Double-gracilis anorectal neosphincter: technique of reconstruction after necrosis of the distal part of the muscles

BACKGROUND: The Lichtenstein tension-free repair has become the standard method for repairing inguinal hernia in many surgical units. This study compared two methods of mesh fixation. METHODS: Fifty men undergoing unilateral primary Lichtenstein inguinal hernia repair under general anaesthesia were randomized into two groups. In the control group polypropylene mesh was secured with 2/0 polypropylene sutures and the skin closed with subcuticular 3/0 polydioxanone. In the study group polypropylene mesh was secured with skin staples and the skin was closed with staples from the same staple gun. Duration of the operation was recorded. Early follow-up was achieved by patient review at 6 weeks and postal questionnaire at 12 weeks. RESULTS: The operation was significantly shorter when staples were used (median 20 min 0 s versus 29 min 30 s, P < 0.001). There was no significant difference in the incidence of postoperative complications or pain score. The study group reported earlier return to normal activity (4 weeks 0 days versus 6 weeks 2 days, P < 0.01) although there was no difference in the time taken to return to work or driving. CONCLUSION: The use of skin staples to secure mesh in the Lichtenstein inguinal hernia repair significantly reduced the duration of the operation and was as effective as conventional mesh fixation with polypropylene in the short term.     

Condom use by Dutch men with commercial heterosexual contacts: determinants and considerations

We report responses from 559 clients of female prostitutes, with a view to determining to what extent previously identified factors play a part in condom use. To increase the response rate to advertisements in daily and weekly newspapers, interviews were held by phone. This procedure had the advantage of ensuring the anonymity many clients demanded. Of those clients having vaginal or anal contact (91%), 14% had not always used condoms in the previous year. Compared with consistent condom users, these men were less highly educated, had twice as many commercial contacts, and had more contacts with "steady" prostitutes. They were either more emotionally motivated to visit prostitutes than were consistent condom users or exhibited a stronger need for sexual variation. They showed a more compulsive attitude toward visiting prostitutes, had a more negative attitude toward prostitution in general, evaluated condoms more negatively, had a higher personal efficacy to achieve unsafe contacts, and had a higher general risk assessment, commensurate with their behavior. Men with only safe contacts had either an intrinsic or an extrinsic motivation for condom use. Among extrinsically motivated men, their behavior change was more recent and had not yet taken root: They still envisioned unsafe commercial sex to be possible in the future. Education aimed at the small group of men practicing unsafe contacts will not easily and directly lead to behavior change. But these educational activities may support prostitutes to persist in (consistent) condom use, regardless of clients' pressure to do otherwise.     

Estimated numbers of deaths from coronary heart disease "caused" and "prevented" by alcohol: an example from Finland

OBJECTIVE: Epidemiological studies show that moderate alcohol consumption rather than abstention is associated with a lower risk of coronary heart disease (CHD) mortality. Our objective was to adjust established methods for calculating attributable fractions to a situation where the risk function is J-shaped and to estimate the number of CHD deaths "caused" and "prevented" by alcohol in Finland. METHOD: Point estimates of relative risk were obtained by a meta-analysis. They were pooled by fitting a nonparametric cubic smoothing spline to the data. Alcohol consumption distribution was estimated from survey data (N = 4,818; 2,488 women). The consequences of various assumptions about changes in alcohol consumption distribution on CHD mortality were estimated. The most detailed analyses are presented for men aged 30-69. The results for the men and women aged 30-79 are summarized. RESULTS: Among men aged 30-69, the beneficial effects of light to moderate alcohol consumption "prevent" some 400 CHD deaths each year which corresponds to 12-14% of the observed CHD deaths. Around 20 CHD deaths are "caused" by alcohol consumption exceeding the estimated optimum level. Among men aged 70-79 and women aged 30-79, the numbers of CHD deaths "prevented" by alcohol consumption were approximately 200 and 100, respectively, whereas there were only a few CHD deaths "caused" by alcohol. CONCLUSIONS: Our best estimates suggest that approximately one-tenth of the observed number of CHD deaths among middle-aged men in Finland is "prevented" by alcohol, while the relative effect is considerably smaller among older men and all women.     

