Showing posts with label adhesions ARD scar tissue. Show all posts
Showing posts with label adhesions ARD scar tissue. Show all posts
Monday, April 07, 2014
Saturday, March 29, 2014
Adhesions Adhesion Related Disorder Wiki
Adhesions are fibrous bands[1] that form between tissues and organs, often as a result of injury during surgery. They may be thought of as internal scar tissue that connect tissues not normally connected.
Contents
[hide]Pathophysiology[edit]
Adhesions form as a natural part of the body’s healing process after surgery in the same way that a scar forms. The term "adhesion" is applied when the scar extends from within one tissue across to another, usually across a virtual space such as the peritoneal cavity. As part of the process, the body deposits fibrin onto injured tissues. The fibrin acts like a glue to seal the injury and builds the fledgling adhesion, said at this point to be "fibrinous." In body cavities such as the peritoneal, pericardial and synovial cavities, a family of fibrinolytic enzymes may act to limit the extent of the initial fibrinous adhesion, and may even dissolve it. In many cases however the production or activity of these enzymes are compromised because of injury, and the fibrinous adhesion persists. If this is allowed to happen, tissue repair cells such as macrophages, fibroblasts and blood vessel cells, penetrate into the fibrinous adhesion, and lay down collagen and other matrix substances to form a permanent fibrous adhesion. In 2002, Giuseppe Martucciello's research group showed a possible role could be played by microscopic foreign bodies (FB) accidentally contaminating the operative field during surgery.[2] These data suggested that two different stimuli are necessary for adhesion formation: a direct lesion of the mesothelial layers and a solid substrate (FB).
While some adhesions do not cause problems, others can prevent muscle and other tissues and organs from moving freely, sometimes causing organs to become twisted or pulled from their normal positions.
Regions affected[edit]
Adhesive capsulitis[edit]
In the case of adhesive capsulitis of the shoulder (also known as frozen shoulder), adhesions grow between the shoulder joint surfaces, restricting motion.
Abdominal adhesions[edit]
Abdominal adhesions (or intra-abdominal adhesions) are most commonly caused by abdominal surgical procedures. The adhesions start to form within hours after surgery and may cause internal organs to attach to the surgical site or to other organs in the abdominal cavity. Adhesion-related twisting and pulling of internal organs can result in complications such as abdominal pain or intestinal obstruction. Small bowel obstruction (SBO) is a significant consequence of post-surgical adhesions. A SBO may be caused when an adhesion pulls or kinks the small intestine and prevents the flow of content through the digestive tract. It can occur 20 years or more after the initial surgical procedure, if a previously benign adhesion allows the small bowel to spontaneously twist around itself and obstruct. SBO is an emergent, possibly fatal condition without immediate medical attention. According to statistics provided by the National Hospital Discharge Survey approximately 2,000 people die every year in the USA from obstruction due to adhesions.[3] Depending on the severity of the obstruction, a partial obstruction may relieve itself with conservative medical intervention. However, many obstructive events require surgery to lyse the offending adhesion(s) or resect the affected small intestine.
Pelvic adhesions[edit]
Pelvic adhesions are a form of abdominal adhesions in the pelvis, typically in women affecting reproductive organs and thus of concern in reproduction or as a cause of chronic pelvic pain. Other than surgery, endometriosis, and pelvic inflammatory disease are typical causes.
Surgery inside the uterine cavity (e.g., suction D&C, myomectomy, endometrial ablation) can result in Asherman's Syndrome (also known as intrauterine adhesions), a cause of infertility.
A meta-analysis in 2012 came to the conclusion that there is only little evidence for the surgical principle that using less invasive techniques, introducing less foreign bodies or causing less ischemia reduces the extent and severity of adhesions in pelvic surgery.[4]
Pericardial adhesions[edit]
Adhesions forming after cardiac surgery between the heart and the sternum place the heart at risk of catastrophic injury during re-entry for a subsequent procedure.
Peridural adhesions[edit]
Adhesions and scarring as epidural fibrosis may occur after spinal surgery that restricts the free movement of nerve roots, causing tethering and leading to pain.
