Does the presence of a mesh have an effect on the testicular blood flow after surgical repair of indirect inguinal hernia?

PURPOSE: Modern treatment of inguinal hernias includes prosthetic mesh repairs. However, direct contact of the mesh to the vessels in the inguinal canal and perimesh fibrosis may have a negative impact on testicular flow. The aim of this prospective study was to evaluate the effect of mesh implantation/perimesh fibrosis on testicular flow after repair of indirect inguinal hernias (IIHs). METHOD: Forty-eight male patients with unilateral IIH were included. Both testicular parenchyma were assessed using gray-scale sonography, and color/spectral Doppler sonography was performed to evaluate testicular arterial impedance, perfusion, and venous flow. Measurements were made bilaterally at the level of the inguinal canal 1 day before and at the end of the 2nd month after the operation. RESULTS: There was no difference in testicular and echotexture perfusion between the hernia and the control sides pre- and postoperatively. No venous thrombosis was found. In all groups, resistance index and pulsatility index, measured at 4 levels, were highest in the proximal inguinal canal and lowest at the extratesticular-intrascrotal level (p < 0.05). For all Doppler parameters there was no significant difference between the pre- and postoperative measurements on both the hernia and the control sides. CONCLUSION: Mesh implantation/perimesh fibrosis does not adversely affect ipsilateral testicular flow. Mesh application is still a safe procedure in male patients in whom testicular function is important.

Mastalgia Due to Degenerative Changes of the Spine.

BACKGROUND: Mastalgia is a common and enigmatic condition; the cause and optimal treatment are still inadequately defined. Cervical radiculopathy, which is the result of cervical nerve root pathology often caused by spaceoccupying lesions such as cervical disc herniation, spondylosis, or osteophytosis, is frequently encountered in physical therapy. OBJECTIVES: The aim of the study was to evaluate the incidence of vertebral pathologies in patients with non-cyclic mastalgia and the efficacy of conservative treatment of these pathologies on relieving breast pain. MATERIAL AND METHODS: One hundred patients were included in the study, all with breast pain continuing throughout the day and lasting at least three months. Breast and axillary physical examinations, mammographic and/or ultrasonographic evaluations were normal in all the patients. The patients' pain levels were scored using a visual analog scale (VAS). Cervical and thoracic spine magnetic resonance imaging (MRI) was performed on all the participants. RESULTS: Among 96 patients that had pathological findings on magnetic resonance imaging (96%), 49 women had diffuse annular bulging of the cervical spine, and 47 had cervical disc protrusion. Additionally, 12 patients had thoracic disc protrusion. At the end of the three-month period, the patients who were given only conservative treatment returned for follow-up evaluations. According to the VAS scores, five patients had mild to moderate improvement, 55 showed significant improvement, and 29 achieved complete remission. CONCLUSIONS: The authors concluded that if none of the known causes of breast pain are found in a patient, the patient should be evaluated for vertebral pathologies.

Comparison of the Effects of Plateletrich Plasma Prepared in Various Forms on the Healing of Dermal Wounds in Rats.

OBJECTIVE: This study was designed to evaluate the effects of 3 different forms of platelet-rich plasma (PRP) on the healing process, wound healing rate, and histopathological changes that occur during recovery of open dermal wounds. MATERIALS AND METHODS: A 2 cm x 1 cm full-thickness skin defect was made on the backs of 40 Wistar female rats that were divided into 4 groups of 10. In group 1 (control group), the wounds were cleaned with saline; in group 2, the wounds were covered with PRP gel obtained by single centrifugation; in group 3, the wounds were covered with liquid PRP obtained by double centrifugation; and in group 4, PRP gel obtained by double centrifugation with added thrombin was applied on the dermal wounds. All treatments were applied on postoperative days 1, 4, 7, and 10. RESULTS: In all PRP groups, the wound closure was almost complete on day 14 while the wound contraction progressed more slowly in the control group. The mean histopathological scores of epithelialization, inflammation, and fibrosis were significantly better in all PRP groups than the scores in the control group. CONCLUSION: In conclusion, although all PRP preparations had positive effects on dermal wound healing, double centrifuged PRP topical treatments (with or without thrombin activation) are more effective than single centrifuged PRP, and double centrifugation methods should be preferred for the preparation of PRP.