Inguinal hernia repair with beta glucan-coated mesh: Prospective multicenter study (115 cases)—Preliminary results

Prosthetic reinforcement is now routine in the management of inguinal hernia, and it significantly reduces the risk of recurrence. However, there may be postoperative pain and discomfort of late onset, the intensity of which appears to be related to the rigidity of the material and its ability to integrate with tissues. We have evaluated the results of implantation with beta glucan-coated polypropylene mesh both objectively (early recurrence) and functionally (pain and quality of life). The mass of the coated mesh is reduced by 50% compared to a typical polypropylene implant. Beta glucan is an entirely natural plant product that eliminates the risk of viral or prion contamination associated with the use of collagen of animal origin. One hundred fifteen patients with a mean age of 55 years with a primary or recurrent inguinal hernia were treated with a prosthesis (Glucamesh). Fifty-eight patients underwent a Lichtenstein procedure, and 57 had a laparoscopic procedure (TEP, TAPP). Mean operative time was 40 min. There was no mortality, and morbidity was 8.6%. At 3 months follow-up, no recurrences were observed. The characteristics of the prosthesis were considered to be good or excellent in 93.9–100% of cases. Residual postoperative pain (analogue pain score less than 2) occurred in 4.3% of cases at day 15 and in 2.7% at day 90. The quality-of-life health score of the SF36 questionnaire preoperatively and postoperatively showed a significant improvement (P<0.05) in the scores and a quality of life equivalent to healthy control subjects. This prosthesis is associated with a rapid and significant resolution of postoperative pain and a quick return to normal activity with an improved quality of life. In addition, the plant origin of the prosthesis eliminates any risk of viral or prion contamination.     

Treatment of a Humeral Metastasis with a Composite Allograft-Prosthetic Reconstruction

Abstract Background: The treatment of impending pathological fractures and symptomatic metastases involving the upper extremity articulations remains a challenge for the trauma surgeon. While the goals of treatment of bony metastases are clearly defined (early restoration of function, excellent pain control and minimal surgical trauma), these are not always easy to realize in upper extremity periarticular metastases. Case Study: A patient with a metastasis of a mediastinal nerve sheet tumor, involving the proximal 12 cm of the right humerus, including the whole head and both the tubercles, is described. A complete resection up to the level of the deltoid insertion was performed. In order to restore maximal function, the shoulder joint was reconstructed using a reversed total shoulder prosthesis. A fresh frozen cadaver proximal humerus was used as an allograft to obtain a secure stabilization of the prosthesis. Short-term results were very promising with restoration of ADL (activities of daily living) functionality within 3 months. Abduction and elevation > 100°, exorotation up to 20° and gluteal endorotation could be performed at that time. Conclusion: To the authors knowledge, this report is the first to describe reconstruction of the shoulder joint using a reversed shoulder prosthesis-allograft construction in case of a resection for malignancy.     

Percutaneous treatment of superior vena cava syndrome using metallic stents

The purpose of this study was to evaluate the results of treatment of superior vena cava syndrome (SVCS) in patients with benign and malignant disease using expandable metallic stent. From January 1995 to April 2000, 87 expandable stents were implanted in 82 patients (59 men, 23 women; mean age 57.8 years, age range 39–79 years) for the treatment of SVCS. The SVCS was defined as symptomatic bilateral obstruction of venous drainage from head, neck and upper extremities. In 68 patients SVCS was due to malignant neoplasia, and in 14 cases it was due to benign aetiology. All patients were treated with expandable stent. We implanted 81 Wallstent prostheses and 6 Palmaz stents. Adjuvant thrombolysis was applied in 12 patients who required fibrinolysis. After recanalization, the stent was implanted in all cases in SVC (infra- or supra-azygos vein). All patients were treated with heparin of low molecular weight (HBPM) during 6 months. Patency was analyzed according to clinical symptoms and Doppler US or venograms exploration. Technical success was observed in all cases. Clinical success was reached in 78 of 82 patients (95.1%) (absence of symptoms in 2 or 3 days). Four patients suffered immediate thrombosis which required fibrinolitic treatment with a new prosthesis placement in 1 case. The follow-up for the malignant process was of 7.1 months (range 1–39 months) and in benign cases was 31.2 months (range 11–61 months). Sixty-two (91.1%) patients with malignancy died without SVCS symptomatology. All the patients with benign pathology are alive. Clinical primary patency in malignant cases was 87% with assisted patency of 96.2%. Endovascular therapy using metallic stent and thrombolysis is a successful method to treat SVCS due to benign or malignant aetiology. Electronic Publication     

高密度多孔聚乙烯片填充治疗爆裂性眼眶骨折

目的：评估高密度多孔聚乙烯片填充治疗爆裂性眼眶骨折的有效性。方法：选择2003年6月至2006年1月，在浙江大学附属第一医院眼科中心就诊的23例眼眶爆裂性骨折患者，进行高密度多孔聚乙烯片修复眶壁缺损并纠正眼球内陷。观察患者手术前后视力、眼球突出度、复视和眼位变化。结果：23例患者术后均未出现患眼视力明显下降和视力丧失，眼球内陷度数为（1．7&#177;0．5）mm，与术前（3．9&#177;1．2）mm比较，差异有统计学意义（P〈0．05）。术后1个月10例患者复视完全消失，11例患者第一眼位无复视，但仍有周边复视，2例术后第一眼位复视仍存在。术后22例患者眼球各方向运动基本正常，但有1例患者术后出现眼位上移，下转轻度受限，2周后恢复正常。结论：高密度多孔聚乙烯片填充治疗爆裂性眼眶骨折安全有效。     

