Effects of bacterial infection on absorbable vascular ligating clips

Electron microscopic observations of two implanted absorbable clips, Absolok and Lactomer, infected with Escherichia coli and Streptococcus faecalis, were carried out. An overgrowth of bacteria was observed over the entire surface of the clips. The mating surfaces of the Lactomer clips and the locking mechanisms of both types of clip were more heavily infected--that is, provided better support for bacterial growth--than other areas of the clips in the initial postimplantation period. However, with longer periods (up to seven days), the initial bacterial deposits developed into a thick, plaquelike layer. This layer appeared to restrict access to the surfaces such that the infected clips degraded at a much slower rate than did the noninfected clips, particularly Lactomer clips, on which little morphologic change was detectable seven days after implantation.     

国产房间隔缺损封堵器乳猪模型实验观察

目的评价国产房间隔缺损封堵器的相容性和内皮化程度。 方法选用乳猪6头，应用房隔穿刺和Rashkind球囊房隔造口术，建立可控大小房间隔缺损(ASD)动物模型；在X线引导下，用测量球囊测定ASD最大伸展直径，并结合超声心动图选择适当大小的国产房间隔缺损封堵器进行猪的房间隔缺损堵塞；术后1个月、3个月和6个月分别将小猪处死(每次2只)，对标本进行肉眼、光镜和扫描电镜检查。 结果所有封堵装置表面均没有发现赘生物、血栓形成、支架发生断裂及被腐蚀；术后1个月，封堵装置表面被胶原纤维和散在内皮细胞所覆盖，大量炎症细胞浸润，封堵装置边缘有小灶性炎症细胞浸润；术后3个月，封堵装置表面几乎被内皮细胞所覆盖，炎症细胞较1个月时明显减少，封堵装置内见纤维化，封堵装置边缘心肌细胞浸入；术后6个月，封堵装置表面完全被心内膜和纤维组织所覆盖，伞尖表面光滑并有内皮细胞上爬，炎症反应明显消散，但仍有少量慢性炎症细胞存在，装置内有新生的血管、淋巴管长入。 结论国产房间隔缺损封堵器具有良好的生物相容性，置入动物体内3个月几乎完全内皮化，6个月已完全内皮化。     

A clinical evaluation of absorbable polydioxanone ligating clips in abdominal and pelvic operations

An absorbable vascular ligating clip made of polydioxanone polymer was evaluated in 44 patients who underwent abdominal and pelvic operations. These clips were used in place of conventional metallic clips primarily in performing pelvic and para-aortic lymphadenectomy. The polydioxanone clips were found to be superior to the metallic clips in ease of clip loading to the applier, security of clips in the transfer to the surgeon and security of the clip in the applier when positioning to ligate vessels. The use of polydioxanone clips, which absorb within 210 days, may also lead to improved CAT or NMR imaging by precluding energy scatter which is known to occur with some metallic clips. Clip applier function, security on tissues ligated and clip visibility were equivalent to previous experience using metallic clips. Selection of proper clip size is important so that excessive amounts of tissue are not contained within the clip jaws which might prevent clip closure. No postoperative complications were noted in the use of these clips.     

Accelerated tissue repair induced by micrococcus varians

The present investigation was undertaken to study the effect of inoculated Micrococcus varians organisms on developing granulation tissue in rats. Subcutaneously implanted hollow cylindrical cellulose sponges were used as an inductive matrix for the growth of granulation tissue. The control implants were injected immediately after implantation with 1 milliliter of physiologic saline solution while the experimental implants were injected with a corresponding volume of saline solution containing live micrococci 10(7) microorganisms per milliliter. Cytologic and bacteriologic analyses of wound fluid aspirated from the central dead space of the implants were carried out three, seven and 14 days after implantation. Local blood flow and albumin extravasation were measured on day seven and granulation tissue grown into the implants was analyzed chemically on days seven and 14. No macroscopic infection with pus formation occurred, while Micrococcus varians was cultured from each inoculated implant. In the inoculated implants, the number of wound fluid neutrophils, granulation tissue blood flow and albumin extravasation increased significantly above the control level. Correspondingly, the amounts of granulation tissue deoxyribonucleic acid, nitrogen, collagen hydroxyproline, hexosamines and uronic acids in the inoculated implants exceeded significantly the control value on both days seven and 14. To conclude, inoculation of experimental wounds with nonpathogenic Micrococcus varians organisms enhanced local inflammatory reaction and blood flow, and promoted granulation tissue formation.     

