THE RATING SCALE FOR THE SEVERITY OF ABDOMINAL ADHESIONS

A retrospective analysis of 154 case histories of patients with adhesive disease of the abdominal cavity complicated by intestinal obstruction was carried out. The following data were taken into account in the analysis: age, sex, history of operations, availability of hospitalizations and operations for adhesions, their number, methods of treatment, intraoperative evaluation of the adhesion process, the outcome of the hospitalization. For an objective assessment of the severity of the adhesive process, we developed a scale for assessing the degree of adhesive process in the abdominal cavity, which takes into account not only the number and location of adhesions in the abdominal cavity, but also the structure of adhesions, the presence or absence of vascularization, and the presence of deformation of the intestinal tube. The degree of adhesion in the operated patients made 13 points, which corresponds to the pronounced adhesion of the abdominal cavity organs. Mortality rate was 10 %. In patients died from complications, the degree of adhesive process made 14 points. The first signs of adhesion of the abdominal organs appeared 3 years after the operation. And the number of operations for acute intestinal obstruction to the recurrence was 0.27. Spearman's correlation analysis revealed an average significant correspondence between the degree of adhesion and the outcome of treatment. A reliable correspondence between the likelihood of postoperative complications and the severity of the adhesion process was also revealed. A pronounced adhesion process in the abdominal cavity suggests a significant likelihood of repeated operations for adhesions. Thus, the proposed scale is an objective method for evaluating the adhesion process in the abdominal cavity and makes it possible to assume the probability of postoperative complications and relapse of adhesive intestinal obstruction

Inducement of experimental Abdominal Adhesions (literature review)

Adhesive disease of the abdominal cavity is a common medical problem that impairs the patients’ life quality. Adhesive intestinal obstruction ranks first in the structure of acute bowel obstruction. The levels of complications and postoperative mortality are not likely to decrease. Consequently, the studies on preventing adhesive disease are still in progress, which requires an animal model to induce abdominal adhesive process. Numerous factors of peritoneum injury result in adhesion formation. Experimental surgery offers various techniques of inducing the adhesive process in the abdominal cavity based on mechanical, chemical, biological, implantation injury factors. Recent trends in intra-abdominal adhesion stimulation are designed to approximate at maximum an animal model and present surgical and gynecologic procedures. In the review article, we survey and systematize different ways of inducing intra-abdominal adhesive process with various injury factors. The choice of study animal, the ways of peritoneum injury, followed by septic or aseptic inflammation are analyzed. The rating scales for the severity of adhesive process are also organized and compared. The number of existing models is large which is evident of the outstanding problem and promising outlook of scientific research

Hospital epidemiology of abdominal adhesions

The purpose of the research was to establish main causes of development and outcomes of adhesive obstruction. We analyzed the outcomes of treatment of 154 patients with acute intestinal obstruction. The following data were taken into consideration: age, gender, surgeries in past medical history, terms of adhesions manifestations, clinical symptoms, findings of additional examinations, methods of treatment, outcome. It has been established, that the most frequent causes of adhesions were appendectomy (23 %), stomach operations (21 %) and gynecological interventions (14 %). After surgeries performed in conditions of regional hospitals, adhesions developed after appendectomy, gynecological operations and interventions on the intestine. In patients operated in city hospitals intestinal obstruction more often occurred after extensive operations on the stomach, appendix, and after gynecological interventions. Urgent surgical interventions more often led to adhesive process in the abdominal cavity (63 %). Mortality made 5.8 %. Causes of death were intestinal fistulas and abdominal sepsis. Thus, acute adhesive intestinal obstruction as an extreme form of abdominal adhesions continues to be an urgent medical issue

Adhesive Process of the Abdominal Cavity as a Risk Factor for the Development of Postoperative Intestinal Fistula

Adhesive disease of the abdominal cavity remains one of the unresolved problems of abdominal surgery. The clinical picture of the pathological process is diverse, treatment of patients is not always effective, and decision-making on the use of certain medical methods is often difficult.The aim of the research was to assess the severity of the adhesive process and the likelihood of complications in patients with adhesive disease of the abdominal cavity.Materials and methods. We performed the retrospective analysis of 160 case histories of patients for the period 2006-2010, who, according to emergency indications, were admitted to the surgical department of the Irkutsk Regional Clinical Hospital with a clinic of acute adhesive intestinal obstruction against the background of adhesive disease. To assess the severity of the adhesive process, our own scale for assessing the adhesive process of the abdominal cavity was developed and tested in clinical conditions. To assess the likelihood of developing postoperative unformed intestinal fistulas, a prospective analysis of the treatment of 36 patients with acute adhesive intestinal obstruction was performed.Results. The severity of the adhesive process in the operated patients was 13 (10-15) points, which indicates a pronounced adhesive process. In patients operated repeatedly for commissural intestinal obstruction, the severity of the adhesion process according to the proposed scale was 14 (14-15) points, which corresponds to pronounced adhesion of the abdominal organs. Based on the proposed scale, the probability of developing postoperative unformed intestinal fistulas was calculated. The sensitivity and accuracy of the probability scale was 71 % (CONSORT). Thus, an intraoperative assessment of the severity of the adhesive process allows us to predict the likelihood of postoperative external intestinal fistula

