Components separation technique is feasible for assisting delayed primary fascial closure of open abdomen

Background and aims: The goal after open abdomen treatment is to reach primary fascial closure. Modern negative pressure wound therapy systems are sometimes inefficient for this purpose. This retrospective chart analysis describes the use of the components separation' method in facilitating primary fascial closure after open abdomen. Material and methods: A total of 16 consecutive critically ill surgical patients treated with components separation during open abdomen management were analyzed. No patients were excluded. Results: Primary fascial closure was achieved in 75% (12/16). Components separation was performed during ongoing open abdomen treatment in 7 patients and at the time of delayed primary fascial closure in 9 patients. Of the former, 3/7 (43%) patients reached primary fascial closure, whereas all 9 patients in the latter group had successful fascial closure without major complications (p=0.019). Conclusion: Components separation is a useful method in contributing to successful primary fascial closure in patients treated for open abdomen. Best results were obtained when components separation was performed simultaneously with primary fascial closure at the end of the open abdomen treatment.Peer reviewe

Purely ropivacaine-based TEA vs single TAP block in pain management after elective laparoscopic colon surgery within an upgraded institutional ERAS program

Publisher Copyright: © 2021, The Author(s).Background: The aim of this study was to compare thoracic epidural analgesia (TEA) with transversus abdominis plane (TAP) block in post-operative pain management after laparoscopic colon surgery. Methods: One hundred thirty-six patients undergoing laparoscopic colon resection randomly received either TEA or TAP with ropivacaine only. The primary endpoint was opioid requirement up to 48 h postoperatively. Intensity of pain, time to onset of bowel function, time to mobilization, postoperative complications, length of hospital stay, and patients’ satisfaction with pain management were also assessed. Results: We observed a significant decrease in opioid consumption on the day of surgery with TEA compared with TAP block (30 mg vs 14 mg, p < 0.001). On the first two postoperative days (POD), the balance shifted to opioid consumption being smaller in the TAP group: on POD 1 (15.2 mg vs 10.6 mg; p = 0.086) and on POD 2 (9.2 mg vs 4.6 mg; p = 0.021). There were no differences in postoperative nausea/vomiting or time to first postoperative bowel movement between the groups. No direct blockade-related complications were observed and the length of stay was similar between TEA and TAP groups. Conclusion: TEA is more efficient for acute postoperative pain than TAP block on day of surgery, but not on the first two PODs. No differences in pain management-related complications were detected.Peer reviewe

Ecotoxicity assessment of boreal lake sediments affected by metal mining : Sediment quality triad approach complemented with metal bioavailability and body residue studies

Highlights • Ecological risk assessment of metal-contaminated boreal lakes and sediments. • Sediment Quality Triad complemented with bioavailability and body residue studies. • Toxicity studies for natural sediments with several organisms and endpoints • Adverse effects observed. High variation on results between different methods. • Standard toxicity tests not suitable for testing, too low pH hampers the results.There are several methods for studying metal-contaminated freshwater sediments, but more information is needed on which methods to include in ecological risk assessment. In this study, we compliment the traditional Sediment Quality Triad (SQT) approach – including information on chemistry, toxicity and ecological status – with studies on metal bioavailability and metal body residues in local organisms. We studied four mining-affected boreal lakes in Finland by conducting chemical analyses of sediment and water, toxicity tests (L. variegatus, V. fischeri, C. riparius, L. stagnalis), and analysis of benthic organism community structure. In addition, we studied the relationships between metal loading, toxicity, metal bioavailability, and metal body residues in the field-collected biota. Chemistry and benthic organism community structures show adverse effects in those lakes, where the metal concentrations are the highest. However, toxicity was connected to low sediment pH during the experiment, rather than to high metal concentrations. Toxicity was observed in 4 out of 6 toxicity tests including growth test with L. variegatus, bulk sediment test with V. fischeri, and the L. stagnalis toxicity test. The C. riparius test did not show toxicity. Metal body residues in biota were not high enough to induce adverse effects (0.1–4.1 mg Cu/kg fw, 0.01–0.3 mg Ni/kg fw, 2.9–26.7 mg Zn/kg fw and 0.01–0.7 mg As/kg fw). Chemical analyses, metal bioavailability assessment and benthic community structures survey revealed adverse effects in the sediments, where metal concentrations are highest (Lake SJ and Lake KS). Standard toxicity tests were not suitable for studying acid, sulfide-rich sediments and, therefore, benthic structure study and chemical analyses are believed to give more reliable results of the ecological status of these sediments

The role of open abdomen in non-trauma patient : WSES Consensus Paper

The open abdomen (OA) is defined as intentional decision to leave the fascial edges of the abdomen un-approximated after laparotomy (laparostomy). The abdominal contents are potentially exposed and therefore must be protected with a temporary coverage, which is referred to as temporal abdominal closure (TAC). OA use remains widely debated with many specific details deserving detailed assessment and clarification. To date, in patients with intra-abdominal emergencies, the OA has not been formally endorsed for routine utilization; although, utilization is seemingly increasing. Therefore, the World Society of Emergency Surgery (WSES), Abdominal Compartment Society (WSACS) and the Donegal Research Academy united a worldwide group of experts in an international consensus conference to review and thereafter propose the basis for evidence-directed utilization of OA management in non-trauma emergency surgery and critically ill patients. In addition to utilization recommendations, questions with insufficient evidence urgently requiring future study were identified.Peer reviewe

WSES guidelines for emergency repair of complicated abdominal wall hernias

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Current concept of abdominal sepsis : WSES position paper

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2013 WSES guidelines for management of intra-abdominal infections

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Hydrocarbons in the Säviä volcanic schist zone, central Finland

Light hydrocarbon gases have been analysed from 21 samples of hydrothermally unaltered and 11 samples of hydrothermally altered metavolcanic rocks from the Säviä volcanic schist zone in the southwestern part of the Proterozoic Vihanti— Pyhäsalmi—Pielavesi Cu—Zn ore province, central Finland. The altered rocks are enriched in the lightest hydrocarbons (propanes and lighter) and depleted in the heavier hydrocarbons (butanes and heavier) compared with the metavolcanic rocks. The difference is clearest for methane (297.3 ppb in the altered rocks vs. 150.3 ppb in the metavolcanic rocks), becoming less marked for the heavier hydrocarbons. A pre-metamorphic hydrothermal origin related to the alteration of the volcanic rocks is the most probable reason for the difference. It is suggested, in the light of the limited data available, that a negative methane anomaly (diameter about 8 km) and positive cyclopropane and pentane anomalies (diameters about 2 km) generated by ore forming processes exist around the Säviä Cu—Zn deposit