A comparative study of sutured versus bovine pericardium mesh abdominal closure after open abdominal aortic aneurysm repair.

BACKGROUND: Open abdominal aortic aneurysm (AAA) repair is followed by a high rate of incisional herniation. The purpose of this study was to evaluate whether this postoperative complication could be avoided by a prophylactic implantation of a biological mesh. METHODS: In a prospective randomized clinical study, patients electively treated by open AAA repair were allocated equally to routine abdominal suture closure or to prophylactic placement of bovine pericardium mesh above the fascia. The study end points were postoperative complications and incidence of incisional hernia at a 3-year follow up. RESULTS: Forty patients with a mean age of 74.3 (SD ± 5.8) years were studied. All patients had a successful operation and a quite uneventful postoperative course. The mean operative time in the mesh group was longer compared to the control group (p < 0.001). Two patients in the mesh group developed wound seroma postoperatively. Six patients (30%) in the control group developed incisional hernia comparing to none in the mesh group. Cumulative proportion of freedom from incisional hernia was 100% for mesh group at 3 years and 74.4% (SE 9.9%) for control group at 2 years (p < 0.008). In five patients (83%), the incisional hernia was diagnosed by the second postoperative year. One patient underwent incisional hernia repair. CONCLUSION: The bovine pericardium mesh reinforcement of fascia closure in patients undergoing open AAA repair showed effectiveness and low complication rate in prophylaxis from incisional herniation. It should be considered as an alternative mesh material in selected patients.

Ectopic thyroid carcinoma. Case report.

INTRODUCTION: Ectopic thyroid tissue can be found in many sites, including the tongue, thyroglossal duct, mediastinum, trachea, lung, aorta and abdomen. Ectopic thyroid tissue may also be involved in the same processes as normal, orthotopic thyroid gland. These processes include tumors, inflammation and hyperplasia. The appearance of such tissue in rare locations may lead to diagnostic and therapeutic dilemmas. CASE REPORT: We report a rare case of ectopic thyroglossal thyroid carcinoma in a 63-year-old Caucasian male with a normal orthotopic thyroid gland. CONCLUSION: Although 99% of thyroid cancers develop within the thyroid itself, in rare cases a carcinoma can arise in ectopic thyroid tissue located in the neck or in other areas of the body. Though rare, the possibility of an ectopic thyroid carcinoma must always be considered by the surgeon in cases of a pathological mass in the neck.

Adult bowel intussusception: presentation, location, etiology, diagnosis and treatment.

Bowel intussusception is rare in adults but common in children. Almost 90% of adult intussusceptions are secondary to a pathologic condition and the clinical picture can be very aspecific and challenging. In this review we discuss the symptoms, location, etiology, characteristics, diagnostic methods and treatment strategies of this rare and enigmatic clinical entity in adults. We have to highlight the high index of suspicion that is necessary for the operating surgeon, when dealing with acute, subacute or chronic abdominal pain in adults, because any misinterpretation may result in unfavorable outcomes.

Appendiceal diverticulitis in a femoral hernia causing necrotizing fasciitis of the right inguinal region: report of a unique case.

De Garengeot's hernia--a rare finding occurring mostly in women--is defined by the presence of the vermiform appendix within the sac of a femoral hernia. The incidence of appendicitis is rarer still, with less than a 100 cases reported to date. We present a unique case of an 84-year-old male patient with perforated appendiceal diverticulitis within a De Garengeot's hernia causing abscess and necrotizing infection of the overlying soft tissues.

Synchronous abdominal aortic aneurysm and colorectal cancer. The therapeutic dilemma in the era of endovascular aortic aneurysm repair.