Management of complicated incisional hernias with underlay-technique implanted polypropylene mesh. An effective technique in French hernia surgery

Incisional hernia repair with conventional techniques (simple closure, Mayo-technique) is associated with unacceptable recurrence rates of 30-50%. Therefore, surgical repair using different prosthetic biomaterials is becoming increasingly popular. Further to favourable results by French hernia surgeons, we studied the results of underlay prosthetic mesh repair using polypropylene mesh in complicated and recurrent incisional hernias. METHOD: After preparation and excision of the entire hernia sac, the posterior rectus sheath is freed from the muscle bellies on both sides. The peritoneum and posterior rectus sheaths are closed with a continuous looped polyglyconate suture. The prosthesis used for midline hernias is positioned on the posterior rectus sheath and extends far beyond the borders of the myoaponeurotic defect. The anterior rectus sheath is closed with a continuous suture. The prosthesis for lumbar and subcostal hernias is placed in a prepared space between the transverse and oblique muscles. Intraperitoneal placement of the mesh must be avoided. RESULTS: Between January 1996 and August 1997 we performed a total of 33 incisional hernia repairs (14 primary hernias, 19 recurrent hernias) using this technique (16 women, 17 men, mean age 56.19 +/- 12.92 years). Local complications occurred in four patients (12%): superficial wound infection (n = 2), postoperative bleeding, requiring reoperation (n = 1), minor hemato-seroma (n = 1). One patient suddenly died on the 3rd post-operative day from severe pulmonary embolism (mortality 3%). Twenty-two patients with a minimum follow up to 6 months were re-examined clinically. The average follow-up time for this group was 9 months (range 6-17 months). To date no recurrent hernias have been observed. There were only minor complaints like "a feeling of tension" in the abdominal wall (n = 3) and slight pain under physical stress (n = 6). CONCLUSIONS: The use of prosthetic mesh should be considered for repair of large or recurrent incisional hernias, especially in high-risk patients (obesity, obstructive lung disease) and complicated hernias. The aforementioned technique of underlay prosthetic repair using polypropylene mesh fixed onto the posterior rectus sheath allows for anatomical and consolidated reconstruction of the damaged abdominal wall with excellent results and low complication rates.     

Late mesh rejection as a complication to transabdominal preperitoneal laparoscopic hernia repair

BACKGROUND: The use of a mesh in transabdominal preperitoneal laparoscopic hernia repair (TAPP) caries the risk of late rejection or infectious complications related to the mesh. The aim of this study was to describe the extent of these complications. METHODS: We performed a retrospective study of 500 consecutive patients with TAPP for inguinal hernia. Results: Late mesh rejection was observed in three patients at 5-19 months after surgery. The mesh was removed via a suprapubic midline incision. At 3-4 month's follow-up, none of the patients had recurrence of the hernia, even though no hernia repair had been done. CONCLUSION: Late mesh rejection is a potential complication of TAPP and has to be considered when choosing the surgical method of hernia repair.     

Mesh plug repair and groin hernia surgery

Since the mid-1980s, dramatic progress has been made in the evolution of hernia surgery, highlighted by the increasing use of prosthetic mesh. Among the mesh-based "tension-free" hernioplasties, the use of mesh plugs has garnered a large number of spirited enthusiasts, and plug herniorrhaphy has become the fastest growing hernia repair currently employed by the American surgeon. To demonstrate the simplicity and effectiveness of mesh plugs, a 9-year experience with almost 3300 patients is reported. Technical details are discussed and presentation of a literature search serves to further emphasize the utilitarian nature of this elegantly unsophisticated surgical operation.     

Review of Intervention for men who batter.

