernia.

Adolescent↗
PubMed1987

[Recurrent gastroduodenal ulcer: controversies in primary and secondary interventions].

Today controversial points of view in ulcer surgery are related to operative tactics. In principal resective and non-resective procedures and the type of anastomosis are discussed. Physiopathological criteria for decision are the effects on acid reduction, motility, intestinal acid exposure and entero-gastric reflux. Therapeutic security and the frequency of side effects are determined by these parameters. Postpyloric ulcer remains the domain of vagotomy. Gastric ulcers should be resected or treated by a combined procedure. In reconstructing the gastrointestinal tract the dualism of residual acid and postresectional reflux must be taken into account.

Anastomosis, Surgical↗
PubMedDate not supplied

Collagen I/III and matrix metalloproteinases (MMP) 1 and 13 in the fascia of patients with incisional hernias.

The late appearance ofincisional hernias several years after laparotomy and the high recurrence rates after operation strongly imply the presence of a disorder of the connective tissue, although a specific defect in patients with incisional hernias has not yet been identified. In the present study we used both immunohistochemistry and Western blot analysis to evaluate the ratio of collagen I and III and the expression of the metalloproteinases (MMP) 1 and 13 in the fascia of patients with incisional or recurrent incisional hernias. Samples of healthy skin or stable skin scar in patients without hernias served as controls. Altogether, our data indicated a significantly decreased ratio of collagen I/III in the fascia of patients with incisional hernias and recurrent incisional hernias. Furthermore, in these patients the expression of MMP-1 was decreased compared to the controls, whereas MMP-13 could not be detected in any fascia sample, with or without hernias present. For the first time, our results give evidence of the existence of a possible collagen disorder in these patients. The decreased ratio ofcollagen I/III is explainable due to a relative increase of collagen type III, which is known to be characterized by thin fibril diameters and lowered mechanical strength. The altered collagen ratio might be the result of the decreased activity of MMP-1, whereas the absent MMP-13 expression did not seem to modify the scar formation. Thus, our data indicate the presence of collagen metabolic disorders in patients with incisional hernias and recurrent incisional hernias. Furthermore, these results might explain the poor results of a mesh-free hernia repair, which again builds up scar tissue of inadequate collagen composition and strength.

Adult↗
PubMedDate not supplied

Influence of mesh materials on collagen deposition in a rat model.

Alterations of the extracellular matrix (ECM) with its major component collagen are increasingly discussed as possible risk factors implicated in the development of abdominal-wall herniation. Because of the widespread use of alloplastic meshes for the surgical repair of hernias, an animal study was performed to analyze the influence of various mesh materials on the quantity and quality of collagen deposition. In 60 male Sprague-Dawley rats an abdominal replacement was performed using three different kinds of mesh materials: polyester (PE), a pure polypropylene (PP), and a composite mesh made of polypropylene and polyglactin (PG). A simple fascia suture repair served as control. The count of fibroblasts, the collagen/protein ratio, the type I/III collagen ratio, and the expression of basic fibroblast growth factor (b-FGF) at the interface were analyzed after 7, 21, and 90 days. The ratio of collagen to overall protein (microg/mg) showed significant differences comparing different mesh materials (sham controls 38.44 +/- 16.33 microg/mg, PE 68.5 +/- 23.8 microg/mg, PP 101.6 +/- 32.3 microg/mg, PG 49.6 +/- 11.6 microg/mg at day 90). The ratio of collagen type I/III increased over time in all groups. However, 90 days after mesh implantation the ratio was always significantly lowered compared to the controls. No significant difference was found comparing different mesh materials. The alteration of the scar composition is closely connected to an increased b-FGF expression. b-FGF and count of fibroblasts highly correlated (r =.95) and showed significant elevated levels compared to simple suture repair. The results of our study strongly support the notion that wound healing is affected by mesh implantation. The quality of the ECM deposition as determined by collagen type I/III ratio is impaired in general, whereas the quantity of ECM deposition is markedly influenced by the kind of mesh material.

Animals↗
PubMedDate not supplied

Mesh implants in hernia repair. Inflammatory cell response in a rat model.

BACKGROUND: In the reinforcement of the abdominal wall with mesh implants, various complications including hernia recurrence, abdominal pain, seroma formation and infection are discussed to depend on the biocompatibility of the alloplastic prosthesis. Particularly macrophages, T-cells and mast cells have been shown to play a major role in the inflammatory response to biomaterials. To approach biocompatibility of surgical meshes we therefore examined the infiltrate of these cells as well as the proliferation rate in response to different clinically applied materials. MATERIALS AND METHODS: Three mesh materials (polypropylene: PP, Prolene; polyethylene terephthalate: PET, Mersilene, and polypropylene/polyglactin: PP + PG, Vypro) were compared after inlay implantation in a standardized rodent animal model. A suture-closed laparotomy served as control. After 7 and 90 days of implantation, histochemical analysis of the inflammatory response to all biomaterials was performed: macrophages (ED3), T-cells (CD3), proliferating cells (PCNA) and mast cells (Giemsa) were investigated. RESULTS: In all groups a persisting T-cell response was observed. Colonization of the interface with macrophages showed a pronounced reduction in the PP + PG-mesh group. Infiltration of mast cells at the tissue graft interface showed a time-dependent decrease in the PET- and PP + PG-mesh groups, whereas in contrast, index of mast cells increased in the PP-mesh group. At both time points, indices of proliferation were highest in the PP-mesh group. CONCLUSION: The present data confirm the development of a biomaterial-dependent chronic inflammatory response to surgical meshes with macrophages as the predominant cell type. Further research on the recruitment of inflammatory cells and in particular on the role of mast cells and their granular products should be encouraged.