Peritendinous adhesions[edit]
Adhesions and scarring occurring around tendons after hand surgery restrict the gliding of tendons in their sheaths and compromise digital mobility.
Association with surgery[edit]
A study in Digestive Surgery showed that more than 90% of patients develop adhesions following open abdominal surgery and 55–100% of women develop adhesions following pelvic surgery.[5] Adhesions from prior abdominal or pelvic surgery can obscure visibility and access at subsequent abdominal or pelvic surgery. In a very large study (29,790 participants) published in British medical journal The Lancet, 35% of patients who underwent open abdominal or pelvic surgery were readmitted to the hospital an average of two times after their surgery due to adhesion-related or adhesion-suspected complications.[6] Over 22% of all readmissions occurred in the first year after the initial surgery.[6]Adhesion-related complexity at reoperation adds significant risk to subsequent surgical procedures.[7]
Applying adhesion barriers during surgery can help to prevent the formation of adhesions.[8] Surgical humidification therapy may also minimise the incidence of adhesion formation.[9] Laparoscopic surgery has a reduced risk for creating adhesions.[10] Steps can be taken during surgery to help prevent adhesions such as handling tissues and organs gently, using starch- and latex-free gloves, not allowing tissues to dry out, and shortening surgery time.[11]
Types[edit]
Types of adhesions:
- Fibrinous adhesions. These are causes of early postoperative obstruction which settles down within 3–5 days. The majority of fibrinous adhesions will disappear in due course of time[citation needed].
- Fibrous adhesions. If the infection is continuous or if foreign[clarification needed] is present, the fibrinous material is converted into fibrous material[citation needed].
References[edit]
- ^ "adhesion" at Dorland's Medical Dictionary
- ^ Torre M, Favre A, Pini Prato A, Brizzolara A, Martucciello G (December 2002). "Histologic study of peritoneal adhesions in children and in a rat model". Pediatr. Surg. Int. 18 (8): 673–6. doi:10.1007/s00383-002-0872-6. PMID 12598961.
- ^ See article at: www.adhesions.org/ardnewsrelease092303.pdf
- ^ Ten Broek, R. P. G.; Kok- Krant, N.; Bakkum, E. A.; Bleichrodt, R. P.; Van Goor, H. (2012). "Different surgical techniques to reduce post-operative adhesion formation: A systematic review and meta-analysis". Human Reproduction Update 19 (1): 12–25.doi:10.1093/humupd/dms032. PMID 22899657.
- ^ Liakakos, T; Thomakos, N; Fine, PM; Dervenis, C; Young, RL (2001). "Peritoneal adhesions: etiology, pathophysiology, and clinical significance. Recent advances in prevention and management". Digestive surgery 18 (4): 260–73.doi:10.1159/000050149. PMID 11528133.
- ^ a b Ellis, H.; Moran, B.; Thompson, J.; Parker, M.; Wilson, M.; Menzies, D.; McGuire, A.; Lower, A.; Hawthorn, R.; Obrien, F. (1999). "Adhesion-related hospital readmissions after abdominal and pelvic surgery: A retrospective cohort study". The Lancet 353 (9163): 1476. doi:10.1016/S0140-6736(98)09337-4.
- ^ Van Der Krabben, AA; Dijkstra, FR; Nieuwenhuijzen, M; Reijnen, MM; Schaapveld, M; Van Goor, H (2000). "Morbidity and mortality of inadvertent enterotomy during adhesiotomy". The British journal of surgery 87 (4): 467–71. doi:10.1046/j.1365-2168.2000.01394.x. PMID 10759744.
- ^ "Adhesion prevention: a standard of care". Medical Association Communications. American Society of Reproductive Medicine. February 2002.
- ^ Peng, Y; Zheng M; Ye Q; Chen X; Yu B; Liu B (2009). "Heated and humidified CO2 prevents hypothermia, peritoneal injury, and intra-abdominal adhesions during prolonged laparoscopic insufflations". J Surg Res. 151(1): 40–47.
- ^ "Adhesions". Better Health Channel. Retrieved 20 February 2014.
- ^ "Abdominal Adhesions (Scar Tissue)". Medicinenet. Retrieved 20 February 2014.