Laparoscopic clips. Evaluation of absorbable and titanium with regard to hemostasis and tissue reactivity.

Advanced laparoscopic techniques require laparoscopic means of providing hemostasis. We tested the hemostatic ability of laparoscopic surgical clips and their tissue reactivity as assessed by adhesion formation in an animal model. Twenty-six New Zealand white rabbits were randomized at laparotomy to one of three treatment groups: titanium surgical clips, absorbable surgical clips (both applied with a laparoscopic clip applicator) and chromic sutures of equal mass. Either the right fallopian tube was transected, with clips or sutures applied proximally and distally to control bleeding, or the clips or sutures were applied 5 mm apart and the tube transected. A clip or suture of the same material was placed on the midportion of the left fallopian tube. Necropsy was performed at 42 days, and each clip/suture site was scored for adhesions. All the materials were easily applied and effective in achieving hemostasis. The adhesion scores tended to be lower with the absorbable clips; however, there were no statistically significant differences between the groups. Laparoscopic clips are effective in providing hemostasis, are easily applied and cause no more adhesion formation than do conventional suture materials.     

Endoscopic sterilization by clips

214 medically indicated sterilizations using Hulka Clemens and Filshie clips were performed between March 1977-December 1981. Lieberman's Samaritan Clip Applicator and later the more manageable Hulka Applicator were used with the Hulka clips and the Filshie applicator was used with Filshie clips. Any laparoscope may be used with the clips, and the Palmer forceps is recommended for better application of the clip, which is only 14 mm long. All the applications were done under general anesthesia with intubation and involved overnight hospitalization, but the procedures have been done under local anesthesia on an outpatient basis in other centers. The procedure takes only a few minutes once the pneumoperitoneum is established. A 3-puncture technique was used, 1 for the laparoscope, 1 for the forceps to grasp the tube and present it perpendicularly to the jaws of the clip, and 1 for the clip applicator. No accidents were observed. Incidents may be related to local conditions, equipment, or operator. Obesity and previous interventions can make pneumoperitoneum and visualization of the tubes difficult. Thick tubes may escape the clip during closing. A 2nd clip was required in 1.4% of cases. In 1.4% of cases the clip dropped into the pelvic cavity and was retrieved with the Palmer forceps. Dropping never occurred when the Hulka applicator was used. In 2.2% of cases more pressure had to be exerted on the clip. No cases of tearing of the large ligament occurred. No pregnancies were recorded among the 214 patients in 11,474 cycles but 30% of patients did not respond to inquiries. The method affords good prospects of reversibility because of the minimal tubal loss. X-rays of the 1st 50 patients 1 1/2 months after the operation showed a unilateral tubal passage in 3 cases. It is likely that a sclerotic reaction would in time have completed the tubal obstruction in the absence of intervention. Some other form of contraception should be used for 3-4 months after application of clips.     

Novel technique and instrumentation for laparoscopic application of hemostatic clips

A novel device for applying hemostatic clips in laparoscopic surgery incorporates a distal hook into a multiple-firing titanium clip applier. The hook may be used for blunt dissection of tissue, and to displace and control ducts and vessels during clip application. A single instrument may be used to achieve hemostasis in areas that are difficult to reach, and past pointing problems encountered with straight on clip appliers are alleviated. Comparative testing of the holding force of the curved clips used with this device versus the straight clips used in conventional multiple-clip appliers demonstrated a higher mean pull-off force of 0.473 lbs versus 0.33 lbs. Clinical application of the device in laparoscopic procedures including cholecystectomy, vaginal hysterectomy, Nissen fundoplication, vagotomy, varicocelectomy, and lymphadenectomy show the utility of the hook clip applier.     

