Correlation between enzymatic estimation of myocardial infarct size and myocardial perfusion defect using SPECT

In patients with acute MI correlation between quantitative estimation of infarct size from the marker enzymes and non enzymatic proteins with perfusion defect using thallium 201 can help in the early choice of management strategy. Concentrations of six-marker enzymes and non-enzymatic protein [CPK, CKMB, LDH, SGOT, alpha HBDH and HFABP] were assayed in serial samples from 12 patients with AMI. Quantitative assessment of infarct size was done by a model developed by Witteveen et al in 1975, a modification was done on the model for estimation of infarct size using HFABP as it overestimates the infarct size using the standard model. Myocardial perfusion defect study using SPECT was done within one week of onset of AMI. Correlation between the infarct size using these enzymes and HFABP with perfusion defect was significant for all except infarct size using peak SGOT. A nearly equal estimate in absolute terms was obtained on using all of total [CPK, LDH, alpha HBDH and HFABP applying the modified model]. Infarct size using CKMB and SGOT underestimates the infarct size, on the other hand infarct size using HFABP is overestimated on applying the standard model. Using peak value of HFABP and applying the modified model can give an early reliable estimate of infarct size within 2 hours of admission or 6 hours of onset of symptoms. Conclusions: Using a single peak value of HFABP at 2 hours from admission or 6 hours from the onset of symptoms and applying the modified model can give an early nearly reliable estimate of infarct size. This can be used for early risk stratification and for the early choice of management strategy

Primary tension - free epigastric hernioplasty: procedure and outcome

Between January 1992 and May 1998, we operated upon 110 patients with large epigastric hernias [3cms or more] performing a primary pure prosthetic tension-free repair using the onlay polypropylene mesh graft technique, aiming to reduce the expected high recurrence rate after other repairs [1,4]. This group is retrospectively reviewed. There were 77.3% females and 22.7% males. Only elective repairs were included. All recurrent cases, the pediatric age group and those with ascites were not included. 7 patients [6.4%] has other types of hernia while 13 [11.8%] had more than one epigastric hernia. 8 patients [7.3%] presented with diastases [divarication] of recti in addition to their hernias. No perioperative mortality. Removal of the mesh, mesh extrusion or deep mesh infection did not occur in any case. Recurrence rate was 2.7% [3 cases] and was attributed either to emergence of a new hernia [in 2 cases] or to a correctable technical error [in one case]. Total complication rate was 18% while, complication rate related to mesh application was 10.7%. All complications were not serious and easily controlled as they necessitated minor surgical reintervention in only 4.5% of cases. It is to be concluded that the results are gratifying and the technique used is simple, durable and has a few and easily treatable complications. So, we recommend this repair as the primary repair of all epigastric hernias 3 cm or more to reduce the high recurrence rates noticed with other repairs

mesh plug epigastric primary hernioplasty: a preliminary report

During 2 years I used the mesh plugi technique to repair primarily 100 epigastric hernia in a similar number of patients. There were 68% of females and 32% of males. Mean age was 39 years. All recurrent cases, patients with associated diastases of recti, those with ascites and the pediatric age group were excluded from this study. Only hernias with definite sac and a defect < 3 cms were operated upon using a polypropylene mesh plug made as a cone or a cylinder and fixed in the rim of the defect with some absorbable synthetic sutures [Vicryl, Dixon]. Mean follow up period was 13 months. No perioperative mortality. There was one [1%] recurrence which was due to new hernia, 2 cases with superficial infection responded readily to antibiotic therapy. No serious complications were reported. It seems that such repair is safe, easy with lower complication rate. However, an additional report with long-term follow up to document the efficacy and the low recurrence rate of this technique seems necessary

Prosthetic mesh repair in incisional Hernia: how I do?

Prosthetic mesh repairs of 250 incisional hernia during a period of 10 years using polypropylene material [Marlex, Prolene] were retrospectively studied to outline the techniques used and the associated short and long-term complications. Two basic surgical techniques were identified. The first was a pure double-strength prosthetic repair used in cases with massive incisional hernia [10 cm or more] i.e. in 41 cases [16.4%]. Both underlay [intraperitioneal] and onlay [subcutaneous] mesh grafts were applied. The second technique was a combined tissue-prosthetic repair. The tissue repair was performed extraperitoneally without opening the sac using an interrupted non absorbable synthetic sutures. This technique was used in the majority of cases [76.4%], while in 7.2% of cases a similar tissue repair was performed but after opening the sac and dealing with the present adhesions because of recent attacks of bowel obstruction. In the last two groups of total 209 patients [83.61], tissue repairs were reinforced with an onlay graft. No perioperative mortality. The total complication rate was 26%. Complications related to mesh application were not serious and met with in 16%. Infection rate was 5.6%, while recurrence rate was 1.6%. Minor surgical reintervention was necessary in 3.6%. In conclusion surgeon should not hesitate to tailor his technique according to the present anatomical and biological factors in each case. Our results is not different from those reported from other centers with special interest. There is an urgent need to conduct a controlled randomized studies to evaluate each technique used in the prosthetic mesh repair of incisional hernia in general

Prosthetic mesh repair. in incisional hernia when I do?

From a total number of 320 patients with incisional hernia, I used prosthetic mesh repair [polypropylene material] in 250 patients [78.1%]. This group is retrospectively studied to identify the indications for this prosthetic repair as I do not advocate its routine use. No perioperative mortality was reported. The total complication rate was 26%. Complications related to mesh application were not serious and met with in 16%. Minor surgical reintervention was necessary in 3.6%. Ten indications for prosthetic mesh repair are identified. They are: [I] recurrence in 32%, [II] large defects [10 cm or more] in 16.4% [III] tension at repair in 9.2%, [IV] multiple defects in 11.2%, [V] attenuated musculofascial components in 15.2%, [VI] diastasis [divarication] of recti in 4.8%, [VII] relaxing incisions in 3.6%, [VII] multiple hernias in 2.8% [XI] incurable straining in 2.4%, [X] simultaneous excision of desmoid tumours in 2.4%. All represent a high risk hernias that would have high recurrence rates with the autogenous repair. In conclusion, I do not advocate the use of prosthetic material in every case with incisional hernia, but rather a flexible and individualized approach is adopted. Depending on the patient's peculiarity as well as the present anatomical and biological factors, ten indications for prosthetic mesh repair were identified. The results are gratifying and the whole item seems to be well accepted