Technical consideration for subxiphoidal incisional hernia repair.

BACKGROUND: The main principle of incisional hernia repair with mesh augmentation is a wide overlap of at least 5 cm in all directions. This is complicated when cartilaginous or osseous structures border the fascial defect, most notably at the xiphoid after sternotomy or in large proximal incisional hernias. METHOD: We performed an anatomic investigation of this "problematic" area with its different structures and layers that form the retroxiphoidal space. RESULTS AND CONCLUSION: The posterior lamina of the rectus sheath inserts on the posterior side of the xiphoid. This lamina inhibits a sufficient mesh placement. By sharp dissection dorsal the xiphoid process, the posterior lamina of the rectus sheath can be detached. This way the retroxiphoidal space can be opened. Further development of this space can be made by blunt dissection. In some cases, with retroxiphoidal scar formation after sternotomy, a sharp dissection might be necessary. This enables a combined retromuscular-retroxiphoid mesh augmentation repair with a sufficient underlay of at least 5 cm, according to the principles of sublay technique.

A simple new method to calculate small intestine absorptive surface in the rat.

The rat is an established model for studying intestinal adaptations following abdominal surgery. In the study of functional and morphological adaptations of the small intestine, it is helpful to estimate the mucosal surface area. In order to simplify measurements and calculation we developed a new mathematical model for calculation of the mucosal surface area on histological sections. In contrast to other methods, it requires only cross-sections of small intestine and includes the measurement of only three histological parameters: length and width of villus and width of crypt. The new approach was compared with the most commonly used procedures, the Harris and the Fisher-Parsons methods, under experimental conditions. An animal study including single-pass perfusion, fixation, staining and subsequent histomorphometry of jejunum and ileum using these different methods was performed. The new method showed the least work and presented no significant differences compared with the precise Harris method. In conclusion, the method described is an adequate tool to estimate the mucosal surface area with less work and with comparable results to established methods. The less-complex method may be a valuable tool in experimental research of small intestine adaptations in rats.

The Pfannenstiel or so called "bikini cut": still effective more than 100 years after first description.

The original Pfannenstiel incision is discussed including the technique, history, current indications, advantages, and disadvantages. Excellent cosmetic results, principles of less traumatic surgery, and a rare incisional hernia complication rate of about 0-2%, as well as long-time use characterise this access path to the pelvic organs first described by the German gynaecologist in 1900. Complications of nerve damage, however, should be recognised, especially when extending the incision too far laterally.

[Foreign body-induced disruption of the gastrointestinal tract-anatomy of the ileocoecal opening]. / Fremdkörperinduzierte Passagestörung des Gastrointestinaltraktes. Anatomie des ileozökalen Ubergangs.

INTRODUCTION: Over 75% of ingested foreign bodies pass the gastrointestinal tract without any complications. Blunt foreign bodies may lead to a disruption of the intestinal passage, mainly in the area of the ileocoecal opening. The size of the reported foreign bodies varies considerably. The aim of this study was the anatomic investigation to clarify the possible causes of obstruction and its influence on the diameter of the ileocoecal opening. MATERIAL AND METHOD: We investigate anatomically and describe the ileocoecal opening on the basis of 27 specimens. RESULTS: We found not a flap mechanism but a valve mechanism in the ileocoecal junction. The median diameter of the formalin-fixated specimens was 10.9 mm respectively 21.8 mm according to an assumed correction factor of 2. The cause for intestinal obstruction most probably is the ingestion of blunt, angular foreign bodies in the ostium ileale. CONCLUSION: The intraindividual differences as well as the considerable size of foreign bodies that pass the ileoceocal opening support the hypothesis, that the complications described are more a consequence of an ingestion of blunt, cornered foreign bodies in the ostium ileale independent ofn the size of the ileocoecal opening itself.

Fluordeoxyglucose positron emission tomography detection of inflammatory reactions due to polyethylene wear in total hip arthroplasty.

A patient experienced chronic pain 8 years after total hip arthroplasty. Radiology and bone scanning showed no signs of aseptic loosening, but fluorine-18 fluorodeoxyglucose positron-emission tomography ((18)F-FDG-PET) showed intensive glucose metabolism in the joint capsule and around the prosthesis neck. The surgical intervention revealed soft tissue reaction in this area. Histologic examination showed a granulomatous foreign body reaction against polyethylene debris particles. Infection and rheumatoid arthritis could be excluded clinically, histologically, microbiologically, and with the bone scan. Therefore, FDG-PET detected inflammatory reaction caused by polyethylene wear in total hip arthroplasty and allowed clinicians to decide on interventions, including removal of granulomatous tissue and the replacement of worn artificial joint components to prevent aseptic loosening.

Recurrent focal myositis of the peroneal muscles.

Recurrent focal myositis is a rare entity and can be difficult to diagnose and treat. A long-term follow-up and diagnostic evaluation was carried out in a patient who presented with ankle stiffness secondary to a painful mass within the calf. This process was diagnosed as focal myositis of the peroneal muscles, which recurred over a period of 7 yr. A review of the literature regarding focal myositis, treatment options and a successful conservative therapy regimen, as an alternative to a surgical protocol, are presented. After making the diagnosis with the help of a muscle biopsy, long-term therapy should be considered. Conservative treatment of focal myositis with anti-inflammatory drugs and physical therapy can be successful but recurrence may occur if the medical treatment is interrupted.

[First experiences with fluorodeoxyglucose-positron-emission tomography (FDG-PET) in the evaluation of painful total knee and hip joint replacements]. / Erste Erfahrungen mit der Fluorodeoxyglukose-Positronenemissionstomographie (FDG-PET) in der Diagnostik schmerzhafter Knie- und Hüfttotalendoprothesen.

AIM: The aim of the study was to describe first experiences using FDG-PET in the examination of painful arthroplasties. METHOD: 12 patients prior to revision of a total hip or knee joint replacement underwent PET. Histopathology, microbiological analysis and intraoperative diagnosis were compared to preoperative PET findings. RESULTS: The analysis of intraoperative findings, of microbiological examinations and of histopathology showed that besides the well known determinants infection and early postoperative granulation tissue, polyethylene wear induced foreign-body reaction was a major cause for increased FDG consumption. CONCLUSION: In vivo imaging of marked foreign-body tissue reaction induced by polyethylene wear is feasible by FDG-PET. This observation, however, leads to reduced specificity of PET imaging for the diagnosis of periprosthetic infection.