Surgical treatment of postop abdominal hernia in elderly and geriatric patients

The results were summarized on surgical treatment of 56 patients, ageing 60-85 years, for femoral hernia using two methods--according to Bassini and original one stipulated for femoral ring strengthening using implant made of poliuretane in hernial sac tunic fixed without tension to inguinal and public ligaments. Recurrence of hernia in the late follow-up period have occurred in 13.6% of patients operated on according to Bassini and was never observed after operation performed using original method.     

Personal experience with the Lichtenstein surgical method in recurrent abdominal hernia

The authors present a group of 21 patients treated with the method of Lichtenstein with the use of polypropylene mesh Prolen. They used the method of an "inlay" mesh for recurrent groin and epigastric hernias, mostly by men. The men:women ratio was 19:2. They emphasise better healing, early recovery to work and almost no wound infection by use of this method.     

Perioperative antibiotic prophylaxis in abdominal surgery for hernia repair: retrospective study of 1,524 consecutive patients

In the surgical units of our Division, from January 1979 to December 1989, the infection rate in surgical groin hernia repair was much higher than expected, in comparison to other reports in the literature. In order to evaluate if correct preoperative antibiotic prophylaxis could decrease the incidence of postoperative infections (wound, urinary and respiratory tract) after abdominal wall hernia repair surgery, a total of 1,524 consecutive patients undergoing this type of procedure were reviewed between January 1990 and December 1996. The patients were divided in three different groups, according to the antibiotic prophylaxis regimen: i) group A: 606 patients (39.8%) treated with ceftriaxone; ii) group B: 408 patients (26.8%) treated with pefloxacin; and iii) group C: 510 patients (33.4%) treated with different regimens using either cephalosporins or quinolones other than ceftriaxone and pefloxacin. Only 1 surgical wound infection was observed (0.06%). The tolerability was good: no significant side effects related to antibiotic prophylaxis were recorded in our experience. In this study, even though retrospective, single-dose ceftriaxone proved to be a valid and cost-effective choice in antibiotic prophylaxis.     

Anatomical correction of the exstrophy-epispadias complex: analysis of 34 patients

OBJECTIVE: To evaluate the surgical procedures required for anatomical reconstruction of the bladder and penis in the exstrophy-epispadias complex. PATIENTS AND METHODS: All primary exstrophy-epispadias repairs carried out by one surgeon between 1987 and 1997 were reviewed. Bladder closure consisted of full extraperitoneal mobilization, transpositional omphaloplasty, drainage with ureteric and urethral catheters and immobilization with a 'frog-leg' plaster-cast or 'mermaid' dressings. Osteotomies were always performed when bladder closure was attempted after 37 h of age. Before 1990 the osteotomies were posterior vertical iliac (one patient) and subsequently anterior oblique iliac (10 patients). Pre-peritoneal herniotomies, in the absence of a clinical hernia, were included in the primary procedure after 1992. A modified Cantwell technique was used for epispadias repair and this was undertaken at a median of 16 months after bladder closure (range 6-30). RESULTS: Thirty-four patients (27 male) were reviewed; one patient had a chromosomal abnormality, a deletion in the short arm of chromosome 4. The male infants required a median of four procedures (range 2-5) for bladder closure, epispadias reconstruction and herniotomies, while the females needed a median of two (range 2-5). Complete bladder dehiscence, requiring re-closure with osteotomies, occurred in three cases (9%, two male). There were no dehiscences in the primary osteotomy group. Fistulae after epispadias repair occurred in four patients (17%). The bladder capacity increased to > 60 mL in 10 of 15 males by 36 months after epispadias repair. Only two of seven female infants attained a capacity of > 60 mL. Of the 15 infants who did not undergo herniotomy at primary closure, 13 subsequently developed inguinal hernias (one uni- and 11 bilateral) with incarceration occurring in two. Twelve infants underwent herniotomy at primary closure and six developed subsequent hernias (two uni- and four bilateral; P = 0.05) with documented incarceration in two. CONCLUSIONS: Anatomical correction of the exstrophy-epispadias complex remains challenging, but can be achieved with complication rates of < 20% for each stage. Bladder volumes large enough to permit adequate bladder neck reconstruction can be anticipated after epispadias repair in a large proportion of male infants, but remains small in female infants with low outlet resistance. Inguinal herniotomy at the time of bladder closure significantly reduces the incidence of subsequent herniation, which nevertheless remains high.     

