Preliminary results of a two-layered prosthetic repair for recurrent inguinal and ventral hernias combining open and laparoscopic techniques

The use of prosthetic mesh has become the standard of care in the management of hernias because of its association with a low rate of recurrence. However, despite its use, recurrence rates of 1% have been reported in primary inguinal repair and rates as high as 15% with ventral hernia repair. When dealing with difficult recurrent hernias, the two-layer prosthetic repair technique is a good option. In the event of incarcerated or strangulated hernias, however; placement of prosthetic material is controversial due to the increased risk of infection. The same is true when hernia repairs are performed concurrently with potentially contaminated procedures such as cholecystectomy, appendectomy, or colectomy. The purpose of this study is to report our preliminary results on the treatment of recurrent hernias by combining laparoscopic and open techniques to construct a two-layered prosthetic repair using a four ply mesh of porcine small intestine submucosa (Surgisis®, Cook Surgical, Bloomington, IN, USA) in a potentially infected field and a combination of polypropylene and ePTFE (Gore-Tex®, W.L. Gore and Associates, Flagstaff, AZ, USA) in a clean field. From September 2002 to January 2004, nine patients (three males and six females) underwent laparoscopic and open placement of surgisis mesh in a two layered fashion for either recurrent incisional or inguinal hernias in a contaminated field. A total of eight recurrent hernia repairs were performed (five incisional, three inguinal) and one abdominal wall repair after resection of a metastatic tumor following open colectomy for colon carcinoma. Six procedures were performed in a potentially contaminated field (incarcerated or strangulated bowel within the hernia), two procedures were performed in a contaminated field because of infected polypropylene mesh, and one was in a clean field. Mean patient age was 56.4 years. The average operating time was 156.8 min. Operative findings included seven incarcerated hernias (four incisional and three inguinal), one strangulated inguinal hernia, and one ventral defect after resection of an abdominal wall metastasis for a previous colon cancer resection. In two of the cases, there was an abscess of a previously placed polypropylene mesh. All procedures were completed with two layers of mesh (eight cases with surgisis and one with combination of polypropylene/ePTFE). Median follow up was 10 months. Complications included two seromas, one urinary tract infection, two cases of atelectasis and one prolonged ileus. There were no wound infections. The average postoperative length of stay was 7.8 days. There have been no mesh-related complications or recurrent hernias in our early postoperative follow-up period. The use of a new prosthetic device in infected or potentially infected fields, and the two-layered approach shows promising results. This is encouraging and provides an alternative approach for the management of difficult, recurrent hernias.     

Determining efficacy of monitoring devices on ceramic bond to resin composite

Objectives: This paper aims to assess the effectiveness of 3D nanoroughness and 2D microroughness evaluations, by their correlation with contact angle measurements and shear bond strength test, in order to evaluate the effect of two different acids conditioning on the bonding efficacy of a leucite-based glass-ceramic to a composite resin. Study Design: Ceramic (IPS Empress) blocks were treated as follows: 1) no treatment, 2) 37% phosphoric acid (H3PO4), 15 s, 3) 9% hydrofluoric acid (HF), 5 min. Micro- and nano-roughness were assessed with a profilometer and by means of an atomic force microscopy (AFM). Water contact angle (CA) measurements were determined to assess wettability of the ceramic surfaces with the asixymetric drop shape analysis contact diameter technique. Shear bond strength (SBS) was tested to a resin composite (Z100) with three different adhesive systems (Scotchbond Multipurpose Plus, Clearfil New Bond, ProBOND). Scanning electron microscopy (SEM) images were performed. Results: Nanoroughness values assessed in 50x50 μm areas were higher for the HF group, these differences were not detected by profilometric analysis. HF treatment created the nano- roughest surfaces and the smallest CA (p<0.05), producing the highest SBS to the composite resin with all tested adhesive systems (p<0.05). No differences existed between the SBS produced by the adhesive systems evaluated with any of the surface treatments tested. Conclusions: Nano-roughness obtained in a 50x50 µm scan size areas was the most reliable data to evaluate the topographical changes produced by the different acid treatments on ceramic surfaces. Key words:Dental ceramic, acid etching, bonding efficacy, resin composite, adhesive systems, contact angle, roughness.     

