Prophylactic prosthetic reinforcement of midline abdominal incisions in high-risk patients

The incisional hernia is one of the major elements of morbidity after abdominal surgery. In the best centers the incidence of post-operative hernia has been at least 10 percent as shown by long follow up. The risk of developing an incisional hernia can be increased due to patients related factors as age, obesity, D.M, cirrhosis, cough, constipation, smoking, glucocorticoid therapy, multiparity, malignancy and previous abdominal operations. It was soon recognized that vertical midline incisions were the most common site of postoperative incisional herniation because of this awareness, more consideration was given to choice of incisions wound closure, and wound healing to protect against incisional hernia. The aim of this work is to reduce the incidence of incisional hernia in high-risk patients after midline abdominal incision by prophylactic prosthetic reinforcement. From October 2002 to September 2003, forty [40] high-risk patients liable to develop postoperative incisional hernia underwent elective abdominal operations through midline incisions were operated upon at Gastroenterology and laparoscopic Unit, Surgery Department, Tanta University Hospital .They were randomly divided into two groups; Group A: Patients for whom the midline abdominal incisions were closed by conventional method and reinforced by subfascial polypropylene mesh, [20 patients]. Group B: Patients for whom the midline abdominal incisions were closed by conventional method only [20 patients].with follow up period up to 3.5 years. This study included 40 patients [18 males and 22 females] divided into two groups [A, B] with most patients around age of 50-60 years [12 patients, 5 in group A and 7 in group B]. In this study, twenty-three patients [57.5%] were presented with more than one risk factor [9 in group A and 14 in group B]. Types of midline abdominal incisions done in this study, upper midline incisions in 19 patients [11 in group A and 8 in group B], extended upper midline in incisions 4 patients [6 in group A and 8 in group B], lower midline incisions in 7 patients.[3 in group A and 4 in group B] Early local postoperative complications, subcutaneous seroma in 7 patients [2 in group A and 4 in group B], surgical site infection. [1 in group A and 2 in group B], partial wound disruption. [4 in group A and 3 in group B] and complete wound disruption. [Complete burst] in only one patients in group B. Late postoperative complications chronic wound pain. Three patients [15%] in group A, ascites three patients in [group A] and one in [group B] all were cirrhotic patients, developed moderate postoperative ascites. None of [group A] patients developed postoperative incisional hernia during follow up, while three patients 15% in [group B] developed postoperative incisional hernia. Prophylactic subfascial non-absorbable mesh reinforcement of midline closure in high-risk patients can be used safely and effectively to provide an extrinsic strength of the wound without relying much on the defective development of its own intrinsic strength and to prevent subsequent incisional hernia. The final statement should await the outcomes of the long term follow up of the studied cases

Risk assessment of spontaneous abortion in Cairo: a case control study

There is an increased risk of spontaneous abortion with high level of chemicals exposures as shown for some occupational groups. Howevere, there are substantial gaps in our knowledge about whether exposure to environmental chemicals has an impact on spontaneous abortion for the general population. The study aimed to measure the blood lead level and investigate the risk factors of spontaneous abortion among married women in Cairo governorate. A case-control-hospital based study was carried out in four different types of hospitals at the emergency and outpatients clinics. The subjects composed of 2 groups, control group [a]: normal pregnant females [232 subjects] attending the hospital after 28th week of gestation and spontaneous abortion group [b]: 230 cases attended the emergency room of the studied hopitals. The researchers collected the required data through an interviewing questionnaire then blood samples from them were collected and analzed for blood lead level by the atomic absorption method. The study revealed that women at high risk of developing spontaneous abortion are those with smoker husbandss, low educational level, low income, living nearby chimney, irregular and painful menstruation. Also women with previous history of abortion[s], congenital anomalies, pelvis operation[s] and abortion investigations are at more risk for the development of spontaneous abortion than the normal pregnancy ones. We have recommended that women who are at the spontaneous abortion risk during pregnancy should have a more frequent antenatal care for monitoring and evaluation. Also, there is a great need for a well developed occupational health programs and studies in this arena

