Influence of Elevated Intra-abdominal Pressure on Suture Tension Dynamics in a Porcine Model.

Background: Inadequate suture tension is a risk factor for the failure of laparotomy closure. Suture tension dynamics in the abdominal wall are still obscure due to the lack of measuring devices. To answer the questions if intra-abdominal hypertension (IAH) influences suture tension in midline laparotomies and if IAH leads to a permanent loss of suture tension, microsensors were applied in a porcine model of IAH.

[Viral Infections Among the Nursing Personnel - a Survey].

Background And Aim: Healthcare workers (HCW) are at risk of occupational infections and can also transmit diseases to patients. The acceptance of measures to improve safety is linked to knowledge and risk awareness of HCW. The purpose of our study was to ascertain the knowledge and risk awareness of nursing staff regarding occupational infections and vaccinations as well as the frequency of needlestick injuries (NSI) in relation to the level of education.

An implantable sensor device measuring suture tension dynamics: results of developmental and experimental work.

Purpose: Knowledge about suture tension dynamics after laparotomy closure is limited due to the lack of adequate measurement tools. As a consequence, a miniaturized implantable sensor and data logger were developed and applied experimentally in a porcine model to measure suture tension dynamics after laparotomy closure.

Material And Methods: We developed an implantable device (6 × 3 × 1 mm) fitted with silicon strain gauges and an implantable data logger allowing long-term registration.

[Occupational exposure to blood in multiple trauma care].

Background: Trauma care personnel are at risk of occupational exposure to blood-borne pathogens. Little is known regarding compliance with standard precautions or occupational exposure to blood and body fluids among multiple trauma care personnel in Germany.

Aim: Compliance rates of multiple trauma care personnel in applying standard precautions, knowledge about transmission risks of blood-borne pathogens, perceived risks of acquiring hepatitis B, hepatitis C and human immunodeficiency virus (HIV) and the personal attitude towards testing of the index patient for blood-borne pathogens after a needlestick injury were evaluated.

The role of abdominal compliance, the neglected parameter in critically ill patients - a consensus review of 16. Part 2: measurement techniques and management recommendations.

The recent definitions on intra-abdominal pressure (IAP), intra-abdominal volume (IAV) and abdominal compliance (Cab) are a step forward in understanding these important concepts. They help our understanding of the pathophysiology, aetiology, prognosis, and treatment of patients with low Cab. However, there is still a relatively poor understanding of the different methods used to measure IAP, IAV and Cab and how certain conditions may affect the results.

A systematic review and individual patient data meta-analysis on intra-abdominal hypertension in critically ill patients: the wake-up project. World initiative on Abdominal Hypertension Epidemiology, a Unifying Project (WAKE-Up!).

Intra-abdominal hypertension (IAH), defined as a pathologically increase in intraabdominal pressure, is commonly found in critically ill patients. While IAH has been associated with several abdominal as well as extra-abdominal conditions, few studies have examined the occurrence of IAH in relation to mortality. The aim of this paper was to evaluate the prognostic role of IAH and its risk factors at admission in critically ill patients across a wide range of settings and countries.

A Systematic Review And Individual Patient Data Meta-Analysis On Intraabdominal Hypertension In Critically Ill Patients: The Wake-Up Project World Initiative on Abdominal Hypertension Epidemiology, a Unifying Project (WAKE-Up!).

Background: Intraabdominal hypertension (IAH), defined as a pathologically increase in intraabdominal pressure, is commonly found in critically ill patients. While IAH has been associated with several abdominal as well as extra-abdominal conditions, few studies have examined the occurrence of IAH in relation to mortality. Objective: To evaluate the prognostic role of IAH and its risk factors at admission in critically ill patients across a wide range of settings and countries.

Recognition and management of abdominal compartment syndrome among German pediatric intensivists: results of a national survey.

Introduction: Several decades ago, the beneficial effects of goal-directed therapy, which include decompressive laparotomy (DL) and open abdomen procedures in cases of intra-abdominal hypertension (IAH) in children, were proven in the context of closures of abdominal wall defects and large-for-size organ transplantations. Different neonatologic and pediatric disease patterns are also known to be capable of increasing intra-abdominal pressure (IAP). Nevertheless, a considerable knowledge transfer regarding such risk factors has hardly taken place.

Recognition and management of abdominal compartment syndrome among German anesthetists and surgeons: a national survey.

Background: Abdominal compartment syndrome (ACS) is a life threatening condition that may affect any critically ill patient. Little is known about the recognition and management of ACS in Germany.

Methods: A questionnaire was mailed to departments of surgery and anesthesia from German hospitals with more than 450 beds.

Influence of two different levels of intra-abdominal hypertension on bacterial translocation in a porcine model.

Background: The purpose of the present study was to quantify bacterial translocation to mesenteric lymph nodes due to different levels of intra-abdominal hypertension (IAH; 15 vs. 30 mmHg) lasting for 24 h in a porcine model.

Methods: We examined 18 anesthetized and intubated pigs (52.

Systemic toxicity of di-2-ethylhexyl terephthalate (DEHT) in rodents following four weeks of intravenous exposure.

Background: Di-2-ethylhexyl-terephtalate (DEHT) is a general purpose plasticizer and a structural isomer to di-2-ethylhexyl phthalate (DEHP) being known for its toxicity. Despite the fact that DEHT is used in quite a number of synthetics for medical device production including equipment for intravenous administration, toxicity of DEHT has not been assessed after/during intravenous exposure. Hence we report here the results of a toxicity study in male and female rats with continuous intravenous infusion of DEHT over 4 weeks.

