What is adhesion related disorder (ARD)?
Adhesion related disorder is a complex set of symptoms related to adhesions. Patient’s primary complaint is usually chronic abdominal pain. Their symptoms can be primarily in one area of the abdomen but are often generalized, vague, crampy and difficult to define. The symptoms of ARD could include:
•Chronic pain
•Infertility
•Bowel obstruction
•Gastro-esophageal reflux disease, (GERD)
•Urinary Bladder dysfunction
•Pain and difficulty having a bowel movement
•Pain on movement such as: Walking, sitting or laying in certain positions.
•Loss of Nutrients due to poor eating habits or loss of appetite.
•Loss of employment due to lost work days
•Loss of family and social life
•Emotional Disorders such as: Depression, Thoughts of Suicide, Hopelessness
Other intestinal problems can accompany the pain. Constipation or obstruction is sometimes encountered. Alternating constipation with diarrhea from partial obstruction can also be seen. Symptoms may also be related
Showing posts with label Peritoneal adhesions. Show all posts
Showing posts with label Peritoneal adhesions. Show all posts
Thursday, January 12, 2012
Wednesday, December 14, 2011
Sunday, October 02, 2011
Adhesion prevention in gynaecological surgery.
J Obstet Gynaecol Can. 2010 Jun;32(6):598-608.
[Article in English, French]
Robertson D, Lefebvre G, Leyland N, Wolfman W, Allaire C, Awadalla A, Best C, Contestabile E, Dunn S, Heywood M, Leroux N, Potestio F, Rittenberg D, Senikas V, Soucy R, Singh S; Society of Obstetricians and Gynaecologists of Canada.
SourceToronto ON.
Abstract
OBJECTIVES: To review the etiology and incidence of and associative factors in the formation of adhesions following gynaecological surgery. To review evidence for the use of available means of adhesion prevention following gynaecological surgery.
OPTIONS: Women undergoing pelvic surgery are at risk of developing abdominal and/or pelvic adhesive disease postoperatively. Surgical technique and commercial adhesion prevention systems may decrease the risk of postoperative adhesion formation.
OUTCOMES: The outcomes measured are the incidence of postoperative adhesions, complications related to the formation of adhesions, and further intervention relative to adhesive disease.
EVIDENCE: Medline, EMBASE, and The Cochrane Library were searched for articles published in English from 1990 to March 2009, using appropriate controlled vocabulary and key words. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, cohort studies, and meta-analyses specifically addressing postoperative adhesions, adhesion prevention, and adhesive barriers. Searches were updated on a regular basis and incorporated in the guideline to March 2009. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.
VALUES: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care SUMMARY STATEMENTS: 1. Meticulous surgical technique is a means of preventing adhesions. This includes minimizing tissue trauma, achieving optimal hemostasis, minimizing the risk of infection, and avoiding contaminants (e.g., fecal matter) and the use of foreign materials (e.g., talcum powder) when possible. (II-2). 2. The risk of adhesions increases with the total number of abdominal and pelvic surgeries performed on one patient; every surgery needs to be carefully considered in this context. (II-2). 3. Polytetrafluoroethylene (Gore-Tex) barrier is more effective than no barrier or oxidized regenerated cellulose in preventing adhesion formation. (I). 4. Oxidized regenerated cellulose (Interceed) adhesion barrier is associated with a reduced incidence of pelvic adhesion formation at both laparoscopy and laparotomy when complete hemostasis is achieved. Oxidized regenerated cellulose may increase the risk of adhesions if optimal hemostasis is not achieved. (II-2). 5. Chemically modified sodium hyaluronate/carboxymethylcellulose (Seprafilm) is effective in preventing adhesion formation, especially following myomectomies. There is insufficient evidence on the effect of sodium hyaluronate/carboxymethylcellulose on long-term clinical outcomes such as fertility, chronic pelvic pain or small bowel obstruction. (II-2). 6. No adverse effects have been reported with the use of oxidized regenerated cellulose, polytetrafluoroethylene, or sodium hyaluronate/carboxymethylcellulose. (II-1). 7. Various pharmacological agents have been marketed as a means of preventing adhesions. None of these agents are presently available in Canada. There is insufficient evidence for the use of pharmacological agents in preventing adhesions. (III-C).