猪小肠黏膜下层补片植入兔膀胱阴道间隙的转归研究

目的观察猪小肠黏膜下层(SIS)补片植入兔膀胱阴道间隙的转归,探讨SIS补片在妇科盆底手术中的应用价值。方法以家兔作为动物模型,16只雌性家兔随机(抽签法)分为4组,即7 d组、30 d组、90 d组和180 d组,每组4只家兔。4组家兔均通过手术方式于膀胱阴道间隙内植入SIS补片,分别于术后7、30、90、180 d处死各组家兔,并同时整块取出补片及其周围的膀胱阴道组织。标本均制成蜡块后切片,采用HE染色观察补片内部及周围组织产生的形态学变化,采用Masson染色观察补片组织内胶原形态和数量的变化。结果(1)HE染色后光镜下观察,7 d组SIS补片周围可见大量以嗜酸性粒细胞和淋巴细胞为主的炎性细胞浸润,并可见新生血管形成;30 d组炎性细胞浸润区域进一步增大;90 d组炎性细胞浸润区域明显缩小;180天组炎性反应基本消退。(2)Masson染色后光镜下观察,7 d组4只家兔SIS补片胶原结构清晰,保留完整;30 d组4只家兔SIS补片已有部分降解,但仍可见SIS胶原结构;90 d组有2只家兔尚可见少量残留SIS碎片结构,另2只家兔的SIS补片已被完全降解;180 d组4只家兔的SIS补片均被完全降解,其中1只家兔似可见部分有排序的胶原结构。结论SIS补片植入兔膀胱阴道间隙后可导致一过性的非感染性炎症反应,植入180 d后可被完全降解并有少量新生胶原结构产生。SIS补片用于盆底重建手术需谨慎。     

Anatomical findings in fallopian tubes under fertility control by culdoscopic clipping

Tantalum clips placed on the isthmus of the fallopian tube were applied to 47 women by conventional culdoscopy. After 4 to 28 months, segments of tube were removed by culdoscopy, fixed in 10% formalin, and photographed and examined with and without the clip. Eosin and hematoxylin and van Gieson stained serial sections at 7 micro were also studied. Grossly, the clip region showed thickened serosa which sometimes obscured the clip itself. Histologically, 3 types appeared: 13 had gradual narrowing and reduced epithelial folding, 20 showed a narrow slit lined with flat atrophied epithelium, and 6 had a 25 micron slit, no folds, and flat or cuboid epithelium. Some were infiltrated with giant cells and lymphocytes. In 24 patients the 2 tubes had different patterns.     

Implantation site in complete molar pregnancy: a study of immunologically competent cells with monoclonal antibodies

The nature and intensity of inflammatory cellular infiltrate in the implantation sites of 10 complete molar pregnancies were evaluated by immunohistochemical staining of frozen tissue sections with monoclonal antibodies. As compared to the implantation site in normal pregnancy, there was an increase in the number of infiltrating inflammatory cells in the molar implantation site. Most of the inflammatory cells were T cells with predominance of T4+ (Leu-3a+) cells over T8+ cells. Inflammatory cells were not detected in the molar vesicles. The possible implications of these findings in molar pregnancy are discussed.     

Propagation and hormone production by human normal and malignant trophoblast in rats. I. Normal trophoblast from term human placentas in Millipore diffusion chambers

Human trophoblast from term and near-term placentas proliferated in Millipore filter (MF) diffusion chambers in the rat for 4 weeks. The growth pattern and cell morphology showed differences in intact adult females, immature animals and ovariectomized animals indicating that steroid hormones might influence proliferation and differentiation of these cells. In intact adult females, polypoid buddings were observed from the implanted chorionic villi after 2 weeks. After 3 weeks, these formed multilayered epithelioid cell cultures. In ovariectomized rats propagation was delayed and, after 4 weeks, cell cultures of embryonic type appeared with small epithelioid aggregates. In immature animals, proliferation began soon after implantation. 2 weeks later a monolayer cell culture was formed of mesenchymal cells and epithelioid cells aggregated in relatively large clusters. Human chorionic gonadotropin w as produced in these chambers since gonadotropic effects were seen in intact rats but not in ovariectomized rats. This transplantation technique provides a possiblility for a combined tissue culture and hormonal bioassay method.     

