Screening for fetal abdominal wall defects

Polylactic acid (PLA) polymer film was degraded in abiotic and biotic environments to understand the role of microbes in the degradation process of lactic acid based polymers. The degradation studies were conducted in a well-characterized biotic system, an abiotic system, a sterile aqueous system, and a desiccated environment maintained at 40, 50, and 60 degrees C. The combination of experiments in different environments isolated the distinct effect of microbes, water, and temperature on the morphological changes in the polymer during degradation. Due to lack of availability of radiolabeled PLA, various analytical techniques were applied to observe changes in the rate and/or mechanism of degradation. CO2 evolved, weight loss, and molecular weights were measured to evaluate the extent of degradation. X-ray diffraction and differential scanning calorimetry techniques monitored the morphological changes in the polymer. FTIR was used as a semiquantitative tool to gather information about the chemistry of the degradative process. Neither of the above analytical techniques indicated any difference in the rate or mechanism of degradation attributable to the presence of microorganisms. The extent of degradation increased at higher process temperatures. FTIR data were evaluated for significant statistical difference by t-test hypothesis. The results confirmed hydrolysis of ester linkage as the primary mechanism of degradation of PLA. On the basis of these data, a probable path of PLA degradation has been suggested.     

Outcome of prenatally diagnosed anterior abdominal wall defects

One hundred consecutive cases of confirmed anterior abdominal wall defect, identified prenatally in the Oxford Prenatal Diagnosis Unit over 11 years, were studied. Fifty nine per cent of cases were suspected omphaloceles and 41% suspected gastroschisis. Fifty four per cent of omphaloceles were accompanied by other defects compared with 5% of those with gastroschisis. Overall, 29% of fetuses with omphalocele had an abnormal karyotype, and of those with another abnormality identified on scan (excluding four cases with no karyotype performed), 54% had an abnormal karyotype. Of the 27 cases with suspected isolated omphalocele, 14 were live born, all of whom have survived. If the 11 whose parents opted for termination of pregnancy are excluded, survival to birth was 88%. Six of the suspected isolated omphaloceles have Beckwith Wiedemann syndrome (BWS). Eight (57%) of the live born babies with omphaloceles had major problems up to the age of 2, but only one (7%) has long term major problems. This child has BWS and is deaf. Of the 39 cases of suspected isolated gastroschisis, 33 (85%) pregnancies resulted in live birth and one in neonatal death after surgery. Survival rate (excluding terminated pregnancies) was 97%. Gastroschisis was associated with a younger maternal age than omphalocele (p < 0.001) and lower birthweight centile (p < 0.01). Fifteen per cent of the gastroschisis babies had major problems up to the age of 2 years and 12% long term developmental problems. Ninety three per cent of the omphalocele babies and 88% of those who had gastroschisis have no long term problems. Over the study period there have been major changes in scanning equipment and expertise. Since 1991 no woman with a suspected isolated lesion has opted for termination of pregnancy.     

Impaired respiratory function in infants with anterior abdominal wall defects

Pentobarbital alone, pentobarbital plus 1% lidocaine solution, pentobarbital plus 2% lidocaine solution, and pentobarbital plus 3% lidocaine solution were each used to euthanatize 6 dogs. For each dog, time between the beginning of injection of the euthanasia solution and each of the following events was recorded: collapse, onset of apnea, flat-line electrocardiogram, flat-line electroencephalogram, loss of palpable heartbeat, and loss of palpable pulse. Any signs of pain or discomfort were also recorded. There were no significant differences among groups except for time to flat-line electrocardiogram. Dogs euthanatized with pentobarbital alone had significantly longer times than did dogs euthanatized with pentobarbital in combination with any of the lidocaine concentrations. We concluded that pentobarbital in combination with lidocaine was a reasonable alternative to pentobarbital alone when euthanatizing dogs.     