Reviews the book, Intervention for men who batter by Jeffrey L. Edleson and Richard M. Tolman (see record 1994-97694-000). This volume, written for clinicians and policy-makers, is one of a series of handbooks addressing interpersonal violence. The authors adopt an "ecological" approach which is defined as an integrated and comprehensive view for dealing with men who batter. They advocate a systemic approach that includes multiple systems: the "microsystem" which is personal, the "mesosystem" which itself is composed of interconnecting systems, the "exosystem" which includes indirect influences, the "macrosystem" including cultural/ethnic/social influences, and "chronosystem" including the personal developmental history. Overall, this little volume offers sound, practical advice on how to conduct group treatment for men who batter. It should be useful for experienced clinicians already working in this area or beginning to do so. The details of conducting a thorough clinical assessment and providing individual treatment are missing and might inadvertently contribute to a superficial approach by less trained persons working in this area. The ecological approach to this problem should prove beneficial to policy-makers. A list of recent references specific to men who batter is very useful. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contraceptive behavior in the population of the Czech Republic: results of a national survey

Using an anonymous questionnaire the authors investigated in a representative group of the Czech population above 15 years of age (862 men and 857 women) the use of the main contraceptive methods. During the first intercourse more than half the respondents did not use any contraception, a condom was used only by 19% men and 14% women. In a steady partnership the most frequent method of contraception is coitus interruptus, whereby experience with hormonal contraception was reported by cca one third and with a condom by two thirds of respondents. Among younger men and women there are more users of hormonal contraception and condoms. Only 5% of the examined men and 4% of the women opposed any type of contraception, almost one quarter of respondents use only so-called "natural methods" and almost three quarters of the respondents consider them an essential part of sex life. The attitudes of atheists and junior and more educated women are more liberal.     

Research collaboration in parasitology between Indonesia and Australia

Today abdominal wall defect repair can't prescind from the use of prosthetic materials. Inguinal, femoral and incisional hernias represent more frequent events in which, only using prosthetic materials is it possible to perform "tension-free" repair. Prosthetic repairs "agree with" abdominal, wall physio-pathology, guarantee results and prevent recurrences. Permanent biomaterials like polypropylene and dacron mesh deserve special attention for their distinctive features are suitable for abdominal wall defect repair. Selection of material is an important step according to surgical technique and to avoid complications; the most alarming of which is a possible infection. However the average incidence of infection on prosthesis is about 0.5%. While infection risk is really scarce, the benefits of prosthetic repairs are clear: the recurrence rate of traditional hernia repairs is about 33% and 0-0.7% in prosthetic repairs. Likewise the recurrence rate for traditional incisional hernia repair is between 14% and 50%, whereas in prosthetic repairs it is 0-4.5%. Therefore it is necessary to use prosthesis for the following two reasons: firstly to avoid tension on the suture line, the prime cause of recurrence, and secondly to increase formation of collagen fibres on the transversalis fascia that appears histologically and biochemically altered. The authors report their experience of 660 prosthetic repairs, 600 for hernia and 60 for incisional hernia, performed, in the period April 1992-December 1994, at the General Surgery Department in San Giovanni Valdarno Hospital. The surgical techniques used were "tension-free" and "sutureless" and the prosthesis laid down always a polypropylene mesh. Complications only occurred in 33 patients, particularly 4 cases of infection (0.6%) however mesh remove was not required. The follow-up until today evidenced only two early recurrences owing to our technical mistakes in the beginning of our experience. For incisional hernia repair we laid down a giant dacron mesh on preperitoneal space. No complications were registered. The average stay in hospital was 5 days and follow-up showed no recurrence. The use of prosthetic materials in abdominal wall defect repair expressed large benefits with evident and clear reduction in recurrence rate. Traditional techniques produce tension on the suture line and high percentage of early and late recurrences since an essential surgical principle is transgressed. In fact traditionally repair has been accomplished by approximation of anatomical structures, that are not normally in apposition and by utilization of defective tissue. Metabolic alteration involving collagen turnover is evident in these patients. The answer to this problem is prosthetic repair. At present there is no ideal prosthesis, however the surgeon can use several suitable synthetic materials. The selection of prosthetic materials is a fundamental step also considering the possible infection; that however develops rarely. In conclusion the authors think that mesh repairs represent an overcoming of traditional surgical techniques in abdominal wall defect repair.     

