Promising new technique in the repair of parastomal hernia

Parastomal hernia is a common complication after stoma formation. Although not all hernias require surgical repair, a variety of surgical techniques exist. Facial repair, relocation of the stoma, and the local use of a nonabsorbable mesh are the three major approaches. Despite this variety of techniques, recurrence rate and complications are high. We therefore invented a laparoscopic technique where we close the hernia and reinforce it with a hand-made funnel-shaped Gore-Tex dual mesh. This technique has all advantages of laparoscopy (less pain, short hospitalization) combined with the advantages of local mesh repair (no stoma replacement necessary, low recurrence rate). The risk of infection is also minimized. The shape of the Gore-Tex mesh reduces hernia recurrence even more, prevents prolaps, and allows easy colonoscopy and stoma irrigation.     

姑息性右心室-肺动脉连接术中管道材料及型号的选择与应用

目的 评价不同管道材料（Gore-Tex人工血管、牛颈静脉和自体心包管道）在姑息性右心室-肺动脉连接术中的应用效果,探讨患者适用的管道型号与体重、McGoon比之间的相关性。 方法 回顾性分析 2010年7月至2012年7月北京阜外心血管病医院小儿外科中心24例先天性心脏病患者接受姑息性右心室-肺动脉连接术治疗的临床资料,其中男11例,女13例;年龄60 d至6岁;体重（10.22±7.41） kg。肺动脉闭锁合并室间隔缺损（PAVSD） 22例,法洛四联症（TOF） 1例,右心室双出口（DORV） 1例。使用的外管道材料分别为自体心包17例,Gore-Tex人工血管5例,牛颈静脉2例。对重建管道的直径与患儿体重进行线性回归分析,以McGoon比为参数对公式再作矫正。 结果 无围术期死亡,术后全组患儿血氧饱和度较术前增加20.37%±28.33%。心电图均显示窦性心律,心功能（NYHA） Ⅱ级23例,Ⅲ级1例。采用自体心包手术患儿术后呼吸机使用时间短于其它两种材料（P=0.017）。术后随访16例,随访时间10个月～2年。其中采用自体心包手术患儿完成随访12例,采用Gore-Tex人工血管手术3例,采用牛颈静脉手术1例。随访期间采用自体心包手术患儿McGoon比为1.98±0.46,Gore-Tex人工血管手术为1.83±0.33,牛颈静脉手术为1.68,均较术前有明显增加（P＜0.05）。完成根治6例（其中采用自体心包手术患儿完成根治手术5例,采用Gore-Tex人工血管手术患儿完成根治手术1例）。随访过程中未发现明显与手术相关的并发症发生。通过线性回归分析,得出合适的管道型号与患者体重关系的公式：管道直径（mm） =0.327×体重（kg）＋4.599。通过McGoon比、管道型号及公式计算值的对比分析发现：McGoon比＜0.8,可取大于计算值的第一个整数;McGoon比＞1.2,则可取小于计算值的第一个整数。0.8＜McGoon比＜1.2,则前后两个整数均可。病例分组分析发现,术后恢复良好者更符合经公式计算及McGoon矫正后的值。 结论 三种材料均可作为重建右心室-肺动脉连接管道的常规材料;右心室-肺动脉连接术中可以根据患者的体重及McGoon比选择合适的外管道型号。     

Augmentation with a Gore-Tex patch for repair of large rotator cuff tears that cannot be sutured

 The objective of this study was to determine the effectiveness of augmentation with a Gore-Tex patch in reconstruction of rotator cuff tears that cannot be repaired by direct suture. Twenty-eight shoulders of 27 patients underwent this procedure. The average age at surgery was 62 years, the average duration of symptoms before surgery was 16 months, and the average follow-up period was 44 months. The shoulders were classified into two groups according to patch size (anteroposterior dimension up to 2 cm or greater than 2 cm). The clinical outcome was evaluated by using the shoulder surgery classification system issued by the Japanese Orthopaedic Association (JOA score), and the postoperative isometric abduction strength at 90° of abduction was assessed by the method of Constant. The average total JOA score improved from 57.7 to 88.7 points, a statistically significant change. There was no difference in the improvement in score between shoulders treated with small patches (12 shoulders) and those treated with large patches (16 shoulders). The average abduction strength was 6.2 kg in the small-patch group and 1.5 kg in the large-patch group, with a statistically significant difference between the two groups. Good clinical results, especially pain relief, could be achieved with this procedure in both the small- and the large-patch groups, but good abduction strength was obtained only in the small-patch group. The mechanism of the improvement by this procedure is still controversial. Received: December 18, 2001 / Accepted: March 15, 2002     

