Journal of investigative surgery : the official journal of the Academy of Surgical Research
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Comparative Study Clinical Trial
Anterior rectus sheath in inguinal hernia repair: preliminary study.
Inguinal hernia repair using the anterior rectus sheath flap represents a tension-free repair with potential advantages (no foreign material or tension on the suture line). The aim of this research was to evaluate the method of inguinal hernia repair using the anterior rectus sheath and to compare it with tension-free mesh repair (modified Lichtenstein repair). In total, 62 patients were evaluated. ⋯ Total operating-room time was significantly longer in patients undergoing mesh repair (median 80 min, range 45-150) compared to anterior rectus sheath repair (median 65 min, range 45-125) (p = .049). No complications or recurrences were noted in either group. Thus, this study showed good results using the anterior rectus sheath repair for primary, uncomplicated inguinal hernias, comparable to mesh repair.
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Wound infections, especially those associated with methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa, offer considerable challenges for clinicians. Our laboratory has recently developed novel composite biomaterials (DRDC) for wound dressing applications, and demonstrated their in vitro bactericidal efficacy. In the present study, we assessed the proliferation of planktonic and sessile Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus in porcine full-thickness wounds covered for up to 48 h with either saline- or mafenide acetate-loaded DRDC puffs and meshes. ⋯ While the wound bioburdens increased in the ensuing 24 h, they remained approximately 2 log(10) colony-forming units (CFU) below (p <. 05) their respective baseline values. Similarly, less than 4 log(10) CFU was recovered in the drug-loaded DRDC biomaterials throughout the study. These data show that the DRDC puffs and meshes are effective in delivering certain medications, such as antimicrobial agents, to the wound bed, suggesting considerable value of this material for treating wounds, especially those with irregular shapes, contours, and depths.
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Anastomotic leakage is the most important complication leading to morbidity and mortality in colorectal surgery. To prevent anastomotic leakage, a number of drugs with different mechanisms of action were tested, and autogenic grafts and various synthetic materials were used for reinforcement of the anastomotic region. In this experimental study aimed at preventing anastomotic leakage and dehiscence, we used dehydrated, lyophilized human dura mater and free peritoneal graft for reinforcement of anastomotic region after primary repair in rats, and investigated whether they are superior to primary anastomosis. ⋯ Compared to the control group, dura mater and free peritoneal graft groups displayed a lower bowel bursting pressure (p < .05), worse anastomotic healing (p < .05), a higher number of adhesions, and presence of anastomotic stricture. In conclusion, both human dura mater and free peritoneal graft reinforcement groups had worse anastomosis healing. The results could be attributed to avascularity of grafts and to aggravated adhesions between anastomosis and intra-abdominal organs, which created a favorable environment for reproduction and dispersion of bacteria and consequently led to decreased anastomosis healing.
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Biography Historical Article
John Collins Warren: Master educator and pioneer surgeon of ether fame.
John Collins Warren (1778-1856) represented the apex of surgery and medicine of the first half of nineteenth century Boston. Educated at Harvard College where he obtained a Bachelor of Arts in 1797, he contemplated the idea of a business career prior to setting sail for a traditional medical education at Europe's finest universities. From 1799 to 1802, he attended prestigious medical and surgical lectures in London, Edinburgh, and Paris. ⋯ Morton on October 16, 1846. Outside the operating theatre, Doctor Warren and his colleagues were revered for founding the Massachusetts General Hospital in 1821, and years before, in 1812, Warren and his associates established the New England Journal of Medicine and Surgery. In light of his varied contributions, John Collins Warren is remembered as a dedicated and innovative surgeon, as well as a committed medical educator, able administrator and effective leader.
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Improving the diagnosis of acute appendicitis in order to prevent unnecessary surgery is crucial. This study was intended to identify the role of serum inflammatory markers in patients with preliminary diagnosis of acute appendicitis with a retrospective design. Eighty-five patients with the preliminary diagnosis of acute appendicitis were recruited in this study within the period of November-December 2003. ⋯ Interleukin-10 levels within normal range might be helpful in eliminating the possibility of acute appendicitis. Thus, elevated levels of WBC, IL-6 and CRP might be helpful in confirming a potential diagnosis of acute appendicitis. In addition, normal levels of IL-10 might be of additional help to possibly rule out the diagnosis of acute appendicitis.