modified technique for surgical repair of large incisional hernias with polypropylene [Marlex] mesh

In 14 patients with large ventral incisional hernias elective repair was performed. A modified technique of polypropylene monofilament [Marlex] mesh repair that has been particularly effective in preventing the recurrence of hernia, is described herein. In the 14 cases that form the basis of this report, the mesh has remained durable and free of hernia in 13 patients. Minor wound infection was developed in 3 patients, while mesh retaining its elasticity and permitting complete freedom of movement

C-reactive protein: an aid to assessment of suspected acute appendicitis

In a series of 50 patients who were admitted to hospital with suspected acute appendicitis, serum C-reactive protein [CRP] was measured to determine the value of its assessment in management of such cases. 39 patients subsequently underwent operation. In 32 patients the diagnosis of acute appendicitis was confirmed and in another 4 significant intra-abdominal pathology was found. This group of 36 patients had significantly higher C-reactive protein levels than the 3 patients who had a negative laparotomy and the remaining 11 who had no operation. C-reactive protein assay is simple, rapid and may be of value as a diagnostic aid in assessing acute abdominal pain

Fine-needle aspiration biopsy: the surgeon's dilemma

In a cohort study of 106 cases with solid tumors, fine needle aspiration biopsy [FNA] was utilized and correlated with definitive histopathological diagnosis in order to evaluate the reliability of FNA as diagnostic tool. Sensitivity was 61.5% and specificity was 97%. The results of this current study must strongly deprecate the widespread use of FNA for the diagnosis of solid tumors, principally because of the dangerous of sampling errors, high false negative results and inevitable cytological inexperience in this field, particularly in hospitals with limited resources

outcome of one stage surgery in the practice of large bowel emergencies

In a consecutive series of 22 emergency admissions with large bowel disease during a period of 5 years, 13 were of colonic obstruction, 7 for peritonitis and 2 for mesenteric vascular occlusion, urgent operation was performed on all patients. Seventeen patients [77%] underwent immediate resection. An immediate anastomosis was performed in 11 [64.7%] patients. Of these, 2 had protective colostomy. Total group mortality was 18%, 11.8% in the immediate resection group, 9% in those with immediate anastomosis. Complications included an overall clinical anastomotic leak rate of 18%, but all were occurred in those without protective colostomy, intraperitoneal sepsis rate of 9% and wound infection rate of 22.7%. The results of this study suggest that primary resection in selected patients is safe. Immediate anastomosis after proximal colonic resections is feasible and safe, however, in distal colon, it is also safe provided that it is accompanied by protective colostomy