Pulmonary alveolar macrophages in calf: an electron microscopic study

Alveolar phagocytes were found as free cells in the alveolar spaces of calf's lung. These cells appeared large with spherical or irregular nucleus. Their cell surface was rough due to the presence of many cytoplasmic extension and pseudopodia. In cytoplasmic structure, the cells were somewhat similar to the other macrophages. Their cytoplasm showed a variety of inclusions and a large number of phagolysosomes. The alveolar macrophages are suggested to be responsible for the removal of the small foreign particles and the degraded surfactant from the lumen of the air-alveoli

Ultrastructure of the type-II pneumonocyte in lambs lung with special reference to the morphology of its inclusion bodies

The type-II pneumonocytes appeared as large rounded cells occupying the niches and the corners of the alveolar walls. They showed microvilli on their free surface and adjoining the type-1 cells through tight junctional areas. Their cytoplasm was rich with organoids. The most peculiar feature of this cell was the osmiophilic inclusion bodies which were thought to contain surfactant material or its precursor. Some of these inclusions appeared vacuolated or possessed homogeneous density. Others showed lighter osmiophilic material accumulated around a heavily osmiophilic core or they appeared lamellated. It seems possible that this morphological difference may well be related to the difference in the chemical constituents of these inclusion bodies

Histogenesis of the skin of the one-humped camel [Camelus dromedarius]

The fetal epidermis appeared as a single layer of cells at 1.8 cm CVR length. Then increased in thickness by 39-43 cm CVR. The primordia of the stratum corneum was observed in fetuses with 87 cm. At CVR 95 cm the epidermis showed a general decrease in thickness. By 110-117 cm stage the epidermis could be differentiated into many strata. However, the stratum lucidum was not seen. There was a gradual increase in the thickness of dermis throughout the fetal life. At 34 The hair germ started to appear at 15 cm CVR and formed hair plug at 34 cm CVR. By 39-47 cm these hair plugs appeared as slanted column of cells and could be distinguished into primary and secondary with 59 cm length. At 87 cm the hair canal and the bulb were formed. Hair groups were recognized at 95 cm CVR and became clear in fetuses with 110-117 cm. At this stage, many of the hair had emerged from the skin surface. Sweat gland buds appeared as ental swelling on the primary hair plugs at 42 cm CVR fetal length and on the secondary hair plugs at 65 cm. These sweat gland primordia were canalized at 75 cm CVR. In fetuses with 87-110 cm length, the sweat glands appeared more developed. They were located more deeper in the fetal dermis at 117 cm. At 50 cm CVR the sebaceous gland rudiment was first recognized. By the stage of 59-75 cm they bulged into the adjacent dermis as a follicular cell budding and increased greatly in length and in size with the advance of age. At 95 cm, the secondary follicules showed small sebaceous buds. In fetuses with CVR 117 cm the sebaceous glands appeared more organized and became distinct in association with the primary hair. Those with the secondary follicles were short and small

Histogenesis of the thyroid gland of the one-humped camel [Camelus Dromedarius]

The results presented in this investigation elucidate the histological structure of the camel [Camelus dromedarius] thyroid gl and during ontogenetic stages using 68 embryos and fetuses at different ages ranging from 1.8 to 120 cm CVR length

Evaluation of prosthodontic needs in an industrial community

A certain industrial community was chosen for this survey. Workers were examined thoroughly and a precise history was recorded. The study aimed at surveying prevalance of edentulous areas at various age groups, and its distribution, utilization rate of prosthetic appliances and possible causes of loss of teeth. Data obtained revealed that increase of prevalance of edentulous area increases with age distributed mostly in upper pre molar and molar areas and the main cause being caries. As for utilization rate of appliances in the partially edentulous this proved to be low. From this study it is clear that there is no coordination between the using dental needs and the dental facilities and services given. The survey has attracted our attention of the paramount importance of preventive dental care, education and motivation of workers as regards earlyprosthetic treatment and encouragement of further studies by Health Insurance Programmes as the health of our workers in general affects our industrial flourishment