THE ROLE OF PERITONEAL-LAVAGE IN THE MANAGEMENT OF PENETRATING ABDOMINAL INJURY

Preventing negative laparotomies is one of the most challenging problems in the management of penetrating abdominal injuries. The term "selective laparotomy" has been therefore introduced and has found an ever increasing acceptance. The peritoneal lavage is a useful tool in patient selection for laparotomy but the main problem is where to set the boundary between a positive and a negative peritoneal lavage. The manipulation of this boundary leads to significant changes in the sensitivity and specificity of the peritoneal lavage. Here we are presenting 162 consecutive cases of penetrating abdominal trauma and discussing our methods of evaluation and management

The effect of prostaglandin E-1 on experimental colitis in the rat

Prostaglandin E-1 (PGE(1)) is known to have a strong vasodilator effect and to block coagulation and inflammation in high concentrations. The aim of this study has been to investigate whether PGE(1) has an inhibitory effect on inflammation in experimental colitis. Experimental colitis was produced by rectal instillation of 10% acetic acid in 60 rats. These were divided into prostaglandin (PG) (n = 30) and control groups (n = 30). Twelve hours later, an intraperitoneal injection of 2 mu g PGE(1) in 1 ml saline was given to the PG group and 1 ml saline to the control group. This was repeated daily and the animals were sacrified in groups of 10 on the 3rd, 7th and 10th day. Histopathological examination and hydroxyproline determination for assessment of collagen synthesis were performed. PGE(1) significantly decreased inflammation on third day with the hydroxyproline level significantly higher in the PG group compared with the control group (p < 0.05). This difference was however not significant at the 7th and 10th day. The present study supports a beneficial role for prostaglandin E-1 in reducing the severity of colonic inflammation following chemically induced colitis but only in the early stages of development

Gastroesophageal reflux and a comparison of the different antireflux procedures following esophagomyotomy: An experimental study in rabbits

The surgical options for achalasia remain controversial regarding the surgical access route, whether it be transthoracic or transabdominal, the need of, and the type of an added antireflux procedure following an esophagomyotomy. These questions were investigated in an experimental study that used 30 albino rabbits divided into six groups, as follows: transabdominal Heller's esophagomyotomy (TAHE), transthoracic I-feller's esophagomyotomy (TTHE), TAHE and Nissen total fundoplication (NF), TAHE and partial fundoplication (PF), TAHE and modified fundoplication (MF), and a control group, Esophageal transit time (ETT) and gastroesophageal reflux (GER) were evaluated by scintigraphy on the seventh postoperative day. When an esophagomyotomy was performed either with a transabdominal or transthoracic approach, a significantly increased GER rate was found in comparison to the controls. All types of antireflux procedures performed prevented GER effectively. Although NF and PF groups showed a significant delay in ETT when compared to the control group (P < 0.001), no such finding was observed in the MF group. In conclusion, an antireflux procedure following an esophagomyotomy is recommended, A modified fundoplication was thus found to be as effective as the other techniques in preventing GER, and was even a safer method when obstructive findings following a total or partial fundoplication were considered