Mesh fixation with human fibrin glue (Tissucol) in open tension-free inguinal hernia repair: a preliminary report

Background: The Lichtenstein technique for inguinal hernia repair is easy to learn and associated with few complications. However, recent studies have suggested that this technique is inferior to some ‘sutureless’ repair systems in terms of perceived difficulty, operating time, surgeon satisfaction, etc. Methods: We employed a sutureless Lichtenstein technique in 80 consecutive patients with primary unilateral inguinal hernia, to assess patient and trainee surgeon outcomes. Human fibrin glue was used in place of conventional sutures. Results: The mean operating time was 36 min and all patients were discharged 5–6 h after the operation. On a 100-point visual analogue scale, the surgeons rated the difficulty of the operation as low (mean score, 31), and perceived satisfaction as high (mean score, 84). No complications were observed at 12-month follow-up. Conclusion: This study confirms the efficacy of mesh fixation with human fibrin glue, and supports the viability of a sutureless Lichtenstein procedure.     

Primary Alloproliferative TH1 Response Induced by Immature Plasmacytoid Dendritic Cells in Collaboration with Myeloid DCs

The role played by dendritic cell (DC) subsets in the immune response to alloantigens is not well defined. In vitro experiments have extensively shown that freshly isolated myeloid (M)DCs induce a strong T lymphocyte proliferation whereas plasmacytoid (P)DCs do not, unless activated by CD40 ligation. The aim of these studies was to explore whether the interplay among PDCs, MDCs and T cells modulates alloresponse. Freshly isolated MDCs and PDCs were merged in different proportions and used as antigen presenting cells (APCs) in mixed lymphocyte cultures (MLC). As described, isolated PDCs only induced a mild alloresponse, while MDCs were potent inducers of alloproliferation. Unexpectedly, when PDCs were merged with even low numbers of MDCs (down to 100 cells) and used as APCs, a potent Th1 cell proliferation was detected. Survival and maturation of PDCs was increased in these MLC conditions, which could partially explain the magnitude of the T-cell response. Interestingly, the proportion of IFNgamma-producing cells generated in such cultures was higher compared to MDC-stimulated cultures. These data suggest that the interaction between both DC subsets is determinant to generate a potent Th1 response, at least in an allogeneic situation, and may be relevant to the outcome of allogeneic stem cell transplantation.     

The vertical midface lift. An improved procedure.

We describe a novel procedure for an anatomically-based face lift to correct vertical vectors in the ageing face. It has the advantage of surgical simplicity, minimal tissue removal and minimal risk. It provides an effective readjustment of cheek volume and correction of periorbital hollowness. Natural facial expression is preserved largely because there is no change in the position of the lateral canthus. The cheek is mobilised subperiosteally through a blepharoplasty incision. A second dissection is made via a short temporal incision, to join the infraorbital dissection. A Hagedorn needle is then inserted through a point inferior to the lateral canthus and in line horizontally with the nasal ala. It is passed to the orbital incision, charged with a loop of suture material, and pulled down again to the cheek incision, from where it is pushed back to the orbit to suspend the cheek. The upper border of orbicularis oculi is fixed firmly to the temporalis aponeurosis at the level of the temporal incision. We now frequently use an Endotine Midface device for fixation. Of the first 150 patients, results were excellent or good in 145. This represents a revival of the subperiosteal mask lift, and abandons the use of endoscopic techniques. In spite of its simplicity, the operation involves subperiosteal dissection as well as delicate eyelid surgery that necessitate plastic surgical skill.     

The sympathetic trunk and its neural pathway to the upper limb: review of the literature

Zusammenfassung GRUNDLAGEN: Kenntnisse der Anatomie des Truncus sympathicus und des autonomen Nervensystems sind von großer Bedeutung in der Sympathikuschirurgie. Allerdings existiert eine Vielzahl an unterschiedlichen sympathischen Nervenverbindungen zur oberen Extremität, wobei der Großteil im ersten Zwischenrippenraum zu liegen kommt. Aus unterschiedlichsten Gründen führt die chirurgische Sympathektomie im Bereich der oberen thorakalen Ganglien zu einer Unterbrechung der sympathischen Innervation der oberen Extremität. Entscheidend ist, diese variablen Verbindungen zu durchtrennen, um optimale chirurgische Ergebnisse zu erzielen. METHODIK: Diese Arbeit basiert auf einer Durchsicht der Literatur der letzten 80 Jahre über die Anatomie des kranialen thorakalen Truncus sympathicus und seiner Verbindungen, die in der Sympathikuschirurgie von besonderer Bedeutung sind. Die Evaluation basiert auf einer Literaturrecherche in der Medline, ergänzt um Wissen aus Anatomiebüchern; es wird zudem eine Übersicht über die historische Entdeckung des sympathischen Systems gegeben. ERGEBNISSE: Zwei wichtige Ergebnisse liegen vor. 1. Intrathorakale Nervenverbindungen zwischen zweitem und erstem intrathorakalen Nerv dürften sympathische Fasern der oberen Extremität zuführen. Diese Verbindungen kommen bei mehr als 50 % der Menschen vor und dürften für Misserfolge und/oder Rezidive nach Sympathektomie verantwortlich sein. 2. Aktuelle chirurgische Studien weisen darauf hin, dass das Hauptganglion für die sympathische Innervation der oberen Extremität im Segment T4 liegen könnte. Dies steht jedoch im Gegensatz zur bisher anerkannten Ansicht, dass das Hauptganglion der sympathischen Innervation für die obere Extremität das T2-Ganglion sei. Bislang können diese klinischen Erkenntnisse nicht durch anatomisches Wissen erklärt werden. SCHLUSSFOLGERUNGEN: Profunde anatomische Kenntnisse sind eine unabdingbare Voraussetzung, um in der Sympathikuschirurgie optimale Ergebnisse zu erzielen.     

Transesophageal echocardiography in the surgical management of renal cell carcinoma with intracardiac extension.

Renal cell carcinomas may extend into the vena cava and the tumor thrombus occasionally involves the right atrium. The operative approach depends upon precise preoperative and intraoperative staging and thrombus localization. We report a case of renal cell carcinoma with complete inferior vena caval and hepatic vein occlusion with tumor extension into the right atrium. Preoperatively, transesophageal echocardiography provided superior images of the tumor and its extension, and intraoperatively allowed continuous monitoring of cardiac function and the removal of tumor from the atrium and inferior vena cava. Its use obviated the need for more costly and invasive preoperative and intraoperative procedures.     

The Fagerström Test for Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire

We examine and refine the Fagerström Tolerance Questionnaire (FTQ; Fagerström, 1978). The relation between each FTQ item and biochemical measures of heaviness of smoking was examined in 254 smokers. We found that the nicotine rating item and the inhalation item were unrelated to any of our biochemical measures and these two items were primary contributors to psychometric deficiencies in the FTQ. We also found that a revised scoring of time to the first cigarette of the day (TTF) and number of cigarettes smoked per day (CPD) improved the scale. We present a revision of the FTQ: the Fagerström Test for Nicotine Dependence (FTND).     

Seborrheic dermatitis and daylight.

Patients with mood depression have been found to have a higher prevalence of seborrheic dermatitis (SD), possibly related to their tendency to live indoors. The prevalence of outpatients with SD has now been found to be directly related to the number of gloomy days in the area. Since UV light might not be the only reason for the well-known improvement in SD in summer, an explanation possibly related to melatonin is envisaged.