Case Report: Abdominal Wall Reconstruction in a High-Risk Patient With Incisional Hernia and Complications From Oncological Treatment.

Introduction: A high risk patient with evisceration underwent to abdominal wall reconstruction without mesh or drains. We present a case of a 62 years-old female patient with a significant medical history of Wilson's disease-related hepatopathy Child-Pugh class B classification, sequelae of a stroke, and relevant surgical background including total hysterectomy, oophorectomy, and Hartmann's procedure for ovarian neoplasm stage 3. The patient developed a large incisional hernia in the midline incision while undergoing Bevacizumab (Avastin) treatment for clinical oncology. During an attempt at skin closure due to erosion and necrosis, there was progressive deterioration leading to evisceration. We opted for abdominal wall reconstruction by transposing the hernia sac without using mesh and employing hemostatic powder (Arista) to mitigate the risk of bleeding in a high-risk patient due to recent bevacizumab use and hepatopathy. The patient had a favorable postoperative course without any other intervention in abdominal wall. Patient developed worsening hepatic function with the presence of ascites, constipation, and disorientation. On the 6th day postoperative, a tomography was performed, which showed colonic distension without obstructive factors and a slight amount of supra-aponeurotic fluid. The patient was discharged on the 10th day postoperative after improvement of the condition with clinical treatment. The patient has been progressing under outpatient follow-up for 5 months, with a resumption of chemotherapy cycles and no evidence of hernia recurrence. Conclusion: Further studies and long-term follow-up are necessary to evaluate the efficacy and safety of hernia sac transposition as a mesh-free technique and the use of hemostatic powder without drains in high-risk patients. However, our case highlights the potential feasibility of these approaches in carefully selected cases.

Acute Effects of T'ai Chi Chuan Exercise on Blood Pressure and Heart Rate in Peripheral Artery Disease Patients.

OBJECTIVE: To investigate the acute effect of a t'ai chi chuan session on blood pressure and heart rate in patients with peripheral artery disease (PAD). DESIGN: Randomized crossover intervention study. SETTING: Outpatient therapy center. PARTICIPANTS: Seven patients with PAD, aged 50-79 years, not using ß-blockers, calcium-channel blockers, or nondihidropiridinic vasodilators. INTERVENTION: T'ai chi chuan and control session (both sessions lasted 40 minutes). OUTCOME MEASURES: Systolic and diastolic blood pressure and heart rate, which were evaluated before and after the intervention (10, 30, and 50 minutes). RESULTS: T'ai chi chuan exercise acutely decreased systolic blood pressure at 30 minutes after exercise (p = 0.042) and increased diastolic blood pressure at 50 minutes after exercise (p = 0.041). Heart rate did not change after t'ai chi chuan exercise. CONCLUSION: T'ai chi chuan acutely decreases systolic blood pressure in patients with PAD.