rimmed prolene mesh in ventral hernioplasty: a novel configuration for a better pro-peritoneal application

The development of abdominal wall defects is remarkable in surgical practice. Therefore, trials are never stopping to improve the methods of repair of such defects. Tension-free repairs using prosthetic materials are highly recommended, as long as a durable reconstruction is desirable. Debate always exists as regards the best prosthetic material; however polypropylene is the most commonly used one. Polypropylene mesh implants are available in many designs, configurations, thicknesses of weaves and strands, and sizes of pores. Is to revive the valuable sublay positioning of the prolene mesh by presenting a novel configuration of the mesh "rimmed prolene mesh", which is supposed to facilitate its application in the pro-peritoneal space, with comparison of the results to those of the commonly used onlay technique. Eighty nine patients with ventral hernia were enrolled into the study, during the period between January 2004 and October 2006. Seventy five cases were females, and 14 were males. They were randomly allocated between two groups of management, [A] and [B]. Group [A] was formed of 44 patients with a mean age of 40 years [30-57]. In this group, pro-peritoneal [sublay] rimmed prolene mesh [RPM] ventral hernioplasty was done. Group [B] included 45 patients with a mean age of 42 years [32-54]. This represented the cotrol group in which the common procedure of pro-parietal [onlay] flat mesh hernioplasty was applied. The method of preparation of the rimmed mesh and the technique of its application are described. Intra-operative and postoperative findings were recorded for both groups, and the results were compared. The presence of the rim configuration of the mesh had the following benefits in the pro-peritoneal application: It allowed fixation of the mesh to the edge of the fascial defect and obviated the need to close the defect over the mesh as in Rives Stoppa technique. Consequently, this insured a more tension-free repair. The 3-5 mm-height rim made it easier and faster to take the bites in the mesh during its fixation to the facial defect. The height of the rim also obviated the need to dip the needle down into the mesh that overlies the peritoneum, thus avoiding any event of a suture entangling a bowel loop, thus adding an element of safety. Otherwise, the comparison of results of the two groups of cases revealed shorter operative time and hospital stay in group A compared to B, being 92 [60-140] minutes and 1.86 [1-3] days for group A and 120 [75-180] minutes and 2.97 [4-9] days for group B. The overall rate of complications was also less in group [A], particularly the incidence of seroma. No recurrence was encountered in either group till the end of October 2006. The rimmed prolene mesh [RPM] is a novel configuration for a simple, rapid, efficient and safe pro-peritoneal application in treatment of ventral hernia. Further trials of application of the RPM are recommended to evaluate its effectiveness. A ready-made RPM may then be available, allowing its use at a wide scale

Evaluation of harmonic scalpel [SH] in thyroid surgery: a prospective randomized study

The harmonic scalpel [HS] using mechanical vibration rather than high temperature has been widely used in laparoscopic surgery and is documented to be safe and fast for cutting and coagulating tissues. We studied whether the use of [HS] could have advantages in thyroid surgery compared to conventional thyroidectomy. Our study was a prospective randomized trial of thyroidectomies performed for benign thyroid diseases between March 2004 and August 2005 in Cairo University Hospital. Patients were randomized into 2 groups: group A [n=50] underwent thyroidectomy using HS and group B [n=50] with the conventional technique, clamp and tie and electrocautery. The outcome measures in this study included operative time; postoperative drainage; hospital stay; and procedure complications including recurrent laryngeal nerve injury RLN as well as hypoparathyroidism. The two groups were similar in age and sex. Mean -+SD operative time was shorter in the SH group compared with the conventional group for both hemithyroidectomy [61- +6vs 78- + /10 minutes] and subtotal thyroidectomy [86- +2Ovs 101-+ / 6minutes]. The difference was statistically significant. There were no statistically differences between the two groups regarding transient postoperative complications. There was no mortality in both groups and no intraoperative complications or postoperative definitive sequelae. We concluded that the use of HS is safe in thyroidectomy: it does not reduce or increase operative morbidity but has a clear advantage of reducing operative time by almost 30 minutes. These results my have implications for significant hospital cost saving. By shortening operative anesthesia time the use of HS might accelerate postoperative recovery. Further studies are needed to show the cost-effectiveness of both techniques

