Renal epithelial cell lines (BSC-1, MDCK, LLC-PK1) express 11 beta-hydroxysteroid dehydrogenase activity.

Renal tissue of several species has been shown to express considerable 11 beta-hydroxysteroid dehydrogenase (11-HSD, EC 1.1.1.146) activity. However, it is uncertain as to which renal cell types exhibit 11-HSD activity. In the present study, we investigated corticosterone metabolism in BSC-1 cells, a continuous renal epithelial cell line derived from the African green monkey (Cercopithecus aethiops). In incubation experiments using 3H-labelled corticosterone and HPLC, we have demonstrated oxidative 11-HSD activity in intact monolayers of BSC-1 cells as well as in BSC-1 cell homogenates. 11-HSD activity in cell homogenates could be stimulated 7-9-fold by the addition of exogenous NADP+ (1 mM). In contrast, no reductive 11-HSD could be detected either in intact cells or in cell homogenates under various experimental conditions which were designed to favor reductive 11-HSD activity. Pilot experiments were performed in cell homogenates from two other renal epithelial cell lines derived from canine (MDCK) and porcine (LLC-PK1) kidney. They also revealed oxidative but no reductive 11-HSD activity. The data provide evidence for an epithelial localization of renal oxidative 11-HSD activity.

Neutrophil dysfunction in the rabbit model of spur cell anemia.

In the rabbit model for spur cell anemia, animals fed a 5% cholesterol diet develop marked hypercholesterolemia and hemolytic spur cell anemia after several weeks on the diet. In vitro tests of granulocytes showed a 15% increase in cholesterol: phospholipid ratio, and decreased membrane fluidity measured with a fluorescent probe. Function tests revealed impairment of adherence, phagocytosis, and chemotaxis. Both a plasma factor and an intrinsic cellular defect appeared to contribute to the abnormal adherence. Bactericidal activity was normal. In vivo demargination in response to epinephrine was increased in animals on the diet, but exudation of granulocytes into sterile peritonitis fluid was diminished to 39.4% of control at 8 hours. Therefore, rabbits with experimental spur cell anemia have impaired in vitro and in vivo granulocyte function. The clinical significance of these findings for patients with spur cell anemia and less severe alcoholic liver disease is uncertain.

Effect of growth hormone on gastrocnemius muscle of aged rats after immobilization: biochemistry and morphology.

Immobilization of limbs of aged animals is associated with swift muscular damage and atrophy. We investigated the effect of rat growth hormone (rGH) on immobilized hindlimb muscles of 26-mo-old rats. Administration of rGH significantly reduced muscle weight loss and muscle protein oxidation caused by immobilization. Capillary blood volume, measured by photoplethysmography of the hindlimb, showed a 34% reduction in immobilized animals, which was eliminated by rGH. The activity of creatine phosphokinase in immobilized gastrocnemius muscle was significantly reduced by immobilization. This damage was diminished by rGH administration. Similarly, the increase in acid phosphatase activity in immobilized muscle was reduced after rGH treatment. Morphologically, marked muscle atrophy and fiber disorientation were observed in immobilized limbs. Therapy with rGH prevented some of these changes. These results indicate that administration of rGH may provide a useful means to attenuate the degenerative effects of limb immobilization of aged rats, as evident from physiological, biochemical, and morphological parameters.

Interaction of 11 beta-hydroxysteroid-oxido reductase in different organs of various mammalian species.

Distribution of 11 beta-HSOR activity in different organs has been measured using tissue slices, homogenates, and microsomes. The biological material was incubated in vitro with cortisol/ cortisone (human preparations) or corticosterone/11-dehydrocorticosterone, respectively (animal preparations). Metabolites formed were quantified using RP-HPLC and on-line detection of labeled compounds. The typical pattern of CS-metabolism as obtained with rat tissue slices revealed that testis, rectum and kidney are predominant oxidizers of active gluco-CS, while liver and lung mainly function as reducers. Human placenta preparations display an exclusive oxidase activity. To trace different types of 11 beta-HSOR homogenates and microsomes of various organs were incubated with different cosubstrates (NAD+/NADH or NADP+/ NADPH, respectively). In accordance with previous reports, this study found that isoenzymes with different cosubstrate preferences exist in individual organs. 11 beta-HS oxidase activity displays a NAD+ preference in the human placenta. There was no apparent difference in cosubstrate preference between human and guinea pig placenta homogenates. In mice there is also a detectable reductive activity, whereas the Sprague-Dawley rat and golden hamster do not show any detectable activities.

The 'plug' repair of 1402 recurrent inguinal hernias. 20-year experience.

