European surgical research. Europäische chirurgische Forschung. Recherches chirurgicales européennes
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The innate immune system is suppressed after major orthopaedic surgery, implicating a risk of septic complications. Whole-blood ex vivo testing with lipopolysaccharide (LPS) has shown a depression of the tumour necrosis factor alpha (TNF-alpha) production until 12 days postoperatively. As part of the innate immune system, the Toll-like receptors TLR2 and TLR4 recognize antigens from Gram-positive and Gram-negative bacteria, respectively. The receptors CD14 and CD11b are involved in the LPS receptor complex, whereas human lymphocyte antigen (HLA)-DR binds endotoxin peptides. It is still uncertain whether the expression of all these receptors changes after major surgery. ⋯ After aseptic orthopaedic surgery, there is no change in the display of the LPS receptor complex on monocytes. Other mechanisms have to be investigated to gain insight into the decrease of the TNF-alpha production capacity postoperatively.
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The mechanisms of abnormal lymphocyte apoptosis in sepsis are only partially defined. The present study was designed to investigate whether the endoplasmic reticulum (ER) is implicated in the extensive apoptosis of lymphocytes in sepsis. ⋯ These data demonstrate activation of the unfolded protein response in lymphocytes and that ER stress may contribute to abnormal lymphocyte apoptosis during sepsis. Accordingly, the ER stress-mediated apoptosis pathway may be a novel target in clinical prevention and therapy of sepsis-induced lymphocyte apoptosis.
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We evaluated the technical feasibility and stability of measurements using visible light spectroscopy to measure microvascular oxygen saturation (StO(2)) in gastrointestinal anastomoses. ⋯ Visible light spectroscopy is a feasible and fast method for intraoperative assessment of microperfusion of the serosa in esophageal and colorectal anastomosis. Future clinical studies will define its role in the prediction of anastomotic leakage.
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This article reports the efficacy of percutaneous autologous platelet-leukocyte-rich gel (PLRG) injection as a minimally invasive method alternative to open grafting techniques. Each of 32 participants was followed on a regular basis with clinical examinations, roentgenograms, dual-energy X-ray absorptiometry examinations. In the delayed union group, the average time to union was 9.3 weeks after PLRG injection and the union was achieved in all cases. ⋯ Our investigation showed that percutaneous PLRG injection in delayed union is a sufficient method to obtain union, which is less invasive procedure than bone marrow injection. Percutaneous PLRG grafting can be also an effective method for the treatment of selected cases of nonunion. The essential factor is the average time from the initial surgery to PLRG injection for nonunion; <11 months seems to be critical for good outcomes.
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Seroma formation is the most common complication following mastectomy and axillary dissection (AD). Currently available interventions have aimed at obliterating dead space by inducing fibrosis and through various mechanical methods. Here, 5-fluorouracil (5-FU), used as a sclerosing agent for the prevention of seroma formation, was investigated in a rat mastectomy model. ⋯ The mechanisms underlying seroma prevention by 5-FU are probably related to a decrease in the inflammation and angiogenesis rather than a local fibrotic process. Seroma formation may be due to a prolonged inflammatory phase of wound healing.