Restoring abdominal wall integrity in contaminated tissue-deficient wounds using autologous fascia grafts

Necrotizing abdominal wall infections, enteric fistulae, or exposed prosthetic material after ventral hernia repair often results in a loss of abdominal wall integrity. Further surgical reconstruction with prosthetic material is usually contraindicated in the contaminated wound because of the high infection rate necessitating prosthetic removal and further abdominal wall debridement. Consequently, for the past 9 years, we have been using free grafts of autologous fascia lata to replace deficient abdominal wall fascia and muscle in situations where prosthetic material is contraindicated and local tissue rearrangement (i.e., component separation) would be inadequate. Thirty-two patients (mean age 59 years) underwent abdominal wall reconstruction with autologous fascia lata grafts. Indications included exposed mesh (31 percent), enteric fistulae (28 percent), enteric contamination (22 percent), wound infection (13 percent), and immunosuppression alone (6 percent); 31 percent of all patients were immunosuppressed secondary to either a solid organ transplant or a systemic inflammatory disorder. Fascia grafts (mean size 10 x 17 cm) were sutured to the surrounding abdominal wall and covered by local skin flap advancement and/or myocutaneous flap rotation. All abdominal reconstructions were initially successful. Subsequent local abdominal wall complications included cellulitis (n = 3), seroma (n = 2), and skin dehiscence with exposed fascia grafts (n = 7). Five of seven patients with skin dehiscence healed by secondary intention, whereas two had split-thickness skin grafts successfully applied to the granulating fascia. Thigh donor site complications included hematoma (n = 1), skin dehiscence (n = 1), and seroma (n = 2). There have been no cases of lateral knee instability. The average follow-up period is 27 months (range 3 to 106 months). Recurrent hernia has been seen in three patients (9 percent). Interestingly, laparotomy has been performed through an intact fascia lata patch in three patients for unrelated intra-abdominal conditions. In each case, the graft was intact and revascularized, confirming experimental animal data performed in our laboratory. Recurrent hernia has not been observed through the laparotomy site. Our 9-year experience has demonstrated that in the face of large, contaminated abdominal wounds where prosthetic material is contraindicated and local tissue rearrangement would be inadequate, fascia lata autografts are a reliable adjuvant to abdominal wall reconstruction.     

Free innervated latissimus dorsi muscle flap for reconstruction of full-thickness abdominal wall defects

The aim of this study was to develop a maturation protocol for immature oocytes and assess the protocol with cryopreserved oocytes. Nuclear maturation (mature spindle and aligned chromosomes) occurred irrespective of the treatment regime: 71-89% of oocytes matured in vitro had a normal spindle and chromosomes compared with 87% matured in vivo. Fertilization rates were not significantly different from those of in-vivo matured oocytes. Of the maturation treatment regimes investigated, the initial treatment producing best development to blastocyst (cytoplasmic maturation) involved a 2 h incubation in standard maturation medium (SMM) containing 7.5 IU follicle stimulating hormone (FSH) followed by 14 h in SMM plus 7.5 IU FSH:luteinizing hormone with follicular cells [62% (range 49-69)]. The addition of 1 ng/ml epidermal growth factor (EGF) in this protocol resulted in development [75% (range 71-81)] that was not significantly different from in-vivo matured oocytes [82% (range 73-90)]. Exposure of the oocytes to 1.5 M dimethylsulphoxide (DMSO) did not affect fertilization or development rates. Following a slow-cool/thaw freezing regime, 81% (range 74-89) of the oocytes were morphologically normal, i.e. had a spherical shape with an intact zona and oolemma; they had, however, lost their previously attached cumulus and corona cells. Maturation of frozen-thawed oocytes in the presence of EGF gave good fertilization rates but poor development rates [80% (range 77-86) and 37% (range 33-40) respectively]. In conclusion, the best maturation, both nuclear and cytoplasmic, occurred in the presence of a combination of gonadotrophins, EGF and follicular cells. Oocytes cryopreserved using a slow-cool/thaw regime can be matured to produce blastocysts after in-vitro fertilization.     

Temporary impairment of lung function in infants with anterior abdominal wall defects who have undergone surgery

Compliance of the respiratory system (CRS) was measured before and after surgical intervention in 14 infants who had anterior abdominal wall defects (AWD) (7 exomphalos, 7 gastroschisis). The median gestational age was 37 weeks (range, 34 to 40) and median birth weight was 2.38 kg (range, 1.94 to 3.45). The infants had stiff lungs before surgery (median CRS, 0.58 mL/cm H2(O)/kg). During the first and second postoperative days, the median CRS decreased to 0.33 mL/cm H2(O)/kg (P < .05). In seven cases, measurements also were obtained on the third and fourth postoperative days, which showed an increase in the median CRS (day 3, 0.47 mL/cm H2(O)/kg; P < .05). These findings show that in infants with AWD, primary surgical closure is associated with deterioration of lung function, but this effect is temporary.     

