Mesh size in Lichtenstein repair: a systematic review and meta-analysis to determine the importance of mesh size.

PURPOSE: Small mesh size has been recognized as one of the factors responsible for recurrence after Lichtenstein hernia repair due to insufficient coverage or mesh shrinkage. The Lichtenstein Hernia Institute recommends a 7 × 15 cm mesh that can be trimmed up to 2 cm from the lateral side. We performed a systematic review to determine surgeons' mesh size preference for the Lichtenstein hernia repair and made a meta-analysis to determine the effect of mesh size, mesh type, and length of follow-up time on recurrence. METHODS: Two medical databases, PubMed and ISI Web of Science, were systematically searched using the key word "Lichtenstein repair." All full text papers were selected. Publications mentioning mesh size were brought for further analysis. A mesh surface area of 90 cm(2) was accepted as the threshold for defining the mesh as small or large. Also, a subgroup analysis for recurrence pooled proportion according to the mesh size, mesh type, and follow-up period was done. RESULTS: In total, 514 papers were obtained. There were no prospective or retrospective clinical studies comparing mesh size and clinical outcome. A total of 141 papers were duplicated in both databases. As a result, 373 papers were obtained. The full text was available in over 95 % of papers. Only 41 (11.2 %) papers discussed mesh size. In 29 studies, a mesh larger than 90 cm(2) was used. The most frequently preferred commercial mesh size was 7.5 × 15 cm. No papers mentioned the size of the mesh after trimming. There was no information about the relationship between mesh size and patient BMI. The pooled proportion in recurrence for small meshes was 0.0019 (95 % confidence interval: 0.007-0.0036), favoring large meshes to decrease the chance of recurrence. Recurrence becomes more marked when follow-up period is longer than 1 year (p < 0.001). Heavy meshes also decreased recurrence (p = 0.015). CONCLUSION: This systematic review demonstrates that the size of the mesh used in Lichtenstein hernia repair is rarely discussed in clinical studies. Papers that discuss mesh size appear to reflect a trend to comply with the latest recommendations to use larger mesh. Standard heavy meshes decrease the recurrence in hernia repair. Even though there is no evidence, it seems that large meshes decrease recurrence rates.

The effects of tramadol infiltration on wound healing in rats.

PURPOSE: Infiltration of a local anesthetic to provide postoperative analgesia is a frequently used method. However the infiltrated agents may have negative effects on wound healing. This study aimed to investigate the effects of tramadol, a weak opioid with a local anesthetic effect, on wound healing. METHODS: Wistar albino rats were used in the study. Tramadol and saline infiltration was randomly performed on the left and right backs of rats. Following a linear incision, the site was sutured. A follow-up was conducted after seven days, and the tissue samples from both locations were extracted for histopathological examinations (fibrotic index : no fibrosis 0, mild 1, moderate 2, severe 3) and hydroxyproline measurements. RESULTS: The hydroxyproline level found in the tramadol group was 0.060 +/- 0.04 ng/mg.protein. In the control group the hydroxyproline level was 0.012 +/-0.01 ng/mg.protein (p = 0.01). The fibrotic index levels in the tramadol group were higher than the control group (p < 0.001). CONCLUSION: It was concluded that tramadol infiltration in a surgical incision site has no adverse effect on wound healing.

The effects of supplementation with a mixture of arginine, glutamine, and beta-hydroxy beta-methylbutyrate on the healing of colon anastomoses.