RECOMMENDATIONS: 1. Surgeons should attempt to perform surgical procedures using the least invasive method possible in order to decrease the risk of adhesion formation. (II-1B ). When feasible, for example, a laparoscopic surgical approach is preferable to an abdominal approach, and a vaginal or laparoscopic hysterectomy is preferable to an abdominal hysterectomy. 2. Precautions should be taken at surgery to minimize tissue trauma in order to decrease the risk of postoperative adhesions. These precautions include limiting packing, crushing, and manipulating of tissues to what is strictly required for safe completion of the procedure. (III-B). 3. Surgeons could consider using an adhesion barrier for patients who are at high risk of forming clinically significant adhesions (i.e., patients who have endometriosis or pelvic inflammatory disease or who are undergoing a myomectomy). If there is a risk of ongoing bleeding from the surgical site, oxidized regenerated cellulose (Interceed) should not be used as it may increase the risk of adhesions in this situation. (II-2B).
PMID:20569542[PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/20569542
[Article in English, French]
Robertson D, Lefebvre G, Leyland N, Wolfman W, Allaire C, Awadalla A, Best C, Contestabile E, Dunn S, Heywood M, Leroux N, Potestio F, Rittenberg D, Senikas V, Soucy R, Singh S; Society of Obstetricians and Gynaecologists of Canada.
SourceToronto ON.
Abstract
OBJECTIVES: To review the etiology and incidence of and associative factors in the formation of adhesions following gynaecological surgery. To review evidence for the use of available means of adhesion prevention following gynaecological surgery.
OPTIONS: Women undergoing pelvic surgery are at risk of developing abdominal and/or pelvic adhesive disease postoperatively. Surgical technique and commercial adhesion prevention systems may decrease the risk of postoperative adhesion formation.
OUTCOMES: The outcomes measured are the incidence of postoperative adhesions, complications related to the formation of adhesions, and further intervention relative to adhesive disease.
EVIDENCE: Medline, EMBASE, and The Cochrane Library were searched for articles published in English from 1990 to March 2009, using appropriate controlled vocabulary and key words. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, cohort studies, and meta-analyses specifically addressing postoperative adhesions, adhesion prevention, and adhesive barriers. Searches were updated on a regular basis and incorporated in the guideline to March 2009. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.
VALUES: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care SUMMARY STATEMENTS: 1. Meticulous surgical technique is a means of preventing adhesions. This includes minimizing tissue trauma, achieving optimal hemostasis, minimizing the risk of infection, and avoiding contaminants (e.g., fecal matter) and the use of foreign materials (e.g., talcum powder) when possible. (II-2). 2. The risk of adhesions increases with the total number of abdominal and pelvic surgeries performed on one patient; every surgery needs to be carefully considered in this context. (II-2). 3. Polytetrafluoroethylene (Gore-Tex) barrier is more effective than no barrier or oxidized regenerated cellulose in preventing adhesion formation. (I). 4. Oxidized regenerated cellulose (Interceed) adhesion barrier is associated with a reduced incidence of pelvic adhesion formation at both laparoscopy and laparotomy when complete hemostasis is achieved. Oxidized regenerated cellulose may increase the risk of adhesions if optimal hemostasis is not achieved. (II-2). 5. Chemically modified sodium hyaluronate/carboxymethylcellulose (Seprafilm) is effective in preventing adhesion formation, especially following myomectomies. There is insufficient evidence on the effect of sodium hyaluronate/carboxymethylcellulose on long-term clinical outcomes such as fertility, chronic pelvic pain or small bowel obstruction. (II-2). 6. No adverse effects have been reported with the use of oxidized regenerated cellulose, polytetrafluoroethylene, or sodium hyaluronate/carboxymethylcellulose. (II-1). 7. Various pharmacological agents have been marketed as a means of preventing adhesions. None of these agents are presently available in Canada. There is insufficient evidence for the use of pharmacological agents in preventing adhesions. (III-C).