The behavior of different types of polytetrafluoroethylene (PTFE) prostheses in the reparative scarring process of abdominal wall defects

Currently one of the most widely used prosthetic materials in the repair of abdominal wall defects, is expanded polytetrafluoroethylene (ePTFE). It has been suggested that its behavior with respect to the reparative process may depend on its structure. The aim of the present study was to evaluate the effect of the structure of 3 ePTFE prostheses on the scarring process in an abdominal-wall-defect experimental model. The prostheses employed were the Soft Tissue Patch (STP) which is laminar in structure, Mycro Mesh (MM) which is multilaminar with perforations, and the Dual Mesh (DM) prosthesis which has one non-porous surface. Abdominal wall defects (7 x 5 cm) were created in 36 New Zealand rabbits and repaired using fragments of STP, MM and DM. Follow-up periods were 14, 30, 60 and 90 days post-implant. At these times prostheses were macroscopically examined for the presence of infection and/or rejection and the formation of adhesions to abdominal viscera. Specimens were also taken for microscopic analysis (optical and scanning electron) and for immunohistochemical analysis using the rabbit macrophage-specific monoclonal antibody RAM-11. Labelled macrophage counts were performed at each follow-up session. No cases of infection or rejection were found. Loose adhesions between prosthesis and underlying viscera were observed in 2 of the STP, 4 of the MM and 2 of the DM implants. STP and DM implants were progressively encapsulated by organized connective tissue on both peritoneal and subcutaneous surfaces. Cellular colonization was observed on both STP surfaces and on the porous surface of the DM although no more than a third of the biomaterial was penetrated by cells in either case. Colonization was very slight at prosthesis anchorage points. MM implants differed only in the formation of connective tissue bridges in perforated areas, and cellular infiltration in interlaminar spaces. Macrophage response was similar in the 3 prostheses with a reduction in RAM-11 labelled cells (p < 0.05) between 14 and 90 days post-implant. We conclude: a) the 3 types of PTFE prosthesis induced low incidence of adhesion formation between biomaterial and viscera; b) integration mechanism of the 3 prostheses were similar and culminated with the encapsulation of the PTFE by the neoformed tissue; c) the macrophage response induced by the 3 prostheses was similar to that of any reparative process in the absence of biomaterial.     

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.     

CT in the diagnosis of abdominal wall hernias: a preliminary study

The aim of the study was to estimate the value of CT in the diagnosis of abdominal wall hernias and at the same time to create a standard for this CT investigation. Twenty-four patients with suspected hernia of the abdominal wall were examined. All were operated on. The CT scans were assessed by two radiologists to estimate the interobserver variation. The CT diagnoses made by the two radiologists were correct in 83 % and 79 % of cases, respectively. The sensitivity was 0.83 in both CT evaluations and the specificity was 0.83 and 0.67, respectively. The predictive value of a positive CT finding was 0.94 and 0.88, while the predictive value of a negative CT finding was 0.63 and 0.57, respectively. The interobserver variation (kappa) was 0.87. The study therefore indicates that a positive CT finding of abdominal wall hernia is reliable, while a negative finding does not exclude the diagnosis. The interobserver variation of the CT diagnoses is acceptable. To achieve the highest diagnostic accuracy, it is recommended to always use the Valsalva manoeuvre, oral intake of contrast and 10/10 mm CT slices.     

Experimental assay of a Dual Mesh polytetrafluoroethylene prosthesis (non-porous on one side) in the repair of abdominal wall defects

The porosity of the prosthetic biomaterials used to repair defects in the abdominal wall seems to influence the tissue repair process insofar as tissue integration of the prosthetic material and the formation of adhesions with abdominal viscera are concerned. We studied the behaviour of a new type of polytetrafluoroethylene prosthesis used for the repair of abdominal wall defects. Dual Mesh (DM), which has two different faces; one face has a porosity between 30 and 60 microns, while the other is non-porous. In 20 New Zealand White rabbits, a full-thickness (except skin) 7 cm x 5 cm defect was created in the anterior abdominal wall that was repaired with DM. At 14, 30, 60 and 90 days, samples were obtained and studied by light and scanning electron microscopy. An immunohistochemical study was made with antibody anti-rabbit macrophages (RAM-11). Tensile strength was measured with an Instron tensiometer using 2-cm-wide strips obtained parallel to the shorter axis of the implant. DM induced little tissue adhesion to the material on the visceral peritoneum interface and was surrounded by organized repair tissue. The biomaterial was integrated in the repair tissue on the subcutaneous interface, but not on the peritoneal interface. The macrophage response decreased between days 14 and 90 (P < 0.001). Tensile strength increased significantly (P < 0.05) at every study period. We conclude that the DM prosthesis has little tendency to formation of visceral adhesions, the DM prosthesis was well tolerated by the receptor organism and the tensile strength of the prosthesis/receptor tissue interface increased with time.     

