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

Common pleuro-pulmonary complications of uremic patients under hemodialysis

The current study was conducted in hemodialysis unit - Minufiya University Hospital to detect common pleuro-pulmonary complications in uremic patients under regular hemodialysis. This study included 20 patients [8 males, 12 females] with mean age of [44.6 -/+ 13.78] years on regular thrice weekly hemodialysis for a period 6 months .We excluded from the study smokers,other diseases that affect chest, non compliant patients during the period of study and patients who received recombinant human erythropoietin. All patients were subjected to full history taking, full clinical examination, renal function tests, complet blood picture, arterial blood gases analysis, radialogical study of chest and heart, spirometric study. In this study about 55% of the patients showed pulmonary complications in the form of bronchopneumonia, acute bronchitis, lobar pneumonia, pleural effusion, tuberculosis and pulmonary oedema. The caustive organisms in these cases of pulmonary infection were Staphylococcus aureus, Streptococcus viridans haemophillus, pneumococci and tuberculous bacilli. Pleural effusion was transudative in nature. The PaO[2] was significantly decrease after 1 hour from begining of hemodialysis. This was due to hypoventilation caused by decrease CO[2] due to its loss in dialysis fluid, alkalosis and use of bioincompatable membranes. As regards spirometric measures, there was no significant improvement of VC, FVC, FEV[1] /FVC, MMV where as improvement in FEF [25-75%] was significant: This is due to removal of interstial, peribronchial fluid by hemodialysis with removal of toxins that impair distensibility and causes reversible spasm to smaller airways. Also there was signifcant fall in PEFR one hour after the start of hemodialysis. This is correlated with occurence of hypoxaemia and broncho-constriction which occur at that time, although there was significant improvement of PEFR after hemodialysis but not correlated to normal values. Recommendations include use of non complement activating membrane and a dialysis system in which loss of carbon dioxide can be prevented, measuring spirometric variables before and after dialysis and close observation both clinically and radiologically, for these patients

Myosin light chain one [M.L.C.I], a diagnostic marker for acute myocardial infarction [A.M.I.]

Myosin light chain one [MLCI], total CPK and total LDH were estimated in 70 individuals; 40 patients with acute myocardial infarction [AMI]; [18 patients were successfully reperfused with streptokinase [STK] while the remaining 22 patients received conventional treatment] and 30 healthy persons as a normal control group. All patients were followed up by serial ECG. MLCI was measured by enzyme immunoassay reagents supplied by Yamasa Shoyu Co. Ltd. Tokyo, Japan, while total CPK and LDH were determined Colorimetrically by reagents supplied by Boehringer Mannheim GmbH Mannheim, Germany MLCI was of value in the diagnosis of AMI. MLCI persisted for 10 days, that is more than any enzyme and it is of value to make the diagnosis in patients who presented late i.e. after one week of the infarction in whom the ECG is equivocal and all enzymes returned to the normal level. Both MLCI and CPK were positive in 11% while LDH was positive in 2.7% of cases after 8hrs of the onset of chest pain [OCP]. This positivity went up to 88% for MLCI, 100% for CPK and 44% for LDH 24hrs after OCP in patients who had conventional treatment only. In patients who received STK, the positivity for these enzymes was 50%, 100% and 44% respectively 24hrs after OCP