BACKGROUND: Several researchers have investigated how wound healing is effected by supplementation with each of the following amino acids : arginine (Arg), glutamine (Glu), and beta-hydroxy beta-methylbutyrate (HMB). This research investigates how a combination of these amino acids improves the wound healing associated with anastomoses. METHODS: We tested the effects of a combination of Arg, Glu, and HMB on the healing of colon anastomoses in 50 male rats. We randomly divided the animals into two equal groups. In each animal, the cecum was transected from its midpoint to create an end-to end anastomosis. During the first postoperative week, Group 1 (G1) animals were fed standard chow, and Group 2 (G2) animals were fed standard chow plus a ready-to-use supplement that contained a mixture of Arg, Glu, and HMB. At the end of the week, all of the rats were sacrificed, and a cecum segment containing the anastomosis line was resected. Bursting pressure and tissue hydroxyproline were measured for all animals. RESULTS: The mean values for hydroxyproline were 0.0013 ng/mg protein/ml (SD +/-0.00075) and 0.034 ng/mg protein/ ml (SD +/- 0.022) for G1 and G2, respectively (p <0.0001). The mean values for bursting pressure measurements were 122.8 mmHg (SD +/- 9.4) and 192.8 mmHg (SD+/- 31) for G1 and G2, respectively (p <0.0001). Statistically significant differences between the groups in terms of both bursting pressure levels and tissue hydroxyproline levels were observed. CONCLUSION: In an animal model of colon surgery, supplementation with a combination of three amino acids seemingly benefits anastomosis healing.

Tuberculosis of the breast: medical treatment.

Two patients with breast tuberculosis (BT) were discussed. In the presentation of each of the patients were a breast lump without pain and purulent discharge. There was associated axillary lymphadenopathy in one patient. Diagnoses were done by open biopsy and only antitubercular therapy was given to the patients. After two months of therapy, the breast lumps disappeared completely from both patients. Treatment was continued for 9 months. In breast tuberculosis, medical therapy can be used without further surgical intervention.

Development of a nursing home vision-targeted health-related quality of life questionnaire for older adults.

PURPOSE: To develop a questionnaire assessing vision-targeted health-related quality of life in older adults residing in nursing homes. METHODS: Using content previously identified through structured interviews with nursing home residents, the 57-item Nursing Home Vision-Targeted Health-Related Quality of Life questionnaire (NHVQoL) was drafted with nine subscales - general vision, reading, ocular symptoms, mobility, psychological distress, activities of daily living, activities/hobbies, adaptation/coping and social interaction. Construct validity and internal consistency and test-retest reliability of subscales were evaluated in a sample of adults >or=60 years old residing in nursing homes in Birmingham, Alabama, who had Mini Mental State Exam (MMSE) scores of >or=13. RESULTS: Participants (n=189) had a mean age of 82 years (SD=7.7), were 84% women and 16% men, 24% African-American and 76% Caucasian and had resided in a nursing home for two years on average. All NHVQoL subscales were correlated with subscales from other vision-targeted and generic health-related quality of life instruments (ADVS, 0.43 to 0.85; VF-14, 0.46 to 0.84; SF-36, 0.19 to 0.43). Lower scores were associated with increased depressive symptomatology by the Geriatric Depression Scale (-0.23 to -0.59), increased mobility problems (-0.17 to -0.54), worse distance and near acuity (-0.21 to -0.51) and worse contrast sensitivity (0.20 to 0.50). All subscales had Cronbach alpha>0.95. Test-retest reliability (two-week period) for subscales ranged from 0.57 to 0.84. Subscale scores did not differ as a function of MMSE scores. CONCLUSIONS: The NHVQoL has subscales with good internal consistency reliability and validity. Test-retest reliability is comparable to other questionnaires designed for the nursing home population. This questionnaire may ultimately be useful in understanding the personal burden of visual impairment and eye disease on quality of life and mental health in older nursing home residents and for evaluating the impact of psychosocial and eye care interventions on health-related quality of life in this population.

Applicability of modelling tools in watershed management for controlling diffuse pollution.

Diffuse pollution is hard to analyze, control and manage by its nature. Watershed models and Geographical Information Systems (GIS) are recently developed tools that aid analysis of diffuse sources of pollution. However, their applications are not always easy and straightforward. Turkey is a typical example of a mountainous country rich in rivers and streams. Due to the complex geomorphology, land-use and agricultural practices in most of the watersheds in Turkey, modelling, analyzing and managing diffuse pollution has been a challenge. The complex watershed structure forces the modellers to work with spatially high resolution data. Apart from the data, the models themselves may also cause operational problems. These issues and their probable solutions form the basis of the discussions in this paper. It acts as a guideline for modelling and analyzing diffuse pollution by emphasizing the referred problems and difficulties. Design of an Information Technology-based system tool for watershed and/or water quality modelling, which would be suitable for countries having watersheds with similar structure and problems to those of Turkey, is also outlined.