Endometriosis in postoperative abdominal wall scar after cesarean section

Endometriosis in postoperative abdominal wall scar after cesarean section is rarely observed. In professional literature, only single cases are reported. The author presented 27 cases of this diseases. The women were treated in the Gynaecology and obstetrics Department of Medical School in Lód?, in 1985-1994. Because of the small response to pharmacological treatment, the treatment of choice was surgical of the lesion. In the article, the literature concerning the disease is presented.     

Laparoscopic cholecystectomy using the abdominal wall lift in a cardiac patient

We present a case report of a patient with impaired cardiac function after aortic valve replacement and open mitral commissurotomy who underwent a laparoscopic cholecystectomy for cholecystolithiasis. In preventing reduced cardiac output due to pneumoperitoneum, the laparoscopic operative procedure was performed using the abdominal wall lift. Cardiac function was continuously evaluated by transesophageal echocardiographic examination and remained stable during the surgery. Because of the patient's co-existing chronic atrial fibrillation and prosthetic aortic valve, perioperative anticoagulation management was carried out. The patient's post-operative course was uneventful, and he was discharged on the 7th post-operative day.     

Respiratory mechanics during laparoscopic cholecystectomy: the effects of the abdominal wall lift

The abdominal wall lift (AWL) has been proposed for laparoscopic cholecystectomy to reduce hemodynamic effects caused by carbon dioxide (CO2) and high intraabdominal pressures (IAP). Data concerning effects of AWL on respiratory mechanics are scant. We therefore used a noninvasive method to evaluate whether the AWL could offset these effects. The PETCO2, airflow, and airway pressure were continuously measured in nine patients undergoing laparoscopic cholecystectomy using an AWL with minimal CO2 insufflation. We used a least-squares method to calculate maximal airway pressure (Pmax), elastance (Ers), and resistances (Rrs) of the respiratory system. After CO2 insufflation, the initiation of AWL resulted in a significantly decreased IAP (from 13 to 6 mm Hg; P < 0.001) and Rrs (from 20.6 to 17.8 cm H2O.L(-1).s(-1); P = 0.029), whereas Ers was partly modified (34.0 to 33.3 cm H2O/L; not significantly different). With AWL, we hypothesized that the diaphragm remained flat and stiff, outweighing the beneficial effect of the decrease of IAP on Ers. PETCO2 significantly increased after AWL and at the end of the procedure. We conclude that AWL partly reverses the impairment of the respiratory mechanics induced by CO2 insufflation during laparoscopic surgery. IMPLICATIONS: The abdominal wall lift (AWL), acting on the abdominal chest wall, had some benefits during laparoscopic surgery by limiting CO2 peritoneal insufflation and several side effects, such as hemodynamics. We examined the consequences of this technique on respiratory mechanics in nine patients undergoing laparoscopic cholecystectomy. Our findings suggest that the AWL decreases intraabdominal pressure and respiratory resistances without a significant effect on respiratory elastance.     

Malignant mesenchymoma arising in an incisional scar of the abdominal wall

A case of malignant mesenchymoma of the anterior abdominal wall, composed of leiomyosarcoma, chondrosarcoma and osteosarcoma is described. The tumour, arising in the old scar of a previous operation, was completely removed surgically. Eleven months after the operation the patient is well with no evidence of recurrence. There have been no previous reports of malignant mesenchymoma developing in operation scars. We believe that this traumatic factor played a significant role in the aetiology of this rare soft-tissue neoplasm.     

