Which mesh site is best in the repair of incisional hernia?

20 patients 12 males, 8 females with age 35_8 with huge oval incisional hernia were subjected to four methods of mesh implantation. Anatomical reconstruction was found difficult in those patients. They were divided into four groups each comprised 5 patients 1st group subjected to on lay of mesh application [Fig.1]. 2nd group: subjected to subfascial extraperitoneal mesh application [Fig. 2]. 3 th group: subjected to subfascial intraperitoneal mesh application [Fig. 3]. 4th group: subjected to the application of two mesh grafts one extrafascial and the other intraperitoneal [Fig. 4]. Ml patients were put under the same preoperative regime and strict aseptic technique. Recurrence occurred in 2 patients in gp, 1.2 patients in group III and 1 patients in group IV, fecal fistula developed in one patient in group I. No recureence ocucrred in group II. Mild wound infection developed in 2 patients in group I, 1 patient in group III and 1 patient in group IV. Severe wound infection developed in one patient in group 1, this necessiated removal of the mesh under general anaesthesia also severe infection developed in one patient of group IV but was controlled by drainage

transendoscopic adrenaline local injection in the control of bleeding gastroduodenal peptic ulcer

A prospective randomised trial was performed to assess the efficacy of local injection of adrenaline through upper G.I.T. endoscopy. Among 65 patients admitted with upper G.I.T. haemorrhage, 16 patients with actively bleeding ulcers were identified 8 of them subjected to endoscopic injection of adrenaline g p I. The other 8 patients had no endoscopic treatment g p II. After endoscopy both g p s were managed identically by medical regime and/or emergency operation if required. Bleeding was initially controlled in 7 patients in g p I the remaining patient needed an emergency surgical operation after 24 hours when Medical control failed to arrest bleeding. In g p II 6 patients needed emergency operation to control bleeding and 2 patients improved with Medical control. During post endoscopy period the medium blood transfusion was 2 and 6 units in g p I and II respectively. No complications were observed with adrenaline injection with unchanged heart rate during the injection. Hospital stay in g p I was 3 +/- 7 days and in g p II was 10 +/- 8 days. Reendoscopy after 2 months revealed healing occurring in 75% in g p I and 62.5% in g p II. Local injection of adrenaline is effective in stopping bleeding from actively bleeding gastro duodenal ulcers. This conservative approach offers a worth while option in the management of acute bleeding peptic gastroduodenal ulcer

value of clinical, radiologic and cytologic diagnostic triade in the management of breast masses

The validity of a preoperative diagnostic triade of clinical, Radiologic and Cytologic parameters was tested in 50 patients with breat masses. The diagnostic accuracy of the clinical examination was 88%, while that of the radiologic and the cytologic methods were 86% and 92%, respectively. When applied together, the diagnostic accuracy of the triade amounted to 100%

elimination of causal factors in pilonidal sinus treated by advancement gluteal flap

25 patients, 18 male and 7 female with age range 20-45 years with pilonidal sinus, 8 of them with recurrent ones. All patients were subjected to excision of the sinus, then alteration of the regional anatomy of the intergluteal area which is an important causative factor in the occurrence of pilonidal sinus or its recurrence [Mc Dermott, 1967], by advancement gluteal falp [Ronald et al., 1979]. All patients had uneventful post-operative period. Minimal local pain was experienced. Primary intention healing was observed in 24 patients with early return to normal activity. Recurrence was limited to one patient which represents 4% recurrence rate. This figure is superior than other techniques dealing with the treatment of pilonidal sinus whether primary or recurrent