Mesh ingrowth with concomitant bacterial infection resulting in inability to explant: a failure of mesh salvage.

PURPOSE: Removal is the standard treatment for mesh infection following prosthetic hernia repair. However, certain types of mesh may be less amenable to removal even in the setting of active infection; we present four such cases, all involving the same composite mesh. METHODS: Four high-risk patients underwent Parietex mesh implantation for large ventral wall hernias and developed subsequent Staphylococcus infections with attempted explantation of infected mesh and wound care. RESULTS: There was inability to completely explant mesh in all four cases, leading to chronic purulent wounds and long-term complications. CONCLUSION: While mesh infection is a recognized complication of prosthetic hernia repair, many synthetic meshes form a slimy biofilm and thus can be removed relatively easily. However, the structural qualities of certain types of mesh create ingrowth into tissues even in the setting of infection, resulting in inability to explant with subsequent long-term chronic wound complications.

Measurement of the sound intensity during suction of middle-ear fluid following myringotomy.

OBJECTIVE: To determine noise intensity during middle-ear aspiration in order to evaluate whether levels can be potentially harmful. METHODS: In this prospective, observational study, middle-ear effusion was aspirated following myringotomy using a suction instrument with a probe tube microphone. Sound pressure levels and duration were measured, and frequency domain analysis was performed. RESULTS: Forty-four ears were analysed, consisting of 20 with mucoid effusion, 11 with serous effusion and 13 with no effusion. Maximum peak sound intensity ranged from 84 to 157 dB. Half of the ears (50 per cent) were exposed to greater than 140 dB; of these, 82 per cent were exposed for longer than 0.2 ms (range, 0.05-14 ms). There was no significant difference in sound pressure level between ears with mucoid and serous effusion; however, ears with mucoid effusion required longer suction times (p < 0.0030). In addition, peak intensity was greater for ears with mucoid effusion versus those with serous or no effusion (p < 0.0001). CONCLUSION: Middle-ear aspiration during myringotomy caused noise levels within a potentially harmful range.

Minimally invasive open cystgastrostomy for pancreatic pseudocyst.

One of the complications of pancreatitis is pancreatic pseudocyst. Many different techniques have been described for internal drainage of pancreatic pseudocyst. Indication for surgery is either symptomatic or large cysts that can turn into complications such as hemorrhage, obstruction, infection, rupture and malignancy. Our technique includes an incision between 5 cm to 9 cm below the left subcostal margin and the opening of the anterior stomach and a posterior cystgastrostomy performed with a reticulated laparoscopic staple. We have been able to perform surgery in a very large pseudocyst (up to 26 cm) in a small amount of time, within 45 min, and with a shorter length of hospital stay (36 h). In this paper, we present our technique on how to approach large pseudocysts utilizing a minimally invasive small incision.

A single proposed algorithm for the surgical treatment of hepatic hemorrhage.

Angiographic embolization safely and effectively controls hemorrhage from the liver. Contrasting algorithms and protocols have, however, created confusion as to how and when to use this procedure. After performing a Medline search, a proposed protocol for the use of angiographic embolization was created. This algorithm, which focuses on general hepatic response to injury, not to any particular disease, is best applied in busy tertiary hospitals. The generalized applicability of the proposed protocol may allow for a more uniform, easily remembered, and effective treatment of liver hemorrhage.

Alveolar adenoma of the lung: a clinicopathological description of a case of this very unusual tumour.

Alveolar adenomas are extremely rare, and are probably benign lung tumours of unknown histogenesis. This report describes a case of alveolar adenoma in a 43 year old white man, who presented with pleuritic chest pain. A chest x ray and computerised tomography scan demonstrated a solitary left lower lobe lung nodule. Although a positron emission tomography scan seemed to document the benign nature of the lesion, a thoracoscopic wedge resection was performed to alleviate the symptoms and verify the diagnosis. Histologically, the lesion was well demarcated, dominated by large and small cysts with no normal lung parenchyma. The interstitial cellular component consisted of both epithelioid and vaguely spindle shaped cells. The cystic cell linings were mostly indistinct, although areas of cuboidal epithelial cells were seen. Multiple histochemical and immunohistochemical tests were performed. There were no histological signs of malignancy and the patient is doing well one and a half years postoperatively.

Parvalbumin-immunoreactive neurons in the human anteroventral thalamic nucleus.

We immunohistochemically characterised the expression of the calcium-binding protein parvalbumin in the normal human anteroventral thalamic nucleus (AVN). Two morphologically distinct neuronal populations were found to be parvalbumin-immunoreactive (PV-IR): a large population of lightly staining PV-IR neurons and a smaller population of intensely PV-IR neurons. This second type of neuron, which displayed many characteristics normally associated with GABAergic interneurons, has not previously been described in human thalamus. Thus, presumptive thalamic interneurons in the human brain can be further subtyped on the basis of immunoreactivity to parvalbumin. This may have implications for the understanding of thalamocortical function in the normal state and in dysfunctional conditions such as Wernicke-Korsakoff syndrome and schizophrenia.