Laparoscopic hepatic resection: a new and safe procedure by abdominal wall lifting method

HCC is well known for its high incidence of intrahepatic tumor recurrence and many patients suffering from them, usually undergo further treatments, such as PEI, TAE, MCNT or hepatic resection. However, conventional hepatic resection by large skin incision causes severe intraabdominal adhesions, which disturb US examination and further treatments. The aim of the laparoscopic procedure is to prevent intraabdominal adhesions. This is a study of the feasibility of laparoscopic hepatic resection without CO2 pneumoperitoneum, which is not yet popular, as a safe and effective procedure. The patient in this study had a solitary HCC in the lateral segment. Mobilization of the lateral segment, dissections of the left hepatic artery and portal venous branches, i.e. P2 and P3, were performed under CO2 gas insufflation. However, to avoid CO2 gas embolism, further procedures, including parenchymal compression and hepatic venous dissection, were performed using the abdominal wall lifting method without pneumoperitoneum. The patient could eat on the second postoperative day and had an uneventful postoperative recovery and was discharged from the hospital 13 days after surgery. Hospital stay was shorter than conventional hepatic resections with large skin incisions. The importance of this procedure lies in that it is not only a minimally invasive procedure, but also provides us with the possibilities of further treatments, including PEI and re-hepatic resection.     

Gangrene of the anterior abdominal wall after orthotopic liver transplantation: invasive cutaneous candidiasis

Fungal infections following liver transplantation are not uncommon and may be life-threatening. Superficial candidal infections of the bronchus, oesophagus and urinary tract are the most common mode of presentation. Invasive cutaneous and subcutaneous candidiasis is, however, very rare. We report two patients with invasive cutaneous and subcutaneous candidiasis after orthotopic liver transplantation.     

Penetration of gastroenteroanastomosis peptic ulcer in anterior abdominal wall stimulating a tumor

The results of operative intervention in 157 patients with recurrent peptic ulcer of gastroenteroanastomosis are studied up. The advantages of vagotomy with the ulcer substrate excision or the gastric remnant reresection are noted.     

Limb-body wall malformation complex: an unusual developmental abnormality of the abdominal wall. Case report, clinicopathological and etiological implications

Anterior abdominal wall defects are not too rare between developmental abnormalities. A case of abdominal wall defect associated with complex malformations diagnosed prenatally is reported in the paper. In the present case of limb-body wall complex a right sided abdominoschisis was associated with rotational abnormality of the lower limbs, clubfoot, scoliosis, meningomyelocele, lack of developed pelvic organs, consecutive dilatation of the upper urinary tract, anal atresia, lack of external genitalia, lack of diaphragm and hypoplastic lungs. Review of the pertinent literature has revealed over 100 cases that clearly indicate the possible phenotypic variation of the limb-body wall complex. These data add further evidence to support the existence of two different phenotypes and possibly pathogenesis under the heading of limb-body wall complex. The three principal theories on the possible aetiology of the complex are also discussed. Because the limb-body wall complex is incompatible with life, it is important to diagnose the lesions prenatally, and to differentiate them from other anterior abdominal wall defects. Serum alpha-fetoprotein measurement, and ultrasonographic examination are the key to prenatal diagnosis.     

The role of diagnostic laparoscopy in treatment of penetrating injuries of the lower thoracic wall and anterior abdominal wall

Penetrating injuries of the lower thoracic wall and anterior abdominal wall cause difficulties in the decision for laparotomy. For gunshot wounds laparotomy without further investigations is in most cases justified, but in other penetrating traumata one should use every diagnostic modality to prevent unacceptably high negative laparotomy rates. We performed diagnostic laparoscopy (DL) on 39 patients with penetrating injuries of the anterior abdominal wall and/or lower thoracic wall. Of these 39 patients, 25 had negative and 14 positive results. We had only one false-negative finding. No false-positive result occurred. We think that DL is a very reliable diagnostic tool which requires a relatively high technology.     

Genetic control of fission yeast cell wall synthesis: the genes involved in wall biogenesis and their interactions in Schizosaccharomyces pombe

While most pediatric patients with peroneal spastic flatfoot demonstrate tarsal coalitions, not all do. The absence of coalition may present a diagnostic challenge and make appropriate treatment difficult. Past and present etiologic theories, diagnostic modalities, and treatments are outlined in this article. The common peroneal nerve block is of great value in the diagnosis and treatment of peroneal spastic flatfoot with or without coalition. With adjunctive treatments, increased motion and decreased symptomatology are often obtained. A protocol, applied to five cases described herein, is suggested.