Risk prediction of coronary artery disease among naval forces

Coronary artery disease [CAD] risk factors seem to cluster in some occupational groups. The present study was designed to investigate CAD risk factors among naval forces as an example of a high risk sector and to construct a risk prediction model for the disease. A case control study was carried out at the general naval hospital [GNH] in Alexandria. The study included 250 male consecutive naval CAD cases with a control group of 250 males matches for age, occupational level, sociodemographic characteristics and, free from CAD. All participants were subjected to a questionnaire about personal data, occupational history and exposures, occupational and leisure physical activity, dietary habits, smoking, and medical history. Anthropometric measurements, sifting blood pressure, and lipid profile were determined by the standard methods. Results revealed that occupational sedentary activity and perceived occupational noise were the significantly reported special occupational characteristics together with other conventional risk factors among CAD naval cases verses controls [p< 0.000 and < 0.009 respectively]. Logistic regression analysis with the dependent variable as being a CAD case showed independently significant effects for family history of premature CAD, history of hypertension, smoking, history of diabetes mellitus, body mass index [BMI], leisure physical activity, fish consumption, and HDL-cholesterol. A risk prediction model utilizing these variables was constructed with an overall correct percent of 74.6%. Application of the model expresses the risk of having CAD in an individual eligible with criteria of the study population. These results are of special importance for design of preventive programs for CAD in similar high risk occupational groups

Safety of repair of large parastomal hernias using a prosthetic mesh in the sub lay position

Background: The disappointing outcome of local fascial repair and stoma relocation in parastomal hernias has stimulated a variety of new techniques that use a prosthetic mesh for herniorrhaphy. Many of these procedures either carry the risk of mesh contamination or allow only a local repair. We established a method that allows both an aseptic operation and the management of concurrent incisional hernias

Methods: Thirty-two patients [20 males and 12 females] with a mean age of 56 years [range 52-69 years] with paracolostomy hernias in the period from September 1997 to September 2004 were included in this study. All the patients are assessed preoperatively and treated surgically by midline approach and a prosthetic mesh in the sublay position in a plane between the peritoneum and transversus abdominal muscle. The mean follow up of our patients was 4.5 years [range 6months-6 years]

Results: The mean duration of the operation was 150 minutes. The mean size of the mesh used was 15 x 30 cm. Their were no major intra operative complications. Four major postoperative complications developed. Small adhesive bowel obstruction, two patients developed severe wound infection and one patient developed pulmonary embolism the mean follow up period was 4.5 years [range 6 months - 6 years]. The overall recurrence rate verified by clinical and ultra sonographic examination is nearly 10%. Moreover two patients developed incisional hernia who had no problem with their old scar

Conclusion: it is our opinion that the use of a polypropylene mesh extraperitoneally in the sublay position for treatment of large paracolostomy hernias avoids the high recurrence rate seen with local repair or relocation of the stoma, avoids the complications seen with the intraperitoneal placement of the mesh and furthermore allows the possibility of repair of other fascial defects whether related to the mid line or not with safety, with no major intra operative complications, with no major wound Infection that warrants mesh removal and accepted low recurrence rates