RECOMMENDATIONS: 1. Surgeons should attempt to perform surgical procedures using the least invasive method possible in order to decrease the risk of adhesion formation. (II-1B ). When feasible, for example, a laparoscopic surgical approach is preferable to an abdominal approach, and a vaginal or laparoscopic hysterectomy is preferable to an abdominal hysterectomy. 2. Precautions should be taken at surgery to minimize tissue trauma in order to decrease the risk of postoperative adhesions. These precautions include limiting packing, crushing, and manipulating of tissues to what is strictly required for safe completion of the procedure. (III-B). 3. Surgeons could consider using an adhesion barrier for patients who are at high risk of forming clinically significant adhesions (i.e., patients who have endometriosis or pelvic inflammatory disease or who are undergoing a myomectomy). If there is a risk of ongoing bleeding from the surgical site, oxidized regenerated cellulose (Interceed) should not be used as it may increase the risk of adhesions in this situation. (II-2B).
PMID:20569542[PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/20569542
Wednesday, June 15, 2011
Ceftriaxone Injection
Ceftriaxone Injection(sef try ax' one)
Last Revision: March 16, 2011.
Why is this medication prescribed?
Ceftriaxone injection is used to treat certain infections caused by bacteria such as gonorrhea (a sexually transmitted disease), pelvic inflammatory disease (infection of the female reproductive organs that may cause infertility), meningitis (infection of the membranes that surround the brain and spinal cord), and infections of the lungs, ears, skin, urinary tract, blood, bones, joints, and abdomen. Ceftriaxone injection is also sometimes given before certain types of surgery to prevent infections that may develop after the operation. Ceftriaxone injection is in a class of medications called cephalosporin antibiotics. It works by killing bacteria. Antibiotics will not work for colds, flu, or other viral infections.
How should this medicine be used?
Ceftriaxone injection comes as a liquid to be injected intravenously (into a vein) or intramuscularly (into a muscle). It is sometimes given as a single dose and sometimes given once or twice a day for 4-14 days, depending on the type of infection being treated. You may receive ceftriaxone injection in a hospital or doctor's office, or you may administer the medication at home. If you are using ceftriaxone injection at home, use it at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use ceftriaxone injection exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.
You should begin to feel better during the first few days of your treatment with ceftriaxone injection. If your symptoms do not improve or get worse, call your doctor.
If you will be using more than one dose of ceftriaxone injection, use the medication until you finish the prescription, even if you feel better. If you stop using ceftriaxone injection too soon or skip doses, your infection may not be completely treated and the bacteria may become resistant to antibiotics.
Other uses for this medicine
Ceftriaxone injection is also sometimes used to treat endocarditis (infection of the heart lining and valves), chancroid (genital sores caused by bacteria), Lyme disease (an infection that is transmitted by tick bites that may cause problems with the heart, joints, and nervous system), relapsing fever (an infection that is transmitted by tick bites that causes repeated episodes of fever), shigella (an infection that causes severe diarrhea), typhoid fever (a serious infection that is common in developing countries), salmonella (an infection that causes severe diarrhea), and Whipple's disease (a rare infection that causes serious problems with digestion). Ceftriaxone injection is also sometimes used to prevent infection in people who have been sexually assaulted or who have been bitten by humans or animals. Talk to your doctor about the risks of using this medication for your condition.
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.
What special precautions should I follow?
Before using ceftriaxone injection,
•tell your doctor and pharmacist if you are allergic to ceftriaxone injection, other cephalosporin or penicillin antibiotics, or any other medications.
•tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any intravenous medications or feedings that contain calcium such as total parenteral nutrition (TPN, a liquid feeding that is given intravenously to people who cannot eat or digest food).
•tell your doctor if you have or have ever had problems with your digestive system, especially colitis (inflammation of the large intestine), malnutrition (you do not eat or cannot digest the nutrients needed for good health), or kidney or liver disease.
•tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using ceftriaxone injection, call your doctor.
What special dietary instructions should I follow?
Unless your doctor tells you otherwise, continue your normal diet.
What should I do if I forget a dose?
Use the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not use a double dose to make up for a missed one.
What side effects can this medication cause?
Ceftriaxone injection may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
pain, tenderness, hardness, or warmth in the place where ceftriaxone was injected
headache
dizziness
sweating
flushing
diarrhea
Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:
rash
bloody, watery stools
fever
stomach cramps
stomach pain or bloating
nausea and vomiting
heartburn
chest pain
Ceftriaxone injection may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
What storage conditions are needed for this medicine?
