Monofilament nylon suture material undergoes both plastic and elastic elongation when stretched. Nylon inserted as a continuous suture for approximation of the abdominal musculo-aponeurosis may, therefore, allow early separation of the cut edges, which may predispose to the later development of an incisional hernia. This hypothesis was tested in a consecutive series of 302 major laparotomies randomized to be sutured with continuous mass nylon either to approximate or to compress the deep layers. The incidence of incisional hernia at 6 months in the group sutured with normal tension was 10.0 per cent, compared with 5.5 per cent in those tightly sutured. There was, however, an increased rate of minor wound infection in the latter group.
One hundred and sixty-six patients undergoing elective major laparotomy were skin tested preoperatively with four common recall antigens in an attempt to correlate preoperative cell-mediated immune status with postoperative septic complications. Nineteen patients were anergic, 22 relatively anergic and the remaining 125 reacted to two or more of the antigens and were regarded as normally reactive. No significant differences in morbidity or mortality were found between patients who had depressed delayed cutaneous hypersensitivity reactions and those who reacted normally. We conclude that identification of those patients with depressed cell-mediated immunity preoperatively does not help in predicting postoperative problems.
We measured the phagocytic capacity of the reticulo-endothelial system by assay of the clearance of colloidal carbon from the blood stream in both normal mice and mice in which shock had been induced by intraperitoneal injection of hypertonic glucose. The group of shocked mice was further subdivided into those pretreated with the immunoadjuvant, muramyl dipeptide (MDP), and those given placebo. Shock reduced reticulo-endothelial phagocytosis (P less than 0.01), whereas pretreatment of shocked mice with MDP led to a hyperphagocytic state (P less than 0.01). In a second series of experiments we subjected shocked mice, pretreated with MDP or placebo, to a virulent Klebsiella pneumoniae infection. MDP significantly improved survival (P less than 0.01).
Experiments have been undertaken to further characterize the actions of the synthetic immunoadjuvant compound, muramyl dipeptide (MDP), in an animal model simulating surgical infection. When used prophylactically in combination with antibiotics, MDP proved to be significantly additive in terms of local and systemic effects, and survival, to both chloramphenicol (p less than 0.01) and cephaloridine (p less than 0.05). The combined use of MDP and cephaloridine therapy, initiated four or six hours following infectious challenge and including a surgical foreign body in starved and refed animals, showed statistically significant decreases in bacteremia during early time periods, as well an increased early survival (p less than 0.02), compared with the use of cephaloridine alone. Benefits observed in the therapeutic mode were of lesser magnitude than those observed following prophylactic use, but the model used was a much more significant physiologic challenge. Evidence indicating additive effects to those of antibiotics is essential prior to the use of MDP in clinical trials.
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