Spontaneous mesh evacuation per rectum after incisional ventral hernia repair.

We present a case of a 58-year-old man who was admitted to our hospital because of abdominal pain. He underwent incisional ventral hernia repair with intraabdominal mesh (ePTFE). On the day of admission, physical examination included the discovery of a foreign body in the rectum. There were no signs of acute abdomen. We induced stool, and the mesh came out with it. His further course was uneventful. Gastrografin series showed persisting fistula between the small intestine and colon, but without extralumination into the peritoneal cavity. The patient was discharged in good health and without signs of incisional ventral hernia.

The prevalence of anaerobic infection in pilonidal sinus of the sacrococcygeal region and its effect on the complications.

Bacteriologic characteristics of pilonidal disease of the sacrococcygeal region were assessed in two groups of patients: patients with disease recurrence (group A), and patients who first ever presented for surgical treatment (group B). The frequency of anaerobic colonization was studied. Bacterial colonization is frequently present in patients with pilonidal disease of the sacrococcygeal region. Samples of the skin over the sacrococcygeal sinus showed the presence of bacterial colonization in 78% and 70% of group A and group B patients, respectively. Analysis of sinus fluid samples revealed the presence of bacteria in 88% of group A patients and 78% of group B patients. Anaerobic colonization in the content of pilonidal sinus was found in approximately 2/3 (64%) group A patients and about a half (52%) group B patients. Considerable bacterial colonization was also recorded in skin swab samples, i.e. in 48% of group A patients and 38% of group B patients. Anaerobic bacteria were rarely detected in pure cultures (in group A 6% skin swab, and 20% of sinus fluid samples, and in group B, 4% of skin swab and 12% of sinus fluid samples). Anaerobes were mostly detected in combined cultures (42% of skin swab and 44% of sinus fluid samples from group A, 32% of skin swab and 40% of sinus fluid samples from group B). Surgical methods to considerably reduce the conditions for anaerobic bacterial colonization of the wound should be the methods of choice in the management of pilonidal disease of the sacrococcygeal region.

The treatment of pilonidal disease of the sacrococcygeal region by the method of limited excision and open wound healing.

Results of the surgical treatment of the pilonidal disease of the sacrococcygeal region in correlation with anaerobic infection are analyzed. Fifty patients with the disease recurrence (group A) and fifty patients presenting for operative treatment for the first time (group B) were observed. Twenty-five patients from group B were operated on by the method of limited excision and wound healing by open granulation and the other half were operated on by the method of excision and primary suture. The material for bacteriologic examination was obtained during the operative procedure. All patients underwent control examination at twelve months after the surgery. Recurrence was found in three (6%) group A patients and two (8%) group B patients operated on by the method of excision and open wound healing. Perioperative bacteriologic analysis showed anaerobic colonization in all study patients. Among the patients operated on by the method of excision and primary suture, recurrence was recorded in six (24%) cases. Bacteriologic analysis pointed to anaerobic colonization in five, and to aerobic colonization in only one patient. The significantly lower recurrence rates recorded with the method of limited excision and wound healing open granulation, were explained by favorable conditions for healing in such a wound (reduced conditions for anaerobic infection) compared to wound healing after excision and primary suture.

The influence of increased intra-abdominal pressure on blood coagulation values.

AIMS/BACKGROUND: Increased intra-abdominal pressure during laparoscopic cholecystectomy changes pressure values in the thoracic cavity, in blood vessels, and in biochemical blood values. METHODOLOGY: In this prospective study, we investigate whether CO2 pneumoperitoneum causes blood absorption and whether there is an increased risk of thromboembolism because of its mechanical influence on reographic and biochemical blood attributes. We analyzed pH, BE and arterial blood pCO2 pre-operatively, three times during surgery and post-operatively; and blood coagulation values pre-, during and 30 minutes after the operation. Blood samples were taken from 75 patients, divided into two groups. The first group consisted of 50 patients on whom laparoscopic cholecystectomies were performed, while the second (control) group consisted of 25 patients who were operated on by open laparotomy. All patients had a pre-operative physical status of ASA I and ASA II. RESULTS: There was no statistically significant difference in pCO2 in any measurement, but in the group of patients treated with a laparoscopy there were statistically significant increases in pCO2 in three measurements during the operation. CONCLUSIONS: The data show that during the laparoscopy the pneumoperitoneum had no physical or biochemical influence on coagulation values and so reduced the risk of thromboembolism.

