Preliminary experience with new bioactive prosthetic material for repair of hernias in infected fields

Surgisis (Cook Surgical, Bloomington, Ind., USA) is a new four-ply bioactive, prosthetic mesh for hernia repair derived from porcine small-intestinal submucosa. It is a naturally occurring extracellular matrix which is easily absorbed, supports early and abundant new vessel growth, and serves as a template for the constructive remodeling of many tissues. As such, we believe that Surgisis mesh is ideal for use in contaminated or potentially contaminated fields in which ventral, incisional, or inguinal hernia repairs are required. From November 2000 through May 2002, 25 patients (11 male, 14 female) underwent placement of Surgisis mesh for a variety of different hernia repairs. A total of 25 hernia repairs were performed in our patient population. Fourteen procedures (56%) were performed in a potentially contaminated setting (i.e. with incarcerated/strangulated bowel within the hernia or coincident with a laparoscopic cholecystectomy/colectomy). Eleven repairs (44%) were performed in a grossly contaminated field, including one in which an infected polypropylene mesh from a previous inguinal hernia repair was replaced with Surgisis and one in which necrotic bowel was discovered within the hernial sac. Median follow-up was 15 months with a range of 1–20 months. Of the 25 total repairs, there was one wound infection complicated by enterocutaneous fistula in a patient originally operated on for ischemic bowel. The fistula was in a location independent of the Surgisis mesh. There were no mesh-related complications or recurrent hernias in our early postoperative follow-up period. Surgisis mesh appears to be a promising new prosthetic material for hernia repair, especially in contaminated or potentially contaminated fields. Obviously, long-term follow-up is still required. Electronic Publication     

Blood gas and ventilatory parameters in predicting survival in congenital diaphragmatic hernia

Blood gas analysis can be used to reliably predict outcome in infants with congenital diaphragmatic hernia (CDH) both before and after surgical repair, providing these values are indexed to some measurement of alveolar ventilation. Until recently there has been difficulty in interpreting some of the published data because of differing sampling sites and the fact that ventilatory parameters, which have major influences on all blood gas values in this anomaly, were not included. Application of this information enables us to identify infants with similar degrees of severity of CDH in order to evaluate the efficacy of novel forms of therapy and to determine whether they represent a genuine advance in management where more conventional forms of treatment have failed.     

神经根变异与特殊型椎间盘突出症

回顾5例由于神经根变异或特殊类型椎间盘突出引起的腰腿痛病人,对其病理及术中处理做了介绍,认为由于神经根的解剖变异,更容易受到椎间盘突出的卡压。手术中如临床症状符合椎间盘突出症,而预定探查间隙未发现突出物,或与临床症状不符者,应根据神经根激惹及松紧程度,扩大探查范围,查明造成疼痛的原因,避免二次手术。     

Long-term result and current status of the Lichtenstein open tension-free hernioplasty

Summary The tension-free hernioplasty project began in 1984 at the Lichtenstein Hernia Institute. The method consists of complete reinforcement of the inguinal floor with a large sheet of mesh, with adequate mesh tissue interface beyond the boundary of the inguinal floor and creation of a new internal ring made of prosthesis. The preliminary report of this operation was published in 1989, with no recurrence at that point in time. Shortly after the submission of the report, several recurrences were encountered. Based on the lesson learned from those recurrences, the operation was slightly modified and reported in 1991 [Amid 1993]. Since then, the Lichtenstein technique has gained world-wide popularity. Outcome measures identical to ours and other authors have been achieved by even those surgeons who have no special interest or expertise in herniology. The purpose of this article is to report the current state of the open tension-free hernioplasty for the repair of primary and recurrent inguinal hernias.     