Incidence of abdominal wall hernia in aortic surgery

In chronic tophaceous gout, tophi may occur in various tissues of the body. The joints are one of the main tissues of the tophaceous deposits. The articular surface may be coated by heavy deposits. We present a case of a patient with chronic tophaceous gout where the tophaceous deposits formed an intra-articular mass causing symptoms of a loose body.     

Morpho-functional aspects of pathogenesis and surgical treatment of the abdominal wall hernia in elderly and senile patients

The abdominal wall tissues atrophy was revealed while histological and electromyographic investigation in 16 patients with primary hernia (the mild one) and in 17--with secondary, recurrent and postoperative (much more significant atrophy). The data obtained are applied for the choice of optimal method of operation conduction.     

The basis of surgical treatment for extensive postoperative abdominal hernia

The hernioplasty method was elaborated by the authors. The method stipulates the prosthesis of polyurethane placement in the duplicature from the hernial sac and parietal peritoneum and is sewn under the hernial defect edge, which are then sewn contactly. With the application of method elaborated 36 patients were operated on, suffering from large abdominal hernia. In 2 patients the lymphorhagia was observed in postoperative period during 9 days, in 1 the wound have suppurated and the prosthesis was removed. The late follow-up results were observed from 3 months till 3 years, the hernia recurrence was not revealed.     

Inhibition of mitochondrial complex I may account for IDDM induced by intoxication with the rodenticide Vacor

Human intoxication with the rodenticide Vacor [N-3-pyridylmethyl-N'-p-nitrophenyl urea or 1-(4-nitrophenyl)-3-(3-pyridylmethyl) urea] induces acute IDDM. We report here that Vacor specifically inhibits the NADH:ubiquinone reductase activity of complex I in mammalian mitochondria. The activity of other respiratory enzymes of mitochondria is unaffected by Vacor at concentrations that completely inhibit the redox and energetic function of complex I. Vacor inhibition of complex I activity quantitatively correlates with the inhibition of insulin release in insulinoma cells and pancreatic islets and is also consistent with the doses reported in cases of human poisoning. These results indicate that the toxic and diabetogenic action of Vacor primarily derives from the inhibition of mitochondrial respiration of NAD-linked substrates in the high-energy demanding cells of the pancreatic islets. This newly identified mechanism of the pathological effects resulting from Vacor intoxication could constitute a paradigm in which to understand environmental or metabolic causes of IDDM.     

Acute ethanol intoxication increases the risk of infection following penetrating abdominal trauma

Acute alcohol (ETOH) intoxication as a risk factor for infection in trauma victims to our knowledge has not been previously reported. To determine if ETOH intoxication increases infection risk we examined data from 365 patients with penetrating abdominal trauma who were enrolled in a multi-center antibiotic study. Ninety-four patients sustained an injury to a hollow viscus. To separate acute from chronic ETOH effects, infections were divided into two categories: (1) trauma related; infections caused by bacterial contamination at the time of injury, while blood alcohol level (BAL) was elevated. (2) nosocomial; infections caused by bacteria acquired during hospital stay, after BAL had normalized. A BAL > or = 200 mg/dL was associated with a 2.6-fold increase in trauma-related infections. There was no association between BAL and subsequent nosocomial infection. Since infection rates for intoxicated patients were not higher after BAL had normalized, acute rather than chronic effects of ETOH appear to be responsible.     

