Comparison between modified rives procedure and bilayer mesh repair in management of large inguinoscrotal hernia and their effect on testicular volume and perfusion

To compare two different techniques in management of inguinoscrotal hernia with destroyed transversalis fascia of myopectineal orifice [Nyhus type III B and IV B and D], modified Rives procedure [MRP] and hilayer mesh repair [BMR] as regard: surgical problems, operative time, postoperative complications, hospital stay, effect on testicular volume [TV] and pcrfusion [TP] and recurrence rate. Patients -were divided into 2 comparable groups as regard age, BMI and type of hernia: I: 29 patients underwent MRP. II: 30 patients underwent BMR, preperitoneal mesh inserted through internal ring and onlay patch. US and CDUS were done to measure TV and peak systolic and end diastolic velocities and accordingly resistive index [RI] measured as indicator of TP. TP on hernial side was compared with healthy side preoperatively and with same side after one year. TV was measured postoperatively after one year. MRP was demanding and difficult especially in patients with BMI >30 and time consuming than BMR [111.24 +/- 16.42/87.8 +/- 15.96 min, P < 0.001]. BMR had less hospital stay [1.5 +/- 0.68/1.96 +/- 0.74 days, P = 0.016] but insignificant low postoperative morbidity than MRP. No recurrence in both groups after 2.42 +/- 1.007 and 2.48 +/- 0.95 y respectively. TP was impaired on hernial side preoperatively in both groups compared with healthy side [RI: 0.68 +/- 0.05 / 0.62 +/- 0.08, P - 0.0025 and 0.69 +/- 0.04 / 0.62 +/- 0.05, P< 0.001 respectively] and improved postoperatively [0.61 +/- 0.007, P < 0.001 and 0.62 +/- 0.07, P < 0.007 respectively]. TV was insignificantly affected [18.62 +/- 2.93 / 17.56 +/- 2.39 cm3, P= 0.762 and 18.38 +/- 2.641 / 16.57 +/- 2.51 cm3, P = 0.158 respectively]. On conclusion, BMR of Nyhus type III B and IV B and D is easier, and less time consuming than MRP. Both techniques are safe on testicles with improvement of TP postoperatively and economic

randomized comparative study between needle aspirations versus surgical drainage in liver abscess

To compare the therapeutic effectiveness of ultrasound guided needle aspiration versus open surgical drainage in treatment of liver abscess. Between March 2003 and May 2006, 60 consecutive patients with liver abscesses were treated with intravenous antibiotics and randomized in two groups: ultrasound guided intermittent needle aspiration [18G disposable trocar needle]; and open surgical drainage. There was no statistically significant difference between the two groups regarding patient demographics, abscess size and number, the presenting clinical symptoms and laboratory findings. The success rate was 80% in needle aspiration group versus 100% of open surgical group, the number of aspirations required varied from one aspiration [10 patients] up to 3 aspirations in 8 patients. The average time needed for clinical relief and the mean hospital stay for the successful treated patients were similar in both groups. Although both needle aspiration and open surgical drainage are safe methods for treatment of liver abscesses, open surgical drainage is more effective

Wound complications and pro-inflammatory cytokine levels in wound fluid as a result of scalpel versus diathermy dissection

Diathermy [electrocautery] has been postulated as a risk factor for wound complications. This study was conducted to evaluate the effects of diathermy and scalpel dissections on wound complications and local cytokine levels. From Jan. 2007 to Dec. 2007, we recruited 36 patients with operable breast cancer for this study. Those patients undergoing modified radical mastectomy were assigned to flap dissection with either diathermy [n = 18] or scalpel [n = 18]. Blood loss, drain volume and duration, seroma formation and wound complications were recorded. Tumor necrosis factor-alpha [TNF-alpha] and interleukin [IL]- 6 levels were measured in drain fluids at postoperative 24 hours. The diathermy group had significantly reduced blood loss and total drain volume, but increased seroma formation rate. Significantly elevated levels of TNF-alpha were measured in drain fluids of patients with diathermy dissection. The use of diathermy causes less bleeding and total drain output with an increased rate of seroma formation. Diathermy dissection increases pro-inflammatory cytokine response in wound fluid, which may reflect an aggravated inflammation and increased potential for tissue damage

Role of systemic inflammatory response in prognosis and survival after curative resection of colorectal cancer

Some studies have shown that the presence of a systemic inflammatory response, as evidenced by raised circulating concentrations of C. reactive protein [CRP] predicted recurrence and overall survival in patients with colorectal cancer. The aim of this study was to examine the relationship between the inflammatory response and prognosis and survival in patients undergoing potentially curative resection for colorectal cancer. 90 patients considered to have undergone curative resection were studied. Circulating CRP concentration was measured before and after operation. The majority of patients were aged 65 years or more, had colonic tumours and Dukes stage B lesions. 23 patients had raised preoperative value, 11 [47.8%] of them, had raised concentration after operation. 67 patients with a normal preoperative value, 60 [89.5%] of them had normal postoperative value. During follow up, 17 [18.8%] patients developed recurrence and 25 [27. 7%] died. In patients who have undergone potentially curative resection for colorectal cancer the presence of a systemic inflammatory response predicts a poor outcome