The mitogenic activity of peritoneal tissue repair cells: control by growth factors

The purpose of this study was to determine the proliferative activity of tissue repair fibroblasts recovered directly from injured peritoneum at various times after surgery and to test the mitogenic response of tissue repair cells (TRC) to growth factors. Rabbits underwent bilateral peritoneal abrasion (5 X 5 cm) with sterile gauze until punctate bleeding developed. Postsurgical (Days 2, 5, 7, and 10) tissue repair cells were recovered from the injured peritoneum by scraping with a scalpel blade. Although tissue repair cells consisted of a mixed cell type after 4 days in culture, recovered cells were essentially fibroblasts. These TRC were then pulsed with [3H]thymidine after 4 days in culture. The incorporation of thymidine into Postsurgical Day 5 TRC increased significantly compared to that of Day 2 TRC (P less than 0.05). Incorporation then decreased with time following surgery. Fibroblast growth factor (FGF) and epidermal growth factor (EGF) stimulated the incorporation of thymidine into TRC. However, the response of Postsurgical Day 7 and 10 TRCs to 1 microgram/ml EGF was significantly greater than those of Postsurgical Day 2 and 5 TRCs (Day 2 TRC, 166 +/- 7.4; Day 10 TRC, 420 +/- 96% of control cells without EGF, P less than 0.05). Platelet-derived growth factor (PDGF, 10 ng/ml) also stimulated the incorporation of thymidine into Day 10 TRCs, but this stimulatory activity (129.9 +/- 8.5% of control) was less than EGF or FGF. IL-1 alpha and IL-2 did not stimulate the incorporation of thymidine into TRC at a concentration of 100 pg/ml, but these cytokines did stimulate protein synthesis by TRC.(ABSTRACT TRUNCATED AT 250 WORDS)

[Embryologic and anatomo-surgical presuppositions in intraoperative injuries of the spleen. A clinical study]

Records related to 2559 patients submitted to main abdominal surgery have been reviewed. Accidental splenic injury and subsequent splenectomy occurred in 4.5% of cases. A study of the embryological development and anatomical patterns of the splenic peritoneum has been carried out as well as an analysis of the site and the shape of the capsular damage in order to assess the mechanism of injury. Avulsion of splenic capsule occurring from traction on the peritoneal attachment of the spleen appears to be the most common mechanism of injury. Previous surgery and geriatric age seem to be factors predisposing to splenic injury.

Mitogenic and protein synthetic activity of tissue repair cells: control by the postsurgical macrophage

It is well known that fibroblasts are a main source of extracellular matrix synthesis necessary for tissue repair. In addition, macrophages secrete products that are known to modulate synthesis of extracellular matrix. Accordingly, we studied the incorporation of [3H]thymidine, [3H]proline, and [35S]sulfate into macromolecules produced by fibroblasts recovered from the site of peritoneal tissue repair cultured with and without spent media from postsurgical peritoneal macrophages. Rabbits underwent resection and reanastomosis of their small intestines. Peritoneal exudative cells (PEC) were then collected on postsurgical day 5 and day 10 as well as from nonsurgical controls, separated by discontinuous Percoll gradient centrifugation, and cultured for 48 h. A second group of rabbits underwent peritoneal wall abrasion from which fibroblast tissue repair cells (TRC) were collected from the site of injury at postsurgical day 7 and maintained in culture for varying times. Incorporation of radiolabeled precursors into DNA, collagen, and sulfated proteoglycans was determined. Incorporation of [3H]thymidine and [3H]proline into untreated TRC gradually decreased with culture duration. Conversely, [35S]sulfate incorporation gradually increased during prolonged culture. Macrophage spent media increased the levels of [3H]thymidine incorporation by the TRC. [3H]Proline and [35S]sulfate incorporation into TRC were also stimulated by macrophage spent media. However, this stimulation may be due to the enhanced proliferation of TRC by macrophage spent media. In conclusion, tissue repair fibroblasts are activated for postsurgical repair at the site of injury by many factors including secretory products from postsurgical macrophages.

[The internal variability of the mesothelium during regeneration following trauma applied at various times of the day]

A quantitative investigation of the mitotic activity (MA) dynamics, size of the cells, amount of their mutual contacts (as an index of the epithelial layer regulation) and amount of nucleoli in the nuclei of mesothelium after a trauma, performed at 9 a.m. and at 9 p.m. has been carried out. The investigation lasted for 96 h. According to statistically significant differences two zones are revealed: a nearer and a remote one. Changeability of mesothelium increases in both zones, but it is greater manifested in the nearer zone. MA dynamics in both zones demonstrates a quick growing and a similarly quick drop, except the remote zone after the morning operation, where MA decreases slower. Amount of the cells, whose nuclei contain more nucleoli than in the norm, increases before the development of the MA waves. MA increase is accompanied with decreasing size of the cells. Normalization of MA and size of the cells occur approximately simultaneously. This process is more manifested after the morning operation, and after the evening one, normalization of these signs, during the time of observation, is reached only in the remote zone. Disorganization of mesothelium, as a tissue system, precedes the MA increase. A significant difference of this sign from the control takes place only in the nearer zone after the morning operation. As a whole, the changeability of mesothelium is more manifested after the morning operation.

