Izvanbolnička istodobna operacija ventralne i preponske hernije u lokalnoj anesteziji: prikaz slučaja

Umbilical and epigastric hernias are occasionally seen in patients with groin hernias, however, there is almost no published evidence about their simultaneous repair. In a 3-year period, 10 patients were subjected to simultaneous repair of groin hernias (7 unilateral, 2 bilateral inguinal and 1 femoral) and ventral hernias (7 primary, 2 recurrent umbilical and 1 epigastric) with local infiltration anesthesia and intravenous sedation. The mean total bupivacaine dose was 18 (10- 30) mL and mean total lidocaine dose 21 (14-30) mL. The mean time to resuming normal daily activity was 5.5 days, whereas the time to car driving was 3-7 days. The oral analgesic (naproxen sodium) requirement was 6-10 tablets for 3-5 days. Patient acceptance was excellent. Simultaneous repair of groin and ventral hernias with local anesthesia in outpatient setting is feasible and associated with a low complication rate and maximum patient comfort.Umbilikalne i epigastrične hernije ponekad se nalaze u bolesnika s preponskom hernijom, međutim, gotovo da nema objavljenih podataka o njihovom istodobnom operacijskom liječenju. Tijekom 3-godišnjeg razdoblja istodobna operacija preponskih hernija (7 jednostranih, 2 obostrane ingvinalne i 1 femoralna) i ventralnih hernija (7 primarnih i 2 opetovane umbilikalne i 1 epigastrična) u lokalnoj infiltracijskoj anesteziji i intravenskoj sedaciji izvedena je u 10 bolesnika. Srednja ukupna doza bupivakaina bila je 10 (10-30) mL, a srednja ukupna doza lidokaina 21 (14-30) mL. Srednje vrijeme do povratka normalnih svakodnevnih aktivnosti bilo je 5,5 dana, a za upravljanje motornih vozilima 3-7 dana. Potreba za oralnim analgeticima (naproksen natrij) bila je 6-10 tableta kroz 3-5 dana. Bolesnici su izvrsno prihvatili ove zahvate. Istodobno rješavanje preponske i ventralne hernije uz lokalnu anesteziju u izvanbolničkim uvjetima izvedivo je, ima nisku stopu komplikacija i najvišu razinu udobnosti za bolesnika

Diagnostic Value of Blood D-dimer Level in Acute Mesenteric Ischaemia in the Rat: An Experimental Study

ObjectiveThe high mortality rate of mesenteric ischaemia is mainly due to delay in diagnosis. For this reason, it is of great importance to find a specific and rapidly elevating marker. The present study investigated the diagnostic value of blood D-dimer level as a potential marker for acute mesenteric ischaemia in a rat model.MethodsThirty male Wistar albino rats were divided into three groups. Basal D-dimer and L-lactate levels were determined in the non-operative control group (I). In the operated control group (II), the superior mesenteric artery was simply manipulated, while the artery was ligated in Group III. Blood samples were drawn in all groups for D-dimer and L-lactate assays.ResultsBoth Group II (p = 0.016) and Group III (p = 0.001) had significantly higher mean D-dimer levels in the first postoperative hour compared with the basal level in Group I. However, there was no difference between the levels in Groups II and III. The mean level in Group II in the sixth hour had dropped to a statistically insignificant level compared with the basal value, while the mean value in Group III kept rising during this period (p = 0.001). Nevertheless, there was no significant difference between Groups II and III. On the other hand, the mean L-lactate level in the first postoperative hour in Group III was significantly higher than the basal level in Group I (p = 0.003). No significant rises were recorded in Group II in the first and sixth postoperative hours. The difference between Groups II and III in the first hour was significant (p = 0.005). Group III also had significantly higher mean serum L-lactate value in the sixth hour compared with both the basal value in Group I (p = 0.001) and the sixth-hour value in Group II (p = 0.003).ConclusionThese results do not adequately support the use of blood D-dimer level as an independent parameter in the diagnosis of mesenteric ischaemia due to arterial thrombosis. However, this parameter can be used together with other tests in eliminating the possibility of a thromboembolic event

Recurrent Incisional Hernia due to Pseudomyxoma Peritonei

Pseudomyxoma peritonei is a rare but challenging neoplastic disease which is characterized with intraperitoneal mucinous-gelatinous fluid accumulation. It rarely presents as a mass mimicking abdominal wall hernias A recurrent incisional hernia due to pseudomyxoma peritonei is presented here. A 60-year-old female patient had been operated on for a left mucinous ovarian cyst 20 cm in diameter in 1998. Mucinous material had disseminated into interloop spaces through the right subdiaphragmatic region. Total abdominal hysterectomy + bilateral salpingooophorectomy and peritoneal toilet had been performed. She was rehospitalized for abdominal distention and a 4 cm defect over the incision and underwent a hernia repair using polypropylene mesh in 2001. Abdominal distention recurred to give a rise to an incisional hernia in 2006. She was reoperated for decompression and repair, but nothing could be done because of sticky adhesions and the incision were simply closed. The patient was referred to our department for operation. A prosthetic hernia repair with 30 × 30 cm polypropylene mesh was performed. The patient was discharged on the postoperative 5th day following an uneventful recovery. However, she died of disseminated disease after 18 months

