Is mesh always necessary in every small umbilical hernia repair? Comparison of standardized primary sutured versus patch repair: retrospective cohort study.

PURPOSE: A retrospective analysis was carried out to compare the results of patch repair using ready-made, synthetic mesh (PR) and sutured repair (SR) based on standard protocols. The accumulated recurrence rate was accepted as the primary outcome. Pain at rest and during exercise, cosmetic effect and treatment satisfaction were chosen as the secondary endpoints. METHODS: Adult patients after elective, open surgical repair of a single, primary umbilical hernia < 2 cm in diameter were included. Patients with incarceration or strangulation, after previous umbilical hernia repair or other abdominal surgical interventions were excluded. In the SR group, single-layer sutures were placed using the short-stitch technique. In PR group, a 6.3-mm ready-made Parietene Ventral Patch (Medtronic) was used. RESULTS: 161 patients (104 in PR and 57 in SR groups) were included in the study (22 months follow-up). Nine recurrences were observed [six in PR (5.8%) and three in SR group (5.2%)]. In PR group, three patients (2.9%) reported complaints at rest and none in SR group, while 18 patients (17.3%) in PR group reported pain during exercises and 7 (12.3%) in SR group. CONCLUSION: For the smallest umbilical hernias, the use of dense fascia suturing (short-stitch technique) may be an effective alternative to patch repair techniques in patients with no additional risk factors for recurrence. The mesh patch repair method is associated with a significantly higher risk of postsurgical pain. Diastasis recti is a factor favoring umbilical hernia recurrence after both pure tissue repair and patch repair.

Long-term follow-up of a randomized controlled trial of Lichtenstein repair vs the Valenti technique for inguinal hernia.

PURPOSE: The aim of the study was to offer a prospective comparative assessment of long-term outcomes for inguinal hernia repair using Valenti and Lichtenstein techniques. MATERIALS AND METHODS: 568 surgical procedures for unilateral inguinal hernia repair using the Valenti (group V) or the Lichtenstein technique (group L) were performed. After the mean follow-up time of 9 years (8-12), 185 patients (70.1%) treated using Valenti method and 186 patients (71.3%) treated using Lichtenstein method were clinically assessed. All clinical data were registered in National Hernia Registry. The rate of recurrence was assessed as primary outcome. The secondary outcome involved chronic pain (VAS). RESULTS: 9-year recurrence rate was 2.2% in both groups. No significant difference in recurrence rate was demonstrated in analysis adjusted for surgeon's education, type of hernia, hernia size, hernia duration, or BMI between two groups (OR 1.0; 95% CI 0.69-1.67; p = 1.0). In follow-up the majority of patients reported no pain (71.9% in V; 73.7% in L). A constant pain was reported by four patients in each group. Severe pain was reported by 1.6% in V and 2.1% in L (p = 0.192). CONCLUSIONS: Inguinal hernia repairs using Valenti and Lichtenstein methods show high, long-term effectiveness and do not significantly differ in the recurrence rate. Both methods ensure a low rate of chronic pain. The use of a single mesh size with a precisely defined shape and of a uniform mesh fixation method ensures the standardization of surgical technique. The Valenti method is an uncomplicated, technically reproducible procedure with a low learning curve.

Factors influencing inguinal hernia symptoms and preoperative evaluation of symptoms by patients: results of a prospective study including 1647 patients.

