Totally extraperitoneal inguinal hernioplasty with titanium-coated lightweight polypropylene mesh: early results

Background This prospective study of a new titanium-coated low-weight polypropylene (PP) mesh (16 g PP/m²) was designed to investigate the clinical efficacy and safety of totally extraperitoneal endoscopic hernioplasty (TEP). Methods In this study, 400 patients (average age, 53.5 years; range, 19 – 80 years) with a total of 588 inguinal hernias underwent surgery with the TEP technique between September 2002 and October 2003. Of these patients, 12.4% had experienced recurrent hernias after open suture herniotomy. In 92% of the cases (368 patients with 540 hernias), a lightweight (16 g PP/m²) titanium-coated polypropylene mesh was implanted without fixation, and in 8% (32 patients with 48 hernias) an identical medium-weight (35 g PP/m²) mesh was implanted. The first follow-up examination was scheduled for postoperative week 6. Results In the lightweight mesh group, the mean group, operating time per patient was 61 min, corresponding to a calculated time per hernia of 41 min. Two intraoperative major complications occurred: an injury to the cecum and an injury to the bladder. In 12 cases (2%), bleeding from epigastric, testicular, or pubic bone vessels was observed. No injuries to pelvic vessels were seen. One patient was underwent an endoscopic revision to deal with an anticoagulation-related bleed. The mortality rate was 0%. In 12 patients, postoperative hematomas developed. One preperitoneal lipoma had to be extirpated. No infections of the mesh occurred. The median follow-up period for 371 patients (92.3%) was 7.2 weeks (range, 4–14 weeks). These 343 patients (with 504 hernias) had been provided with a lightweight titanium-coated polypropylene mesh (16 g PP/m²) (follow-up rate, 93.2%). Of these patients, 3.5% reported persistent ingunial pain, 1.7% described a sensation of rigidity in the region of the groin, and 3.2% reported dysesthesia. The early recurrence rate was 0.2%. Conclusions The TEP procedure can be performed safely and effectively with the appreciably material-reduced and titanium-coated polypropylene mesh without the need for fixation of the implant. The low early recurrence rate of 0.2% is evidence that the posterior wall of the inguinal canal is adequately augmented. The question whether the material reduction and the titanium coating of the mesh may bring about a reduction in postoperative chronic pain and the sensation of rigidity in the inguinal area via an improvement in biocompatibility must await the results of the scheduled follow-up examination 1 year after the surgical procedure.     

Comparative investigation of alloplastic materials for hernia repair with improved methodology

Background: A variety of alloplastic materials are used for hernia repair. We discuss the long-term stability and possible shrinkage of these materials. In the past, measurement of pore sizes was used to study the physical properties of alloplastic meshes. The aim of this study was to evaluate the measurement of pore sizes with regard to its correlation to possible mesh alteration. Methods: The water absorption of different polypropylene (PP) and polyester (PE) mesh materials under defined conditions was studied. For shrinkage studies, meshes were stored in formaldehyde, distilled water, saline solution, trypsin solution, urea solution, and hydrogen peroxide. The measurement of the relation between material and pore was evaluated to investigate the potential shrinking and enlargement processes. This material–pore index (MPI) before as well as 1, 7, and 14 days after incubation was measured. Results: In comparison to measuring single pore sizes, MPI determination is the more efficient method to evaluate the possible shrinking or enlargement processes of alloplastic materials. With this technique, incorrect determination of pore sizes due to the dynamic textile structure of meshes and to shrinkage or enlargement, is excluded. All tested alloplastic materials showed an insignificant increase in water absorption under the condition of rehydration up to 0.4%. We did not observe variances in the material in shrinking or enlargement. Conclusions: MPI was found to be more reliable than measuring single pores to investigate possible external influences on polymer materials. Biomaterials such as PP and PE proved to be absolutely inert under various in vitro conditions.     