Multifocal tuberculosis presenting with osteoarticular and breast involvement

BACKGROUND: Polyarticular involvement, wrist and ankle arthritis are uncommon presentation of skeletal tuberculosis. Tuberculosis of the breast is also extremely rare. CASE PRESENTATION: Wrist, ankle and breast involvement were detected in the same patient. Mycobacterium tuberculosis was isolated from both synovial and breast biopsy specimen cultures. CONCLUSIONS: In general, tuberculosis arthritis is a frequently missed diagnosis, especially in different clinical patterns. A high level of suspicion is required particularly in high-risk populations and endemic areas

Instant Abdominal Wall Reconstruction with Biologic Mesh following Resection of Locally Advanced Colonic Cancer

We present a case of immediate abdominal wall reconstruction with biologic mesh following the resection of locally advanced colonic cancer. The tumor in the right colon did not respond to neoadjuvant chemotherapy. Surgical enbloc excision, including excision of the invasion in the abdominal wall, was achieved, and the defect was reconstructed with porcine dermal collagen mesh. The patient was discharged with no complication, and adaptation of the mesh was excellent at the six-month followup

Hernia and Cancer: The Points Where the Roads Intersect

Introduction: This review aimed to present common points, intersections, and potential interactions or mutual effects for hernia and cancer. Besides direct relationships, indirect connections, and possible involvements were searched.Materials and Methods: A literature search of PubMed database was performed in July 2018 as well as a search of relevant journals and reference lists. The total number of screened articles was 1,422. Some articles were found in multiple different searches. A last PubMed search was performed during manuscript writing in December 2018 to update the knowledge. Eventually 427 articles with full text were evaluated, and 264 included, in this review.Results: There is no real evidence for a possible common etiology for abdominal wall hernias and any cancer type. The two different diseases had been found to have some common points in the studies on genes, integrins, and biomarkers, however, to date no meaningful relationship has been identified between these points. There is also some, albeit rather conflicting, evidence for inguinal hernia being a possible risk factor for testicular cancer. Neoadjuvant or adjuvant therapeutic modalities like chemotherapy and radiotherapy may cause postoperative herniation with their adverse effects on tissue repair. Certain specific substances like bevacizumab may cause more serious complications and interfere with hernia repair. There are only two articles in PubMed directly related to the topic of “hernia and cancer.” In one of these the authors claimed that there was no association between cancer development and hernia repair with mesh. The other article reported two cases of squamous-cell carcinoma developed secondary to longstanding mesh infections.Conclusion: As expected, the relationship between abdominal wall hernias and cancer is weak. Hernia repair with mesh does not cause cancer, there is only one case report on cancer development following a longstanding prosthetic material infections. However, there are some intersection points between these two disease groups which are worthy of research in the future

Effects of Ethylene oxide resterilisation and In- Vitro degradation on mechanical properties of partially absorbable composite hernia meshes

Background: Prosthetic mesh repair for abdominal wall hernias is widely used because of its technical simplicity and low hernia recurrence rates. The most commonly used material is pure polypropylene mesh, however newer  composite materials are recommended by some centers because of their advantages. However, these meshes are more expensive than pure polypropylene meshes. Resterilisation of a pure polypropylene mesh has been  shown to be quite safe, and many centers prefer slicing a large mesh into smaller pieces that suitable for hernia type or defect size. Nevertheless there is no data about the safety after resterilisation of the composite meshes.Objective: To search the effects of resterilisation and In vitro degradation in phosphate buffered saline solution on the physical structure and the mechanical properties of partially absorbable lightweigth meshes.Design: Laboratory-based research.Subjects: Two composite meshes were used in the study: One mesh is consisted of monofilament polypropylene and monofilament polyglecaprone -a copolymer of glycolide and epsilon (ε)-caprolactone- (Ultrapro®, 28 g/m2, Ethicon, Hamburg, Germany), and the other one consisted of multifilament polypropylene and multifilament polyglactine (Vypro II®, 30 g/m2, Ethicon, Hamburg, Germany). Two large meshes were cut into rectangular specimens sized 50x20 mm for mechanical testing and 20x20 mm for In vitro degradation experiments. Meshes were divided into control group with no resterilisation and gas resterilisation. Ethylene oxide gas sterilisation was performed at 55°C for 4.5 hours. In vitro degradation in 0.01 M phosphate buffered saline (PBS, pH 7.4) solution at 37 ± 1°C for 8  weeks was applied to one subgroup in each mesh group. Tensiometric measurements and scanning electron microscopyic evaluations were completed for control and resterilisation specimens.Results: Regardless of resterilisation, when meshes were exposed to In vitro degradation, all mechanical parameters decreased significantly. Highest reduction in mechanical properties was observed for Ultrapro due to the degradation of absorbable polyglecaprone and polyglactin parts of these meshes. It was observed that resterilisation by ethylene oxide did not have significant difference on the degradation characteristics and almost similar physical structures  were observed for resterilised and non-resterilised meshes. For Vypro II meshes, no significant mechanical  difference was observed between resterilised and non-resterilised meshes after degradation while resterilised Ultrapro meshes exhibited stronger characteristics than non-resterilised counterparts, after degradation