Gender differences in risk behaviors among HIV+ persons with an IDU history. The link between partner characteristics and women's higher drug-sex risks. The Manif 2000 Study Group

BACKGROUND AND OBJECTIVES: Risk-taking behaviors differ among women and men injection drug users (IDU). GOAL: To specify the nature of sexual and drug risk-taking among women IDU and ex-IDU and how it relates to partner characteristics. DESIGN: A cross-sectional analysis of 324 HIV+ subjects enrolled into a prospective cohort study in Marseille, France. RESULTS: Women, as compared with men, were considerably more likely to report nonuse of condoms with a main partner (31% versus 12%). They were more likely to shoot with a partner at last injection (39% versus 12%), but far less likely to sterilize used needles (4% versus 16%). Two thirds of both men and women reported consistent condom use with a seronegative partner, but only 47% of men and 23% of women reported the same with a seropositive partner. Among the women only, needle and syringe sharing was associated with consistent use of a condom. CONCLUSIONS: Women reported behaviors which protect their partners from STD infection more frequently than behaviors which protect themselves. Greater attention must be paid to sexual risk-taking among HIV+ women.     

Social motives and cognitive power–sex associations: Predictors of aggressive sexual behavior.

The present study investigated whether implicit social motives and cognitive power–sex associations would predict self-reports of aggressive sexual behavior. Participants wrote stories in response to Thematic Apperception Test pictures, which were scored for power and affiliation–intimacy motives. They also completed a lexical-decision priming task that provided an index of the strength of the cognitive association between the concepts of "power" and "sexuality." For men, high levels of power motivation and strong power–sex associations predicted more frequent aggression. There was also an interaction: Power motivation was unrelated to aggression for men with the weakest power–sex associations. For women, high levels of affiliation–intimacy motivation were associated with more frequent aggression. Strong power–sex associations were also predictive for women but only when affiliation–intimacy motivation was high. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Percutaneous electrical nerve stimulation (PENS): a complementary therapy for the management of pain secondary to bony metastasis

BACKGROUND: Metal skin clips are used in surgery. They may contain metals that might cause allergic reactions and delayed wound healing. METHODS: The metal composition of 18 different surgical clamps was examined. The allergy status of 184 patients was determined by patch tests and was correlated with the clinical outcome of wound healing after application of skin clips. RESULTS: Skin clips contained chromium, nickel, molybdenum, cobalt, and titanium in concentrations high enough to cause allergic reactions. Eighteen percent of the men and 23% of the women were sensitive to nickel and 16% of the men to chromium. We found a positive correlation between the grade of nickel allergy and the reaction to the skin clips. CONCLUSIONS: Our study suggests that allergic reactions and delayed wound healing can be caused by the use of surgical skin clips. Therefore skin clips are not recommended for patients with a history of contact dermatitis to metals and/or atopy.     

Regulation of metabolic pathways in various groups of aboriginal populations of the European North (as exemplified by the thyroliberin test)]

Injectable progestogen-only contraceptives can be considered for the woman who is unwilling or unable to use oral contraceptives or an IUD. They have a very low failure rate. They appear to have few serious life-threatening side-effects. The woman does not have to remember to take a daily pill. The method requires little compliance from the client and is independent of patient error. Short-term uses include for partners of men undergoing vasectomy, women being immunised against rubella and for women awaiting sterilisation. Noristerat can be used immediately after an abortion or birth of a baby. Breast feeding is not inhibited. Main side-effects are menstrual irregularities and delayed return of fertility after use. It is essential that women are counselled about the method and its side-effects before injectable contraceptives are given.     