Animals↗
PubMedDate not supplied

Vypro II mesh in hernia repair: impact of polyglactin on long-term incorporation in rats.

BACKGROUND: To the Vypro II mesh, a large-pore-sized multifilamentous polypropylene mesh for hernia repair, supplementary polyglactin 910 multifilaments were added to improve intraoperative handling. As it has been suggested that polyglactin induces fibroplastic reactions and wound complications, this study was designed to evaluate the long-term tissue reaction to polyglactin in the Vypro II mesh. MATERIALS AND METHODS: Two mesh materials, the Vypro II composite mesh (PP + PG) and the pure polypropylene variant (PP), were compared after inlay implantation in a standardized rodent animal model. After 14, 28, 42, 56, 84 and 112 days of implantation, histological analysis of the inflammatory response was performed: material absorption, inflammatory tissue reaction, fibrosis and granuloma formation were investigated. RESULTS: Total absorption of polyglactin filaments of the Vypro II mesh occurred between 56 and 84 days of implantation. Both the inflammatory and the fibrotic reaction were initially increased in the PP + PG mesh group. These differences disappeared in the following implantation period. After 112 days, inflammation was even less pronounced in the PP + PG mesh group. CONCLUSION: The present data confirm a short-term polyglactin-induced increase in inflammation and fibrosis around implanted Vypro II meshes in rats. With regard to the long-term tissue response, even an anti-inflammatory property of polyglactin multifilaments in low-weight and large-pored polypropylene meshes cannot be ruled out.

Absorption↗
PubMedDate not supplied

Persistent extracellular matrix remodelling at the interface to polymers used for hernia repair.

On the one hand, recurrence rates and postoperative complications following hernia repair are supposed to be influenced by the kind of mesh material used. On the other hand, an impaired collagen metabolism and cleavage within connective tissue has been suggested as decisive factor in the pathogenesis of recurrent hernia formation. The aim of our study was, therefore, to analyze the impact of commonly used mesh materials on quality of collagen deposition, expression of collagenases (matrix metalloproteinases; MMP-1/MMP-13), and specific tissue inhibitors of MMPs (TIMPs) in an animal study. Four different mesh materials were used (Prolene = polypropylene, Mersilene = polyester, and Vypro and Vypro II = combinations of polypropylene and polyglactin) and implanted as abdominal wall replacement in 60 male Wistar rats. Mesh samples were explanted after 3, 21, and 90 days and investigated using immunohistochemistry (expression of MMP-1/MMP-13 and TIMP-1) and cross-polarization microscopy (percentage of collagen type III to overall collagen). Besides an insufficient collagen composition with an increased percentage of collagen type III, we found a complex expression of collagenases and their inhibitors combined with a persistent chronic foreign-body reaction even 90 days after implantation. Except for TIMP-1 expression, which was significantly related to a lowered amount of inflammatory (r = -0.980, p = 0.02) and connective tissue formation (r = -0.951, p = 0.049), there was no relation to the expression of collagenases (MMP-1/MMP-13) with regard to the amount of inflammatory and connective tissue formation despite partly significant differences between implanted polymers.

Animals↗
PubMedDate not supplied

Surgical mesh as a scaffold for tissue regeneration in the esophagus.

BACKGROUND: Textiles in the form of surgical meshes are widely used in hernia surgery. Their porous structure allows tissue infiltration to incorporate the fabric for complete healing and device stabilization. This study was aimed to reconstitute the esophageal wall and to investigate the functional and histological consequences of a new, non-absorbable polyvinylidene fluoride (PVDF) mesh and an absorbable polyglactin 910 (Vicryl((R))) mesh. METHODS: Semicircular esophageal defects of 0.5 x 1 cm were created 2 cm proximal of the cardia in 10 rabbits. This gap was bridged using either polyglactin 910 or PVDF and additionally covered by omental wrapping. The clinical outcome was observed by clinical observation, regular esophagoscopies and X-ray contrast medium examinations. Local tissue regeneration was verified by light microscopy and immunohistochemistry. RESULTS: After an observation period of 3 months we found no anastomotic strictures, complete mucosal regeneration, minimal inflammation reaction and initial regeneration of the muscle layer for the PVDF group. Within the polyglactin 910 group, three patch failures with consecutive anastomotic leakage occurred. CONCLUSION: The results indicate that PVDF mesh structure gives the opportunity of local tissue regeneration in the esophagus. Though re-epithelialization and muscle cell ingrowth could be detected for absorbable polyglactin 910 mesh, this implant was accompanied by a high and early rate of anastomotic leakage.

Animals↗