Apoptosis in human gastric polyps and adenocarcinomas: a stereological analysis.

BACKGROUND/AIM: The occurrence of apoptotic cells was analyzed in human normal gastric mucosa, polyps and adenocarcinomas. METHODOLOGY: Histological classification was carried out on hematoxylin and eosin stained slides. The tissue was classified as follows: Normal gastric mucosa or adenomatous polyps. Gastric carcinoma specimens were histologically classified according to Lauren's classification into: A: Diffuse adenocarcinoma without metastasis, B: Diffuse adenocarcinoma with metastasis, C: Intestinal adenocarcinoma without metastasis, D: Intestinal adenocarcinoma with metastasis, E: Mixed adenocarcinoma without metastasis and mixed adenocarcinoma with metastasis. The counting of apoptotic cells was performed using the 40X objective with a calibrated eyepiece Weibel's multi-purpose M 42 stereological test system. Each group was evaluated stereologically, determining numeric density of apoptotic cells. RESULTS: The results show the progressive and statistically significant increase of apoptotic numeric densities from normal gastric epithelium to adenomatous polyp and finally to cancer, which contained the highest number of apoptotic cells. Comparing gastric carcinoma with and without metastasis in intestinal and diffuse adenocarcinoma there was statistically significant difference. In these two groups, carcinomas with metastasis contained higher number of apoptotic cells than without metastasis. Gastric cancer according to numeric densities of apoptotic cells can be separated in tree statistically different groups: A: Intestinal type gastric cancer with metastasis (the highest number of apoptotic cells), B: Intestinal type gastric cancer without metastasis and diffuse gastric cancer with metastasis (medium number), C: Diffuse type gastric cancer without metastasis, mixed gastric cancer with and without metastasis (the lowest number of apoptotic cells). CONCLUSION: These results suggest that numeric densities of apoptotic cells are associated with tumor progression in human gastric carcinogenesis and can be used as prognostic mark.

Meaning of prognostic factors in patients with acute pancreatitis.

The aim of the study was to investigate reliability of Ranson's prognostic factors in our 43 patients with acute pancreatitis during a ten year period (1984-1993). Based on the retrospective analysis and Ranson's prognostic factors, the patients were divided into groups and severe form of pancreatitis. The patients with less than 3 prognostic factors were classified into the mild form group. The patients who had 3 or more Ranson's factors were considered as having the severe form of the disease. Sixty percent of the patients with severe form of the disease survived. All the patients who died (2 females and 7 males) had more than 6 Ranson's prognostic factors and died within 15 days from admission to hospital. Of the patients who died, eight had been operated on for multiorgan injury. None of the patients with mild form of the disease died. The prognosis of the outcome of pancreatitis with severe complications and of death mode, on the basis of Ranson's factors, was found to be more certain when more factors were present.

Surgical resection in the treatment of bulbostenosis.

The aim of the study was to evaluate surgical methods used in the treatment of gastric outlet obstruction. From 1983 till 1994, 151 patients were surgically treated for gastric outlet stenosis at the Dubrava University Hospital. There were 120 males and 31 females, mean age 54.13 +/- 13.07 years. The treatment was evaluated by a modified Visick index. The most commonly surgical method used was Billroth I gastric resection. Postoperative complications developed in 8% of the patients, while early postoperative mortality was 2%. The authors compiled data on the postoperative course for 46 patients, 20 of whom were examined gastroscopically and radiologically. One recurrence which required reoperation was verified. Ninety-four percent of these patients were evaluated as Visick I and II. Billroth I gastric resection yields good results in treating gastric outlet obstruction, but postoperative complications and early postoperative mortality of 2% make it less suitable than proximal selective vagotomy with dilatation or duodenoplasty.

Anaphylactic shock in a female patient due to a spontaneous rupture of a hepatic hydatid cyst: a case report.

A 27-year-old female patient, a refugee from Bosnia and Herzegovina, was admitted to our hospital in a state of shock. She developed an anaphylactic reaction. The US and CT of abdomen revealed a spontaneous rupture of a hepatic hydatid cyst. An emergency operative procedure was performed and in the postoperative period she was treated conservatively with albendazol during the next two months. There was no recurrence of the disease.

Three-dimensional observation of wound temperature in primary healing.

