Inguinal Hernia Repair using Prolene Hernia System – a Simplified Technique for Beginners

Introduction: Surgical repair of the inguinal hernia is themost common general surgery procedure performed today.Even today inguinal hernias pose a great burden on thehealthcare system. Hence even modest improvements inclinical outcomes are warmly welcomed. This study describesthe technique of Prolene Hernia System (PHS) in its simplifiedform for the beginners to learn it quickly.Material and methods: A prospective study was conductedin 50 patients in a tertiary centre from April 2010 to Oct 2011for period of 18 months. Patients’ demographic data wascollected and patient selected as per the selection criteria. ThePHS mesh repair was performed as described by Gilbert etal3 with some simplification and modification as described.Absorbable sutures were used to fix the mesh in the describedfour stitch technique. All data collected from study wereentered in the database for statistical analysis.Results: All participants were males and most of them werefrom manual labour background (38 patients (76%). Most ofthe patients belonged to 26-35 year age group (18 patients(36%). 40 participants were found to have indirect hernias(80%). Right sided hernia was found more common (33patients (66%). The mean duration of surgery was 31.96 min(SD – 2.303). Intraoperative complication included 2 cases ofnerve damage (4%). The mean pain score in first 24 hours was6.82/10 (SD – 1.848). None of the patients reported recurrenceof hernia (0% recurrence).Conclusion: The PHS mesh, consisting of an underlay patch,an overlay patch, and a joining connector, has potentialbenefits over the traditional Lichtenstein, Mesh Plug Repair(MPR) and Laparoscopic repairs. The PHS mesh providescomplete coverage of the entire myopectineal orificethrough the underlay placed in the preperitoneal space, theoverlay placed in the inguinal canal and the connector whichmaintains the mesh in position. In our study we also found thatuse of absorbable sutures helped in relieving neuralgia andlessened chronic groin pain by causing less permanent nerveentrapment without affecting the recurrence rate.

Urban health: Needs urgent attention

Urban population in our country has increased at an annual rate of 2.7% during the last decade and it is estimated that by 2031, there would be about 600 million people living in urban India. The fast pace of urbanization has come to stay with increasing proportion of urban poor and vulnerable with health indicators much worse than their rural counterparts. The need to provide health care to urban poor has been emphasized in the past in various health committees' reports and National 5-year Development Plans, but no significant dent was made to improve the urban health scenario of the country. The National Urban Health Mission launched in May 2013 provides us a concrete mechanism to address special health needs of urban population with focus on urban poor. There is a strong need to set up primary healthcare system in urban areas and systematically deal with urban health challenges in terms of vector-borne diseases, rising incidence of noncommunicable diseases, air pollution and acute respiratory infections, road traffic accidents, trauma, and injuries. The initiatives to address these challenges do not remain confined to health sector alone but also need to be supported by sectors other than health such as social welfare, women and child development, road transport and highways, school education, drinking water, and sanitation. We really need to address wider and social determinants of health to effectively improve the urban health scenario.

Binding interaction of phosphorus heterocycles with bovine serum albumin:A biochemical study / 药物分析学报

Interaction between bovine serum albumin (BSA) and phosphorus heterocycles (PHs) was studied using multi-spectroscopic techniques. The results indicated the high binding a?nity of PHs to BSA as it quenches the intrinsic fluorescence of BSA. The experimental data suggested the fluorescence quenching mechanism between PHs and BSA as a dynamic quenching. From the UV–vis studies, the apparent association constant (Kapp) was found to be 9.25×102, 1.27×104 and 9.01×102 L/mol for the interaction of BSA with PH-1, PH-2 and PH-3, respectively. According to the F?rster's non-radiation energy transfer (FRET) theory, the binding distances between BSA and PHs were calculated. The binding distances (r) of PH-1, PH-2 and PH-3 were found to be 2.86, 3.03, and 5.12 nm, respectively, indicating energy transfer occurs between BSA and PHs. The binding constants of the PHs obtained from the fluorescence quenching data were found to be decreased with increase of temperature. The negative values of the thermodynamic parametersΔH,ΔS andΔG at different temperatures revealed that the binding process is spontaneous;hydrogen bonds and van der Waals interaction were the main force to stabilize the complex. The microenvironment of the protein-binding site was studied by synchronous fluorescence and circular dichroism (CD) techniques and data indicated that the conformation of BSA changed in the presence of PHs. Finally, we studied the BSA-PHs docking using AutoDock and results suggest that PHs is located in the cleft between the domains of BSA.