The incidence of synchronous abdominal aortic aneurysm (AAA) and colorectal cancer (CRC), although quite rare, still represents an issue of controversy regarding the optimal treatment. This study attempts a historical review of the surgical practice during the past decades by reviewing the existing English literature on this topic. The dilemma between one or two stage treatment has remained as both options offer advantages but also carry some substantial risks. The current practice gives priority to the life threatening disease (AAA>5.5 cm, symptomatic or complicated CRC) (two stage treatment) or suggest simultaneous management (one stage) when both diseases require urgent surgical treatment. The evolution of vascular endografts and the reported efficacy of endovascular aortic repair (EVAR) provide an alternative method for treating these high risk patients, by surpassing some significant obstacles. If the anatomical criteria are satisfied, EVAR could become the optimal solution for the concomitant AAA and CRC patients, especially those who require one stage treatment.

Assessment of local stage in rectal cancer using endorectal ultrasonography (EUS).

BACKGROUND: Preoperative staging of rectal cancer is essential for the selection of the optimal treatment. This study aims to evaluate the accuracy of endorectal ultrasonography (EUS) in local staging of rectal cancer. PATIENTS AND METHODS: During a 4-year period, 33 patients with biopsy-proven rectal cancer underwent evaluation of the invasion of the rectal wall, the mesorectal lymph nodes status and the pelvic organs using EUS. We compared the EUS findings (uTN) to the histopathology examination of the resected specimens (pTN) according to TNM classification. RESULTS: Most patients had T3 tumours. Overall accuracy in assessing the depth of rectal wall invasion (T) and the lymph node status was 79% and 59% respectively. Two patients previously treated by preoperative chemoradiation were correctly staged only for N stage. CONCLUSIONS: EUS is a valuable diagnostic tool in local staging of rectal cancer. Progressively increasing experience will overcome the obstacles in accurate interpretation of ultrasound images.

[Evaluation of the effect of professional dental cleaning and education in dental hygiene in type 1 diabetic patients]. / Studie zur Uberprüfung des Effektes einer professionellen Zahnreinigung und einer Schulung in Zahnhygiene bei Typ 1-Diabetikern.

In the setting of a prospective, randomized trial the impact of professional oral hygiene and of intensive patient education in oral hygiene was investigated. It was studied, whether in young to middle-aged type 1 diabetic patients the risk or the progression of periodontal disease can be influenced during one year. Primary endpoint was bleeding at probing, secondary indices, the plaque index and probing pocket depth. 83 patients were enrolled, 70 completed the study according to the protocol. Oral cleansing was dramatically improved by education in the short term, however, the effect was much weaker after 6 and 12 months, respectively, although there remained some improvement compared to the basic level. Bleeding at probing increased in both groups, without reaching the level of statistical significance. Probing pocket depth increased in the intervention group weakly but significantly and remained unchanged in the control group. The tested intervention (professional oral hygiene, patient education in oral hygiene) could not improve the periodontal status in our type 1 patients.

[Retrospective analysis of the incidence of severe hypoglycemia in 458 type 1 diabetic patients]. / Retrospektive Analyse zur Inzidenz schwerer Hypoglykämien bei 458 Typ-1-Diabetikern.

During 1 year a retrospective study concerning frequency and risk markers of severe hypoglycemia was conducted in type-1 diabetic patients undergoing their annual routine check-up. The aim was to contribute to the epidemiology of severe hypoglycemia and to investigate, whether severe hypoglycemia is associated with specific features of therapy (strategy of insulin treatment, level of metabolic control expressed as mean blood glucose and glycosilated hemoglobin, insulin species, use of betablocking agents) or with patient characteristics (age, duration of diabetes, awareness of hypoglycemic symptoms, late complications of diabetes). From the cohort of 710 eligible patients 458 agreed to participate in the study, 61% had experienced severe hypoglycemia at least once, 17% during the last year. The incidence calculated for the whole diabetes duration is 21/100 patient years, and for the last year 56/100 patient years. The following were risk markers for severe hypoglycemia: older age, longer duration of diabetes, reduced awareness of hypoglycemic symptoms, decreasing frequency of symptomatic hypoglycemic episodes, and lower HbA1c. No association was found with the following variables: Serum creatinine, autonomic neuropathy, use of betablocking agents, and presence of anti-insulin antibodies. Intensive insulin therapy with individualized treatment goals in terms of blood glucose control was successful in avoiding severe hypoglycemia in patients who had already experienced them before.