If you will be injecting ceftriaxone injection at home, your health care provider will tell you where you should store it and how long you may keep it. Follow these directions carefully. Be sure to store ceftriaxone in the container it came in and out of reach of children. Throw away any medication that is outdated or no longer needed. Talk to your health care provider about the proper disposal of your medication.
In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
What other information should I know?
Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your body's response to ceftriaxone.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
American Society of Health-System Pharmacists, Disclaimer
AHFS® Consumer Medication Information. © Copyright, 2011. The American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.
The following brand names are from RxNorm, a standardized nomenclature for clinical drugs produced by the National Library of Medicine:
Brand names
•Rocephin
Last Revision: March 16, 2011.
Why is this medication prescribed?
Ceftriaxone injection is used to treat certain infections caused by bacteria such as gonorrhea (a sexually transmitted disease), pelvic inflammatory disease (infection of the female reproductive organs that may cause infertility), meningitis (infection of the membranes that surround the brain and spinal cord), and infections of the lungs, ears, skin, urinary tract, blood, bones, joints, and abdomen. Ceftriaxone injection is also sometimes given before certain types of surgery to prevent infections that may develop after the operation. Ceftriaxone injection is in a class of medications called cephalosporin antibiotics. It works by killing bacteria. Antibiotics will not work for colds, flu, or other viral infections.
How should this medicine be used?
Ceftriaxone injection comes as a liquid to be injected intravenously (into a vein) or intramuscularly (into a muscle). It is sometimes given as a single dose and sometimes given once or twice a day for 4-14 days, depending on the type of infection being treated. You may receive ceftriaxone injection in a hospital or doctor's office, or you may administer the medication at home. If you are using ceftriaxone injection at home, use it at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use ceftriaxone injection exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.
You should begin to feel better during the first few days of your treatment with ceftriaxone injection. If your symptoms do not improve or get worse, call your doctor.
If you will be using more than one dose of ceftriaxone injection, use the medication until you finish the prescription, even if you feel better. If you stop using ceftriaxone injection too soon or skip doses, your infection may not be completely treated and the bacteria may become resistant to antibiotics.
Other uses for this medicine
Ceftriaxone injection is also sometimes used to treat endocarditis (infection of the heart lining and valves), chancroid (genital sores caused by bacteria), Lyme disease (an infection that is transmitted by tick bites that may cause problems with the heart, joints, and nervous system), relapsing fever (an infection that is transmitted by tick bites that causes repeated episodes of fever), shigella (an infection that causes severe diarrhea), typhoid fever (a serious infection that is common in developing countries), salmonella (an infection that causes severe diarrhea), and Whipple's disease (a rare infection that causes serious problems with digestion). Ceftriaxone injection is also sometimes used to prevent infection in people who have been sexually assaulted or who have been bitten by humans or animals. Talk to your doctor about the risks of using this medication for your condition.
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.
What special precautions should I follow?
Before using ceftriaxone injection,
•tell your doctor and pharmacist if you are allergic to ceftriaxone injection, other cephalosporin or penicillin antibiotics, or any other medications.
•tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any intravenous medications or feedings that contain calcium such as total parenteral nutrition (TPN, a liquid feeding that is given intravenously to people who cannot eat or digest food).
•tell your doctor if you have or have ever had problems with your digestive system, especially colitis (inflammation of the large intestine), malnutrition (you do not eat or cannot digest the nutrients needed for good health), or kidney or liver disease.
•tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using ceftriaxone injection, call your doctor.
What special dietary instructions should I follow?
Unless your doctor tells you otherwise, continue your normal diet.
What should I do if I forget a dose?
Use the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not use a double dose to make up for a missed one.
What side effects can this medication cause?
Ceftriaxone injection may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
pain, tenderness, hardness, or warmth in the place where ceftriaxone was injected
headache
dizziness
sweating
flushing
diarrhea
Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:
rash
bloody, watery stools
fever
stomach cramps
stomach pain or bloating
nausea and vomiting
heartburn
chest pain
Ceftriaxone injection may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
What storage conditions are needed for this medicine?