Epidemiology of drowning deaths in the Philippines, 1980 to 2011

Drowning kills 372 000 people yearly worldwide and is a serious public health issue in the Philippines. This study aims to determine if the drowning death rates in the Philippine Health Statistics (PHS) reports from 1980 to 2011 were underestimated. A retrospective descriptive study was conducted to describe the trend of deaths caused by drowning in the Philippines from official and unofficial sources in the period 1980 to 2011. Information about deaths related to cataclysmic causes, particularly victims of storms and floods, and maritime accidents in the Philippines during the study period were reviewed and compared with the PHS drowning death data. An average of 2496 deaths per year caused by drowning were recorded in the PHS reports from 1980 to 2011 (range 671-3656). The average death rate was 3.5/100 000 population (range 1.3-4.7). An average of 4196 drowning deaths were recorded from 1980 to 2011 (range 1220 to 8788) when catacylsmic events and maritime accidents were combined with PHS data. The average death rate was 6/100 000 population (range 2.5-14.2). Our results showed that on average there were 1700 more drowning deaths per year when deaths caused by cataclysms and maritime accidents were added to the PHS data. This illustrated that drowning deaths were underestimated in the official surveillance data. Passive surveillance and irregular data management are contributing to underestimation of drowning in the Philippines. Additionally, deaths due to flooding, storms and maritime accidents are not counted as drowning deaths, which further contributes to the underestimation. Surveillance of drowning data can be improved using more precise case definitions and a multisectoral approach.

Prolene hernia system in the tension-free repair operation of inguinal saddle hernia / 国际外科学杂志

Objective To explore the therapeutic efficacy and operation experience of Prolene Hernia System (PHS) in the tension-free repair operation of inguinal saddle hernia. Methods All 41 cases using PHS were selected as the subjects of this study and the results were analyzed. Results All patients were performed operation under the local anesthesia, and lasted from 25 min to 60 min. They had been keeping in ward for observation from 24 h to 72 h. No serotal swelling, hematoma, and incisional wound infection hap-pened after the operation. The follow-up time had been lasting from 6 months to 42 months, and none of pa-tients catehed a relapse or had the sensation of the foreign bodies. Conclusions Using PHS is safe and ef-fective in the tension-free repair operation, and it is more suited to inguinal saddle hernia. The key of opera-tion success is attaching importance to operation skills.

Post-traumatic Lumbar Hernia Repaired with PHS (Prolene Hernia System)

Lumbar hernia is a rare disease. Only five papers on lumbar hernia are found in the Journal of the Korean Surgical Society. Lumbar hernia is an extrusion of intraperitoneal or extraperitoneal organs of the abdomen through a defect of the transversalis fascia or the transversus abdominis muscle aponeurosis in the posterolateral abdominal wall. The most frequent symptom of this hernia is a protruding mass at the lateral abdominal wall with increased abdominal pressure. I encountered a case of lumbar hernia. The subject fell off of a subway platform. The cervical spine was injured and he suffered from quadriplegia. After several operations, he recovered from the quadriplegia. Following that, he discovered a left lumbar mass, incidentally. CT and MRI revealed this mass to be a Grynfeltt's hernia. This hernia was corrected by open method with PHS. There were no complications or discomfort after the operation. I report this case with a review of the literature.

Clinical Analysis of 473 Cases of Inguinal Hernia in Adult Patients

PURPOSE: This article compares the results of various methods of inguinal hernia repair in adults. METHODS: We retrospectively reviewed the medical records of 473 patients over 20 years of age who received an inguinal hernia repair procedure between January 2000 and June 2007. We analyzed the patients' clinical factors and outcomes, dividing them into five groups according to method of repair: Bassini group, Lichtenstein group, mesh plug group, Prolene Hernia System (PHS) group, and laparoscopic group. RESULTS: The mean number of used analgesics was significantly smaller in the PHS group than in other groups (P<0.05, PHS group: 0.46, Bassini group: 1.55, Lichtenstein group: 1.20, mesh plug group: 0.82, laparoscopic group: 1.44). The mean operation time was significantly shorter in the PHS group than in the other groups (P<0.05, PHS group: 45.18 min, Bassini group: 59.85 min, Lichtenstein group: 68.20 min, mesh plug group: 66.73 min, laparoscopic group: 83.33 min). Finally, the mean postoperative hospital staywas significantly shorter in the PHS group than in the other groups (P<0.05, PHS group: 2.93 day, Bassini group: 4.96 day, Lichtenstein group: 4.17 day, mesh plug group: 4.01 day, laparoscopic group: 5.11 day). Out of five groups, there was onecase of postoperative recurrence in the Bassini group. CONCLUSION: Mesh PHS operation is a more preferred method of inguinal hernia repair in adults because it offers a lower postoperative pain, shorter operation time, shorter postoperative hospital stay.