[Follow-up of albumin excretion during pregnancy and post partum in type 1 diabetic patients in comparison with health pregnant probands]. / Verlauf der Albuminexkretion während der Gravidität und post partum bei Typ-1-Diabetikerinnen im Vergleich zu gesunden Schwangeren.

32 diabetic and 31 metabolic healthy pregnant women are studied to answer the following questions: Is there a difference in the albumin-excretion rate (AER) during the pregnancy in primary normoalbuminuric type 1 diabetics and non-diabetics? Is there a difference 6 months post partum between the 2 groups? The average age of the diabetics (D) is 28, of the non-diabetics (ND) 27 years; the diabetics suffer from diabetes mellitus 12.5 years. In the 16th week of pregnancy, we find a AER (D vs. ND) of 5.0 vs. 2.37 micrograms/min (not significant [n.s.]), creatinin in serum 0.77 vs. 0.75 mg/dl (p < 0.05), creatinin clearance 92.5 vs. 103.4 ml/min (n.s.). In the 28th and in the 34th to 38th week, there is no significant elevation of the AER compared to the 16th week; but there is a significant elevation in the diabetics vs. the non-diabetics. 6 months post partum, the AER (D vs. ND) are: 6.13 vs. 5.11 micrograms/min (n.s. vs. 16th week and D vs. ND); in each group one person is found with a positive microalbuminuria (MA): 48.2 micrograms/min (D) and 27.4 mg/min (ND). Another diabetic woman shows post partum an isolated higher value of creatinin in serum: 1.5 mg/dl (without MA). This parameter is post partum significant higher (0.97 [D], 0.96 [ND] mg/dl) than in the 16th week of pregnancy (0.77 [D], 0.75 [ND] mg/dl). The creatinin clearance decreases post partum (pp): 92.2 ml/min (pp) vs. 102.0 ml/min (28th week) in the diabetics (n.s.) and 80.6 ml/min (pp) vs. 111.0 ml/min (28th week) in the non-diabetics (p < 0.05). Concerning the studied renal parameters, there is a significant difference of the albumin-excretion rates during the pregnancy between preconceptional normoalbuminuric type 1 diabetic and non-diabetic women, but 6 months post partum, there is no significant difference. The diabetics show a significant increase of the creatinin in urine and in serum and no significant change of the creatinin clearance 6 months post partum.

Detection and genotyping of herpes simplex virus types 1 and 2 by polymerase chain reaction.

A simple and rapid polymerase chain reaction (PCR) procedure was developed for simultaneous detection and typing of herpes simplex virus (HSV) types 1 and 2. It was possible to detect and type HSV using two primers pairs in a simultaneous double PCR reaction, where the type of HSV present was determined on the basis of an ethidium-bromide-stained band after agarose gel electrophoresis. This PCR assay was tested on about 500 clinical specimens.

[ExacTech--a new measuring system for personal control of blood glucose]. / ExacTech--ein neues Messsystem zur Blutzuckerselbstkontrolle.

ExacTech is a pen-sized glucose meter that uses an amperometric principle for blood glucose determination. Accuracy was assessed in 94 capillary blood samples by comparing the ExacTech values to the hexokinase method. Correlation between the methods was 0.983. 76% of ExacTech measurements were within +/- 10% of the reference method. Coefficients of variation for within run precision determined in two different blood glucose levels were 3.2% (81 mg/dl) and 4.2% (222 mg/dl) resp. 12 diabetic patients compared ExacTech to their reflectance meters. The ExacTech readings when correlated with the hexokinase method gave slightly better results than those obtained with common glucose meters. Patients acceptability of this novel measuring system was excellent.