Small bowel obstruction caused by mesh migration. Case report.

INTRODUCTION: Endoscopic hernia repair methods have become increasingly popular over the past 15 years. Nonetheless, there is no consensus regarding an optimal fixation method. Transabdominal sutures and titanium tacks or staples are the most traditional ones. CASE REPORT: We present a case of mechanic small bowel obstruction due to mesh migration occurring one year and a half after incisional hernia repair with polytetrafluoroethylene mesh fixed by spiral tacks. DISCUSSION: Titanium spiral tacks are dangerous because of their sharp components, which can damage organs such as the small intestine, by causing microperforations. The type of prosthesis used has also contributed to the intraluminal migration, since polytetrafluoroethylene mesh is very flexible and poorly integrates in the abdominal wall. CONCLUSION: A prosthesis of a different material combined with a different fixation system such as absorbable tacks, biological glue, or mechanical tacks without sharp components, would have obviated mesh migration.

Laparoscopic trans-peritoneal hernioplasty (TAPP) for the acute management of strangulated inguino-crural hernias: a report of nine cases.

BACKGROUND: Inguinal hernioplasty has always been one of the most commonly performed operations in clinical practice. In the last 15 years, thanks to the development of mini-invasive surgery, new video-endoscopic techniques for the treatment of inguinal hernia using trans-peritoneal (TAPP) and extraperitoneal (TEP) access have emerged. Both have a definite role in the treatment of bilateral and recurrent hernias, while the debate is still open about the treatment of primary mono-lateral hernias. In acute incarcerated hernia requiring an emergency operation, the endoscopic approach is uncommon and controversial, and even considered contraindicated. The aim of this publication is to verify the efficacy and the technical feasibility of TAPP operation by analyzing a consecutive series of patients operated on for incarcerated inguino-crural hernia associated with suspected visceral ischemic lesion in an emergency setting. MATERIALS AND METHODS: From September 2004 to October 2005, 13 patients were operated on acutely for inguino-crural incarcerated hernia associated with suspected visceral ischemic damage. Four were excluded from the endoscopic treatment due to anesthesiologic contraindications or huge hernia dimensions. Nine patients were operated on using a trans-peritoneal approach (TAPP). Visceral mobilization and hernia reduction were obtained by incision and opening of the hernia ring. Visceral resection was performed in one case with intestinal ischemia following a prolonged observation time or "test time." RESULTS: One case was associated with intestinal resection and incisional hernia repair, one with obturator hernia repair, and one with hepiployc appendix repair. None of the cases were converted to open technique, and no intra- or postoperative complications were recorded. Mean operative time was 72 min (35-180); mean hospital stay was 2.7 days (1-8). No recurrences were observed after a mean follow-up time of 18 months (8-24). CONCLUSIONS: The TAPP procedure can be proposed for emergency treatment of inguino-crural incarcerated hernias, allowing not only hernia correction, but also visual control and the contestual treatment of the hernia content. TAPP is a more challenging procedure compared to the traditional open anterior approach and therefore requires an adequate laparoscopic training. Exclusion criteria are constituted by anesthesiologic contraindications or dimensional criteria of the hernia.

Assessment of inertial and gravitational inputs to the vestibular system.

A new device for the assessment of instantaneous angular and linear accelerations of the head is presented, which is based on four linear tri-axial accelerometers suitably attached to the head by an helmet. A procedure for reproducible helmet placement and calibration is given. A method is also illustrated to work out the different linear accelerations sensed by the vestibular organs in the left and right labyrinths and the components of the angular acceleration sensed by their semicircular canals. The computation is based on few individual parameters describing the helmet position with respect to external landmarks and on the average internal position and orientation of the vestibula. The purpose is to study the components of internal inertial forces, which represent the primary inputs to the vestibular system devoted to equilibrium and oculomotor control. The system is designed to be of easy application during rehabilitation exercises and in clinical environment during diagnostic and therapeutic manoeuvres. The prototype is tested with simple free movements such as "yes", "no", and gait.