Direct Comparison of PHS(R) and Perfix(R) Herniorrhaphy under Local Anesthesia

PURPOSE: The aims of this study were to evaluate the feasibility of local anesthesia in tension-free herniorrhaphy, using prosthetic mesh, and to directly compare PHS(R) and Perfix(R) herniorrhaphy under local anesthesia. METHODS: Patients with a groin hernia, who underwent tension-free herniorrhaphy (n = 107) under local anesthesia between March 2003 and February 2006, were included. PHS(R) (n = 63) and Perfix(R) (n = 44) meshes were randomly used, with no difference between the PHS(R) and Perfix(R) groups in relation to mean age, gender, number of combined diseases, body mass index (BMI), recurred hernia and types of hernia. RESULTS: Intraoperative analgesics and/or sedatives were used in 55 patients (51.4 %) where local anesthesia was insufficient. In a univariate analysis, the additional use of intraoperative analgesics and/or sedatives was related to the patient's age and BMI. The patients at an older age and with a lower BMI were more tolerant to local anesthesia. However, only the BMI was found to be a statistically significant factor from the multivariate analysis. There was no significant difference between the PHS(R) and Perfix(R) groups on the additional use of intraoperative analgesics and/or sedatives, the use of postoperative analgesics, length of hospital stay, complication and recurrence (P > 0.05). CONCLUSION: With tension-free herniorrhaphy using the PHS(R) or Perfix(R) mesh, local anesthesia was acceptable and securable, regardless of the mesh type used. Among these patients, those at an older age and with a lower BMI were more tolerant to local anesthesia.

Comparison between Lichtenstein and Prolene Hernia System (PHS) in Anterior Tension-Free, Inguinal & Femoral Hernioplasty

PURPOSE: The aim of this study was to see if there are any differences in the post-surgical outcomes between 2 tension-free hernioplasty methods. METHODS: We selected those patients with unilateral, bilateral inguinal hernias and femoral hernias who had undergone Lichtenstein n=224) and PHS (n=62) mesh hernioplasty at the Pundang Jaesang Hospital, Department of Surgery, between January 2000 and February 2004, and compared the post-surgical results of each method. The factors analyzed for this comparative study included the patient's age, gender, operation time, length of hospital stay, use of analgesics, cost and recurrences. RESULTS: The results from the statistic showed significant differences between the 2 methods with respect to postoperative pain, cost, duration of hospital stay and recurrences. CONCLUSION: The PHS hernioplasty is a superior method to that of Lichtenstein's herni-oplasty in terms of hospital stay, operation time, postoperative pain & recurrences.

Medical Education in Japan: Changes and Challenges / 医学教育

Medical education programs of USA leading to the Medical Doctor are offered not only from 125 medical schools where only those who completed a four-year undergraduate college can apply for admission, but also from a combined post high school M. D. educational programs (PHM) equipped with the one-third of the 125 medical schools. In response to more frequent patient reports of dissatisfaction with their physicians' interpersonal skills and conducts towards patients, medical educators have emphasized the importance of personal and professional conduct among applicants for medical licensure. In 1984, the AAMC published the report entitled “Project Panel on the General Professional Education of the Physician and College Preparation for Medicine (subsequently referred to as “The GPEP Report” )” which ensured medical students' access to opportunities for more active learning, better integrated learning, and more patientoriented learning in medical school. In view of the current situation of the medical school in USA, the author strongly emphasized medical education reform in Japan to restructure the medical education to a four-year undergraduate college plus four-year medical school curriculum. If efforts to reconstruct the medical education system will be successful in the future, the author recommends significant changes in entrance examination so as to reconsider the content, timing and the process of their assessment techniques as well.

Hospital mobile communication system based on PHS technology / 医疗卫生装备

According to information interchange situation in our hospital,this article analyzes and discusses the PHS,GSM,CDMA and DECT technologies,selects the PHS technology to construct hospital mobile communication system for the better construction of hospital information interchange environment.