Study of the effect of a new antiadhesive agent on peripheral blood indices (experimental study)

Adhesive process in the abdominal cavity was simulated in Wistar rats, which were divided into two groups: the main one - simulation of adhesive process in the abdominal cavity and introduction of 3 ml of saline into the abdominal cavity; the controls - simulation of adhesive process in the abdominal cavity and introduction of 3 ml of new antiadhesive preparation. The mechanism of drug action bases on the ability to inhibit the growth of connective tissue in the adhesion area by effecting the activity of mitogen-activated protein kinases. Examination of peripheral blood indices was performed at eight time points during the period from 2 hours to 28 days. The concentration of red blood cells in the peripheral blood in both main and control groups decreased moderately in the early postoperative period (2 hours, 6 hours and 12 hours), and this rate was significantly lower in the control group as compared to the main one by 12 hours term. Later the index restored to normal. Hemoglobin concentration in the peripheral blood was higher in the main group than in the control one, the differences were significant in 2 hours, 3 days, 28 days. The level of hematocrit in the main group was higher than that in the controls during the entire follow-up period; the difference was maximal to the final term of experiment (28 days). The level of leukocytes in peripheral blood of the main group rats did not exceed the normal value for the given species of animals throughout the follow-up period. The number of eosinophils in the peripheral blood of the rodents of both groups did not differ at every period of survey. Thus, the introduction of the drug reduced the severity of leukocyte response to injury, improvement in postoperative hemoglobin and hematocrit levels

Involvement of the ERK MAPK Cascade in the Formation of Adhesions in the Abdominal Cavity

Background. ERK1 and ERK2 (extracellular signal-regulated kinase) are related protein serine / threonine kinases that are involved in the regulation of the cell cycle, cell migration and survival, differentiation, metabolism, and proliferation. Evaluation of this cascade is promising to determine the possibility of influencing  pathological conditions through the regulation of ERK1/2.Aim of the study. To assess the involvement of the ERK MAPK cascade in the development of adhesions in the abdominal cavity.Methods. The experiments were carried out on male Wistar rats. The adhesion process in the abdominal cavity was simulated (n = 40). The research time is from 2 hours to 30 days. Tissue samples from 5 intact animals were examined as a control. Histological sections were prepared and stained histochemically for ERK1. The expression of ERK1 and ERK2 was assessed by PCR.Results. Using the PCR method, the involvement of both the ERK1 and ERK2 cascades in the process was established, and, judging by the change in gene expression, the latter is more actively involved in the process. Histochemical study confirmed the role of ERK cascades in the management of repair in serous membrane injury. Histochemically revealed an increase in ERK1 expression with two peaks of activity – at 1 and 30 days.Conclusion. Our data establish multichannel control of the reparative process in the area of damage to the serous membrane with the involvement of both the p38 and ERK MAPK cascades, which is important to consider when developing methods of influencing the wound healing process in the abdominal cavity

EXPRESSION OF COLLAGENS IN THE DAMAGE AREA AT ABDOMINAL ADHESIONS

Background. Postoperative adhesions are a serious problem in surgery. However, at the present time molecular mechanisms of the adhesion process are insufficiently studied. Aim. To study the dynamics of expression of genes encoding the synthesis of collagen in case of damage to the serosa on the example of the peritoneum in conditions of aseptic inflammation. Materials and methods. Aseptic inflammatory process in the abdominal cavity was modeled (Wistar rats, n = 40). A micro- and macroscopic picture of the damage area was studied. Immunofluorescent staining for Type I collagen (Col 1A1) was performed. The expression of genes encoding collagen of different types was evaluated using the RT2-Profiler PCR kit Array Rat Wound Healing. Results. It has been established that the adhesion process with peritoneal damage in aseptic conditions reaches its maximum by the 30th day of observation. The same period coincides with the maximum of collagen synthesis in fibroblasts in the repair area, revealed by immunofluorescence study. The interrelation of synthesis of type I and III collagens went as expected - the onset of expression of type III collagen (from day 3) is ahead of the expression of collagen type I (from day 7). Peak gene expression of collagens type I, Alpha-1 and -2; type III Alpha-1, type IV Alpha-1 and -3, type V Alpha-1, -2 and -3; type XIV Alpha-1 (Col14a1) falls on the 14th day. For the first time, active involvement of type V alpha-3 collagen in the adhesion process was noted - we detected both early (from day 1) and maximum intensive (up to 166.96 times increase in comparison with intact animals). Conclusion. Perhaps, the hyperexpression of collagen V alpha-3 that we revealed is an important link in the pathogenesis of adhesion in the abdominal cavity

