The use of mesh in acute hernia: frequency and outcome in 99 cases

Background: Incarceration of inguinal, umbilical and cicatricial hernias is a frequent problem. However, little is known about the relationship between the use of mesh and outcome after surgery. The goal of this study was to describe the relationship between the use of mesh in incarcerated hernia and the clinical outcome. Patients and methods: Correspondence, operation reports and patient files between January 1995 and December 2005 of patients presented at one academic and one teaching hospital in Rotterdam were searched for the following keywords: incarceration, strangulation and hernia. The patient characteristics, clinical presentation, pre-operative findings and clinical course were scored and analysed. Results: A total of 203 patients could be identified: 76 inguinal, 52 umbilical, 39 incisional, 14 epigastric, 14 femoral, five trocar and three spigelian hernias. In the statistical analysis, epigastric, femoral, trocar and spigelian hernias were pooled, due to their small group sizes. One patient was excluded from the analysis because the hernia was not corrected during operation. In total, 99 hernias were repaired using mesh versus 103 primary suture repairs. Twenty-five wound infections were registered (12.3%). One mesh was removed during a reintervention for anastomotic leakage, although no signs of wound infection were present. Nine patients died, none of them due to wound-related problems [one cardiovascular, one ruptured aneurysm, two anastomotic leakage, two sepsis e causa incognita (e.c.i.), three pulmonary complications]. Univariate analysis showed that female patients (P = 0.007), adipose patients (P = 0.016), patients with an umbilical hernia (P = 0.01) and patients who underwent a bowel resection (P = 0.015) had a significantly higher rate of wound infections. The type of repair (e.g. primary suture or mesh), use of antibiotic prophylaxis, gender, ASA class and age showed no significant relation with post-operative wound infection. After logistic regression analysis, only bowel resection (P = 0.020) showed a significant relation with post-operative wound infection. Conclusions: Wound infection rates are high after the correction of acute hernia, but clinical consequences are relatively low. Mesh correction of an acute hernia seems to be safe and should be considered in every incarcerated hernia

Rubber Clay Nanocomposites

The use of nanofillers allows the development of nanocomposites with improved properties and novel applications. The technological goal is possible due to the new compounding method that allows a particle dispersion in the nanometer scale increasing the specific surface area.Fil: Cova Sánchez, Mariajose. Instituto Nacional de Tecnología Industrial. Instituto Nacional de Tecnología Industrial - Caucho; Argentina. Universidad Nacional de San Martín. Instituto de Investigación e Ingeniería Ambiental. - Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigación e Ingeniería Ambiental; ArgentinaFil: Bacigalupe, Alejandro. Universidad Nacional de San Martín. Instituto de Investigación e Ingeniería Ambiental. - Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigación e Ingeniería Ambiental; Argentina. Instituto Nacional de Tecnología Industrial. Instituto Nacional de Tecnología Industrial - Caucho; ArgentinaFil: Escobar, Mariano Martin. Instituto Nacional de Tecnología Industrial. Instituto Nacional de Tecnología Industrial - Caucho; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Mansilla, Marcela Angela. Instituto Nacional de Tecnología Industrial. Instituto Nacional de Tecnología Industrial - Caucho; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

How the Dutch plan to stay dry over the next Century

Over two-thirds of the Netherlands’ economy and half its population is below sea level. The Dutch government recently set out far-reaching recommendations on how to keep the country flood-proof over the next century given the likelihood of rising sea levels and river flows. This paper explains the recommendations, which are based on a gradual upgrading of safety standards in the light of economic growth and group casualty risk, together with triggers provided by debates and data on climate change. It concludes that protection is feasible both technically and economically, costing up to \u803 billion a year, and that the approach could be useful for other low-lying areas.Hydraulic EngineeringCivil Engineering and Geoscience