BACKGROUND: Current recommendations for hernia treatment suggest applying techniques aimed at reducing postoperative pain in patients experiencing intense preoperative pain. However, there is still no reliable stratification method of preoperative pain, its circumstances, intensity and frequency, and the current assessments of hernia symptoms are performed by means of a subjective evaluation. The aim of this work is to discuss preoperative pain before hernia repair and determine its nature depending on the type and length of hernia persistence and the patient's age. MATERIALS AND METHODS: The data from 1647 patients before inguinal hernia repairs (2010-2017) were registered prospectively in the National Hernia Repair Register (demographic data, pain score and influence on everyday activities). RESULTS: The most common symptom upon admission was pain (949 patients at rest; 57.6% and 1561 at physical activity; 94.8%). A significant influence of hernia persistence on the pain occurrence and intensity was not observed between patients with hernia < 12-months (60.8%;VAS5.0) and > 5-years (58.3%;VAS5.4) (p = 0.068). The occurrence and intensity of pain was significantly higher patients < 40-years (63.7%;VAS5.4) than patients > 60-years (54.3%;VAS4.8) (p = 0.008). CONCLUSIONS: While pain at rest is not a significant problem, undertaking physical activities may intensify pain and increase the number of patients suffering from it. Preoperative assessment of pain may help determine the group of younger patients who could benefit the most from inguinal hernia repair. New indications for prompter admission for treatment should be planned in future studies of patients showing pain at rest for possible prevention of postoperative neuropathy.

The influence of different sterilization types on mosquito net mesh characteristics in groin hernia repair.

BACKGROUND: In low-resource countries, a suture repair is still in common use due to the limited access to commercial mesh implants. The search for less expensive alternatives to the synthetic meshes has led to using mosquito nets. Sterilized mosquito net appears to be a low-cost and commonly available product that closely resembles commercially available meshes. However, the extent to which sterilization alters the structure of mosquito nets is still unknown. The aim of this research was to assess the effects of different sterilization types on physico-mechanical properties of mosquito nets. MATERIALS AND METHODS: Nine different polymers were analyzed (six mosquito nets from low-resource countries, one European net, and two commercial meshes). The analyzed parameters included: polymer type, net surface area, fiber diameter, net thickness, mesh weight, pore size, tensile strength, and tear force. The measurements were taken before sterilization, after sterilization at 121 and at 134 °C. RESULTS: Sterilization altered net surface and pore size, but did not significantly alter the single fiber diameter, weave of filaments, or net thickness. Steam sterilization did not affect the tensile strength or tear force. CONCLUSIONS: The reduction of the mosquito net surface area by more than 40% due to sterilization at 121 °C, results in a loss of macroporous structure, turning the mesh into hard, shrunken, non-pliable masses. Sterilization at 134 °C causes some mosquito nets to melt and completely destroys their porous structure. Maximum pressure in the abdominal cavity is higher than the tensile strength and tear force of some locally available mosquito nets; therefore, these nets should not be used.

Stimulation of production of reactive oxygen and nitrogen species in endothelial cells by unmodified and Fenton-modified ultradisperse detonation diamond.

In recent years, the development of nanotechnology opens up new prospects for biomedical applications of unmodified and chemically modified diamond nanoparticles (DNPs). The problem of biocompatibility of DNPs is thus of primary importance. The first step in the modification of DNPs is usually the introduction of -OH groups, which can bind other functional groups. One of the basic methods to introduce -OH groups onto DNPs is the Fenton reaction. The aim of this study was to compare the effect of unmodified DNPs and nanoparticles modified by the Fenton reaction on human endothelial cells. Ultradisperse diamond (UDD) was modified by the Fenton reaction introducing surface -OH groups. Immortalized human umbilical cord endothelial cells (HUVEC-ST) were incubated with 2-100 µg/mL nanopowders in the opti-MEM medium. For comparison, graphite powder (GRAF and GRAF+OH) was also employed. UDD and GRAF augmented generation of reactive oxygen species in the cells after 24 H incubation, estimated by oxidation of 2',7'-dichlorofluorescin diacetate (H2DCF-DA). Cellular production of nitric oxide, estimated with DAF-FM-DA (3-amino-4-aminomethyl 2',7'-dichlorofluorescein diacetate), was also affected by UDD and GRAF after 24 H. Fenton-modified OH, in contrast to unmodified diamond, decreased NO production. Detonation nanoparticles also affected the cellular content of glutathione and activities of main antioxidant enzymes (superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase, and glutathione S-transferase). This article was published online on 5 February 2013. Errors in the byline and affiliation line were subsequently identified. This notice is included in the online and print versions to indicate that both have been corrected 18 April 2013.

Induction of apoptosis in human endothelial cells by nanodiamond particles.