A new method for evaluating the rheological properties of the erythrocytes in surgical patients with endogenous intoxication

An examination of 30 patients against the background of using both the operative and conservative methods of treatment was performed in order to study the rheological properties of blood and selection of the most informative tests for diagnosis of microcirculatory disturbances in diseases of the gastrointestinal tract and gastroduodenal area. The authors propose methods of investigation of deformability and viscosity of erythrocytes in patients with the surgical diseases in question. The methods are simple, quite handy for any surgical hospital and polyclinic laboratories. In addition to being used in investigations of the aggregative ability of erythrocytes and viscosity of the whole blood, these methods can be of use in express diagnosis of rheological disorders. The endogenous intoxication in patients with the diseases in question was found to be accompanied by deep rheological disturbances. The deformability of erythrocytes and their viscosity index which can pass ahead of the shifts in other parameters characterizing the hemocoagulative and rheological properties of blood are changed. A conclusion is drawn that the parameters of the erythrocyte deformability and viscosity can be an additional criteria of the adequacy of therapy used for patients with the diseases in question.     

Study of pathogenetic mechanisms of intoxication in patients with anaerobic non-clostridial infection

Pyoinflammatory diseases continue to be one of the most topical problem of modern medicine. Anaerobic non-clostridial infection is essential in the etiological pattern of pyoinflammatory diseases. Its specific feature is early developed severe intoxication. The authors have developed laboratory criteria for evaluating the degree of intoxication in patients with anaerobic non-clostridial infection, which are based on chromatographic determination of the concentrations of specific metabolic products, such as volatile fatty acids and toxic metabolites of the phenol group, in the patients' peripheral blood, which allows the detected disorders to be promptly corrected. The metabolic products of non spore-forming anaerobes, such as volatile fatty acids, are important pathogenetic factors since they inhibit the dynamic activity of platelets and the phagocytic activity of leukocytes in blood.     

Management of bowel obstruction in patients with abdominal cancer

OBJECTIVE: To determine the value of operation in patients with bowel obstruction caused by recurrent abdominal cancer. DESIGN: Retrospective case review. SETTING: The University of Connecticut Health Center, Farmington. PATIENTS: Ninety-eight patients admitted with a diagnosis of bowel obstruction and malignant neoplasm between November 1, 1987, and June 30, 1995. RESULTS: Data for 75 patients who developed a bowel obstruction within 5 years of a malignant diagnosis were analyzed. Forty-six patients (61%) were treated operatively and 29 (39%) were treated nonoperatively. The operative group included 32 patients (70%) whose obstruction was caused by carcinomatosis; 6 (19%) of these 32 patients had had at least 1 episode of previous obstruction requiring hospitalization. They had a 22% in-hospital mortality, stayed an average of 21 days in the hospital, and survived 7 +/- 6 months (mean +/- SD) after discharge; 5 (16%) had at least 1 episode of postoperative obstruction that required hospitalization. After discharge from the hospital, 53% had an excellent or good quality of life (assessed retrospectively). Of the 29 patients in the nonoperative group, 16 (55%) had carcinomatosis. These 16 patients had a 38% in-hospital mortality (6 of 16), stayed an average of 10 days in the hospital, and survived a mean of 13 +/- 9 months; 3 (19%) had at least 1 episode of recurrent obstruction requiring hospitalization. After discharge from the hospital, 6 (37%) had an excellent or good quality of life. CONCLUSION: The value of operative intervention for bowel obstruction in patients with cancer is derived from the possibility of a benign cause, not alleviation of the consequences of carcinomatosis.     

The correction of immunoendocrine disorders in patients with hyperplastic processes in the endometrium

The nervous systems of invertebrates and vertebrates consist of neuronal networks of varying complexity, and the elucidation of the organization of these networks is essential if we are to understand neural function. Up until the mid-19th Century gross dissection was the primary tool available to scientists to study the nervous system. The development of neurohistological techniques, electrical stimulation, and observation of neural function in humans and animals following injury added rapidly to our understanding of the nervous system during the following century. Over the last 3 decades investigators seeking to unravel the complexities of neural circuits have made use of analytical methods based upon the biological properties of neurons, including orthograde and retrograde axonal transport of tracer substances, the expression of particular genes and gene products that can be assessed with immunocytochemical or in situ methods, and the imaging of the utilization of oxygen or glucose by active populations of neurons. Advances in neuroscience have led to an enormous expansion in our knowledge of normal neural functioning and how that function is altered by injury or disease. Modern studies of neuronal organization have been at the center of our increased understanding of how the brain works.