Sleep apnea and Down's syndrome

OBJECTIVE: Obstructive sleep apnea has been reported to occur in 20-50% of children with Down's syndrome in case series of patients referred for evaluation of suspected sleep apnea. In this population-based controlled study, we aimed to investigate whether sleep apnea is related to Down's syndrome. MATERIAL AND METHODS: Every child aged 2-10 years with Down's syndrome residing in the Ume? healthcare district (n = 28) was invited to participate in the study, with their siblings acting as controls. Successful overnight sleep apnea recordings and echocardiography were performed in 17/21 children with Down's syndrome and in 21 controls. RESULTS: Obstructive sleep apnea could not be diagnosed, either in children with Down's syndrome or in the control children. The apnea-hypopnea index in the children with Down's syndrome was 1.2 +/- 1.5 and did not differ from that in controls. Snoring and hypertrophy of the tonsils were more common in children with Down's syndrome than in controls. Children with Down's syndrome slept for a shorter time (p < 0.001) and changed body position more often (p < 0.05) than the control children. CONCLUSIONS: Snoring, restless sleep and hypertrophy of the tonsils were common among children with Down's syndrome. Obstructive sleep apnea was, however, not related to Down's syndrome in the present population-based controlled study.     

Intense pulsed light treatment of hirsutism: case reports of skin phototypes V and VI

Removal of unwanted hair is a common cosmetic concern. For hirsute women, treatment often requires drug therapy and various methods to physically remove the hair. Traditional methods of hair removal include shaving, waxing, tweezing, depilatory creams and electrolysis. Hair removal methods based on light technology, such as lasers and intense pulsed light systems, are alternative methods for longer-term hair removal. Intense pulsed light has been used in our clinic during the past 2 years to treat light-to-dark skinned patients, including skin types V and VI. We present here the treatment, using an intense pulsed light source, of three dark skinned patients with hirsutism. Patients were treated during multiple sessions (five to seven) for unwanted facial hair. Sessions were conducted monthly and patients were evaluated at follow-up sessions 2–7 months after the final treatment. Successful clearance of unwanted hair was achieved in all three patients with no pigmentary changes observed during the final follow-up sessions. Folliculitis and hyperpigmentation from tweezing were also treated by the intense pulsed light source. These results suggest that intense pulsed light is an effective source for hair removal and may, with proper parameter selection, be useful in the treatment of very dark skin types.     

Robust directional computation in on-off directionally selective ganglion cells of rabbit retina

The spatial and temporal interactions in the receptive fields of On-Off directionally selective (DS) ganglion cells endow them with directional selectivity. Using a variety of stimuli, such as sinusoidal gratings, we show that these interactions make directional selectivity of the DS ganglion cell robust with respect to stimulus parameters such as contrast, speed, spatial frequency, and extent of motion. Moreover, unlike the directional selectivity of striate-cortex cells, On-Off DS ganglion cells display directional selectivity to motions not oriented perpendicularly to the contour of the objects. We argue that these cells may achieve such high robustness by combining multiple mechanisms of directional selectivity.     

Validity of arm ergometer blood pressures immediately after exercise

It is not possible to assess blood pressure (BP) by the standard cuff method during exercise primarily involving the arms. Consequently, such measurements are often taken immediately after (within 15 seconds) exercise. To assess the validity of this practice, 18 healthy men (mean age 32 years) who completed 3 progressive 3-minute workloads were studied during arm-crank ergometry. Ankle systolic BP was measured at the dorsalis pedis artery at seated rest, 15 seconds before completion of each exercise stage and immediately after each workload, using a Doppler stethoscope; simultaneous postexercise brachial systolic BPs were determined by auscultation. Brachial systolic BP during armcrank ergometry was estimated by the formula: (resting brachial systolic BP) + (exercise ankle systolic BP - resting ankle systolic BP). Brachial systolic BPs, obtained immediately after arm-crank ergometry, were significantly lower than those estimated during exercise (p less than 0.001), with corresponding mean values of 141 versus 153, 144 versus 173 and 151 versus 182 mm Hg at 150, 300, and 450 kg.m.min-1, respectively. The difference between measured (postexercise) and estimated pressures increased with progressive workloads. These findings indicate that systolic BPs taken by the standard cuff method immediately after arm-crank ergometry are likely to underestimate "true" physiologic responses.