RESUMO
BACKGROUND: Incisional hernia is a serious complication of abdominal surgery. We compared incisional hernia frequency following gastric bypass (GBP) for morbid obesity versus total abdominal colectomy and ileal pouch-anal anastomosis (IPAA) for ulcerative colitis. A prefascial polypropylene mesh repair was also evaluated. PATIENTS AND METHODS: All patients had midline incisions, xiphoid to umbilicus in GBP patients and midepigastrium to pubis in IPAA patients. Fascia were closed with running No. 2 polyglycolic acid suture. Ninety-eight patients underwent prefascial polypropylene mesh repair; 80 were GBP patients, 46 had 1 previous repair, and 17 had 2 to 9 previous repairs (6 with properitoneal mesh). RESULTS: Incisional hernia occurred in 20% (198/968) of GBP patients (19% without versus 41% with a previous hernia, P < 0.001) versus 4% (7/171) of the IPAA patients (P < 0.001), of whom 102 (60%) were taking prednisone (32 +/- 2 mg/d) and 5 were quite obese (body mass index > or = 30 kg/m2). Additional risk factors for hernia in GBP patients included wound infection, diabetes, sleep apnea, and obesity hypoventilation. For the 98 patients who underwent prefascial polypropylene mesh repair, the mean follow-up was 20 +/- 2 months (range 6 to 104), and complications occurred in 35% of patients, including minor wound infection (12%), major wound infection (5%), seroma (5%), hematoma (3%), chronic pain (6%), and recurrent hernia (4%). CONCLUSIONS: Severe obesity is a greater risk factor for incisional hernia and hernia recurrence than chronic steroid use in nonobese colitis patients. A prefascial polypropylene mesh repair minimizes recurrence.
Assuntos
Abdome/cirurgia , Derivação Gástrica , Hérnia Ventral/etiologia , Hérnia Ventral/cirurgia , Obesidade/complicações , Polipropilenos , Prednisona/efeitos adversos , Proctocolectomia Restauradora , Transtornos Relacionados ao Uso de Substâncias/complicações , Telas Cirúrgicas , Colectomia , Colite Ulcerativa/cirurgia , Fáscia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , RecidivaRESUMO
Adrenal cysts are uncommon lesions. The authors discuss two cases of adrenal pseudocyst, and its classification and possible pathogenesis and complications. The role of radiologic findings in preoperative evaluation of renal/suprarenal masses also is detailed.
Assuntos
Doenças das Glândulas Suprarrenais/diagnóstico , Cistos/diagnóstico , Doenças das Glândulas Suprarrenais/diagnóstico por imagem , Doenças das Glândulas Suprarrenais/patologia , Idoso , Idoso de 80 Anos ou mais , Cistos/diagnóstico por imagem , Cistos/patologia , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Renais/diagnóstico , Masculino , Tomografia Computadorizada por Raios XRESUMO
The increasing emphasis on the emergency physician's role in the community led us to investigate the role of residency training programs in providing more than clinical competence to their graduates. Using guidelines provided by the American College of Emergency Physicians, the Joint Commission on Accreditation of Hospitals, the Department of Health, Education and Welfare, and program alumni, we set about to determine methods of enhancing the EMS and administrative aspects of the residency program at Charity Hospital. We describe the curriculum that was developed.