Plication of Haemorrhoids [haemorrhoidorrhaphy] versus milligan-morgan haemorrhoidectomy

Excision of advanced haemorrhoids involving most of the anal circumference is associated with excessive bleeding, extensive raw area and anal stenosis. On the other h and, incomplete eradication means recurrence. Plication of haemorrhoids or haemorrhoidorrhaphy obliterates any degree of haemorrhoids without leaving raw areas. This r and omized study compared plication with Milligan-Morgan haemorrhoidectomy. A total of 120 patients having advanced 3rd or 4th degree haemorrhoidal disease were r and omized to undergo haemorrhoidorrhaphy [73 cases forming Group A] or conventional haemorrhoidectomy [47 cases forming Group B]. The two methods showed no significant difference as regards the operative time, cost of surgery and postoperative care, amount of pain on days 1 and 7 and on first evacuation, length of postoperative hospital stay and patients' overall satisfaction score after 6 months. However, haemorrhoidorrhaphy was associated with a significantly smaller amount of bleeding. Conventional haemorrhoidectomy was associated with temporary incontinence to flatus in 5 cases, a persistent painful raw area beyond 6 weeks postoperatively in 4 cases, anal stenosis in 2 cases and recurrence in 2 cases, while none of the cases of haemorrhoidorrhaphy had such complications. Postoperatrive retention of urine that needed catheterization was noted in 6 cases of Group A and 7 cases of Group B.A peri-anal abscess was also reported in 2 cases of group A and 3 cases of group B within the first postoperative month and were completely cured by urgent drainage. Plication of haemorrhoids gives better results in comparison to conventional haemorrhoidectomy in advanced cases although it is applicable to all grades of the disease. Such advanced cases will have the advantage of minimization of bleeding, complete avoidance of leaving raw areas which precipitate anal stenosis and complete eradication of the disease that prevents recurrence, together with preservation of the normal anal cushions

Comparative study between prolene hernia system mesh and pre-peritoneal mesh in treatment of recurrent inguinal hernia

Repair of recurrent inguinal hernia is technically more dem and ing than a primary repair, with potential for a new recurrence, and a higher risk of complications. Between June 2002 and December 2003, sixty-four patients with recurrent inguinal hernia had been selected for this prospective comparative study. The patients were r and omized to undergo treatment using either the prolene hernia system [PHS] or the open pre-peritoneal configured prolene mesh repair [group A and B respectively]. No re-recurrence or mesh infection was reported in both groups. In group A, haematoma was reported in 2 cases [6.25%] cord injury and testicular atrophy in one case [3.12%] and scrotal oedema in 12 cases [37.5%]. These complications were not reported in group B which showed an incidence of seroma in one case [3.12%]. Compared to the PHS, the open pre-peritoneal configured prolene mesh repair for recurrent inguinal hernia is technically easier, safer and cheaper. The incidence of scrotal oedema is significantly less with the pre-peritoneal approach than with the open anterior approach using the PHS. The open pre-peritoneal repair using a configured prolene mesh should be considered at the top of hierarchy for treatment of recurrent inguinal hernia especially in bilateral cases

