Use of an experimental model to evaluate infection resistance of meshes in abdominal wall surgery.

BACKGROUND: Staphylococcal species are the most common organisms causing prosthetic mesh infections, however, infections due to rapidly growing mycobacteria are increasing. This study evaluates the resistance of biomaterial for abdominal wall prostheses against the development of postoperative infection in a rat model. MATERIAL AND METHODS: In 75 rats, we intramuscularly implanted three different types of prostheses: (1) low-density polypropylene monofilament mesh (PMM), (2) high-density PMM, and (3) a composite prosthesis composed of low-density PMM and a nonporous hydrophilic film. Meshes were inoculated with a suspension containing 108 colony-forming units of Staphylococcus aureus, Staphylococcus epidermidis, Mycobacterium fortuitum, or Mycobacterium abscessus before wound closure. Animals were sacrificed on the eighth day postoperatively for clinical evaluation, and the implants were removed for bacteriologic analyses. RESULTS: Prostheses infected with S aureus showed a higher bacterial viability, worse integration, and clinical outcome compared with infection by other bacteria. Composite prostheses showed a higher number of viable colonies of both M fortuitum and Staphylococcus spp., with poorer integration in host tissue. However, when the composite prosthesis was infected with M abscessus, a lower number of viable bacteria were isolated and a better integration was observed compared with infection by other bacteria. CONCLUSIONS: Considering M abscessus, a smaller collagen-free contact surface shows better resistance to infection, however, depending on the type of bacteria, prostheses with a large surface, and covered with collagen shows reduced resistance to infection, worse integration, and worse clinical outcome.

[Melanoma of the small intestine and adenocarcinoma of the colon]. / Melanoma de intestino delgado y adenocarcinoma de colon.

The clinical case of a 73-years old male who was admitted for diarrhea and loss of weight is presented. Barium enema and colonoscopy demonstrated small size polyps in the sigmoid colon, one of which had a histologic diagnosis of adenocarcinoma. Abdominal examination detected a mass in the mesohypogastrium which did not appear to be related to the previous findings. CAT and intestinal transit confirmed a second tumor in the small bowel with the histologic diagnosis of a resected specimen being melanoma.

Caroli's disease: study of six cases, including one with epithelial dysplasia.

Six cases of Caroli's Disease are reviewed. Three of the patients had an associated form of the disease, one of which had a congenital hepatic fibrosis, another a cystic dilatation of extrahepatic bile duct and the last one suffered both the above mentioned associated anomalies. Three patients presented with the simple form which was initially described by Caroli. The distribution of the biliary lesions was a bilobar one in four cases and monolobar in two. One patient presented areas of biliary ectasia partially lined by dysplastic epithelium. Surgical treatment was used in four cases, a left hepatectomy being carried out in two of them and an internal biliary drainage by Roux-Y hepaticojejunostomy in the other two. This is a rare disease, frequently associated with congenital hepatic fibrosis, possibly pre-malignant and whose treatment of choice is hepatic resection.

[Primary gallbladder carcinoma. A review of 41 cases]. / Carcinoma primario de vesícula biliar. Revisión de 41 casos.

We present a retrospective study of primary carcinoma of the gallbladder with a total of 41 cases over a period of 11 years. In the majority of cases the clinical presentation (cholelithiasis, choledocholithiasis); there were only 7 cases of suspected diagnosis, mainly through the use of new diagnostic techniques (echography, computerized tomography). The classification used is that described by Nevin (1976) of affection of gallbladder wall and adjacent tissues. The conclusions of our study are as follows: a) primary neoplasias of the gallbladder are aggressive tumours carrying a poor prognosis aggravated usually late diagnosis due to the scarce symptomatology, b) given the high incidence of cholelithiasis, it is advisable to perform routine cholecystectomy, c) survival is related to the histological grading of the tissues.

Effect of povidone iodine and chlorhexidine on the mortality and bacterial clearance in the abdominal cavity of peritonitis rats.

Peritonitis was induced in Wistar rats by intraperitoneal inoculation of pure Escherichia coli. The mortality rate in the untreated control group was 36% (18/50). Rats in which 2 ml 1% povidone iodine had been injected intraperitoneally 5 min after the bacterial challenge, had a significantly increased mortality rate (43/50, 86%) (p less than 0.01). When the same experiment was done with 2 ml of 0.05% chlorhexidine the mortality rate decreased significantly to 16% (8/50) (p less than 0.05). Povidone iodine did not have any bactericidal effect; on the contrary, the number of colonies of bacteria had increased in all the animals 12 and 24 hours after challenge. Chlorhexidine, on the other hand, had sufficient bactericidal effect to cause a progressive decrease in the concentration of intraperitoneal bacteria.

[Cystic mucinous tumor of the pancreas . A new case]. / Tumores quísticos mucinosos de páncreas. Un nuevo caso.

The case of a woman with a mucinous cystadenoma of the pancreas is presented. Caudal pancreatectomy was performed. Post-operative course was uneventful.

[Ogilvie syndrome treated with endoscopic decompression]. / Síndrome de Ogilvie tratado mediante descompresión endoscópica.

An elderly woman with multiple myeloma was admitted to the hospital because of colonic obstruction due to Ogilvie's syndrome. Successful decompression was obtained by colonoscopy.