Sunday, March 23, 2014
Vaginal mesh for pelvic organ prolapse: Information for healthcare professionals
Vaginal mesh implants used to treat pelvic organ prolapse (POP) include a range of different types of mesh implanted in the pelvic floor area in a number of different ways to support the vaginal wall and/or internal organs. The mesh can be synthetic, ‘biological’ or a combination of the two and it may be absorbable or non-absorbable.
MHRA investigation into vaginal mesh implants
In light of an increasing number of adverse events and patient concerns being reported, the MHRA launched an investigation to better understand the use of these devices and the complications associated with their use.
MHRA workshop
The MHRA held a workshop in March 2012 under the chairmanship of Professor Paul Abrams, which included representatives of the Royal College of Obstetricians and Gynaecologists, the British Association of Urological Surgeons, the British Society of Urogynaecology, NICE, the University of Aberdeen Health Services Research Unit, and representatives of some manufacturers of these devices, to consider how to make this a safer procedure.
The meeting covered:
- types of vaginal mesh
- clinical experience, training and outcomes of prolapse surgery
- complications arising from the use of vaginal mesh
- NICE/IPAC guidance
- adverse event reporting
- responsibilities of involved parties (clinicians, regulators and manufacturers).
Further information on the outcomes of this workshop can be found in the section Responsibilities of the parties involved in the manufacture, regulation and surgical provision of vaginal meshes
MHRA review
In light of an increasing number of adverse events and patient concerns being reported, the MHRA launched an investigation to better understand the use of vaginal tapes/slings and meshes and the complications associated with their use.
Although MHRA have had very few reports of problems with these devices we have noted concerns about their safety that are being expressed by patients and patients’ groups. We do take the problems and issues reported very seriously and share concern for their safety, and those that have experienced unwanted complications from them.
In February 2012, the MHRA commissioned a systematic review of the available literature on the incidence of the most frequently reported adverse events associated with different meshes/tapes/slings. The results can be found on Summaries of the safety/adverse effects of vaginal meshes for prolapse
We continue to actively investigate and gathering evidence on the safety of these vaginal mesh and tape devices to better inform patients, doctors and surgeons about the risks, benefits and uses of these devices.
Adverse events that should be reported
The MHRA is still gathering information on the use and complications associated with these devices and would encourage reporting of adverse events to us.
Adverse events related to these devices that we expect clinicians to report to us include the following:
Pre-procedural
- mesh appears unsuitable to implant e.g. rough or sharp edges; too hard or brittle; not to specification
- packaging compromised affecting sterility.
Procedural related
- tape/mesh tears or disintegrates when implanting or fixing mesh in place
- bladder perforation.
Post operatively
- patient has an unexpected severe adverse/allergic tissue reaction to the mesh
- bladder perforation.
Longer-term patient follow-up
- evidence of mesh shrinkage, disintegration, hardening, brittleness
- recurrence of prolapse
- bladder perforation
- vaginal perforation
- recurrence of stress or urge incontinence
- mesh erosion/extrusion through tissues - especially where further surgery is needed for partial or total mesh removal
- dyspareunia
- persistent pelvic/groin pain.
Further information
NHS Choices webpage on treatment for prolapse of the uterus (external link).
NICE guidance
The National Institute for Health and Clinical Excellence (NICE) has produced guidance on the use of mesh for pelvic organ prolapse, which is available on the NICE website, along with summaries of the guidance produced for patients.
For the following procedures NICE guidelines state that current evidence on the efficacy and safety of these procedures is inadequate in quantity and quality. Therefore the procedure should only be used with special arrangements for clinical governance, consent and audit or research.
Infracoccygeal sacropexy using mesh for uterine prolapse repair (IPG280)
- Interventional procedure guidance for healthcare professionals (external link).
- Summary of this guidance for patients and carers (external link).
Infracoccygeal sacropexy using mesh for vaginal vault prolapse repair (IPG281)
- Interventional procedure guidance for healthcare professionals (external link).
- Summary of this guidance for patients and carers (external link).
Insertion of mesh uterine suspension sling (including sacrohysteropexy) for uterine prolapse repair(IPG282)
- Interventional procedure guidance for healthcare professionals (external link).
