Incisional Hernia after McBurney Incision: Retrospective Case-control Study of Risk Factors and Surgical Treatment

Background Few reports have dealt with incisional hernias originating at a McBurney incision after appendectomy. The purpose of the present study was to identify risk factors for development of incisional hernia at a McBurney incision, and to describe our experience with the treatment of this kind of hernia. Patients and methods We reviewed 4,862 files of patients older than 15 years of age operated on for acute appendicitis. Some 4,523 (93%) of that group were operated on through a McBurney incision, and 34 (0.7%) of them developed incisional hernia. To identify risk factors for development of incisional hernia we used binary logistic regression analysis. Results The following risk factors were identified: female gender (p = 0.011), diabetes (p < 0.0001), peritonitis, abscess or phlegmon as the cause of the first operation (p = 0.009), wound infection (p = 0.034), seroma (p = 0.023), the use of catgut to suture the aponeurosis (p < 0.0001), and interrupted suture to the aponeurotic layer (p = 0.046). Twenty-two hernias were repaired with Mayo-herniorrhaphy and 12 with a subaponeurotic polypropylene prosthesis. Recurrences developed in 3 patients, none in hernias repaired with prosthesis. Conclusions The risk of incisional hernia after a McBurney incision for acute appendicitis was very low; we recommend the repair of this uncommon incisional hernia with current standard tension-free prosthetic techniques.     

Occult pancreaticobiliary reflux in gallbladder cancer and benign gallbladder diseases

BACKGROUND AND OBJECTIVES: It was proposed that occult pancreaticobiliary reflux (OPBR) was associated with precancerous mucosal changes in the gallbladder, hence the importance of this disorder. There are no published reports investigating the incidence of OPBR in patients operated on for the entire spectrum of benign gallbladder diseases and gallbladder cancer. Our aim was to determine the incidence of OPBR and measure the levels of active pancreatic enzymes (amylase and lipase) in gallbladder bile of patients undergoing cholecystectomy for benign and malignant gallbladder diseases. METHODS: One hundred eight patients with normal pancreaticobiliary junction evidenced by operative cholangiography were included in the study. RESULTS: According to gallbladder bile amylase and lipase levels, 84.2% and 89% patients respectively had OPBR. OPBR was present in all gallbladder cancer patients; in these patients the biliary levels of amylase and lipase were significantly higher than the levels found in patients with benign gallbladder pathology (P < 0.0001). CONCLUSIONS: OPBR could lead to inflammatory changes of the biliary epithelium and progress towards the development of precancerous mucosal changes and gallbladder cancer. The reason why such high levels of pancreatic enzymes are regurgitated into the biliary tree of patients with gallbladder cancer should be clarified.     

恒牙根尖部侧孔形态的显微解剖研究

目的 研究恒牙根尖部侧孔，为临床和国人提供解剖学资料。方法 采用ＸＴＬ－２型链续变倍体视摄影显示微镜，对１５０２个恒牙根尖部出现的２３０个侧孔的形状和孔径进行观测。结果 ２３０颗恒牙根尖部侧孔的形状可分为４型：圆形１４１个，占６１．３０％；椭圆形８５，占３６．９６％；肾形３个，占１．３０％；不规则形１个，占０．４３％。结论 恒牙根尖部侧孔的孔径为根尖孔的一半，并约有１／７的恒牙出现根尖部侧孔。     

Pancreaticobiliary Reflux in Patients with and without Cholelithiasis: Is It a Normal Phenomenon?

Background  

Pancreaticobiliary reflux is a pathologic phenomenon occurring in patients with gallstones. However, the occurrence of pancreaticobiliary reflux has not been studied in patients without gallstones. The objective of the present study was to measure the bile levels of amylase and lipase in patients without gallstones submitted to cholecystectomy as part of another surgical procedure, and to compare these values with the bile levels of amylase and lipase of patients submitted to cholecystectomy for gallstone disease.     

Is hyperbilirubinaemia in appendicitis a better predictor of perforation than C-reactive protein? — a prospective study

Purpose  

To compare the performance for the prediction of perforated appendicitis of total bilirubin versus C-reactive protein (CRP), white blood cell count, the time period of symptoms’ evolution, and systemic inflammatory response syndrome (SIRS).     

B超仪与腹腔内窥镜在绵羊早期妊娠诊断中的应用

为了确定经胚胎移植的母羊受胎情况 ,利用B超仪与腹腔内窥镜对母羊群进行早期妊娠诊断 ,对检出未孕的母羊及时进行相应处理。结果表明B超仪与腹腔内窥镜诊断母羊妊娠诊断准确率分别可达到 92 .6 % (6 3/6 8)和 94 .4 % (33/ 35 ) ,差异不显著 (P >0 .0 1)。     

不同低出生体重儿听力损失相关因素分析

目的探讨不同低出生体重儿听力损失及损失程度与出生体重、胎龄的关系。方法应用听性脑干诱发电位对不同低出生体重儿进行听力测试,以单侧耳Ⅴ波反应阈>30dBnHL者作为2～4kHz范围内听力损失指标。结果测试不同低出生体重儿246名,听力损失63名。<1000g超极低出生体重儿3例,听力损失发生率100%;<1500g的极低出生体重儿46例,其听力损失发生18例(39.1%);<2500g的低出生体重儿197人,其听力损失发生42人(21.3%),不同出生体重发生听力损失差异显著(P<0.001)。其中中～重度10例,极重度2例,且出生体重与听力损失程度呈负相关,出生体重越轻,听力损失越重(r=0.378P=0.002)。胎龄<30周的早产儿3例,均有听力损失发生;胎龄30～34周的早产儿47例,听力损失22人(46.8%);胎龄34～37周的早产儿共171人,听力损失发生30人(17.5%);胎龄>37周的足月小样儿25例,听力损失发生8例(32%),不同胎龄患儿发生听力损失差异显著(P<0.001)。结论不同低出生体重儿是听力损失的高发人群,听力损失与不同低出生体重、胎龄有明显的关系,听力损失程度与出生体重呈显著负相关。足月小样儿是独立的高危因素。