[Laparotomy closure and incisional hernia prevention - what are the surgical requirements?].

In the light of an incisional hernia incidence of between 10 and 20 % that remains constantly high in spite of modifications of suture materials and suture techniques, intensified scientific efforts aiming at incisional hernia prevention are -required. This article reviews the scientific results dealing with incisional hernia incidence, time of manifestation, risk factors and the influence of suture material and suture technique. A lack of evidence-based data and no current consensus concerning the ideal material and technique to close laparotomies has to be mentioned.

Comet-tail-like inflammatory infiltrate to polymer filaments develops in tension-free conditions.

Background: Mesh reinforcement in hiatal hernia repair becomes more frequent but is charged by complications such as erosion or stenosis of the oesophagus. These complications are accompanied by an intense inflammatory infiltrate around the polymer fibres. To characterize this effect, the response to polypropylene fibres in the absence of tension was examined.

Abdominal compartment syndrome in childhood: diagnostics, therapy and survival rate.

Purpose: The abdominal compartment syndrome (ACS) in childhood is a rare but dire disease if diagnosed delayed and treated improperly. The mortality amounts up to 60% (Beck et al. in Pediatr Crit Care Med 2:51-56, 2001).

Serum analyses for protein, albumin and IL-1-RA serve as reliable predictors for seroma formation after incisional hernia repair.

Purpose: The aim of this study was to identify potential parameters as predictors for seroma formation after incisional hernia mesh repair.

Methods: The incidence of postoperative seroma was determined prospectively in 37 patients who underwent incisional hernia repair with lightweight polypropylene-polyglactin composite mesh (Vypro-II®). Postoperative seroma manifestation was related to patient characteristics (gender, age, BMI, comorbidity, nicotine abuse) and to preoperative serum concentration of total protein, albumin, interleukin-1-receptor-antagonist (IL-1-RA), propeptid-III-procollagen, hyaluronan and fibronectin.

Intraoperative laser fluorescence angiography in colorectal surgery: a noninvasive analysis to reduce the rate of anastomotic leakage.

Purpose: Up to 19% of all colorectal resections develop clinically apparent insufficiencies. Insufficient perfusion of the anastomosis is recognized as an important risk factor. As tissue perfusion can be objectified intraoperatively using laser fluorescence angiography (LFA), its effect on the rate of anastomotic complications was evaluated in a retrospective matched-pairs analysis.

Harrahill's technique: a simple screening test for intra-abdominal pressure measurement.

Background: Repair of giant incisional hernias may lead to an increase in intra-abdominal pressure (IAP) and, sometimes, to abdominal compartment syndrome. Measurement of IAP using Kron's technique (Kron et al. in Ann Surg 199:28-30, 1984) is currently accepted as the gold standard, whereas Harrahill has described a simple measurement setup using urinary drainage manometry (Harrahill in J Emerg Nurs 24:465-466, 1998).

Effects of preserved spontaneous breathing activity during mechanical ventilation in experimental intra-abdominal hypertension.

Purpose: Ventilation problems are common in critically ill patients with intra-abdominal hypertension. The aim of this study was to investigate the effects of preserved spontaneous breathing during mechanical ventilation on hemodynamics, gas exchange, respiratory function and lung injury in experimental intra-abdominal hypertension.

Methods: Twenty anesthetized pigs were intubated and ventilated for 24 h with biphasic positive airway pressure without (BIPAP(PC)) or with additional, unsynchronized spontaneous breathing (BIPAP(SB)).

Do drainage liquid characteristics serve as predictors for seroma formation after incisional hernia repair?

Background: Though the occurrence of postoperative seroma after incisional hernia repair using mesh reinforcement is very common, little is known about the genesis of seroma formation. The aim of this study was to determine the characteristics of drainage liquid as a potential predictor for the development of seroma after incisional hernia mesh repair. Furthermore, the characteristics of drainage liquid were compared to the characteristics of seroma liquid.

Histomorphologic and ultrastructural lesions of the pancreas in a porcine model of intra-abdominal hypertension.

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome are increasingly observed in patients with severe acute pancreatitis (SAP). The aim of this study was to investigate the effects of IAH on pancreatic histology and ultrastructure in a porcine model. We examined 16 intubated and anesthetized domestic pigs with a mean body weight of 50.

[Importance of abdominal compartment syndrome in Germany: a questionnaire].

Background: The abdominal compartment syndrome (ACS) is a life-threatening condition and may affect any critically ill patient. Little is known about the recognition and management of the ACS in Germany.

Methods: A postal questionnaire was sent to departments of surgery and anesthesia of German hospitals with more than 450 beds.

[Influence of volume increase on intra-abdominal pressure].

The aim of this review is to summarize the physiological and pathological aspects of the relationship between volume and intra-abdominal pressure (IAP). A capillary leak following trauma or inflammation can induce a volume shift into the abdomen. An increase of the IAP depends on the abdominal compliance, which is reduced by increases in intra-abdominal volume and pressure as well as by an upright body position and obesity.

Direct intra-abdominal pressure monitoring via piezoresistive pressure measurement: a technical note.

Background: Piezoresistive pressure measurement technique (PRM) has previously been applied for direct IAP measurement in a porcine model using two different devices. Aim of this clinical study was to assess both devices regarding complications, reliability and agreement with IVP in patients undergoing elective abdominal surgery.

Methods: A prospective cohort study was performed in 20 patients randomly scheduled to receive PRM either by a Coach-probe or an Accurate(++)-probe (both MIPM, Mammendorf, Germany).