Incisional hernias – results of present therapy options

Sp. Sf. Pantelimon, București, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Introducere: Hernia incizională este cea mai frecventă complicație după operațiile abdominale. Este dificil de estimat exact costul acestei patologii pentru societate. Dacă adăugam la costul intervenției chirurgicale și costul spitalizării, dificultățile operațiilor de recidivă multiplă, costul protezelor, morbiditățile pacienților neoperați, afectarea capacității de muncă și a calității vieții, vom avea magnitudinea problemei dezvoltate de această complicație redutabilă a tuturor intervențiilor chirurgicale. Material și metodă: Am analizat rezultatele mai multor studii de prestigiu ale unor colective românești și internaționale în domeniul herniilor incizionale. Rezultate: Din nefericire rezultatele globale ale tratamentului în hernia incizională oscilează între 12-63% pentru procedeele tisulare și între 2-36% pentru procedeele allopalstice. Abordul chirurgical este cel mai adesea bazat pe traditie si pe liberul arbitru, decat pe evidențe statistice sau ghiduri de tratament. Nu este deloc surprinzător faptul că, în ciuda noilor cuceriri în domeniul defectelor parietale și a folosirii explozive a protezelor, rata de re-operații pentru recidiva incizională se situează la același nivel. Concluzii: Componența operatorie ca unică etiologie în hernia incizională este supraestimată. Datorită faptului că și alți factori etiologici, cunoscuți sau nu, concura la apariția herniei incizionale și la re-recidivă, și datorită faptului că acești “factori” nu sunt deocamdată influențabili de tratamentul medical nu ne rămțne decât să analizăm lucid și responsabil factorii chirurg-dependenți. Greselile de tactică/tehnică chirurgicală trebuie evidențiate, explicate, și înlăturate. Soluția nu este o abordare pur tehnică, ci una fiziologică, în termeni de elasticitate, complianța și rezistența a întregului perete abdominal, deseori modificat profund de marile defecte incizionale.Introduction: incisional hernia is the most common complication after abdominal surgery. It is difficult to estimate the exact cost to society of this pathology. If we add to the cost of surgery and hospitalization costs, the difficulties of relapse multiple operations, the cost of prostheses, unoperated patient morbidity, impaired work capacity and quality of life, the magnitude of the problem we have developed this redoubtable complication of all surgical procedures. Methods: We analyzed the results of several studies of prestigious romanian and international collectives about incisional hernias. Results: Unfortunately, the overall results of treatment in incisional hernia procedures vary between 12-63% for tissular procedures and between 2-36% for allopalstic procedures. Surgical approach is most often based on tradition and the free will, rather than obvious statistical treatment guidelines. Not surprisingly, despite the new advancements in the field of herniology and the use of new parietal prosthesis, the rate of re-operations for recurrent incisional fall at the same level. Conclusions: Surgery as the only component in etiology of incisional hernias is overestimated. Due to the fact that other etiological factors, known or not compete in the emergence and re-incision hernia recurrence, and because these “factors” are not influenced by medical treatment for now, we are just lucid and analyze the factors responsible - surgeon dependent. Mistakes tactics/surgical technique must be highlighted, explained and removed. The solution is not a purely technical approach, but a physiological, in terms of elasticity, compliance and resistance of the entire abdominal wall

Cyanomethylene-bis(phosphonate)-Based Lanthanide Complexes: Structural, Photophysical, and Magnetic Investigations

10 pagesInternational audienceThe syntheses, structural investigations, magnetic and photophysical properties of a series of 10 lanthanide mononuclear complexes, containing the heteroditopic ligand cyanomethylene-bis(5,5-dimethyl-2-oxo-1,3,2λ5-dioxa-phosphorinane) (L), are described. The crystallographic analyses indicate two structural types: in the first one, [LnIII(L)3(H2O)2]*H2O (Ln = La, Pr, Nd), the metal ions are eight-coordinated within a square antiprism geometry, while the second one, [LnIII(L)3(H2O)]*8H2O (Ln = Sm, Eu, Gd, Tb, Dy, Ho, Er), contains seven-coordinated LnIII ions within distorted monocapped trigonal prisms...

The R403Q Myosin Mutation Implicated in Familial Hypertrophic Cardiomyopathy Causes Disorder at the Actomyosin Interface

Mutations in virtually all of the proteins comprising the cardiac muscle sarcomere have been implicated in causing Familial Hypertrophic Cardiomyopathy (FHC). Mutations in the beta-myosin heavy chain (MHC) remain among the most common causes of FHC, with the widely studied R403Q mutation resulting in an especially severe clinical prognosis. In vitro functional studies of cardiac myosin containing the R403Q mutation have revealed significant changes in enzymatic and mechanical properties compared to wild-type myosin. It has been proposed that these molecular changes must trigger events that ultimately lead to the clinical phenotype.Here we examine the structural consequences of the R403Q mutation in a recombinant smooth muscle myosin subfragment (S1), whose kinetic features have much in common with slow beta-MHC. We obtained three-dimensional reconstructions of wild-type and R403Q smooth muscle S1 bound to actin filaments in the presence (ADP) and absence (apo) of nucleotide by electron cryomicroscopy and image analysis. We observed that the mutant S1 was attached to actin at highly variable angles compared to wild-type reconstructions, suggesting a severe disruption of the actin-myosin interaction at the interface.These results provide structural evidence that disarray at the molecular level may be linked to the histopathological myocyte disarray characteristic of the diseased state

Influence of the Carbo-Chromization Process on the Microstructural, Hardness, and Corrosion Properties of 316L Sintered Stainless Steel

We report on the changes on the microstructural, hardness, and corrosion properties induced by carbo-chromization of 316L stainless steel prepared by Spark Plasma Sintering technique. The thermo-chemical treatments have been performed using pack cementation. The carburizing and chromization were carried out between 1153 K (880 A degrees C)/4 h to 1253 K (980 A degrees C)/12 h and 1223 K (950 A degrees C)/6 h to 1273 K (1000 A degrees C)/12 h in a solid powder mixture of charcoal/BaCO3 and ferrochromium/alumina/NH4Cl, respectively. The obtained layers were investigated using X-ray and electron diffraction, optical and scanning electron microscopies, Vickers micro-hardness, and potentiodynamic measurements. The thickness of the carbo-chromized layer ranges between 300 and 500 mu m. Besides the host gamma-phase, the layers are mainly constituted of carbides (Fe7C3, Cr23C6, Cr7C3, and Fe3C) and traces of alpha'-martensite. The average hardness values decrease smoothly from 650 HV at the sample surface down to 200 HV at the center of the sample. The potentiodynamic tests revealed that the carbo-chromized samples have smaller corrosion resistance with respect to the untreated material. For strong chromization regimes, the corrosion rate is increased by a factor of four with respect to that of the untreated material, while the micro-hardness of the layer is three times larger. Such materials are suited to be used in environments where good corrosion resistance and wear properties are required