INFLUENCE OF TIN POWDER CHARACTERISTICS ON THE SINTERING OF IRON-TIN-COPPER POWDER COMPACTS

Abstract

In view of increasing industrial interest in the use of tin additions as an aid to the sintering of iron-based powder compacts, an examination has been made of the influence of the characteristics of the tin powder on sintering performance.

The effect of additions of narrow size-range fractions of atomized tin powder on the dimensional changes and tensile properties obtained on sintering Fe-Sn-Cu compacts made with –100 mesh (–152 μm) or – 300 mesh (– 53 μm) sponge iron and – 300 mesh (– 53 μm) atomized copper powders has been determined. The compacts contained tin and copper in the ratio 2:3. The narrow size fractions were separated from – 300 mesh tin powder by air elutriation. It was found that the use of coarse tin powder reduced the tensile strength of – 300 mesh iron-based Fe–1% Sn–1 ½% Cu compacts, but had no influence when this mixture was based on –100 mesh iron powder, or when the mixture composition was Fe–2% Sn–3% Cu. The effects have been examined in relation to the sintering mechanism by scanning electron microscopy and by X-ray microanalysis.     

Purification and characterization of agarases from a marine bacterium, Vibrio sp. PO-303

OBJECTIVE: To examine the relationship of skill, as represented by NCAA division level, to anterior cruciate ligament rupture in collegiate men's and women's basketball and soccer players. DESIGN: Randomized, retrospective. PARTICIPANTS: Women's and men's basketball and soccer players at NCAA Division I, II, and III institutions. MAIN OUTCOME MEASURE: Athletes with or without ACL injury. RESULTS: There was no relationship of ACL injury rate to NCAA division level in men's or women's basketball or soccer. CONCLUSIONS: There are many different variables that contribute to a player's skill level. Although these variables may relate to ACL injury and may be responsible for the differential in injury rate between men and women, skill level as represented by collegiate division does not relate to ACL injury. When considering possible etiologies of the differential in ACL injury rates between men and women, the use of the term "skill" should be avoided, and more specific terms used.     

Testicular self-examination: attitudes and practices among young men in Europe

BACKGROUND: Testicular self examination (TSE) is recommended for the early detection of testicular cancer. Evidence from North America suggests there is only limited public awareness of its importance among the young male population. Compliance with regular TSE is found in only a small minority of young men. Attitudes toward and practice of TSE have rarely been studied outside North America. METHOD: Attitudes to TSE were evaluated by questionnaire in a sample of 16,486 students. Frequency of TSE practice was reported by the 7,304 men in the sample. The data were collected as part of the European Health Behavior Survey, an international study on health beliefs and health behavior. RESULTS: Eighty-seven percent of men reported never having practiced TSE. Regular practice (monthly) was reported by only 3% of the sample, with another 10% reporting occasional TSE. Significant differences emerged between countries, ranging from 76% of German men to 98% of Icelandic men reporting no TSE. Men rated TSE as less important to health than women. Attitude toward TSE among men was a significant predictor of TSE practice. CONCLUSION: Both the low levels of TSE and the low ratings of the importance of TSE suggest that young men in Europe are unaware of the value of this comparatively simple method of early detection of cancer. If a highly educated population group in the "at risk" age category is not carrying out the recommendations, it is unlikely that there are higher levels of compliance in other groups. These results suggest an important role for health education in the early detection of testicular cancer.     