Carbon nanoparticles are a promising material which finds application in different fields in industry and medicine. For medical applications, biocompatibility of nanoparticles is of critical importance because a lot of medical implants are coated by carbon coating. Our previous results showed that nanoparticles may induce increased production of ROS by the cells so we decided to checked if nanopowders can induce apoptosis. Apoptosis was quantified by double-staining with acridine orange and ethidium bromide. For comparison, we identified apoptotic cells with annexin V-FITC/propidium iodide. Our data demonstrate that treatment of the cells with diamond nanopowders may induce apoptosis and necrosis and this effect is dependent on the time of treatment and concentration of the nanopowders. The highest level of apoptotic cells was observed after incubation with Ultrananocrystalline Detonation Diamond (UDD) suggesting that the size is the main determinant of nanoparticle cytotoxicity.

Biological properties of carbon powders synthesized using chemical vapour deposition and detonation methods.

Carbon powders can be synthesized using variety of CVD and detonation methods. Several interesting properties of carbon powder particles make them a very attractive material examined in many laboratories all over the world. However there is a lack of information discussing investigation of carbon powders directed to its application in pharmaceutical-cosmetic industry and medicine. Earlier investigation results proved that diamond powders present properties fighting free radicals. Presented work discusses the influence of carbon powder particles manufactured using MW/RF PACVD, RF PACVD and detonation methods onto hydro-lipid skin coat. Before the biological examinations physicochemical properties of carbon powders were determined. Grain size, shape and chemical composition of carbon powders were determined using the scanning electron microscopy. Surface functional groups were characterized by IR Fourier-transform spectroscopy and X-ray photoelectron spectroscopy. Structure and phase composition were investigated by means of the Raman spectroscopy. Results of allergy tests performed on laboratory mice proved that carbon powder particles synthesized using different methods do not cause allergy. In the following stage, the group of 20 patients applied the formula including carbon powder on their face skin. The influence of carbon powder onto hydro-lipid skin coat was determined by measurement of such parameters as: pH reaction, skin temperature, lipid fotometry and level of hydration. Additionally, macro pictures of places where the cream had been applied were registered. As the result of the investigation it was found that powders synthesized using various methods present different physicochemical properties which may individually affect the face skin parameters. The noticeable improvement of hydro-lipid skin coat kilter was observed.

Biological properties of different type carbon particles in vitro study on primary culture of endothelial cells.

Carbon powders have extended surface of carbon layers, which is of significant biomedical importance since the powders are employed to cover implants material. Carbon Powder Particles are produced by different methods: by a detonation method, by RF PACVD (Radio Frequency Plasma Activated Chemical Vapour Deposition) or MW/RF PCVD (Microwave/Radio Frequency Plasma Activated Chemical Vapour Deposition) and others. Our previous data showed that Carbon Powder Particles may act as antioxidant and/or anti-inflammatory factor. However the mechanism of such behavior has been not fully understood. The aim of the work was tested influence carbon powders manufactured by Radio Frequency Plasma Activated Chemical Vapour Deposition RFPACVD method and detonation method on selected parameters of human endothelial cells, which play a crucial role in the regulation of the circulation and vascular wall homeostasis. Graphite powder was used as a control substance. Endothelial cells are actively involved in a wide variety of processes e.g., inflammatory responses to a different type of stimuli (ILs, TNF-alpha) or regulating vasomotor tone via production of vasorelaxants and vasocontrictors. Biological activation is dependent on the type and quantity of chemical bonds on the surface of the powders. The effect of powders on the proliferation of HUVECs (Human Umbilical Vein Endothelial Cells) was determined by MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) reduction assay. We found decreased cell proliferation after 72 h treatment with graphite as well as Carbon Powder Particles.

[Histochemical studies of the kidney of white rats after experimental external application of sulfur mustard gas]. / Histochemische Untersuchungen der Niere der weissen Ratte nach experimenteller äusserer Anwendung von Schwefelyperit.

After the experimental application of sulphur mustard contained in Psoriazin produced by Medexport, the kidney of white rats is examined by means of histologic and histochemical methods. It was noted that the prolonged application of Psoriazin caused changes in the convoluted tubules.