Absence of a tachycardic response to shock in penetrating intraperitoneal injury

The belief that tachycardia is an early and reliable indicator of shock has recently been challenged. We examined 144 battlefield casualties with penetrating intraperitoneal injury to determine whether patients in shock presented with pulse rates that were significantly more rapid than those in patients not in shock. No differences in mean pulse rates were found when using objective operational definitions of shock. In contrast, the only pulse rate difference was noted when shock was defined on the basis of the surgeon's subjective clinical impression and this was attributed to selection bias. The absence of a tachycardic response in battlefield casualties with penetrating abdominal wounds cannot be taken as an indication that serious injury and significant intraperitoneal bleeding have not occurred. Caution should be exercised when using this parameter as a guide for therapeutic interventions, and further study is indicated to determine whether a similar pattern is seen in civilian practice.

Chondroitin sulphate. A new intraperitoneal treatment for postoperative adhesion prevention in the rabbit

A study was designed to test chondroitin sulphate and other high-molecular-weight solutions, using the rabbit uterus as the surgical model, in the prevention of postoperative adhesions. Eighty-five mature white female New Zealand rabbits underwent surgical injury of each uterine horn, with surgical repair of the left horn only in all animals using 9-0 nylon. The rabbits were randomly divided into five groups: groups A, B and C received 25 mL of chondroitin sulphate, sodium carboxymethylcellulose or 32% dextran 70, respectively. The remaining two groups received either 50 mL of normal saline (D) or no solution (E). Postoperatively the animals were killed, and the adhesions were carefully scored. The results clearly demonstrated the superiority of chondroitin sulphate as an intraperitoneal treatment for the prevention of postoperative adhesions (P less than .001 vs. carboxymethyl cellulose, dextran, saline and control).

A histologic evaluation of peritoneal injury and repair: implications for adhesion formation

A study of peritoneal healing after specific types of peritoneal injury was conducted in rabbits. Histologic specimens were examined at four, eight, 12, 24, and 48 hours, and at five, seven, and 14 days postperitoneal injury. Comparison of types of injury and attempts at peritoneal repair revealed differences in healing mechanisms. Histologic evidence of rapid reperitonealization was associated with those types of repair that involved minimal tissue necrosis and absence of foreign body reaction.

Selective management of abdominal and thoracic stab wounds with established peritoneal penetration: the eviscerated omentum

In a prospective study involving 276 patients, stab wounds to the abdomen and lower chest with certain penetration into the peritoneal cavity were managed selectively. On the basis of physical findings, patients underwent either immediate laparotomy or close observation with frequent reexaminations and operation only if signs changed. The reliability of physical examination and the safety of nonoperative treatment in the absence of peritoneal signs were assessed. The overall incidence of major damage, including damage to the diaphragm, was 59.1 percent. Significant intraperitoneal visceral injury was found in 45.7 percent of patients with transabdominal stab wounds and in 25 percent of those with transthoracic stab wounds. Physical examination correctly predicted the findings in 90 to 96 percent of patients at initial assessment, with a sensitivity of 88.4 percent and a specificity of 93.9 percent. As delayed laparotomy after a change in signs during observation did not increase morbidity or hospital stay, and the unnecessary laparotomy rate in this study was 5.9 percent, we recommend a policy of selective management of abdominal and thoracic stab wounds with omental evisceration or other evidence of peritoneal penetration. Local wound care with amputation of the protruded omentum followed by close observation and monitoring of vital signs is safe surgical practice when no peritoneal signs or other indication for urgent exploration are present on admission.

[Space-time characteristics of DNA synthesis in mesothelial cells of the rat after surgery at different times of the day]

Differences in the DNA synthesis dynamics (according to the label index-LI) and those of mitotic activity (MA) in the mesothelium of the rat parietal peritoneum have been studied after burn performed at 9 AM, or at 9 PM. A number of peculiarities in the regeneration character are dependent on the day time of the operation. Immediately after the PM operation inhibition of both DNA synthesis and MA is manifected more distinctly and lasts longer, but then activation of the processes occurs more intensively the LI and MA values are greater than after the AM operation. Drop in the LI and MA takes place also with a greater rate after the PM operation, but their absolute values are kept higher up to the 7th day. Despite the fact that the reaction after the AM operation is comparatively weak, it is more rhythmical: against the background of general dynamics the fluctuations are more distinctly manifested, their period is nearly similar to the circadian. Increase in the proliferative activity is accompanied with a widening of the zone, where the dividing cells are situated. After the PM operation the wavy character of the process is expressed only in the pattern of the spatial organization of the regenerating mesothelium: nearly at regular intervals the area of the MA distribution becomes widen or narrow in turn. Thus, the LI and MA dynamics in the regenerating mesothelium depend on the circadian phase of the organism's state at the moment of the operation.