Hyaluronate, tetrachlorodecaoxide, and galactolipid prevent adhesions after implantation of Gore-Tex and dura mater into the abdominal wall in rats

Gore-Tex (GT) and dura mater (DM) are used as prosthetic materials for the closure of the abdominal wall defects, however, they create intra-abdominal adhesions. This study addresses the question of which substances can reduce these adhesions. In rats, Gore-Tex and DM were placed on the inner abdominal wall. Two weeks later the animals were killed; the anterior abdominal wall was excised and photographed. The photographs were digitized and the surface area covered by adhesion was measured by computer analysis. In animals where DM or GT was implanted without the addition of an anti-adhesive substance, 45% of the DM and 34% of the GT surface was covered by adhesions. When hyaluronate (HA), tetrachlorodecaoxide, or galactolipid was applied to the bowel intra-operatively, adhesions were found on only 14%, 11% or 8% of the GT surface. For DM, only HA was effective, and reduced adhesions to 9% and 10%, respectively. Plasmin, taurolidine, and streptokinase-streptodomase were ineffective in preventing adhesions in both DM and GT. Accepted: 5 January 1999     

Serum concentrations of per- and poly-fluoroalkyl substances and factors associated with exposure in the general adult population in South Korea

Per- and polyfluoroalkyl substances (PFASs) are ubiquitous contaminants found worldwide, including in South Korea. As a result, they are frequently detected in Koreans. However, there is limited representative data and information on potential sources in Korea. Therefore, we measured the serum concentrations of ten PFASs in nationally representative samples of the Korean population (n = 1874, 18–69 years) and evaluated the factors associated with their exposure. Serum PFOS, PFDA, PFOA, and PFNA were detected in nearly all participants (83.1–99.9%). However, serum PFPA, PFHxA, and PFHpA were almost undetected (<0.5% of participants). PFOS had the highest population-weighted geometric mean of 10.23 ng/mL (95% CI: 9.99–10.47), which was followed by PFOA with 2.85 ng/mL (95% CI: 2.73–2.97) and PFDA with 2.17 ng/mL (95% CI: 2.12–2.23). PFNA, PFDA, PFHxS, PFOA, and PFOS concentrations were higher in males (p < 0.001) and older adults (p < 0.001). PFNA was higher in those who used wax, polish, and water-resistant materials (adjusted proportional change = 1.14; 95% CI: 1.08–1.22), and those who ate cooked fish (1.16; 95% CI: 1.03–1.31) compared to those who ate nearly no fish. PFDA was higher in those who used herbicides and pesticides (1.05; 95% CI: 1.02–1.09), those who drank beverages in a plastic bag on a daily basis (1.10; 95% CI: 1.03–1.19), and those who ate raw fish (1.15; 95% CI: 1.03–1.29) or cooked fish (1.13; 95% CI: 1.05–1.23) compared to those who ate nearly no fish. PFHxS was higher in those who used traditional Korean health supplement foods (1.08; 95% CI: 1.01–1.15). PFOA was higher in those who used plastic wrap in a microwave daily or weekly (1.08; 95% CI: 1.00–1.16), and those who used disposable paper cups (1.07; 95% CI: 1.01–1.13). PFOS was lower in underweight participants (0.84; 95%CI: 0.75–0.93) compared to those who were obese, and higher in those who exercised regularly (1.08; 95% CI: 1.03–1.14) or irregularly (1.06, 95% CI: 1.01–1.12) compared to those who did not exercise. Subjects who used severely damaged Teflon appliances had lower concentrations of PFOA (0.78, 95% CI: 0.65–0.95), while regular use of Gore-Tex goods was related to higher PFNA (1.15, 95% CI: 1.03–1.28) and PFDA (1.11; 95% CI: 1.02–1.20) levels. These findings suggest that most Koreans are frequently exposed to PFASs, and that serum concentrations of PFASs vary with age, sex, and exposure factors.     

