[Pneumoperitoneum and Mersilene mesh in the treatment of giant abdominal wall hernias]. / Pneumoperitoneum und Mersilennetz in der Behandlung riesiger Bauchwandhernien.

Fourteen patients with giant abdominal hernias were treated at our institution from 1985-1989. In all cases the hernial orifice was at least 20 x 20 cm, and the hernia had at least a size of a child's head. In 11 cases a progressive preoperative pneumoperitoneum of 10-14 liters over 14-21 days was performed. This procedure was initially done in hospital and then on an outpatient basis. In 13 patients the hernia was repaired using a retromuscular/preperitoneal Mersilen-mesh fixed subcutaneously. In one patient the hernia could be repaired with a Mayo type repair after preparation with a pneumoperitoneum. Postoperative problems were minimal, and no recurrence has so far been observed after a follow-up period of 5 to 44 months. By the combination of preoperative pneumoperitoneum and a retromuscular Mersilen-mesh even giant abdominal hernias in polymorbid patients can be repaired.

Effects of posture and ageing on circulating atrial natriuretic peptide levels in man.

Possible influences of posture or age on plasma immunoreactive atrial natriuretic peptide (irANP) levels and potential correlates were assessed in 12 young (age +/- s.e.m. 24 +/- 1 year) and 12 elderly (63 +/- 8 year) healthy subjects on a liberal sodium intake. The groups did not differ significantly in their basal 24-h urinary sodium excretion (210 +/- 23 versus 180 +/- 15 mmol/l). However, plasma irANP was five- to ninefold higher in the elderly (P less than 0.05-0.01). Plasma irANP averaged 167 +/- 31 and 24 +/- 3 pg/ml in the elderly and young, respectively, during recumbency, fell (P less than 0.05) to 101 +/- 21 and 11 +/- 1 pg/ml, respectively, with upright posture, and rose (P less than 0.01) to 250 +/- 51 and 50 +/- 9 pg/ml, respectively, after intravenous (i.v.) loading with 0.9% saline (2.14 l in 3 h). Supine blood pressure (BP) and plasma norepinephrine tended to be higher while renin and aldosterone levels were lower (P less than 0.01) in the elderly; the three latter variables rose (P less than 0.001) with upright posture. These findings demonstrate that in normal humans, circulating irANP levels vary with posture and ageing. These changes may have potential physiological relevance and should be considered when interpreting plasma irANP levels in pathological conditions.