Islet isolation and transplantation techniques in the primate

Aspects of islet transplantation in the primate have been investigated using a model of autotransplantation of islets in the monkey after total pancreatectomy. The results showed that the subcapsule of the kidney was not a good site for implantation of relatively impure islet preparations, or of purified islet preparations if the mass of tissue implanted was marginal. The spleen was a much better site for the islet implantation, allowing fasting normoglycemia in many of the animals. The results of histologic examination of the spleen four to six weeks after intrasplenic islet transplantation showed good preservation of islet morphologic features, with numerous islets scattered throughout the spleen. Cells secreting insulin, glucagon and somatostatin were present in approximately normal proportions. Transplantation of islets into the portal vein produced good short and long term function. A number of grafts failed between four and 18 months, this failure being related to the function demonstrated at six weeks by intravenous glucose tolerance tests. Animals with poor initial function tended to fail early. However, those with good initial function continued to gain weight and remain normoglycemic up to 2.5 years, providing encouragement to improve further the yield and purity of the islet preparation as well as seeking more efficient techniques for islet implantation.     

Tissue reaction to polypropylene mono-or multi-filament tapes used in surgical techniques of stress urinary incontinence treatment

OBJECTIVES: The "gold standard" in surgical treatment of stress urinary incontinence (SUI) is sling operation with polypropylene tape appliance under the mid urethra. There are two types of polypropylene tape which are the most popular nowadays. These two tapes are differently knitted so they have different biomechanical features. The TVT tape is monofilament, rarely knitted and highly elastic but the IVS mesh is multifilament, densly knitted and has only little possibility to stretch. The aim of our study was to assess the tissue reaction to the mono-(TVT) and multifilament (IVS) tapes. MATERIAL AND METHODS: The 10 mm x 10 mm pieces of TVT and IVS tapes were implanted inlay the fascia of musculus abdominis rectus of 14 rat females (2 groups of 7 animals). The tapes with the margin of surrounding fascia were taken off after 6 weeks of healing. All samples were fixed in 10% Formaldehyde in phosphate buffered saline and embedded in paraffin. Four micron tissue sections were stained with hematoxylin and eosin, the reticulin silver impregnation stain according to Gomori (for collagen type III) and periodic acid Schiff and alcian blue (for proteoglycan). RESULTS: In all sections filaments visible as elipsoids were surrounded by resorptive granulation with large multinucleated giant cells like around "foreign body". The diameter of monofilaments was about 150 microns. The connective tissue in the vicinity of mesh was rich of inflammatory cells like histiocytes, lymphocytes, a few polymorphonuclear leucocytes as well as adipocytes and fibroblasts. The large multinucleated giant cells adjacent to monofilaments were relatively bigger than these cells around multifilaments. Moreover, this granulation tissue has a lot of new blood vessels and collagenous fibrous tissue. The multifilaments were about 40 microns in diameter. The inflammatory granulation infiltrated aggregates of multifilaments. This tissue had only few inflammatory cells in comparison to tissue around monofilaments. The large multinucleated giant cells apposed to the mesh were small and collagen created thicker, more compacted bundles. CONCLUSION: The multifilament polypropylene tape induces weaker inflammatory tissue reaction than monofilament mesh. The thicker and more compacted collagen bundles are created around multifilaments so the natural tensile strength of the surrounding tissue is probably higher.     

Endocrine and clinical effects of estradiol and testosterone pellets used in long-term replacement therapy

Ten women with estrogen deficiency symptoms because of premature menopause [3], gonadal dysgenesis [3], or surgical menopause [4] received subcutaneous implants consisting of 25--75 mg estradiol (E2) with or without 75 mg testosterone (T). All had elevated plasma FSH, and LH, and low E2 prior to treatment. Plasma levels of FSH, LH, E2, T and estrone (E1) were measured by specific radioimmunoassay techniques prior to treatment, three times a week for the first week and once a week for up to 76 weeks after implantation. Mean plasma E2 levels rose abruptly and reached a maximum of 190 +/- 35 pg/ml within 2 weeks. They fluctuated around 150 pg/ml for 46 weeks, then gradually declined, but remained above pretreatment values for more than 68 weeks. Plasma E1 increased to a lesser extent resulting in E2:E1 ratio between 1 and 5. Elevated FSH and LH titers became suppressed within 4--6 weeks. The lowest average E2 increased occurred after 25 mg implant and was associated with incomplete FSH and LH suppression. There were no differences in maximal E2 levels reached after 50 mg or 75 mg implant, however, after 75 mg implant, E2 levels appeared less variable and were sustained for a longer period of time, averaging 125 pg/ml for 70 weeks. Plasma FSH and LH concentrations were suppressed below pretreatment levels in all patients. The degree of suppression was related to the dose of E2 implanted and, therefore, to plasma E2 levels. The FSH and LH suppression appeared more complete in women with gonadal dysgenesis than in those with premature or natural menopause. Plasma T rose abruptly to a peak mean level of 2.5 +/- 1.6 ng/ml within 2 weeks of implantation. A precipitous and steady decline with return to preimplantation titers between 17th and 18th week were then observed. The E2:E1 ratio during the first 18 weeks after implantation was significantly higher in women who received E2 implant alone than in those who received E2 + T implant. Clinically, all patients had symptomatic improvement within 24--48 hours. Regular withdrawal bleeding followed administration of oral progestogen for up to 76 weeks after implantation in six patients with intact uterus.     