EXPRESSION OF COLLAGENS IN THE DAMAGE AREA AT ABDOMINAL ADHESIONS

Background. Postoperative adhesions are a serious problem in surgery. However, at the present time molecular mechanisms of the adhesion process are insufficiently studied. Aim. To study the dynamics of expression of genes encoding the synthesis of collagen in case of damage to the serosa on the example of the peritoneum in conditions of aseptic inflammation. Materials and methods. Aseptic inflammatory process in the abdominal cavity was modeled (Wistar rats, n = 40). A micro- and macroscopic picture of the damage area was studied. Immunofluorescent staining for Type I collagen (Col 1A1) was performed. The expression of genes encoding collagen of different types was evaluated using the RT2-Profiler PCR kit Array Rat Wound Healing. Results. It has been established that the adhesion process with peritoneal damage in aseptic conditions reaches its maximum by the 30th day of observation. The same period coincides with the maximum of collagen synthesis in fibroblasts in the repair area, revealed by immunofluorescence study. The interrelation of synthesis of type I and III collagens went as expected - the onset of expression of type III collagen (from day 3) is ahead of the expression of collagen type I (from day 7). Peak gene expression of collagens type I, Alpha-1 and -2; type III Alpha-1, type IV Alpha-1 and -3, type V Alpha-1, -2 and -3; type XIV Alpha-1 (Col14a1) falls on the 14th day. For the first time, active involvement of type V alpha-3 collagen in the adhesion process was noted - we detected both early (from day 1) and maximum intensive (up to 166.96 times increase in comparison with intact animals). Conclusion. Perhaps, the hyperexpression of collagen V alpha-3 that we revealed is an important link in the pathogenesis of adhesion in the abdominal cavity

An examination of hepatotoxicity and nephrotoxicity of a new antiadhesive preparation (experimental study)

Adhesive process in the abdominal cavity was simulated in Wistar rats. The animals were divided into two groups: the main one - simulation of adhesive process in the abdominal cavity and introduction of 3 ml of saline into the abdominal cavity; and the controls - simulation of adhesive process in the abdominal cavity and introduction of 3 ml of new antiadhesive preparation. We evaluated biochemical parameters at eight time points during the period from 2 hours to 28 days. The introduced drug for adhesion prevention did not affect the protein-synthetic function of the liver: the blood level of whole protein was the same in both groups and remained within the normal range throughout the follow-up period. The blood level of creatinine, which is the end product of protein metabolism reflecting the renal excretory function, was within normal values in both groups throughout the observation period. Significant differences between the groups were noted only on the 28th day of the experiment: in the main group creatinine level was higher as compared to the control group (p = 0.014), but remained within the normal range. The same pattern was observed when evaluating the blood urea level, which reflects the renal excretory function - the blood urea level remained normal in both groups throughout the experiment. Hence, the new antiadhesive drug does not produce toxic effect on liver and kidneys in a single intraperitoneal introduction in experiment. Biochemical indices are the same as in single intraperitoneal infusion of saline

INVOLVEMENT OF JNK MAPK CASCADES IN THE FORMATION OF ADHESIONS IN THE ABDOMINAL CAVITY

Adhesive process in the abdominal cavity is one of the most frequent complications of intra-abdominal surgery.The aim of the study was to evaluate the activation of the JNK MAPK cascade during the experimental adhesion process.Materials and methods. Experimental studies were performed on 40 male Wistar rats (9 months old). We modeled the adhesive  process in the abdominal cavity. At the time from 2 hours (2, 6, 12  hours) to 30 days (1, 3, 7, 14, 30 days), a JNK MAPK cascade was  evaluated in the zone of damage to the serosa using  immunohistochemical methods (painting on JNK1 Phospho (pT183) /  JNK2 Phospho (pT183) / JNK3 Phospho (pT221)) and real-time  PCR (the MAP Kinase Signaling Pathway RT2 - Profiler ™ PCR Array  (Qiagen) kit). Results. We have found that the expression of the  phosphorylated part of the JNK MAPK cascades has an undulating dynamics with two  peaks on the 3rd and 14th day. It has been determined that all  three JNK cascades are involved in the process, and all JNK cascades are synchronously activated on the 3rd day (JNK1 increases 12-fold  in comparison with the group of intact animals, JNK2 is 8-fold, JNK3  is 10-fold). On the 14th day, the activity of the JNK3 cascade is the  most intensively increased – 30 times (for JNK1 – about 6 times,  JNK2 – 12 times).  Conclusion. Significant activation of MARK cascades has been established on the 14th day after traumatic injury, which indicates the need for long-term prevention of posttraumatic changes, in particular, the formation of adhesions