POST-OPERATIVE ADHESION

Medicinal Uses. One of the earliest medicinal applications of the thiol proteases was the use of fig latex as an anthelmintic agent 16, 17). In more recent times papain has been used as a digestive aid in the treatment of dyspepsia and gastric distress. Its usefulness in this respect derives from the fact that papain remains active under acid conditions and is resistant to attack by pepsin. The intraperitoneal injection of sterile solutions of papain has proved to be effective in preventing post-operative adhesions. Papain is sometimes referred to as a T io-logical scalpel because of its specific proteolytic action on dead tissue without affecting live tissue. For this reason it serves as a very useful debridement in the treatment of bums and the removal of scar tissue. When used in combination with antibiotics, it has proved to be effective for topical treatment of ulcerating and infected lesions. 

Zhang, Z., Ni, J., Chen, L., Yu, L., Xu, J.W., Ding, J.D. Biodegradable and thermorevers-ible PCLA-PEG-PCLA hydrogel as a barrier for prevention of post-operative adhesion. Biomaterials 32,4725-4736 (2011)... 

Ellis H. The cause and prevention of post operative intraperitoneal adhesions. Surg Gynecol Obstet 1971 133 497-511. 

Becker, J. et al.. Prevention of post-operative abdominal adhesion by a sodium hyaluronate-based absorbable membrane A prospective, randomized, doubleblind multicenter study, /. Am. Coll. Surg., 183, 297, 1996. 

The essential mechanism of action of self-etch adhesives is that they simultaneously etch and prime the freshly cut tooth surface, and in doing so, incorporate the components of the smear layer [58,60]. Because of the presence of the smear layer, and also because of smear plugs blocking the dentinal tubules, self-etch adhesives have been claimed to provoke less post-operative sensitivity in patients than the etch-and-rinse approach [61,62]. However, this has not been confirmed by scientific studies [63,64], but rather any reduction in patient discomfort has been attributed to operator technique [15]. 

Oxidized regenerated cellulose has been used clinically as an absorbable adhesion barrier since 1989. Available as a knitted fabric (INTERCEED Absorbable Adhesion Barrier), it is the first material in the United States indicated for the prevention of post-operative pelvic adhesions. Since its introduction, additional clinical studies have been completed (Azziz et al, 1993 Sekiba et al, 1992 Franklin et al, 1995 Li Cooke 1994 Nordic Study Group, 1995) that confirm the efficacy of oxidized regenerated cellulose as an adhesion barrier. 

Some of the adhesive characteristics of fibrin sealant used to attach two pieces of tissue have also been measured. For example, a comparison of Tissucol fibrin sealant with sutures for incisional wounds in rodent dorsal skin indicated that the fibrin sealant repair had a higher bonding strength than the suture controls until four days post-operatively, when both groups were equivalent (Jorgensen et al, 1987). With these two methods there was a difference in the development of mechanical strength over time. 

Transdermal scopolamine is a muscarinic receptor antagonist used for the prevention of post-operative nausea and vomiting. It is supplied as a circular adhesive patch (0.2 mm thick and 2.5 cm ) applied to the post-auricular skin. Each patch contains 1.5 mg of the belladonna alkaloid programmed to continuously release in vivo approximately 1.0 mg over 72 hours. The patch consists of four distinctive layers. Going from visible surface to the surface adherent to the skin, these layers are (1) backing layer (2) drug reservoir of scopolamine (3) microporous polypropylene membrane that controls the rate of scopolamine delivery (4) adhesive contact surface with the skin. 

Copolymerisation of polycaprolactone with especially poly(D,L-lactide) gives flexible matrices (more flexible than either polylactide or polycaprolactone) with lower crystallinity and, therefore, higher degradation rates are achieved. An 80/20 copolymer of D,L-lactide/caprolactone was used to produce flexible suturable films that were successfully tested in vivo for the prevention of post-operative pleural and pericardial adhesion. These films maintained integrity for about one month post-implantation and were estimated by in vitro tests to be absorbed in about five months. Histological examination of the copolymer films revealed no evidence of interference with the natural healing of adjacent tissues. 

Post-operation tissue adhesion can occasionally cause serious complications. Materials for tissue adhesion prevention should be flexible and tough enough to provide a tight cover over the traumatized soft tissue. In addition, they should be... 

In order to obtain maximum corrosion protection for painted metal articles, the metal parts are pretreated with an inorganic conversion coating prior to the painting operation. These zinc or iron phosphate coatings greatly increase both paint adhesion and corrosion protection. Traditionally, a chromic acid post-treatment has been applied to these phosphatized metal surfaces to further enhance corrosion protection. 

If the instrument system is considered a Class 1 or Class 2 system, the Lead Operator (or Shifi Foreman) must be consulted and follow established procedures and his knowledge of the unit and the specifics of the situation to determine the temporary steps required. (Typically a Class 1 Shutdown System would have already tripped by this time.) Fhe Lead Operator will decide if it is tolerable to take the instrument out of service. If it is safe to do so, the Lead Operator will complete an out-of-service tag and mount it on the control panel. (This is a small brightly colored tag with adhesive on the back, like a Post It tag. It should be mounted on the control panel or other prominent place.)... 

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