Parental smoking and lower chest problems in infants and children

Tobacco is the commonest indoor environmental pollutant to which children-are exposed. Passive smoking, the major source of indoor pollution has been identified as a risk factor for a variety of diseases. Children appear to be particularly vulnerable to passive smoking with increased incidence of wheezing, bronchial hyperreactivity, asthma, atopy, frequent cough, otitis media, persistent ear effusion, snoring and sudden infant death syndrome. The aim of this work was evaluation the relationship of parental smoking and lower chest problems, serum immunoglobulin E and eosinophil count in infants and children in Sharkia Community.This study included 2 main groups. Group I: Consists of 100 children with history of exposure to indoor passive smoking and group II: included 50 children without history of exposure to parental smoking as a control group. Every child in both groups was subjected to general and local chest examination, stool and urine analysis; chest X-ray; urinary cotinine level; absolute eosinophil count and serum IgE. This study showed that passive smoker children had statistically significant increase in urinary cotinine level; serum total IgE; and the frequency of lower respiratory illness than in control group. This increase was more in boys than girls and in children aged less than 2 years than those above 2 years. Also passive smoker children had significant increase in total eosinophil count than controls but there was no difference regarding the sex and age. Lastly there was positive and significant relationship between urinary cotinine level and serum IgE and the frequency of lower respiratory illness. From the above we can conclude that children exposed to environmental tobacco smoke are more vulnerable to health hazards especially lower respiratory illness

Evaluation of percutaneous intratumoral injection of p53 gene in the treatment of inoperable hepatocellular carcinoma as compared to alcohol injection

P53 is a tumour suppressor gene on chromosome 17 P. Alterations [deletion or mutation] within the coding sequences of the gene are among the most frequent genetic changes detected in human neoplasm. The use of gene therapy in some tumours is a new trend nowadays which carries many hopes for the future treatment of these tumors. This modality of treatment utilizes transfer vectors [plasmid, virus,] for delivering certain genes into malignant cells to induce tumour suppression. Injection of P53 intratumoral [I.T] in Hepatocellular Carcinoma [H.C.C.] is an example of this therapy. The aim of this study is to compare the effect of intratumoral injection of P 53 to that achieved with alcohol injection in cases of H.C.C. In a prospective study, eleven consecutive patients, diagnosed as H.C.C., were subjected to I.T injection of alcohol [Group I] and another eleven patients were subjected to I.T P 53 injection [Group II]. The results show that alcohol injection has superior results in treating H.C.C. over P 53 injection

Vitiligo: genetic linkage analysis

Since the familial aggregation of vitiligo has suggested a genetic role in the disease susceptibility and the conflicting results of the association studies with the ABO blood groups, we performed this study to clarify the possibility of an ABO blood group-linked control of the susceptibility to vitiligo. Twenty four multi-case families were chosen for the study. The linkage analysis was performed by the computer program LIPED. The highest Lod score [-0.08] achieved with a hypothetical dominant disease susceptibility gene with two alleles at a recombination fraction [] 0.4 and penetrance rate 20%

Pólipos de colon y recto / Polyps of the colon and rectum

Se presenta un estudio retrospectivo de 189 casos pólipos colorrectales durante el período 1985-1989, que incluye la revisión de historias clínicas, diagnóstico anatomopatológico y manejo en los archivos de los diferentes servicios del Hospital Central de Sanidad de la Policía Nacional. Destaca la sintomatología que lleva el paciente a la consulta, siendo el síntoma principal Rectorragía (41 por ciento), se evalúa el tiempo de evolución y su relación con el cáncer colorrectal, considerándose esta entidad como lesión premaligna. Se revisaron las 189 láminas incluyéndolas en la clasificación actual. Se demuestra un predominio del sexo masculino en 69 por ciento, con un aumento sustancial a partir de la quinta década de 62 por ciento de la presentación total. Asimismo, se comprueba que la incidencia de malignización alcanza el 2 por ciento

Age of attainment of night dryness in Egyptian children

This study was done on 1250 normal healthy children. They were selected from urban and rural areas in Sharkia Governorate. Noturnal enuresis represents a real home problem as the incidence was relatively high [16% in rural and 12% in urban areas at age of 5 years]. The incidence of enuresis was more in children of low social classes, in boys more than girls, more in rural than urban areas, more with house wive's children, higher with too early and too late toilet training and more in relatives of enuretics. Organic causes were uncommon