Analysis of electronically pulsed versus quasi-continuous wave carbon dioxide lasers in an animal model

In this study we sought to compare laser tissue interaction in both the quasi-continuous waveform and electronically pulsed waveform of the carbon dioxide laser. An intramode analysis of the electronically pulsed form (at 350 and 650 pulses per second) was also undertaken. Intraperitoneal laser incisions were made on New Zealand white female virginal rabbits and tested at days 0, 5, 15, and 20. Testing involved proximal and midsection analysis of the laser sites to evaluate total area of vaporization, total area of tissue thermal damage, maximum diameter of injury at epithelial surface, maximum depth of laser penetration, angle of vaporization crater edges, and angle of tissue thermal injury of the three modes. Analysis of proximal versus midsection preparation revealed different zones of vaporization and injury within the same laser site. The zone of injury with respect to time was nonuniform, suggesting that the laser output in the electronically pulsed mode was not constant. An in vivo tissue lens phenomenon was also detected, resulting in a compound thermal vaporization and injury pattern.

Massive subcutaneous emphysema following colonoscopy

A case of massive subcutaneous emphysema following colonoscopic polypectomy is reported. The incidence of colonic perforation following colonoscopy is 0.1% and may be intraperitoneal or retroperitoneal. Intraperitoneal perforation is usually immediately apparent and likely to require urgent surgical exploration. The development of subcutaneous emphysema or a pneumoscrotum suggests a retroperitoneal perforation and in the majority of cases management is conservative. Contrast studies are often unhelpful but plain x-rays may help to distinguish between intraperitoneal and retroperitoneal perforations.

Selective conservative management of penetrating abdominal wounds: a prospective study

This is a prospective study comprising 156 cases of abdominal stab wounds. The cases were assessed exclusively on clinical grounds: 37.18 per cent of them were treated conservatively without any mortality and minimal complications. Shock, blood on abdominal paracentesis, omentum protruding through the wound, and radiologically free air under the diaphragm, were not absolute indications for surgery. Alcohol consumption did not interfere with the clinical assessment. Of all 130 cases with proved peritoneal penetration, 28.46 per cent had no significant visceral injury. The incidence of negative laparotomies was 7.0 per cent.

Acute changes in peritoneal morphology and transport properties with infectious peritonitis and mechanical injury

Peritoneal clearance studies were performed in rats undergoing acute peritoneal dialysis. Some of these animals were then exposed to laparotomy and mechanical drying of the peritoneum. Peritoneal clearance studies were repeated at intervals up to 11 days. Another group of rats was placed on daily peritoneal dialysis and allowed to spontaneously develop peritonitis which was not treated. These rats underwent peritoneal transport studies at differing durations of infection. In all groups, animals were sacrificed at the time of the last transport studies for morphological assessment of the peritoneum by light microscopy, scanning electron microscopy, and transmission electron microscopy. The results showed similar decreases in drainage volume and increases in glucose absorption and protein losses with both infection and drying. Both types of injury resulted in extensive mesothelial structural changes. While drying caused mainly denudation of the mesothelial surface, infectious peritonitis was associated with separation of mesothelial cells, and the appearance of numerous white blood cells between and on mesothelial cells. Exposure to peritoneal dialysis alone had no obvious effects on anatomy. Although changes in the peritoneal microcirculation and deeper structures cannot be excluded as contributing to peritoneal transport alterations, the findings suggest that alterations of mesothelium might explain some of the changes in peritoneal transport properties under the conditions of these studies.

Management of foreign bodies and trauma of the rectum

A series of 101 patients with trauma of the rectum, secondary to homosexual practices, presenting at this hospital and medical center is reviewed. Two patients were injured twice. Thirty-six patients had retained foreign bodies in the rectum, 55 had lacerations of the mucosa, two had disruptions of the anal sphincter and ten had perforations of the rectosigmoid. The majority of retained foreign bodies can be removed on an outpatient basis. If removal is not immediately possible, the patient should be admitted for observation and removal of the foreign body transanally under anesthesia. Routine sigmoidoscopic examination is performed after removal. Removal seldom requires laparotomy. Simple nonbleeding lacerations of the mucosa can be managed on an outpatient basis. Patients with abdominal pain, fever, continued bleeding, large lacerations or tear of the sphincter should be admitted and observed or operated upon, or both, as needed. Serious injuries, secondary to homosexual acts, can and do occur, as evidenced by the mortality reported in this series. Perforations of the rectosigmoid above the peritoneal reflection can be treated by laparotomy, repair of the perforation, removal of gross contamination by irrigation, proximal loop colostomy and appropriate antibiotic therapy. Perforations below the peritoneal reflection are challenging instances which require individualized management.

The importance of the WBC count in peritoneal lavage

A subset of ten consecutive patients who had sustained penetrating and blunt abdominal trauma came to the hospital with stable vital signs. None had any clinical evidence of intraperitoneal injury. All patients underwent peritoneal lavage, and surgical exploration was performed on the basis of a 100,000/cu mm in the effluent. Substantial intraperitoneal injury was found in nine of ten patients. We suggest that as a further refinement of peritoneal lavage, in addition to RBC count, the WBC count be measured in the effluent fluid and if it is found to be greater than 500/cu mm, surgical exploration be carried out.