Postoperative disrupted abdominal wall management by a new tissue expansion technique

A new technique has been presented that results in an acceleration of delayed primary healing with full thickness skin and subcutaneous tissue coverage. Sixteen patients [ten with one or more intestinal fistula] developed abdominal wall dehiscence were included in this study. At discharge, all wounds were closed. The follow up was limited for various reasons. The technique appears to be successful. Its simplicity allows an easy learning and may avoid a major operative procedure. Accelerated delayed primary closure by full thickness skin and subcutaneous tissue has considerable economic benefits for the patient

new score for palpable breast mass in women under age 40

This study was to develop a rapid and accurate diagnostic test for palpable breast masses in women under age 40. masses were evaluated utilizing a modified triple test score [MTTS],Which assigned scores of 1 point for benign, 2 point for suspicious and 3 point for Malignant findings from physical examination, ultrasonography and fine needle aspiration. The MTSS was the sum of the three scores and was correlated with biopsy or follow up. among 113 masses, 100 scored 3 points, 8 scored 4 points, and all were benign. Three scored 5 points [1 was malignant], two scored>6 points both were malignant. The MTTS has 100 percent diagnostic accuracy when other than 5 points. Masses scoring < 4 points are benign. Masses scoring > 6 points may proceed to definitive therapy. Masses scoring 5 points [3 percent] require biopsy. This approach avoids open biopsy in the majority of cases, while capturing all malignancies

Fundoplication for gastroesophageal Reflux Disease: Indications and current status

The Nissan fundoplication and in particular the laparoscopic Nissen fundoplication, has received wild Spread acceptance as the most definitive therapy for gastro esophageal reflux disease. There remain, however, certain patients who do better with a less aggressive surgical augmentation of lower esophageal sphincter. Partial fundoplication originated in the early 1960s, as an alternative procedure to the Nissen, which was associated with moderately high rates of postoperative side effects. These more physiological procedure have proved successful in the treatment of reflux disease in patients with poor or no esophageal motility In particular, the use of partial fundoplication in association with Heller's myotomy for achalasia has been demonstrated to be well tolerated and to reduce the risk of late dysphasia resulting from uncontrolled gastro esophageal reflux [GER]. The use of partial fundoplication in GER patients with normal motility, however, has been less successful. High recurrence rates are documented by many centers with the main cause appearing to be related to a less competent lower esophageal sphincter and a higher rate of wrap hernia ion. This has led to the current practice of a tailored approach to reflux disease, in which all patients receive a through preoperative physiological evaluation to determine the best ant reflux procedure for the individual. This is generally a Nissen repair for those with normal motility and either an extra short floppy Nissen or partial wrap for those with impaired peristalsis

Predication of failure of percutaneous drainage of postoperative abdominal abscesses

Percutaneous drainage [PD] of complex postoperative abscesses associated with a variety of factors such as multiple loc or enteric fistula remains a matter of debate. Accordingly, their retrospective study was designed to determine the predictive factors for failure of PD of postoperative abscesses in order to better select the patients who may benefit from PD. From 1998 to 2002 the data of 73 patients who went computed tomography CT guided or ultrasonographic-guided PD for postoperative intrabdominal abscesses, were reviewed. PD was considered as failure when clinical sepsis persisted or subsequent surgery was needed in possible association between failure of PD and27 patient, abscess, surgical, and drainage-related variables where assessed using univariate and multivariate analysis. Successful PD were achieving in 59 patients [81 percent]. The overall mortality was 3 percent, but no patient died after salvage surgery. Multivariate analysis showed that only abscess diameter of less than 5 cm [P = 0.042] and abscess of antibiotic therapy = 0.01. Significant predictive variable for failure of PD CT guided and U/S guided PD associated with antibiotic therapy could attempted as the initial treatment of postoperative abscesses even in complex cases such as loculated abscesses or those associated with enteric fistula