The fate of rectus fascia suburethral slings

OBJECTIVE: Autologous rectus fascia is commonly used to construct suburethral slings for the treatment of genuine stress incontinence. This fascia performs well and has not been associated with clinical problems related to its choice as a sling material. However, the histologic appearance of such slings after implantation has not been documented. STUDY DESIGN: At the time of revision of autologous rectus fascia suburethral slings in 5 patients, biopsy specimens of the slings were obtained and submitted for histologic examination. A specimen of rectus fascia before implantation was also obtained from a sixth patient who had no symptoms. RESULTS: After implantation autologous rectus fascia slings remain viable. There is fibroblast proliferation, neovascularization, and remodeling of the graft. No evidence of inflammatory reaction or of graft degeneration was detected. A linear orientation of connective tissue and fibroblasts was seen in some areas, whereas other areas had remodeled to form tissue similar to noninflammatory scar. CONCLUSION: Autologous rectus fascia slings undergo extensive remodeling after implantation.     

Effect of BCG vaccine on peritoneal endometriotic implants in a rat model of endometriosis

OBJECTIVE: To investigate the effect of Bacillus Calmette-Guerin (BCG) vaccine on peritoneal implantation of endometrial tissue in rats. METHODS: Forty sexually mature virgin Wistar albino rats weighing 190-200 g were randomly assigned (double blind) to two groups. The rats in the first group were vaccinated with 0.1 mL BCG and those in the second group were injected with 0.1 mL saline into the tail, intracutaneously. All the rats underwent median laparotomy after 4 weeks of vaccination or injection. The right uterine horn was excised, and the two samples of endometrial tissue dissected from myometrium were implanted on each side of peritoneum at the 2 cm lateral line of the median laparotomy incision. The implanted peritoneal segments were excised after 8 weeks of laparotomy. The tissue samples were accepted, histologically, as endometriosis when both glands and stroma of endometrial tissue were seen in sections. RESULTS: Thirty-six implants from the study group and 34 implants from the control group were obtained. Ten and 23 implants were accepted as endometriosis in the study and control group, respectively. The number of endometriotic foci were significantly lower in the study group than in the control group (P = 0.01). CONCLUSIONS: Stimulation of the cellular immune response with BCG vaccine could exert an inhibitory effect on ectopic endometriotic implants.     

A clinically relevant orthotopic implantation nude mouse model of human epithelial ovarian cancer—based on consecutive observation

The aim of this study is to establish an orthotopic implantation nude mouse model of epithelial ovarian cancer (EOC) and observe its biologic features. A human ovarian tumor line SKOV3ipl previously grown subcutaneously was implanted orthotopically as intact tissue into the ovarian capsule of 64 nude mice. Every week eight mice were taken randomly, and the tumor growth pattern and extent of metastatic disease were monitored continuously. Those mice that died of disease were necropsied and the end date was recorded. The orthotopic implanted tumors demonstrated a 100% take rate. Three weeks after implantation the tumors grew fast and weighed 1149 +/- 152 mg, and 5 weeks after implantation the tumors reached a flat stage. The tumors metastasized more often to peritoneum (32/56) and diaphragm (18/56), then to pelvic lymph nodes (11/56) and lung (10/56), and then to the seldom invaded organs including the pancreas, the liver, the contralateral ovary, and the para-aortic lymph node. Eight nude mice became exhausted 7 weeks after implantation and died within 68 days after implantation. Our study, utilizing the SKOV3ipl cell, is the first model of consecutive observation of the process of invasion and metastasis of EOC. It should be useful in understanding the molecular biology of EOC and in the development of therapeutic modalities against metastasis.     

