An ovary as unusual contents of an incarcerated umbilical hernia

We present the unusual case of a woman presenting with an incarcerated umbilical hernia. Intraoperatively, the contents of the hernia were found to be an ovary. We outline the clinical presentation of our patient, investigations and management as well as a discussion on unusual contents of umbilical hernias. To our knowledge, this is the first case of a non-malignant ovary incarcerated in an umbilical hernia.     

Managing the open abdomen in a district general hospital

Introduction

The need to manage an open abdomen is becoming more common in general surgical practice and a variety of methods of temporary abdominal closure (TAC) are available. The evidence for the efficacy of the various forms of TAC as well as the subsequent definitive fascial closure (DFC) rates and complications comes mainly from large trauma series in the US, which represent a different patient population to those in the UK in whom TAC is usually required.

Methods

All cases of open abdomen management in our hospital over a five-year period were reviewed to ascertain the methods of TAC used, our success in achieving DFC and the applicability of managing such cases in a district hospital environment.

Results

Nineteen patients underwent TAC, with two deaths (10.5%) and an overall DFC rate at hospital discharge of 12/17 (70.6%). The median lengths of critical care and hospital stays were 19.5 and 38.0 days respectively. Thirteen out of seventeen survivors had at least one significant complication.

Conclusions

The management of the open abdomen can be achieved safely in a district general hospital setting with acceptable outcomes for the non-trauma patients commonly seen in UK practice but it is a resource intensive and expensive undertaking.     

Modeling Structural Dynamics Using FE-Meshfree QUAD4 Element with Radial-Polynomial Basis Functions

The PU (partition-of-unity) based FE-RPIM QUAD4 (4-node quadrilateral) element was proposed for statics problems. In this element, hybrid shape functions are constructed through multiplying QUAD4 shape function with radial point interpolation method (RPIM). In the present work, the FE-RPIM QUAD4 element is further applied for structural dynamics. Numerical examples regarding to free and forced vibration analyses are presented. The numerical results show that: (1) If CMM (consistent mass matrix) is employed, the FE-RPIM QUAD4 element has better performance than QUAD4 element under both regular and distorted meshes; (2) The DLMM (diagonally lumped mass matrix) can supersede the CMM in the context of the FE-RPIM QUAD4 element even for the scheme of implicit time integration.     

Charpy Impact Behavior of a Novel Stainless Steel Powder Wire Mesh Composite Porous Plate

A novel powder wire mesh composite porous plate (PWMCPP) was fabricated with 304 stainless steel powders and wire mesh as raw materials by vacuum solid-state sintering process using self-developed composite rolling mill of powder and wire mesh. The effects of different mesh volume fractions, mesh diameters, and sintering temperatures on the pore structure and Charpy impact properties of PWMCPPs were studied. The results show that PWMCPPs have different shapes and sizes of micropores. Impact toughness of PWMCPPs decreases with increasing wire mesh volume fraction, and increases first and then decreases with increasing wire mesh diameter, and increases with increasing sintering temperature. Among them, the sintering temperature has the most obvious effect on the impact toughness of PWMCPPs, when the sintering temperature increased from 1160 °C to 1360 °C, the impact toughness increased from 39.54 J/cm² to 72.95 J/cm², with an increased ratio of 84.5%. The tearing between layers, the fracture of the metallurgical junction, and the fracture of wire mesh are the main mechanisms of impact fractures of the novel PWMCPPs.     

Meta-analysis of randomized controlled trials comparing Lichtenstein and totally extraperitoneal laparoscopic hernioplasty in treatment of inguinal hernias

Background

Finding the optimal approach to repair an inguinal hernia is controversial. Therefore, for the scientific evaluation of the total extraperitoneal (TEP) and Lichtenstein mesh techniques for the repair of inguinal hernia, meta-analyses of randomized controlled trials are necessary.

Methods

A complete literature search was conducted in the Cochrane Controlled Trials Register Databases, Pubmed, Embase, International Scientific Institute databases, and Chinese Biomedical Literature Database in various languages.

Results

Randomized controlled trials (13), including 3279 patients, were retrieved from the electronic databases. The Lichtenstein group was associated with a shorter operating time; however, results show that TEP repair enabled patients a shorter time to return to work, less chronic pain compared with Lichtenstein operation. There was no significant difference in seromas, wound infections, or neuralgia. There are no statistically significant difference in terms of hernia recurrence when the follow-up time is ≤3 y. When follow-up time is >3 y, TEP repair shows a higher recurrence rate compared with Lichtenstein repairs.

Conclusions

There was insufficient evidence to determine the greater effectiveness between TEP and Lichtenstein mesh techniques. In future research, it is necessary for subgroup analyses of unilateral primary hernias, recurrent hernias, and simultaneous bilateral repair to be conducted to define the indications for the TEP approach.     

复合补片和生物补片治疗食管裂孔疝的疗效对比研究

目的:对比应用复合补片和生物补片治疗反流性食管炎和食管裂孔疝的疗效。方法:21例应用Crurasoft誖复合补片组及20例应用BiodesignTM Surgisis誖生物补片组修补食管裂孔疝病人,对比分析术后复发率和补片相关并发症发生的差异。结果:两组病人一般情况、食管裂孔长径和手术时间等方面无统计学差异。应用复合补片和生物补片均能使术前反流性食管炎的症状显著缓解。复合补片组和生物补片组围手术期并发症发生率分别为9.5%和30.0%,两组间无统计学差异。术后6个月随访裂孔疝复发率均为0。复合补片组和生物补片组长期随访平均时间分别为(16.3±8.9)个月和(17.3±6.8)个月,解剖性复发率分别为4.8%和5.0%,无统计学差异。两组病人均未发生食管侵蚀的并发症。复合补片组病人术后吞咽困难发生率高于生物补片组(38.1%比20..0%),但无统计学差异。结论:应用新一代小肠黏膜下基质补片和复合补片修补食管裂孔疝后疗效满意,复发率低,补片相关的严重并发症发生率差异无统计学意义。