非手术防治人工假体周围骨溶解的研究进展

人工关节置换术后假体周围骨溶解所引起的假体无菌性松动是影响其使用寿命的主要原因之一。晚期患者必须行关节翻修手术,但手术难度大、风险高、费用多,非手术治疗人工假体周围骨溶解已成为目前关节研究领域研究的热点。目前药物主要从抑制破骨细胞的骨吸收、作用于炎症过程及细胞因子、促进成骨三方面来防治骨溶解;基因治疗骨溶解和其他方法也在研究中。     

大转子髋关节融合术治疗全(半)髋关节置换后假体松动

目的:探讨针对人工全(半)髋关节置换术后因假体松动而采取补救性的关节融合手术的适应症与禁忌症。方法:6例人工全(半)髋关节置换术后假体松动的患者应用大转子髋关节融合术予以治疗。结果:经术后12~36个月,平均16个月随访,X线片示髋关节均获骨性融合,融合时间为5~8个月,平均6.5个月。Harris髋关节评分由术前的26~41分,平均31分,提高到术后56~80分,平均72分。结论:本手术是一种疗效可靠、简单实用、切实可行的补救性治疗方法。     

感染科对人工植人物的规范管理

目的 探讨医院对人工植入物的规范管理.方法 通过制度和措施,对人工植入物在采购、使用前、中、后进行有序的管理.结果 实施过程管理,确保患者的使用安全,也可以避免使用后的人工植入物被不良利用.结论 维护医患双方的利益,确保患者不受伤害,减少医院在使用中所产生的纠纷,并在执行中持续改进.     

联合血管重建的胰十二指肠切除问题（附45例报告）

目的：探讨联合血管重建胰十二指肠切除术的适应证和方法。方法：回顾自1994年4月－2001年3月多家协作医院45例联合血管重建胰十二指肠切除术的经验。本组45例行胰十二指肠切除，其中1例胰头癌累及结肠肝曲合并右半结肠切除，全组均联合SMPV切除，其中合并SMA和HA切除重建者分别为4例和2例，SMPV，SMA及HA三者同时重建者3例，1例胰头癌因与下腔静脉前壁粘紧不能分开则合并下腔静脉前壁部分切除修复。结果：本组病例围手术期死亡3例（7．1％），无胆胰瘘及人工血管感染并发症，病理检查结果：胰腺神经内分泌恶性肿瘤1例，其余无均为腺癌，切除血管内膜和胰腺切缘均无肿瘤浸润，本组失访2例，随访时间3－87个月，7例死于术后7个月－3年，其中6例为合并SMA，HA重建者，存活超过3年19例，超过5年6例，其余病例尚在随访中。结论：在选择适宜的病例中施行联合切除血管的胰头癌根治术可提高其切除率，延长存活时间，手术安全。     

Utility of a new soft non-woven polypropylene mesh for the transabdominal extraperitoneal laparoscopic hernia repair: preliminary results

SummaryAims Tension-free mesh reinforcement is the mainstay of laparoscopic hernia repair. Problems with current prostheses include shrinkage, migration, patient discomfort and neuralgias. We prospectively analyzed the short-term utility of a soft, non-woven mesh (Biomesh W/NK®, Cousin Biotech) in the TAPP repair.Methods During surgery, ease of insertion, unrolling, positioning and fixation of the mesh were evaluated. Postoperatively, all patients were followed up at 8 and 30 days.Results Forty-five hernias were repaired in 32 patients. Hernias were classified as Nyhus I-2; II-5; Nyhus III-33; Nyhus IV-5. Mean mesh size for unilateral hernias was 14,4 × 12.8 × 9 cm. All meshes were inserted without difficulty, and unrolled into the correct space with minimal trouble. Once in position, moving the mesh was more difficult than with a conventional woven mesh. Fixing was relatively straightforward. The mesh was noted to mould to tissues, assisting with hemostasis. At follow-up, there were no complications noted, specifically no neuralgias or seromas.Discussion Woven or knitted polypropylene mesh is commonly used for laparoscopic hernia repair, due to its ease of manipulation. However, the stiffness of such mesh probably contributes to its well-recognized complications. The Biomesh is much softer, lighter and more pliable, and can potentially reduce complications related to mesh stiffness. We have demonstrated the ease of insertion and fixation of the mesh, and the absence of short-term complications related to its use. In light of our experience, we believe that, in selected cases, the Biomesh offers an attractive alternative to traditional mesh.     

Myoelectric Hand Prosthesis Force Control Through Servo Motor Current Feedback

This paper presents the prehension force closed-loop control design of a mechanical finger commanded by electromyographic signal (EMG) from a patient's arm. The control scheme was implemented and tested in a mechanical finger prototype with three degrees of freedom and one actuator, driven by arm muscles EMG of normal volunteers. Real-time indirect estimation of prehension force was assessed by measuring the DC servo motor actuator current. A model of the plant comprising finger, motor, and grasped object was proposed. Model parameters were identified experimentally and a classical feedback phase-lead compensator was designed. The controlled mechanical finger was able to provide a more accurate prehension force modulation of a compliant object when compared to open-loop control.