Since 1968, we have treated virtually all recurrent inguinal hernias by suturing a polypropylene mesh plug into the defect. Treatment of recurrent inguinal hernias by the usual standard methods results in a high rate of failure. This is due to reapproximation under tension of already scarred tissues. The plug is designed to occlude the hernial defect without tension. Several improvements in technique based on extensive experience with this method have been developed. Such repairs result in minimal postoperative discomfort and rapid rehabilitation. This report is based on 1402 operations, with a follow-up of 91% of the patients. There were 1276 patients who were followed up for 3 to 21 years and the recurrence rate was 1.6%. The plug repair for most recurrent inguinal hernias is recommended.

Herniorrhaphy. A personal experience with 6,321 cases.

The results of 6,321 consecutive herniorrhaphies have been reported. Over 20 percent of the cases were referred recurrences when first seen. Ninety-one percent of the patients were followed from 2 to 14 years, with an overall recurrence rate of 0.7 percent. A low recurrence rate was not unfavorably affected by the prompt resumption of activity postoperatively. Some recurrences are unavoidable; however, it is essential to accept the dictum that all hernias can be cured.

Repair of large diffuse lumbar hernias by an extraperitoneal binder technique.

Lumbar hernias may be classified into two broad groups. The small protrusions of fat which appear in the superior or inferior lumbar triangles and large diffuse hernias which involve the entire flank. The small hernias are easily cured by simple closure of the defect similar to the treatment of small epigastric hernias. The surgical treatment of large lumbar protrusions, utilizing fascial and prosthetic onlay grafts, is ineffective. The new technique described, which employs a large sheet of polypropylene mesh as a binder in the extraperitoneal space, effectively bridges the large defect and provides firm support for the lumbar region.

Repair of recurrent ventral hernias by an internal "binder".

A technic for the repair of massive recurrent incisional hernia is described. Use of a polypropylene mesh prosthesis as an intraperitoneal "binder" permits reconstruction of the abdominal wall when primary closure is impossible. Intraoperative testing of the repair provides reassurance that unrestricted postoperative activity will not invite recurrence.

Exploding the myths of hernia repair.

Sacred prinicples guiding surgical repair of groin hernias have remained basically unaltered since their inception. This may explain the failure of results to improve significantly over the years. Ten hallowed concepts have been critically analyzed in the light of modern technology and contemporary experience. Although challenging established surgical traditions invariably invites debate, it is essential to scientific progress.

Critical scrutiny of the open "tension-free" hernioplasty.

Tension-free hernioplasty is rapidly gaining worldwide acceptance. Since June 1984, 3,125 consecutive adult male primary inguinal hernias have been repaired by employment of an open tension-free prosthetic repair without approximation of the margins of the defect. Since the original publication of our technique in the 1989 February issue of The American Journal of Surgery, we have encountered four recurrences. These recurrences were caused by technical errors early in our experience and have since been corrected. The purpose of this paper is to bring those errors to the attention of surgeons, as well as to suggest certain modifications to further simplify the operation. Three of the recurrences occurred at the pubic tubercle and were caused by placing the mesh in juxtaposition to the tubercle. This error has since been corrected by overlapping the mesh at the pubic bone. One recurrence was caused by disruption of the lower edge of the mesh from the shelving margin of Poupart's ligament. The error here was utilization of a patch that was too narrow and therefore under tension. It became apparent that a wider patch, fixed in place with an appropriate degree of laxity, was required.

Patch or plug for groin hernia--which?

Prosthetic mesh is becoming widely used in the management of both primary and recurrent groin hernias. Confusion exists as to when to choose which of the two popular forms: patch or plug. Here are presented the indications for each type of tension-free hernia repair based on the experience of over 20 years in the exclusive surgery of groin hernias.

Cause and prevention of postherniorrhaphy neuralgia: a proposed protocol for treatment.

The cause of severe and persistent neuralgia after hernia surgery is due to sensory nerve crushing. An operative technique has been described that prevents inadvertent crushing or division of the sensory nerves to the groin. With persistent postoperative pain, the offending nerve is usually difficult to identify. A protocol has been suggested to differentiate ilioinguinal from genitocrural causalgia. When the particular nerve is incriminated, its division will ordinarily cure the problem.

The tension-free hernioplasty.

Since the first true herniorrhaphy was performed by Bassini over 100 years ago, all modifications and surgical techniques have shared a common disadvantage: suture line tension. The anatomic, physiologic, and pathologic characteristics of hernia recurrence are examined. The prime etiologic factor behind most herniorrhaphy failures is the suturing together, under tension, of structures that are not normally in apposition. With the use of modern mesh prosthetics, it is now possible to repair all hernias without distortion of the normal anatomy and with no suture line tension. The technique is simple, rapid, less painful, and effective, allowing prompt resumption of unrestricted physical activity.

The cause, prevention, and treatment of recurrent groin hernia.

At present, groin hernia repair is associated with a 10% recurrence rate. Despite innumerable modifications of the Bassini technique, this depressing figure remains essentially unimproved. This article documents the two major reasons for failure and presents techniques that are simple, can be performed under local anesthesia in an outpatient setting, allow patients to return home within hours of their surgery, encourage rapid return to unrestricted activity, and are associated with a recurrence rate approaching 0%.