Effects of Ethylene Oxide Resterilization and In-vitro Degradation on Mechanical Properties of Partially Absorbable Composite Hernia Meshes*

Rezumat Efectele resterilizãrii cu oxid de etilen aei degradãrii in-vitro asupra proprietãåilor mecanice ale plaselor chirurgicale din material mixt paråial absorbabile Principiul aei scopul lucrãrii: Protezarea cu plase chirurgicale a herniilor de perete abdominal este o tehnicã extensiv utilizatã datoritã simplitãåii sale aei ratelor scãzute de recurenåã aferente. Cele mai utilizate materiale sunt plasele din polipropilenã, însã noi materiale mixte sunt recomandate de unele centre datoritã avantajelor pe care le prezintã. Aceste plase sunt, însã, mai costisitoare decât cele realizate exclusiv din polipropilenã. Resterilizarea unei plase de polipropilenã purã s-a dovedit a fi o procedurã destul de sigurã, iar multe centre preferã sã taie o plasã de dimensiuni mari în mai multe plase mai mici, ce pot fi folosite pentru orice tip de hernie sau orice dimensiune a defectului. Cu toate acestea, nu existã date privind gradul de siguranåã al resterilizãrii plaselor din material mixt. Studiul curent a fost desfãaeurat în vederea evaluãrii efectelor resterilizãrii aei degradãrii in-vitro cu fosfat tamponat cu soluåie salinã asupra structurii fizice aei a proprietãåilor mecanice ale plaselor chirurgicale uaeoare paråial absorbabile. Materiale aei metode: Douã tipuri de plase din material mixt au fost utilizate în acest studiu: o plasã alcãtuitã din monofilamente de polipropilenã aei monofilamente de poliglecapronã -un copolimer din glicolid aei epsilon (ε)-caprolactonã (Ultrapro®, 28 g/m 2 , Ethicon, Hamburg, Germania), iar cealaltã din multifilamente de polipropilenã aei multifilamente de poliglactinã (Vypro II®, 30 g/m 2 , Ethicon, Hamburg, Germania). Douã plase de dimensiuni mari au fost tãiate în probe rectangulare de 50x20 mm pentru testarea mecanicã aei de 20x20 mm pentru experimentele de degradare in-vitro. Plasele au fost distribuite în grupuri de control, fãrã sterilizare, aei de resterilizare cu gaz. Sterilizarea gazoasã cu oxid de etilen a fost efectiatã la 55°C timp de 4,5 ore. Câte un subgrup din fiecare grup de plase a fost supus degradãrii in-vitro cu 0,01 M fosfat tamponat cu soluåie salinã (PBS, pH 7,4) la 37 ± 1°C timp de 8 sãptãmâni. Mãsurãtorile tensiometrice aei de microscopie electronicã au fost efectuate pentru probele de control aei cele resterilizate. Rezultate: Indiferent de resterilizare, la expunerea plaselor la degradarea in-vitro, toåi parametrii mecanici au scãzut semnificativ. Cea mai mare scãdere în termeni de proprietãåi mecanice a fost observatã la plasele Ultrapro, din cauza degradãrii componentelor de poliglecapronã aei poliglactinã absorbabile ale acestor plase. S-a observat cã resterilizarea cu oxid de etilen nu a determinat diferenåe semnificative în ce Cuvinte cheie: plasã chirurgicalã, hernie, plasã din material mixt, resterilizare, degradare, proprietãåi mecanice, tensiometrie, rezistenåã la tracåiune, polipropilenã, poliglecapronã, poliglactinã Abstract Background and Aim: Prosthetic mesh repair for abdominal wall hernias is widely used because of its technical simplicity and low hernia recurrence rates. The most commonly used material is pure polypropylene mesh, although newer composite materials are recommended by some centers due to their advantages. However, these meshes are more expensive than pure polypropylene meshes. Resterilization of a pure polypropylene mesh has been shown to be quite safe, and many centers prefer slicing a large mesh into smaller pieces, suitable for any hernia type or defect size. Nevertheless there is no data about the safety after resterilization of the composite meshes. The present study was carried out to investigate the effects of resterilization and in vitro degradation in phosphate buffered saline solution on the physical structure and the mechanical properties of partially absorbable lightweight meshes. Methods: Two composite meshes were used in the study: One mesh consists of monofilament polypropylene and monofilament polyglecaprone -a copolymer of glycolide and epsilon (ε) -caprolactone -(Ultrapro®, 28 g/m 2 , Ethicon, Hamburg, Germany), and the other one consisted of multifilament polypropylene and multifilament polyglactine (Vypro II®, 30 g/m 2 , Ethicon, Hamburg, Germany). Two large meshes were cut into rectangular specimens sized 50 x 20 mm for mechanical testing and 20 x 20 mm for in vitro degradation experiments. Meshes were divided into control group with no resterilization and gas resterilization. Ethylene oxide gas sterilization was performed at 55°C for 4.5 hours. In vitro degradation in 0.01 M phosphate buffered saline (PBS, pH 7.4) solution at 37 ± 1°C for 8 weeks was applied to one subgroup in each mesh group. Tensiometric measurements and scanning electron microscopic evaluations were completed for control and resterilization specimens. Results: Regardless of resterilization, when the meshes were exposed to in vitro degradation, all mechanical parameters decreased significantly. Highest reduction in mechanical properties was observed for Ultrapro due to the degradation of absorbable polyglecaprone and polyglactin parts of these meshes. It was observed that resterilization by ethylene oxide did not determine significant difference on the degradation characteristics and almost similar physical structures were observed for resterilized and non-resterilized meshes. For Vypro II meshes, no significant mechanical difference was observed between resterilized and non-resterilized meshes after degradation while resterilized Ultrapro meshes exhibited stronger characteristics than non-resterilized counterparts, after degradation. Conclusion: Resterilization with ethylene oxide did not affect the mechanical properties of partially absorbable composite meshes. No important surface changes were observed in scanning electron microscopy after resterilization