Analysis and modelling of land-based nutrient pollution by watershed models coupled with GIS: a case study from Turkey.

Diffuse pollution is usually temporally and spatially uncertain, and thus hard to analyze. In many cases, discretizing a diffuse source of pollution into individual point sources can ease diffuse pollution modelling and analysis, and therefore reduce high uncertainty especially in the spatial distribution of pollution loads. This is however a difficult task, since quite a number of sub-drainage areas, with complex structures and land-use properties, has to be delineated. Watershed models can be used to delineate the sub-drainage areas in a watershed with high accuracy and locate the related outlets which connect the sub-drainage areas to the main waterbody in a watershed. In this study, such an approach has been used on a case study to model the diffuse nutrient loads carried to streams that reach to a medium-sized lake in Turkey. The annual nutrient loads, which were calculated by using mathematical models, were then converted to a load-map with the help of a geographical information system.

Use of a geographic information system in an epidemiological study of measles in Istanbul.

A geographic information system was used in an epidemiological study of measles in Istanbul, Turkey. The aim was to obtain more reliable results and to increase the facilities for spatial monitoring in epidemiological studies. The Gaziosmanpasa district of Istanbul was selected as it experiences the highest level of migration, and currently has the highest population growth rate of the city's districts. The epidemic distribution of measles was investigated on the basis of examination of 320 children. The number, geographical distribution, complications and time of measles outbreaks were analysed and represented in thematic maps (a small selection is shown in this paper). The results were evaluated and, in view of these results, new vaccination plans were arranged.

Photogrammetric analysis of the articular surface of the distal radius.

Three-dimensional measurements made using photogrammetry have recently gained popularity with the development of real-time detection facilities and up-to-date equipment. The modelling of human bones presents a particular challenge as the measurements required are difficult to obtain, especially from uneven surfaces. In this study, the articular surfaces of 12 radius bones were evaluated using photogrammetry to obtain three-dimensional coordinates of certain points. Morphometric characteristics of the digital topography of the articular surface were analysed using three-dimensional data from more than 200 points for each specimen. The coronal plane curve, from the tip of the styloid process to the centre of the distal radioulnar articular notch, was found to be similar to the fourth degree polynomial function. A mathematical expression representing the sagittal curve passing through scapholunate border could not be found. Close-range photogrammetry is a safe and precise technique that can provide reliable, reproducible and accurate data for evaluating complex morphological surfaces.

Risk assessment of a dam-break using GIS technology.

Flood disasters cause massive loss of human lives and immense damage to the infrastructure and economic activities, not only in Turkey but also all over the world. Governments consider several long-term and short-term precautions for flood control. The numerical simulation of dam-break problems could be accomplished with geographic information systems and innovation maps. Spread of the flood wave after a dam break can be predicted using these enabling technologies. This kind of advanced modelling technology is becoming an inevitable tool for the decision-making process. Data produced by GIS are used as initial values for FLDWAV. ArcView GIS has been used to produce a Digital Elevation Model and visualization of dam-break effects and propagation of a possible flood wave. Using GIS techniques and hydrologic modelling software, possible effects and damage of a dam-break flood have been investigated and results were simulated to show significant dam break effects on the region.

Investigation of coastal morphological changes due to river basin characteristics by means of remote sensing and GIS techniques.

The Riva River is located on the Anatolian (Asian) side of Istanbul by the Black Sea coast, with a wonderful sandy beach and delta formation which has been selected as the study area. The Riva is the largest river in this region, which flows into the Black Sea and also gives its' name to the area. The river carries some amount of sediments to the Black Sea. These particles cause considerable changes not only in the bed bathymetry and coastal boundaries of the river but also along the coastline of the Black Sea. The aim of this study is to determine these variations by means of satellite data and GIS. In the study, satellite images dated 1975, 1984, 1992 and 2001 have been used. At the end of the study, the possibility of observing bathymetric changes in front of the coastline by means of satellite data has been investigated and results were evaluated and visualised by means of GIS.