Analysis of fumarate hydratase mutations in a population-based series of early onset uterine leiomyosarcoma patients

Germline mutations in fumarate hydratase (FH) gene at 1q43 predispose to hereditary leiomyomatosis and renal cell cancer (HLRCC) syndrome. In HLRCC, the most common clinical features are leiomyomas of the skin and uterus, and in a subset of the families, renal cell cancer (RCC) and uterine leiomyosarcoma (ULMS) occur frequently at young age. This study was conducted to evaluate the possible contribution of FH mutations in a population-based series of early onset (< or = 45 years) ULMSs. Eighty-one cases were identified through the national cancer registry, and samples from 67 cases (83%) were available for FH mutation screening and analysis of allelic imbalance (AI) at the FH locus. Seventeen percent of tumors showed AI. In the mutation analysis, a novel missense mutation K424R was found. The mutation was also found from the patient's normal tissue. To study whether this variant has functional consequences, FH enzyme activity assay was performed in a cell model. The activity of the mutated protein was significantly reduced as compared to wild type (p = 0.009). This study shows that FH germline mutations can occur in seemingly nonsyndromic cases of ULMS (1/67, 1.5%). It appears that on the population level hereditary FH defects do play a role in pathogenesis of sporadic early onset ULMSs, albeit rarely.     

反－丁烯二酸二甲酯的放大合成实验

在实验室合成反－丁烯二酸二甲酯（ＤＭＦ）的基础上，放大合成规模。研究此基础上合成ＤＭＦ的各种适宜条件，提高合成产率。根据广泛的社会调查，对应用ＤＭＦ的社会及经济价值进行了论述     

聚丙烯熔融法接枝HEMA的研究

由熔融法制得聚丙烯接枝甲基丙烯酸β－羟乙酯，用毛细管流变仪、示差扫描量热计、广角Ｘ－射线衍射仪、结晶速率仪、偏光显微镜等对接枝物的流变性能和结晶性能进行了定性、定量表征，比较了接枝前后聚合物结晶形态的变化。     

局麻下行聚丙烯网片修补术治疗腹股沟疝24例临床分析

目的探讨局麻下行聚丙烯网片修补腹股沟疝的优点。方法观察24例局麻下行聚丙烯网片修补术治疗腹股沟疝的病人手术时间、输液天数、并发症。结果局麻下行聚丙烯网片修补术治疗腹股沟疝时间短、输液天数少、疼痛轻、并发症少。结论局麻下行聚丙烯网片修补治疗腹股沟疝手术可于临床广泛推广。     

非水滴定和傅立叶红外光谱在聚丙烯马来酸酐接枝物表征中的应用

采用非水滴定法中的无机碱直接滴定方法测定了马来酸酐在聚丙烯上的接枝率，并对该方法作了可行性验证，讨论了非水滴定中的两个难点：化学计量比的确定和滴定终点的判断。通过傅立叶红外光谱法(FTIR)对聚丙烯马来酸酐接枝物的纯化效果、自由基引发反应对非水滴定的影响及聚丙烯接枝马来酸酐的反应机理作了定性分析，并结合非水滴定的数据绘制了红外定量校准曲线。     

聚丙烯酰胺接枝改性聚丙烯膜的血液相容性

背景：绝大多数高分子材料在与血液接触时都导致不同程度凝血,使其应用受到限制。因此研制有优良抗凝血性能的高分子材料成为生物人工肝材料临床研究中的关键问题。目的：体外检测新型人工肝反应器材料——聚丙烯酰胺接枝改性聚丙烯膜(PP-g-AAm)的血液相容性。方法：对改性前、后的聚丙烯膜行溶血试验、凝血酶原时间和活化部分凝血激酶时间试验,用流式细胞术检测血小板CD62P和CD63的表达率,扫描电镜观察两种膜上血小板的黏附情况。 结果与结论：聚丙烯膜和PP-g-AAm膜的溶血率分别为1.32%和1.46%;聚丙烯膜的凝血酶原时间和活化部分凝血激酶时间较PP-g-AAm膜明显缩短(P < 0.05);PP-g-AAm膜激活血小板表达CD62P、CD63的百分率都明显少于聚丙烯膜(P < 0.05);扫描电镜观察两种材料表面黏附的血小板都有明显变形,但PP-g-AAm膜表面黏附的血小板明显少于聚丙烯膜。提示PP-g-AAm膜具有良好的血液相容性。关键词：人工肝;血液相容性;生物相容性;聚丙烯;膜生物材料doi:10.3969/j.issn.1673-8225.2010.08.045