The safety of mesh repair for primary inguinal hernias: results of 3,019 operations from five diverse surgical sources.

Initial attempts by surgical pioneers to repair hernias with prosthetic mesh met with failure because of faulty materials. As a result, surgeons experienced anxiety about performing this procedure. This anxiety persists, despite the present availability of new, safe patches and sutures. It was the unacceptably high failure rate of standard methods of repair for recurrent hernias that led to the use of plastic screens to bolster such repairs. However, persistent reluctance to use mesh for primary hernioplasty continued. Within the past two decades, true, tension-free patch repair of primary inguinal hernias without suture closure of hernial margins has been examined and clarified, and the technique has been perfected. In 3,019 reported primary inguinal hernias so treated by five different groups, there have been no mesh rejections, a 0.2 per cent recurrence rate, and insignificant incidence of infection. A new era of hernia repair appears to be at hand; therefore, such results warrant a new look at inguinal hernia repair.

Twenty questions about hernioplasty.

The twenty most asked and answered questions about advances in hernia surgery are enumerated. These inquiries have been collected over 20 consecutive years of exhibiting at a scientific booth at the American College of Surgeons conventions. The questions generally are concerned with synthetic patches, the use of local anesthesia, and, more recently, the "tension free" hernia repairs. The treatment of hernial sacs, the diagnosis, prevention and treatment of postoperative pain, the Shouldice Clinic repair, the importance of Cooper's ligament, and the cause, prevention, and treatment of recurrences are also examined.

Mesh between the oblique muscles is simple and effective in open hernioplasty.

Controversy exists as to the best position for insertion of the mesh patch in open inguinal herniorrhaphy. The "inlay" mesh graft, which is laid under the transversalis fascia, has been considered preferable by some authors. But in the Lichtenstein open tension-free inguinal hernia repair, the mesh is preferably placed under the external oblique aponeurosis. It is not an "onlay graft" because it lies under the external oblique and over the internal oblique muscles and transversalis fascia. The possible development of an "interstitial" hernia is without basis and has never been seen. This particular "onlay graft" (more correctly an intermuscular graft) is much simpler to apply and has resulted in almost no recurrences and side effects. Placing the patch between the two oblique muscles is therefore recommended for open tension-free primary inguinal hernioplasties.

A simple stapling technique for prosthetic repair of massive incisional hernias.

This article introduces a simpler, faster, and safer method of performing the Stoppa procedure with an articulating stapler. It also encourages use of preperitoneal repair instead of the often unsuccessful onlay mesh repair. The latter repair involves placing the mesh over the abdominal aponeurotic layer and can result in a high incidence of infection, seroma accumulation, and chronic fibrous cyst formation. In the preperitoneal repair technique, the same force that created the hernia--the intraabdominal hydrostatic pressure--keeps the mesh tightly in place and prevents recurrence of the hernia. The authors base their recommendation of the stapling technique on the experience of 54 large incisional hernias successfully repaired by preperitoneal insertion of a large sheet of Marlex mesh (Stoppa's procedure). In 29 of the 54 patients, the mesh was fixed in place with hand suturing. In the other 25, articulating staplers attached the mesh. The authors have found the stapling technique to be both simpler to accomplish and safer for the patient.

In vitro 6 beta-hydroxylation of progesterone in human renal tissue.

Increased levels of 6 beta-hydroxylated steroids have been found in the urine of several species under different physiological and pathophysiological conditions. Until now, liver, adrenal glands and placenta have been identified as organs which contain 6 beta-hydroxylase activity. However, it has not yet been established whether 6 beta-hydroxylation occurs in mammalian kidney. In this study we have performed in vitro studies with preparations from rat and human kidney cortex and have obtained evidence for the presence of a small but significant renal 6 beta-hydroxylation activity. Two points deserve to be mentioned: 1) A species difference is documented by the presence of the enzyme in human, but not in rat kidney; 2) Substrate specificity is evident. Progesterone, but not corticosterone, was transformed to the 6 beta-hydroxylated metabolite in human tissue. The biological significance of the 6 beta-hydroxylation of endogenous, as well as exogenous steroids could be that 6 beta-hydroxylation opens an alternate route of progesterone metabolism in parallel to other conversion and/or degradation pathways. Furthermore, since other 6 beta-hydroxylated steroids have been reported to exert biological effects, this may also be the case with 6 beta-hydroxy progesterone.

Prosthetic mesh plug repair of femoral and recurrent inguinal hernias: the American experience.

Prosthetic mesh in the form of a plug has been used extensively in the United States for hernia repair. It has been popular for all types of femoral hernias and for the majority of recurrent inguinal hernias. It follows the basic principle of 'tension-free' repair and permits unrestricted postoperative physical activity. The method has resulted in a long-term success rate better than the many modifications of the Bassini repair.