Sudies in simpler tubocclusion methods.

This report reviews animal and human studies undertaken to develop simpler, safer, and more acceptable methods of female sterilization. Animal studies revealed inadequate prevention of pregnancy by tubocclusive methods from within the uterus, and the laparoscopic route was chosen. A series of clips were evaluated, and a clip was designed which would have a spring load, be wide enough to cause true tissue necrosis, have a firm grip on the tube to prevent dislodgement, and have a smooth external surface. Extensive human trials of the clip and applicator have resulted in over 1,000 patients with clips applied by 27 physicians in 10 centers throughout the world. Six pregnancies appear to have been due so far to application onto structures other than the isthmic portion of the tube. Complications due to the clip itself appear to be minimal, and the feasibility of performing this operation under local anesthesia in a hospital facility other than the operating room is currently under evaluation.     

Female Sterilization By the Vaginal Route: A Positive Reassessment and Comparison of 4 Tubal Occlusion Methods

Summary: Over the last 15 years female sterilization by the vaginal route has been abandoned in favour of the abdominal approach via a laparoscope or a suprapubic incision. This was justified when the vaginal route was used for a fimbriectomy or a Pomeroy type of sterilization. The use of tubal occlusion methods designed for the laparoscope has simplified the technique of vaginal sterilization and lowered the morbidity.
Four hundred and ninety consecutive cases over an 18-year period are reviewed. Four hundred and eighty five were completed vaginally. The methods used were Pomeroy with catgut, Falope ring, Hulka and Filshie clips. The Filshie clip was the most satisfactory. Vaginal sterilization is suitable for day care. The readmission rate was 1%. There was no case of pelvic infection in 177 clip cases but 5 in 173 where the Pomeroy technique was used. The pregnancy rate was highest with the Hulka clip. The overall rate was 1%. With clip methods strong analgesics were only required in 6% postoperatively and only 14% took any analgesic after returning home; consequently return to normal activities was rapid. The patient's weight was not related to operative difficulty when clips were used so the vaginal route may prove to be the method of choice in the obese. Filshie clip sterilization via the posterior fornix of the vagina could be the most cost-effective method of sterilization available at present . The vaginal route needs reappraisal using contemporary methods of tubal occlusion.     

冻融后移植的小鼠卵巢组织对促性腺激素的反应

目的 探讨冻融后移植的小鼠卵巢组织对促性腺激素的反应.方法 将36只性成熟雌性小白鼠随机分为新鲜移植组、冻融移植组和对照组,每组12只.新鲜移植组小鼠切除双侧卵巢,将卵巢切成小组织块,立即移植人双侧肾被膜下;冻融移植组小鼠切除双侧卵巢,将卵巢切成小组织块,采用玻璃化冷冻方法冷冻保存,2周后将冷冻卵巢组织复苏,移植入小鼠双侧肾被膜下.卵巢组织移植2周后,新鲜移植组和冻融移植组每组随机取6只小鼠应用7.5 IU人绝经期促性腺激素及10 IU绒毛膜促性腺激素,观察移植后的卵巢组织对促性腺激素的反应.同时应用免疫组化染色方法观察各组卵泡中卵泡刺激素受体的表达情况.结果 新鲜移植组、冻融移植组和对照组未应用促性腺激素小鼠卵巢组织内近成熟卵泡百分率分别为2.3%、2.3%和2.6%,应用促性腺激素小鼠卵巢组织内近成熟卵泡百分率分别为4.2%、4.0%和5.8%,各组内分别比较,差异均有统计学意义(P＜0.05);新鲜移植组和冻融移植组与对照组比较,差异均元统计学意义(P＞0.05).新鲜移植组、冻融移植组和对照组卵泡刺激素受体表达积分吸光度值在窦状卵泡中分别为9408±2777、9175±3093和8838±2064,在窦前卵泡中分别为4531±1903、4808±1386和5516±1136,各组间分别比较,差异均无统计学意义(P＞0.05).结论 卵巢组织冷冻保存、复苏及移植过程未影响卵巢卵泡刺激素受体的表达,冻融后移植的小鼠卵巢组织对外源性促性腺激素的反应未受冷冻、复苏及移植等过程影响.