In a group of 30 patients the temperature in the epigastric region was followed pre-operatively for four days. After upper medial laparotomy the temperature of the wound and its surroundings was followed during eight post-operative days. Thus every examinee was a control to himself. The temperature was measured on AGA 780 thermovision system. The advantages of thermovision in observing temperature in primary healing are manifold. The method is painless, non-contact, thereby decreasing the risk of contamination from outside, gives an absolutely accurate image of temperature over a larger or smaller area, and analysis of the thermogram is relatively simple. The defining of the healing process as thermal change in intensity, extensiveness and time is, in essence, three-dimensional. It gives the possibility of accurate indirect observation of biochemical and chemico-physical changes in the wound and its surroundings.

A prospective study of the application of transfusions in a field hospital during the war in Croatia.

Use of blood products are recommended worldwide as a substitution for whole blood. In the case of war wounds, because of their specificity, this is not possible. We studied prospectively the use of blood and blood products during management of the wounded in a field hospital during the war in Croatia. During a 6-month period, 178 soldiers out of a total number of 593 were hospitalized, and of this number 64 (36%) received transfusions. Localization of the wound, and speed and quality of first aid had significant effects on the average amount of blood used. Consequently, norms for blood use in wartime in west European countries and NATO are lower than what we used for each wounded patient. Ensuring an adequate amount of whole blood still remains one of the primary tasks of the transfusion service in wartime.

Contact Thermography in a study of primary healing of surgical wounds.

Occurrences in the wound until complete healing are manifested in different ways, one of which is temperature change. The aim of this study was establish if there is regularity in temperature changes in wounds healing by primary intention. Thirty examinees (27 female, 3 male) admitted for gallstone surgery were included. Temperature was measured for eight post-operative days at a fixed time each day and in the same room using the semi-quantitative, contact method of liquid crystal strips. The findings demonstrated that there were few differences among the collective thermal images of individual examines for any given post-operative day. During the first 3 post-operative days, the temperatures rose, with few differences between the temperatures of the wounds and their wider surroundings. From day 4 through 8, the temperatures of the wounds and surroundings fell gradually. Stitches were removed on day 7, and on day 8 only the narrow zones of the incision sites were warmer than the surroundings. The findings suggest that there is regularity in the course of temperature of the surgical wound in primary healing. The clinical implications are that the persistence of a wider zone of increased temperature after day 4 predicts the possibility of wound infection and disturbed healing.

Syncope caused by carotid body tumor.

A 71-year-old woman with a syncope and carotid body tumor is described. On palpation of the tumor on the left side of the neck, the patient felt vertiginous and has a syncope, while ECG showed an asystolic pause of 7.6 s. The tumor was completely surgically removed. After the surgery, massage of the left side of the neck provoked neither sinus bradycardia nor asystole, and the pacing electrode was removed. Temporary pacemaker is recommended in patients with syncope caused by carotid body tumor for the safe performance of diagnostic and surgical procedures. This report describes the successful operation of carotid body tumor as a rare cause of syncope. The patient feels well one year after the surgery.

[The temperature dynamics during the healing processing of a surgical wound]. / Die Temperaturdynamik während des Heilungsprozesses der chirurgischen Wunde.

Using biomechanical principles, the qualitative occurrences in the wound were quantified. On the basis of the empirical knowledge that the wound, from its inception to healing, is warmer than its surroundings, we presumed that there was a certain regularity in the course of temperature values of the wound during primary healing. For measuring the temperature of the wound and its surroundings an electric thermometer of the ELLAB type was used. First, the temperature of the skin in the epigastric region in 30 healthy examinees, who were due to undergo a gall-bladder concrements operation was determined. The temperatures were measured within a traced dotted network. After the operation, in the same examinees, the temperatures were registered proximal to the wound and in its closer surroundings throughout the first eight post-operative days. Statistically evaluated the results showed that the temperature of the wound and of its surroundings, measured after operation, was higher than prior to operation. The temperature of the wound gradually rises up to the third post-operative day, and then gradually falls from the fourth post-operative day. This course of temperature is explained in part by the biological occurrences in the wound. The inflammatory reaction as a consequence of damage to the tissue is responsible for the initial increase of wound temperature. It lasts a limited time and has a limited intensity. This could be proved by histological preparations of the wound. The persistence of increased temperature after the third post-operative day is a sign of disturbed healing and predicts infection and secondary healing.(ABSTRACT TRUNCATED AT 250 WORDS)