- Summary of this guidance for patients and carers (external link).
Sacrocolpopexy with hysterectomy using mesh for uterine prolapse repair (IPG284)
- Interventional procedure guidance for healthcare professionals (external link).
- Summary of this guidance for patients and carers (external link).
For the procedure Sacrocolpopexy using mesh for vaginal vault prolapse repair (IPG283), current evidence on the safety and efficacy of sacrocolpopexy using mesh for vaginal vault prolapse repair appears adequate to support the use of this procedure provided that normal arrangements are in place for clinical governance and audit.
- Interventional procedure guidance for healthcare professionals (external link).
- Summary of this guidance for patients and carers (external link).
Sunday, March 16, 2014
Transvaginal endoscopy and small ovarian endometriomas: unravelling the missing link?
Gynecol Surg. 2014;11:3-7. Epub 2013 Oct 17.
Abstract
The incidence of endometriosis in the infertile female is estimated to be between 20 and 50 %. Although the causal relationship between endometriosis and infertility has not been proven, it is generally accepted that the disease impairs reproductive outcome. Indirect imaging techniques and transvaginal laparoscopy now offer the possibility of an early stage diagnosis. Although it remains debated whether the disease is progressive, treatment in an early stage is recommendable as it carries less risk for ovarian damage, hence premature ovarian failure. Under water, inspection with the technique of transvaginal hydrolaparoscopy (THL) accurately shows the invagination of the ovarian cortex as minimal superficial lesions but with the presence of well-differentiated endometrial like tissue at the base, the lateral walls and especially the inner edges of the small endometrioma. An inflammatory environment is responsible for the formation of connecting adhesions with the broad ligament and lateral wall with invasion of endometrial-like tissue and formation of adenomyotic lesions. In around 50 % of the small endometriomas, adhesiolysis is necessary at the site of invagination with opening of the cyst, to free the chocolate content and hereby recognize the underlying endometrioma. The detailed inspection of these early-stage endometriotic lesions at THL reunites the hypothesis of Sampson with the observation of Hughesdon.
KEYWORDS:
Endometrioma, Endoscopy, Hydroflotation, Ovarian endometriosis, Pathogenesis, Surgery, Transvaginal hydrolaparoscopy
- PMID:
- 24611037
- [PubMed]
Saturday, March 08, 2014
Breaking News Genzyme Seprafilm
Attorney General J.B. Van Hollen Announces Settlement with Genzyme Corporation to Resolve Allegations of Off-Label Marketing
March 07, 2014
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| Targeted News Service |
Attorney General J.B. Van Hollen announced today that Wisconsin has joined with other states and the federal government to settle allegations thatGenzyme Corp. (Genzyme ) marketed and caused false claims to be submitted to federal and state health care programs for use of a "slurry" version of its Seprafilm adhesion barrier. Seprafilm is a thin film intended to reduce adhesions after surgery by forming a bio-resorbable barrier between abdominal tissue and organs. Genzyme is a biotechnology corporation based in Cambridge, Mass. , and was acquired by Sanofi-Aventis SA in April 2011 . As part of the settlement, Wisconsin Medicaid will receive $44,698.27 in restitution and other recoveries. Medicaid is a health insurance program for the needy and disabled jointly funded by the state and federal governments. The agreement resolves allegations that Genzyme sales representatives taught doctors and other staff to cut the Seprafilm sheets into small pieces, add saline and allow the pieces to dissolve until the desired consistency was reached. This mixture was referred to as "slurry." Genzyme sales representatives traded recipes for slurry, and trained each other in how to create it. The slurry was used in laparoscopic surgeries by inserting a catheter filled with the mixture into the body and applying it into the abdominal cavity. Seprafilm isFDA -approved for use in open abdominal surgery but not for minimally invasive surgeries, such as laparoscopic surgery. Allegedly, as a result of this conduct,Genzyme knowingly caused hospitals and other purchasers of Seprafilm to submit false and fraudulent claims to health care programs for uses that were not reimbursable.
TNS 30FurigayJof 140307-4659904 30FurigayJof
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