If you will be injecting ceftriaxone injection at home, your health care provider will tell you where you should store it and how long you may keep it. Follow these directions carefully. Be sure to store ceftriaxone in the container it came in and out of reach of children. Throw away any medication that is outdated or no longer needed. Talk to your health care provider about the proper disposal of your medication.
In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
What other information should I know?
Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your body's response to ceftriaxone.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
American Society of Health-System Pharmacists, Disclaimer
AHFS® Consumer Medication Information. © Copyright, 2011. The American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.
The following brand names are from RxNorm, a standardized nomenclature for clinical drugs produced by the National Library of Medicine:
Brand names
•Rocephin
Tuesday, May 10, 2011
Intraperitoneal adhesions-an ongoing challenge between biomedical engineering and the life sciences.
J Biomed Mater Res A. 2011 May 4. doi: 10.1002/jbm.a.33083. [Epub ahead of print]
Intraperitoneal adhesions-an ongoing challenge between biomedical engineering and the life sciences.
Brochhausen C, Schmitt VH, Rajab TK, Planck CN, Krämer B, Wallwiener M, Hierlemann H, Kirkpatrick CJ.
SourceREPAIR-Lab, Institute of Pathology, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany. brochhausen@pathologie.klinik.uni-mainz.de.
Abstract
Peritoneal adhesions remain a relevant clinical problem despite the currently available prophylactic barrier materials. So far, the physical separation of traumatized serosa areas using barriers represents the most important clinical strategy for adhesion prevention. However, the optimal material has not yet been found. Further optimization or pharmacological functionalization of these barriers could give an innovative input for peritoneal adhesion prevention. Therefore, a more complete understanding of pathogenesis is required. On the basis of the pathophysiology of adhesion formation the main barriers currently in clinical practice as well as new innovations are discussed in the present review. Physiologically, mesothelial cells play a decisive role in providing a frictionless gliding surface on the serosa. Adhesion formation results from a cascade of events and is regulated by a variety of cellular and humoral factors. The main clinically applied strategy for adhesion prevention is based on the use of liquid or solid adhesion barriers to separate physically any denuded tissue. Both animal and human trials have not yet been able to identify the optimal barrier to prevent adhesion formation in a sustainable way. Therefore, further developments are required for effective prevention of postoperative adhesion formation. To reach this goal the combination of structural modification and pharmacological functionalization of barrier materials should be addressed. Achieving this aim requires the interaction between basic research, materials science and clinical expertise. © 2011 Wiley Periodicals, Inc. J Biomed Mater Res Part A: , 2011.
http://www.ncbi.nlm.nih.gov/pubmed/21548063
Intraperitoneal adhesions-an ongoing challenge between biomedical engineering and the life sciences.
Brochhausen C, Schmitt VH, Rajab TK, Planck CN, Krämer B, Wallwiener M, Hierlemann H, Kirkpatrick CJ.
SourceREPAIR-Lab, Institute of Pathology, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany. brochhausen@pathologie.klinik.uni-mainz.de.
Abstract
Peritoneal adhesions remain a relevant clinical problem despite the currently available prophylactic barrier materials. So far, the physical separation of traumatized serosa areas using barriers represents the most important clinical strategy for adhesion prevention. However, the optimal material has not yet been found. Further optimization or pharmacological functionalization of these barriers could give an innovative input for peritoneal adhesion prevention. Therefore, a more complete understanding of pathogenesis is required. On the basis of the pathophysiology of adhesion formation the main barriers currently in clinical practice as well as new innovations are discussed in the present review. Physiologically, mesothelial cells play a decisive role in providing a frictionless gliding surface on the serosa. Adhesion formation results from a cascade of events and is regulated by a variety of cellular and humoral factors. The main clinically applied strategy for adhesion prevention is based on the use of liquid or solid adhesion barriers to separate physically any denuded tissue. Both animal and human trials have not yet been able to identify the optimal barrier to prevent adhesion formation in a sustainable way. Therefore, further developments are required for effective prevention of postoperative adhesion formation. To reach this goal the combination of structural modification and pharmacological functionalization of barrier materials should be addressed. Achieving this aim requires the interaction between basic research, materials science and clinical expertise. © 2011 Wiley Periodicals, Inc. J Biomed Mater Res Part A: , 2011.
http://www.ncbi.nlm.nih.gov/pubmed/21548063
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