A model of an electro-goniometer and its calibration for biomechanical applications.

The paper describes a detailed model of an electro-goniometer based on a elastic beam connecting two 'bases' whose relative orientation should be measured. This kind of device, which has been developed for the analysis of human motion, is also suitable for different applications even when one or more rotations around moving axes occur. After a theoretical analysis of the device working principles, experimental verifications of the model are presented. The paper analyses the characteristics of the device and shows how the goniometer outputs can be converted into more familiar angular conventions avoiding cross-talk and other artifacts.

A histological procedure to determine dental age.

Sclerosis of dentine has become one of the well established indicators of ageing and age determination. In this study a new technique was reported where a photomicrographic image of a cross section of sclerotic dentine was converted to a grey scale of 256 tones and then reduced to black and white and read by computer using specially developed software. A regression analysis was applied to a sample of 62 teeth (age range 17-84 years) and an age determination within an error limit of 11 years was obtained. Using a Neural Network software however the error was reduced to 8 years.

Age determination by teeth examination: a comparison between different morphologic and quantitative analyses.

Age determination by teeth examination is one of the main means of determining personal identification. Current studies have suggested different techniques for determining the age of a subject by means of the analysis of microscopic and macroscopic structural modifications of the tooth with ageing. The histological approach is useful among the various methodologies utilized for this purpose. It is still unclear as to what is the best technique, as almost all the authors suggest the use of the approach they themselves have tested. In the present study, age determination by means of microscopic techniques has been based on the quantitative analysis of three parameters, all well recognized in specialized literature: 1. dentinal tubules density/sclerosis 2. tooth translucency 3. analysis of the cementum thickness. After a description of the three methodologies (with automatic image processing of the dentinal sclerosis utilizing an appropriate computer program developed by the authors) the results obtained on cases using the three different approaches are presented, and the merits and failings of each technique are identified with the intention of identifying the one offering the least degree of error in age determination.

Cervicofacial and pulmonary actinomycosis associated with non-Hodgkin's lymphoma.

A case of cervicofacial and pulmonary actinomycosis associated with non-Hodgkin's lymphoma (NHL) is reported. The patient underwent antimicrobial treatment and surgical debridement of a palatine lesion. Complete clinical recovery was achieved. The presence of actinomycosis may obscure and delay the diagnosis of NHL.

[Septic arthritis in the setting of HIV disease. A case report and literature review]. / Artrite settica in corso di infezione da HIV. Presentazione di un caso clinico e rassegna della letteratura.

A case of septic arthritis due to Haemophilus influenzae is described in a HIV-infected patient. Even though complicated by large effusion and extensive subcutaneous involvement, the clinical picture showed a favourable outcome after prolonged ceftriaxone treatment, leading to complete cure. The case report is discussed with respect to both other bacterial complications caused by H. influenzae in the setting of HIV disease, and the broad aetiological spectrum of HIV-associated acute arthritis. In particular, no other cases of H. influenzae purulent arthritis have been described until now in patients with HIV disease, at our best knowledge.

Venous aneurysm of extremities: a case report and literature review.

A case of venous aneurysm of the short saphenous vein is described in a young woman. The aetiology, diagnosis and treatment of this rare anomaly is reviewed.

[Acute pseudo-obstruction of the colon (Ogilvie syndrome). Apropos of a case]. / La pseudo-obstruction aiguë du côlon (syndrome d'Ogilvie). A propos d'une observation.

An additional case of acute colonic pseudo-obstruction (Ogilvie's syndrome) is reported. Conservative management was successful. Etiology of this syndrome is still uncertain. The aim of the treatment is to stop natural evolution to ischemia or perforation. Medical therapy, colonoscopic decompression and surgery are employed following prognostic criteria (age, cecal diameter, therapeutical delay). Mortality rate remains high, especially if complications occur. Colonoscopic decompression is a safe and efficacious first line of treatment when cecum is less than diameter 12 cm. Surgery is mandatory when perforation or ischemia are suspected and colonoscopy failed or is contraindicated.