Survival rates during the first trimester of multiple gestations achieved by ICSI: a report of 1448 consecutive multiples

BACKGROUND: The purpose of this study was to determine the rate of spontaneous gestational sac loss during the first trimester in women achieving multiple pregnancies by ICSI. METHODS: A retrospective analysis was performed of 1448 consecutive multiple pregnancies conceived by ICSI. RESULTS: Of the cohort of 1448 pregnancies, twin gestations constituted 59.6% (864), triplets 30.2% (438) and quadruplets 10.0% (146). During the first trimester, 69 (4.7%) patients miscarried, while 179 (12.3%) continued their pregnancies and had fewer gestational sacs at the end of the first trimester than at the beginning. The overall loss rate of any gestational sac during the first trimester in these multiple pregnancies was 10.1%. There was a significant difference in the frequency of spontaneous reduction to twin or singleton pregnancies in the first trimester between women carrying triplets (11.7%) and those carrying quadruplets (3.5%) [P = 0.004; odds ratio (OR) 3.5; 95% confidence interval (CI) 1.3-9.1]. The frequency of gestational sac loss was significantly greater among women >35 years old (20.9%) than in women less than 35 years old (15.9%) (P = 0.03; OR 1.4; 95% CI 1.0-1.9). CONCLUSION: In multiple pregnancies there is a significant risk of spontaneous loss of any embryo during the first trimester. These findings should be considered prior to any decision about selective embryo reduction.     

Extraembryonic motor activity during the embryogenesis of higher vertebrates

Extraembryonic rhythmic motor activity in higher vertebrates, along with the intrinsic motor activity of the embryo, is important for the normal development of the embryo. This can have different natures in different classes of amniotes (i.e., motor activities of the amnion, yolk sac, and uterus), but these have similar functional importance. This activity changes reproducibly during the process of embryogenesis, providing the optimum conditions for normal embryo development. During embryogenesis, a system for controlling extraembryonic rhythmic motor activity is also formed. There is a trend for the regulation of this activity to become more complex in mammals as compared with birds. Reptiles have received little study from this point of view. In addition to regular changes in extraembryonic rhythmic motor activity during embryogenesis which depend on the developmental stage of the embryo, motor activity can also change in response to changes in a number of environmental factors (for example, temperature and the gas composition of the air). This demonstrates the possible involvement of embryo-associated extraembryonic motor activity in adapting the embryo to changing environmental conditions and maintaining homeostasis for the development of the embryo itself. Translated from Rossiiskii Fiziologicheskii Zhurnal imeni I. M. Sechenova, Vol. 84, No. 10, pp. 961–968, October, 1998.     

老年腹股沟疝患者疝环充填式无张力修补术86例

目的总结弛环充填式无张力修补术治疗老年腹股沟疝患者的经验。方法回顾分析2002年3月-2005年7月采用德国Braun公司生产的Braun mesh和plug治疗的86例老年腹股沟疝患者的临床资料。结果平均手术时间35min，术后8-10h下床活动，2周恢复日常生活，伤口均一期愈合，术后尿潴留15例，异物感3例，随访3—40个月无一例复发。结论疝环充填式无张力修补术操作方便，创伤小，恢复快，复发率低，是老年患者理想有效的疝修补术。     

网膜囊上隐窝的CT应用解剖

在42套腹部断面标本及50例整尸上观察到:网膜囊上隐窝呈“V”形间隙围绕肝尾状叶,前界为小网膜及肝左叶,后界是膈,顶由肝冠状韧带或膈形成,下抵胰,左邻食管;在正中矢状面上均出现肝尾状叶,且尾状叶套入或游离于网膜囊上隐窝。这些结果对在 CT 图像上鉴别尾状叶周围的积液及肿块具有重要意义。     

Fluid compartments of the embryonic environment

The exocoelomic cavity was probably the last remaining physiological body fluid cavity to be explored in the human embryo. Its unique anatomical position has enabled us to study the protein metabolism of the early placenta and secondary yolk sac and to explore materno-embryonic transfer pathways. The exocoelomic cavity forms inside the extraembryonic mesoderm alongside the placental chorionic plate and is now believed to be an important transfer interface and a reservoir of nutrients for the embryo. Maternal or placental proteins filtered in the extraembryonic coelomic cavity are probably absorbed by the secondary yolk sac which is directly connected with the primitive digestive system throughout embryonic development. Protein electrophoresis has shown that the coelomic fluid results from an ultrafiltrate of maternal serum with the addition of specific placental and secondary yolk sac bioproducts demonstrating that the exocoelomic cavity is a physiological liquid extension of the early placenta. The selective sampling of fluid from the exocoelomic cavity has also offered a novel approach to the study of drug and toxin transfer across the early human placenta and as a unique tool to explore embryonic physiology in vivo. Further investigation should include a comparison between the coelomic fluid values of a molecule and its quantifiable presence in decidual, placental and fetal tissues.