Leukocyte formula

The relevance of the prevention of postoperative adhesions can not speak: on the adhesive disease annually in the surgical wards treated about 1% of previously operated patients, intestinal obstruction occurs in 50-75% of patients with adhesive disease and soprovodzhaetsya high mortality rate, conservative treatment it is ineffective, and after surgeries recurrence 32 - 71%, reliable means of preventing postoperative adhesions of the abdominal cavity is still missing (Zhenchevsky RA, 1989; Kurguzov OP, Kuznetsov NA, Artyukhin, EG, 1990; Vorobiev AA, Geburashvili AG Pisarev, EE, 1998; Filenko BP, 2000).

The aim of our study was to develop a new effective way to prevent postoperative adhesions of the abdominal cavity and its validation in a surgical experiment.

In the literature, most authors are unanimous that the main etiopathogenetic brand viagra factor in the disease is damage to the peritoneal mesothelium and inflammation with a predominance of its proliferative phase (Cherenko MP, 1988; Zhenchevsky RA, 1989; Makshanov IJ, Karpik A. I. Polynsky AA, 1992; Osipov VI, 1992; Bezhin AI, Lipatov, VA, Gridasov YA, 2000; Thompson, J., 1998; Hooker GD, Taylor BM , Driman DK, 1999).

Considering literature data and data of their studies, it seems not enough to respect the principles of gentle attitude toward the peritoneum during the operation, since in some cases deserozirovaniya and loss of peritoneal mezoteliotsitov unavoidable. In this regard, and most authors, and we believe a rational use of additional resources aimed at prevention of postoperative adhesions. In studying the literature we found a tendency in recent years: it is considered that the most promising principle of providing a high prophylactic effect, is the use of funds, uncoupling of the wound surface (Osipov, VI, 1992; Di Zerega GS, 1994; Alponat A, Lakshminarasappa SR, Yavuz N, Goh PM, 1997; Baykal A, Onat D, Rasa K, Renda N, Sayek I., 1997, Zerega GS, 2001).

The most promising in this area is considered to be solutions of dextran and membrane consisting of cellulose ethers (methylcellulose, sodium carboxymethylcellulose), which possess high biological inertness, (Onat D, Rasa K, Renda N, Sayek I., 1997; Baykal A, Onat D , Rasa K, Renda N, Sayek I., 1997). However, dextran brand name drugs solutions rapidly eliminated from the peritoneal cavity, which requires their re-introduction, and the film is a mechanical irritant that can cause an aseptic reaction from both damaged, and from the healthy peritoneum. In this regard, we believe prospective intra-abdominal application of viscous substances indifferent to prevent postoperative adhesions of the abdominal cavity. In the available literature we have not found a way to prevent postoperative adhesions by intraperitoneal injection of gels.

Method was tested on a model of abdominal adhesions. In aseptic conditions, two series of male rats of Wistar (30 animals in each group) was reproduced adhesions by trauma abdomen. And the first group was control, and the second trial. After modeling adhesions animals of the latter group deserozirovannye sites peritoneum treated with 3% methylcellulose gel. Animals were removed from the experiment in 14 days by an overdose of ether anesthesia. Before the withdrawal of experience to assess the overall state, produces the total blood count. Rats were subjected to autopsy, a thorough study of the abdominal cavity, assess severity of adhesions visually and by using the method of semantic differential (Lipatov, VA, Grigoryan VV, 2000). Parietal peritoneum and abdominal organs were subjected to histological examination by standard methods with fixation in neutral formalin, embedded in paraffin casting, painting medium with hematoxylin-eosin, by Van Gieson, using silver impregnation Foot's method and staining with PAS-reaction. The research results are processed statistically (calculated using average values, Student's criterion, the coefficient of conjugation, the methods used chi-square, linear regression and correlation).

Statistically significant differences overall state performance of clinical blood leukocyte formula and indexes between control and experimental groups, we have not been found. In the control group, adhesions occurred in all animals, the severity of adhesions by the semantic differential was 3,39 ± 0,18 points. In the experimental group in only four animals occurred podpaivanie omentum to the median postoperative scar, and severity of adhesions by the semantic differential was only 0,02 ± 0,001 points (Table 1).

Histological examination of the animals of the first group corresponded to morphological organization of adhesions term breeding animals from the experiment. Evolution of the newly formed connective tissue tended to further differentiation. The basis of her was ripe kallogenovaya network with few elastic fibers. Cellular composition of the poor, represented mainly by differentiated fibroblasts and fibroblast. Parietal and visceral peritoneum of animals first series of thickened, fibrotic change. In the connective tissue adhesions is determined by the degeneration of the muscular layer of the intestine with the phenomena of disintegration of muscle fibers. This phenomenon was noted and parietal region of adhesions. By that time, union have well-defined vascular network, which already has an ordered structure.

In the second series examined the morphology of the peritoneum from the defect. By their histostructure peritoneum was not different from intact. Only in some preparations were determined by field focal fibrosis, signs of inflammation in the peritoneum of animals of the second series was not recorded.

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