Prevention of abdominal compartment syndrome by absorbable mesh prosthesis closure

OBJECTIVE: To determine whether prevention of the abdominal compartment syndrome after celiotomy for trauma justifies the use of absorbable mesh prosthesis closure in severely injured patients. DESIGN: Retrospective analysis of case series from July 1, 1989, to July 31, 1996. SETTING: University-based level I trauma center. PATIENTS: Seventy-three consecutive trauma patients requiring celiotomy who received absorbable mesh prosthesis closure and 73 control patients matched for injury severity and trauma type who received celiotomy without a mesh prosthesis closure. INTERVENTIONS: Absorbable mesh prosthesis closure was used in cases of excessive fascial tension, abdominal compartment syndrome, necrotizing fasciitis, traumatic defect, or planned reoperation. MAIN OUTCOME MEASURES: Demographics, Injury Severity Score, Abdominal Trauma Index, highest abdominal Abbreviated Injury Scale score, number of abdominal/pelvic injuries, highest head Abbreviated Injury Scale score, shock, indication for mesh closure, complications, number of operations and time required for closure, days in the intensive care unit, length of stay, and mortality were determined. The highest abdominal Abbreviated Injury Scale score was multiplied by the number of abdominal/pelvic injuries to calculate the abdominal pelvic trauma score. RESULTS: Group 1 consisted of 47 patients who received mesh at initial celiotomy, and group 2, 26 patients who received mesh at a subsequent celiotomy. These 2 groups were statistically similar in demographics, injury severity, and mortality. However, group 2 had a significantly higher incidence of postoperative abdominal compartment syndrome (35% vs 0%), necrotizing fasciitis (39% vs 0%), intra-abdominal abscess/peritonitis (35% vs 4%), and enterocutaneous fistula (23% vs 11%) compared with group 1 (P < .001). Group 1 patients with preoperative abdominal compartment syndrome had more abdominal/ pelvic injuries and higher abdominal trauma index than matched controls (P < .05). There was a trend toward higher abdominal pelvic trauma score in patients who developed abdominal compartment syndrome. The Pearson coefficient of correlation between the abdominal trauma index and the more easily calculated abdominal pelvic trauma score was 0.91 (P < .001). CONCLUSION: The use of absorbable mesh prosthesis closure in severely injured patients undergoing celiotomy was effective in treating and preventing the abdominal compartment syndrome.     

New possibility in inguino-femoral hernia repair: laparoscopic herniaplasty

The development of minimally invasive surgery brought up the challenge: to repair the frequent inguino-femoral hernias laparoscopically. The authors performed 65 laparoscopic hernioplasties in one year: "transabdominal preperitoneal" technique was used in 61 cases und "intraperitoneal onlay mesh" in 4 cases. Fifty-three patients were operated on, 12 of them had bilateral hernias. Recurrent hernia was the indication in 22 patients (34%). The average operating time was 102 and 144 minutes in the unilateral and the bilateral cases, respectively. There was no wound infection, or general complication. Spontaneously dissolving seroma/hematoma of the spermatic cord was noticed and detected by ultrasound in 5 patients (7.7%). The neuralgia caused by the irritation of the nerves of the region in 4 patients (6.1%) disappeared without sequels after treatment with vitamins B. The 2 early recurrences (3.2%), considered to be caused by technical inexperience, these patients were treated successfully with the "intraperitoneal onlay mesh" technique. In the authors' opinion there are definite advantages of laparoscopic hernioplasty, namely the minimal postoperative pain, early mobilization, shorter hospital stay and early restoration of full physical activity (in 1-2 weeks) as well as the known disadvantages of this technique (narcosis, longer operative time, intraperitoneal procedure, higher costs).     

Patient satisfaction with current impotence therapy

One hundred ninety-eight impotent men were evaluated between July 1993 and June 1994. A "patient goal-directed" approach was used in all cases. Treatment options presented to patients included: oral yohimbine, vacuum constriction devices, penile self-injection therapy, penile prostheses, and testosterone supplementation when clinically indicated. Thirty-two percent of patients declined treatment, and 67% chose nonsurgical therapy. Only two patients (1%) chose penile prostheses. In August 1994, a survey addressing satisfaction with therapy was mailed to all patients, and 99 men (50%) responded. Of the treated respondents, 80% stated that their therapy was "easy to use," and 70% reported that they were "able to have intercourse." Patients prefer nonsurgical impotence therapy, which restores satisfactory sexual function in most men.