Permacol: a potential biologic patch alternative in congenital diaphragmatic hernia repair

Purpose

Recurrence is a well-known complication after patch repair of congenital diaphragmatic hernia (CDH). We propose that a newer, “bioprosthetic” material may lower recurrence rates. The purpose of this study is to compare outcomes of CDH repair with synthetic Gore-Tex (W. L. Gore and Associates, Neward, Del) to the bioprosthetic Permacol (Tissue Science Laboratories Inc, Andover, Mass).

Methods

We performed a retrospective review of 100 consecutive patients with CDH with survival more than 30 days at Children's Medical Center of Dallas (Dallas, Tex) from 1999 to 2007. The incidence and timing of recurrence, as well as comorbidities were assessed.

Results

Primary repair was performed in 63 patients and patch repair in 37, divided between Gore-Tex (29) and Permacol (8). Overall recurrences were as follows: 1 (2%), 8 (28%), and 0 in the primary, Gore-Tex, and Permacol groups, respectively. Median follow-up was 57 months for Gore-Tex and 20 months for Permacol. Median time to recurrence in the Gore-Tex group was 12 months, with no Permacol recurrences. Both the Gore-Tex and Permacol groups had similar comorbidities, including prematurity, congenital heart disease (76% and 63%, respectively), and the need for extracorporeal membrane oxygenation support (38% and 25%).

Conclusion

Our results suggest that Permacol may have lower recurrence rates compared to Gore-Tex and is a promising alternative biologic graft for CDH repair.     

The Use of Expanded Polytetrafluoroethylene (Gore-Tex) in Rhinoplasty

Background Septal cartilage still is the most appropriate graft material used in rhinoplasty. In traumatic or revision cases, septal cartilage can be insufficient, and the need for an implant material emerges. In this study, the safety and efficacy of polytetrafluoroethylene (Gore-Tex) used as an implant material in nasal dorsal augmentation were assessed. Methods This study retrospectively reviewed 74 patients who underwent nasal dorsal augmentation with Gore-Tex. Of the 74 patients who underwent rhinoplasty with Gore-Tex for dorsal augmentation from February 1999 to January 2006, 46 (62.2%) represented primary cases and 28 (37.8%) represented revision cases. The patients were followed from 5 to 62 months (average, 28 months) and questioned about cosmetic and functional outcomes. The results were assessed according to patients’ charts as well as preoperative and postoperative photographic documentation. Results There were no complications such as infections, foreign body reaction, extrusions, resorption, or migration, and all the patients were satisfied with their results. Only one case of soft tissue reaction was observed, which lasted for 3 weeks postoperatively. Conclusions Biocompatibility, ease of use, lack of extrusion or resorption, and low rate of infection make Gore-Tex a good alternative to autogenous tissue. However, long-term success and complication rates still are lacking, and large numbers of patients with longer follow-up periods are required.     

The use of polytetrafluoroethylene for particular augmentation of the nasal dorsum

In 24 cases scutiform polytetrafluoroethylene patches were implanted to correct saddle malformation and irregularities of the nasal dorsum. For smaller tissue defects of the nasal bone and cartilage, the patches are very suitable in rhinosurgery. One of the advantages of the implant is that it makes the reconstructed area appear as natural as possible.Extracts of this paper were presented at the 5th International Symposium of AAFRS, Toronto, Canada, June 1989     

Gore-Tex在耳郭部分缺损修复中的应用

目的:探索用于部分耳郭缺损再造的理想材料。方法:对13例外伤后导致的部分耳郭缺损的病人,采用Gore-Tex整形材料作为再造耳的支架,在耳后设计局部皮瓣覆盖进行修复,供瓣区直接缝合或另取皮片植皮。结果:本组共13例13耳,4例术后发生假体外露,经再次手术修整,随访1～2年,所有再造耳郭外形满意,与对侧正常耳外形基本一致。结论:Gore-Tex材料具有良好的组织相容性和可塑性,是部分耳郭再造的理想材料之一。