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

Detection of chromosome 22q11 micro deletions among children with isolated congenital heart disease using PCR

Congenital heart disease [CHD] is the most common form of human birth defects, affecting 0.4% to 0.9% of all live-born neonates. It is the leading non-infectious cause of mortality in newborns. Nowadays echocardiogram plays an important role on the diagnosis. This procedure is able to identify a wide range of malformations. However, despite the advances in diagnosis and treatment of congenital heart malformations, our understanding of the causative mechanisms has been limited. Previous studies suggest that a substantial number of patients with CHD have a 22q11 deletion. The type of CHD observed is variable, but frequently there is involvement of the conotruncal anomalies. Chromosome 22q11 deletion syndrome can be inherited in an autosomal dominant fashion or result from a de novo deletion or translocation. Therefore, early diagnosis of this syndrome is important both for management of the patient and for assessing risk of recurrence in future pregnancies. The objectives of this study were to determine the frequency of chromosome 22q11 deletions in patients with isolated CHD, and to compare between this prevalence among different groups of CHD. We studied a series of 75 children with CHD [proven by detailed echocardiography] attending the cardiology unit in El-Shatby pediatrics university hospital. After taking the parents consent, each patient was subjected to complete genetic assessment. Of 75 patients approached, 15 were found affected with well recognized genetic syndromes, and, therefore, excluded from the study. We analyzed the 60 patients with' apparently' isolated CHD for 22q11 microdeletions by PCR assay using three highly polymorphic microsatellite markers [D22S941, D22S944 and D22S264]. The results proved that VSD was the most common type of CHD. Cardiac phenotypes were classified into 2 groups: conotruncal anomalies [5/60], and non- conotruncal anomalies [55/60]. Chromosome 22q11 deletions were identified only in three patients. The prevalence of 22q11 microdeletion in different groups of CHD was: 20% [1/5] among the group of conotruncal anomalies, and 3.6% [2/55] among those with non-conotruncal anomalies. The 22q11 microdeletions are more prevalent among patients of the conotruncal group. There fore, it is recommended that patients with CHD of conotruncal type should undergo 22q11 microdeletion testing so genetic counseling can be offered as well as proper diagnosis management of associated manifestations

role of fine needle aspiration cytology and imprint cytology in cervical lymphadenopathy

To determine the diagnostic accuracy of cervical lymphadenopathy by fine needle aspiration [FNAC] and imprint cytology [IC]. This study included 94 patients with cervical lymphadenopathy. This study was carried out in the Departments of General Surgery and Pathology, King Fahad Hospital, Hofuf, Kingdom of Saudi Arabia, from June 2001 through to July 2002. They were subjected to clinical examination and FNAC of one of the enlarged lymph nodes. This was followed by IC and histological examination of this lymph node after its excision. Clinical examination was correct in 78% of the cases. The overall accuracy of fine needle aspiration was 93%. It was accurate on all cases of reactive hyperplasia, 93% of tuberculosis lymphadenitis, 90% in Hodgkin's lymphoma, 86% in non-Hodgkin's lymphoma, and 91% of metastasis lymphadenopathy. On the other hand, the overall accuracy of IC was higher than that of fine needle aspiration, being 97%. It diagnosed all cases of reactive hyperplasia and non-Hodgkin's lymphoma, 97% in tuberculosis lymphadenitis, 90% in Hodgkin's lymphoma and 95% in metastasis lymphadenopathy. These techniques proved to be reliable, rapid, and inexpensive procedures in diagnosis of lymphadenopathy. They can differentiate well between inflammatory and neoplastic lesions, in cases of lymphoma, cytological diagnosis should be followed by histological diagnosis for accurate classification and grading