Izvanbolnička istodobna operacija ventralne i preponske hernije u lokalnoj anesteziji: prikaz slučaja

Umbilical and epigastric hernias are occasionally seen in patients with groin hernias, however, there is almost no published evidence about their simultaneous repair. In a 3-year period, 10 patients were subjected to simultaneous repair of groin hernias (7 unilateral, 2 bilateral inguinal and 1 femoral) and ventral hernias (7 primary, 2 recurrent umbilical and 1 epigastric) with local infiltration anesthesia and intravenous sedation. The mean total bupivacaine dose was 18 (10- 30) mL and mean total lidocaine dose 21 (14-30) mL. The mean time to resuming normal daily activity was 5.5 days, whereas the time to car driving was 3-7 days. The oral analgesic (naproxen sodium) requirement was 6-10 tablets for 3-5 days. Patient acceptance was excellent. Simultaneous repair of groin and ventral hernias with local anesthesia in outpatient setting is feasible and associated with a low complication rate and maximum patient comfort.Umbilikalne i epigastrične hernije ponekad se nalaze u bolesnika s preponskom hernijom, međutim, gotovo da nema objavljenih podataka o njihovom istodobnom operacijskom liječenju. Tijekom 3-godišnjeg razdoblja istodobna operacija preponskih hernija (7 jednostranih, 2 obostrane ingvinalne i 1 femoralna) i ventralnih hernija (7 primarnih i 2 opetovane umbilikalne i 1 epigastrična) u lokalnoj infiltracijskoj anesteziji i intravenskoj sedaciji izvedena je u 10 bolesnika. Srednja ukupna doza bupivakaina bila je 10 (10-30) mL, a srednja ukupna doza lidokaina 21 (14-30) mL. Srednje vrijeme do povratka normalnih svakodnevnih aktivnosti bilo je 5,5 dana, a za upravljanje motornih vozilima 3-7 dana. Potreba za oralnim analgeticima (naproksen natrij) bila je 6-10 tableta kroz 3-5 dana. Bolesnici su izvrsno prihvatili ove zahvate. Istodobno rješavanje preponske i ventralne hernije uz lokalnu anesteziju u izvanbolničkim uvjetima izvedivo je, ima nisku stopu komplikacija i najvišu razinu udobnosti za bolesnika